The Present Epidemic of 
Influenza. 
BY 
LOUISE EISKE BRYSON, M. D. 
BBPBINTBD FROM 
Neto ¥ova JHeUfcal journal 
for February 1 and 8, 1890. Reprinted from the New York Medical Journal 
for February 1 and 8, 1890. 
THE PRESENT EPIDEMIC OF INFLUENZA* 
LOUISE FISKE BRYSON, M. D. 
Ever since the year 1510 epidemics of influenza, dis- 
tinctly recognizable as such, have visited various parts of 
the world. Parkes traces the disease to the ninth century ; 
and it is probable that grippe formed one of the plagues of 
the earlier ages, giving rise to the expression " God help 
us!" uttered after sneezing, because those attacked died 
too quickly to expect aid from any human means. 
There were five epidemics of influenza in the sixteenth 
century that are recorded, eight in the seventeenth, and thir- 
teen in the eighteenth - in 1709, 1729, 1732, 1737, 1744, 
1751, 1761, 1769, 1772, 1781, 1789, and 1798. Our own 
times have had their share-in 1803,1805, 1830, 1833, 1836, 
1837, 1841, 1847, 1848, 1879, 1880, and 1889-'90. It is 
estimated that the disease returns on an average about once 
in ten years. Its duration is usually from four to six weeks, 
though it may last nine or ten months. The present un- 
pleasantness appeared in St. Petersburg about the four- 
teenth of November. Advices from the Caroline Islands 
state that the epidemic makes semi-annual visits to Ponape, 
and now prevails on all the Maishall and Caroline Islands, 
* Read before the Section in Theory and Practice of Medicine of the 
New York Academy of Medicine, January 21, 1890. 2 
THE PRESENT EPIDEMIC OF INFLUENZA. 
one hundred or more, extending from east to west about a 
thousand miles. The influenza there presents two distinct 
classes of symptoms-one in which fever and pain are the 
chief symptoms, while the other manifests itself in nasal 
trouble and cough. It is not uncommon for a victim of one 
class to have another attack during the same epidemic of 
the other form. Grippe in Ponape does not differ materi- 
ally from our own, except that some stress is laid upon ter- 
rible pains beginning over the region of the heart-pains 
over an area the size of a silver dollar at first, which chase 
each other in wave after wave, never catching up, and ex- 
panding in equal proportion until the affected spaces are as 
large as saucers. This corresponds, in regard to the charac- 
ter of the pain, very nearly to another epidemic disease that 
will be considered farther on. 
Influenza is said to be the precursor of cholera; and in 
some instances this has been the case. While the disease 
is no respecter of persons, it seems to prefer the rich to 
the poor, and is often very kind to children. Those who 
are much in the air and exposed to outside influences are 
more liable to attacks than others more protected. The 
weak and the aged are therefore advised to stay within 
doors, except for necessary exercise. First women are at- 
tacked, then men, and lastly children. The mortality is 
about two per cent. In view, however, of the immense 
numbers attacked, this small percentage is sufficiently appall- 
ing in point of actual death-rate. The prognosis is good, 
barring certain conditions that equal numerically the ex- 
ceptions to a rule in French grammar. Many intercurrent 
and pre-existing maladies are gravely affected by grippe. 
Among those unfavorably influenced in marked degree may 
be mentioned phthisis, emphysema, diseases of the heart 
and kidneys, neuralgia, and other chronic nervous affec- 
tions. One seizure does not secure immunity from a sec- THE PRESENT EPIDEMIC OF INFLUENZA. 
3 
ond, as has been stated; and certain highly unfavored in- 
dividuals have succumbed several times during the same epi- 
demic. It is very probable that the morbific principle, 
whatever its nature, is not limited to man. Epizootics very 
similar to the epidemics in the human family have fre- 
quently prevailed among domestic animals, especially horses 
and dogs, and have been known to attack birds. Such con- 
ditions often exist simultaneously with or immediately pre- 
cede epidemics of influenza. It is said that this year an epi- 
zootic among horses preceded grippe in London. The epi- 
demic is not connected in any way with climate, soil, eleva- 
tion, or any known local terrestrial cause. The mountains 
of Cathay, the waters of the Nile, the Swiss lakes, the 
English downs, and the broad American prairies have all 
been visited by this rude and unceremonious guest. In 
Europe its starting-point is thought to be the far north. 
Some have asserted that it originates in Asia, especially in 
Tartary, though China has also been alleged as its birth- 
place. Later research would seem to indicate that the epi- 
demic influenza is really Russian, having its point of origin 
in the plains about Ladoga and Onega. It is also said to 
germinate in North America, at or about the Great Lakes, 
and along the banks of the river St. Lawrence. 
