largely in this disease, both internally and as a local application.
Originally recommended in the latter manner on account of its power of
controlling the development of low organisms, it has not proved so
satisfactory or valuable as when given internally. Binz in 1870 was
perhaps the first to recommend quinia given frequently and in
solution, and Dawson in 1873[15] reports excellent results from the
sulphate or muriate of quinia given in full and frequent doses, and in
such solutions as will not prevent its acting on the mucous membrane
in its passage through the pharynx. Breidenbach[16] gives the quinia
muriate in larger doses--one and a half to fifteen and a half grains
per diem. The effects were surprising as soon as the proper dose for
each person had been determined; this, he says, is the keynote of
success. To prevent complications he continued it for a long time in
small doses.
[Footnote 15: _Am. Jour. Obstetrics._]
[Footnote 16: _Practitioner_, Feb., 1871.]
Our own experience favors the view that quinia, when given in solution
or suspended in mixture, is valuable in many cases of this disease; it
can be ordered in powder, and given in a spoonful of simple syrup or
of the preparation known as the syrup of yerba santa, which makes an
excellent vehicle. Liquorice also disguises the taste of quinia
admirably for children.
Albrecht[17] has found from an experience of ten cases of whooping
cough in children between the ages of one and a half and nine years,
all of a marked scrofulous type, much benefit from the muriate of
pilocarpine, given in small doses after every fit of coughing. To
prevent collapse, he advises that it should be given in a mixture
containing a little brandy. After twenty-four hours of its
administration an obvious change for the better takes place in the
appearance of the mucous membrane of the throat, velum palati, and
uvula, which becomes paler, less swollen, and more moist;
laryngoscopic examination shows a similar improvement. During the
catarrhal period cold compresses to the neck and sweetened milk
containing potassium chlorate are used instead of the pilocarpine,
which is to be resumed as soon as a whoop recurs.
[Footnote 17: _London Med. Rec._, March 15, 1882, p. 110.]
Dr. Tordeus, of the Hospice des Enfants Assistés, Brussels, states
that he has found the sodium benzoate useful in whooping cough,
diminishing the frequency and violence of the paroxysms, and by its
action on the pulmonary mucous membrane preventing those pulmonary
complications which so frequently supervene and constitute the danger
of the disease.
Sulphur has been largely used by the Germans in two- or three-grain
doses, and is said to be greatly esteemed by them. Cantharides has
been recommended, and it is stated that when strangury is produced the
whoop will cease; we should consider this rather severe treatment. The
{848} fluid extract of castanea is used by many with undoubtedly good
results, though this also has been somewhat of a disappointment in the
way of treatment, as at one time it was looked upon almost as a
specific. Many claim that an infusion of the fresh leaves gives a
better result. Dewar[18] regards ergot with great favor in the
treatment of pertussis. Certainly in those cases where, from violent
straining, hemorrhages have taken place we have found it to be highly
valuable. We have had no experience with it in the treatment of
ordinary cases, though Dewar claims that it shortens the attack. The
ammonium picrate, and recently resorcine, have been used with success.
[Footnote 18: _The Practitioner_, London, May, 1882.]
Counter-irritation to the neck and chest has always been found useful
in the treatment of this disease. Autenreith[19] recommends tartar
emetic to the epigastrium till vesicles appear and even ulcerate.
Milder forms of counter-irritation over the chest seem equally
efficacious if continued for some time. The oil of amber, when used in
liniment with camphor or turpentine, is by some considered almost a
specific. Great care should also be observed in the dress of children
with whooping cough. Warmth about the chest is always indicated, while
there should be nothing close or tight about the throat allowed.
[Footnote 19: _Dict. des Sciences Med._, 1813.]
In the third stage, when there is the nervous element remaining,
tonics, such as cod-liver oil, iron, the phosphates and
hypophosphites, are required.
The diet should be nutritious, easy of digestion, and abundant, and
the bowels should be kept regular by fruits or laxatives. Over-feeding
should of course always be avoided, and the attempt at weaning a babe
with this disease would certainly meet with unfavorable results.
Bicarbonate of soda or lime-water should be given freely with the milk
taken by children with this disease. Milk certainly should form the
basis of the diet of children with pertussis, and reliable
meat-extracts are to be recommended in this disease even for older
children, who from the severity of the attack would vomit more solid
food. If the vomiting be so severe as to affect nutrition, the child
should be sustained by peptonized milk, soup, or gruel, given by the
bowel.
