Influenza is an acute, highly contagious disease due to a special germ, and tending to spread with amazing rapidity over vast areas. It has occurred as a world wide epidemic at various times in history, and during four periods in the last century. A pandemic of influenza began in the winter of 1889 90, and continued in the form of local epidemics till 1904, the disease suddenly appearing in a community and, after a prevalence of about six weeks, disappearing again. One attack, it is, perhaps, unnecessary to state, does not protect against another. The mortality is about 1 death to 400 cases. The feeble and aged are those who are apt to succumb. Fatalities usually result from complications or sequels, such as pneumonia or tuberculosis; neurasthenia or insanity may follow.

Symptoms. There are commonly four important symptoms characteristic of grippe : fever; pain, catarrh; and depression, mental and physical. Grippe attacks the patient with great suddenness. While in perfect health and engaged in ordinary work, one is often seized with a severe chill followed by general depression, pain in the head, back, and limbs, soreness of the muscles, and fever. The temperature varies from 100° to 104° F. The catarrh attacks the eyes, nose, throat, and larger tubes in the lungs. The eyes become reddened and sensitive to light, and movements of the eyeballs cause pain. Sneezing comes on early, and, after a day or two, is followed by discharge from the nose. The throat is often sore and reddened. There may be a feeling of weight and tightness in the chest accompanied by a harsh, dry cough, which, after a few days, becomes looser and expectoration occurs. Bodily weakness and depression of spirits are usually prominent and form often the most persistent and distressing symptoms.

After three or four days the pains decrease, the temperature falls, and the cough and oppression in the chest lessen, and recovery usually takes place within a week, or ten days, in serious cases. The patient should go to bed at once, and should not leave it until the temperature is normal (98 3/5° F.). For some time afterwards general weakness, associated with heart weakness, causes the patient to sweat easily, and to get out of breath and have a rapid pulse on slight exertion.

Such is the picture of a typical case, but it often happens that some of the symptoms are absent, while others are exaggerated so that different types of grippe are often described. Thus the pain in the back and head may be so intense as to resemble that of meningitis. Occasionally the stomach and bowels are attacked so that violent vomiting and diarrhea occur, while other members of the same family present the ordinary form of influenza. There is a form that attacks principally the nervous system, the nasal and bronchial tracts escaping altogether. Continual fever is the only symptom in some cases. Grippe may last for weeks. Whenever doubt exists as to the nature of the disorder, a microscopic examination of the expectoration or of the mucus from the throat by a competent physician will definitely determine the existence of influenza, if the special germs of that disease are found. It is the prevailing and erroneous fashion for a person to call any cold in the head the grippe ; and there are, indeed, many cases in which it becomes difficult for a physician to distinguish between grippe and a severe cold with muscular soreness and fever, except by the microscopic test. Influenza becomes dangerous chiefly through its complications, as pneumonia, inflammation of the middle ear, of the eyes, or of the kidneys, and through its depressing effect upon the heart.

These complications can often be prevented by avoiding the slightest imprudence or exposure during convalescence. Elderly and feeble persons should be protected from contact with the disease in every way. Whole prisons have been exempt from grippe during epidemics, owing to the enforced seclusion of the inmates. The one absolutely essential feature in treatment is that the patient stay in bed while the fever lasts and in the house afterwards, except as his strength will permit him to go out of doors for a time each sunny day until recovery is fully established.

Treatment. The medicinal treatment consists at first in combating the toxin of the disease and assuaging pain, and later in promoting strength. Hot lemonade and whisky may be given during the chilly period and a single six to ten grain dose of quinine. Pain is combated by phenacetin, three grains repeated every three hours till relieved. At night a most useful medicine to afford comfort when pain and sleeplessness are troublesome, is Dover’s powder, ten grains (or codeine, one grain), with thirty grains of sodium bromide dissolved in water. After the first day it is usually advisable to give a two grain quinine pill together with a tablet containing one thirtieth of a grain of strychnine three times a day after meals for a week or two as a tonic (adult). Only mild cathartics are suitable to keep the bowels regular as a Seidlitz powder in the morning before breakfast. The diet should be liquid while the fever lasts as milk, cocoa, soups, eggnog, one of these each two hours. A tablespoonful of whisky, rum, or brandy may be added to the milk three times daily if there is much weakness.

The germ causing grippe lives only two days, but successive crops of spores are raised in a proper medium. Neglected mucus in nose or throat affords an inviting field for the germ. Therefore it is essential to keep the nostrils free and open by means of spraying with the Seiler’s tablet solution, and then always breathing through the nostrils.