The epidemic, once started, spreads out in fan-like ex- 
pansion from the lakes of northern Russia, from northeast 
to southwest, and travels with a rapidity equal to the speed 
of a good horse. The influenza epidemic of 1782 made the 
distance from Konigsberg to Berlin-ninety-six Prussian 
miles-in about four days. Within eight hours after its 
arrival in any given place, one third or one half the inhabit- 
ants may become its victims. It attacked the entire popu- 
lation of Nismes in one day, with scarcely a single excep- 
tion. La grippe reached Venice at night in 1640, and by 
morning one half the population had been attacked by it. 4 
THE PRESENT EPIDEMIC OF INFLUENZA. 
Shops and colleges were closed, streets deserted, and a 
death-like stillness pervaded the usual busy thoroughfares. 
That the disease is infectious is not assured. The evi- 
dence in favor of its contagiousness is, in a way, too forci- 
ble to be disregarded. It is a matter of history that the 
epidemic in Paris began in the streets around the Russian 
embassy ; and the Marquis of Salisbury attributed its early 
occurrence at the foreign office in London to the dispatches 
received there. Yet this mode of communication-contagion 
-is not an essential factor in its propagation, for it attacks 
vast regions at once, descends upon remote and isolated 
habitations, and clutches sailors on shipboard in raid-ocean. 
Forry, writing in 1843, thinks we are warranted in placing 
influenza very low in the scale of contagiousness. 
The history of the present epidemic is the history of all 
past epidemics. However great certain other discrepancies 
among earlier authors, whose quaint ambiguities are often 
sufficiently fantastic, the main characteristics of grippe in 
their records are distinctly those of the present time. Am- 
broise Pare, writing in 1562, speaks of that " famous Catarrh 
with difficultie of breathing, which in the year 1510 went 
almost over all the world, and raged over all the cities and 
towns of France, with great heaviness of the head, with a 
straightness of the heart and lungs, and a cough, and a con- 
tinued fever, and sometimes raveing. This, although it 
seized upon many more than it killed, . . . showed itself 
pestilent by that violent and peculiar and unheard of kind 
of malignitie." And afterward Sydenham, treating of the 
epidemic cough of 1675, thus describes the grippe of to-day : 
"It scarce suffered any one to escape, of whatever age and 
constitution he were. Nor was it remarkable only for the 
numbers it attacked . . . but also on account of the danger 
that attended it. . . ." There was no other epidemic exist- 
ing, he goes on to say, which, by its opposition, might in THE PRESENT EPIDEMIC OF INFLUENZA. 
5 
some measure lessen the violence of epidemic cough. The 
symptoms were pain in the head, cough, fever; and then the 
development of pulmonary trouble. "The cough assisted 
the constitution in producing the fever," says Sydenham, 
"so the fever on this account attacked the lungs and pleura, 
just as it had affected the head the week preceding this 
cough; which sudden alteration in the symptoms occa- 
sioned some,/or want of sufficient attention, to esteem this 
fever an essential fever or peripneumony, though it remained 
the same that it had been during this constitution." Its 
sudden onset and often critical termination, its general seiz- 
ure, the severe nervous symptoms, the decided disposition 
to cough with only a proportionately slight increase of the 
secretion of the mucous membrane-all these are in favor of 
the view that epidemic influenza is a profound disturbance 
which rapidly affects the organism at large. Handheld 
Jones affirms that nervous phenomena are sometimes the 
only evidences of grippe. Graves notes the absence of 
fever in many cases that terminated fatally. He states that 
several of his friends and himself had conza, hoarseness, 
cough, and pulmonary irritation without fever. In a short 
treatise on influenza as it occurred in Birmingham, Dr. 
Peyton Blakiston announces that his researches have led 
him to the conclusion "that influenza is an affection of the 
nervous system, with its concomitant derangements of the 
organs of digestion, circulation, respiration, etc., commonly 
known under the name of nervous fever, accompanied 
throughout its whole course by irritation of the pulmonary 
mucous membrane, which not infrequently amounts to 
congestion and even inflammation." The so-called compli- 
cations, such as bronchitis, pneumonia, peritonitis, etc., may 
reasonably be considered a part of the original disorder ex- 
pressing itself along lines of least resistance. 
