28 118 603
November 4 213 908
11 267 993
18 166 783
25 124 635
The high mortalities of the weeks following may be taken as due to the
sequelae of the epidemic (pneumonias, pleurisies, malignant fevers) and
are indeed so explained in one contemporary account:
Week ending Fever All causes
December 2 92 678
9 132 779
16 116 707
23 123 710
30 109 628
The influenza of October and November, 1729, was the occasion of a London
essay[617], which appears to treat solely of the epidemic catarrh and its
after-effects, and not of the two years’ previous sicknesses, which are
the subject of another essay, by Strother, written before the influenza
began. London, says this author, as well as Bath, and foreign parts, have
been on a sudden seized universally with the disorders named in his title
(fevers, coughs, asthmas, rheumatisms, defluxions etc.). These had come in
the course of an unusually warm and wet, or relaxing, winter; “we have for
some time past dwelt in fogs, our air has been hazy, our streets loaden
with rain, and our bodies surrounded with water.” So many different
symptoms attend the “New Disease” that a volume, he says, would not
suffice to describe them, but he thus summarizes them:
Sudden pain in the head, heaviness or drowsiness, and anon their noses
began to run; they coughed or wheezed, and grew hoarse; they felt an
oppression and load on their breasts, and turned vapourish, either
because they apprehended ill consequences, or because their spirits
were oppressed with a load of humours. The victims of the epidemic, he
says again, were very subject to vapours; they are, upon the least
fatigue or emotion of mind, dispirited, and flag upon every emergency.
Among other symptoms were, quick pulse, thirst, loss of appetite and
vertigo: the mouth and jaws hot, rough and dry, the thrush raising
blisters thereon; the throat hoarse; a fierce brutal cough, which
weakens by bringing on profuse sweats; the urine, muddy and white, “if
they who are seized have been old asthmaticks.”
He speaks of cases that had proved suddenly fatal and says that all who
died of “epidemical catarrhs” had been found to have polypuses in their
hearts. If reference be made to the Table, it will be seen that the high
mortality continued in London for at least a month after the epidemic had
passed through its ordinary course of rise, maximum and decline; and it is
probably to that post-epidemic mortality that the author refers in the
following passages:
“Numbers, as appears by our late bills, are taken with malignant
fevers, or malignant pleurisies or with pleuritic fevers....
Whosoever, then, would prevent a defluxion from turning into a fever,
or from anything yet worse, if worse can be, must keep warm and
observe a diluting regimen so long as till their water subsides and
the symptoms are vanquished.... I am convinced by experience that many
poor creatures have perished under these late epidemical fevers, from
the fatal mistake of never retiring from their usual employments till
they have rivetted a fever upon them, and till they have neglected
twelve or fourteen days of their precious time.” This was fully
endorsed by Huxham for the influenza of 1733: “Morbus raro lethalis,
quem tamen, multi, vel ob ipsam frequentiam, temeri spernentes, seras
dedêre poenas stultitiae, asthmatici, hectici, tabidi.”
Hillary’s account for Ripon is very brief[618]:
“The season continuing very wet, and the wind generally in the
southern points, about the middle of November [1729] an epidemical
cough seized almost everybody, few escaping it, for it was
universally felt over the kingdom; they had it in London and Newcastle
two or three weeks before we had it about Ripon.”
Wintringham, of York, says the epidemic in the early winter of 1729 was “a
febricula with slight rigors, lassitude, almost incessant cough, pain in
the head, hoarseness, difficulty in breathing, and attended with some
deaths among feeble persons, from pleuritic and pulmonary
affections[619].” There was a tradition at Exeter as late as 1775 that two
thousand were seized in one night in the epidemic of 1729. Huxham, of
Plymouth, says of the epidemic in November:
“A cartarrhal febricula, with incessant cough, slight dyspepsia,
anorexia, languor, and rheumatic pains, is raging everywhere. When it
is more vehement than usual, it passes into bastard pleurisy or
peripneumony; but for the most part it is easily got rid of by letting
blood and by emetics.” In December, the coughs and catarrhal fever
continued, while mania was more frequent than usual, and in January,
1730, the cartarrhal fever still infested some persons.
Rutty, of Dublin, merely says: “In November raged an universal epidemic
catarrh, scarce sparing any one family. It visited London before us[620].”
These references to the unusual catarrhal febricula in November, 1729, are
all that occur in the epidemiographic records kept by some four British
writers who recorded the weather and prevalent diseases of those years.
The epidemic catarrh made a slight impression upon them beside some other
epidemics, and hardly a greater impression than another of the same kind,
which seems to have occurred in the beginning of 1728. Thus, Rutty says,
under November, 1727: “In Staffordshire and Shropshire their horses were
suddenly seized with a cough and weakness. In December, it was in Dublin
and remote parts of Ireland; some bled at the nose.” On December 25th, he
enters: “The horses growing better, a cough and sore throat seized mankind
in Dublin[621].” Huxham, for Devonshire, under Oct.-Nov. 1727 confirms
this: “a vehement cough in horses, which lasted to the end of December;
the greater number at length recovered from it.” He does not say in that
context that an epidemic cough followed among men, as Rutty does say for
Dublin; but in a subsequent note upon horse-colds, he says: “In 1728 and
1733 it [the precedence of the horse-cold] was most manifest; in which
years a most severe cough seized almost all the horses, one or two months
earlier than men.” From which it would appear that the influenza of
Nov.-Dec. 1729, was not the only one during the aguish years 1727-29.
In the weekly London bills the other series of mortalities that look most
like those of an influenza are in the month of February, 1728 (748, 889,
850 and 927 in four successive weeks, being more than double the average).
The Influenza of 1733.
The next influenza was three years after that of 1729--in January, 1733.
In London, it raised the weekly deaths for a couple of weeks to a far
greater height than the preceding had done. Also the purely catarrhal
symptoms of running from the eyes and nose are more prominent in the
accounts for 1733 than for the influenza of 1729. The first notice of it
comes from Edinburgh. The horses having been “attacked with running of the
nose and coughs towards the end of October and beginning of November,” the
same symptoms began suddenly among men on the 17th December, 1732[622]. By
the 25th the epidemic was general in Edinburgh, very few escaping, and it
continued in that city until the middle of January, 1733. In a great many
it began with a running of lymph at the eyes and nose, which continued for
a day. Generally the patients were inclined to sweat, and some had profuse
sweats. It was noted as remarkable that the prisoners in the gaol escaped;
also the boys in Heriot’s Hospital, as well as the inhabitants of houses
near to that charity. The Edinburgh deaths rose as in the following table;
the bulk of these extra burials are said to have been at the public
charges, the epidemic having swept away a great number of poor, old, and
consumptive people:
Buried in November, 1732 89
" " December, 1732 109
" " January, 1733 214
" " February, 1733 135
Hillary[623] fixes the date of its beginning at Leeds on 3 February, one
week later than at York, three weeks later than at Newcastle, or than in
London and the south of England generally. At Leeds in three days’ time
about one-third part of the people were seized with chills, catarrh,
violent cough, sneezing and coryza; the epidemic lasted five or six weeks
in the town and country near. Dr John Arbuthnot, who was then living in
Dover Street, is clear that the outbreak in London was later than in
Edinburgh, which indeed appears also from the paragraph in the
_Gentleman’s Magazine_, dated Wednesday the 11th January, and from a
comparison of the dates of highest mortalities in London (p. 349) and
Edinburgh. It was in Saxony from the 15th November to the 29th of that
month, and in Holland before it broke out in England. But it had begun in
New England in the middle of October, and had broken out soon after in
Barbados, Jamaica, Mexico and Peru. Its outbreak in Paris was at the
beginning of February, 1733, and at Naples in March. The symptoms, says
Arbuthnot, were uniform in every place--small rigors, pains in the back, a
thin defluxion occasioning sneezing, a cough with expectoration. In France
the fever ended after several days in miliary eruptions, in Holland often
in imposthumations of the throat. In some, the cough outlasted the fever
six weeks or two months. The horses were seized with the catarrh before
mankind[624].
The account of the influenza of 1733 in London in the _Gentleman’s
Magazine_ is under the date of 11 January: “About this time coughs and
colds began to grow so rife that scarce a family escaped them, which
carried off a good many, both old and young. The distemper discovered
itself by a shivering in the limbs, a pain in the head, and a
difficulty of breathing. The remedies prescribed were various, but
especially bleeding, drinking cold water, small broths, and such thin
liquids as dilute the blood[625].”
Huxham says that it was in Cornwall and the west of Devon in February,
1733, and that at Plymouth, on the 10th of that month, some were suddenly
seized: “the day after they fell down in multitudes, and on the 18th or
20th of March, scarce anyone had escaped it.”
It began with slight shivering, followed by transient erratic heats,
headache, violent sneezing, flying pains in the back and chest,
violent cough, a running of thin sharp mucus from the nose and mouth.
A slight fever followed, with the pulse quick, but not hard or tense.
The urine was thick and whitish, the sediment yellowish-white, seldom
red. Several had racking pain in the head, many had singing in the
ears and pain in the meatus auditorius, where sometimes an abscess
formed: exulcerations and swelling of the fauces were likewise very
common. The sick were in general much given to sweating, which, when
it broke out of its own accord and was very plentiful, continuing
without striking in again, did often in the space of two or three days
carry off the fever. The disorder in other cases terminated with a
discharge of bilious matter by stool, and sometimes by the breaking
forth of fiery pimples. It was rarely fatal, and then mostly to
infants and old worn out people. Generally it went off about the
fourth day, leaving a troublesome cough often of long duration, “and
such dejection of strength as one would hardly have suspected from the
shortness of the time.” The cough in all was very vehement, hardly to
be subdued by anodynes: and it was so protracted in some as to throw
them into consumption, which carried them off within a month or
two[626].
Huxham is unusually full on the coughs and anginas of horses for several
months before the influenza of men. In August, 1732, coughs were troubling
some horses; in September, a coughing angina (called “the strangles”)
everywhere among horses which almost suffocates most of them; in October
the disease of horses is raging at its worst; and in December it is still
among them.
The Influenza of 1737.
