In a few cases the abdominal symp toms centered more in the region of the duodenum and hepatic ducts. This was indicated by constant nausea, occasional vomiting, scanty and high-colored urine, yellow or jaundiced hue of the conjunc tiva and skin, with much epigastric dis tress and general weakness.
In another class of cases the predomi nant symptoms are limited to the nerv ous structures of the body, and consist in not only violent pains and moderate general fever, but a general hyperms thesia throughout the cutaneous and muscular structures of the body. Mus cular movements, both voluntary and in voluntary, are painful. These give rise to a distressed feeling of constriction around the chest and soreness, with much pain in different parts of the line of at tachment of the diaphragm, the pectoral muscles, and in the region of the heart. Both cardiac and respiratory movements are variable or irregular, a feature adding much to the general sense of prostration.
In a few instances it has caused feelings so closely resembling those in angina pectoris as to greatly alarm the patients.
Affections of the heart arc far more common than those of the vessels. The cardiac affections may concern the nerv ous mechanism of the heart, or the heart-muscle and its lining membrane. In the former group stands heart failure; in some eases this is the first indication to the patient that anything is amiss; in other cases it occurs during the febrile stage, and in yet others dur ing convalescence. Disorders of rhythm are very frequent, and include tachy cardia, bradycardia, and arhythmia, which may take the form of intermit tence, irregularity, or regularity with sudden changes of rhythm. Anginal at tacks are occasional. In the second group of affections, those concerning the heart-muscle and its membranes, endo carditis stands out pre-eminently. The inflammatory diseases of the heart principally co-exist with a pulmonary complication, especially broncho-pncu monia. Endocarditis may be of simple or malignant type. Pericarditis is found, and may be dry, serous, sero fibrinous, or purulent. Among diseases of vessels, venous thrombosis, arterial, thrombosis, and arterial embolism have been described. Venous thrombosis is
usually met with in the second or third week, in cases with prolonged fever, and before convalescence has set in. The femoral is the vein most often con cerned. Lateral sinus-thrombosis is due to conveyance of septic material from the throat to the middle ear, and reach ing the sinus through the mastoid cells. Arterial embolism and thrombosis have been described in many situations. Jor dan (Med. Chronicle, Feb., 1902).
In this class of cases especially, and to some extent in all severe cases of each cavity, the functions of the cardiac, vaso motor, and respiratory nerves remain im paired for a long time after general con valescence is established. Consequently the patients do not regain ability to take active physical exercise without short ness of breath, palpitation, and a sense of great weariness for months—and, in some, years—after the original attack.
All the varieties of influenza have, in rare instances, been complicated with inflam mations of the brain or its membrane, of the endocardial structures, the urinary organs, and even the uterus.
Meningitis may arise directly as a re sult of the general infection, in which case it occurs during the progress of the disease; or secondarily to otitis, in which case it occurs after the influenza has disappeared. The myelitis of influ enza may be diffuse or systemic. The most frequent variety of the former has been transverse dorsal myelitis.
The complications of the peripheral nervous system are the most common. and, among these, neuralgia takes first rank. Trigeminal neuralgias are most frequent. Disorders of motility are much less common than those of sensibility. Influenza may reawaken neuroses from which the patient has long been free, exaggerate existing or even provoke the explosion of neuroses in those who have never been affected. These nervous com plications distinguish influenza from dengue. De Brun (La Med. Moderne, Nov. 13, '90).
Case of hmmorrhagic nephritis noted consecutive to grippe, in a woman 32 years of age, the liwmaturia lasting three weeks. Thorough recovery ensued. Bock (Deutsche med.-Zeit., Apr. 2, '94).