A writer, Forry, in the New York Journal of Medicine 6 
THE PRESENT EPIDEMIC OF INFLUENZA. 
for July, 1843, gives the usual early symptoms of grippe as 
it manifests itself to-day, always has manifested itself, and 
possibly always will: 
" It commences with slight chills, amounting some- 
times to shiverings and alternate flushings of heat, with lan- 
guor and sense of extreme weariness; then soreness over the 
eyes, or pain in the course of the frontal sinuses ; these are 
quickly followed by frequent sneezing, a copious discharge 
of thin, clear fluid from the nose and eyes, sometimes so 
acrid as to excoriate the upper lip; heat and soreness in the 
top of the larynx and oesophagus, and along the course of 
the windpipe, with hoarseness and dry cough ; sense of 
stricture in the chest, and difficulty of breathing, sometimes 
attended with darting pain in the muscles subservient to 
respiration ; weight and anxiety about the pnecordia ; fly- 
ing pains in the back, knees, calves of the legs, and various 
parts of the body ; depression of spirits, and sudden and 
extraordinary prostration of strength. The tongue is most- 
ly covered, at an early period of the complaint, with ex- 
tremely white mucus like cream." 
The pulse, 90, 100, 120, is weak and soft, intermittent 
frequently, ami ven changeable. Graves observed that it is 
often completely changed in from six to eight hours; and 
he adds that he has always taught that the pulse indicates 
irritation of the nervous system more than anything else. 
The urine is diminished, sometimes suppressed, and is in- 
variably of a high specific- gravity that is not warranted by 
the degree of fever. There is restlessness, sleeplessness, or 
sleepiness. When the fever is high at first, it is said that 
the disease seldom becomes chronic-that is, it begins ac- 
cording to the classical description given above, runs a 
light course, and gradually disappears, the intense weakness 
soon wearing off. 
The following typical cases of grippe, from the rec- THE PRESENT EPIDEMIC OF INFLUENZA. 
7 
ords of a conservative hospital where only conventional 
symptoms are allowed to be christened epidemic influ- 
enza, illustrate one view of the disease and of its treat- 
ment : 
John C., aged thirty, on January 3d became prostrated 
by sudden rigor, followed by fever, headache, and general 
pain. Had slight cough. Temperature on admission, Janu- 
ary 8th, 102-5°. Physical examination negative. Treat- 
ment : cathartic, quinine, and antip\ rine. Discharged, cured, 
January 13th. 
.Robert S., aged thirty-seven; for three da} s had had 
headaches, pains in back and limbs; also numerous parox- 
ysms of sneezing and dry cough. Been hot and cold by 
turns. Physical and urinary examinations negative. High- 
est temperature, 101-5°. Treatment: calomel, quinine, and 
antipyrine. Discharged, cured, in three days. 
William S., aged fifty ; pains in head and in bones, slight 
cough, bronchial irritation, and feeling of general prostra- 
tion. Physical and urinary examinations negative. High- 
est temperature, 102°. Treatment as above. 
Thomas M., aged thirty-four; three weeks earlier, caught 
cold, had cough, sweats, headache, pains in the bones, and 
profuse expectoration. Temperature on admission, 99-8° ; 
rose to 101-5°. Physical examination : subcrepitant rales ; 
otherwise negative. Urinary examination negative. Treat- 
ment : antipyrine and cough mixture. 
Giuseppe C., aged thirty, great weakness, nausea, loss 
of appetite, no chills, but a feverish feeling. Complained 
of pain on micturition. Physical and urinary examinations 
negative. Treatment as above. Discharged, cured, three 
days after. 
Lizzie A., a young girl, three days ago had pains all 
over, and several rigors followed by rise of temperature, 
this, on admission, being 102°. Appetite lost; bleeding 8 
THE PRESENT EPIDEMIC OF INFLUENZA. 
from nose; chronic tonsillitis. Treatment: cathartic, fol- 
lowed by antipyrine. Well in three days. 
Some have thought - Dujardin-Beaumetz among the 
number-that the present epidemic is a form of dengue. 
Others, that it closely resembles, in the earlier stages, cere- 
bro-spinal meningitis. Comparison reveals certain simi- 
larities among these three morbid entities, and marked dif- 
ferences as well. The specific cause of each and all has thus 
far eluded discovery. Their appearance, according to the 
mass of testimony, is dependent in greater or less degree on 
vicissitudes or anomalies of weather, on fogs, winds, heavy 
rains, or some peculiar electric condition of the atmosphere. 
