The above brief sketch of the disease must be described in detail.
The temperature rises rapidly with the outset of the disease to 40°-41° C. (104°-105° F.), and in uncomplicated cases subsides to normal in 24 to 4S hours. In rare cases it terminates by lysis and may resemble the typhoid curve. A condition of collapse, with a temperature of 30° C. (90° F.) or less, may occur in infants and children with mening,eal symptoms.
Headache generally accompanies the fever and is referred by older children to the frontal region, less often to the temporal. The supra orbital region and the eyes are very sensitive to pressure due to cerebral congestion. The headache is very severe.
The pulse shows nothing typical of the severity of the disease. It is small, compressible, arrhythmic and of varying frequency.
The striking exhaustion and subjective lassitude as well as the gen eral hyperasthesia are symptoms present in children equally with adults. The tenderness becomes apparent in young children when attempts are made to lift or move them.
Examination of the buccal cavity and pharynx of a fresh case shows a diffuse and characteristic congestion of the parts. Soltmann in 1SS7 described the appearance as follows: "Influenza in children does not begin with a nasal catarrh but with a retropharyngitis." As a number of diseases in children are characterized by a hyper aemia of this region it is necessary to describe the diagnostic features. The congestion is sharply defined from the unaffected tissue. Redness and cyanosis frequently appear in lines along the surface of the pharynx and later a fibrinous exudate is formed which strips off. The entry into the system occurs through the pharynx.
The influenza infection may first show itself in older children as in adults, with a coryza having a scant, thin secretion. A dry bronchitis with a paroxysmal cough may follow this. The younger the child the less pronounced are the respiratory symptoms.
In Schlossmann's cases under three years, 35 per cent. showed no or only slight broneho or pulmonary involvement at the beginning of the dis ease, while in cases over ten years of age, five-sixths began in this manner.
The coryza is accompanied by a severe congestion of the nasal mucous membrane which often produces nosebleed.
The cough is dry, severe and racking and similar to that in the prodromal stages of measles, and may simulate the paroxysm of per tussis. Sonic authors speak of a "pseudopertussis" in the course of influenza. This irritative cough often continues during the period of convalescence. The termination of the congestive catarrh is in all cases rather late and the discharge may finally become mucopurulent.
In certain epidemics a severe and dangerous membranous croup or pseudocroup has been reported. Concetti describes this as the "forma laryningea" of influenza.
Complications on the part of the respiratory system unfortunately are not uncommon. Bronchopneumonia appears in its characteristic way in older children, but in very young or weak infants it may run a latent course and terminate suddenly in a fatal outcome. Lobar pneu monia occurs rarely but in an outspoken manner, as in childhood. The typical influenza pneumonia so thoroughly described by Finkler appears only rarely in children. Whether the pneumonia is a specific symptom of the disease or a secondary infection on a fertile and predisposed ground is an academic question. The course of the disease as well as the severe systemic toxemia stamps this as a very serious complication. Pleurisy is not uncommon and Meunier found a serous effusion in ten out of eleven cases.
In the early years of life all affections of the respiratory organs have a less menacing character than in later years. The danger of a secondary tuberculous infection is less than after measles or pertussis.
The congested condition of the mucous membranes of the mouth and throat is participated in by the conjunctive. Conjunctivitis with photophobia is of frequent occurrence and reminds one of the prodromal symptoms of measles. In small children the inflammation may extend into a blepharitis ciliaris and a resulting spasm of the lids. A superfi cial keratitis and herpes cornea' have been observed. Dakryocystitis may follow by extension from the nasal mucous membrane.