One of the most interesting of recent developments in the field of infectious diseases has been the demonstration of viruses as an important factor in the etiology of acute upper respiratory infections.
The common cold is really an acute catarrhal condition of the nose and throat which usually involves to some extent the accessory sinuses, constitutional symptoms being absent or slight. It is difficult to draw a sharp line between the common cold and so-called grippe. In fact it is doubtful whether any such differentiation should be attempted. Both the laity and physicians consider grippe as a cold with definite constitutional symptoms, such as fever, headache, and malaise.
Influenza represents the third degree of severity, and might be defined as an acute catarrhal infection of the upper respiratory tract, occurring in epidemics of varying extent and severity, characterized by rapid dissemination, high morbidity, sudden onset with fever, extreme prostration and aching together with leukopenia. The attack in influenza on the bronchial tree is more rapid and intense.
Recent knowledge on the subject reveals that the common cold and influenza are initiated by a filterable virus, but that most of the toxaemia, discomfort and complications are caused by the invasion of secondary pathogenic bacteria such as the pneumococcus, streptococcus, staphylococcus and influenza bacillus.
Since its discovery by Pfeiffer during the influenza epidemic of 1889-1890, the influenza bacillus has been regularly found in cases of rhinitis which is accompanied with influenza, while in common rhinitis generally it has not been demonstrated. Artificial infection of animals with in tracheal, intrapulmonary or intravenous innoculations has been unsuccessful.
During the epidemic of 1918-1919, Pfeiffers bacillus was held responsible for grave complications, such as pneumonia, meningitis and septicemia. The bacillus was found in 91 percent of specimens examined at the bedside. Examinations made after an interval of three hours revealed a 3 percent positive incidence, which fell to zero in twenty-four hours. During this epidemic the exclusive role of Pfeiffers bacillus was debated. Material taken from the mouth washings of five patients was passed through a Berkefeld filter, dried, pulverized and its freedom from pathogenic bacilli ascertained. Since inhalation of this material resulted in a typical mind influenza, a filterable virus was considered the causative factor in grippe.
In 1931, Shope of Princton, furnished definite proof that in hog influenza, a disease simulating the human type, the combined action of two factors, a filterable virus and a small bacillus resembling Pfeiffers, produced all the clinical and epidemiologic symptoms. The virus if isolated from the bacillus produces in pigs a very mild influenza; it is responsible for the contagiosity, the changes in blood serum and the immunity.
The bacillus if isolated from the virus, is not pathogenic for hogs, but when associated with the virus, causes a severe infection with complication. In 1933, the same symbiosis of filterable virus and bacillus was demonstrated for influenza in men, pigs, ferrets and mice. In men, transmission of the virus only, produces mild rhinitis but not the fully developed picture of grippe. In mice and ferrets typical influenza leading to bronchopneumonia could be produced by the virus only.
Eighty volunteers were examined in Leningrad in 1936; forty- two were infected with living Pfeiffers bacilli, by inhalation. The others received cultures of killed bacteria, material from mouth wash of infected patients, etc. Repeated bacteriologic examinations performed before and after the inhalations demonstrated that the influenza bacilli multiply abundantly in the mucosa of the nasal cavity and pharynx during the first five to ten days. The number of hemolytic streptococci and pneumococci, verified in several individuals, did not increase during the infection with the influenza bacillus.
It is therefore concluded that the clinical symptoms are to be attributed to the toxins of Pfeiffers bacillus only. Contrary to the typical leukopenia of epidemic influenza there was moderate leukocytosis in 60 percent of the cases. NOne of the forty-two patients developed complicating lesions, and while in free contact with other persons, no transmission of the disease was observed. Control studies with the isolated virus fully confirmed the fact that the observations made in hog influenza are valid for human influenza also.
Animal experiments have revealed the presence of at least three types of virus and the fact the serum from vaccinated animals and from animals as well as human recovering from the natural disease contain anti-viral neutralized bodies.
Study has revealed also that the influenza previously classified as as a single disease in reality consists of a number of clinically and epidemiologically separable entities. Stuart- Harris states that the sudden onset with the constitutional symptoms followed later by coryza, sore throat ad cough, are the outstanding characteristics of the virus disease. The typical facies is heavy and drowsy with drooping eyelids, glistening eyes, dusky facial flush and slightly cyanosed lips.
The temperature rises rapidly on the second day and may or may not be followed by a remission on the third day, but there is usually renewed pyrexia on the fourth day. This is called diphasic temperature. Bronchiolitis is a common later complication. IN the febrile catarrhs the onset is insidious, and respiratory symptoms or angina appear early. The general symptoms are inclined to be overshadowed by the local symptoms in the respiratory tracts. The fever has no characteristic course, and shows no tendency to become diphasic. The general aspect is that of a patient with a severe cold.
