Herpes is mentioned in one place by Wittich (1580): "On some of them there was an eruption on the point of the nose which formed a scab." Slevogt mentioned herpes in 1712; Blass in 1772; Gray in 1782.
Concerning the "rash of scarlet eruption," mention is made by Whytt (1758), Heberden (1775), and Hamilton (1782).
Fr. Hoffmann (Berlin) mentions "urticaria" even in 1729, as well as the miliary eruptions and purpura hemorrhagica.
We may again emphasize at this point, having the skin manifestations of influenza under consideration, the increased sweat secretion, combined with the "vasomotor" redness of the skin, as a characteristic sign of influenza (" grippe sudorale ") by a few authors. Peters describes hyperidrosis universalis as an obstinate sequela of influenza.
All acute infectious diseases are occasionally followed by polyarthritis. Influenzal synovitis is of extremely rare occurrence.
It is certainly far more rare than the synovitis of scarlet fever and epidemic cerebrospinal meningitis. It is not mentioned at all in the hospital statistics from Hamburg, Leipsic, Munich, Wiirzburg, nor in the statistics of Bristowe, Preston, Robertson, and Elkins. Senator and Holmberg each report but one case. In the large German collective investigation only 7 per cent, of the observers reported polyarthritis. Among the 55,263 cases in the German army, 44 cases of articular rheu- , matism were attributed to influenza. In our influenza lectures we reported 6 cases from the first pandemic. All these influenza synovitides were mild and of brief duration, analogous to the true synovitis of scarlet fever and cerebrospinal meningitis. We may also call attention to the rarity of polyarthritis in influenza in contrast to its frequency in dengue fever.
As regards the muscles, we have drawn attention above to the violent myalgias. Annequin describes cases of "myositis" or "neuromyositis"; Bossers, a peculiar case of permanent contracture of numerous muscles, in which a chronic fibrous myositis was supposed to have been the cause. Multiple abscesses of the muscles, doubtlessly due to secondary infection, were found by Kohts; Kuskow found extravasation of blood into the muscles in three cases; in many cases he found finely granular cloudiness with partial loss of the transverse striations.
Apart from empyema of the pleura, antrum of Highmore, and the frontal sinus, the surgeons often had opportunity of seeing the effects of influenza in some rare affections of the joints, bones, tendons, and upon neuroses.
Witzel, Kronlein, and Walker observed cases of acute suppurative inflammation of the knee joint which, in the first case, was due to a "mixed infection with the Streptococcus pyogenes." Early during the pandemic of 1889 Moser described two cases of periostitis of the upper jaw in direct relation to influenza. Periostitis and ostitis were observed also in other bones, especially the tibia and fibula. Bose describes a case of purulent periostitis combined with superficial ostitis necroticans of the tibia in a young, healthy man.
As characteristic of influenza painful inflammation and thickening of the plantar fascia ("fasciitis plantaris") are mentioned. It reminds one of the extremely painful plantar neuralgias following enteric fever.
J. Franke has compiled the surgical literature on this subject in the "Archiv fur klinische Chirurgie," 1895, vol. xlix.
The unfavorable influence which influenza exerts upon surgical patients, especially those operated on or injured, as well as upon "old inflammations, especially in bones," was mentioned by several authors (Verneuil, Liicke, and Walker). Verneuil advises the postponement of every non important operation during an influenza epidemic.