registration. According to the Superintendent of Statistics, it caused an
excess of 5000 deaths during the six weeks that it lasted, of which about
a fourth part only were set down to influenza, and the rest to pneumonia,
bronchitis, asthma, etc. During the three worst weeks it raised the deaths
in the age of childhood 83 per cent., in the age of manhood 104 per cent.,
in old age 247 per cent., whereas the deaths between fifteen years and
twenty-five were but little raised by it, and those between ten and
fifteen hardly at all. It raised the deaths during six weeks in St
George’s-in-the East to a rate per annum of 73 per 1000 living: in some
other parishes it increased the death-rate very little. But it had the
usual effect of lengthening enormously the obituary columns of the
newspapers, which shows that it fell, as usual, to a large extent upon the
richer classes. It went all over England in a short time, the month of
December being the time of excessive mortality in the towns, according to
the following sample totals of deaths from all causes:
1847
Manchester Sheffield York Places in
(Ancoats) (West) (Walmgate) Scotland
October 169 27 61 521
November 135 27 52 728
December 270 85 99 1001
In some parts of England, as in Kendal, a district of Anglesea and in the
Isle of Wight, the mortality of the last quarter of 1847 was actually
lower than that of the year before. From St Albans the sub-registrar
reported that there had been “no epidemic.” In most parts of the country,
including the medium-sized towns, the mortality directly or indirectly due
to influenza was lower than in London. The principal returns did not come
in from the country until after the new year, the effects of the epidemic
having been, as usual, later in rural districts. Hence, while London had
1253 deaths put down to “influenza” in 1847 (nearly all in December), and
659 in 1848 (nearly all in the first quarter), the rest of England had
4881 influenza deaths before the New Year, and 7963 after it[742]. This
influenza in the mid-winter of 1847-8 made a great impression
everywhere[743]. As regards its range and its fatality, it was like those
of 1833 and 1837; and it had once more so much of the catarrhal type, that
the name of influenza became still more firmly joined to the idea of a
feverish cold or defluxion.
* * * * *
By the year 1847, agues had almost ceased to be written of in England,
although they still occurred in the Fens. But Peacock begins his account
of the influenza of that winter with an enumeration of prevailing
diseases, which reads somewhat like an old “constitution” by Sydenham or
Huxham. The summers and autumns of 1846 and 1847, he says, were both
highly choleraic, and dysentery (as well as enteric fever) was unusually
common in the former year. Fatal cases of “ague and remittent fever” were
also more numerous than usual. Then came much enteric fever, “not
unfrequently complicated with catarrhal symptoms.” Throughout the spring
and early summer of the influenza year, 1847, “intermittent fevers were
common, and in March, April and May, purpura was frequently met with,
either as a primary or secondary disease. Scurvy also, owing to the
deficiency of fresh vegetables, and from the general failure of the
potato crop in the previous year was occasionally seen.” Then follows much
concerning a fever called remittent, which reads more like relapsing fever
than anything else[744]. “The remittent form of fever was frequent in the
course of the epidemic [of influenza], though seldom registered as the
cause of death.” Peacock says truly that the rather unusual concurrence of
so many sicknesses was “not peculiar to the recent influenza alone;” and
he can “scarcely refrain from acknowledging that these several affections
are not merely coetaneous but correlative, and types and modifications of
one disease, with which they have a common origin. Assuming this inference
to be admitted, we may advance to the solution of the further question of
what is the essential nature or proximate cause of the disease.” But the
inquiry led him to no result: the precise cause he leaves “involved in the
obscurity that veils the origin of epidemics generally”--which are surely
not all equally obscure[745].
* * * * *
Influenza having continued epidemic for a few weeks in the beginning of
1848, ceased thereafter to attract popular notice in Britain during a
period of more than forty years. But a certain number of “influenza”
deaths continued to appear steadily year after year in the registration
tables. In 1851 this number was nearly doubled, in 1855 it was more than
trebled; and those two years were undoubtedly seasons (about January and
February) of real influenza epidemics in Europe, recorded by several but
not by English writers. A slight epidemic was described for Scotland in
1857, and one for Norfolk in 1878, neither of which seems to have
influenced the registration returns in an obvious degree. After the
undoubted influenza of 1855, the annual total of deaths in England set
down to that cause steadily declined from four figures, to three figures,
and then to two figures, standing at 55 in the bill of mortality for 1889.
