The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 3).

Date:
1845
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Credit: The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 3). Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    and extraordinary prostration of strength. The tongue was mostly covered, at an early period of the complaint, with extremely white mucus, like cream—a symptom particularly noticed by Hux- ham, Baker, Pettit, and others : there was loss of appetite, the thirst was inconsiderable, and the pulse generally quick, weak, and soft. The preceding symptoms appeared in various degrees and combinations, as the violence of the disease fell more j)articularly upon the mucous membrane, in the head, in the throat and chest, or in the stomach and bowels. When the disease chiefly affected the head, vertigo, violent headach, greatly increased by the cough, and delirium, were not unfrequent: there was hemorrhage from the nose, and pain in tlie ears; from which, in one case, a clear fluid was poured out like that from the nostrils. (Med. Trans, of the College of Physicians, vol. iii. p. 69.) In some rare cases the tonsils and back jiart of the throat were in- flamed, so that suppuration was the consequence. When the violence of the disease fell upon the lungs, as in old people, asthmatic patients, and those predisposed to phthisis, hemoptoe was not uncommon, and frequent troublesome cough which prevented sleep. It often degenerated into pleu- risy and j>eripneumony. In common cases the cough became loose in three or four days. The stomach was affected with nausea in many, and vomiting in some ; and a spontaneous diarrhoea relieved both head and lungs, and speedily cut short the complaint. But in many instances, and in several visitations of the epidemic catarrh, a morbid determination to the intestinal canal was manifest from the beginning; which, so far from being considered a salutary effort of nature to relieve the system in that way, required especial care in the treatment, and the utmost caution in the use of purgatives. The fever was generally mild in the day-time, and it increased in the evening ; and it seldom abated till some critical amendment took jdace by perspiration or other- wise. There was little remarkable in the urinary secretion. The duration of the complaint was from a day or two to a week or fortnight. In some, the symptoms, after abating in two or three days, returned and raged with violence. The far greater part had critical sweats about the third day, which, attended with free expectoration, banished the fever on the fifth day. One of the most remarkable features of influenza is the de- bility ; so that many could not rise from the hori- zontal posture without sudden faintings, even in the state of convalescence ; and the debility often remained for a considerable time. The sudden- ness of the invasion, the pain and tightness in the forehead, with pain in the back, knees, and mus- cles, and singular prostration of strength, were thought to be distinguishing marks between the influenza and common catarrh. Indeed, the pain or soreness in the face, temples, and cheekbones, was considered the most certain pathognomonic symptom in 1782; and now and then was felt previously to the catarrh, and not unfrequcnlly was followed by very little or no catarrhal aliec- tion. In one district in Gloucestershire, a practitioner states that in no two persons in 1803 did he observe precisely the same symptoms. (Med. and Phys. Journal, vol. x. p. 309.) If h « was the case, the symptoms might be expected to vary considerably in diflferent places, as well as in dif- ferent visitations of the distemper. And this has happened accordingly. The rarer occurrences were, an unusual disposition to sleep, strangury and bloody urine independent of blisters, peculiar slow and strong pulse, with excessive debility, as at Newark ; ringing in the ears and abscess, and abscess in the frontal sinus ; of which last Dr. Rush had three cases in 1790. (Trans, of Col. of Phys. iii. 68, and Rush's Med. Inquir. ii. 354. Mem. of Med. Soc. vol. vi. p. 383.) The duration of influenza in any one place sel- dom has exceeded six weeks. Upon the whole few have died of this complaint, although it has often attacked more than one-half or even three- fourths of a whole community. The chief vic- tims have been the aged and asthmatic, those of tender lungs and of full oppressed habits. Those of middle age were more liable to be affected than old persons and children ; and persons exposed to the air than those who were confined. Many recovered their strength very slowly, and some, especially in 1762, fell into incurable consumption. [Some epidemics have, however, proved ex- tremely fatal. The mortality of the ejiidemic of 1837 in Europe was greater than that from cholera, although the disease was by no means so severe, or so rapidly fatal. This was owing to its attacking almost every one, whilst the ravages of cholera were comparatively limited. It has been estimated by Dr. Graves (^Clinical Lectures) that in Dublin alone, 4,000 persons died of the influ- enza of 1837.] III. One general observation seems to apply to almost every epidemic disease, including even those of a pestilential nature, viz. that during its prevalence numbers are attacked in so slight a manner as to require but little medical care. Hence the influenza, which in all its visitations has had a favourable character in the majority of cases, has been easily removed by mild diluents, rest, and abstinence for a few days from animal food and fermented liquors. Besides this, a com- plaint so various not only in its symptoms but in the degrees of their intensity, modified too at dif- ferent periods by season, climate, and epidemic constitution, would of necessity call for the exer- cise of much discretion in the employment of remedies. But, making due allowance for all this variety of character in the complaint, and for the judicious adaptation of a corresponding treatment, physicians of eminence, in diflerciit countries, seem to have agreed remarkably in their testi- mony as to the general rules and principles of their practice ; and from the very beginning of the sixteenth century, in their reports, with respect to bloodletting, to the caution about active purga- tives, to the employment of a cold regimen, and to the restricted use of opiates, there is a very striking and satisfactory coincidence. In the mild attacks of the disorder, few if any medicines have been required. In severe cases, emetics at the beginning relieved the sufferings of the head and chest, and, combined with gentle aperients and antimonial or saline medicines, were found useful in mitigating the fever and nro- inoting a salutary diaphoresis. ker and pro-
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