Experimental studies in the University o;f Pennsylvania have demonstrated the close relationship between all strains of human influenza virus s;o far isolated , these beings immunologically homologous. This knowledge was obtained by observation on the cross-immunity and cross-neutralizing with viruses isolated from different localities during the mild pandemic of influenza in 1936-1937.
A comparison with strain from previous years and from other parts of the world gives added confirmation of this relationship. Certain strains, however, do possess antigenic difference.
Magill and Francis recently; described cross immunization studies on sixteen strains of influenza virus which showed wide difference between strains. Most adults in England and America have in their blood serum protective antibodies for both swine and human viruses, but children under ten rarely have antibodies against the human virus. This suggests have the swine virus was formerly the common infective agent in humans. However, there is no direct evidence that the swine influenza virus is today capable of infecting man. Indeed evidence indicates that it does not infect man, because while influenza has has occurred annually since 1918, the serologic evidence suggests that the human prototype of swine influenza virus ceased infecting man generally about ten years ago.
The most apparent interpretation of these findings is that the swine virus represents a surviving form of an extinct or temporarily quiescent human influenza virus which has become so fixed in swine as to be no longer pathogenic for human beings. If this is the case, then the history that swine influenza appeared for the first time in human virus.
The experimental and historical facts seem best explained by the theory that the swine influenza virus represent a surviving form of the pandemic in man in 1918. On this basis then the presence in human sera of antibodies neutralizing swine virus would be considered to indicate that the donors of these sera had undergone immunizing exposures to , or infections with, an influenza is more than merely an interesting analogue of the human disease; it may actually bear a relationship to pandemic influenza.
Bacillus influenzae is a small gram negative, non-motile hemophilic bacillus, consistently found in the secretions of the respiratory tract in influenza. The only filterable bacillary organism at present deserving consideration is Bacterium pneumosintes, discovered by Olitsky and Gates in the nasopharyngeal secretions of patients during the epidemic of 1918-1919, 1920 and the 1921-1922 epidemic. By producing a leukopenia, especially of the lymphocytes, there is an increased susceptibility of the organism t secondary infections.
During the epidemic of the 90s the coal-tar products were used in great quantities. Since these substances tend to destroy red blood cells and as the disease has a similar tendency, the combined effect can lead to serious consequences. The pain in the bones at the beginning of influenza represents the effects of the disease on the blood -forming marrow of the flat bones, and the consequent blood deterioration predisposes to cardiac and other complications.
For the treatment of this universal malady, the homoeopathic armamentarium offers many remedies.
The sudden violent onset of influenza suggests Aconite, the leading expression of which is a feverish, nervous restlessness or mental distress, which characterizes its entire action. Inflammatory symptoms with hyperpyrexia, dry , skin,dry violent racking cough, and full bounding pulse call for this dynamic remedy.
Allium cepa acts especially on the mucous membrane of the conjunctiva and the respiratory tract, producing a highly irritated condition. The hacking cough is worse from inhaling cold air. There is violent catarrhal laryngitis; the hoarse cough seems to split the larynx. The secretions are profuse, that from the eyes being bland and non-excoriating, while that which flows from the nostrils is acrid and excoriating, while that which flows from the nostrils is acrid and excoriating, being the reverse of Euphrasia.
Ammonium carb. has as its keynote a stopping up of the nose, mostly at night. He breathes through the mouth; a smothering sensation awakens him at night. The dry cough from tickling in the throat as from dust, worse from three to four a.m. recalls the action of Kali carb. It has a tendency to produce gangrenous ulcerations of the tonsils, and to effect the right side chiefly.
Ammonium mur. has a watery acrid coryza, corroding the lip. Its most characteristic action is upon the mucous membranes, whose secretions are greatly increased. Usually there is profuse expectoration with much rattling of mucus in the chest. In all chest affections, a coldness between the shoulder blades is characteristic.
Antimonium tart. plays its greatest roles in the treatment of respiratory infections characterized by rattling of mucus in the chest, oppressed breathing, rapid pulse, nausea, vomiting and a state of drowsiness. The small amount expectorated, which brings relief, is far out of proportion to the abundance of material which rattles within the chest.
Arsenicum album produces profuse watery discharge, corroding the upper lip and nostrils, with lachrymation and excessive photophobia. The leading characteristics of this remedy are the intense restlessness and anxiety, the profound exhaustion, the frequent thirst for small amounts of cold water, the rapid emaciation, the relief from warmth and the aggravation of all complaints after mid-night.
Arsenicum iod. has irritating corrosive discharge with sneezing, puffiness of the lower lids and face, a short, dry cough and tightness felt in the chest. He is worse in the open air. In pulmonary disease, the indications are profound debility, night sweats, recurring fever, and emaciation progressing to cachexia.
