212 THE AMERICAN MONTHLY [June 



that these cases are really very puzzling, especially those 

 in which we have a rise and fall of temperature, with 

 either mild pulmonary or moderate gastric-enteritic com- 

 plications. 



Older children have attacks similar to those witnessed 

 in adults, that is, the neuralgic pains are less marked, 

 but there is headache, at times rigors. The attack is al- 

 ways sudden, the temperature running up to 103° F or 

 more, sore throat, headache, the conjunctiva? are injected 

 sometimes there is an earache. Frequently the tonsils 

 are enlarged and covered with small follicular points re- 

 sembling diphtheria. At times the glands may be en- 

 larged in the neck secondary to the tonsilitis. An in- 

 teresting point is the fact that frequently an eruption 

 similar to scarlet fever is present, and it is very hard 

 to differentiate it unless we are positiv^e of the existence 

 of an epidemic of influenza, and furthermore that the 

 rash disappears in a short time. Retro- pharyngeal ab- 

 scess is a very frequent sequel to influenza. So also have 

 I seen several cases of empyjema secondary to a severe 

 attack of the grippe. 



Let me illustrate. A child, R. F., seven months old, 

 was attended by Dr. A. Bienenstock on March 9, with a 

 diarrhoea and an acute bronchial catarrh. Two days 

 later he found the lower lobe of the left lung consolidated, 

 the bronchi full of mucus. The treatment ordered did 

 not relieve the engorgement of the lungs. The child did 

 not improve, but had a coryza, cough, suffused eyes, tem- 

 perature 101.6°; as Dr. Bienenstock told me, had all the 

 appearances of a cliild about to develop measles. But an 

 additional symptom; wherever the child was touched it 

 commenced to scream. 



I saw this case in consultation with Dr. Bienenstock, 

 and found the entire left lobe consolidated, and diagnosed 

 influenza of the pulmonary type. I ordered salicylate of 

 soda 3.0 with essence of pepsin 60 0, a teaspoonful every 



