It is not our intention to enter into a detailed consideration of the special literature on diseases of the ear and eye following influenza. As far as diseases of the eye are concerned, important and voluminous accounts of a particularly rich variety of diseases exist.
A glance at the statistics from the practice of the specialists, both private as well as hospital and outpatient cases, shows an enormous increase in disease of the ear during the period of influenza and immediately following it. From them one might imagine that influenza attacks the organ of hearing with an enormous frequency beyond all other infectious diseases. But it is evident that these statistics of a special branch of medicine merely emphasize the enormous morbidity of influenza.
According to the reports of large general hospitals, otitis as a complication of influenza plays only a minor role from a statistical point of view. These general statistics represent the true relative frequency of this complication, even admitting that many cases of ear and, we may add, many cases of eye disease arise only during the period of convalescence-that is, after the discharge of the patient from the hospital.
The following figures will convey some idea of the frequency of otitis:
Of the 3185 contributors to the German collective investigation, 1209 (or 38 per cent.) .mention complication with diseases of the ear. Among the 55,263 influenza patients in the German army, disease of the ear was observed in 0.5 per cent, of the cases. Among 30,000 patients in Strassburg, Jankau found diseases of the ear in 0.5 per cent. We* observed otitis media with perforation of the tympanic membrane in 2 per cent, of our cases. The Swiss report contains the statistics from the practice of a number of physicians (not specialists). They saw otitis media in 2 per cent, of 1508 influenza patients.
We will confine ourselves to a simple enumeration of the most important diseases of the ear.
* Influenza lectures, p. 35.
As in all infectious diseases, the middle ear is especially liable to invasion by the specific bacilli and their products by way of the nasopharyngeal space. Otitis media terminating in suppuration and perforation of the tympanic membrane is by far the most frequent disease of the ear in influenza.
Suppuration from the ear as a sequel of influenza is first mentioned by Huxham (1729), although the report of Wittich (1580), "Some clamored about the pain in the ears/' may be interpreted as referring to otitis.
The inflammation frequently assumes a hemorrhagic character. The intense hyperemia of the mucous membrane of the tympanic cavity and the tendency to hemorrhage and veritable hemorrhages from the ear are universally emphasized by all observers.
In the purulent secretion of otitis the ordinary pyogenic organisms, and especially the Diplococcus lanceolatus, have been found. Scheibe succeeded, in 1892, in demonstrating the bacillus of Pfeiffer in the discharge.
The extension of the purulent inflammation to the mastoid occurred but rarely in comparison with the total frequency of the influenza otitis, as Keller and Auerbach rightly point out.*
We may further mention myringitis, which frequently, showed a marked hemorrhagic character, giving rise to the formation of ecchy moses, hematomata, and blood blebs (M. bullosa).
Otitis externa with the formation of blood blebs upon the surface of the auditory passage was repeatedly observed.
We know of but one observation, and that by Lannois, concerning primary or secondary disease of the labyrinth terminating in deafness as a sequel of influenza.
Influenza did not influence the deaf mute statistics.
The prognosis of influenzal ear diseases is a very good one-considerably better than when following scarlet fever, epidemic cerebrospinal meningitis, enteric fever, and small pox.
Worthy of mention are the not infrequent aural neuralgia, hyperesthesia, and tinnitus aurium.
To meningitis and pseudomeningitis of otitic origin we have alluded above (p. 651).
As we have mentioned above, there is a very extensive literature of the most varied forms of diseases of the eye following influenza. Nevertheless, apart from simple conjunctivitis and the associated diseases of the lids, the actual frequency of influenzal and post influenzal diseases of the eye is remarkably small. Even the specialist statistics of the large eye clinics and polyclinics have not reported any appreciable increase in the number of ocular diseases during the time of influenza.* We will here only enumerate the observations, without giving the names of the numerous authors.
* Collective investigations of Cologne (influenza lectures, pp. 36, 37. Nevertheless, the reports of the specialists concerning the frequency of purulent mastoiditis are very contradictory.
Affections of the conjunctiva (hyperemia, inflammation) are by far the most frequent in influenza.
Differences in the definition of conjunctivitis have caused great differences in the statistics. Thus Stintzing found 159 cases of "inflammation of the conjunctiva" among 405 influenza patients. Comby found but 10 among 218 patients. Robertson and Elkins (Edinburgh) observed conjunctivitis in 71 per cent.; Preston, on the other hand, in only 16 per cent, of the cases.
Accompanying the conjunctivitis, as in any ordinary cold, edema of the lids and chemosis of the conjunctiva frequently exist. But O. Rosenbach believes that "edema of the eyelids" may be a diagnostic sign in itself in influenza-that is, in an epidemic period.
The "moist, watery luster of the eye" is considered by many to be characteristic of influenza. Great stress is laid on the "watery eyes" in the English collective investigations. Bristowe found it in 96 per cent., and Anton (Wiirzburg) in 68 per cent, of the cases.
In some cases the edema of the lids was followed, through mixed infection with pyogenic cocci, by abscess of the lids. There occurred also subconjunctival and episcleral ecchymoses, inflammations of the caruncle, the semilunar folds, episcleritis, catarrhal and purulent dacryocystitis.
Of much greater interest are the diseases of the cornea, notwithstanding that they belong to the rarities. Among the 55,263 soldiers of the German army that were ill with influenza, inflammation of the cornea was observed only in three. Mention may be made of the varieties noted by the specialists, namely, "keratitis punctata superficialis," herpes of the cornea, and keratitis dendritica or sulcata.