After several years, unhealthy in other ways, the influenza came again in
the autumn of 1737. In Devonshire, according to Huxham, the horses began
to suffer from cough and angina, and some of them to die, as early as
January, 1737, the epizootic being mentioned again in February, but not
subsequently. The same observer says the influenza began at Plymouth in
November and lasted to the end of December, 1737, seizing almost everyone,
and proving much more severe than the epidemic catarrhal febricula of
1733[627]. In London it must have begun in the end of August, to judge by
the characteristic rise in the weekly bills, and in the item of “fevers”
more especially; and although the deaths kept high for a longer period
than in 1733, yet no single week of 1737 had much more than half the
highest weekly mortality of the preceding influenza season.
_London Weekly Mortalities._
1733
Week ending Fevers All causes
January 16 69 531
23 83 783
30 243 1588
February 6 170 1166
13 110 628
20 66 591
1737
Week ending Fevers All causes
August 30 117 611
September 6 161 720
13 201 837
20 229 861
27 167 770
October 4 143 687
11 114 551
In Dublin the worst week’s mortality in 1737, in the month of October, was
144, whereas in the influenza of 1733 the highest weekly bill had been
only 98[628]. Hardly any particulars of the influenza of 1737 remain,
although it appears to have been widely diffused, being recorded for
Barbados and New England. The only source of English information is Huxham
of Plymouth, who mentions some symptoms which should serve to characterize
this outbreak, namely: violent swelling of the face, the parotids and
maxillary glands, followed by an immense discharge of an exceedingly acrid
pituita from the mouth and nose; toothache and, in some, hemicrania; “in
multitudes,” wandering rheumatic pains; in others violent sciatics; in
some griping of the bowels. Huxham makes one interesting statement: “This
catarrhal fever has prevailed more or less for several winters past;” or,
in other words, the interval between the severe influenza of 1733 and the
milder influenza of 1737 was not altogether clear of the disease. He adds
that it put on various forms, according to the different constitutions of
those it attacked.
The Influenza of 1743.
Six years after, in 1743, came another influenza, which presents some
interesting points. A writer in the _Gentleman’s Magazine_ for May, 1743,
says that the epidemic began in September last in Saxony, that it
progressed to Milan, Genoa, and Venice, and to Florence and Rome, where it
was called the Influenza; in February last (1743) no fewer than 80,000
were sick of it [? in Rome] and 500 buried in one day. At Messina it was
suspected to be the forerunner of a plague--which did, indeed, ensue. It
is now (May) in Spain, depopulating whole villages. The outbreak in Italy
is authenticated by many notices collected by Corradi, Brescia having had
the epidemic in October, 1742, Milan and Venice in November, Bologna in
December, Rome, Pisa, Leghorn, Florence and Genoa in January, 1743, Naples
and the Sicilian towns in February. The English troops, in cantonments
near Brussels, were little touched by it when it reached that capital
about the end of February, but, strangely enough, “many who in the
preceding autumn had been seized with intermittents then relapsed[629].”
In London the epidemic appears to have begun in the end of March, and had
trebled the deaths in the week ending 12th April; by the beginning of May
it was practically over.
_London Weekly Mortalities._
1743
Week ending Fevers All causes
March 29 94 579
April 5 189 1013
12 300 1448
19 223 1026
26 115 629
May 3 82 537
The familiar view of the influenza in London is given in a letter by
Horace Walpole from Arlington Street, 25 March, 1743[630]:
“We have had loads of sunshine all the winter: and within these ten
days nothing but snows, north-east winds and _blue plagues_. The last
ships have brought over all your epidemic distempers; not a family in
London has scaped under five or six ill; many people have been forced
to hire new labourers. Guernier, the apothecary, took two new
apprentices, and yet could not drug all his patients. It is a cold and
fever. I had one of the worst, and was blooded on Saturday and Sunday,
but it is quite gone; my father was blooded last night; his is but
slight. The physicians say there has been nothing like it since the
year thirty-three, and then not so bad [the bill of mortality almost
the same]; in short our army abroad would shudder to see what streams
of blood have been let out! Nobody has died of it [as yet, but later
some 1000 in a week above the usual bill] but old Mr Eyres of Chelsea,
through obstinacy of not bleeding; and his ancient Grace of York;
Wilcox of Rochester succeeds him, who is fit for nothing in the world
but to die of this cold too.”
The account in the _Gentleman’s Magazine_ confirms the vast shedding of
blood: “In the last two months it visited almost every family in the city;
so that the surgeons and all the phlebotomists had full employment.
Bleeding, sweating and blistering were the remedies usually prescribed.
All over the island it cut off old people. At Greenwich upwards of twenty
hospital men and boys were buried in a night[631].” In Edinburgh, as in
London, the weekly burials were trebled. On Sunday, May 6th, fifty sick
persons were prayed for in the Edinburgh churches, and in the preceding
week there had been seventy burials in the Greyfriars, being three times
the usual number[632]. It reached Dublin in May, proving milder and less
fatal than in London (perhaps that is why the writer in the _Gentleman’s
Magazine_ says it did not visit Ireland at all); it visited, also, the
remote parts of Ulster and Munster, scarce sparing a family[633].
It had reached Plymouth in the end of April. Huxham, who is again the
chief witness to its symptoms, says that it was much less severe there
than in the south of Europe or even than in London.
Innumerable persons were seized at once with a wandering kind of
shiver and heaviness in the head; presently also came on a pain
therein, as well as in the joints and back; several, however, were
troubled with a universal lassitude. Immediately there ensued a very
great and acrid defluxion from the eyes, nostrils and fauces, and very
often falling upon the lungs, which occasioned almost perpetual
sneezings, and commonly a violent cough. The tongue looked as if
rubbed with cream. The eyes were slightly inflamed; and, being
violently painful in the bottom of the orbit, shunned the light. The
greater part of the sick had easy, equal and kindly sweats the second
or third day, which, with the large spitting, gave relief. Great loss
of strength, however, remained. Frequently towards the end of this
“feveret,” several red angry pustules broke out: often, likewise, a
sudden, nay a profuse, diarrhoea with violent griping. In many cases
Huxham was astonished at the vast sediment (yellowish white), which
the urine threw down, “than which there could not be a more favourable
symptom[634].” One remarkable feature of the epidemic of 1743 was
recalled by W. Watson in a letter to Huxham on the epidemic of 1762:
“In the disorder of 1743 the skin was very frequently inflamed when
the fever ran high; and it afterwards peeled off in most parts of the
body[635].”
Some Localized Influenzas and Horse-colds.
For the space of nineteen years, from 1743 to 1762, there occurred no
universal cold common to all the countries of Europe; the convergence of
positive testimony, which is so remarkable on many occasions from the 16th
century onwards, is found on no occasion during that interval. And yet the
period is not wanting in instructive notices of epidemic catarrh, which I
shall take from English writings only. British troops occupied Minorca
during some of those years, and the epidemics of the island were carefully
noted by Cleghorn. Under the year 1748 he writes:
“About the 20th April there appeared suddenly a catarrhal fever, which
for three weeks raged so universally that almost everybody in the
island was seized with it. This disease exactly resembled that which
was so epidemical in the year 1733. For in most part of the sick the
feverish symptoms went off with a plentiful sweat in two or three
days; while the cough and expectoration continued sometime longer. In
a few athletic persons, who were not blooded in time, it terminated in
a fatal pleurisy or phrensy[636].”
Another English epidemiographist, Hillary, who had begun his records at
Ripon, was in those years resident in Barbados; and in that island, as in
Minorca, we hear of unmistakeable universal colds, although none of them
at the same time as the one recorded by Cleghorn. The Barbados annalist
records a general catarrhous fever in September, 1752[637], and a
recurrence of the same in the end of December, lasting until February 1753
(catarrh and coryza, cough, hoarseness, a great defluxion of rheum, some
having fever with it). As it ceased in February, 1753, a slow nervous
fever began, and continued epidemic for eighteen months, until September,
1784, when it totally disappeared, and was not seen again so long as
Hillary remained in the island (1758). In 1755 there was another epidemic
catarrhal fever, first in February and again in the end of the year. In
the earlier outbreak, few escaped having more or less of it, the symptoms
being cold ague for a few hours, followed by a hot fever with great pain
in the head, or pains in the back and all over the body, which lasted two
or three days, or longer, and then went off in some by a critical sweat.
In the October outbreak it affected children mostly. Once more, in 1757,
the same catarrhous fever returned, with almost the same
circumstances[638]. That year there was a universal catarrh in North
America.
Not less remarkable than the epidemic catarrhal fever in Minorca in 1748,
or those in Barbados in 1752-3, 1755 and 1757, was the epidemic of 1758 in
Scotland[639]. It was first noticed with east winds from the 16th to 20th
September, several children having taken fever like a cold. In the last
week of September thirty out of sixty boys at the Grammar School of
Dalkeith were seized with it in two or three days. In October it became
more general, among old and young, and increased till about the 24th, when
it began to abate. In Edinburgh not one in six or seven escaped. It was in
most parts of Scotland in October--Kirkaldy, St Andrews, Perthshire (where
many died of it), Ayrshire, Glasgow, Aberdeenshire, Rossshire (end of
October). A gentleman told Dr Whytt that in the Carse of Gowrie, in
September, “before this disease was perceived, the horses were observed to
be more than usually affected with a cold and a cough.”
The symptoms in Scotland were of the Protean kind of “influenza”: there
might be fever with no cold; or a coryzal attack with little or no fever;
or some had bleeding at the nose for several days, which might be profuse;
or the soreness and pains in the bones might be in all parts of the body,
or confined to the cheekbones, teeth and sides of the head. Others had a
fever without any distinctive concomitant, but a cough when the fever
subsided[640]. One of Whytt’s patients, a lady aged thirty, had been
feverish for four days, when a scarlet rash appeared, but did not come
fully out; the fall of the pulse and fever coincided with the beginning of
a troublesome tickling cough, “so that the cough might be said to have
been truly critical.” Those who exposed themselves too soon frequently
relapsed. Few died of the disease, except some old people. “In some parts
of the country, when the disease was not taken care of in the beginning,
as being attended with no alarming symptoms, it assumed the form of a slow
fever, which sometimes proved mortal.”
The year after the localised influenza of Scotland there was an epidemic
of the same kind in Peru and Bolivia, that year, 1759, being one in which
no universal fever or catarrh is reported from any other country. It
extended from south to north, along the coast as well as over the high
table-lands of Bolivia and the sierra region of Peru, invading, among
others, the populous towns of Chuquisaca, Potosi, La Paz, Cuzco and Lima.