The bruised sore feeling of Arnica gives it a prominent position in the sphere of influenzal remedies. The remedy acts chiefly on the blood, producing a tendency to haemorrhages, capillary stasis, and ecchymoses. It acts secondarily on the capillaries, stimulating their power of absorption, especially after having been weakened by external injuries. There is epistaxis with dark and fluid blood. The stitching pain in the left chest is worse from motion and better from external pressure. The profound weakness with a bruised, weary feeling makes him lie down, even though the bed feels so hard.
Arum triphyllum causes an excessive irritation of the nose, mouth and throat. The discharge is ichorous, and the surfaces raw, red, and sometimes bloody, with a sensation which causes the patient to bore with his fingers into the raw and sensitive surfaces.
Belladonna gives expression to its characteristic features in the flushed face, the throbbing arteries, the hard bounding pulse, and the wild delirium which always accompanies the action of this drug.
Baptisia, like Arnica, is indicated in states of profound toxemia, giving rise to prostration and paralysis, both motor and sensory. In whatever position he lies, the parts rested upon feel sore and bruised, as in Pyrogen as well as in Arnica. The restlessness just as in Arsenicum creates a desire to move constantly from place to place.
Bromine acts as a powerful irritant to the mucous membranes, especially of the respiratory tract, the larynx being chiefly involved. The profuse nasal discharge is watery and excoriating with alternating stopped nostrils. There is a sensation of constriction in the larynx with rattling of mucus in the throat, and hoarseness. The spasmodic constriction of the glottis is temporarily relieved by a drink of water. The suffocative attacks with a sensation as though breathing through a sponge, due to the constriction, is the most essential feature of the drug in disorders of the respiratory tract.
The characteristic action of Bryonia on the serous membranes, synovial membranes and the mucous membranes of the respiratory and alimentary tracts in expressed by stitching, tearing pains, and the aggravation of all symptoms by motion. Relief is obtained by absolute rest either mental or physical, and by lying on the painful side. The great thirst is satiated by large quantities at great intervals.
A sensation of rawness or soreness is characteristic of Causticum. The cough, which is > by a swallow of cold water, causes rawness or soreness in the chest. He is unable to expectorate, and swallows the sputum. The main sphere of action of action of this drug is paralysis of single parts, such as the vocal organs, tongue, eyelids, face, extremities or the bladder, the right side generally being involved, and also in laryngotracheal inflammations where aphonia is the chief indication.
Camphor presents the picture of profound prostration. The strange, characteristic feature is that he cannot endure to cover for even a moment of body that is icy cold to the touch.
The chief characteristic of Cinchona is an excessive sensitivity of the nervous system, all symptoms being < by the slightest touch, by motion, and by physical or mental effort. The ailments of China are brought on by loss of vital fluids such as haemorrhages, profuse sweat, lactation or diarrhoea. The pains are tearing or drawing in every joint with a soreness all over his body. He moves his limbs frequently since motion brings relief. The face is pale and hippocratic with eyes sunken deep in the orbits. Excessive haemorrhage causes tinnitus, faintness, loss of vision, general coldness and even convulsions. The pains are < by the slightest touch, but are > by hard pressure.
Eupatorium perfoliatum, like Arnica and Pyrogen, produces a bruised feeling as if broken all over the body. The aching and soreness of the eyeballs is < by turning the eyes, even a little. The catarrhal symptoms are over-shadowed by the severity of the pain in the extremities and back. There is an insatiable thirst before and during the chill and fever. The bone pains come before and during the chill which is followed by vomiting. Soreness of the eyeballs and prostration are common symptoms.
The leading expression of Gelsemium is a complete relaxation and prostration of the whole muscular system, hence the desire to be left alone. He dreads motion like Bryonia, but this is due to weakness and not pain. With this weakness there is trembling with lack of muscular co-ordination, heat in the head, with watery nasal discharge, sneezing, dull headache, with rawness and burning in the larynx. The thirstlessness with fever is a differentiating feature. Chills run up and down the spine in wave-like successions from sacrum to occiput.
Hepar sulph. is extremely sensitive to cold air and takes cold from the least exposure to fresh air, as does Tuberculinum. He must be wrapped up to the face even in hot weather, as in Psorinum. He cannot bear to be uncovered, being thus contrary to Nux, Camphor and Secale, which remedies do not tolerate covering the body. The cough is croupy and strangling, coming on when any portion of the body is uncovered, as in Rhus tox. The sensation of a splinter in the throat is characteristic. The skin is very sensitive to touch, so that even contact of the clothes with affected parts cannot be tolerated, as in Lachesis. Cinchona is also sensitive to slight touch, but hard pressure is tolerated.