The importance of a proper regulation of the temperature of the air
which the patient breathes is especially recognized in France. If the
attack occurs in mid-winter and the seashore be inaccessible or
inexpedient, the child should be restricted to a well-ventilated
nursery or suite of rooms, the temperature of which should be kept
uniform.
Salt air is recognized to be of great value in advanced cases of this
disease; this has been attributed partly to the effects of stimulation
of the mucous membrane in rendering less viscid and more copious the
bronchial secretions, and also to the balmy softness and great purity
of the atmosphere at the sea-shore. But probably there is another
element in the local action of the chloride of sodium, either in
establishing a resistance on the part of the patient or in modifying
the germ of the disease.
The most serious complication of whooping cough is pneumonia. It
occasionally happens that an attack of croupous pneumonia may develop
during the course of whooping cough, but in the vast majority of cases
the disease is of the catarrhal type. When, indeed, it is remembered
that a bronchial catarrh, which is the invariable precursor or
accompaniment {849} of catarrhal pneumonia, is a constant factor in
whooping cough, and, further, that all conditions of debility, and
especially of enfeebled or embarrassed respiration, dispose to this
form of pneumonia, it is not surprising that this complication should
be of such frequent occurrence. It is not impossible that in aiming at
securing sufficient fresh air and out-door exercise to maintain the
general health, an injudicious degree of exposure may be permitted
which will aggravate the existing bronchitis and induce an extension
of inflammation to the alveoli. But usually the catarrhal pneumonia
develops in a subacute and more or less insidious manner, and without
being traceable to any such exposure. It may happen occasionally that
in the violent inspiratory efforts at the close of the paroxysms
irritating secretions may be sucked from the bronchioles into the
alveoli, and there excite inflammation. Or, again, it doubtless
happens frequently that, with the existence of swelling of the
bronchial mucous membrane and of viscid secretions in the bronchial
tubes, collapse of portions of lung tissue is developed by the
forcible expulsion of air during the paroxysms of cough, which cannot
be replaced owing to the relative weakness of inspiration and to the
ball-valve action of the plugs of mucus in the obstructed bronchioles.
The intimate relation between pulmonary collapse and catarrhal
pneumonia is familiarly known. It is not to be considered that the
mere occurrence of collapse will induce pneumonia in the areas
affected, but certainly it will aid in rendering effective the other
irritating causes. As a consequence, it usually happens that when
catarrhal pneumonia occurs in whooping cough it is associated with
more or less collapse. When, then, especially in children of
debilitated or rachitic constitution, or in those who are subjected to
unfavorable hygienic influences, such as overcrowding, bad air, and
the like, there is a rather gradual development of dyspnoea, with
increasing debility, emaciation, and evidences of impaired oxygenation
of the blood, it is to be feared that this serious complication has
developed. The physical signs are often difficult of interpretation,
but if careful examination of the chest be conducted, together with
thermometric observations, the approach of this danger or its actual
presence may be detected. The result is fatal in a large proportion of
cases, so that suitable treatment--for the details of which reference
is made to the appropriate section--must be instituted without delay.
* * * * *
Our investigations of this disease have led us to the conclusion that
we have to deal with an affection caused by a specific germ, which is
usually, after a period of incubation, made manifest by a catarrh of a
portion of the air-passages; that this catarrh, existing for an
indefinite period, is capable of being influenced by medication,
applied either by means of inhalation or by acting on the mucous
membrane after absorption by the stomach. In this way we have known
the administration of quinia and of alum diminish the number of
paroxysms, to all appearance checking the excessive secretion to a
marvellous extent. The other element of the disease, the neurosis,
which soon follows the initial catarrh, and seems to last for an
indefinite time after the mucous membrane has regained its normal
appearance, is also capable of being controlled by the use of drugs,
especially belladonna, chloral, the bromides, and hydrocyanic acid,
not to speak of the other antispasmodics and sedatives, and by the
{850} analgesic effect of carbonic acid gas, or by the spray of
bromide of ammonium, carbolic acid, and other substances upon the
larynx.