In five or six days hardly one inhabitant of a place had escaped it,
although some had it very slightly. As it was swift in its attack, so it
was soon over, lasting about a month in each place. Its symptoms were
great dizziness and heaviness of the head (vertigo and gravedo),
feebleness of all the senses, deafness, strong pains over all the body,
moderate fever, weariness, great prostration, complete loss of appetite,
bleeding from the mouth and nostrils (this had been noted in Scotland the
year before), and a long convalescence. Dogs shared the disorder, and
might have been seen lying stretched out in the streets, unable to stand.
It will be observed that the symptoms given do not include catarrh[641].
Before we come to the next general influenza in Britain, that of 1762,
there are some facts to be mentioned as to agues and horse-colds in the
interval since 1743. In Rutty’s Dublin chronology, agues are entered as
prevalent in 1745. In 1750, about the middle or end of December, the most
epidemic and universally spreading disease among horses that anyone living
remembered made its appearance in Dublin, and in Ulster and Munster almost
as soon. It had been in England in November, and was like that which
preceded the universal catarrhs of mankind in 1737 and 1743. In 1751,
irregular agues were frequent in March, as were also tumours of the face,
jaws and throat. Agues also continued to be frequent in April, both in
Dublin and in several parts of the country. In December, 1751, and
January, 1752, there was another horse-cold, the same as a twelvemonth
before. In 1754 the spring agues were frequent in Kilkenny and Carlow,
though rare in Dublin. In 1757, “intermittent fevers, which had not
appeared since April, 1746,” came in the end of February. In 1760, a great
catarrh among horses became general in Dublin in April. Coughs and tumours
about the fauces and throat, with a slight fever, often occurred in March;
and regular intermittents, tertians or quotidians, were more frequent than
for some years past. These, according to Sims, of Tyrone, abated after
1762, so that he had not seen an intermittent since 1764 until the date of
his writing, 1773.
The horse-cold of 1760 was observed in London in January. The _Annual
Register_ says under date 27 Jan.: “A distemper which rages amongst horses
makes great havock in and about town. Near a hundred died in one week.” In
a letter a day later (28 Jan.) Horace Walpole writes: “All the horses in
town are laid up with sore throats and colds, and are so hoarse you cannot
hear them speak.... I have had a nervous fever these six or seven weeks
every night, and have taken bark enough to have made a rind for
Daphne[642].” This same horse-cold is reported from the Cleveland district
of Yorkshire: “In February, [1760] horses were invaded by the most
epidemic cold or catarrh that has ever happened in the remembrance of the
oldest men living[643].” The same authority for Cleveland says that
intermittents were frequent and obstinate in the spring of 1760.
Among these miscellanies of the history may be mentioned an outbreak of
“violent pleuritic fever or peripneumene” in the spring of 1747, which was
fatal to a comparatively large number in the parish of George Ham, North
Devon. Thirteen died of it from the 20th to the 31st March, four in April,
four in May, and one in June, “most of them in four or five days after the
first seizure.” The same family names recur in the list[644].
The Influenza of 1762.
The universal slight fever or catarrhal fever of 1762 was, in London, much
less mortal than those of 1733 and 1743.
_London Weekly Mortalities._
1762
Week ending Fevers All causes
May 4 72 467
11 104 626
18 159 750
25 162 659
June 1 121 516
8 85 504
It began in London about the 4th of April, and by the 24th of that month
“pervaded the whole city far and wide, scarcely sparing anyone.” It was in
Edinburgh by the beginning of May, and in Dublin about the same time, but
did not reach some parts of Cumberland until the end of June. Short, who
was then living at Rotherham, says that it “continued most of the
summer[645].” It had the usual variety of symptoms in the individual
cases, of which only a few need be again particularized. Where the fever
was sharp, it usually remitted during the day, having its exacerbation in
the night. Sometimes it proved periodical, and of the tertian type: “it
usually returned every night with an aggravation of the feverish symptoms”
(Rutty). Perspiration was a constant symptom; the tongue was as if covered
with cream (Baker repeats this figure of Huxham’s in 1743). “Depression of
mind and failure of strength were in all cases much greater than was
proportionate to the amount of disease. A great number of those affected
were very slowly restored to health, languishing for months, and some even
for a whole year with cough and feverishness--relics of the disease which
it was difficult to shake off. Some, after struggling long with impaired
health, fell victims to pulmonary consumption. In some there were pains in
all the joints and in the head, with lassitude and vehement fever, but
with little signs of catarrh.” Rutty, of Dublin, says that in some a
measly efflorescence or a red rash was seen, attended by violent
itching[646]. Among labourers in the country, the pestilence was so
violent as to destroy many within four days, from complications of
pneumonia, pleurisy and angina. Sometimes it took the form of a slow
fever, “and approximated to that form of malady which the ancients
denominated ‘cardiac’[647].”
The mortality is said to have varied much. White, of Manchester, declared
that fewer died there than in ordinary while the epidemic lasted. On the
other hand Offley, of Norwich, said there were more victims there than by
the epidemic of 1733 “or by the more severe visitation called influenza in
1743”--the two visitations which were incomparably the worst in the whole
history, according to the London bills. Baker says that it infested cities
and the larger towns crowded with inhabitants earlier than the surrounding
villages, and is inclined to think that it was mostly brought by persons
coming from London[648].
The progress of this epidemic over Europe had been peculiar. It was seen
in the end of February, 1762, at Breslau, where the deaths rose from 30 or
40 in a week to 150. It was in Vienna at the end of March, and in North
Germany about the same time as in England--April and May. There were at
that time British troops in Bremen, among whom the epidemic appeared
shortly after the 10th April[649].
“It looked at first as if they were going to have agues, but soon they
were attacked with a cough and a difficulty of breathing and pain of
the breast, with a headache, and pains all over the body, especially
in the limbs. The first nights they commonly had profuse sweats. In
several it had the appearance of a remitting fever for the two or
three first days.” The cough in many was convulsive. The epidemic
seized most of the people in the town of Bremen: very few of the
British escaped, but none of them died, except one or two, from a
complication of drunkenness and pneumonia.
It is said to have been nowhere in France except in Strasburg and the rest
of Alsace, in June. Baker says, “Whilst it raged everywhere else, it did
not reach Paris or its vicinity, a fact which I learned from trustworthy
persons.” On board British ships of war in the Mediterranean it occurred
in July. Its severity appears to have varied greatly in different cities
of the same country. Rutty, for Ireland, agrees with Baker, for England,
that it was more fatal in the country than in the towns.
The Influenza of 1767.
The next influenza, that of 1767, was so unimportant that its existence in
England would hardly have been known but for Dr Heberden’s paper, “The
Epidemical Cold in June and July 1767[650].” Those few who were affected
by a cold in London early in June observed that it differed from a common
cold, and resembled the epidemical cold of the year 1762, on account of
the great languor, feverishness, and loss of appetite. It became more
common, was at its height in the last week of June or beginning of July,
and before the end of July had entirely ceased. It was less epidemical and
far less dangerous than the cold of 1762, so much so that the London bills
of mortality hardly witness at all to its existence. The attack began with
several chills; then came a troublesome and almost unceasing cough, very
acute pains in the head, back, and abdomen under the left ribs,
occasioning want of sleep. Many of the symptoms hung upon several for at
least a week, and sometimes lasted a month. The fever might be great
enough to bring on deliriousness, yet had plain remissions and
intermissions. The same disorder was reported to be common about the same
time in many other parts of England, and more fatal than it was in London.
Heberden did not anticipate from it the lingering effects in the
individual, for months or years, which marked so many of the cases in
1762[651].
The Influenza of 1775.
Heberden invited physicians in the provinces to send in accounts of the
epidemic of June and July, 1767, but no one seems to have responded.
However, the next epidemic catarrh, of November and December, 1775, was
made the subject of many communications from all parts of Britain, in
response to a circular drawn up by Dr John Fothergill. This was a
distinctly catarrhal epidemic, running of the nose and eyes, cough and
(or) diarrhoea, being commonly noted.
At Northampton some had “a severe pain in one side of the face, affecting
the teeth and ears, and returning periodically at certain hours in the
evening, or about midnight, attended with vertigo, delirium and limpid
urine during the exacerbation. Some whose cases were complicated with the
above symptoms had a general rash, but without its proving critical....
Many of those who escaped the catarrh have been more or less sensible of
giddiness, or pains in the head or face,” with limpid urine, etc., as if
they had a full attack[652]. The epidemic began in London about the 20th
October, and made a slight impression upon the bills of mortality in some
weeks of November and December[653]. Grant says that it lasted nearly five
months in London, having been attended by the same “comatose” fever which
Sydenham associated with the epidemic catarrh of 1675. The fatalities in
Grant’s practice occurred late in the epidemic:
“On the 23rd December [1775] I had lost one patient, and soon after
two others; all died comatous, owing, as I then imagined, to the
remains of the comatose fever of Sydenham, which had raged all the
autumn, was complicated with the catarrhous fever, and continued by
the wet, warm uncommon weather for the season of the year; and I still
[1782] am of opinion that this complication is the reason why the
epidemic catarrh of 1775 proved much more fatal than it did in 1782--a
fact known to all of us[654].”
A Liverpool writer also says that the catarrh of 1782 “distinguished by
the same title,” was a much slighter complaint than the “influenza” of
1775. The latter, however, was a summer epidemic, and was naturally less
complicated with pneumonia and bronchitis, whatever the “comatose” fever
of 1775 may have been. Grant’s statement that the influenza of 1775 lasted
five months in London is borne out by the Foundling Hospital records: on
11 November, there were 16 in the Infirmary with “epidemic fever and
cough,” next week 22 with “fevers, coughs and colds,” and so on week by
week under the same names until the 9th of March, 1776[655]. At Dorchester
it was general after 10th November; about the same time it was in Exeter,
where within a week it seized all the inmates, but two children, in the
Devon and Exeter Hospital, to the number of 173 persons. The middle of
November is also the date of its decided outbreak at Birmingham, at
Worcester, and at Chester, where Howard found the prisoners suffering from
it. At York in the north, as at Blandford in the south, it is claimed to
have begun earlier than in London. At Lancaster it was not seen until
three weeks after the accounts of its prevalence in London began to come
in, but only three days after it was first heard of in Liverpool. At
Aberdeen it was fully a month later than in London. It did not visit
Fraserburgh, though there was a putrid fever there very fatal at that
time[656].
