But all these are regarded rather as complications than as essential features of the general disease. The general feb rile symptoms appear to result from the direct action of the bacillus or its pto maines on the corpuscular elements of the blood and of the cerebral-nerve cen tre, creating great pain and soreness, with marked depression and impairment of vital resistance. This view is sus tained by A. Cantani, Jr., who injected cultures of the influenza bacillus into the brain of rabbits, by which severe nervous symptoms were produced, and from which he inferred the bacillus to be an intracellular poison acting primar ily on the central system.
In post-influenzal meningitis no lesion whatever to be found at necropsy, either in brain or medulla. In rare cases, sup purating lesions of the brain and menin ges found. T. C. Maxime (Lancet, Apr. 13, '95).
Effect of intracranial inoculation of the influenza bacillus in rabbits studied. Virulent cultures were introduced into the brain by trephining. Severe nervous symptoms, high temperature, and death followed in about twenty-four hours. At the autopsy at the site of the wound was an cedema containing numerous in fluenza bacilli and hemorrhages. The meninges were hyperemic and infiltrated with hemorrhagic exudation. The brain was markedly hyperaemic, the ventricles often containing a purulent exudation in which numerous influenza bacilli were found. The substance of the brain, on section, showed many small hemorrhages and numerous bacilli, with polynuclear leucoeytes. The bacilli appeared to spread, especially by the lymph-channels. The spinal cord was also invaded to a slight extent, the bacilli passing by the way of the central canal. The processes were generally those of a myelitis, simi lar to the encephalitis of the brain, but not nearly so severe. The other lesions present were bloody, serous exudate in the peritoneal cavity, acute congestion of the spleen, hyperemia of the kidney, small hemorrhages into the suprarenal bodies, and incipient fatty degeneration of the liver. The lungs were injected. Practically the same results could be ob tained by inserting a few milligrammes of the dead growth of the bacilli (killed by heat) beneath the dura mater. This proves that the toxins are the really ac tively hurtful agents. Cantani (Zeit. f. Hyg. u. Infect., B. 13, '90).
Three cases of influenza which termi nated fatally, in which the presence of Pfeiffer's bacilli in the nervous centres was ascertained. A. Pfuhl (Zeits. f. Hyg. u. Infect., p. 112, '97).
We are justified in assuming two forms of heart dilatation in influenza: One pre sumably produced by the action of the toxin upon the nervous system of the heart and possibly upon the myo cardium; the second form occurring in such conditions in which outflow of the blood is materially interfered with on ac count of mechanical conditions.
The first form, according to the excel lent observations made by West, un doubtedly may end fatally, although this has not been the case in the writer's ex perience. The second form is one that lasts much longer than the first, but in children has a tendency to recovery. F. Forchheimer (Jacobi Festschrift, p. 127, 1900).
Although albuminuria is fairly fre quent with influenza, nephritis is a rare complication. The nephritis complicating influenza is clinically of the acute limor rhagic type and morphologically shows toxic lesions. It apparently attacks chil dren more often than adults. The kid ney disturbance may appear a few days after the acute symptoms of the influ enza, or as long as a month later. The prognosis is favorable. Rowland G. Free man (Archives of Pediatrics, Oct., 1900).
In the study of streptococcic bron chitis in influenza in 24 males and 30 females the symptoms were as follow: The onset of the disease always follows an attack of influenza, the primary at tack being, in the majority of cases, of the respiratory type; in the minority, of the nervous or gastrointestinal form. The symptoms of influenza disappear be fore the attack of bronchitis develops. Exceptions to this rule occasionally oc cur. If the patient be in the period of convalescence from influenza the symp toms of that period will persist. The at tack begins rather suddenly; so that in the most common form it will be fully developed in from twenty-four to forty eight hours. The dominant symptom is the cough; always spasmodic, some times simulating whooping-cough, occur ring at night as well as in the day-time, and annoying the patient exceedingly. On account of the violence of the cough the patient complains of headache, pain in the lower region of the thorax, and sometimes in the 'abdominal muscles. For the same reason vomiting occurs, 1 and not infrequently the appearance of the face is the same as in whooping cough. The attack of coughing is usually followed by expectoration, the sputum varying from mere serous through the various grades of mucous and purulent. The amount of coughing is disproportionate to the quantity of expectoration; so that in 10 of the cases there was an admixture of blood; in of these there was bloody mucus, hi 4 unmixed pure blood,—in 2 of the latter apparently independent of the effort of coughing.