It is improbable that those small annual totals of deaths in all England
and Wales were caused by the real influenza; the name at that time was
synonymous with a feverish cold, and would have been given here or there
to fatalities from some such ordinary cause. An epidemic ague was reported
from Somerset in 1858[746].
The Influenzas of 1889-94.
More than a generation had passed with little or no word of epidemic
influenza in this country, when in the early winter of 1889 the newspapers
began to publish long telegrams on the influenza in Moscow, St Petersburg,
Berlin, Paris, Madrid and other foreign capitals. This epidemic wave, like
those immediately preceding it in the Eastern hemisphere, in 1833, 1837
and 1847, and like one or more, but by no means all, of the earlier
influenzas, had an obvious course from Asiatic and European Russia towards
Western Europe[747]. In due time it reached London, and produced a decided
effect upon the bills of mortality for the first and second weeks of
January, 1890, but a moderate effect compared with that of 1847, which was
the first to be recorded under the same system of registration. It spread
all over England, Scotland and Ireland in the months of January and
February, 1890, proving itself everywhere a short and sharp influenza of
the old kind, but with catarrhal symptoms on the whole a less constant
feature than in the epidemics of most recent memory. At the end of
February it looked as if Great Britain and Ireland had got off lightly
from the visitation which had caused high mortalities in many countries of
Continental Europe. But this epidemic in the beginning of 1890 was only
the first of four, and less severe than the second and third. It returned
in the spring and early summer of 1891, in the first weeks of 1892, and in
the winter of 1893-94. To understand this influenza prevalence as a whole,
its four great seasons should be compared. The following tables show its
incidence upon London on each occasion:
_Four epidemics of Influenza in London, 1890-94._
1890
Annual
death-rate Deaths
Week per 1000 from all
ending living causes Influenza Bronchitis Pneumonia
Jan. 4 28·0 2371 4 530 215
11 32·4 2747 67 715 253
18 32·1 2720 127 630 281
25 26·3 2227 105 468 193
Feb. 1 21·8 1849 75 339 145
8 20·6 1749 38 369 117
1891
Annual
death-rate Deaths
Week per 1000 from all
ending living causes Influenza Bronchitis Pneumonia
April 25 21·0 1809 10 240 179
May 2 23·3 2006 37 280 241
9 25·6 2069 148 302 230
16 27·7 2245 266 352 207
23 27·6 2235 319 337 219
30 28·9 2337 310 353 189
June 6 27·0 2189 303 320 176
13 23·3 1886 249 255 166
20 23·0 1865 182 248 159
27 19·0 1538 117 151 113
July 4 16·8 1363 56 108 103
1891-92
Annual
death-rate Deaths
Week per 1000 from all
ending living causes Influenza Bronchitis Pneumonia
Dec. 26 21·9 1771 19 355 131
Jan. 2 42·0 3399 37 927 256
9 32·8 2679 95 740 246
16 40·0 3271 271 867 285
23 46·0 3761 506 1035 317
30 41·0 3355 436 844 255
Feb. 6 30·6 2500 314 492 215
13 24·6 2010 183 368 140
20 20·7 1693 79 259 137
1893-94
Annual
death-rate Deaths
Week per 1000 from all
ending living causes Influenza Bronchitis Pneumonia
Nov. 4 20·2 1695 8 191 125
11 21·4 1679 20 220 137
18 24·4 2016 22 318 228
25 26·5 2190 36 384 215
Dec. 2 27·1 2235 74 426 248
9 31·0 2556 127 491 266
16 29·1 2401 164 421 232
23 26·3 2170 147 387 203
30 23·3 1920 108 306 157
Jan. 6 24·5 2040 87 342 169
13 29·5 2462 75 490 211
20 23·7 1975 69 320 172
27 19·8 1655 41 232 152
It will be seen that the third epidemic, that of Jan.-Feb. 1892, had the
highest maximum weekly mortality from influenza (506) as well as the
highest maxima from bronchitis and pneumonia not specially associated in
the certificates with influenza; that the second epidemic, of 1891, had
the next highest maxima, and that the first and last of the four outbreaks
were both milder than the two intermediate ones. All but the second, which
fell in early summer, are strictly comparable as regards season
(mid-winter). But although the second, in 1891, had the advantage of
falling in some of the healthiest weeks of the year, it was more
