extended over Russia, Poland, Germany, Sweden, and Denmark. In Vienna
sixty thousand persons fell ill of it. In the autumn it spread to
England, and reached France and Switzerland; from there it extended to
Italy, and by February it had reached Rome and Naples. Spain did not
escape its ravages, and it is said to have found its way to Mexico.
The symptoms did not differ in any important respect from those
already described as characterizing previous epidemics. Pains in the
limbs and fever marked the onset of the attack; catarrh, oppression,
hoarseness, cough followed. In some cases delirium, drowsiness, and
faintings occurred. A petechial eruption was observed, in some
instances, between the fourth and seventh days. This renders it
probable that typhus or cerebro-spinal fever prevailed at the same
time. Turbid urine, copious sweats, bilious stools, and nose-bleeding
were often noted. In Switzerland only children and old persons died.
The disease was not very fatal.
Two years later (1732-33) an epidemic, starting from Saxony and
Poland, overran Germany, Switzerland, and Holland, and invaded Great
Britain in the month of December. Toward the end of January it spread
in a south-easterly direction to France, Italy, Spain, and westward to
North America, thence southward to the islands of the West Indies, and
on to South America. The course of the disease in this epidemic was
favorable. The attack terminated in from three to fourteen days, with
sweating, bleeding from the nose, or an abundant discharge from the
nasal passages. The aged and those suffering from chronic pulmonary
diseases mostly perished. In Scotland three forms of the affection
were described--namely, the cephalic, the thoracic, and the abdominal.
The epidemic slowly spread over Eastern Europe and in a south-easterly
direction, and may be said to have lasted till 1737.
Concerning this epidemic John Huxham of Plymouth wrote as follows:[10]
"About this time a disease invaded these parts which was the most
completely epidemic of any I remember to have met with; not a house
was free from it; the beggar's hut and the nobleman's palace were
alike subject to its attacks, scarce a person escaping either in town
or country; old and young, strong and infirm, shared the same fate."
The malady had raged in Cornwall and the western parts of Devonshire
from the beginning of February; it reached Plymouth on the 10th, which
was on a Saturday, and that day numbers were suddenly seized. The next
day multitudes were taken ill, and by the 18th or 20th of March
scarcely {856} any one had escaped it. "The disorder began at first
with a slight shivering; this was presently followed by a transient
erratic heat and headache and a violent and troublesome sneezing; then
the back and lungs were seized with flying pains, which sometimes
attacked the heart likewise, and though they did not long remain
there, yet were very troublesome, being greatly irritated by the
violent cough which accompanied the disorder, in the fits of which a
great quantity of a thin, sharp mucus was thrown out from the nose and
mouth. These complaints were like those arising from what is called
catching cold, but presently a slight fever came on, which afterward
grew more violent; the pulse was now very quick, but not in the least
hard and tense like that in a pleurisy; nor was the urine remarkably
red, but very thick, and inclining to a whitish color; the tongue,
instead of being dry, was thickly covered with a whitish mucus or
slime; there was an universal complaint of want of rest and a great
giddiness. Several likewise were seized with a most racking pain in
the head, often accompanied by a slight delirium. Many were troubled
with a tinnitus aurium, or singing in the ears; and numbers suffered
from violent earaches or pains in the meatus auditorius, which in some
turned to an abscess. Exulcerations and swellings of the fauces were
likwise very common. The sick were in general very much given to
sweat, which, when it broke out of its own accord, was very plentiful
and continued without striking in again, and did often in the space of
two or three days wholly carry off the fever. You have here a
description of this epidemic disease such as it prevailed hereabouts,
attacking every one more or less; but still, considering the great
multitude that were seized by it, it was fatal to but few, and that
chiefly infants and consumptive old people. It generally went off
about the fourth day, leaving behind a troublesome cough, which was
very often of long duration, and such a dejection of strength as one
would hardly have suspected from the shortness of the time.