Vogel tells us in his classical work on children, "If now, as a
résumé, I would give an explanation of my views, it would go to show
that there never has been, and most probably never will be, a remedy
by which whooping cough may be abridged, any more than we are able to
cut short the acute exanthemata or typhus fever or pneumonia." And yet
the experience of many whom we have quoted in this article tends to
support the view that by a form of treatment calculated to act on the
two elements of the disease which we have just noted, the affection
can be greatly modified in its intensity, and probably the attack be
somewhat shortened. Certain it is that the recent studies of this
disease give us hope that the day is not far distant when the cause,
whatever it is, will be definitely known, and if it is found to reside
in the secretions from the larynx, that treatment by inhalation or
atomization will modify or destroy it, and prevent its dissemination.
{851}
INFLUENZA.
BY JAMES C. WILSON, M.D.
DEFINITION.--A continued fever, occurring in widely-extended
epidemics, and due to a specific cause; it is characterized by early
catarrh of the mucous membrane of the respiratory tract, and in many
cases also of the digestive tract; by quickly oncoming debility out of
proportion to the intensity of the fever and the catarrhal processes;
and by nervous symptoms. There is a strong tendency to inflammatory
complications, especially of the lungs. Uncomplicated cases are rarely
fatal except in feeble and aged persons. An attack does not confer
immunity from the disease in future epidemics.
SYNONYMS.--Febris catarrhalis; Defluxio catarrhalis epidemicus;
Catarrhus a contagio; Rheuma epidemicum; Cephalalgia contagiosa;
Epidemic catarrhal fever; Tac; Horion; Quinte; Coqueluche; Ladendo,
also written La Dando; Baraquette; Générale; Coquette; Cocotte;
Allure; Follette; Petite poste; Petit courier; Grenade; La Grippe;
Ziep; Schaffhusten and Schaffkrankheit; Huhner-Weh; Blitz-Katarrh;
Mödefieber; Mal del Castrone. There are also several names indicating
its supposed origin; thus it has been called in Russia, Chinese
catarrh; in Germany and Italy, the Russian disease; in France, Italian
fever, Spanish catarrh, and so forth.
It is a remarkable fact that in two instances at least the popular
name for the disease under consideration has found its way widely into
medicine and medical literature, almost to the exclusion of the
studied terms by which science has sought to designate it; these are
influenza and la grippe.
Such obsolete and now meaningless terms as Peripneumonia notha
(Sydenham, Boerhaave), Peripneumonia catarrhalis (Huxham), Pleuritis
humida (Stoll), have been omitted from this list of synonyms as being
of interest rather to the student of medical history than to the
student of medicine.
Febris catarrhalis, Defluxio catarrhalis epidemicus, Rheuma epidemicus
are terms which no longer retain the place given them in the
literature of influenza by the older medical authorities.
Catarrhis a contagio (Cullen) and Cephalalgia contagiosa are derived
from a view of the nature of the disease, which has been the cause of
no little controversy.
Epidemic catarrhal fever is, with its Latin equivalent, the most
satisfactory of the so-called scientific names by which the disease is
at present known.
In the popular names for the affection there is to be noted an {852}
indication of the national character of some of the peoples who have
suffered from its frequent visitations.
Among the English it is known as cold or epidemic cold, or, in
deference to medical authority, as catarrh or epidemic catarrh; and at
present, both among the folk and the doctors, as influenza. Englishmen
are neither quick to see in the disease a resemblance to some common
circumstance or thing, nor are they disposed to make a joke about it.
The Germans find obvious resemblances. In the labored respiration and
the character of the cough they find a suggestion of a common
epizoötic affecting the sheep, hence Schaffhusten and Shaffkrankheit;
or, because the cough is like the crowing of a cock and the
disturbance of respiration and rapid prostration suggest some
resemblance to a common disease of the domestic fowl, it has been
called Huhner-Weh (chicken disease, whooping cough), and Ziep, which
is about equivalent to pip. They call it also, from its rapid
invasion, Blitz-Katarrh, and from its diffusion, Mödefieber.
The French are disposed to make a jest of everything, and the more
serious the subject the better the joke. Hence they have found a new
name for almost every great epidemic, and each more trivial than the
last. Thus, tac (rot); horion (in jest, a blow); quinte, because the
spells occur at intervals of five hours (sic); coqueluche (a hood or
cowl), from the cap worn by those suffering from the malady; and so on
through the long list given above.