protracted than the original outbreak, much more fatal than it in the
article influenza, more fatal also in the article pneumonia, and less
fatal only in the article bronchitis. The third outbreak was not only more
protracted than the first, in the same season of the year, but much more
fatal in all the associated articles. As to the deaths referred to
influenza (whether as primary or secondary cause), the numbers are not
strictly comparable in all the outbreaks; they are probably too few in the
first table, more nearly exact in the second, third, and fourth, the
diagnosis having at length become familiar and the fashion of nomenclature
established. It is undoubted that many of the deaths from bronchitis and
pneumonia in January, 1890, were due to the epidemic; for, “while the
ordinary rise of mortality in cold seasons is mainly among the very aged,
the increased mortality in this fatal month was mainly among persons
between 20 and 60 years” (Ogle).
While the first epidemic of the series was universal and of short duration
all over the kingdom, the second and third were more partial in their
incidence and more desultory or prolonged. The second, which began in Hull
(and at the same time on the borders of Wales), produced the following
highest weekly death-rates per annum from all causes among 1000 persons
living:
_Highest Weekly Death-rates in the Second Influenza._
1891
Annual death-rate
from all
Week causes per
ending 1000 living
Hull Apr. 11 42·5
Sheffield May 2 70·5
Halifax " 2 42·1
Leeds " 9 48·5
Manchester " 9 43·6
Bradford " 16 56·7
Huddersfield " 16 54·5
Leicester " 16 44·6
Oldham " 23 50·4
London " 30 28·9
Salford " 30 45·9
Blackburn June 6 48·5
The third was heard of first in the west of Cornwall and in the east of
Scotland, in the last quarter of 1891. It was in the following English
towns that it produced the maximum weekly death-rates per annum from all
causes:
_Highest Weekly Death-rates in the Third Influenza._
1892
Annual death-rate
Week from all causes
Town ending per 1000 living
Portsmouth Jan. 16 57·0
London " 23 46·0
Norwich " 23 44·7
Brighton " 23 60·9
Croydon " 30 47·2
These highest death-rates in the third successive season of influenza were
all in the southern or eastern counties; in the latter, Colchester also
had a maximum death-rate during one week of about 80 per 1000 per annum.
Liverpool, among the northern great towns, appears to have had most of the
third influenza. The fourth outbreak, in the end of 1893, was noticed
first in the Midlands (Birmingham especially), and was afterwards heard of
in the mining and manufacturing districts of Staffordshire, South Wales,
Lancashire, Yorkshire and Durham, as well as in Scotland and Ireland,
London, as in the table, having a share of it. The tables given of the
London mortality in each of the four outbreaks, from influenza and the
chest-complaints which were its most usual secondary effects, are a fair
index both of the period and of the severity of the disease all over the
kingdom in each of its successive appearances[748]. Everywhere the first
and the fourth were the mildest, the second and third the most fatal.
Deaths from “influenza” were reported from all the counties of England and
Wales in the first and second epidemics, the highest rates of mortality
per 1000 inhabitants in the corresponding calendar years having been in
the following counties, while in all the counties the greater fatality of
the second epidemic is equally marked:
1890
Cumberland ·35
North Wales ·28
Herefordshire ·28
Salop ·28
Wilts ·28
Somerset ·26
Dorset ·25
Bucks ·25
1891
Rutland 1·36
Lincolnshire 1·19
North Wales 1·09
Westmoreland 1·02
Monmouth 1·00
E. Riding Yorks ·98
Herefordshire ·98
Northamptonshire ·95
In London the entry of influenza is in the weekly bills of mortality
throughout the whole period, with the exception of a few weeks; but the
deaths were often reduced to unity, and there was perhaps only one
occasion, besides the four great outbursts, namely the months of March and
April, 1893, when cases were so numerous or so close together in
households or neighbourhoods as to constitute a minor epidemic.
