VISUALISE the ordinary, typical influenza case, probably developing over six to eight hours. The patient feels a little out of sorts the day before, possibly a little headache, a little feverish, has a little indefinite pain, is probably a little catarrhal; he goes to bed, does not sleep awfully well, and next morning feels rotten.
Fortunately, there is a drug in the materia medica which produces exactly that picture, and which will cover a large percentage of the cases of straightforward influenza. The drug is Gelsemium. It develops its symptoms fairly slowly and produces exactly the symptom picture given above. Other influenza drugs will be dealt with in due course.
Gelsemium is somewhat slow in onset, and produces primarily a feeling of intense weariness. The patients are very dull and tired, look heavy and are heavy-eyed and sleepy; not wanting to be disturbed but to be left in peace, and yet-the first outstanding symptom-if they have been excited at all, they spend an entirely sleepless night, in spite of their apparently dull, toxic state.
The patient is definitely congested, the face slightly flushed rather a dull kind of flush-the eyes a little injected the lips a little dusky; the skin generally is a little dusky, and the surface is definitely moist-hot and sticky.
Another Gelsemium symptoms is that with the hot, sticky sensation, the patients have a very unstable heat reaction. The feel hot and sticky, and yet have the sensation of little shivers of cold up and down their backs-not actual shivering attacks but small trickles of cold, just as if somebody ran a cold hand, or spilt a little cold water, down their back.
With their general torpor, Gelsemium influenza patients always have a certain amount of tremulousness, their hands become unsteady much more quickly than you would expect from the severity of their illness; they are definitely shaky when they lift a cup to try and drink. Frequently linked with the shakiness is a feeling of instability, and very often a sensation of falling. They feel as if they are falling out of bed, particularly when they are half asleep: they wake with a sudden jerk and feel as if they have fallen out of bed. As one would expect with anyone in this toxic state, the Gelsemium patient does not want to make any effort at all discomforts of every kind are aggravated by moving. With their unstable circulation they are definitely sensitive to cold draughts, which make them shiver.
As a rule, their mouths are intensely dry and the lips very dry: very often dry and cracked, or dry with a certain amount of dried secretion on them. The patients complain of an unpleasant taste, and there is frequently a sensation of burning in the tongue. The tongue itself usually has a yellowish coating- though, sometimes, it is quite red and dry.
Gelsemium influenzas always include a very unpleasant, severe headache. Typically, there is a feeling of intense pain in the occipital region, spreading down into the neck with a sensation of stiffness in the cervical muscles; and, as it is a congestive headache, it is usually throbbing in character.
The patient is most comfortable when keeping perfectly still, propped up with pillows, so that the head is raised without the patient making any effort. With these headaches, the patients often complain of a sensation of dizziness, particularly on any movement.
There is another type of headache sometimes met with in Gelsemium. Again, it is congestive in character, but the sensation is much more a feeling of tightness- as if there were a tight band round the head, just above the ears from the occiput right forward to the frontal region. This, also, is very much aggravated by lying with the head low.
Peculiarly, these patients often find relief from their congestive headaches by passing a fairly large quantity of urine.
In nearly all Gelsemium influenzas there is a sensation of general aching soreness, an aching soreness in the muscles. This is worth remembering; there are other drugs which have similar pains but are much more deep-seated than the Gelsemium pains.
Now for a few details of actual local disturbances.
Most GELSEMIUM patients have that appearance of intense heaviness of the eyelids that is associated with this dull toxic condition. But there is also a good deal of sensitiveness of the eyes themselves, a good deal of congestion, a definite sensitiveness to light. probably a good deal of lachrymation and general congestive engorgement. There is an apparent contradiction here: despite this ocular sensitiveness, occasionally a Gelsemium patient becomes scared in the dark and insists on having a light.
These patients get very definite acute coryza, with a fluid, watery discharge, accompanied by very violent sneezing and a feeling of intense fullness and pressure just about the root of the nose. It is not uncommon in Gelsemium influenza-where there is this feeling of blockage at the root of the nose-to find a story of epistaxis on forcible clearing of the nose. This, again, is worth remembering, for certain Mercurius cases tend to run in the same way.
With their acute coryzas, Gelsemium patients, despite a general hot stickiness, very often complain of very cold extremities. (This appears to be a contradiction, and might mislead you when you consider the general heat of the typical Gelsemium patient.)
As a rule, in Gelsemium influenzas, there is no very marked localised tonsillitis, but more a generalised, puffy, red, congested throat. There may be a certain amount of enlargement of the tonsils, but it is not the spotty throat that some of the other drugs have.
In spite of the absence of acutely localised symptoms there is often acute pain on swallowing. Swallowing may be actually difficult- with a feeling of constriction or of a lump in the throat-and it is much more difficult when the patients take cold fluids than warm; this is unexpected, considering the dryness of their mouths.
Associated with these conditions of nose and throat, Gelsemium influenzas quite frequently have an involvement of the ears. But, in spite of what is recorded in the materia medica, I have not observed the acute stabbing pains that the described under Gelsemium, and, where I have tried to clear up such pains with Gelsemium, I have not had any success.
Gelsemium is given as one of the drugs that has stabbing pain into the ear on swallowing: in my experience, it has not been effective. Gelsemium does get a good deal of roaring in the ears, feeling of blockage and obstruction and you very often get dullness of hearing, and giddiness; but I have not seen acute earaches respond to Gelsemium.
Quite frequently there is an extension downwards, with involvement of the larynx and loss of voice. Associated with the laryngitis, there is liable to be an intensely croupy cough which is almost convulsive in character, coming in spasms and associated with very intense dyspnoea.
Typical Gelsemium patients, despite their sweatiness and dryness of mouth, are not usually very thirsty. Occasionally a patient is intensely thirsty, but the typical one is not.
They hardly ever have an appetite-they do not want anything at all. They very often complain of horrible empty sensation in the region of their chest, often near the heart. This sometimes spreads down into the epigastric region, and they may describe it as an empty feeling; but it is not really a sensation of hunger, and is not associated with any desire for food.
Associated with the digestive system, Gelsemium patients often have a definitely yellowish tinge, and actual jaundice may develop. again, the patient quite frequently develops very definite acute abdominal irritation accompanied by diarrhoea. Usually, the stool is very loose and yellowish but not particularly offensive.
There is quite often a story of intense feeling of weakness in the rectum-an incontinence, or a feeling of prolapse- after the bowels have acted; and there is sometimes a definite prolapse associated with the diarrhoea.