La grippe is said to be derived from the Polish Chrypka (Raucedo); it
may, however, be derived from agripper (to seize).
Influenza is of Italian derivation. It is said that the disease
received this name because it was attributed to the influence of the
stars, or from a secondary signification of the word indicating
something fluid, transient, or fashionable.
HISTORICAL SKETCH.[1]--Epidemics of influenza have been clearly
recorded only since the beginning of the sixteenth century. There are
numerous accounts of earlier epidemic diseases resembling it, but they
are not sufficiently particular to warrant us in inferring its
undoubted existence. It is supposed to be referred to in the writings
of Hippocrates, who, however, gives no exact description.[2] An
outbreak in the Athenian army in Sicily (415 B.C.), recorded by
Diodorus Siculus, has been supposed to have been influenza. Despite
these statements, and those of others to the effect that it is a
disease known from a remote antiquity, it may be said that no accounts
can be confidently established, as referring to the disease now known
as influenza, in the writings of classical antiquity.[3]
[Footnote 1: See also _The Continued Fevers_, by the author of this
paper, New York, 1881.]
[Footnote 2: Parkes, _Reynolds's System of Medicine_, vol. i., 1868.]
[Footnote 3: Zuelzer, _Ziemssen's Cyclopædia of Medicine_, vol. ii.,
1875.]
As early as the ninth century several epidemics of catarrhal fever,
Italian fever, and the like, which were probably influenza, were made
matter of history. In the year A.D. 827 a cough which spread like the
plague was recorded. In 876 there appeared in Italy a similar
epidemic, which spread with great rapidity over all Europe. It is
related that dogs and birds suffered with symptoms not unlike those
characterizing the affection in man. In 976, Germany and all France
suffered from a fever of which the chief {853} symptom was cough. No
further epidemic is noted until two centuries later, when, in 1173, a
widespread malady, of which the symptoms were chiefly catarrhal, raged
throughout Europe; while less important epidemics of a like character
are recorded as having occurred during the following century
(1239-99).
In the medical writings of the fourteenth century there are to be
found records of six epidemics, and in the fifteenth seven great
visitations of influenza are described (Parkes).
Aitken[4] speaks of a very fatal prevalence of influenza throughout
France in 1311, and of an epidemic in 1403 in which the mortality was
so great that the courts of law in Paris were closed in consequence of
the deaths.
[Footnote 4: Aitken's _Practice of Medicine_, vol. i., 1872.]
Influenza is mentioned in the _Annals of the Four Masters_ as having
prevailed in Ireland in the fourteenth century, and a disease
characterized by similar symptoms is alluded to in early Gaelic
manuscripts under the name of Creatan (creat, the chest). The disease
is described also in an Irish manuscript of the fifteenth century
under the terms Fuacht and Slaodan.[5]
[Footnote 5: Theophilus Thompson, _Annals of Influenza_, 1852.]
The earliest epidemic that prevailed in the British Isles of which any
accurate description remains is that of the year 1510. The disease
came from Malta, and invaded first Sicily, then Italy and Spain and
Portugal, whence it crossed the Alps into Hungary and Germany as far
as the Baltic Sea, extending westward into France and Britain. Its
track widened over the whole of Europe from the south-east to the
extreme north-west, and it is said that not a single family and scarce
a person escaped it. It was attended by a "grievous pain in the head,
heaviness, difficulty of breathing, hoarseness, loss of strength and
appetite, restlessness, retchings from a terrible tearing cough.
Presently succeeded a chilliness, and so violent a cough that many
were in danger of suffocation. The first day it was without spitting,
but about the seventh or eighth day much viscid phlegm was spit up.
Others (though fewer) spat only water and froth. When they began to
spit, cough and shortness of breath were easier. None died except some
children. In some it went off with a looseness, in others by sweating.
Bleeding and purging did hurt."[6] Blisters were commonly
employed--two each upon the arms and legs, and one to the back of the
head. The description is sufficiently clear to place the nature of
this epidemic beyond all doubt.
[Footnote 6: Thomas Short, _A General Chronological History of the
Air, Weather, Meteors, etc._, London, 1749; quoted in the _Annals of
Influenza_.]
