This preparation is attracting a great deal of favorable comment among the members of the medical profession. It is easily assimilated, acceptable to the most delicate stomach, possesses all the advantages and none of the disadvantages of cod liver oil. SAMPLES AND LITERATURE ON APPLICATION. For Physician's Prescriptions only. PREPARED BY THE TILDEN COMPANY, NEW LEBANON, N. Y. ST. LOUIS, MO. WHEELER'S GLYCERITE OF TISSUE PHOSPHATES. WHEELER'S COMPOUND ELIXIR OF PHOSPATES AND CALISAYA.-A Nerve Food and Nutritive Tonic, for the Treatment of Consumption, Bronchitis, Scrofula and all forms of Nervous Debility. This elegant preparation combines in an agreeable Aromatic Cordial, in the form of a glycerite acceptable to the most Irritable Conditions of the Stomach, Bone-Calcium Phosphate Ca3 2 PO4, Sodium and Phosphate Na2 HPO4, Ferrous Phosphate, Fe3 2 PO4, Trihydrogen Phosphate H3 PO4, and the Active Principles of Calisaya and Wild Cherry. The special indication of this combination of phosphates in spinal affections, caries, necrosis, ununited fractures, marasmus, poorly developed children, retarded detention, alcohol, opium, tobacco habits, gestation and lactation to promote development, etc., and as a physiological restorative in sexual debility, and all used-up conditions of the nervous system and should receive the careful attention of good therapeutists. Notable Properties.-As reliable in dyspepsia as quinine in ague. Secures the largest percentage of benefits in consumption and other wasting diseases by determining perfect digestion and assimilation of food. When using cod-liver oil may be taken without repugnance. It renders success possible in treating chronic diseases of women and children, who take it with pleasure for prolonged periods, a factor essential to maintain the good will of the patient. Being a tissue constructive, it is the best general utility preparation for tonic restorative purposes we have, no mischievous effects resulting when exhibited in any possible morbid conditions of the system. When strychnia is desirable, use the following: R. Wheeler's Tissue Phosphates, one bottle; Liquor Strychnia, half fluid-drachm. M. In dyspepsia with constipation, all forms of nerve prostration; and a good pick-me up for daily use in constitutions of low vitality. DOSE.-For an adult, one tablespoonful three times a day; after eating; from seven to twelve years of age, one dessertspoonful; from two to seven, one teaspoonful. For infants, from five to twenty drops, according to age. Prepared at the chemical laboratory of T. B. WHEELER, M.D., MONTREAL, B. C. To prevent substitution, it is put up in pound bottles only and sold by all druggists at $1. LOOK at the outside of the Mailing Wrapper of your Journal, and if your time of subscription has ex pired please forward renewal; or if you do not want the journal to continue its visits a Postal Card or other notification will be sincerely appreciated by Nashville, Tenn. Yours very truly, DEERING J. ROBERTS, M.D., Ol. amygdala dulcis... 3 j. ·z iv. 3 ij. M. Sig. Apply locally.-Journal Amer. Med. Asso. URTICARIA. The following combinations are recommended by Ther. Gaz. in the itching of urticaria: Acidi borici....... Glycerini....... Aq. coloniensis....... . M. Sig. For local application. In rheumatic subjects the following is of value taken in ternally: R Sodii salicyl........ Potass. bicarb... Aq. menth. pip..... ........aa dr. iv. .q. s. ad oz. iij. M. Sig. One teaspoonful after meals in water. The following is recommended by Merck's Archives as a local application: .aa dr. vj. M. Sig. Spray the affected part and dust with zinc. oxid powder.-Jour. Amer. Med. Asso. Exhibits 50%Choicest Norway Cod Liver Oil with Soluble ProductsPHILLIPS' EMULSION Pancreatized. THE CHAS. H. PHILLIPS' CHEMICAL CO., NEW YORK. THE SOUTHERN PRACTITIONER, AN INDEPENDENT MONTHLY JOURNAL, DEVOTED TO MEDICINE AND SURGERY. SUBSCRIPTION PRICE, ONE DOLLAR PER YEAR. DEERING J. ROBERTS, M.D., Vol. XXIV. Editor and Proprietor. NASHVILLE, APRIL. 1902. No. 4. Original Communications. THE CLINICAL VARIATIONS OF "LA GRIPPE."