The control of the debility must be regarded as the most important indication in old and feeble persons. Wine, spirits, milk-punch, ammonia, spirits of chloroform, are to be used, not in accordance with fixed rules, but as occasion may require. In many cases wine or whiskey will be indicated from the beginning, the quantity being determined rather by the effect upon the circulation and the general condition of the case than by rule. Women and others unaccustomed to the use of alcoholic drinks often take wine and brandy in considerable quantities, with striking benefit and without flushing or other evidences of its disagreeing.
Chloral is inadmissible as a hypnotic by reason of its depressing effect upon the heart. Paraldehyde may be used, or the bromides in connection with opium if the latter alone is not well borne.
Diarrhoea must be managed in accordance with general principles. If slight, it does not require special treatment. It is apt to occur at one period or another in the course of most cases, and not infrequently marks the beginning of convalescence. Colic may be treated with warm fomentations and carminatives; if it be due to constipation, mild laxatives are to be combined with them.
Severe cases of influenza demand the careful attention of the physician, who must be on the alert to detect the inflammatory lung complications which so often lead up to the fatal issue as early as possible. Their treatment must be regulated by the circumstances of the case, the nature of the particular complication, the age of the patient, and so on, in accordance with general therapeutical indications.
Finally, all measures, of whatever kind, that tend to depress the general nervous system or the functional activity of the respiration, and especially the heart-power, are to be sedulously avoided in the management of influenza. During the convalescence unfavorable influences of the weather are to be guarded against. It is important to warn the patient that a severe attack of influenza renders him liable for some time afterward to pulmonary disorders. The sequels, and in particular those implicating the respiratory tract, are to be appropriately treated. After severe cases a course of tonics is commonly of advantage, and a change of climate often necessary to re-establish the health.
As bearing on what is stated in the foregoing pages on the causation of influenza, reference may be made to the investigations of Seifert,24 who claims to have found in the mucus expectorated by patients with influenza numbers of a peculiar micrococcus. It is evident, however, that no conclusions can be based upon these observations until the results have been subjected to careful examination in other epidemics.
24 Volkmann's klinische Vorträge, No. 240, June 20, 1884.