The epidemic of 1557, starting westward from Asia, spread over Europe,
and then crossed the Atlantic to America. The malady broke out in
England, after a season of unusual rain and great scarcity of corn, in
the month of September. "Presently after were many catarrhs, quickly
followed by a more severe cough, pain of the side, difficulty of
breathing, and a fever. The pain was neither violent nor pricking, but
mild. The third day they expectorated freely. The sixth, seventh, or
at the farthest the eighth day, all who had that pain of the side
died, but such as were blooded on the first or second day recovered on
the fourth or fifth; but bleeding on the last two days did no
service." "Some, but very few, had continual fevers along with it;
many had {854} double tertians; others simply slight intermittent. All
were worse by night than by day; such as recovered were long
valetudinary, had a weak stomach, and hypped." Gravid women either
aborted or died. This epidemic spread with frightful rapidity.
Thousands were attacked at the same time. The entire population of
Nismes, with scarcely an exception, fell ill of it upon the same day.
It was extremely fatal. In Mantua Carpentaria, a small town near
Madrid, it broke out in August, and so fatal were the bloodletting and
purging which constituted the treatment at first, that, of the two
thousand persons who were bled, all died. The disease raged in some
parts till the middle of the following year (1558), and carried off,
in Delft alone, five thousand of the poor. In all cases mild treatment
was called for, with warm broths and speedy immersals, "to recall the
appetite and keep the vessels of the throat open."
In 1580 a great epidemic of influenza spread from the south-east
toward the north-west over Asia, Africa, and Europe. From
Constantinople and Venice it overran Hungary and Germany, and reached
the farthest regions of Norway, Sweden, and Russia. It spread into
England, and has been described by Dr. Short. In Italy it prevailed
during August and September, in England from the middle of August to
the end of September, and in Spain during the whole summer. In most
places its duration was about six weeks. As a rule, the termination
was favorable, although the disease ran a somewhat protracted course.
In the account of Dr. Short it is stated that "few died except those
that were let blood of or had unsound viscera." In some places, on the
contrary, the course of the disease was very severe. In Rome two
thousand died of it, according to the author just cited, but Zuelzer
informs us that the victims of this epidemic in the Eternal City were
not less than nine thousand, and adds that Madrid must have been
almost depopulated by it. This high mortality has been attributed to
the bloodletting practised in the treatment of the disease. The
symptoms were similar to those of the previous epidemics, with a
greater shortness of breath, which continued in many cases for some
time after the disappearance of the catarrhal trouble. There was great
sweating at the end of the attack. The plague, measles, and small-pox
prevailed also, and with considerable violence, during the year 1580.
Influenza, unfelt for several years, reappeared in Germany in 1591; an
epidemic extending from Holland through France and into Italy occurred
in 1593. In 1610 catarrh is said to have prevailed throughout Europe.
In 1626-27 epidemic catarrhal fever made its appearance in Italy and
France; in 1642-43 in Holland; in 1647 in Spain and in the colonies of
the Western World; and again, in 1655 in North America. According to
Webster,[7] this epidemic of 1647 was the first catarrh mentioned in
American annals.
[Footnote 7: Noah Webster, _A Brief History of Epidemic and
Pestilential Diseases_, London, 1800.]
In 1658 and 1675 it again visited Austria, Germany, England, etc. The
first of these two epidemics is described by Willis,[8] and the second
by Sydenham,[9] as they occurred in England, and the accounts are to
be {855} found in the _Annals of Influenza_. It is about this period
that the disease began to be known as influenza, and it is not without
interest to observe that the influence of the stars suggested itself,
in connection with its sudden appearance and wide prevalence, to the
minds of the physicians of this date. Willis writes that "about the
end of April (1658), suddenly a distemper arose, as if sent by some
blast of the stars, which laid hold on very many together; that in
some towns in the space of a week above a thousand people fell sick
together."
[Footnote 8: Dr. Willis, _The Description of a Catarrhal Fever
Epidemical in the Middle of the Spring in the Year 1658: Practice of
Physick_, 1684.]
[Footnote 9: _The Epidemic Coughs of the Year 1675, with the Pleurisy
and Peripneumony that supervened_: from the _Works_ of Thomas
Sydenham, M.D.]
Epidemics are recorded as having occurred in Great Britain and Europe
in 1688, 1693, and in 1709. The disease raged in 1712 widely over
Europe from Denmark to Italy.