The type of the influenza of 1890-93 was not quite the same as on the last
historical occasions. When it was announced as approaching from the
Continent, everyone looked for “influenza colds”; but the catarrhal
symptoms, although not wanting, were soon found to be unimportant beside
the nameless misery, prostration and ensuing weakness. Some, indeed,
contended that the disease was not influenza but dengue, so pronounced
were the symptoms of break-bone fever[749]. Many cases had a decided
aguish or intermittent character. The name of ague itself was once more
heard in newspaper paragraphs, and more freely used in private talk; but,
as we have long ceased to write of epidemic agues, equally as of marsh
intermittents, in this country, it is not probable that there will remain
any record of agues in Britain accompanying the influenzas of the years
1890-94. On the other hand the complications and after-effects of our
latest influenza, more especially as affecting the nervous system, have
been very fully studied[750].
That which chiefly distinguishes the influenza of the end of the 19th
century from all other invasions of the disease is the revival of the
epidemic in three successive seasons, the first recurrence having been
more fatal than the original outbreak, and the second recurrence more
fatal (in London at least) than the first. The closest scrutiny of the old
records, including the series of weekly bills of mortality issued by the
Parish Clerks of London for nearly two hundred years, discovers no such
recurrences of influenza on the great scale in successive seasons. It is
true that several of the old influenzas came in the midst of sickly
periods of two or more years’ duration, such as the years 1557-58,
1580-82, 1657-59, 1678-80, 1727-29 and 1780-85. But in those periods the
bulk of the sickness was aguish, the somewhat definite episodes of
catarrhal fever having been distinguished from the epidemic agues by
Willis in 1658, by Sydenham in 1679, by several in 1729, and by Baker,
among others, in 1782. It is probable, indeed, that there were two
strictly catarrhal epidemics in successive years in the periods 1657-59
and 1727-29, just as we know that, in New England, there was a catarrhal
epidemic in the autumn of 1789 and an equally severe influenza, less
catarrhal in type, in the spring of 1790[751]. But history does not appear
to supply a parallel case to the four successive influenzas in the period
1889-94, unless we count the seasonal epidemic agues of former
“constitutions” as equivalent to influenzas for the purpose of making out
a series.
The Theory of Influenza.
Influenza is not an infection which lends itself to a simple theory of its
nature or a neat formula of its cause. All that one can do is to indicate
the direction in which the truth lies. Something broad, comprehensive,
steady from age to age, telluric if not cosmic, must be sought for. Some
have thought that the legendary or representative universal sickness at
the siege of Troy was influenza, because it began upon the horses and
dogs, as so many historical influenzas have done. But it will be
sufficient to show that influenza was the same in the Middle Ages as now;
for what circumstances make a broader contrast than medieval and modern?
The first writer in England to mention influenza--of course not under that
name--was a dean of St Paul’s in the reign of Henry II., Radulphus de
Diceto[752]. He is narrating the journey to Rome of the archbishop-elect
of Canterbury: his election in England was in June, 1173, he had got as
far as Placentia by Christmas, whence he turned aside to Genoa, and at
length reached Rome, to have his election confirmed by the pope in the
nones of April, 1174. It is in the midst of this account of the
archbishop’s journey, that reference is made to an influenza, otherwise
known, from German and Italian chronicles, to have happened in December,
1173: “In those days the whole world was infected by a nebulous corruption
of the air, causing catarrh of the stomach and a general cough, to the
detriment of all and the death of many”--_universus orbis infectus ex
aeris nebulosa corruptione_. What kind of infection can that be which has
befallen men on both sides of the Alps within the same short time in the
12th century as in the 19th? And what kind of infection is it which has
outlived so many changes in the great pestilences of mankind, has seen the
extinction of plague and the rise of cholera, and all other variations,
most of them for the better, in the reigning types of epidemic sickness?
