[reprinted from medicine, April, 1895.J 
GRIP, AND ITS EFFECTS ON THE NOSE, THROAT, AND EAR. 
BY SETH SCOTT BISHOP, M.D., 
Professor of Diseases of the "Nose, Throat, and Ear, irfUe Chicago Summer School of Medicine; 
Professor of Otology in the Post-Graduate Medical School; Surgeon to the 
Illinois Charitable Eye and Ear Infirmary. 
While we are in the midst of the widespread epidemic of grip, 
and the high and the humble alike are laid low, it is profitable to take 
account of its methods of attack, and our most potent weapons against 
it. This disease cannot be called one of filth or fright. In England 
Herbert Spencer, the Prince of Wales, many members of Parliament, 
and other distinguished personages, are struggling in the clutches of the 
grip. Germany and Russia are also afflicted. In America the condi- 
tion is similar. Those in high places, as well as the poor, are afflicted. 
Members of the medical profession are no more exempt than the laity. 
Since the middle of January last the disease has made itself felt, and 
I have had constantly under observation and treatment a large propor- 
tion of physicians among the sufferers. 
The term "influenza," as applied to the epidemics that have pre- 
vailed during the years from 1889 to the present time, is a misnomer; 
for, although there have been many typical cases of influenza, there 
were very many others (purely epidemic in nature) that lacked the 
characteristic symptoms of influenza: I have seen frequent instances 
in which the symptoms were referable almost wholly to the digestive 
tract-nausea and copious diarrhoea. It may be argued that such 
cases should not be classed in this category; but how, for instance, 
would you class such a case as this, which I saw only yesterday: A 
physician, first taken with a violent diarrhoea, was sick for five days, 
and on recovering was immediately attacked with the nose and throat 
symptoms characteristic of influenza. Another has no symptoms 
referable to the nose or throat, but suffers from profound nervous 
depression, muscular weakness and soreness, with circumscribed pneu- 
monia in one lung: this is the present condition of a well known 
physician of my acquaintance. The epidemic character of the malady 
was never better illustrated than by the present experience of the 
inhabitants of Chicago. All the members of various families I could 
mention have been stricken at the same time; father, mother, and all 
the children, in some instances, have been confined to the house or 
the bed at once. 
But it was my purpose to speak more particularly of the disease 
as it affects the patients of a specialist in diseases of the nose, throat, 2 
GRIP, AND ITS EFFECTS 
and ear. Those who were under treatment when the epidemic made 
its appearance, and who were making good progress, were set back, 
and a change of tactics was necessitated to combat the new element 
introduced; in other words, treatment had to be addressed to the gen- 
eral as well as to the special condition. Considerable work had to be 
done over again. The nasal mucous membrane would become turgid, 
swollen, and hyperaesthetic. Hydrorrhoea and stenosis made the 
patients miserable and discouraged. In follicular pharyngitis, where 
the cautery had been applied the membrane became thickened, and 
minute granulations puffed up like erectile tissue. Stiffness and sore- 
ness of the muscles of deglutition rendered swallowing painful; the 
appetite was impaired; the tongue was covered with a pale, dirty gray 
coating, was flabby, tremulous, and indented by the teeth; and wake- 
fulness at night added to the general discomfort. 
There were numerous cases suffering from an extension of the 
naso-pharyngeal inflammation along the Eustachian tube, producing 
pain and difficulty in mastication and deglutition. The closure of the 
tube and the swelling of the membranous lining of the tympanic cavity 
diminished the hearing distance in those whose hearing had been 
growing more acute, and the distressing tinnitus was intensified. 
There was a sensation of fullness or stuffiness in the ears, and actual 
pain in some. However, I do not remember to have seen more than 
a few cases of acute inflammation supervening upon chronic non- 
suppurative inflammation during the epidemic. Such cases are very 
rare at other times, but I have had a few under treatment during the 
past six weeks. A number of old patients whom I had cured of 
middle-ear suppuration a long time ago, and who had remained well 
up to the present prevailing epidemic, have returned with a new out- 
break of the discharge. 