Cerebro-spinal meningitis has prevailed the same year that 
epidemic influenza was doing its work elsewhere. It prefers 
the poor to the rich, and children suffer most severely in 
point of susceptibility and mortality. No age is spared, and 
men are oftener attacked than women. The three diseases 
generally begin abruptly and strike their victims down, like 
a thunderbolt out of a clear sky, although slight prodro- 
mata may have passed unnoticed. Dengue and epidemic 
influenza bear such a close relationship that it is reasonable 
to mistrust they are first cousins. They spread with equal 
rapidity, and present many symptoms in common. There 
is the same sudden loss of strength, of appetite, and of 
mental force. There are in each frontal pains, conjunc- 
tivitis, and the quick appearance of emaciation. Certain 
cases of pregnancy result in abortion, and little children are 
liable to convulsions. The pain of dengue is something that 
is never forgotten, and described as the sum-total of human 
suffering. So also are pictured the headaches of grippe, 
even by women familiar with the pangs of childbirth. In 
dengue there is pain everywhere-pains fixed, fugitive, lan- 
cinating, boring, contusive, and bruised-bad when the pa- 
tient is quiet, and worse when he moves. There are but few THE PRESENT EPIDEMIC OF INFLUENZA. 
9 
diseases, influenza excepted, that express themselves in so 
many ways as dengue or are subject to such serious com- 
plications and sequelae. The nervous centers suffer very 
much in severe forms, and the mild ones often present cere- 
bral lesions and neurotic complications. Subsequently pul- 
monary abnormities can often be traced to dengue. A trouble- 
some cough in the earlier stages may remain and annoy long 
after the fever has subsided. In Bengal, dengue was sup- 
posed very frequently to develop into a form of phthisis; 
and in America and India a peculiarly obstinate kind of 
ulcerative sore throat has followed in its train. The most 
striking similarity of the two diseases is the fact that, though 
the sufferers are cured, they do not always get well. As re- 
mote causes of death, these two epidemics form interesting 
subjects for future investigation. The course of dengue is 
divided into three stages, as follows: First, febrile access, 
lasting two to three days, beginning with lassitude, drowsi- 
ness, chilliness, pain in the bonesand about the joints, sleep- 
lessness, cream-like coating of the tongue, nausea, anorexia, 
and a temperature of 102° to 104°, sometimes higher. Then 
comes an intermission of one, two, or three days' duration. 
After this the second febrile stage arrives, characterized by 
an eruption of which some half dozen varieties are recorded. 
Convalescence is marked by great weakness, emaciation, 
and sometimes by a more or less persistent affection of the 
joints. Persons on first getting up, as in grippe, say they 
feel worse than any time before in the whole course of their 
existence, so great is the prostration and weariness. Dr. 
John E. Bacon, who reported the epidemic of dengue in 
Columbus, Ga., in 1886, looked upon the disease as situated 
in the nervous system, including, of course, its greater cen- 
ter, the brain. He did not consider it an inflammation, but 
a peculiar morbific effect produced by an unknown poison. 
Stages resembling the three stages of dengue are often 10 
THE PRESENT EPIDEMIC OF INFLUENZA. 
present in grippe. It may be assumed that many of the 
so-called relapses after apparently light attacks are merely 
the presence of the third stage of influenza following the 
period of remission. One case will illustrate this : 
B. L., aged fourteen ; chill; temperature, 104° ; pulse, 
120; complete and sudden loss of strength. Milk, quiet, 
and ten grains of calomel removed all symptoms in about 
two days. The patient got up, and made fair use of a Christ- 
mas vacation. In about three days a sudden cough, a rise 
of temperature to 102°, with a weak intermittent pulse, an 
erythematous eruption across the chest, and pain in the 
joints of the lower limbs, sent the child to bed again, where 
she remained for two days. The eruption, which caused 
intense itching, remained some time longer, and the pain in 
the feet came and went for several days. 
Mild attacks run their course in from four to seven days, 
under the use of diaphoretics and a regulated diet, without 
the development of any second fever. In cases marked by 
gastric irritation and depression of nerve vitality, the dis- 
ease lasts from twenty-one to twenty-eight days. The final 
termination is either by disappearance of the symptoms- 
local as well as general-or by some critical crisis, such as 
an increase in the secretion of mucus, of urine, sudden per- 
spiration, or diarrhoea. When death occurs, it may be due 
to one or all of the following causes: (a) To paralysis of 
the lungs and to capillary bronchitis, especially in the aged: 
(6) to pneumonia; (c) to cerebral congestion, to apoplexy 
resulting from violent coughing, or to profound exhaustion 
of the nerve centers. 
As to the real cause of the disease any theory is admis- 
sible, since no two experts agree, and whole communities 
are at variance in regard to it. There are food diseases, 
house diseases-why not air or electric diseases? Epidem- 
ics of influenza may be due to some astronomical influence THE PRESENT EPIDEMIC OF INFLUENZA. 
