Salipyrin was immediately followed by migrainin, salophen, and other compositions with similar recommendations as specifics. [Many eminent physicians obtained excellent results by the administration of quinin, and several consider it to be preferable to any other drug.-Ed.]
As regards the treatment of the severe neuralgias, especially of the headache and the nervous jactitations at the height of the attack, we have often seen, as already mentioned, useful results from the careful administration of the above named sedatives (antipyrin, phenacetin, salicylic acid, and salipyrin). In the stubborn neuralgias during the period of convalescence the use of quinin must also be considered; we agree entirely with the experiences of Curschmann and Baumler that "the tried drug quinin is in many cases of subsequent neuralgia more effective than its modern competitors, and is frequently useful when they have failed."
The inflammatory pains of pleurisy, the spasmodic attacks of cough, the dyspnea and distress of the patient occasionally reach a degree in which the previously mentioned sedatives are useless, and opium or morphin must be resorted to. The fear of its "paralyzing action upon the heart" of the latter, the anxiety that the first injection of morphin is at the same time the first step to morphinism, is very wide spread but without foundation. We have repeatedly seen, after a sufficient injection of morphin, the severe attacks of cough and the pleuritic pains become much milder, the excited respiration become quieter and deeper, and, as a result of this, the circulation improve and the pulse become stronger. I might relate here the clinical history of a physician who suffered from a severe attack of cardiac influenza, in whom anginal attacks were severe and of long duration, which nothing relieved so much as injections of morphin. It was with hesitation at first that we gave them, but after each injection the respiration became quieter and the pulse, which had become imperceptible, returned.
The good results obtainable from the moderate administration of opium were observed even in the earlier epidemics by Nelson and Pearson (1803), and in the most recent pandemic by Brown and Noe. But it should not be given as a matter of routine.
The use of morphin, sulphonal, and trional should generally be withheld in the insomnia of influenza, since the disease lasts only a few days. In cases of severe agrypnia following influenza it is often impossible to do without these drugs.
Only in rare cases does the pyrexia itself require interference; generally in those where the temperature remains on a high level and the patient is suffering visibly thereby. Antipyretics, by decreasing the temperature, often improve the general condition of the patient as well as the condition of the pulse and the elimination of urine. In seeking this antipyretic result the chief rule to be observed is to give the smallest dose of the drug that is necessary to produce its antipyretic effect and keep the temperature on a lower level.
The routine administration of antipyrin every two hours in doses of 2 + 2 + 1 gm. is, curiously enough, taught even to the present day by some medical authorities. It is only this totally misguided application of the remedy that has discredited modern antipyretics. Many cases with high fever can have their temperature reduced to the desired level by 0.3-0.5 gm. of phenacetin or lactophenin, or by 0.3-1.0 gm. of antipyrin. Consequently the variations in temperature must be studied in each case during the administration of antipyretics.
During the administration of antipyretics the temperature should be regularly taken, at least every two hours, so that the administration may not be unnecessarily continued. Febrile temperatures which remain refractory against 0.5 gm. phenacetin, 1.0 gm. of antipyrin, or 2.0 gm. of quinin, as notably in some hyperpyrexial cases, cannot be suitably treated by antipyretic drugs.
Acting according to these principles, we have for some time found the previously mentioned antipyretics extremely efficacious and quite harmless. We cannot, however, as the result of daily experiences at the bedside, agree with the modern conception of the favorable influence of high body temperature upon the course of the disease. On the other hand, we are just as opposed to the maxim, " Febris est delenda."
Alcohol in most cases of influenza increases the headache. Those patients who ask for and feel themselves strengthened by alcohol should not be refused wine and brandy. In the treatment of the cardiac weakness the alcoholic stimulants are of great use. At the beginning of the last pandemic it was stated, especially by French physicians, that alcohol, particularly in the shape of hot drinks, would produce protection against influenza-a view quite devoid of foundation.
The advice to be particularly careful during convalescence, not to get up too early nor to leave the room, to guard against catching cold in order to escape relapses or complications with pneumonia and pleurisy, should be strictly followed.
We cannot here further consider the symptomatic treatment of influenza, particularly the innumerable manifestations of the disease referable to the nervous, respiratory, and circulatory apparatus; still less the large number of complications and sequelae. We must refer our readers to the respective sections in this work.