In many cases the disease assumed the type of an intermittent towards its
decline, but bark was not useful (Fothergill, Ash, while Baker says that
bark did good when the fever was spent). All the observers agree both as
to its slight fatality and its universality. At Chester it attacked 73 out
of 97 affluent persons, neighbours in the Abbey Square; at the Cross,
inhabited by people in trade, 109 had the disease out of 144; in the
House of Industry, not one escaped out of 175; it attacked people in the
country rather later than in the town, and less generally, but it was in
villages and even in solitary houses.
The unusual prevalence of catarrh among horses (and dogs) is asserted by
John Fothergill (“during this time”), Cuming (“after the middle of August
very generally in Yorkshire”), Glass (in September), Haygarth (in North
Wales, about August and September), Pulteney (“before we heard of it among
the human race”). The fullest statement is by Dr Anthony Fothergill, of
Northampton:
“This distemper prevailed some time among horses before it attacked
the human species. The cough harassed them severely and rendered them
unfit for work, though few died. About the same time also it infested
the canine species and with great fatality, especially hounds. An
experienced huntsman informed me that it ran through whole packs in
many parts of England and that several dogs died[657].”
The progress of influenza from other countries towards Britain was so much
a matter of rumour or vague statement in the earlier periods that it has
not seemed worth while to make a point of it under each epidemic. It
happens, however, that there is good evidence of the line of progress of
the epidemic of 1775. The afterwards celebrated Professor Gregory, of
Edinburgh, encountered it in Italy in the autumn, and followed it all the
way home to Scotland. He saw it successively in Genoa, in the south of
France, in the north of France, in London, and last of all in Edinburgh,
where he himself at length fell ill with it, several of his travelling
companions having taken it in Italy two or three months before. In his
lectures long after (as reported by Christison, who heard them about 1817)
he traced the influenza of 1775 from south to north: “It appears to have
broken out somewhere on the north and west coast of Africa, whence it
spread not only north into Europe, but likewise eastward to Arabia, Egypt,
Syria, Palestine, Asia Minor, Hindostan, China, and was ascertained to
have spread over the whole immense empire of the Chinese. From China it
returned westward by a northern route through the extensive dominions of
Russia and from that country it was sent again over Europe in 1782[658].”
The Influenza of 1782.
Seven years after, in the early summer of 1782, there came another swift
and brief wave of catarrhal fevers over England, Scotland and Ireland, in
the midst of a great “constitution” of epidemic agues which continued for
several years. This was the occasion when the Italian name of “influenza”
was formally adopted by the College of Physicians. Perhaps the first
appearance of the name in English was in an account of the epidemic in
Italy in 1729, given by a London periodical devoted to political news from
foreign countries, and called, “The Political State of Great
Britain[659].” In 1743 the news of the Italian epidemic under its native
name reached London before the infection itself, the Italian name being
frequently given to it while it lasted that season in England. When the
next epidemic came, in 1762, it was not called the influenza as a matter
of course, but was compared to the disease in 1743 “called the influenza.”
In the epidemic of 1775, “influenza” came more into use, and in 1782 it
was the name usually given to the epidemic malady. The adoption of this
name put an end at length to the ambiguity between epidemic agues and
influenzas, leaving the curious correspondences between them in time and
place, or the nosological affinities between them, as interesting as ever.
As late as the very fatal aguish years 1727-29, there was no clear
separation of the epidemic agues from the influenzas, of which latter
there were two or more, the one in the end of 1729 being easy to identify.
In the great aguish constitution of 1678-81, Sydenham distinguished the
epidemic coughs and catarrhs in Nov. 1679; but Morley made no such
distinction, describing the whole series of agues for two seasons (and he
might have done so for two seasons more) as the “new fever,” “new ague,”
or “new delight,” as in Derbyshire, without a suspicion that the universal
coughs, catarrhs and fevers in November, 1679, were something
nosologically distinct, which the future would identify as “influenza.” In
like manner Whitmore, in the great aguish period immediately preceding,
that of 1658-59, had described the “new disease” as one single Proteus. In
the still earlier epidemic seasons of 1557-58 and 1580-82, everything was
“ague,” although we now discover influenza mixed therewith. I do not say
that this inclusive naming was the better scientifically; nor do I uphold
Willis and Sydenham in their teaching that the intermittent constitution
passed into the catarrhal, in 1658 and 1679 respectively. But it is
necessary to bear in mind the matter of fact, namely, that those agues,
amidst which the “great colds” occurred, were epidemic agues, and not the
endemic fevers of malarious places; and I have now to show that the
“influenza” of 1782 was in like manner a brief episode in the midst of
several successive seasons of agues, which were as much “new” or “strange”
as any of those in the earlier history. Whether the epidemic agues of
1780-85 were the last of the kind in Britain had better be left an open
question until our most recent and most strange experiences in 1890-93 are
read in the light of history.
The influenza of 1782 was a very definite incident of a few weeks--_teres
atque rotundus_. It is easily discoverable in the weekly bills of
mortality in London to have fallen in the month of June:
_London Weekly Mortalities._
1782
Week ending Fevers All causes
May 21 45 336
28 49 390
June 4 57 385
11 121 560
18 110 473
25 89 434
July 2 49 296
The sudden rise and fall of the deaths and the height reached are much the
same as in other such epidemics in the summer--the “gentle correction” of
1580, the “transient slight fever” of 1688, and the epidemic catarrh of
1762. On the other hand the epidemics of autumn, winter or spring in 1729,
1733, 1737 and 1743 were far more severe, while the winter epidemics of
1675 and 1679 had figures almost the same as the summer epidemics.
The influenza of 1782 was not remarkable, whether in its fatality or in
its characters; but it received far more attention than any that had
preceded it. Two collective inquiries were held upon it, one by a Society
for promoting Medical Knowledge[660], the other by a committee of the
College of Physicians of London[661], many physicians all over England,
Scotland and Ireland contributing to one or other. There were also three
or more separate essays[662].
The epidemic appeared in 1782 at Newcastle in the end of April, and raged
there all May and part of June. In London it appeared between the 12th and
18th of May, in the Eastern Counties about the middle of May, in Surrey
and at Portsmouth, Oxford and Edinburgh, also about the third week of May,
but not in Musselburgh until the 9th or 10th of June. It was at Chester on
the 26th of May, at Plymouth on the 30th, at Ipswich, Yarmouth, York,
Liverpool and Glasgow in the first week of June. In Northumberland it was
raging in July, and did not cease until the third week of August. In
Scotland it was at a height in July, during the haymaking[663]. The most
curious fact in its incidence comes from North Devon; it was prevalent in
Barnstaple at the usual time, the month of June; but the neighbouring town
of Torrington was not then affected by it, having previously gone through
the epidemic, it is said, from a date as early as the 24th of March[664].
In all places it spread quickly, affecting from three-fourths to
four-fifths of the adult inhabitants, but children not so much. At
Christ’s Hospital, London, only fourteen out of seven hundred boys had it.
Wherever it attacked children, it did so mildly. It lasted under six weeks
in each place that it came to. There were some strange attacks of it in
London in September, “two months after the late epidemical catarrh had
entirely disappeared from England.” The king’s ships ‘Convert’ and
‘Lizard’ arrived in the Thames from the West Indies in September. Their
crews were perfectly healthy till they reached Gravesend, where they took
on board three custom-house officers; and in a very few hours after that
the influenza began to make its appearance. Hardly a man in either ship
escaped it; and many both of the officers and common seamen had it in a
severe degree[665]. Others who came to London from the West Indies in
merchantmen in the end of September were attacked by influenza in their
lodgings in the beginning of October[666]. To this epidemic belong also
the strange experiences of the Channel Fleet in its two divisions under
Howe and Kempenfelt; but I postpone for the present the whole question of
influenza at sea.
Gray thus sums up the great variety of symptoms as related by his numerous
correspondents:
Chilliness and shivering, sometimes succeeded by a hot fit, the
alternation continuing for some hours; languor and lassitude,
sneezing, discharge from the nose and eyes, pain in the head
(particularly between or over the eyes), cough, sometimes dry,
sometimes accompanied with expectoration, inflammation in one or both
eyes, oppression and tightness about the praecordia, difficulty of
breathing, pain in the breast or side, pain in the loins, neck,
shoulders or limbs, sense of heat or soreness in the throat and
trachea, hoarseness, bleeding from the nose, spitting of blood and
loss of smell and taste, nausea, flatulence. Also watery blisters
about the upper parts of the body, and swellings in the face and other
parts, attended with considerable soreness, apparently erysipelatous.
In some the catarrhal symptoms were very slight, or entirely wanting,
the disorder in those cases being like a common fever.
The committee of the College of Physicians said that “the universal and
almost pathognomonic symptom was a distressing pain and sense of
constriction in the forehead, temples, and sometimes in the whole face,
accompanied with a sense of soreness about the cheek-bones under the
muscles,” reminding one of the _fierro chuto_ or “iron cap” of the South
American epidemic in 1719. Sometimes no catarrhous affection followed
these strange head pains. The languor of body and depression of spirits
were thought to be more protracted than in 1762, but the fatalities at the
time were fewer than in the earlier epidemic, and there were fewer
consumptions following. Sweating, also, was said by some to be less
remarkable than in 1762; but Carmichael Smyth said: “The late influenza
[1782] might very properly have been named the sweating sickness, as
sweating was the natural and spontaneous solution of it[667].” One
distinctive thing in the epidemic of 1762 was missed by most in 1782,
namely, the peculiar constriction of the breast, with heat and soreness of
the trachea, as if excoriated; but Hamilton describes that very thing for
1782 in Bedfordshire[668]. As in other epidemics of the kind, especially
those which have been least catarrhal, there were hardly two cases quite
the same.
The Epidemic Agues of 1780-85.
Let us now take up the strange history of epidemic agues for two or three
years preceding and following the influenza of June, 1782. Sir George
Baker begins his account of them thus[669]: “The predominance of certain
diseases observable in some years, and the total or partial disappearance
of the same in other years, constitute a subject worthy of our
contemplation.”