To have lasted unchanged through so many mutations of things, from
medieval to modern, and from modern to ultra-modern, and to have become
more inveterate or protracted at the end of the 19th century than it had
ever been, is unique in this history. Influenza appears to correspond with
something broadly the same in human life at all times. Or is it rather a
thing telluric, of the crust of the earth or the bowels of the earth? Or
is it perhaps cosmic, affecting men as the vintage is affected by a comet,
or as if it came from the upper spheres? My belief is that we need not
transcend the globe to look for its source, and that, upon the earth, we
need not go deeper than the surface, nor beyond the inhabited spots. I
shall come back to this from giving the history of English opinion upon
it.
The best known influenzas of the 16th century all came in summer, as some
of the later ones have done, so that no one thought of them as exaggerated
common colds. But it happened that the influenzas observed by Willis in
1658, and by Sydenham in 1675 and 1679, came in spring or winter and in
such weather as to suggest to each of those physicians that the catarrhal
symptoms corresponded to the season. Robert Boyle, their great
philosophical contemporary, was also a witness of one or more of these
influenzas, and it appeared to him that there was more than season and
weather in them.
“I have known a great cold,” he says, “in a day or two invade
multitudes in the same city with violent, and as to many persons,
fatal symptoms; when I could not judge (as others also did not), that
the bare coldness of the air could so suddenly produce a disease so
epidemical and hurtful; and it appeared the more probable that the
cause came from under ground, by reason that it began with a very
troublesome fog[753].”
I am unable to say whether Boyle was the first to apply the doctrine of
telluric or subterranean emanations to influenza; he was certainly not the
first to apply it to pestilences in general, for it is found in Seneca
among the ancients[754], and it is clearly stated in Ambroise Paré’s essay
“Sur les Venins,” having been probably a familiar notion of the sixteenth
century, although a mystical and undefined one. Sydenham also, who must
have discussed these questions with Boyle, referred all the more obscure
or “stationary” epidemic constitutions to effluvia discharged into the air
from “the bowels of the earth”: those hypothetical miasmata were for him
the τὸ θεῖον of Hippocrates, the mysterious something which had to be
assumed so as to explain plague, pestilential fever, intermittent and
remittent fevers, the “new fever” of 1685-6, and all other epidemic
constitutions which were not caused by obvious changes of season and
weather. But it does not appear, and it is not probable, that he ascribed
to that mysterious cause the two transient waves of influenza which fell
within his own experience, those of November, 1675, and of November, 1679.
On the other hand, Boyle certainly did so; he included influenza in his
hypothesis explicitly; and if one examines its general terms, it will
appear as if it had been made specially for influenza.
Boyle’s general expression, for both endemial and epidemic maladies, is
that they are due to subterranean effluvia sent up into the air. As a
chemist, and as dealing with the new knowledge then most in vogue, he
assumed the sources of these miasmata to be for the most part mineral
deposits in the crust of the globe, especially “orpimental and other
mischievous fossiles”; but later in his writing he says:
“To speak candidly I do not think that these minerals are the causes
of even all those pestilences whose efficients may come from under
ground”; there were many mischievous fossils of which physicians and
even chymists had no knowledge, and “the various associations of
these, which nature may, by fire and menstruums, make under ground and
perhaps in the air itself, may very much increase the number and
variety of hurtful matters.”
He makes provision, also, for the hurtful matters multiplying in their
underground seats, according to a principle which we know now to be true
for organic, instead of mineral matters, and to be true for them above
ground, or in the air, as well as under ground:
“I think it possible that divers subterraneal bodies that emit
effluvia may have in them a kind of propagative or self-multiplying
power. I will not here examine whether this proceeds from some seminal
principle, which many chymists and others ascribe to metals and even
to stones; or (which is perhaps more likely) to something analogous to
a ferment, such as, in vegetables, enables a little sour dough to
extend itself through the whole mass, or such as, when an apple or
pear is bruised in one part, makes the putrefied part by degrees to
transmute the sound into its own likeness; or else some maturative
power ... as ananas in the Indies, and medlars ... after they are
gathered, acquire (as it were spontaneously) in process of time a
consistence and sweetness and sometimes colour and odour, and, in
short, such a state as by one word we call maturity or ripeness.”
