has Chicago been free from this organism. During the year 1902, the months in which the highest percentage of influenza cases occurred were April and December. Forty per cent of the examinations for April, and 30 per cent of those for December showed the presence of the bacillus in question. The smallest number of examinations in which it was found were made in August, the proportion falling below 10. The throat manifestations of 173 of the 2,460 cases were so severe that a probable clinical diagnosis of diphtheria was made, yet the diphtheria bacillus could not be found, while the Canon-Pfeiffer bacillus was obtained, in cultures which were nearly pure.

CITY HALL.

THE AFTER TREATMENT OF INFLUENZA.

BY JOHN S. PEREKHAN, M. D., CHICAGO.

My attention was called, last winter, to "Hemoquinine" (Schieffelin) as an excellent preparation in cases of chronic malarial cachexia. Being struck with the formula, which contains peptonate of iron, arsenic and quinine, to which some manganese is added, I decided to give it a long and thorough trial in appropriate cases which seemed to be very numerous during this epidemic of grippe.

In all grades of cases of influenza as soon as convalescence was begun, the patient was placed on this remedy. This was done not only as the correct and rational thing to do in rebuilding and restoring his weakened constitution, but also as a safeguard against reinfection and return of the disease. Of course he was cautioned about going out too early and to avoid the damp night air, was fed more liberally, protected against chilling of the skin by wearing woolen under garments, and the treatment continues until health was completely restored.

I have had patients return to me after an attack of influenza, with a statement like this: "Doctor, I have never been what you may really call a well man since I had the grippe." These cases which refused or neglected a course of tonic treatment subsequent to their illness, show symptoms of general cachexia and some would actually drag on to chronicity. They have fever at times but do not have. chills. Chilliness and goose flesh sensations are of frequent occurrence. The skin is pale and of a yellowish brown color; the spleen is enlarged; the blood count shows, almost always, a diminution of the red blood corpuscles and an increase of leucocytes.

The general symptoms of anemia are quite marked. We find debility, loss of flesh and appetite, with frequent sweating. The nervous system suffers, causing neuralgia, headache, vertigo, palpitation of the heart, with insomnia or restless sleep when the latter does occur. Nausea, diarrhea, and other symptoms of gastrointestinal catarrh are very frequently met with. Pains of various kinds and severity are complained of in the joints.

These symptoms and other prostrating and enervating effects which we also frequently meet with during the incubative period of influenza and other infectious diseases, I have been able to cut short of development or to mitigate in their severity by the prompt exhibition of the stimulating and bracing effects of Hemoquinine. As we are not only administering to the system the iron, arsenic, and manganese in the most soluble form, but I believe in this combination we get the quinine to act as a specific against the bacillus of Pfeiffer.

Case 1. Mr. T. B., age 36, weight about 140 pounds, family history excellent. Had been complaining for several days of lack of energy, weakness and pain all over the body, especially in the lower extremities and heels. Appetite poor, does not relish his smoking, sleeps poorly, and feels tired and depressed in the morning. He was obliged to go to bed, and when I visited him I found him. with a temperature of 101° F., pulse 105, had slight cough and bronchial catarrh, tongue coated, bowels constipated, and the stomach quite irritable. The urine was of a high color, and the quantity for the first twenty four hours was only thirty ounces, with sp. gr. of 1016. Urea was only 6 grains to the ounce or 180 grains in twenty four hours. Albumin and sugar absent. The case was

diagnosed as influenza and treated symptomatically. At one time the temperature was 103.5° F. The most decided and prominent symptom was the aching all over the body. The flesh was so sore that he could not lie in one position for ten minutes at a time.

In a week's time the temperature was normal but the depressing and enervating effects of his illness were plainly visible in his looks and actions. At this time the blood count showed only 70 per cent of hemoglobin and 3,800,000 red corpuscles. He was placed on hemoquinine one teaspoonful and increased to two, three times daily after meals.

The improvement in the patient's general condition was steady and very rapid. In two weeks' time he was feeling good and in three weeks he was perfectly well and looked it. I examined his blood and urine at this time with the following results. Hemoglobin 90 per cent red blood corpuscles 4,500,000. Urine-quantity 24 hours, 45 ounces, sp. gr. 1020. Urea, total 400 grains, no albumin or sugar.

Case 2. Miss B., 18 years of age, weight 108 pounds, school girl. Has had chills and fever in the South. before coming to Chicago; she has never been strong. Commenced menstruating at the age of fifteen, but the flow has always been scanty and irregular. Skin sallow and the lips of a blueish pale color. She complains of chilly feeling and goose flesh sensation. Hands and feet always cold, no appetite, no energy for walking or exercising: in short she was showing all the symptoms attributed to malarial cochexia. I placed this young lady on hemoquinine and in the very beginning I examined her blood and urine. The latter was negative; but the blood showed a marked state of anemia. In the first examination she had only 60 per cent of hemoglobin and only 2,800,000 red cells. At the end of the first month the hemoglobin had increased over 15 per cent, i. e., to 75 per cent and the red corpuscles to 3,200,000. The third examination one month later showed that the hemoglobin had reached 85 per cent and the red cells to 3,700,000. The improvement in her general condition and complexion was proportionally noticeable; she feels better than at any time for years.

