We do not intend in any way to give our views in a dogmatic manner, nor to touch upon all of the remedies that have been advanced. At the onset of the disease a moderate calomel purge, followed by a saline, was given in all cases. We were practically free from the so-called intestinal type of influenza which was seen in some other communities, consequently we did not hesitate to use calomel. Castor oil or magnesium sulphate was given afterward, as was found necessary. Abdominal distention was rarely seen, and when it occurred a plain soapsuds enema with turpentine was administered.
Quinine sulphate (gr. iii-v, three times a day) combined with phenyl-salicylate (gr. v) was a routine measure. We often noticed deafness after a very few doses of quinine. It was then discontinued. Acetyl-salicylic acid (gr. v, three to six times a day) seemed to have a palliative effect on the severe headaches, although during the height of the disease the general muscular aching did not appear to be relieved by its use. It was not used routinely. These drugs possibly made the patients more comfortable, but we were very skeptical as to their influence on the general infection. The raising of the leucocyte count by quinine in influenza appears very unlikely. The use of alkaline salts has been a general procedure, particularly as we are now on the alkaline wave of therapeutics. Sodium bicarbonate was added to the drinking water of all patients (two drams to the quart). We gave this salt for its diuretic effect. In a few cases more active diuresis by the alkalines was readily and easily produced by the use of “imperial drink” three or four times a day. We felt that good kidney elimination was of considerable importance.
The use of tartrates and citrates, as in “imperial drink” in a condition where we know some kidney impairment is present, is possibly flying in the face of danger—especially in view of the fact that these salts are so available in the production of experimental nephritis. But we have only to see their application in the human in mercury bichloride poisoning, where an intense nephrosis usually develops, to fully realize that these salts may be given without danger to the kidney. We do not suggest that the kidney lesions of influenza and mercury bichloride poisoning are the same. We are merely bringing out this point of analogy in support of their use in certain desirable cases.
The respiratory symptoms gave us more concern than any other phase of the uncomplicated case. The irritating, distressing, non-productive cough suggested both a sedative and expectorant. Ammonium chloride (gr. iii-v, t. i. d.) was the usual expectorant. It seemed to increase in value with the more chronic type of case. It is our impression with those acute hacking coughs that the sedatives produced more gratifying results. Elixir terpin hydrate with heroin, codeine and occasionally morphine were preferred. When good results were noted sedatives were given liberally. Steam inhalations combined with tr. benzoin co., followed by spraying the throat with medicated liquid petroleum, gave some relief. The tendency to œdema, however, as we saw it in the cases complicated by pneumonia made us hesitate to use inhalations. Possibly the fear was groundless. Morphine (grs. ⅙) was given for sleeplessness, and it was repeated if necessary.
Cardiac stimulants were rarely needed. The tincture of digitalis was the choice, but in the uncomplicated cases was very seldom used.
At the beginning of the epidemic we prescribed whisky in almost every case. Our idea was that it would have a sedative action. At the present time we are very doubtful of its value. Toward the end of the epidemic we used it very moderately. The results obtained possibly depended for the most part upon the type of patient. Some of the soldiers asked to have it discontinued, not from any moral point of view, while others wished more frequent doses. The elderly patients seemed to appreciate this remedial agent to a fuller extent.
Pneumonia
The pneumonia following the original infection was, from the standpoint of physical diagnosis, often difficult of diagnosis in its early stages. The infection commencing as an influenza would at times pass imperceptibly into pneumonia, and obviously the points brought out in the previous paragraphs on treatment were applied until the diagnosis of pneumonia had been established. Some new factors were peculiar to the pneumonia and demanded further changes in the handling of the cases.
We would again emphasize the value of careful nursing to conserve the patients’ strength. They should be kept warm, well covered, with plenty of fresh air. Water should be given regularly and abundantly. The diet should be light, one depending a good deal upon the severity of the case. We believe it is safer to limit the diet to fluids while the infection is still pronounced, but as soon as the crisis has passed one may increase the diet freely and fairly rapidly.
Regular elimination from the bowel should be helped by the use of castor oil every other day, the dosage made to comply with the patient. We noticed much less abdominal distention in this form of pneumonia than one is accustomed to see in the ordinary lobar pneumonia. If distention were present, plain soap enemas with turpentine gave very satisfactory results. Turpentine stupes also are of considerable value. Rest at night is needed. When a hypnotic was necessary we gave morphine (gr. ⅙), and repeated if the desired results were not obtained.