The Richmond palladium and sun-telegram. [volume] (Richmond, Ind.) 1907-1939, 1918-10-03

said to be frequent in Spain. It is
supposed that in some places aberrant
types may be found, but In the alb
sence of definite criterion for dag
nosis, it is impossible to affirm this
with certainty.
In its onset, epidemic influenza may
simulate almost any of the acute in
fectious diseases, but in the civil pop
ulation it must be differentiated chief
ly from an ordinary coryza or bron-
chitis, from cerebrospinal fever, and
from such conditions as the glandular
fever of children. In the usual coryZa
or bronchitis the general symptoms
are by no means so severe or so sud
den in appearance as in epidemic in
f1uenZa, and the spread of these infec-
lions through a community is not so
complete. Even in the absence of an
outbreak of epidemic meningitis, the
symptoms mentioned as typical of in
fluenza, if combined with a stiff neck
or Kernig's sign, would justify lum-
bar pun cture. A negative result with
the lumbar puncture or the absence of
a leucocytosis would indicate that
meningitis was not present. Glandu-
lar fever is limited to children; other
ephemeral fevers have not occurred in
widespread fashion. The short course
of the fever always less than seven
days. in uncomplicated influenza is
thus an aid in diagnosis.
The incubation period is probably
as a rule very short, though with such
universal prevalence this is hard to
verify. All ages are attacked, young
active adults being especially suscep-
tible. In Germany there has been
such preponderance of cases among
the young that it is supposed that the
1889 epidemic conferred an immunity
on most of those at present over 80
years of age. This has not been OBJ
served elsewhere.
All evidence points to human con-
tact as being the means of spread,
and from the local symptoms it has
been assumed that the nose and throat
have been the points of egress of the
virus and the points of incubation.
There is nothing to show that other
animals have any part in carrying the
disease.
Discussion as to the etiology of the
disease has been chiefly concerned
with the question whether the influ-
enza bacillus of Pfeiffer (1892) is the
specific causative factor. This organ
ism offers difficulties in recognition,
cultivation and Identification, and it
may be that the failure to find it in the
last pandemic and the failure of many
psychologists of standing to demon
strate it in the present pandemic are
due to these difficulties 1t is certain
ly found outside of epidemics, and we
cannot regard it's absence at present
as indicating that the disease is not
epidemic influenza. For the present
the diagnosis must be clinical rather
than meteorological. Streptococci and
other diplococci, some similar to or
identical with the micrococcus catar-
rhalis, have been reported as very
frequent in the nose and throat of
patients. Pneumococci and bacilli OF
the Friedlaender group have been
found in complicated cases. The mere
performance of certain organism in
the respiratory tract cannot be accept
ed as proof that it causes the disease
1t may be that the actual causative
factor is a filterable virus.
The treatment is symptomatic. On
account of cardiac weakness, rest in
bed should be prolonged after defer
vescence in proportion to the severity
of the case. Attention to cleanliness
Of the mouth. adequate ventilation,