"On the whole, this disorder was rarely mortal, unless by some very
great error arising in the treatment of it; however, this very
circumstance proved fatal to some, who, making too slight of it,
either on account of its being so common or not thinking it very
dangerous, often found asthmas, hectics, or even consumptions
themselves, the forfeitures of their inconsiderate rashness."
[Footnote 10: _Observations on the Air and Epidemical Diseases,
translated from the Latin_, London, 1758.]
Arbuthnot also described this visitation of the disease.[11] He
regarded the uniformity of the symptoms in every place as most
remarkable, and tells us that during the whole season in which it
prevailed there was "a great run of hysterical, hypochondriacal, and
nervous distempers; in short, all the symptoms of relaxation."
[Footnote 11: _An Essay concerning the Effects of Air on Human
Bodies_, London, 1751.]
During the years 1737-38 influenza again swept over England, North
America, the islands of the West Indies, and France; in 1742-43 it
prevailed in Western Europe and the British Isles; in 1757-58 in North
America, the West Indies, France, and Scotland. In 1761 it overran the
North American colonies and the West Indies.
The epidemic of 1762 extended very generally over Europe and Great
Britain. In Germany nine-tenths of the population were attacked by the
disease.
Widely extended epidemics prevailed in Europe and America in 1767
{857} and 1775; in 1772 it raged in North America; in 1778-80, in
France, Germany and Russia. Noah Webster found influenza prevalent in
North America in 1781; the next year one of the most remarkable
epidemics of this disease (described as the epidemic of 1782) appeared
in Europe. It came from the East, from Asia into Russia. From St.
Petersburg it spread during the winter and spring over Sweden,
Germany, Holland, and France. In the autumn it was in Italy, Spain,
and Portugal. The crews of Dutch and English ships were taken ill with
the disease upon the high seas.
In Vienna three-fourths of the population fell ill of it with such
suddenness that it got here for the first time its name of "Blitz
Katarrh" (lightning catarrh). It was characterized by great pain in
the back, breast, and throat, and by extraordinary enfeeblement.
Relapses occurred, and inflammation of the lungs and bowels was
common. Children remained relatively exempt from its seizure. This
epidemic broke out in England about the end of April and raged until
the end of June. "The duration of the malady in some was not above a
day or two, but it usually lasted near a week or longer. In a few the
symptoms seemed to abate in two or three days, but some returned and
raged with more violence than at first."[12] The disease was not
regarded as in itself fatal, and few could be said to have died of it
"but those who were old, asthmatic, or who had been debilitated by
some previous indisposition."
[Footnote 12: _An Account of the Epidemic Disease called the Influenza
of the Year 1782. Collected from the Observations of several
Physicians in London and in the Country, by a Committee of the Fellows
of the Royal College of Physicians in London. Read at the College,
June 25, 1783._]
Numerous recurring outbreaks took place in Europe and America during
the years 1788-90. One of these, as it occurred in America, is well
described by Dr. John Warren[13] of Boston in a letter to Lettsom.
This letter is dated May 30, 1790, and among other matters of great
interest respecting the disease it is stated that "Our beloved
President Washington is but now on the recovery from a very severe and
dangerous attack of it in that city" (New York).
[Footnote 13: _Memoirs of the Life and Writings of J. Coakley
Lettsom_, Thomas Joseph Pettigrew, 1817.]
Webster mentions an epidemic in America in 1790, one in Europe in
1795, and another in Europe in 1797, but there seems to have been no
general epidemic of sufficient importance to attract the attention of
other writers upon the subject until 1798, when the malady again broke
out in Russia and spread over the greater part of Europe, continuing
to prevail in various regions till 1803, when it again appeared in
England, and is described by several writers of that country.
From 1805 to 1827 influenza prevailed (according to Zuelzer, who tells
us that few years during this interval were free from it) in
frequently-recurring epidemics in Europe and America. Thompson
mentions no visitation in England between 1803 and 1831.