Hydrastis canadensis is indicated in debilitated states, with viscid mucous discharges, as in Corallium rubrum. There is profuse discharge of thick yellow stringy mucus from the nasal passages, and hawking of yellow viscid mucus from the posterior nares and fauces.
Ipecac is indicated in all diseases with constant and continual nausea as a concomitant. There is profuse salivation and vomiting of white glairy mucus without relief. Haemorrhages are bright red from all the orifices of the body. The cough may be dry and constricted or there is rattling of mucus as in Antimonium tart., with threatening suffocation, the face turning pale or even cyanotic. The pains are as if the bones were all torn to pieces, being similar but not identical to Eupatorium where the pains are though the bones were broken.
The individuality of Kali bi. is expressed in the discharge of a tough, stringy mucus which adheres to the parts and can be drawn into long strings, as in Hydrastis. The pains are located in small areas as in Ignatia, shifting rapidly as in Kali sulph., Lac can. and Pulsatilla, appearing and disappearing suddenly as in Belladonna, Ignatia and Magnesia phos. The discharge of plugs are clinkers from the nose is highly characteristic. The cough as in Hepar is < when undressing (uncovering), is violent and rattling with gagging from viscid mucus in the throat.
Kali iod. produces redness and swelling of the nose together with constant discharge of watery acrid colorless liquid, together with lachrymation and oedema of the eyelids, as in Apis, Kali carb. and Rhus tox.
It is a great anti-syphilitic and comes in often to supplement the action of Mercury when the latter ceases to act.
Lachesis, too, has hypersensitivity to touch. He cannot tolerate the contact with clothes. Its pathogenesis is chiefly left-sided. All the symptoms are < after sleep, or the aggravation wakes him from a state of sleep. The pains in the darkly injected throat are < by hot drinks and on awakening, and the swallowing of liquids is more painful than solids.
Lycopodium, contrary to Lachesis, affects the right side. The nostrils are stopped up at night. The discharge of crusts and elastic plugs is similar to Kali bi. The affected throat becomes involved from right to left, is < after sleep and from cold drinks. Gastric symptoms are usually present when Lycopodium is the remedy, the chief characteristic being the excessive accumulation of flatus in the abdomen and the satiety on partaking of only a small quantity of food. The rapid motion of the alae nasi in respiratory troubles recalls the action of Phosphorus and Antimonium tart. The aggravation of all symptoms from 4 to 8 p.m. is a grand characteristic.
Mercurius viv. has fluent acrid corrosive coryza, the nostrils being raw and ulcerated. There is profuse discharge of tenacious fetid saliva which he must constantly swallow, yet with this oral moisture the thirst is great. The large flabby tongue shows the imprint of the teeth. Creeping chilliness is a frequent symptom. The chief characteristic of Mercurius, regardless of the disease entity it is called upon to cure, is the aggravation of all symptoms at night and also from the warmth of the bed. The perspiration is profuse yet brings no relief as it does when Psorinum or Natrum mur. are the remedies.
Nux vomica suffers from profuse discharge of the acrid mucus from the obstructed nostrils. The coryza is fluent in the morning and stopped at night. Like Pulsatilla the coryza is better in the open air and < from the warmth of the room. A guiding concomitant is a sensation of heat in the face as though standing near a hot stove.
Over-sensitivity to all impressions and irritability are the characteristic mental states. He is chilly on the least movement and even though his body is burning hot he cannot move or uncover without feeling chilly.
Phosphorus, like Nux vomica, has over-sensitivity of all the senses to external impressions. A weak, empty, all gone feeling, the vomiting of drink as soon as it becomes warmed in the stomach, a painless diarrhoea, the cough which is < from laughing, talking, reading, drinking, eating, and from lying on the left side, and on going from warm to cold air, being here the reverse of Bryonia, the laryngitis with hoarseness and the sensation of a weight on the chest, are the characteristics which paint the picture of this drug.
Phytolacca occupies a position between Bryonia and Rhus tox, and often cures when these fail though apparently well indicated. The throat is of a dark red color, with large, dropsical, almost translucent uvula. The pain shoots from the throat into the ears on swallowing. Deglutition also causes pain at the root of the tongue with burning as from a coal of fire, yet with this and the sensation of lump in the throat, there is a continuous desire to swallow. Hot drinks cause an aggravation as in Lachesis. A tendency to induration of the cervical and carotid glands in common.
Pyrogen, a product of sepsis, is often called for when the best selected remedy fails to improve the patient or bring relief. The bed feels hard as in Arnica; parts lain on feel sore and bruised as in Baptisia. A restlessness which brings relief from the soreness, the large clean fiery red tongue and a pulse abnormally rapid, being out of proportion to the temperature, are frequent indications for Pyrogen in septic states.