Other of Boyle’s fruitful principles (I am separating them out from amidst
much other matter not specially related to influenza) are these:
“It is possible that these effluvia may be, in their own nature,
either innocent enough, or at least not considerably hurtful, and yet
may become very noxious if they chance to find the air already imbued
with certain corpuscles fit to associate with them.”
Again, the effluvia sent up into the air may pass by certain places
without causing an epidemic, because these “are not inhabited enough
to make their ill qualities taken notice of; but, more frequently,
because by being diffused through a greater tract of air, they are
more and more dispersed in their passage, and thereby so diluted (if I
may so speak) and weakened as not to be able to do any notorious
mischief.”
Again, the effluvia may not produce epidemic disease at the part of
the globe where they had emerged from under ground; an illustration of
which may be intended in the case of the Black Death, which, as he
says, came from China, yet plague is little heard of in that country,
a Jesuit, Alexander de Rhodes, who spent thirty years in those parts,
testifying that the plague is not so much as spoken of there. Again,
why are some epidemics of so short duration at a given place? Either,
he answers, because the morbific expiration from under ground had
ascended almost at once, and been easily spent; or the subterraneal
commotion which sends up the miasmata “may pass from one place to
another and so cease to afford the air incumbent on the first place
the supplies necessary to keep it impregnated with noxious exhalation;
and it agrees well with this conjecture that sometimes we may observe
certain epidemical diseases to have, as it were, a progressive motion,
and leaving one town free, pass on to another”--as notably in the case
of sweating sickness and influenza.
Lastly there are ever new forms of epidemic disease appearing, not to
count every variation of an autumnal ague “which the vulgar call a New
Disease.” Of the really new types Boyle offers the following
explanation: “Some among the emergent variety of exotick and hurtful
steams may be found capable to disaffect human bodies after a very
uncommon way, and thereby to produce new diseases, whose duration may
be greater or smaller according to the lastingness of those
subterraneal causes that produce them. On which account it need be no
wonder that some new diseases have but a short duration, and vanish
not long after their appearing, the sources or fumes being soon
destroyed or spent; whereas some others may continue longer upon the
stage, as having under ground more settled and durable causes to
maintain them.”
As a chemist, Boyle sought for the source of the pestilential emanations
in underground minerals, in the new combinations of these under the action
of “fire and menstruums,” in their self-multiplying power as if by
subterraneous fermentation (“which many chymists and others ascribe to
metals and even to stones”), and in their meeting with suitable
“corpuscles” in the air of an inhabited spot wherewith to combine for
their morbific effects. He assumed, also, their discharge into the air at
particular spots of the globe (where they might not be directly morbific
in their effects), or in a series of localities from the wave-like
progress of the underground commotion; in which assumption he seems to be
applying the very old idea of classical times that earthquakes and
volcanic eruptions were a cause or antecedent of epidemics. Sometimes his
mineral fossils were deep in the crust of the globe, touched only by the
greater cataclysms; and then we might expect novelties in the forms of
epidemic disease. But he does not exclude emanations from the earth’s
surface proceeding more gently or insensibly.
It would be a mistake to set aside Boyle’s hypothesis of epidemical
miasmata as made altogether void by his choosing strange minerals to be
the source of them, and by his assuming a kind of fermentation in these
inorganic matters so as to explain the continuance and spreading of the
infections. Substitute organic matters in the soil for minerals in the
crust of the earth, and read a modern meaning into the doctrine of
underground or aërial fermentation or leavening, and we shall find Boyle’s
hypothesis, especially as applied to influenza, far from obsolete. Some
such adaptation of the doctrine of miasmata was made two generations later
by Dr John Arbuthnot in his ‘Essay concerning the Effects of Air upon
Human Bodies,’ the immediate occasion of which was the London influenza of
1733. There is nothing to note between Boyle and Arbuthnot; for Willis
and Sydenham, using the Hippocratic language of “constitutions,”
explained, as we have seen, the epidemic catarrhs of the spring or winter
as the reigning febrile constitution modified to suit the season and
weather.