It would be waste of time and valuable space to report many other cases which similarly responded; however I wish to state that from personal point of view I consider that in hemoquinine we certainly seem to have a happy combination of quinine with iron, by this combination we are able to reach in these subacute and chronic malarial cases, results unobtainable, when the two above mentioned drugs are used separately. The blood is fed and the hemoglobin is increased, by stimulating the glandular system especially the spleen which is supposed to be the blood elaborating organ and the one most frequently attacked. By this stimulation we are able to increase elimination, freeing the system from waste materials, thus improving digestion, assimilation and absorption.

2600 INDIANA AVENUE.

THE

CHICAGO MEDICAL RECORDER.

Journal of the Chicago Medical Society.

DRS. ARTHUR R. EDWARDS, FRANK BILLINGS, WILLIAM E. QUINE, Committee on Publication.

DR. ARCHIBALD CHURCH, Editor for the Committee.

CHICAGO MEDICAL SOCIETY.

A regular meeting of the Chicago Medical Society was held April 1, 1903.

Dr. W. A. Evans presiding.

The minutes of the previous meeting were read and approved.

The Membership Committee reported favorably on the following applications: Drs. G. Steurnagle, Charles F. Weir, C. Hubert Lovewell, E. von Rehm, M. H. Worthington, M. D. Bates, F. E. Wynekoop, E. Windmuller, A. J. Richter, F. F. Avery, G. B. Butts, A. P. Horwitz, R. E. Ransmeier, R. McW. Wheeler and Theodore J. Doederlein.

On motion, the Secretary was instructed to cast the ballot of the Society for their election...

1.

2.

SYMPOSIUM ON INFLUENZA.

BACTERIOLOGY OF INFLUENZA. By F. E. WYNEKOOP.
NERVOUS COMPLICATIONS. By C. L. MIX.

3. PULMONARY MANIFESTATIONS. By F. S. JOHNSON.

4. DIAGNOSIS. By B. W. SIPPY.

5. TREATMENT. By R. W. BABCOCK.

DR. W. C. SANFORD: Owing to the lateness of the hour and the thoroughness of the papers, I hardly think it wise to go into details. I merely wish to bring out a few points that are interesting to me at least, and I hope to other members.

The first essayist spoke of the progressive development of the germs through the system affecting so many different organs which is illustrated by the large number of cases in which there are abdominal symptoms, resembling, for instance, typhoid fever or some other intestinal disturbance, many times so misleading to physicians. We have at first symptoms confined to the stomach entirely, i. e., severe pain of a neuralgic character, vomiting, etc., as I have often seen, before the ordinary symptoms manifested themselves, as we naturally expect them to do in a typical case. I believe that some of these cases are due to the extension of the process rather than to a general infection, as is the rule in most cases.

In Dr. Johnson's paper regarding the complications of influenza, the point struck me that in many of my cases of influenza the disease followed other affections rather than pneumonia, for example: Quite recently I had a case of lobar pneumonia which after the crisis developed symptoms of influenza, and on making a bacteriological examination found the influenza bacillus in abundance, which were not present on previous examination. I have had quite a number of cases of severe bronchitis, which were followed by typical influenza, due undoubtedly to the low vitality of the patient following the original disease, which fact I have long regarded as an important one in influenza, namely, that any factor acting to reduce the general vitality, not only seems to render the system much more susceptible to the influenza infection, but likewise materially increases the severity of the attack.

Dr. Babcock spoke of the prophylactic treatment which should be carried out in this disease in which I heartily concur and undoubtedly this can be carried out in some cases, but with a large percentage of our patients it is very difficult to have such rules fully carried out. In regard to the medical treatment, when I was an interne in the hospital a number of years ago, phenacetine was used in large doses, we soon learned that the depressing effect produced by the disease, augmented, as we believed, by phenacetine, was very marked, yet a large percentage of cases were and are still being treated by the use of the phenacetine in various combinations. I am a strong advocate of strychnine in the treatment of influenza, giving full doses in cases where there is marked cardiac depression, until the full physiological effects are obtained. I have followed this plan in order to combat the marked depression so commonly seen in even the more mild cases, but I believe it to be imperative in the more severe cases. We find many strong, healthy individuals suffering from the disease who have nervous depression, as well as cardiac depression, and I am sure strychnine, if used early and thoroughly in such cases, will obviate or prevent much of the depression that so frequently occurs.

The other treatment recommended I most heartily concur in.