11 
that upsets temporarily the normal electric equation. Cer- 
tain physical phenomena, quite capable of altering in marked 
degree atmospheric electricity, have preceded and accom- 
panied the present epidemic. Among these are earthquakes 
and excessive humidity. Earthquakes may produce ex- 
traordinary phenomena, the modes of motion-heat, light, 
and electricity-being correlated to each other and to me- 
chanical motion or the motion of matter in the mass. The 
generally accepted theory of earthquakes at present ascribes 
the cause to terrestrial gravitation or condensation of the 
earth, by which the mass moves slowly toward the center. 
This motion is partially arrested by the resistance of matter 
to further condensation, and so molar motion is converted 
into molecular motion, manifested as heat and electricity. 
Evaporation being the source and some impurity in the wa- 
ter a necessity of air electricity, the conditions favoring an 
increase of this fluid have greatly prevailed of late. In 
seasons that do not swerve from their regular course the 
wastes of the summer are gathered into the soil in the fall, 
and, there decaying, are carried away and neutralized if the 
ground be dry and air can And its way into it. But where 
water is, air can not penetrate. Remove the water, and air 
follows, forced by the pressure of flfteen pounds to the 
square inch, carrying with it the warmth of the sun, puri- 
fying, vivifying, and vitalizing the ground. Heat, moisture, 
and impurity are necessary elements in the production of 
infectious disease, though neither of the three, or the three 
combined, can create the morbid fltness needed for its ap- 
pearance and propagation, unless there is present a fourth 
constituent, which thus becomes the essential factor. This 
something may yet be found to be an altered condition of 
atmospheric electricity, capable of causing corresponding 
derangements of the nervo-electric fluid.* So long as any 
* See New Orleans Medical and Surgical Journal, July, 1881, 12 
THE PRESENT EPIDEMIC OF INFLUENZA. 
excess of electricity is neutralized by suitable atmospheric 
conditions, it remains without injury to health. But if the 
earth is highly excited negatively, the air being also in high 
negative tension, the natural positive of the human body 
having been abstracted and leaving a high tension negative 
struggling to coalesce with suitable outside fluid, what be- 
comes of poor humanity? It is supposable that the im- 
pression of irritant and untoward electricity falls in our 
present epidemic upon the nerve-centers and upon the 
pneumogastric nerve, chiefly upon its pulmonary, gastric, 
and cardiac branches, causing excitation first, then nerve 
exhaustion or paralysis in greater or less degree, according 
to the condition of the nerves as to susceptibility, recep- 
tivity, or powers of resistance. It is not impossible that 
this peculiar nervous irritation may produce the phenomena 
of grippe, and also be the cause of other epidemics that 
resemble it. The power of wind and wave on healthful 
and abnormal conditions is of greater moment than has 
hitherto been recognized and considered. 
Successful treatment, like the epidemic itself, always 
has been, and is, essentially the same. Earlier observers 
found that venesection, the use of stimulants and narcotics, 
generally did harm, and therefore wisely gave up such 
measures. Whatever the course pursued, it is undertaken 
with the aim of securing three distinct and equally impor- 
tant results: (1) To unlock and stimulate secretion ; (2) to 
counteract the evil effects of nervous exhaustion ; and (3) to 
sustain nutrition during the period of convalescence. Or, to 
express it quaintly, in the words of an old writer: " To re- 
call the appetite, keep the vessels of the throat open, and to 
overcome the dejection of strength." To this end, calomel, 
aconite, tartar emetic, ipecac, valerian, iron, hyoscyamus, 
camphor, morphine, senega, and lactucarium have held their 
own in the treatment of influenza. All earlier authorities THE PRESENT EPIDEMIC OF INFLUENZA. 
13 
agree as to their efficacy, and disagree only in regard to 
dosage. The experience of the past few weeks has justified 
this claim to first consideration. To this list may be added 
digitalis, nux vomica, and cardiac tonics. The use of 
alcohol is interdicted, except for emergencies. Nourish- 
ing, non-stimulating diet, the most careful watching, and 
perfect quiet are essential in the treatment of grippe, 
which is an insidious, dastardly affair at best, with possi- 
bilities of the most harrowing nature. Whoever has an 
attack should go immediately to bed and stay there five 
days, in spite of personal sentiment or sensation. He 
will need many simple things-such as a hot mustard foot- 
bath, a purgative or laxative, milk, cereals, or some standard 
prepared food-no meat-hot or cold lemonade, Rhine 
wine and Seltzer-one part to three-Vichy, or some similar 
drink, the absence of friends (except attendants), and all the 
peace of mind the situation will allow. Baths, the local ap- 
plication of dry or moist heat, and friction are of great service 
in allaying restlessness and pain. Twenty years ago Petit 
advised the application of a few drops of chloroform on wet 
linen, for the relief of pain about the joints. It has the 
same effect to-day. Inhalations of steam medicated with 
camphor, turpentine, or menthol, and of the fumes of boil- 
ing vinegar, greatly diminish the sensation of dryness and 
stuffiness about the nose and throat. Phenacetin in smaller 
doses than are otherwise required will drive away headache, 
and bathing the face or temples with eau de laitue-an old- 
fashioned preparation containing lactucarium-is soothing 
and induces sleep. Great stress should be laid on sub- 
duing pain and restlessness. One of the pressing ques- 
tions of the hour is what to do with those who have had 
the grippe who are cured but not well. The persistent 
cough is best treated, according to Schbnlein, by ammo- 
nium chloride, hyoscyamus, and preparations of lactuca- 14 
THE PRESENT EPIDEMIC OF INFLUENZA. 