These agues were first noticed in London in the spring and autumn of
1780, but they infested various parts of England a little earlier. In
the more inland counties the agues were “often attended with
peculiarities extraordinary and alarming. For the cold fit was
accompanied by spasm and stiffness of the whole body, the jaws being
fixed, the eyes staring and the pulse very small and weak.” When the
hot fit came on the spasms abated, and ceased in the sweating stage;
but sometimes the spasm was accompanied by delirium, both lasting to
the very end of the paroxysm. Even in the intermissions a convulsive
twitching of the extremities continued to such a degree that it was
not possible to distinguish the motion of the artery at the wrist.
“This fever had every kind of variety, and whether at its first
accession it were a quotidian, a tertian or a quartan, it was very apt
to change from one type to another. Sometimes it returned two days
successively, and missed the third day; and sometimes it became
continual. I am not informed that any died of this fever whilst it
intermitted. It is, however, certain that many country people whose
illness had at its beginning put on the appearance of intermission,
becoming delirious, sank under it in four or five days.”
Reynolds, another London physician, in a letter to Sir George Baker
confirms all that the latter says of these singular epidemic agues: “No
two cases resembled each other except in very few circumstances[670]”--the
remark commonly made about the influenza itself. If these descriptions of
the epidemic ague had not been given by physicians living as late as 1782,
and altogether modern in their methods, we might have supposed that they
were confusing influenzas with agues, or using the latter term inexactly.
“The ague with a hundred names” is the striking phrase of Abraham Holland,
in his poem on the plague of 1625. Whitmore, describing the fatal epidemic
ague (with an episode of influenza) in 1658-59, does not say that it had a
hundred names, but that it assumed a hundred shapes, “which render it such
a hocus-pocus to the amazed and perplexed people, they being held after
most strange and diverse ways with it.... So prodigious in its alterations
that it seems to outvie even Proteus himself[671].”
As farther showing the anomalous character of these epidemic agues, or
their difference from the endemic, Baker adds:--
“It is a remarkable fact, and well attested, that in many places,
whilst the inhabitants of the high grounds were harassed by this
fever, in its worst form, those of the subjacent valleys were not
affected by it. The people of Boston and of the neighbouring villages
in the midst of the Fens were in general healthy at a time when fever
was epidemic in the more elevated situations of Lincolnshire.” Women
were nearly exempt, but few male labourers in the fields escaped it.
Baker heard from all parts that the same constitution continued through
1781 and 1782; and that since that time, though it seemingly abated,
yet agues had been much more prevalent than usual, and had even been
frequent in places where before that period they were uncommon. They
were very noticeable in London from 1781 to 1785, not least so during
the very severe cold of the winter and spring of 1783-84. We hear
of great numbers attacked at Hampstead with common intermittents in
February and the following months of 1781, during which time even
the measles, in the greater number of cases, “ended in very troublesome
intermittents[672]”--just as they were apt to end often in troublesome
coughs.
The annals of Barker, of Coleshill, are full of references to agues, among
other fevers, from 1780 onwards. Under 1781 he writes:--
“This spring that very peculiar, irregular, dangerous and obstinate
disease, the burning, or as the people in Kent properly enough called
it, the Plague-ague, made its appearance, became very epidemical in
the eastern part of the kingdom, and raged in Leicestershire, the
lower part of Northamptonshire, Bedfordshire, and in the fens
throughout the year.... This strongly pestilential disease had such
an effect upon them that the complexion of their faces continued for a
time as white as paper, and they went abroad more like walking corpses
than living subjects.”
As many as five persons in an evening were buried from it in some large
towns in Northamptonshire; and about Boston it was so general and grievous
that out of forty labourers hired for work in harvest, half of them, it
was said, would be laid up in three days[673]. In 1783 the “pestilential
agues” were as bad in Northamptonshire and eastern parts as the year
before. A Liverpool writer says:
“In the autumn of 1782 the quartan ague was very prevalent on the
opposite shore of the river in Cheshire: it was universal in the
neighbourhood of Hoylake, where many died of it. Yet it was scarcely
heard of in Liverpool, although from the uncommon wetness of the
season it prevailed throughout the kingdom[674].”
On October 25, 1783, a correspondent of the _Gentleman’s Magazine_ offered
an explanation of the “present epidemic disorder, which has so long
ravaged this country, and that in the most healthy situations of it,”
namely, “the putrescent air caused by the number of enclosures, and the
many inland cuts made for navigation[675].” Next year, 1784, appears to
have been the principal season of epidemic agues on both sides of the
Severn valley, one practitioner at Bridgenorth making them the subject of
a special essay[676].
It was at this time that Fowler brought into use his solution of arsenic
as a substitute for bark in agues, the latter having notably failed in the
epidemics since 1780.
Baker says: “The distinguishing character of this fever was its obstinate
resistance to the Peruvian bark; nor, indeed, was the prevalence of the
disease more observable than the inefficacy of the remedy:” in that
respect the epidemic agues had belied the experience with bark in ordinary
agues. Again, it is singular that bark had failed most, and arsenic been
especially useful in those parts of England where ordinary malarious agues
were never seen. One practitioner in Dorset laid in a large stock of
arsenic, wherewith he “hardly ever failed to stop the fits soon[677].”
Another, at Painswick, in Gloucestershire, used it successfully in two
hundred cases of epidemic agues from 1784 onwards. He gives the following
account of these unusual agues at Painswick:
“This town, which is situated on the side of a hill, and is remarkable
for the purity of its air, is very populous. In the year 1784 the
epidemic ague, that prevailed in many parts of the kingdom, made its
appearance in this place, and has continued till the present time
[Nov. 1787], although previously to that period the disease was hardly
ever seen here, unless a stranger came with it for the recovery of his
health, on account of the healthy situation of the place. It affected
whole families, and appeared to be most violent in spring and autumn.
In the summer of 1786 it was followed by a fever of the kind called
typhus, or low nervous fever, which not unfrequently degenerated into
a putrid fever and proved very fatal[678].” In May, 1785, at a general
inoculation of smallpox, “many had been afflicted with intermittents
of several months’ duration attended with anasarcous swellings[679].”
It will be seen from the following table of cases treated at the Newcastle
Dispensary, under the direction of Dr John Clark, during twelve years from
1 October, 1777, to 1 September, 1789, that influenza makes the smallest
show among them, being far surpassed by the intermittent fevers and
dysenteries, while all three together are greatly exceeded by the
perennial typhus fever:
Cases treated
Putrid fever 1920
Intermitting fever 313
Epidemic dysentery in 1783 and 1785 329
Influenza of 1782 53
In Scotland, also, agues became epidemic about the year 1780. There is no
reason to suppose that their prevalence in these years was less
exceptional there than in England and Ireland. It will be seen, indeed,
from the following table compiled from the books of the Kelso Dispensary
that the only years of their considerable prevalence were the same as the
years of epidemic ague in England.
_Kelso Dispensary_[680].
All Cases
Year Cases of Ague
1777 302 17
1778 306 33
1779 460 70
1780 675 161
1781 510 103
1782 440 61
1783 510 73
1784 459 40
1785 573 62
1786 563 48
1787 525 24
1788 577 25
1789 546 48
1790 640 18
1791 715 13
1792 570 16
1793 666 19
1794 447 9
1795 513 23
1796 355 12
1797 318 9
1798 415 7
1799 558 2
1800 665 4
1801 433 9
1802 377 5
1803 308 2
1804 422 5
1805 469 0
1806 318 1
It was doubtless the recollection of these epidemic agues that led the
parish ministers who wrote in the ‘Statistical Account of Scotland’ from
1791 to 1799 to remark upon a supposed progressive decline of endemic
ague, which they set down to drainage of the land[681]. It is probable,
however, that each tradition of ague in Scotland dated from one of its
epidemic periods; it has been shown, indeed, in the foregoing that
Scotland in the end of the 17th century was reputed tolerably free from
ague, and that the severe agues previous to 1728, which belonged to the
epidemical kind, were thought to be something new.
The Influenza of 1788.
According to Barker, of Coleshill, who kept systematic notes of the
epidemic maladies from year to year, there were several recurrences of the
influenza of 1782[682]. But there is only one of these seasons, the
summer of 1788, that other English writers have singled out as a time of
influenza. It was undoubtedly of a very mild type, producing hardly any
effect upon the bills of mortality; but it attracted the notice of
several. Dr Simmons, the editor of the _London Medical Journal_, became
the recorder of it, collecting reports from various parts, as others had
done in 1782. He himself treated 160 cases at the Westminster General
Dispensary, and 65 more elsewhere. It was most prevalent in London from
the second to the fourth week of July, but the mortalities for those weeks
show no abrupt rise. It was at Chatham, Dover, Plymouth and Bath about the
same time, at Manchester in the beginning of August, in Cornwall in the
middle of August, and at Montrose about the end of August, or perhaps most
certainly in October. On 5 August, a physician at York wrote: “We have not
had the slightest appearance of a catarrh in our city or neighbourhood
during the year.” The epidemic was undoubtedly a partial one in Britain,
and so slight as to have made little impression where it did occur. It is
said to have been very general at Warsaw in April or May, at Vienna in
April (20,000 cases before the 20th), at Munich in June, at Paris in the
end of August and still continuing on the 24th October, at Geneva on the
10th October. Its most constant symptom in England was pain in the
fore-part of the head, with vertigo; next most constant was a pain at the
pit of the stomach and along the breast-bone; cough was wanting in perhaps
a third of the cases and was always slight, diarrhoea was somewhat
general, running from the eyes exceptional, sore-throat in perhaps
one-sixth of the cases[683]. At Plymouth where it was seen earliest and
clearest among the regiment of artillery and in the guardships, the
symptoms were pain in the head and limbs, soreness of the throat, pain in
the breast, a feeling of coldness all over the skin, and these followed by
cough, a great discharge from the nose and eyes, and slight nausea. It was
much less noticeable among the townspeople than among the troops and
sailors[684]. It occurred chiefly among soldiers or sailors also at Dover
and Chatham. At Bath it was marked by chills, headache, swelling of the
throat, difficult swallowing, quick pulse, hot, dry skin (but not pungent
as in malignant fever), ending in a sweat; no delirium, but broken sleep
or vigil; the eyes scarcely affected, cough in some, but not vehement; in
some, sublingual swellings which suppurated[685]. At Manchester it looked
as if it had been brought in by travellers who had acquired it in
London[686].
