INFLUENZA IN EAST ANGLIA.

378 coagulated blood, which has been extravasated on the abundant,-has been a more prominent symptom. In all the snrface of serous membranes. cases languor and depression have been much complained I come, lastly, to of suppression of haemorrhage of ; and there has frequently been present a peculiar damp, speak from veins. When a vein of the rabbit’sear alone was cut sodden, and perspiring condition of the skin, which has across, blood appeared at the lips of the wound, but none attracted the patients attention, and which has either reactually flowed. On the farther side of the wound from the curred several times in the day, or has been more or less heart blood was seen accumulated in the vessel; on the side present both by day and night for several consecutive days. next the heart the vein appeared rather collapsed and empty. The invasion of the disease has usually been sudden, and The absence of bleeding, or bleeding only to an inconsider- marked by more or less of chilliness or shivering, soon folable amount, from a vein larger than the arteries operated lowed by the catarrhal symptoms or the cough previously alluded to. In some cases one member of a family has had on in the experiments I have related, is explicable (in the absence of marked contraction of the walls of the vessel pro- " a bad cold" ; whilst the others, less severely affected, have ducing constriction of its calibre) by the flow of blood in the only felt weak and perspiring, or have been merely teazed vein being so much less impetuous than that in the artery, with a troublesome and irritating cough which has been and thus permitting the coagulating blood to collect in the slow to pass away, and whose persistence has been appawound, and form an external clot at once. Here we may rently causeless and inexplicable. The apparent duration of stop to observe more particularly on the bearing which the these "colds" has usually been about a fortnight, and they difference in coagulability between arterial and venous have in some cases disappeared rather suddenly, convalescence blood has on the suppression of hsemon-hage. The coagula- when once begun having gone on unexpectedly rapidly. tion of arterial blood begins sooner than that of venous blood In the majority of cases the disease has passed harmlessly after escape from the vessel, and is sooner completed; the away, but not in all ; for many children and elderly adults clot also is firmer. The importance of this is obvious. Thus, have, during the presence of the epidemic, succumbed to the as it were to meet the greater impetuosity with which the bronchitis, the congestions of the lungs, and the pneumonias blood issues from a divided artery than from a vein, we have which have been largely prevalent, and which have doubttwo conditions on which the stoppage of haemorrhage in the less been due to the same morbid atmospheric influence. first instance depends operating to a much greater degree The severest types of the disease were seen at its commencein the artery-viz., retraction and constriction of the mouths ment a few weeks ago. It has lately-though more extenof the vessel, and the more rapid and firm coagulation of the sively diffused and often affecting whole households-become arterial blood. more mild, and would appear now to be gradually passing When a vein of the frog’s web has been divided, neither away. retraction nor contraction is observed to take place; but the It should be recorded that the season has been, as a whole, surrounding tissue appears to close in around the mouths both damp and mild, and that the prevailing winds have of the vessel somewhat, but not to so great a degree as in been from the west. During this same period whoopingthe case of arteries. Blood may not flow, apparently owing cough and false measles have been present in the district. to this closing in of the surrounding tissue, the little force with It is unnecessary to dwell minutely upon the other sym. which the blood is propelled, and the remarkable readiness ptoms, since these are in broad outline like to those observed with which the stream finds another channel in consequence in other similar epidemics, and so ably described by Sir T. of the free anastomosis of the veins with each other. Bleeding Watson; but I have thought it well to record the fact of is, however, observed to take place more frequently from a the present existence of the disorder, and to note the slight divided vein than from a divided artery of the frog’s web; peculiarities which havemarked its passage through this and it is seen to be first arrested by the coagulation of the district, as they have come under my observation. It has blood in the wound forming an external clot which closes doubtless prevailed in a similar way in other districts of the

the mouth of the vessel. Between the cut end and the next considerable branch, there is, within either segment of the vein, an accumulation of blood as in the analogous part of a divided artery-forming an internal clot. This clot is composed of aggregated red corpuscles immediately within the mouth of the vein, then a mass of granular coagulated fibrin mixed with colourless and a few red corpuscles. The arrestment of the bleeding from a divided vein, we thus see, takes place by means of an external clot in a somewhat similar manner to that from a divided artery. The conditions which contribute to the stoppage of bleeding from an artery-namely, retraction and constriction of its mouth and the speedy and firm coagulation of the arterial blood-are commensurate with the force with which the blood is propelled in the artery. If in the case of veins those conditions operate in a much less degree, so also is the force with which the blood flows in veins very much less.

country.

The treatment which has been found most

been, speaking generally, broths and other

a

appropriate has supporting treatment. Nourish-

light but nutritious foods have been champagne or other fermented liquors have frequently been found useful. Sinapisms and hot applications to the chest, &c., have usually given some relief; and small doses of opium or morphia have often greatly comforted, and allayed the irritating cough. For the general symptoms, ammonia, with nitric or chloric ether or comwell pound tincture of bark, or with expectorants, appeared suited, and has usually afforded distinct relief to the feeling of general malaise. ing

necessary, and

Norwich.

THE FUNCTIONS OF THE FRONTAL LOBES OF THE BRAIN, AS ILLUSTRATED BY A CASE OF INJURY. INFLUENZA IN EAST ANGLIA. BY FREDERICK TREVES, M.R.C.S. BY PETER EADE, M.D. LOND., F.R.C.P., PHYSICIAN TO THE NORFOLK AND NORWICH

HOSPITAL,

five weeks a wave of epidemic this district. It has affected more or less a considerable proportion of the community, whether old or young, and has produced symptoms and effects which, though varying greatly in intensity, have been distinctly and manifestly of the same type throughout. This epidemic disorder has been regarded as "influenza," and in many of its features resembles the former epidemics to which this name has been applied ; but it has differed from these in some particulars, and especially in the fact of the frontal oppression and the true catarrhal symptoms being generally marked and pronounced. In many cases, it is true, "a bad cold" has been the most noticeable feature of the disorder; but, in a large proportion, cough, either dry and irritable or moister and with some expectoration-rarely

DURING the past four disease has been passing

or

over

(Concluded from page 346.)

ETC.

AT the post-mortem examination of the case narrated (made within three hours after death) the following con-

observed : -The fracture of the frontal bone oval hole, about an inch and a half in length in the vertical direction, and one inch in width at the widest point. The edges were clean cut, and no fresh fragments of bone were discovered. The dura mater was healthy, except the portion covering the frontal lobes, the anterior part of which had sloughed, and the remainder, as far as the right ascending frontal convolution, was thickened, soft, and somewhat injected. These changes occurred on the left side also, but to a less extent, being observed only over about the anterior third of the frontal lobes. The pia mater and arachnoid on the left side were normal, but over the entire convexity of the right cerebrum there was effusion of a puriditions

were

appeared

as an