Both in private practice and in my clinics I have observed 
the influx of acute middle-ear diseases, beginning in the latter part 
of January. The ear manifestations of the grip do not appear to 
develop usually at the first onset of the disease, but are often delayed 
until the fourth dr fifth day or even later. Then, as a rule, there is 
sudden and violent pain in the ear; the upper segment of the drum- 
head assumes a cherry-red color, the malleal plexus of vessels is 
injected with blood, fugitive pains radiate over the temporal and 
parietal regions, and the mastoid periosteum is prone to involvement 
in the inflammation. The otitis media resulting from the grip is likely 
to terminate in suppuration unless prompt and effective treatment is 
employed. Most of the dispensary patients were already in the stage 
of otorrhcea when they first presented themselves, though the attack 
of otitis may not have come on more than thirty-six or forty-eight GEIF, AND ITS EFFECTS 
3 
hours before. In such cases the discharge was not purulent, but 
watery, and in some the serum was mixed with blood. A notable 
feature was that these people presented a decidedly sickly appearance, 
weak, depressed, and despairing-characteristics unusual in simple 
acute catarrhal attacks, even when they result in suppuration. 
These facts suggest a slight digression to mention the remote 
results of previous epidemics of the grip in diseases of the ear. The 
most hopeless cases of sclerosis of the middle ear are those that were 
caused by such attacks. Even when the inflammation was unaccom- 
panied by much pain, and when there was no discharge, there was a 
progressive impairment of hearing that resisted the most painstaking 
treatment. The labyrinth was sometimes involved, so that perception 
of sound by bone-conduction was diminished, although there was not 
actual paresis of the auditory nerve. Indeed, the condition resembled 
very closely those old hopeless cases of quinine deafness that tax the 
ingenuity and skill of the otologist. 
Since the epidemic began I have made it a rule to inquire of all 
patients with recent ear disease if they have had the grip. The term 
is so common in Chicago that few patients of the reading class seem 
to be ignorant of it. The reply usually is either an affirmative one, or 
to the effect that they have had a cold in the head. But these colds 
m the head come in groups. Just before the advent of the epidemic 
I saw but few cases of acute coryza; but one day every case, except 
one, that came into my office complained of having taken cold. This 
one exception very rarely has even a slight cold, but has a chronic 
suppuration of the tympanic attic. Every day after the one mentioned 
I had cases of influenza, up to the present date (March ist), and now 
the excepted case spoken of is suffering from it. 
Another feature relative to the grip is that acute suppurative 
inflammation of the middle ear does not respond to treatment with 
the brilliant results that we now obtain in simple cases occurring during 
the interval between these epidemics. This is undoubtedly due to the 
great depression of all the vital forces, the loss of ordinary resistance to 
disease, the reduction of the normal recuperative power of the tissues. 
When the latter are once invaded by the suppurative process they 
respond less readily and more slowly to such treatment as effects the 
most radical changes in a few days in uncomplicated otitis. But if the 
patient can be put under treatment within a few hours of an attack, 
the disease can be deprived of its virulence. It can be aborted-just as 
in the case of a burning building, if deluged with water at the first 
outbreak, the fire can be quenched; and the sooner the water is used, 
the quicker the quenching and the greater the salvage. To illustrate: 
A neighboring physician came into my office a few days ago suffering 4 
GRIP, AND ITS EFFECTS 
from coryza and a severe pain in the middle ear. Examination revealed 
an inflammation involving the upper part of the drumhead. The ves- 
sels along the malleus were greatly injected, but the attack was only 
about fifteen hours old. The general condition of the patient was not 
promising; his tongue presented the appearance which I have already 
described. I immediately gave him one-eighth grain of morphia with 
grain of atropia; threw a spray of lavoline through the Eustachian 
tube into the middle ear by means of the improved inflator; filled the 
external auditory canal with pure vaselin as warm as could be comfort- 
ably borne, keeping the medicament in place by a pledget of cotton; 
and used mustard over the mastoid process for counter-irritation. The 
nose was deluged with a spray of a 3-per-cent. solution of camphor- 
menthol in lavoline. On the following morning not a vestige of the 
inflammation remained; the drumhead appeared as natural as before 
the attack, and the coryza had vanished. 