rium. Cough so obstinate as to defy remedies-and there 
are many such-will disappear entirely under the influence 
ofachange-of air. Cod-liver oil naturally suggests itself. 
In point of fact, it is not at all well borne. Malt extract, 
quinine and coca, and beef, wine, and iron, are of far greater 
value. The Turkish bath, massage, and electricity are 
standard resources of peculiar value during convalescence. 
Diminished chest expansion requires immediate attention in 
the form of systematized mechanical movements. New im- 
pressions in this way may be sent to the brain, and thus is 
secured an advantageous redistribution of nervous energy. 
For this purpose the respirator used in the establishment of 
Dr. Henry Ling Taylor is possibly the best means known. 
Failing this, the same passive movements made by a trained 
attendant, according to the rules laid down by Ling, will be 
of great assistance. An important element in this kind of 
physical training is the absence of volition on the part of 
the patient. The chest expansion must be increased for 
him; he must have nothing to do with the work. While 
any feeling of fatigue or of perpetual weariness remains, it 
is folly to undertake the real business of life, for the period 
of convalesence is fraught with unknown yet certain dan- 
ger, that is liable to assume a local habitation and a name 
without a word of warning. 
Epidemic influenza exercises a powerful alterative effect 
upon the whole organism. Pare and more modern writers 
speak of the liability of pregnant women to abort, and it is 
known that in girls and women suffering from amenorrhoea 
the menses return. The foundations of very serious dis- 
orders are often distinctly traceable to the depressing in- 
fluence upon the nervous system of an attack. The rekin- 
dling during convalescence of old and fading neuralgias is a 
curious feature of the disease. Relapses from cold have re- 
sulted in insanity, as was especially noted in 1847. Chronic THE PRESENT EPIDEMIC OF INFLUENZA. 
15 
asthma, chronic bronchitis, chronic catarrh, and chronic 
amygdalitis are frequent sequelae. Influenza also lights up 
asthma that has long since died down, and fans into flame 
the latent vitality of tubercle. Those who doubt that 
phthisis may have any such starting-point are agreed that 
phthisical patients remain permanently worse after an attack 
of grippe. Serious ophthalmia has followed epidemics in 
France. Possibly the most disastrous results are phthisis 
and diseases of the mind, as these are wide-reaching in 
their influence for evil. While not sharing the ultra-catho- 
licity of the school-girl who translated " chacun a son gout" 
everybody has yout, it is possible to affirm with a certain 
degree of verity that everybody has been more or less the 
victim, not of grippe necessarily, but of the influences that 
produced the epidemic. Under their malign sway the cheer- 
ful have become irritable, the irritable melancholy, and the 
melancholy given over to nameless sorrow and leaden-eyed 
despairs. Physicians and laymen alike have ceased to re- 
gard as absurd a disease of such formidable proportions. 
" It would conduce greatly to the advantage of medical 
science if a brief and accurate history were left to posterity 
of the character, symptoms, pathological phenomena, and 
treatment of every epidemic. Such a record would prove 
a guide and beacon to the practitioners of future ages, 
would enable them to draw important comparisons between 
the existing and the past, and thus arrive at a more fixed 
and available knowledge of the nature and habits of epi- 
demic complaints." It has been suggested that if every 
form of epidemic were noted and the order of its succes- 
sion marked it would remain to be seen by those who come 
after us whether there may not be cycles of epidemics. 
This is not impossible if we suppose that such visitations 
are connected with telluric or electric influences which are 
known to observe a periodic course. Were this ascer- 16 
THE PRESENT EPIDEMIC OF INFLUENZA. 
tained, a sort of observatory of epidemics could easily be 
established in all civilized countries. A resume of each phy- 
sician's personal experience, carefully and concisely worded, 
would be a generous contribution to medical literature, and 
might enable us to know the disease when it comes this 
way again, which Dr. Macdonald suggests would be rather 
a good thing. 
