The sun. [volume] (New York [N.Y.]) 1916-1920, 1918-09-22

abiy certain that they will make requests
that diagnostIcians OF the bureau be sent
TO give aid In arriving at a conclusion. l
am therefore submitting a very brief
sketch which Is to serve as an aid to the
ciagnosticianr. several of whom have re-
qrested Information with reference to the
diaenostic features OF Spanish influenza.
In our experience the cases which
have been seen thus far generally give
history Of an attack of coryza or acute
| bronchitis which subsidies In a few days,
but In followed In about two or three
weeks by tho onset OF the symptoms
which have been commonly described as
constituting the feature Of Spanish infiu-
ensa. In other words. II seems as IL a
special susceptibility IL created by a
previous attack Of coryxa or acute bron-
chitis.
The onse. Of the attack is, rather sud
, den. without prodromal symptoms as a
! rule. and Ia characterized by fever of
varying degree, marked headache,
marked palms In tho bones and Joints,
frequently by chilliness. and Is usually
| associated with coryna and acute bron-
chitis. In many cases. and particularly
those OF the severer type. the conjunc-
tivR and the throat are somewhat In
jected. The headache. marked pains In
the back and Joints. prostrstion and
| fever constitute the chief and outstand-
Ing symptoms.
"Anorexia Is also present and in q
number of instances the patient vomits
ut the onset of the disease, and this vom-
iting may be frequently repeated. In
| robust and well nourished individuals the
attack Is as a rule fairly mild and rap
idly subsidies after the second or third
day. terminating In almost all instances
after q duration OF three or four days. /.
The picture generally speaking IL the
familiar one which has been presented
year after year In the typical cases OF
influenza. The severer types of cases
| are generally observed In undernour-
| ished persons who have been subject 10
considerable nervous and physical strain
and have thus far been seen almost
| exclusively among persons who have
| arrived from foreign ports.
Errors in Diagnssis.
My attention4has been called to a
| tendency on the part Of several physi.
clans to jump at conclusions that
patients suffering from symptoms VIII On
have Just been described are necessar ily
| cases Of influenza. when in reality q
| typical follicular exudate on the tonsils
clearly showed that the symptoms are
| attributable to an ordinary attack OF
follicular tonsilitis. 1t In timely, I be.
| lieve. to warn against this possible error
In diagnosis. A few cases have been
observed In which the manifestations
| have been largely gastric, with vomit-
, ing as the prominent symptom; a mum.
| ber' Of cases. on the other hand. have
been seen in which the attack seemed to
concentrate itself upon the respiratory
organs
The large majority OF cases run a
mild course and the tendency toward
the development of bronchial pneumonia
IS complication has been observed. SC
far as our experience goes, in only a
| relatively small number. and these as a
| rule were cases in which the patien,
was up and about and tried to fgh,
| of the attack.
ITO sum It all up. the diagnosticians
| must not expect to md a new symptom
| complex. and those who have In the past
! seen a large number of cases of infiu-
! enza will readily recognise the cases
which seem now to be current. 1t Il
desirable SO far as practicable to have
cultures taken from the throat and the
blood to isolate. II possible. the organism
| responsible for the disease. This step
| seems. however, to be futile II the case
10 seen after the first or second day"