[Reprint from the St Louis < T.ixi > r. August 1892 ] The Sequelae of La Grippe. by w. .mlkp-y, m. d. Before considering the morbid phen- omena resulting from La grippe, it may not be inappropriate to first notice briefly its nature, origin, mode of prop- agation, varieties, etc. Influenza is an acute infectious disease of microbian origin, as numerous microscopists claim to have discovered the bacteria; it is epidemic and always travels rapidly from east to west, being a stranger to neither climate nor any class of society. It has a score or more of names accord- ing to the countries through which it has extended, but the most common term is " La grippe," from the French word gripper, meaning " to seize " ; and as this is easily changed into the English word " grip," to all victims who have had it severely, the word " grip " has a wonderful significance. There were well-authenticated epi- demics of influenza before the birth of Christ. Old Hippocrates, whose accu- rate powers of observation made him familiar with almost everythin/, no doubt knew all about it. There are twenty well-recorded outbreak-; from 1557 to 1889. Many puzzling facts are to be noticed in the spread of this dis- ease. Unlike most other infectious diseases it has appeared in localities far remote from each other on the same day, which would seem to indicate that its spread is not dependent upon one center of infection. It occurred simul- taneously in New York, Cincinnati, and St. Louis. How ■£hen are we to explain its transmission either from person to person or through the medium of the atmosphere? Tyndall in his philosophic work on " Floating Matter in the Air" says on the tops of the highest moun- tains in Switzerland there are no germs of any kind to be found; yet when the grip germs were carried there from the lowlands, they lived and multiplied luxuriantly. The influenza which has prevailed here for the past three winters was almost as hydra-headed in its mani- festations as malaria; but the multitu- dinous symptoms arising from it may be classed into three principal varieties or groups: 1, Nervous. 2, Catarrhal. 3, Gastric. In the tirst, headache, | ains in the limbs and trunk, general soreness, etc., are prominent symptoms ; in the second, bronchial catarrh, sneezing, sore throat, CHAS. W. MURPHY. coryza are more dominant; while in the third we have nausea, vomiting, diar- rhoea and other symptoms of catarrh of the alimentary tract. In all there is fever of remittent character, accelera- tion of pulse, and there is occasionally noticed a combination of two or all three of these varieties. Unlike most infectious diseases one attack does not confer immunity from subsequent at- tacks. When we consider how protean La grippe is in its manifestations-attack- ing so many different anatomical struc- tures - we at once come to the conclu- sion that the sequelae which it may in- duce would naturally be variegated in their nature, seat, and importance. In the great majoiity of cases no bad re- sults follow La grippe: but it is un- questionably true that a great many nervous, mental, aural, respiratory, alimentary, urinary, and other diseases we have been called upon to treat within the past three years, have their sole etiological factor in this malady. Many of the sequelae were also complications, inasmuch as their commencement oc- curred before the subsidence of the acute symptoms of La grippe. Toe mortality of this disease was due in most instances to some complication, as capillary bronchitis, croupous, pneu- monia, pleurisy, acute nephritis, dysen- tery, acute purulent meningitis, and syncope. In the Annual of the Universal Medi- cal Sciences, issue 1891, is given quite a list of sequelae recorded by different observers. Chatelier reports five cases of otitis media or suppurative catarrh of the middle ear, following influenza. Wilkes calls attention to the extreme prostration and cardiac weakness which occasionally follows this disease, and mentions four fatal cases in profes- sional men in whom there was no pre- vious history of heart disease. Dr. Irwin, of Louisville, in a paper read before the Kentucky State Medical Society, mentions a case of cardiac asthenia in which there was frequent pulse, palpitation, edema of the feet, but no valvular lesion. Myocarditis, endocarditis and peri- carditis may result from influenza; so also rheumatism, phlegmasia, hematu ria, purpura hemorrhagica, hemoptysis, phlebitis, gangrene of the leg, erysipe- las, mumps, abortion, nephritis and cystitis ; three cases of the latter1 affec- tion having come under my observation and treatment. A disease which is so debilitating in its effects, so depressing on all the great nerve centers, naturally induces indisposition to bodily and mental exercise. I have frequently ob- served prolonged physical exhaustion and anemia following La grippe; and as a consequence of this impoverish- ment of the blood and defective nutri- tion, we have many peripheral neural- gias ; the most frequent of which is trigeminal neuralgia; next in frequency intercostal, then sciatica. In the spi- nal cord we may have as sequelae, my- elitis, meningitis, or posterior spinal sclerosis; in the brain meningitis, ab- scess and insanity. Cases of insanity following recent epidemics of influenza are quite numer- ous, and, on the other hand, instances are not wanting in which La grippe acted as a therapeutical measure, ap- parently hastening the recovery of an existing mental derangement. It is a fact which should not be lost sight of, that febrile delirium during an infec- tious disease is in reality an acute at- tack of insanity; and the same may be said of the delirium of some other feb- rile diseases as pneumonia, rheumatism, typhoid, cholera and erysipelas. Some- times this delirium is most prominent during convalescence and this variety may very properly be denominated BANDAGING IN SOME ABDOMINAL DISEASES asthenic delirium or the "delirium of inanition." All the forms of insanity may be seen in which influenza was the etiological factor, but those most fre- quent recorded are cases of acute mania and melancholia. The prognosis in all these psychoses is usually favorable and the treatment, in the light of the very depressing effects of influenza, should be of a constructive character, combining with these, such soothing agents as are indicated. That La grippe acts as an exciting cause in the production of pulmonary tuberculosis there is not in my mind the slightest doubt. At the present time I have under treatment four cases of phthisis, and all of them date the com- mencement of their symptoms to this disease. All of them have a hereditary' history more or less remote, but just as we see cases following ordinary bron- chitis where family history shows free- dom from hereditary proclivities, so do we see a greater number succumb to it in a disease so devitalizing in its effects as the one under discussion. But for this epidemic, it is quite probable a large per centage of the cases now af- fflicted with pulmonary lesions would have escaped. The treatment of the sequelae of La Grippe may be summed up in a few words. It does not differ essentially, from the treatment of these diseases when due to ordinary causes. In those cases of prolonged physical exhaustion, anemia and weak heart action, as well as those sequelae strictly neuralgic in character, strychnia, in decided doses, and iron should not be forgotten. Phthisical cases should have good diges- tion, a very nutritious diet, fresh air, maltine and cod liver oil, hypophos- phites, beechwood creasote, stimulants, etc. The treatment for the other dis- eases mentioned as possible sequelae will readily suggest themselves to the physician. Salem, Indiana.