Bibliography. 
Schoulein's allgeineine nod specielie Pathologie und Therapie. 
Wallace's Sydenham. 
Henle's Handbuch der rationellen Pathologie. 
Works of that famous Chirurgeon, Ambroise Pare. 
Wood's Reference Handbook of Medical Sciences. 
Thomas's Modern Practice of Physic. 
Loomis's Practical Medicine. 
New Orleans Medical and Surgical Journal, Joly, 1881. 
Ziemssen's Cyclopaedia of the Practice of Medicine. 
Boston Medical and Surgical Journal, January 16, 1890. 
Pepper's Sy stem of Medicine. 
Dr. Henry Macdonald's paper on Epidemics of Influenza, in 
the New York Medical Journal, January 11, 1890. 
Graves's Clinical Lectures on Practical Medicine. 
Gazette des hopitaux, 1867. 
Boston Medical and Surgical Journal, 1871. 
Zoonomia, or the Laws of Organic Life, by the elder Darwin. 
Baas's History of Medicine. 
38 West Thirty-eighth Street. 
Discussion. 
Dr. 0. L. Dana said the journals had told us that this dis- 
ease began in St. Petersburg about the middle of November. It 
had arrived here about the middle of December, giving about 
one month in difference of time between the dates of the out- 
break. He thought the general history of the epidemic pointed 
to the fact that it was due to an infectious germ, if we could 
give any reason at all for it, It seemed to him that it must be THE PRESENT EPIDEMIC OF INFLUENZA. 
17 
the result of a bacillus or microbe. He thought it would be im- 
possible for a microbe to travel from St. Petersburg to New 
York in a month. That would be at the rate of about three 
hundred miles a day. Therefore the inference was that the 
actual cause of the epidemic existed here and had not been car- 
ried by persons or borne here by the winds like the cholera germ. 
Possibly there might be something in meteorological, telluric, and 
magnetic influences, but speculations in this direction had not 
so far been very fruitful. He believed certain bacteriologists 
had found a microbe constant to all the secretions, but had not 
been able to reproduce it. The disease seemed to occur in three 
forms--(1) the nervous, (2) the catarrhal, and (3) the gastric 
form. Though the gastric form had been seen here, our expe- 
rience had been principally with the catarrhal form. The 
nervous variety he did not think had been noticed here very 
much. He had seen one or two cases presenting classical symp- 
toms. The patients had become suddenly prostrated by weak- 
ness and had remained for three or four days so feeble that 
they were unable to walk. There was no chill or fever and no 
catarrh or vomiting. In one case facial paralysis had occurred 
the second day of the grip, and the writer of the paper had 
seen a patient of his, about a year old, that was attacked with 
symptoms of anterior poliomyelitis. This child had some of 
the symptoms of grip, and did not have fully developed symp- 
toms of poliomyelitis; but he believed these were directly the 
result of epidemic influences. He had observed a good many 
cases of facial neuralgia arising, he thought, from the same 
cause; some of them were complicated with inflammatory 
symptoms referred to the antrum of Highmore. The most pe- 
culiar of the nervous manifestations was the utter prostration 
and mental depression, lasting not only for days, but in some 
instances for weeks. Patients felt that life was not worth liv- 
ing. This condition was probably due to the action of the poi- 
son upon the heart. Many of these patients seemed to be re- 
lieved when given cardiac stimulants. 
Dr. W. P. Northrup, after giving a detailed account of the 
behavior of the epidemic at the various public asylums with 
which he was connected, said that, as to treatment, he would 18 
THE PRESENT EPIDEMIC OF INFLUENZA. 
like to mention that during this epidemic he had not given one 
grain of antipyrine. The fact was, he had had a very distress- 
ing experience with this drug in the case of a lady to whom he 
had given fifteen grains. She had, with great magnanimity, 
allowed him to give her five grains more that he might watch 
the effect. The result was a very troublesome and painful urti- 
caria and the most distressing dyspnoea he had ever seen. She 
had really taken fifteen grains, had been found on the floor, 
and by the time he got there she was pulseless. He should 
certainly never give any more antipyrine. 