In the year 1830 began a series of epidemics remarkable for their wide
diffusion and the rapid succession with which they followed one upon
another. The disease began in China; in September it reached the
Indian Archipelago; it swept into Russia, and invaded Moscow in
November; in January, 1831, it was raging in St. Petersburg; March
found it in Warsaw; April in Eastern Prussia and Silesia; in May it
prevailed in Denmark, Finland, and a great part of Germany, and in
{858} the same month it fell upon Paris; in June it affected England
and Sweden; it was still creeping about Middle Europe and lingering in
Great Britain at the end of July; in the early winter it swept
southward into Italy, and westward across the Atlantic to North
America, and was still harassing the inhabitants of certain regions of
the United States in January and February, 1832. Meanwhile it
continued in the East, spreading to Java, Farther India, and the
Indian Archipelago. It continued in Hindostan after it had died out in
Europe. But in January, 1833, it again visited Russia, and rolled
thence southward and eastward over the most of Europe. It is recorded
that by February it had reached Galicia and Eastern Prussia; in March
it was in Prussia, Bohemia, and Warsaw, and had extended to Syria and
Egypt; in April to many parts of Germany and Austria and to France and
Great Britain. Midsummer found the disease yet prevailing in some
districts of Germany and Northern Italy, and in the early autumn it
was in Switzerland and Eastern France; in November it visited Naples.
Epidemics so frequent, so widespread, and so unsparing of individuals
wherever the disease appeared could not fail to excite a deep and
general interest. From this period the literature of the subject has
been voluminous.
A brief period of repose ensued. For three years no epidemic occurred
which was of sufficient importance to attract the attention of medical
historians.
In December, 1837, influenza reappeared, and first, as so often
before, in Russia; Sweden and Denmark were almost simultaneously
affected; in January, 1837, it broke out in London, and rapidly swept
over all England and into France and Germany. In January it appeared
in Berlin, and shortly afterward in Dresden, Munich, and Vienna. The
disease spread by February into Switzerland, and into Spain as far as
Madrid by the end of March. In London almost the whole population was
attacked, and the mortality was enormous. It is stated that the deaths
were quadrupled during the prevalence of the disease. Large
populations suffered most. This epidemic spread into the southern
hemisphere, and prevailed at the same time, and consequently at
exactly the opposite season that it prevailed north of the equator, in
Sydney and at the Cape of Good Hope.
From 1837 to 1850-51 numerous epidemics of influenza occurred. Few
years were exempt from them. The epidemic of 1847-48 has been
described by many writers, and more particularly, as it occurred in
London, by Peacock[14] with great exactitude. It is estimated that
one-fourth of the entire population of that city were more or less
affected by the disease. The epidemic prevailed in London for six
months, and, although the deaths registered for the entire period as
from influenza amounted to only 1739, it is stated in the report of
the registrar-general that during the six weeks the epidemic was at
its height not less than five thousand persons died, in the
metropolitan districts, in excess of the average mortality of the
period, the excess showing itself in nearly every class of disease,
the local maladies which had been the predominant affections being
doubtless in many cases assigned as the cause of death. This {859}
epidemic affected between one-fourth and one-half of the population of
Paris, and in Geneva the proportion of those attacked was not less
than one-third of the entire population.
[Footnote 14: _On the Influenza, or Epidemic Catarrhal Fever of
1847-48_, Thomas Berill Peacock. M.D., 1848.]
More or less widespread epidemics of influenza are recorded as having
occurred in 1857-58 and 1860; in 1864 in Switzerland; in 1867 in Paris
in the spring; and at various times in the United States and Canada.
A mild epidemic occurred in 1874 in Berlin.
Influenza prevailed over a wide area in the United States during the
early months of 1879. The characteristics of this visitation have been
well described by Da Costa.[15]
[Footnote 15: "The Prevailing Epidemic of Influenza--Its
Characteristic Phenomena--Pulmonary, Gastro-intestinal, Cerebral, and
Nervous--Its Wide Distribution, Mortality, and Treatment," _Medical
and Surgical Reporter_, Philadelphia, March 8, 1879.]