The morphia not only relieves pain, it checks all the secretions 
and relieves the irritation of the nerves distributed to the affected 
organs. The atropia has a similar effect, and in addition has a special 
affinity for the blood-vessels of these parts; while it does not check 
the secretion of the kidneys, it relaxes the bowels and increases the 
tonicity of the circulatory system. There is no remedy or combina- 
tion of remedies I have ever found, after the most diligent experi- 
menting, that will compare with these two drugs in the proportions 
given. Neither one alone will accomplish these results, but they sup- 
plement each other in the most efficient manner. I ought to say that 
I never under any circumstances permit a patient to know what this 
remedy is. I never write a prescription for it, and am of the opinion 
that no physician should reveal the name or nature of it to a patron, 
for fear of becoming responsible for a possible pernicious drug-habit. 
The emollient effect of the lavoline in the middle ear, and of the 
warm vaselin on the outer side of the drumhead, restored the mem- 
brane to a healthy state in a few hours, and it has remained so to the 
present time. This patient's previous experience with an attack of 
acute otitis media is in strong contrast with the one here outlined. 
When I examined him for the first attack, there was already a bulging 
of the drumhead from the secretions that had accumulated in the 
drum. I opened the drumhead in the posterior inferior quadrant, 
and removed the discharge. I treated him but twice during the next 
eighteen days, for the reason that he was under the care of an eye 
specialist. Nearly seven weeks after I performed paracentesis to 
relieve his suffering, the suppuration had not yet yielded to daily 
treatment; it had diminished, but not ceased. 
A serious mistake is made in giving quinine in large doses for GRIP, AND ITS EFFECTS 
5 
such attacks. Quinine does harm, while the treatment I employ is 
devoid of harm. Quinine produces congestion of the middle ear and 
impairs the functions of the acoustic nerve. Antipyrin, acetanilid and 
phenacetin are preferable to quinine in such cases, but are infinitely 
inferior to the combined morphia and atropia. 
It is not intended to claim that one dose only of this remedy will 
always be sufficient to cut short an attack of the grip. One full dose 
should be given at the outset, and in a certain limited proportion of 
cases may not need to be repeated, but in the majority of attacks it 
will need to be given several times. In severe attacks I have been 
obliged to administer three or four doses a day for two or three days, 
when the worst would be over and convalescence begun. 
It is interesting to note how typical cases of influenza under this 
treatment, combined with sprays of camphor-menthol, would pass 
rapidly, within the space of two or three days, from the first to the 
third stage of rhinitis, and make an excellent recovery in a few days 
more. The whole history of an influenza that naturally would occupy 
three or four weeks if treated on the old-fashioned lines, is limited to 
the space of four or five days with a minimum of suffering and incon- 
venience under this method. Many patients who would be compelled 
to keep in the house or bed under the old management, with sweating 
and quinine and concentrated wretchedness, are enabled, by the treat- 
ment I have used in the past and present epidemics of the grip, to 
attend to their occupations in comparative comfort. Within an hour 
after the first dose is taken the sneezing ceases, the watery discharge 
is controlled, the nasal stenosis is eliminated, the pain disappears, and 
the harassing, exasperating irritability of the nervous system gives 
place to a grateful sense of relief. 
The sprays of the 3-per-cent. solution of camphor-menthol in 
lavoline are used at home, by the patient himself, three or four times a 
day. The lavoline is emollient and protective to the mucous mem- 
brane, while the camphor-menthol contracts the capillary blood- 
vessels, corrects and diminishes the acrid secretions, reduces the 
swelling, and to some extent anaesthetizes the inflamed tissues. 
Another good topical remedy for the throat is guaiacol, espe- 
cially when there is fever. It cannot be applied in full strength in 
sensitive throats, however, as the burning and smarting it produces 
is something appalling, even to a pugilist. It is best to dilute it 
until it can be borne without much discomfort. Glycerole of tannin 
is another excellent remedy to control the angina, but it must be 
applied by means of cotton on a carrier, the same as in the case of 
guaiacol. 
It is not necessary to enter into a discussion of the general prin- 6 
GRIP, AND ITS EFFECTS 
ciples of hygienic management, since they are familiar to every physi- 
cian. When tonics are indicated or rest required, they will naturally 
enter into the treatment. In all these cases-and indeed this should 
be set down as an important medical maxim-the surface of the body 
should be protected, the temperature kept equable by woolen garments 
from neck to toe, and the bowels, the great sewer system, kept well 
flushed.