Dr Pooley said that, as Dr. Page had called on him, he 
wanted to say something as to the way in which the grip 
affected the eye or the ear. He had been as interested as a 
man could be in studying his own eye symptoms; these were 
quite pronounced, and when he had attended a recent meeting 
of the Ophthalmological Society he found that such symptoms 
had been observed by many other gentlemen, and especially by 
one doctor, who said that in a very large majority of cases 
there was a sensation of pain in the eye, pain upon movement 
of the eye, and deep-seated pain in the orbits. To these the 
speaker might add, from his own case, a very decided asthe- 
nopia, exaggerated when he attempted to use his eyes. These 
seemed to have been the prominent symptoms, but it did not 
seem to be recorded that any permanent damage had been 
done. That more would be heard about the asthenopia he 
thought was certain. There had also been noticed considerable 
paresis from weakening of the accommodation. In his own 
practice, since the epidemic began, there had been quite a 
marked number of cases of inflammation of the middle ear, 
and nearly all of these seemed to be attributable to the prevail- 
ing epidemic. 
Dr. O. D. Pomeroy had noticed that there had been a larger 
number of cases than usual in which the ear was affected. In 
both the eye and ear the symptoms seemed to have developed a 
little while after the disease had run its course. Among the 
routine cases had been several of catarrhal conjunctivitis which 
had resulted in well-marked episcleritis. One case was quite 
striking; there was complete ecchymosis of the conjunctivae of THE PRESENT EPIDEMIC OF INFLUENZA. 
19 
both eyes looking exactly like the eccbymosis dependent upon 
whooping-cough. This condition had no doubt resulted from 
violent coughing. The eccbymosis was so great that the cornea 
stood out from the rest of the eyeball with startling distinct- 
ness. He was quite surprised to notice how many, new pa- 
tients suddenly appeared at the clinic. These were cases, most 
of them, of purulent otitis of the acute variety. Where perfora- 
tion of the drum membrane bad taken place this had occurred 
spontaneously. All these cases had been violent enough to 
make him think of a scarlatinous causation. 
Dr. F. Delafield said that everybody had been struck, of 
course, by the great frequency with which both bronchitis and 
pneumonia had occurred, and he supposed they must have 
noticed the same things that he had. As regarded bronchitis, 
there were two things which had attracted his attention. One 
thing was the very satisfactory way in which apparently very 
bad cases of general bronchitis had got well. Cases with pro- 
nounced classical symptoms, with coarse and subcrepitant lAles 
over the whole of both lungs, profuse expectoration of mucus 
with a good deal of blood mixed with it, and very marked diffi- 
culty of breathing, considerable rise of temperature, and severe 
general bronchitis, which under ordinary circumstances would 
have run a protracted course, he had been surprised to see get 
better within a moderate length of time. Many people with 
a general bronchitis, so far as the large tubes were concerned, 
had only a localized bronchitis so far as the small tubes were 
concerned, and that without any consolidation of the lung. 
These patients, although the cases lasted rather longer, all did 
well. As regarded the pneumonia, every one must have been 
struck with the fact that all the patients had a good deal of 
general bronchitis with it. They expectorated a good deal of 
mucus, both alone and with pus and blood. These cases of 
pneumonia showed considerable difference among them. In the 
first place, there were very moderate cases-patients who, with 
their general bronchitis, did not have very high fever and were 
not very sick; with very little dullness and no bronchial 
breathing, perhaps some subcrepitant rales, which, however, 
cleared up in two days. Then there were others who seemed 20 
THE PRESENT EPIDEMIC OF INFLUENZA. 
to be very sick. These would present well-marked physical 
signs of consolidation of one lobe. Here would be found bron- 
chial breathing, crepitant and subcrepitant rales ; but these 
people would get well in two weeks without any trouble. Then 
there were the cases which did not behave so well. There was 
general bronchitis and marked consolidation; these would go on 
day by day, the temperature being sometimes very high, some- 
times low, and at other times continuous at about 102°. This 
would go on from ten to twenty or thirty days, without the 
lungs clearing up. Still, with even some of these patients the 
lungs had at last cleared up, the temperature falling and the pa- 
tients getting all right. The others were the very bad cases. 
Most of these patients who had died had given evidence of a 
great deal of bronchitis, and a great deal of accumulation of 
mucus in the bronchial tubes. There had been accumulation of 
blood in the veins and very poor heart action. That was the 
way patients died in most of the fatal cases he had seen. 
Dr. Wood thought that the use of antipyrine was a question 
which ought to be discussed. He believed the drug was quite 
capable of complicating the disease in its later stage. Those who 
had employed it must have recognized the tendency in patients 
to a profuse cold perspiration after its use. This, with possibly 
a subnormal temperature, subjected a patient to special risks. 
He should like to be understood as being upon that side of the 
profession which had put up its hands against the use of the 
drug, except with the utmost caution. ® & REASONS WHY 
Physicians Should 
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