At Portsmouth a singular thing happened two or three months after the
epidemic had passed. The frigate ‘Rose’ arrived on 4 November from
Newfoundland; within a short time all the dogs on board were seized with
cough and catarrh, and soon after the whole ship’s company were affected
in the same way[687]. Simmons says of the epidemic of 1788 in general:
“During the progress of the influenza, a complaint which was evidently an
inflammatory affection of the mucous membrane of the fauces, etc. was
frequently observed among horses and other cattle, and was generally as
violent among them as it was mild among their rational neighbours”--many
dying after four or six days.
The very slight and partial influenza of July and August, 1788, happened
at a time when there was much fever of a more serious kind in the country.
The history of the latter belongs to another chapter; but there was in
Cornwall, in the same season as the influenza, an epidemic fever which
might in former times have been described as a part, and the most fatal
part, of the “new disease,” and may be taken in this context rather than
in the chapter on typhus. The same physician, Dr William May, of Truro,
gave an account of the influenza first[688] and of the other fever
afterwards[689].
The latter began at Truro in the end of April, 1788, and was also at
St Ives and other small towns in various parts of the county. A
malignant fever had for near two years before been exceedingly rife
among the poor (owing to distress from loss of pilchard fishing), and
had carried off a great number of them; but this was something new.
Yet it was “truly a fever of the typhus type,” one of its symptoms
being constant wakefulness. It passed through whole families,
affecting all ages and constitutions. It ended on the 17th day,
whereas the influenza (says May in his other paper) ended with a sweat
on the fourth or fifth day. In one small neighbourhood this epidemic
fever affected chiefly the aged, who were blooded owing to dyspnoea:
out of ten or eleven so affected, not one recovered, an experience
that reminded May of what Willis said of the village elders being
swept off by the “new fever” of 1658. Surgeons at St Austel, East Looe
and Falmouth are cited as having seen much of the same fever. In like
manner the Manchester chronicler of the influenza of 1788 says:
“Fevers of different kinds, but chiefly of the type now distinguished
by the appellation of typhus, were exceedingly prevalent after the
epidemic catarrh had in great measure ceased to be general; but from
which, by tracing the symptoms, the fever might usually be found to
have originated[690].”
For a good many years after the period last dealt with, nothing is heard
in Britain either of epidemic agues or of influenza[691]. Writing in 1800,
Willan said that intermittents had not, to his knowledge, been epidemic in
London at any time within twenty years. He explains this by “the practice
of draining, and the improved modes of cultivating land in Essex, Kent,
and some other adjoining counties, from which either agues were formerly
imported, or the effluvia causing them were conveyed by particular
winds”--the latter being the doctrine of Lancisi for the country round
Rome. But he forgets that their appearance nearly twenty years before was
a strange phenomenon to the practitioners of that generation, and that
Sydenham, whom he cites to prove agues in London in former times, had also
remarked their absence, except in occasional cases, for as long a period
as thirteen years. Of such occasional agues acquired in London, Willan
and Bateman had each one or two examples in the autumn of 1794, and the
spring of 1805.
As in the case of epidemic agues, so also in the case of influenzas, there
was immunity in Britain for a good many years after 1788; and, as the
slight epidemic catarrh of 1788 was something less than universal, the
clear interval may almost be reckoned from the summer of 1782, a space of
over twenty years. Willan’s monthly reports of the weather and diseases in
London from March, 1796, to December, 1800, twice mention epidemic
catarrhs,--in February and March, 1797, and in February, 1800, the latter
chiefly among children. But to neither of them will he concede the name of
“influenza,” as the complaint was merely epidemical from a particular
state of the atmosphere, and not propagated by contagion, nor quite
general.
The symptoms, however, were headache, sometimes attended with vertigo,
a thin acrid discharge from the nostrils, slight inflammation of the
throat, a sense of constriction in the chest, with a frequent dry
cough, pains in the limbs, a white tongue, a quick and small pulse,
with a sensation of languor and general debility. These symptoms,
fairly complete for influenza of the correct type, lasted about eight
days and ended in a gentle sweat or in a diarrhoea. Coughs had been
remarkably severe and obstinate; they were frequently attended with
painful stitches and spitting of blood[692].
The Influenza of 1803.
The number of the _Medical and Physical Journal_ for March, 1803,
announced that “a cold attended by symptoms of a very alarming nature has
been general in the city of Paris for some time”; but it said nothing of
the alarming disorder being in London. It is in the next number, under the
date of Soho Square, March 11th, that a correspondent identifies the Paris
epidemic with “the complaint now general in this metropolis, and called by
some the Influenza.” In a report upon the diseases “in an Eastern District
of London from February 20 to March 20, 1803,” the “catarrhal fever” is
thus described:
“This disease has been so general as to claim the title of the
reigning epidemic, and is very similar to one which prevailed a few
years ago, and was denominated Influenza. It has generally been
introduced by chilliness and shivering, which have been succeeded by
violent pains in the head, with some discharge from the eyes and
nostrils, as in a common catarrh, together with hoarseness and cough.
The pains in the head have in some cases been the first symptoms and
have been succeeded by giddiness, sickness and vomiting” &c. There
were also rheumatic pains in the limbs, intercostals &c.
Meanwhile the information from various sources showed that the old
influenza was once more really in this country. Two collective inquiries
were made on the influenza of 1803: one by Dr Beddoes of Bristol, who
issued a circular of five queries, and received answers to them (with
other information) from one hundred and twenty-four correspondents[693];
the other by the Medical Society of London[694]. The _Medical and Physical
Journal_ and Duncan’s _Annals_ each received a few independent papers on
it; and several pamphlets were issued, mostly devoted to treatment--two in
London[695], one at Edinburgh[696], one at Bath[697], and one at
Bristol[698].
In these abundant data there is little novelty and not much variety.
The attack began with chills and severe pain in the head, along with
slight running of the eyes and nose, as typhus fever might have begun.
After the slightly catarrhal onset the malady was mostly a fever, with
dry cough, dry and hot skin, pain in the forehead and about the
eyeballs, pains in the limbs, “spontaneous” weariness and extreme
prostration--a group of symptoms which led Hooper to find a rheumatic
character in the malady. Among other symptoms were vertigo, nausea,
vomiting and diarrhoea. Much sweating is not reported; but there was
often a gentle sweat in recovering after about a week, less or more.
There was the usual range from mildness to severity. Pneumonia and
pleurisy were not rare, and were commonly the cause of fatalities.
The deaths were for the most part among the phthisical, the asthmatic and
the aged; but these were not many, certainly not so many as in 1729, 1733
and 1743, and probably in about the same proportion as in 1762, 1775 and
1782. In the London bills the weekly deaths rose in March, to an average
of 537 from an average of 429 in February, and of 375 in January, falling
to an average of 417 in April. In Ireland the epidemic is said to have
been seen among the troops in garrisons as early as December, 1802; it
became universal in spring and summer. In Edinburgh the rise in the
burials at Greyfriars churchyard was in the weeks ending 5th and 12th
April, making them about a half more than usual for the brief period. When
the wave of influenza was past, the public health in nearly all places
became unusually good, as had happened immediately after the influenza of
1782.
The question most to the front in the influenza of 1803 was its manner of
spreading. Beddoes, who believed in personal contagion, had this in view
in his five queries:
1. When did the influenza appear and disappear with you?
2. Was its date different in remote places within your reach?
3. After being general, did it occur for some time in single
instances?
4. Did it ever seem to pass from person to person?
5. If so, is it likely that clothes or fomites conveyed it in any
case?
The dates of commencement were earlier or later according to no rule of
direction or of distance from London. In some large towns of Yorkshire it
appeared to be unusually late, in Chester unusually early; Edinburgh,
certainly, was as long behind London as London was behind Paris. Haygarth,
who took the most narrow view of contagion, made out the incidence thus:
London first, then the towns which have the greatest intercourse with
London, such as Bath and Chester, then smaller towns, and last of all the
villages around each of the more populous centres. Several towns had the
brunt of the epidemic in the same weeks (of March) as London; in very few
was it later than the first weeks of April. In some towns it attracted
little notice. In North Devon, it was said to have been at Hartland and
Clovelly a fortnight before it was seen in Bideford; the first of it seen
by one of the doctors of that town was in a solitary potter’s house four
miles to the eastward, on a peninsula made by the confluence of a small
stream with the Torridge, all the inmates of the house being attacked; in
the town itself from first to last he saw but few cases, whereas there
were many in the adjacent country[699].
The general rule seems to have been that the more sparse populations had
it later, the nearer they were to the extremities of the kingdom, as in
Cornwall, the north of Scotland, and in Ireland. Opinion was divided as to
the part played by persons in carrying contagion from place to place, some
holding that the facts of diffusion could be explained on no other
hypothesis, while most held that the influenza was in the air. Beddoes got
as many answers favouring the doctrine of personal contagion as made a
respectable show for it; but when these had all been set forth to the best
advantage, a practitioner wrote to say that, after all, nine-tenths of
professional opinion was against the contagiousness of influenza. The
practical question for Haygarth, Beddoes, and other contagionists was
whether influenza was not a disease, like smallpox or scarlet fever, which
could be kept from spreading by means of isolation, disinfection (with the
fumes of mineral acids) and other precautions.
Some curious facts came out, showing the effect of influenza upon other
epidemic diseases, or the effect of other epidemic diseases upon
influenza. One writer applied to influenza what used to be said of the
plague or pestilential fever, that these Leviathan constitutions swallowed
up all other reigning epidemics. Holywell, a town in Flintshire, with a
large cotton-weaving industry, had not been free from a bad kind of typhus
for two years. “On the appearance of the influenza the typhus entirely
ceased, and only one case of fever has occurred since. I have not for many
years known this country so healthy as since the influenza
disappeared[700].” The influenza was said also to have superseded typhus
fever at Navan, in Meath[701]. At St Neots typhus was peculiarly prevalent
for three months before the influenza, but ceased thereafter[702]. Another
relation to typhus was seen at Clifton: “In the low, confined, and
ill-ventilated houses in the Hot Well road, where typhus often abounds,
the influenza was very unfrequent; while in the exposed high-lying
buildings on Clifton Hill it was almost universal[703].” As to ague, which
had often before stood in a remarkable relation to epidemics of catarrhal
fever, there is one possibly relevant fact related from the Lincolnshire
fens. A Wisbech physician writes:
“The influenza which ceased here about the middle of April made its
appearance again in May; the leading symptoms were the same as in the
first attack. About the same time also a most malignant fever, having
some symptoms in common with the influenza, began to rage in that part
of Lincolnshire contiguous to us, which has proved fatal to
hundreds[704].”
