GEN. IX. Catarrhus communis. From the similarity between the fluid exhaled from SPEC. I. the skin and that from the lungs, he conceives that, whenever the former secretion is obstructed in its flow, Cold in the it is transferred to, and passes off with the latter; the cough being produced by the stimulus of the increased action, and exhalation. head or chest. Something more than cold as a cause at times. Curative process. There seems, however, to be, in many cases at least, something more than this; for neither cold nor suppressed perspiration will account for every instance of common catarrh. There are few practitioners, perhaps, but have sometimes known persons thus affected who have been bed-ridden from chronic lameness or some other cause, and have had their chamber warmed night and day by a fire. Some ladies always catch a cold in the head on quitting the town for the country; and others on quitting the country for the town. Something must therefore depend on the actual state of the constitution at the moment; and something upon the variable quality of the atmosphere: and a change in both frequently perhaps concurs. in producing the affection of a common catarrh. Where the attack is slight, medical aid is not often sought for or needed. A few days of domestic repose in a warm but not a close atmosphere, diluent drinks, with an abstinence from animal food, and vinous or other fermented liquors, a sudorific posset at night, with an additional blanket thrown over the bed to encourage perspiration, usually succeed in carrying off the complaint. But if there be a sense of oppression on the chest, or of fulness in the head, with the ordinary signs of fever, venesection should be had recourse to, and a smart purgative immediately afterwards, while the preceding process is still continued. If the cough should be troublesome at night, it will be best allayed by a dose of Dover's powder, which will take off the irritation, and determine to the surface. Catarrh is also found occasionally, as a symptom, in measles, small-pox, worms, dentition, and rheumatism. SPECIES II. CATARRHUS EPIDEMICUS. Influenza. THE ATTACK SUDDEN; GREAT HEAVINESS OVER THE EYES; GEN. IX. from the THIS species differs chiefly from the preceding in the abruptness of its incursion, the severity of its symptoms, How disand very generally in the rapidity of its transition. It tinguished probably also differs in the nature of its remote cause, preceding which we shall briefly inquire into after attending to its species. diagnostic character. It commences, according to Dr. J. C. Smith, who has Description. accurately given us its progress as it appeared in 1781 and 1782, with the usual catarrhal symptoms, in conjunction with others that are far more distressing to the patient, and often not less alarming to the physician; such as great languor, lowness and oppression at the præcordia; anxiety, with frequent sighing, sickness, and violent head-ache. The pulse is peculiarly quick and irregular, and at night there is often delirium. The heat of the body is seldom considerable, particularly when compared with the violence of the other symptoms; the skin is moist, with a tendency to profuse sweating; the tongue moist, but white or yellowish. Sometimes there are severe muscular pains general or local; at other times, erysipelatous patches or efflorescences on different parts of the body, which, in a few rare instances, have terminated in gangrene and death. From the onset, for the first twenty-four or forty-eight hours, the symptoms are extremely violent, far beyond the danger or duration of the distemper. For the most part it attacks the healthy and robust; children and old people either escape entirely, or are affected in a slighter manner. Pregnant SPEC. II. Catarrhus GEN. IX. women, however, are disposed to miscarry, and the flooding is in some cases fatal. Patients also subject to pulepidemicus. monic complaints suffer much from the cough, difficulty of breathing, and other peripneumonic symptoms, which occasionally lead on to dissolution*. Influenza. Symptoms vary in severity in different cases. Sometimes succeeded by great chronic debility. Disease de scribed by the Greek writers. How re garded by Such is the general progress of influenza in most of the periods in which it has shown itself. But in every period its symptoms have considerably varied in severity in different individuals. In many instances, they have scarcely exceeded the signs of a common cold; in others, the pleuritic pain has been very acute, or the head-ache intolerable, shooting up to the vertex with a sense of splitting; the pulse has been a hundred and forty, and often considerably more, in a minute, with incoherency or delirium from the first night. Yet cases of real danger are very few; and the violence of the disease is over frequently in forty-eight hours; sometimes in twentyfour. Those who have suffered appear to be insusceptible of a second attack during the continuance of the epidemy, though they have no indemnity against the next that may appear. In many cases, however, the general debility induced on the system does not terminate with the catarrh itself, but remains