1498 



COSMOPOLITAN FEVERS 



in the muscles and bones, as well as a dry burning sensation in the eyes, nose, 

 and throat, and sometimes also behind the sternum. His temperature rises 

 quickly to 103° to 105° F., hispulseand respirationsareincreased, and hesufEers 

 from a troublesome cough, and herpes may occasionally appear onthe lips. 



After two or three days : f these symptoms the temperature falls, slight 

 catarrhal symptoms appear, the patient becomes convalescent, and may 

 recover completely or may feel out of sorts for weeks or months. 



In the catarrhal type there are the ordinary signs of a bronchitis, to which 

 may be added those of a lobular pneumonia, and such cases are very dangerous. 

 In the gastro-intestinal type there are the signs of gastro-intestinal catarrh, 

 which is rare, but more frequently there is a pseudo-enteric condition, with 

 fever, lasting, however, about a week. j 



In the cerebral type the onset may be sudden or gradual, be with or without 

 catarrhal symptoms, and is associated with pains in various parts, delirium, 

 aphasia, hemiplegic or monoplegic symptoms, and, indeed, may at times 

 simulate a cerebral haemorrhage, especially in afebrile cases. These are very 

 fatal cases, but at times recovery takes place, often with permanent mental 

 disturbance. 



Blood.— The blood practically shows no change. The total leucocytes vary 

 from 8,000-12,000, while the differential count is within normal limits. 







ME 















1 



1 lor - 



f 102° - 



^ 100^- 



99- 

 98' - 





























































\ 



\ 











































Fig. 683. Fig. 684. 



Figs 683 and 684. — ^Temperature Charts of Influenza. 



Complications and Sequelae. — These are numerous and frequent, but for 

 them an ordinary textbook of medicine must be consulted. 



Diagnosis. — The cardinal features of a typical attack of influenza are: — 

 (i) The sudden and violent onset; (2) the high fever and quick pulse; (3) the 

 violent pains in the muscles and bones; (4) the catarrhal symptoms; (5) the 

 absence of any typical rash; (6) the presence of Pfeiffer's organism, whether 

 it is the true specific agent or a nosoparasite ; (7) the absence of a marked 

 leucocytosis. 



In the tropics the most important points in the di-fferential diagnosis are the 

 separation of the malady from malaria, dengue and pappataci fevers, and 

 from plague. From malaria it can be recognized by the absence of the 

 parasites in the blood, the absence of the mononucleosis and of the enlarged 

 and tender spleen, and by the presence of catarrhal symptoms. 



From dengue it can be separated by the absence of the leucopenia and of the 

 rash, and by the presence of catarrhal symptoms. 



From pappataci fever it can be diagnosed by the absence of the leucopenia, 

 the quickness of the pulse, and as a rule the presence of the catarrhal symptoms, 

 which in pappataci fever are absent or slight. 



From plague by the absence of plague bacilli in the sputum in the pneumonic 

 type, or in blood as demonstrated by haemo-cultures in the septicaemic variety. 



Prognosis. — This is good quoad vitam in typical uncomplicated cases, and 

 bad in the varieties mentioned above. 



