One may frankly say there is no specific treatment for influenza. Possibly we are in error in introducing the discussion, particularly on treatment with such a definite and unsatisfactory conclusion. The same statement has been made after all the previous pandemics, and one wonders whether a like remark is going to apply to the next similar scourge. The past two or three months should bring to the medical profession a certain humility which should stimulate a keener sense of research, especially as we now have at our disposal highly organized laboratories where unsolved problems can be viewed from almost any angle. Yet we are really, save here and there, putting our forces together in the study of the disease. It is obvious that a fleeting epidemic makes a most difficult subject for study, especially during a time when there is a paucity of physicians. May we not hope, however, that some researches on the disease may be forthcoming, so that we may safely feel that at least preventive or protective measures will be possible?
There is no one who is able to say that this or that drug has not been thoroughly tried. The alkalies, salicylates, antipyretics, quinine and the sedatives have all been freely used in the last as well as the present epidemic. Each group of drugs has its following, although it appears to be a general rule in this epidemic to use the antipyretics (coal tar products) as little as possible. From the distant past we have numerous records of treatment. Willis (1658) emphasized the value of sweating and the use of diaphoretics, but at the same time he states that in mild cases the cure is left to nature; Sydenham (1675) claimed considerable value in fresh air. He also paid more attention to restricting the diet, and was not favorable to the use of anodynes. One certainly obtains the impression from the records of past epidemics that many of the general principles in treatment were similar to what are now in vogue. Medicinal remedies, of course, varied greatly, but to enumerate them would be merely giving a résumé of the progress of therapeutics. Sufficient is it to say that influenza has certainly, since the earliest days, given therapeutists an ample opportunity to test their wares.
The outstanding respiratory complication, pneumonia, has added a very undesirable phase to the disease. In fact, the greater part of the mortality was due to this serious sequela. Some interesting points have been brought out in serum and blood therapy for this type of pneumonia. The use of whole blood or serum from convalescent patients in cases of pneumonia opens up a new and not unlikely fruitful means of treatment. The method of treatment possibly may be applicable as an emergency measure in other diseases, as has been shown in the case of scarlet fever and poliomyelitis. We also have the anti-pneumococcic sera available for therapeutic use. The drugs and the general treatment of the pneumonia are virtually the same for the last two epidemics.
The protean manifestations of the 1890 epidemic, with its unusual nervous sequelæ, have not been seen to any extent, as far as we yet know. In fact, the present epidemic appears to be relatively free from complications other than those occurring in the lung during the acute course of the disease. Hence, in all likelihood, there will be less of the nervous after effects to be treated. It is, however, too early to hope that the nervous system is going to escape.
In another part of this volume the vaccine therapy is discussed in detail, so that we shall not repeat what has been brought out in that article. We would, however, emphasize the value of honest and accurate clinical reports of the use of vaccines, in order to establish their present status in epidemic influenza. Overestimation and commercialism are very likely to ruin a method of treatment, even when it may be of value in a certain phase of the disease. If we do not carefully weigh the pros and cons of the vaccine treatment in this epidemic from a purely scientific and coldly neutral attitude, we are simply doing the public and ourselves an injustice.
The treatment of influenza as the disease presented itself to us in this community will be considered under three divisions—acute influenza, pneumonia, and other complications.
Acute Influenza
There is one important thing to be done in the treatment of influenza, whether the infection be mild or severe. Have the patient go to bed as soon as possible. In most of the acute attacks the individual went to bed of his own accord; but there were, unfortunately, too many instances where the patient refused to surrender, trying, as we say, to fight the attack. Some appeared to be able to accomplish this feat. But how many of our cases of fatal pneumonia can be clearly linked up with this group of the mild or subacute preliminary course? No matter how light the attack may appear to be, the patient should be told of the necessity of remaining in bed until the pulse, respiration and temperature have returned to the normal and remained normal for at least five days. At the onset a hot bath, with care to avoid chilling, followed by a drink of hot lemonade and a Dover’s powder, gave considerable relief to the patient.
The value of good nursing cannot be overestimated. The nurse must see that the patient is always well covered and kept warm, not even permitting him to rise in bed to reach for a drink; also the regulation of the temperature of the room should be carefully watched. The main point is to have plenty of fresh air. We have noticed that the patient appeared more comfortable if the air was slightly warmed. Water should be given at regular intervals. Under no consideration should an acute influenza case be allowed to get up to go to the toilet.
At the onset, and while the febrile attack is still present, there is little desire for food—but one does not need to worry about the question of nourishment in such an acute illness. Milk, cream, cocoa, gruels and fruit juices may be given at first, and as the fever subsides the diet increased. We have found that the appetite returned to normal very readily. In view of the urinary findings indicating a slight transient nephritis, meat broths are to be avoided until the convalescent stage is reached. We have been very guarded in recommending cold sponging in acute influenza. As a rule, it was not necessary. The icebag to the head is often of great value in the intense headache, which is so frequent. It is our opinion that in the treatment of uncomplicated influenza what has just been mentioned constitutes the important part. Most physicians would agree with this. However, when we advance to drug therapy, we come into the personal realm of likes and dislikes of drugs and methods of usage.