In Madeira during November, 1889, there was a severe epidemic of small pox, for which numerous revaccinations were performed. At the beginning of 1890 influenza was brought into the country and quickly disseminated by a lady coming from France. It was very striking, Goldschmidt reports, that all those successfully vaccinated (112 in number) remained unattacked by influenza, while of 98 others who were unsuccessfully vaccinated but 15 were affected. Goldschmidt, therefore, supposes that vaccination confers a protection against influenza. Althaus has made the same observation. With this the problem of general "preventive vaccination" is solved, although by a means in most vivid contradiction of our conceptions regarding natural and artificial immunization.

The treatment of influenza in the absence of a specific remedy can be only symptomatic. It is directed, therefore, to the relief of the most prominent symptoms, clinical conditions, and complications. The enormous area covered by the protean symptomatology of influenza affords many opportunities for the beneficial treatment of patients, partly also by the use of drugs. Naturally we cannot here enter upon the innumerable variations in therapeutic treatment suitable for each individual case, and we, therefore, must confine ourselves to a few salient points.

In the great majority of cases, beyond rest in bed and restricted diet, advisable also in mild cases, and the ordering of certain hygienic measures affecting the comfort of the patient, no further, and particularly no drug, treatment is necessary.

The consensus of opinion that influenza should be treated by warmth is nearly unanimous. As a matter of fact, all experience seems to indicate that cold applications are generally not well borne and increase the discomfort. Many recommended, on the first indication of the attack, immediately taking a hot bath or a Turkish or Russian bath, or enveloping the patient in blankets or giving hot drinks (elder tea and decoction of lime blossoms) to cause thorough diaphoresis (Rosenbach, Frey, Eichhorst, Laffont; compare also the report of the ministry at Baden, p. 169).

The advice given by a celebrated hydrotnerapist that the patient should immediately, on the first indication of influenza, take violent muscular exercise-e. g., a walk of several hours-until he perspired thoroughly, shows but little experience with influenza. In the great majority of cases influenza comes on suddenly without any premonitory symptoms, and the patient is neither inclined at this stage nor is he capable of walking for any length of time. In "influenzaphobes" without influenza such advice may sometimes have had a wonderful suggestive effect.

I have also considerable misgivings concerning the treatment by vapor baths of every stage of the disease (Frey). Such procedures at the height of influenza only increase the fever, intensify the already discomforting sweating and headache, and have a pernicious influence upon the general condition of the patient. All cases of influenza that are at all severe object energetically to the vapor baths. Washing with lukewarm water, on the other hand, with or without the addition of alcohol, lukewarm baths (as consistently ordered by Manassein), the wet pack, and sitz baths (Mettenheimer) may occasionally be of use. The adoption of any hard and fast rule is to be deprecated.

Although supporters of the cold water treatment in most acute infectious diseases, we abandoned it in influenza, finding that so far from attaining any improvement in the headache and other neuralgic pains or of the nervous prostration, we obtained rather the contrary effect. The annoying cough, diffuse bronchitis, dyspnea, general hyperidrosis, and the often existing cardiac weakness are contraindications to the cold bath. Even cold applications and ice bags to the head were often and regularly refused by the patient as being useless and increasing the pain.

Of great use, and frequently indicated on account of the severe nervous manifestations during the influenza attack, are certain sedatives and antineuralgics which, although they do not have any specific influence upon the influenza, nevertheless produce favorable effects. First among these stands antipyrin.

No sooner had the "specific therapeutic power of antipyrin in in fluenza" been advertised at the beginning of the pandemic of 1889 than a regular rush was made for the remedy, which at that time could still be bought over the counter. In small places, where the stock of antipyrin was soon exhausted, there were even hostile demonstrations by the populace against the drug stores. Every one who had influenza or thought he had it, and many who wanted to protect themselves from the disease, took antipyrin ad libitum. No doubt harm was done by this foolish abuse of the remedy, especially by large and long continued doses. Nevertheless, assertions that antipyrin "caused the death of many influenza patients by cardiac paralysis," and was the cause of the frequency of influenza psychoses, are exaggerations.

Only lack of experience or preconceived prejudice can doubt that antipyrin prescribed at the right time in proper doses is often of great use for the severe neuralgias and myalgias and the general hyperesthesia and insomnia, both at the acme of the disease as well as at its onset, and often gives at least transitory rest to the much burdened patient without doing him the slightest harm.

Phenacetin acts much the same as antipyrin. Antifebrin is of much less value. Eichhorst, Drozda, Turner, Heubner, and others especially praise the antineuralgic and sedative action of salicylic acid. Schaffer observed immediate improvement in the pains of the head, back, and legs from the use of sodium benzoate.

The success of antipyrin and salicylic acid led to the commercial production of a mixture of the two-salipyrin. It would have been remarkable if this mixture should not have produced the same results which each of the component parts showed. It was at once lauded to the skies as a specific remedy.

Hennig, one of those especially praising the remedy, remarks: "After a dose of from 3 to 5 gm. of salipyrin, given during a period of one to three hours in an afternoon, one sees the nervous phenomena, the fever, and the prostration disappear; the patient passes a quiet night, and upon the following morning is often completely restored to health," which in our opinion in such a case would have happened without the use of salipyrin. Among the chief eulogists of salipyrin are some of whom one may assume with certainty that their clinical experience of influenza was insufficient to justify their giving an opinion.