* BY W. C. WELBURN, M.D., NASHVILLE, TENN. Influenza, the word, is from the Italian Influentia, meaning a mysterious influence. The French term "La Grippe" has not the meaning of tenacity so generally ascribed to it but is a corruption of a Polish word Crypka meaning a hoarse cough and possibly related to our word "Croup." Influenza is an acute, infectious, communicable, febrile disease, caused by the Bacillus of Pfeiffer and characterized by catarrhal inflammation of mucous membranes, great vital pros. tration, and marked nervous symptoms. History. The disease was first recognized in an epidemic *Read at Nashville Academy of Medicine. form in 1510, since which time epidemics and pandemies have been described at irregular intervals. In this country it made its appearance shortly after the landing of the Pilgrim Fathers. The pandemic of 1889-90, starting in Bokhara, Turkestan, reached St. Petersburg in October, Berlin in November, London and New York in December, becoming wide-spread in this country during January. Since that time epidemics of varying severity have appeared in this country, notably in 1891-'95-'97'99-1901 and the present winter. Etiology.-The Canon-Pfeifer Bacillus, discovered in 1892, is conceded to be the causative factor. It is a small bacillus, 2x5 microns in size and is found in the blood and catarrhal discharges of infected persons. It is grown with some difficulty outside the body and prefers culture media containing hemoglobin. The bacillus is said to live only 48 hours in water and to be killed in 24 hours by dessication; but the appearance of sporadic cases, and a case, recently reported, of recurrence of the disease on the return of the patient to a room, vacated months before, would seem to indicate that the resistance of the bacillus to external influences is very much underrated. The bearing of meteorological conditions on the appearance of the epidemic has been investigated by Anders and others with almost negative results the disease has a predilection for the winter season, changeable and cloudy weather. Young adults are most susceptible. Old persons are almost as susceptible and suffer most from an attack. Children are less liable, generally showing a mild form of Grip, while in infants the disease is rare. Neither natural nor acquired immunity can be said to exist, relapses and recurrent attacks are frequent. Pathology.-There are no characteristic lesions in Grip. We have simply catarrhal inflammation of the respiratory or gastrointestinal mucous membranes or both, which are in no way to be distinguished from other simple catarrhs of these membranes, and in addition the cloudy swelling of liver and kidney commonly found in fevers. Clinical History.-The period of incubation is from 1 to 14 days, averaging about three days. In adults the onset is generally sudden with sneezing and lachrymation or with rigors or chill. This is followed by general depression, severe pains in head, back, and limbs. There is marked palor. Following this there is a rapid rise of temperature with flushed face. Pain, muscular soreness and prostration increased. Pulse and respiration are accelerated, emunctories are inactive, anorexia and thirst marked. Sense of oppression under the sternum and an irritating cough are complained of. On the second day dry congestion of mucous membranes gives place to watery catarrh. Temperature has generally fallen to a lower level at which it is maintained for several days. Cough is not so dry. On third and fourth days cephalalgia, muscular pain and soreness, and the oppression in the chest disappearing. Discharges from upper air passages are now muco-purulent. Temperature perhaps shows evening exacerbations. In a day or so skin and kidneys become active and the patient is convalescent. This brief description applies to a case of pure and simple Influenza of medium severity. Pain is the prominent symptom. This is in simple cases neuralgic or neuritic being described as burning or boring in character. There is often pain and soreness of the eyes and even photophobia. It has been recently claimed that the frontal cephalalgia is not neuralgic but due to the inflammation in the frontal sinuses. The temperature is very variable, may reach 106°, but is usually about 103°, falling after a few hours. Sometimes the fall is by lysis. In other cases the fever line closely simulates that of Typhoid fever or of Remittent Malaria. The pulse rapidly becomes feeble and often irregular, either tachycardia or bradycardia may exist. Respiration is accellerated, sometimes quife labored. Dyspnoea may exist without discoverable physical cause, being of toxic or nervous origin. Influenza is protean in its manifold departures from and modifications of the simple type of disease described above. These variations may be classed under three heads: Respiratory, Gastro-intestinal and Nervous. In the Respiratory Type we may have no more than the simple rhino-pharyngitis but oftener through extension by continuity we have a laryngo-tracheitis and bronchitis. When the process involves the capillary bronchioles we have a patchy lobular pneumonia. The symptoms, of course, depend largely upon the extent of the infection. Ordinarily we have sore throat, hoarseness, and a |