The disease, since the great epidemic of 1847-48, has affected a
smaller proportion of the inhabitants of the localities visited, and
has run a less dangerous course, than in the earlier epidemics. It has
for this reason occupied a less conspicuous place in the medical
literature of recent years. It is nevertheless true that even in the
mildest epidemics, when a relatively small number of persons are
seized and the symptoms are in most cases almost insignificant, cases
do here and there occur which are of a serious or even fatal
character, and that the death-rate from other diseases is for the time
considerably increased.
Catarrhal affections have often prevailed among the domestic animals
when influenza has been epidemic. Horses, dogs, and cats are subject
to these disorders; neat cattle, goats, and sheep have been less
commonly affected; chickens and pheasants have suffered, and it is
stated by some of the older writers that birds, and particularly the
sparrow, have deserted localities in which influenza was prevailing,
and that migratory birds have taken flight earlier than usual.
These epizoötics have sometimes preceded the appearance of influenza
among men by a period of some weeks or days; in other instances they
have appeared at the same time; and in a widespread outbreak among
horses in the United States in 1872, in which the symptoms and morbid
anatomy, accurately observed, were undoubtedly those of influenza, the
disease did not affect man except to a very limited extent. A want of
fulness of description, and the inaccuracy of diagnosis too common in
the consideration of the general diseases of the lower animals, leave
the precise nature of most of the epizoötics described by the earlier
writers doubtful.
An extensive influenza of moderate intensity prevailed as an
epizoötic, chiefly affecting horses, during the latter part of the
summer and the autumn of 1880 in Canada and the United States east of
the Mississippi River. Dogs were also affected, but less generally,
and human beings to a still slighter extent. In several localities
where this invasion was observed by the writer the horses were first
affected, the dogs next, and after the lapse of some weeks, as the
animals were recovering, the disease became epidemic; but those
persons who took care of horses and were much in contact with them
neither suffered earlier nor more severely than others not so exposed.
ETIOLOGY.--1. Predisposing Influences.--There are no {860}
well-established facts pointing to the existence of individual
peculiarities that can be regarded as predisposing influences. When
the disease appears a large proportion of the population is attacked
without distinction of age, sex, social condition, or occupation.
Previous illness, whether acute or chronic, local or constitutional,
affords no protection. Aged and infirm persons and those of nervous
temperament are peculiarly liable to attack, but the robust possess no
immunity. All races and dwellers in every climate are the victims of
influenza. In a community invaded by the disease females are apt to be
the first attacked, adult males next, and children last. It has been
observed that in some epidemics children are but little liable to
contract the disease.
An attack confers no exemption from the disease in another epidemic,
and independently of relapses, which are not infrequent, persons have
been known to experience a second attack during the prevalence of the
same epidemic.
Persons dwelling in overcrowded and ill-ventilated habitations and in
low, damp and unhealthy situations have, in certain epidemics,
especially suffered, and the increase of deaths by influenza is
proportionately much greater in districts in which there is ordinarily
a high mortality than in healthier places.
Influenza appears at all seasons of the year and affects the
inhabitants of every latitude. It has no connection with known
atmospheric conditions. Many of the earlier writers sought to
establish a relation between low temperatures and sudden variations of
temperature and influenza, and by reason of the confusion among the
people between these diseases and common "colds" there has always
existed an opinion that such a relation obtains. There is, however, no
evidence to sustain this view; neither low temperature nor abrupt
changes give rise to the affection. It has prevailed in hot and dry
seasons, in the West Indies, on the coast of Java, in India, in Egypt,
at the Cape of Good Hope, on the Riviera in summer.
The condition of the air as regards moisture, or dryness, does not
influence the spread of the disease. It has occurred at sea, on low
sea-coasts, and in the dryest climates, as, for example, in Upper
Egypt.
Its spread is not much influenced by local winds. It does not travel
with the same velocity, and even sometimes advances against them. In
several well-authenticated instances a dense and foul fog has preceded
and attended the local outbreak of epidemics. The much greater number
of epidemics that have occurred altogether without such manifestations
make it in a high degree probable that this has been a coincidence.
