[An ordinary attack of influenza lasts from three to ten days; of dengue, from one to three weeks. The former is marked by muscular debility; the latter, by intense articular pain, especially at the knees, occasioning a characteristic limping gait. Catarrhs of the various mucous membranes constitute the rule in influenza, the exception in dengue. The latter presents a characteristic eruption. In influenza eruptions are rather excep tional, and, when present, variable. The temperature of dengue is apt to be re mittent and higher than that of influ enza. Convalescence from influenza is generally rapid; from dengue, slow and tedious.
For a few days influenza and typhoid fever might be confounded with one an other. The former, however, does not present the dilated pupil so often seen in the latter, nor ever a rose rash; the temperature-curves of the two diseases are distinctly different, and the charac teristic stool of typhoid fever is wanting in influenza. J. C. WILSON and S. So7,Is-Col-1EN, Assoc. Eds., Annual, '91.] Peculiar vesicular eruption on the soft palate considered characteristic of influ enza. The eruption consists of little vesi cles resembling sago-grains, of from 0.5 to 1.0 millimetre in diameter. Shelly (Brit. Med. Jour., Apr. 15, '93).
Peculiarity of the tongue observed in cases of influenza, and which is believed to be characteristic. It consists in an appearance of porcelain-like whiteness, associated with humidity. The colora tion is sometimes uniform, sometimes mottled. It makes its appearance within the first two or three days of the attack, and sometimes persists until the patient believes himself well. Faisans (Le Bull. Mod., May 28, '93).
Diagnosis of influenza during puerperal state. Marked and repeated chills; se vere pain in the head, body, and extremi ties; gastric and pulmonary disturb ances. Pain and soreness sufficiently characteristic to establish the differential diagnosis between it and puerperal fever. T. M. Burns (Annals of Gyn. and red., Sept., '95).
Attention drawn to a peculiar condi tion of the tongue noticed in cases of in fluenza: the appearance of dark, purplish red spots scattered over the anterior half of the dorsum, about the size of a pin's head, becoming white and vesicular later on; the latter also noticed on the inside of the mouth and soft palate. John Terry (Lancet, Oct. 12, '95).
Symptoms of otitis of grippal origin:— 1. At the outset of the otitis phlyc tenules filled with blood appear on the tympanic membrane, and sometimes cover it completely, but rarely appear on the walls of the auditory canal. When
the phlyctenules break and blood oozes from them, the membrane itself is at first not yet broken through to give exit to pus from within the tympanum.
2. Perforation occurs through a kind of baggy prolapse of the tympanic mem brane.
3. Tendency to early complications with processes rapidly destructive in the mastoid, acute caries and necrosis, throm bosis of sinuses, pyzemia. Osteitis may occur at the outset, developing quietly without accompanying signs of inflamma tion of the tympanic cavity, which may be invaded later.
4. Persistence of pains and buzzings of the ear, often more prolonged after the perforation than in non-grippal cases. The membrane once more healed and the scar closed by cicatrix, deafness may per sist, though repair seems perfect.
These four characteristics, even in the absence of bacteriological confirmation, will establish the diagnosis from non grippal otitis media. Loewenberg (Le Bull. MOd., Mar. 2, '98).
Eruptions of influenza most often ob served to simulate those seen in scarlet fever, measles, and herpes: The measles eruption closely resembles the papular form, is mottled, or at times blotchy. It may be confined to the cheeks or it may cover the entire surface of the body. The herpetic eruption is frequently called urticaria, but it seems to be more prop erly called herpes. One of the personal cases had a typical herpes zoster, and in fected two other children in the same family with a disseminated herpes. J. Edward Herman (N. Y. Med. Jour., Feb. 17, 1900).
The fact that many in the same com munity are attacked simultaneously or in quick succession renders the clinical diagnosis more complete; yet some of the first cases observed are generally denom inated violent "colds," and when not severe are treated with domestic reme dies without the aid of a physician.
A pathognomonic sign of influenza: Congestion of the greater part of the whole of the faucial arch, including usually the uvula and the posterior part of the soft palate. The dilation of the smaller vessels of the mucous membrane is sometimes extreme, and not infre quently arbarescent, but the distinguish ing feature of influenza is a narrow pain less patch of superficial ulceration on the edge of the anterior pillars on both sides, evidently due to desquamation of the epithelium. It is sometimes present long after the disease. F. Phillips (Brit. Med. Jour., Nov. 11, '99).