Influenza-pneumonia is characteristic ally lobular, the inflammatory process spreading from the bronchi to the alveo lar passages and alveoli, the latter being densely and almost exclusively filled with leucocytes. In the bronchi their number is so great that they not only penetrate between the epithelial cells, but cause partial detachment of the epithelial lin ing. The absence of fibrin is noteworthy, and is one of the reasons why the infil tration has, to the naked eye, a smooth appearance.
As a terminal stage of influenza pul monary gangrene occurred in 7.5 per cent. of the writer's cases of influenza pneumonia. Arteriosclerosis may follow influenza. A. Fraenkel (Berliner klin. Woch., Apr. 12, '97).
The influenza bacillus is capable of giving rise to fibrous or serous, or even htemorrhagic, exudate in the lungs, which may become purulent. When the sinuses communicating with the nose are in flamed it is nearly always a result of infection with the influenza bacillus. Lindenthal (Wiener klin. Woch., Apr. 15, '97).
Epidemics of influenza are followed by an increase in the number of chronic heart diseases resultant from acute endo carditis. Schott (Berliner klin. Woch., June 4. 1900).
Post-tracheal haemorrhage several times observed. In all the cases except one there was a more or less recent his tory of influenza and of more than one attack. The tickling in the lower part of the throat, and constant feeling of "something" that must be "got up," was complained of by all, together with the short, dry cough, which is all the more persistent the more recent the influenza. There is no elevation of temperature unless influenza is still present; very often not even then. It is sometimes only attributable to the influence of alarm or of loss of blood if the hmmor rhage has been severe, and is generally only temporary, and the chart presents none of the characteristics found in in cipient phthisis. James Donelan (Jour. of Laryn., Rhin., and Otol., Jan., 1901).
Such a complication has been much more frequently manifested in childhood and old age than in the middle period of life. And it is one of the chief causes of the mortality attributed to influenza. Croupous pneumonia and pleurisy some times, though rarely, occur as complica tions in this disease.
Among the mild forms of influenza there are afebrile types without any in flammation, yet with such profound in fluence on the nervous functions as to cause much moral, physical, and intel lectual depression. As influenza is one of the most powerful factors in lowering the resisting power of the body, these mild types should be recognized and the patient made to avoid contact with tuberculous or other sick people. The
skin, liver, and kidneys must be kept active, the stomach and intestines being treated by alimentation rather than by drugs. The mouth and nose should be cleansed by a solution of formal, men thol, or carbolic acid. H. Huchard (Bull. de Mead. de Mar. 5, 1900).
Those who still underestimate the malign effect of influenza on the public health would do well to ponder certain statements printed in Chicago's Bulletin of the Health Department for the week ending April 4th. Dr. Reynolds us that during "the first four month-" of 1903—we presume he means the first three months—influenza was more prev alent in Chicago than at any time since 1891. The number of deaths from all causes in the month of March, 1903, ex ceeded the number in the same month of 1902 by 350, and there were 330 deaths due, not directly to influenza, but to influenza as a complication of such diseases as pneumonia, consump tion, Bright's disease, heart diseases, bronchitis, measles, and whooping cough, "in about this order of fre quency." Of course it is only the laity who underrate the malignity of influ enza, and we are glad to see that the Chicago department is pushing its cam paign of education in regard to the di- ease. Editorial (New York Med. Jour., April IS, 1903).
In some of the wide-spreading epi demics of influenza, more especially those commencing during the summer and autumn months, there have been less symptoms of inflammation of the re spiratory mucous membranes, and more in the membranous lining, the stomach, and viscera of the abdomen. Such was the case in very many of the attacks dur ing the epidemic commencing in the autumn of 1889 and recurring to some extent almost every year since. There was the same suddenness of the attacks, and the same severe pains, not only in the head, back, and limbs, but in the epigastrium, with tenderness to pressure in different parts of the abdomen, nausea, and occasional vomiting and a disturbed condition of the bowels. The evacua tions both from the stomach and bowels, though not frequent, were generally mixed with mucus sufficient to show a catarrhal grade of general fever present, and sometimes led the practitioner to suspect that his patient was affected with typhoid fever during the first few days of his attendance.