for weeks, perhaps for months, afterwards, and is sometimes removed with great difficulty. The disease has been known and described from the time of Hippocrates to the present day: and is dwelt upon at great length by Sydenham, who regarded it in the autumn of 1675 as a general cough produced by Sydenham. cold and moist weather, grafted upon the autumnal epidemy, and varying its symptoms; whence the fever, which had hitherto chiefly attacked the head or the bowels, now transferred its violence to the thorax, and excited symptoms which had often a semblance to those of genuine pleuritis, but in reality were not so, and demanded a different and less evacuant treatment; the patient being uniformly made worse by copious and re • Medical Communications. Vol. 1. p. 71. SPEC. II. peated bleedings; though a single moderate venesection GEN. IX. was often useful, and in a few instances a second: be- Catarrhus yond which Sydenham always found it mischievous to epidemicus, proceed. And in proof that this was the real nature of Influenza. the case, he observes that "these catarrhs and coughs continued to the end of November, after which they abated, but the fever still remained the same as it was before the catarrhs appeared"; meaning that it then returned to its essential character: "although", he continues, "it was neither quite so epidemic, nor accompanied with quite the same symptoms; since these incidentally depended upon the catarrhs". causes and nature of Influenza, however, as we shall have occasion to show Unquestionpresently, has not only occurred in the autumn, but in ably an epidemy: every season of the year, whether hot, cold, damp, or temperate; and when there has been apparently no other constitutional distemper with which it could unite itself. The chief returns of the disease which have been re- often returning: marked in this country since the above of Sydenham are those of 1732, 1762, 1775, 1782, and 1803; the dura-tion of the epidemy was in every instance from a month to six weeks. That the disease is an epidemy, cannot be doubted for a moment: yet this is to advance but a very little way towards a knowledge of its origin or remote though the cause; for we have still to enquire into the nature of epidemies, their sources, diversities, and means of diffu- epidemies sion; often, as in the case of spasmodic cholera, in the known. very teeth of periodical winds and other meteorological phenomena that we might fairly conclude, if we did not know the contrary, would irresistibly oppose their progress, or disintegrate their principles, and consequently abolish their power. Dr. Sydenham, with the modesty which peculiarly belongs to himself, and always characterizes real knowledge, freely confesses his ignorance upon the subject, though he is rather disposed to ascribe them to "some occult and inexplicable changes wrought in the bowels of the earth itself, by which the atmosphere becomes contaminated with certain effluvia, which predispose the bodies of men to some form or other of but little SPEC. II. Catarrhus Influenza. GEN. IX. disease"; while Hippocrates, who had pursued the same recondite subject with the same indefatigable spirit upepidemicus. wards of two thousand years before, resolves them with a devotional feeling which would do honour to the philosophy of the present day, but which the philosophy of the present day has not always evinced, into a present divinity, a providential interposition; for such, as Galen informs us, is the actual meaning of his TO MEION*, and not some unknown and latent physical principle of the atmosphere, as various expositors have conceived: “non enim quæcunque causas habent incognitas et abditas DIVINA Vocamus; sed ubi admirabilia videntur duntaxat."+ Still further examined ble causes. An epidemy, however, or state of the atmosphere caas to proba- pable of producing any general disorder, whether originating specially or in the ordinary course of nature, may depend upon an intemperament, or inharmonious combination of the elementary principles of which it consists, or upon some foreign principle accidentally combined with it, and which has of late years more especially been called a miasm or contamination. It is possible that both these may be causes of different diseases; and, in this case, the term epidemy might be more correctly limited to those which issue from the first cause than from the second: and Dr. Hosack has endeavoured thus to limit it. But as it is rarely that we can distinguish between the two, and especially as the term has been very generally applied to diseases arising from both sources, it is not worth while to alter its common signification. Influenza how ac traced to the In the disease before us, many writers have endeacounted for. voured to trace it to the first of the above causes, and Sometimes particularly to the atmosphere's being in a state of nefirst of the gative electricity; and M. Weber, fully confiding in this above causes. cause, has recommended, somewhat whimsically, the use of socks made of the most powerful non-conductors, as oiled-silk, or paper covered with sealing-wax, as a cer De Prognost. Lib. 1. + Comment, in Progu. Hipp, |