Ozone in large quantities artificially produced may give rise to the
symptoms of ordinary catarrh, but it is not a cause of influenza. The
disease is not in any way connected with the condition of the soil,
elevation, volcanic eruption, or any other local cause. The history of
every epidemic may be adduced in proof of this statement.
Before taking up the consideration of the exciting causes of
influenza, it is important to review the known facts concerning the
march of epidemics and the spread of the disease in affected
localities. It has prevailed with greater or less frequency in almost
every region of the globe. Epidemics recur at irregular periods. It
was at one time supposed that the course of the disease was cyclical,
with a return at intervals of about one hundred years. This view was
long ago proved to be unfounded. About every {861} twenty-five or
thirty-five years great epidemics have swept over vast areas of the
globe, and influenza may be said to be, at such times, pandemic.
Less-widely extended epidemics have taken place with greater or less
frequency in the intervals between the great outbreaks. But it is not
possible to establish anything like a regular periodicity in the
returns of the disease.
It has been supposed in some instances to prevail within restricted
localities, as, for example, in a single city. Such local epidemics
are without doubt due to local causes, and are of the nature of simple
ordinary catarrhal fever, rather than true influenza.
The epidemics have extended over great areas, usually in a direction
from the east or north-east toward the west and south. At other times
they take the opposite course, and in some years they have appeared to
radiate in various directions from several centres. It is in
consequence of these facts that two views have arisen concerning the
origin of the affection. The first of these is, that each epidemic
starts out from some single unknown source, and spreads thence from
point to point, invading more distant localities successfully as it
advances, until at length it dies out in regions remote from the
starting-point. This opinion is in accord with the popular belief.
Thus, the Italians have called it the German disease; the Germans, the
Russian pest; the Russians, the Chinese catarrh. The geographical
relation of these nations indicates the usual track of the great
epidemics, as shown in the foregoing historical sketch. The other
opinion is, that it arises not from some single particular place, but
that it may start anywhere, and that widespread epidemics are due to
the successive outbreaks of the disease at many distinct points of
origin.
The evidence that the great epidemics of influenza are due to some
general and pandemic influence is conclusive. The point of origin of
the great epidemics has not yet been indicated with precision, and
must remain beyond conjecture until further facts bearing upon the
question of their source are brought to light. When it has prevailed
over a large portion of the earth's surface its progress from place to
place has usually been rapid. In this respect, however, the epidemics
show a great diversity. It sometimes travels exceedingly slowly. It is
said to have overrun Europe in six weeks, and it has again taken six
months to do so. It sometimes attacks places widely remote from each
other within short intervals of time, and it has appeared at the same
time in different quarters of the globe. It does not follow the great
lines of travel and commercial intercourse.
When influenza enters a city it continues to prevail, as a rule, from
four weeks to two months, but exceptionally it remains a longer time;
for example, the epidemic of 1831 was prevalent in Paris for the
greater part of the year. It in all instances finally disappears, and
sporadic cases do not occur in the intervals between the epidemics.
In rare instances the epidemics are heralded by scattered cases. But
as a rule this disease attacks simultaneously great numbers of the
inhabitants of affected districts, so that, when the epidemic is
severe, the sick are in a short time to be counted by thousands and
business is paralyzed as by a blow. Epidemics rapidly reach their
height, and subside almost as suddenly as they began. In a large city
the disease frequently, perhaps always, makes its appearance nearly at
the same time in several {862} different localities, affecting certain
streets and quarters solely or more generally than others for a time,
and spreading thus from several centres through the entire community.
Large towns and cities are generally affected earlier than the
villages around them, and the latter, though closely adjacent,
sometimes escape for weeks. The crews of ships upon the high seas, not
sailing from an infected port, are said to have suffered from the
seizure, and epidemics have many times crossed the Atlantic from the
Old World to the New, and more than once in the opposite direction.
2. The Exciting Cause.--Large as has been the place in medical
literature occupied by the histories of epidemics of influenza, the
nature of the "epidemic influence" which gives rise to the disease is
still unknown.