From 1803 to 1831, nothing is heard in England of a universal influenza,
although there was one such in the end of 1805 and beginning of 1806 in
Russia, Germany, France and Italy; and there were four great influenzas
in the Western Hemisphere (1807, 1815-16, 1824-25, and 1826). Catarrhs
were perhaps commoner than usual in England and Scotland in the winter of
1807-8, but they cannot be reckoned an epidemic of influenza[705]. The
summer following (1808) was unusually hot and agues became more epidemic
in the fens than at any time since the great aguish period of 1780 and
following years[706]. Agues were again unusually rife in England in 1826,
1827 and 1828, at the same time as the remarkable epidemics of them, from
inundations and subsequent drought, in Holland and along the German coast
of the North Sea. Dr John Elliotson, of London, met with cases of agues in
his practice in those years in the following scale:
Year Cases
1823 8
1824 14
1825 15
1826 44
1827 53
1828 27
1829 8
They had increased, he says, throughout the country as well as in London,
owing, as he thought, in agreement with Macmichael, to the higher mean
temperature of the respective years; and he would apply the same law of
increase to the epidemic periods of ague in Britain in former times[707].
Christison saw his first case of ague at Edinburgh in the autumn of 1827,
in a labourer who had caught it working at the harvest in the fen-country
of Lincolnshire.
The Influenza of 1831.
The next influenza in Britain fell in the early summer of 1831. It was a
mild epidemic of the catarrhal type, which attracted hardly any notice in
England. In one of the London medical journals there is no other notice of
it but this, dated 2 July, 1831[708]: “In consequence of the sudden
variations of temperature which have prevailed since the last fortnight of
May an epidemic bronchitis has shown itself in Paris.” Another London
journal[709], on the very same day, wrote: “Influenza in a severe form is
at present prevailing in London and some of the provincial towns. It
commences like a common cold, but is soon discovered to be more serious,
&c.” The physician to the public dispensary in Chancery Lane found that
more than half of the seventy applicants on 23 June came with the symptoms
of influenza--severe, harsh, dry cough, in paroxysms, pain behind the
sternum, a fixed pain in one side, congested state of the throat, nose and
eyes, heaviness of the head, languor, debility, hot skin, foul tongue,
impaired sense of taste. The symptoms went off after three or four days
with a sweat in the night and a discharge from the nostrils[710].
This epidemic hardly affected the London bills of mortality, according to
the following figures:
Four weeks, 25 May to 21 June, 1579 births, 1430 deaths.
Five weeks, 22 June to 26 July, 2153 births, 2010 deaths.
Four weeks, 27 July to 23 Aug., 1997 births, 1652 deaths.
The rise in the last four weeks was due to summer diarrhoea, or choleraic
diarrhoea, which was unusually common in 1831. This slight influenza was
also reported from Plymouth by a surgeon who had seen the disease, and
suffered from it, at Manilla in September, 1830[711], and by a Plymouth
practitioner, who wrote, on 14 July, that it had been extensively
prevalent there and in the neighbouring towns and villages[712]. It is
recorded also from the Isle of Man, Glasgow[713], and Ayr[714], and it is
supposed to have been in Aberdeen[715]. But, while there are many
accounts of this epidemic in Germany in May and June, and undoubted
evidence of it in France and Italy, as well as in Sweden, and in Poland
and Russia earlier in the year, the accounts of it in Britain are so
meagre and casual as to make one doubt whether it really was an influenza
worth reckoning.
The Influenza of 1833.
The next year, 1832, which was the first great season of Asiatic cholera
in Britain, is absolutely free from records of influenza in all Europe. It
was in the spring of the year following, 1833, that the really serious
influenza came. The continental literature of the epidemic of 1833 is
immense, the English literature of it is all but non-existent: and yet it
was a very severe influenza with us, just as with other European peoples.
There was no collective inquiry in Britain on this occasion, such as had
been made first by Fothergill in 1775, by the College of Physicians and
another Society in 1782, by Simmons in 1788, and by Beddoes and the
Medical Society of London in 1803, or such as was made in the next
influenza, that of 1837, by a committee of the Provincial Medical
Association. But enough is known of it to place it among the severer
influenzas. In London the bills of mortality, which relate only to a part
of London, showed the characteristic sudden rise and fall:
Baptisms Burials
Four weeks, 20 Feb. to 16 March 2310 2352
Five " 17 March to 23 April 1955 2105
Four " 24 April to 21 May 2016 3350
Four " 22 May to 18 June 2070 1685
For a whole month the burials in London were nearly doubled, and for the
two worst weeks they were nearly quadrupled. This mortality, by all
accounts, fell most on the richer classes, to whom it was a much more
serious calamity than the Asiatic cholera of the year before. The
president of the Medical Society said, on the 22nd April, that he had
“heard of nine lords or ladies who had been carried off by it or by its
indirect agency, in the course of last week[716].” Its type in the month
of May was worse than in April[717]. When it was first seen it was a
somewhat short catarrhal attack, ending in a sweat after two, three or
four days, with the usual head-pains, soreness of the ribs and limbs,
languor and prostration. Later, it became a more “adynamic” illness,
beginning indeed with slight catarrhal symptoms, but soon passing into
subacute nervous fever which might last for three weeks, involving much
risk to life[718]. Hence arose the warnings, just as in 1890-92, that the
influenza was a much more serious thing than it had been thought when the
epidemic began, and hence the delay, as it were, in the bills of mortality
to show the effects of the epidemic until it had been two or three weeks
prevalent. It is to the month of April, before the highest death-rate was
reached in London, that the following, in the _Gentleman’s Magazine_,
applies[719]:
“During the month a severe form of catarrhal epidemic, generally
termed influenza, has been extremely prevalent in London. It has laid
up at once all the members of many large households, and has attacked
great numbers in several public offices, particularly the Bank of
England and some divisions of the new police. The performers at the
theatres have much suffered, and their houses have been closed for
several nights. It commences suddenly with headache and feeling of
general discomfort, attended or soon followed by cough, hoarseness, or
loss of voice; oppression, and sometimes severe pain in the chest,
tenderness about the ribs, and sense of having been bruised about the
limbs or muscles.... The disease is generally attributed to the
constant north-east winds; but by some of the learned is regarded as
the epidemic influenza which has lately prevailed in the eastern parts
of Europe, and that is travelling, like many of its predecessors, to
the west.”
It would have been in this earlier stage of the epidemic, when it was
laying up whole households, thinning workshops and closing theatres, that
a practitioner was heard to say (as reported by the _Lancet_): “Best thing
I ever had! Quite a godsend! Everybody ill, nobody dying!” The seriousness
of the disease was, however, at length recognized, so that the members of
the Medical Society debated the subject at three successive meetings. One
of the questions was, whether the malady called for blooding--a question
that had divided opinion as long ago as 1658[720]. On 13 May, the
following passed at the Medical Society:
Mr Williams remembered the similar influenza of 1803, and said that
depletion was then regarded as an injurious plan of treatment.
Mr Proctor:--Yes, but the Brunonian doctrines were then in full fling,
and practitioners had not learned the full use of the lancet.
Graves states very fairly the reasons that induced them to take blood in
the influenza of 1833, as well as the results of the practice[721]:
“The sudden manner in which the disease came on, the great heat of
skin, acceleration of pulse, and the intolerable violence of the
headache,--together with the oppression of the chest, cough, and
wheezing--all encouraged us to the employment of the most active modes
of depletion; and yet the result was but little answerable to our
expectations; for these means were found to induce an awful
prostration of strength, with little or no alleviation of the
symptoms.”
The prostration, be it said, was probably as great and as frequent in the
epidemics of 1890-93, when bleeding had gone out altogether; still it was
not understood that all these signs of sthenic action in the attack were
really paradoxical, as Whitmore, in the passage cited in the note, saw
clearly two centuries before.
The epidemic became rapidly prevalent all over England, Scotland and
Ireland in April and May, following no very definite order of progression.
The Liverpool newspapers asserted that ten thousand were down with it in
that town in one week. A doctor at Lincoln wrote, on 13 May, that few
families there had escaped it[722]. Other towns in which it is said to
have been “more or less” prevalent were Portsmouth, Sheffield, Birmingham,
Leeds, York, Halifax, Glasgow, Edinburgh[723], Dublin and Armagh; so that
we may fairly assume, although we are without the detailed evidence
available for earlier epidemics, that it was ubiquitous in town and
country.
At Birmingham[724], among the outpatients of the Infirmary, the cases of
influenza were as follows, the 25th and 26th April being the days when
cases came first in rapid succession, while the middle of May was
practically the limit:
Cases of
Influenza Males Females
April 151 52 99
May 464 159 305
June 28 9 19
--- --- ---
643 220 423
The great excess of females is remarkable, but was probably due to some
local circumstances. Of the 643 cases, 122 were under ten years of age. Of
the females, 9 died, of the males 3. But the deaths in Birmingham caused
by the epidemic directly or indirectly were many; the burial registers of
four churches and chapels showed a marked increase of burials above those
of the corresponding months of 1832:
1832 1833
April 205 245
May 211 434
June 193 230
--- ---
609 909
Medical opinion in 1833 was decidedly adverse to the contagiousness of
influenza. The common remark was that it was just as little contagious as
the cholera of the year before had proved to be. As in 1837 and 1847, when
the doctrine of contagiousness was equally out of favour, the disease was
observed to spread rapidly, in no very definite line, affecting most parts
of the country in the same two or three weeks, affecting the population
within a considerable radius almost at once, and the inmates of houses all
together. These, it was said, are not the marks of a disease that persons
hand on one to another, _quasi cursores_.
The Influenza of 1837.
Between the influenza of April-May, 1833, and that of January-February,
1837, it seems probable that there were minor catarrhal outbreaks,
distinguishable from ordinary colds. One writer on the influenza of 1837
refers to those “who had it in 1834 or in the intervening period between
the two epidemics.” The table of diseases of the outpatients at the
Birmingham Infirmary for the year 1836 contains a large total of catarrhs,
and, in another line, 24 cases of “epidemic catarrh” in the summer months.
