[Reprinted from THE MEDICAL NEWS, February 10, 1894.] 
INFLUENZA FOLLOWED BY PLEURITIS AND 
ENDOCARDITIS. 
BY AUGUSTUS A. ESHNER, M.D., 
ADJUNCT PROFESSOR OF CLINICAL MEDICINE IN THE PHILADELPHIA 
POLYCLINIC. 
The case herewith reported is of interest as illustrating 
the diversity of complications observed in the course of 
influenza. It can be truly said that there-is scarcely an 
organ or a structure that has not in one form or another 
been made to feel the influence of the poison of this 
remarkable and virulent disease. 
J. McG., a laborer, twenty-five years old, presented 
himself at the Polyclinic in December, 1891, with the 
symptoms of a mild attack of influenza, which readily 
yielded to the administration of two grains of quinin 
with three grains of antipyrin in capsules. Physical 
examination at this time showed the pulmonary per- 
cussion-resonance to be unimpaired and subcrepitant 
rales to be audible at various parts of the chest, upon 
both sides, anteriorly and posteriorly, The man was in 
a reasonable time entirely relieved of his symptoms; 
but three months later he returned with a history of pain 
in the left hypochondrium of two weeks' standing, radi- 
ating to the shoulders and accompanied by sharp pain 
shooting down the left arm. 
There was present a slight cough, with an occasional 
sense of chilliness. Upon physical examination dulness 
upon percussion was found upon the left side of the 
chest, extending anteriorly from the level of the fourth 
rib in the nipple line and posteriorly from the level of the spine of the eighth dorsal vertebra to the base of 
the chest; in this area the breath-sounds could not be 
heard, and vocal resonance and fremitus could not be 
elicited. The area of cardiac percussion-dulness was 
unchanged, although the heart-sounds were less well 
heard at the apex than at the base. The patient was 
directed to go to bed, to restrict himself to a dry diet, to 
apply a cantharidal plaster to the left side of the chest, 
and take ten grains of potassium iodid three times 
daily. 
A week later the percussion-dulness on the left side 
was found to have risen to the level of the third rib ante- 
riorly and the fifth dorsal spine posteriorly. The patient 
was now admitted to the Polyclinic Hospital, and re- 
mained for a month. During this time a systolic murmur 
appeared at the aortic valve, which persisted for some 
weeks, gradually growing fainter, until it finally disap- 
peared. The temperature was elevated and pursued an 
irregular course ; the patient complained a good deal of 
pain. The treatment consisted in the administration of 
alkaline diuretics, hydragogue cathartics, and the appli- 
cation of a blister over the heart. The fluid in the left 
pleural cavity was gradually absorbed and dense adhe- 
sions formed, as indicated by the substitution of dulness 
on percussion for the previous flatness and the renewed 
transmission of the respiratory and vocal sounds. 
After dismissal from the hospital the patient slowly 
but progressively improved, and now, after the lapse of 
two years, is well, except for a syphilitic infection, re- 
cently acquired, and for the bone-pains and headache 
of which the man again presented himself. On physical 
examination it is found that the left shoulder has sunk 
to a lower level than the right; a right lateral curvature 
exists in the dorsal region, and a compensatory left 
lateral curvature in the lumbar region. The percussion- 
resonance is impaired over the entire left side of the 
chest, while the breath-sounds seem distant and the 
2 3 
vocal resonance is muffled. The area of cardiac per- 
cussion-dulness appears normal, while the action of the 
heart is quite rhythmic, and its sounds are clear. 
Though the case was not under constant and contin- 
uous observation, I am convinced that the sequence of 
events was an attack of influenza, followed by pleural 
and endocardial inflammation. Influenza is generally 
admitted to be an infectious disease, and an abundant 
experience has demonstrated that it is one of those of 
which one attack rather predisposes to than confers ex- 
emption from subsequent attacks, so that it is not im- 
possible that in the case reported there may have been 
two attacks of influenza, of which the second was com- 
plicated by the inflammation of the serous membranes. 
Clinical testimony is accumulating to show that the 
serous membranes are particularly prone to suffer from 
the intoxications resulting in the course of the various 
infectious diseases.