The _Gentleman’s Magazine_ begins its notice of the epidemic of 1837 by
calling it “an influenza of a peculiar character,” which shows that
influenza of the ordinary kind was a familiar thing. Probably the name was
a good deal misapplied in the years following every great epidemic from
1782 onwards: thus in ‘St Ronan’s Well,’ which was written in 1823, or
twenty years from the last general influenza, a tradesman’s widow in easy
circumstances and given to good living comes to the Spa on account of a
supposed malady which she calls the _influenzy_. But our recent
experiences of four great influenza seasons in succession from 1889-90 to
1893, although it is without precedent in the history, will incline us the
more to credit what is recorded of influenza cases in the intervals
between the years of great historical epidemics[725]. However that may be
for the years following 1833, the influenza of January, 1837, was sudden,
simultaneous, universal.
The first cases, which Watson compares to the first drops of a
thunder-shower, were seen earlier in some places than in others; but from
all parts of England it was reported that the influenza was at its height
from the middle of January to the end of the first week of February.
Possibly it was a few days earlier in London than in most other towns,
inasmuch as the great increase of the deaths that is shown in the
following table, in the second and third weeks of January, would imply a
prevalence of the epidemic for at least a fortnight before.
_Weekly Mortalities in London (by the old Bills)._
1837
Week ending Influenza All causes
Jan. 10 0 284
17 13 477
24 106 871
31 99 860
Feb. 7 63 589
14 35 558
21 20 350
28 8 321
March 7 4 262
This sudden rise in the deaths from all causes is a characteristic
influenza bill, comparable with those already given from 1580 onwards.
But the bill is far from showing the whole of the mortality in London in
1837. The London bills of mortality compiled by the Parish Clerks’ Company
had fallen into the last stage of inadequacy, and were on the eve of being
superseded by the general system of registration for all England and
Wales[726].
The London bills, so long as they existed, never took in the great
parishes of St Pancras, Marylebone, Kensington and Chelsea. The area
“within the bills of mortality” was that of London about the middle of the
18th century. But, instead of becoming more and more crowded as time went
on, it had actually become much less populous, especially in the old City
and Liberties, owing to the erection of warehouses, workshops,
counting-houses and other non-residential buildings where dwelling houses
used to be; so that the decrease of mortality “within the bills” in the
19th century is in part due to the decrease of population within the same
area. This has to be kept in mind when the above table is compared with
one of those for former influenzas, such as that of 1737, exactly a
hundred years before.
It was thought that the 1837 influenza in London was worse than that of
1833, but the figures show the contrary as regards the number of deaths
from all causes[727]. Both of them, however, were in the first rank of
severity, finding their nearest parallels in the three great influenzas of
the 18th century, in 1733, 1737 and 1743, when the deaths from all causes
during the influenza rose, indeed, to a much larger total within the
bills, but rose from a much higher mean level.
In Dublin the great increase of burials from the influenza of 1837 fell
at the same time as in London, according to the following comparison with
the year before for Glasnevin Cemetery[728]:
1835-36
Dec. 1835 355
Jan. 1836 392
Feb. " 362
Mar. " 392
----
1501
1836-37
Dec. 1836 413
Jan. 1837 821
Feb. " 537
Mar. " 477
----
2248
At Glasgow the deaths from influenza were as follows[729]:
1837
Males Females Total
January 111 118 229
February 37 62 99
March 9 20 29
--- --- ---
157 200 357
But the heading of “influenza” did not nearly show the full effects of the
epidemic upon the mortality, which was enormous in Glasgow in January, as
compared with the same month of 1836:
---------------------------------------------------------------
|| All causes||Catarrh| Aged| Asthma| Fever| Decline
----------||-----------||-------|-----|-------|------|---------
Jan. 1836 || 790 || 4 | 73 | 31 | 45 | 124
Jan. 1837 || 1972 || 229 | 274 | 185 | 201 | 247
There was also a great increase in the deaths of infants by bowel
complaint. The only period of life which did not show a great rise of
mortality was from five to twenty; the greatest rise was between the ages
of forty and seventy, corresponding to the London experience in the
epidemic of 1847.
At Bolton, Lancashire, the great rise in the deaths, as compared with the
average of five years before, was in February:
Average of
five years
1831-36 1837
January 111·2 115
February 79·0 205
March 97·8 100
----- ---
288·0 420
At Exeter, the burials in the two chief graveyards were 227 in January
and February, 1837, as compared with 125 in the same months of 1836. These
mortalities, although large, were but a small ratio of the attacks. In
2347 cases enumerated in the collective inquiry, there were 54 deaths, a
ratio of two deaths in a hundred cases being considered a full average.
The attacks were mostly in middle life, and the deaths nearly all among
the asthmatic, the consumptive and the aged. The ages of one hundred
persons attacked at Birmingham were as follows[730]:
Ages 1- 5- 10- 20- 30- 40- 50- 60- 70- 80-90
Cases 3 2 12 23 21 19 12 7 0 1
At Evesham only five out of 93 were under five years. At Leamington, in a
list of 170 cases, there were 26 under fourteen years, 119 from fourteen
to sixty-five years, and 25 above the age of sixty-five[731]. In some
places males seemed to be most attacked, just as at Birmingham in 1833
there was a great excess of female cases; but the collective inquiry
showed that the sexes shared about equally all over. The type of the
malady was on the whole catarrhal, as in 1833. Nearly all the cases had
symptoms of sneezing, coughing, and defluxions; many cases had nothing
more than the symptoms of a severe feverish cold; the more dangerous cases
had dyspnoea, pneumonia and the like; while all had the languor,
weariness, and soreness in the bones which mark every influenza, whether
it incline more to the moist type of catarrhal fever or to the dry type of
the old “hot ague.”
The influenza of 1837 having been remarkably simultaneous, sudden and
brief, the doctrine of personal contagiousness found little favour, just
as in 1833. The 12th query sent out by the committee of the Provincial
Medical Association was: “Are you in possession of any proof of its having
been communicated from one person to another?” The answers are said to
have been nearly all negative; namely, that there was “no proof of the
existence of any contagious principles by which it was propagated from one
individual to another.” Shapter, a learned physician at Exeter, inclined
to a certain modified doctrine of contagion by persons. Blakiston, of
Birmingham, an exact mathematician, declared that the question as
ordinarily stated did not admit of an answer.
At Liverpool there was an interesting observation made, exactly parallel
with those made at Gravesend in 1782 and Portsmouth in 1788. The influenza
of 1837 was practically over by the first or second week of March; but
“that the atmosphere of Liverpool was still contaminated by the epidemic
influence up to the middle and latter end of April was apparent from the
fact that many of the officers and men of the American ships, and
generally the most robust, were violently attacked shortly after their
arrival in port,”--the same being the case also with black sailors on
ships arriving from the Brazils and the West Coast of Africa[732]. At the
naval stations of Sheerness, Portsmouth, Plymouth and Falmouth, every one
of the ships of war had been attacked in January, the ships cruising on
the south coast of Spain, or lying at Barcelona, in February, the ships at
Gibraltar in April, and those at Malta in May. The ‘Thunderer,’ on the
passage from Malta to Plymouth, had the first cases of influenza at sea on
the 3rd of January, four days before reaching Plymouth[733], as if she had
sailed into an atmosphere of it somewhere near the coast of Brittany.
* * * * *
For fully ten years, from March or April 1837 to November 1847, there was
no great and universal influenza in England. But there were several
undoubted minor, and perhaps localized, outbreaks of an epidemic malady
which was in each case judged to be truly the influenza, and not a common
cold. The earliest of these was in the spring of 1841. It was recognized
by the Registrar-General to have been in London from 20 February to 24
April, the mortality having been little affected by it. It was also
recognized in Dublin in March, and remarked upon by two physicians to the
Cork Street Fever Hospital; it was characterized by the usual languor,
weariness, and pains in the head, by defluxions of the eyes, nose and
throat, but not by any affection of the lungs, and was in all respects
mild[734]. Exactly a year after, in March, 1842, influenza was described
as epidemic at York[735]: it was noted also in London in March[736], and
is mentioned as having been again in Ireland in 1842[737]. The next
undoubted influenza is reported from a rural part of Cheshire (Holme
Chapel) in January, 1844, in the wake of an epidemic of scarlatina; it
continued in all kinds of weather until June, and had a remarkable
intercurrent episode, for some weeks from the middle of March, in the form
of an epidemic of pneumonia among young children, which passed into mild
bronchitis in the cases last attacked[738]. Coincidently with the
influenza in Cheshire, there is a report of a series of catarrhal cases in
Dublin about the beginning of January, 1844, in which the sense of
constriction and suffocation under the sternum and the paroxysmal
character of the attacks seemed to point to influenza[739]. Two years
after, a Dublin physician in extensive practice among the rich wrote, at
the request of a medical editor, an account of an epidemic of influenza in
January and February, 1847; he had sixty cases among children under
fourteen in his private practice, usually several children in one house,
and sometimes the adults in the house[740]. This was in the midst of the
great epidemic of relapsing fever in Dublin and all over Ireland, due to
the potato famine. The same prevalence of influenza to a slight extent is
recorded also for London at the end of 1846 and beginning of 1847[741]. It
is easy to object that these “influenzas” between 1837 and 1847 were but
the ordinary catarrhal maladies of the seasons. But the physicians who
took the trouble to record them--probably more might have done so--were,
of course, aware of the distinction that had to be made between many
common feverish colds concurring in the ordinary way, and a truly epidemic
influenza, however slight.
The Influenza of 1847-48.
The great influenza of 1847 began in London about the 16th or 18th of
November, was at its height from the 22nd to the 30th, had “ceased to be
very prevalent” by the 6th or 8th of December, but affected the bills of
mortality for some time longer, as in the following table:
_Weekly Mortalities in London._
1847
Week ending All causes Influenza Pneumonia Bronchitis Asthma Typhus
Nov. 20 1086 4 95 61 12 86
27 1677 36 170 196 77 87
Dec. 4 2454 198 306 343 86 132
11 2416 374 294 299 78 136
18 1946 270 189 234 52 131
25 1247 142 131 107 14 83
Jan. 1 1599 127 148 138 26 74
In the thirteen weeks of the first quarter of 1848 the influenza deaths
declined as follows: 102, 102, 89, 56, 59, 47, 27, 33, 18, 11, 10, 16, 8.