Arbuthnot’s essay makes more modern reading than Boyle’s. He assumes
emanations from the ground, but they are no longer from the bowels of the
earth, or from deposits of strange minerals requiring earthquakes to set
them free, or “fire and menstruums” to give potency to them. Of all the
things that pass into the atmosphere, he makes most of the various steams
and other volatile decomposing matters of men and animals; and when he
brings in the earth, it is as the storehouse or receptacle of such
matters, in a surface stratum no deeper than the effects of drought and
rainfall could reach. While he accepts the Hippocratic doctrine of
epidemic constitutions, and recognizes the air with its various organic
contents as the τὸ θεῖον, the _quid divinum_ or mysterious something of
epidemical causation, he does not forget that the earth is inhabited by
creatures, human and other, who befoul the atmosphere by “their own
steams”; again, he lays stress upon alternations of drought and moisture
in the soil and subsoil as a cause of morbific emanations, not, indeed,
stating the matters of fact in the very terms of Pettenkofer’s law, but
assuming the presence of special organic matters in the soil as much as
that does. Although Arbuthnot was hardly a serious epidemiologist, any
more than Boyle, yet in the growth of opinion on the subject of morbific
matters in the air, he may be said to have shifted the interest from
inorganic or mineral substances and gases, to organic matters chiefly of
human or animal origin, and from the deeper regions of the globe, such as
only earthquakes reach, to the surface stratum of soil and subsoil which
is affected by every rise and fall of the ground-water. I shall now give a
few extracts, to bear out the above summary, from Arbuthnot’s essay.
“Air,” he says, “is the τὸ θεῖον in diseases, which Hippocrates takes
notice of. Air is what he means by the powers of the universe, which,
he says, human nature cannot overcome; and he lays it down as a maxim
‘that whoever intends to be master of the art of physick must observe
the constitution of the year; that the powers and influence of the
seasons (what are seldom uniform) produce great changes in human
bodies.’” He then pays a compliment to Sydenham as “endowed with the
genius of Hippocrates,” and passes on to his own analytic method.
“Many great effects must follow, and many sudden changes may happen in
human bodies by absorbing outward air with all its qualities and
contents. Nothing accounts more clearly for epidemical diseases
seizing human creatures inhabiting the same tract of earth, who have
nothing in common that affects them except air: such as that
epidemical catarrhous fever of 1728 and of this present year
[1733].... It seems to be occasioned by effluvia, uncommon either in
quantity or quality, infecting the air.... It is likewise evident that
these effluvia were not of any particular or mineral nature, because
they were of a substance that was common to every part of the surface
of the earth: and therefore one may conclude that they were watery
exhalations, or, at least, such mixed with other exhalable substances
that are common to every spot of ground.”
In his account of the qualities and contents of the air, he enumerates
them, not so much as detected in the air on analysis, but as having of
necessity passed into it, and in some instances been deposited again
from it, as in strange dews. One class of substances that pass into
the air are the oils, salts, seeds and insensible abrasions of
vegetables. Also all excrements and all the carcases of animals vanish
into air. Another ingredient of the air is the perspirable matters of
animals, the amount of which for human beings he works out by a
curious calculation of a column of their own steams raised so many
feet high in so many days. Perhaps there are insects in the air
invisible to human eyes: one may observe, in that part of a room which
is illuminated with the rays of the sun, flies sometimes darting like
hawks as if it were upon a prey. Some have imagined the plague to
proceed from invisible insects: this system agrees with many of the
appearances in the progress or manner of propagation of that disease,
but is altogether inconsistent with others. Air replete with the
steams of animals, especially such as are rotting, has often produced
pestilential fevers in that place: of which there are many instances.
But why should certain years or seasons have a pestilential
atmosphere, for example the season of the catarrhous fever of 1733?
There had been, he says, an unusual drought for these two years past,
the best estimate of the dryness of the surface of the earth being
taken from the falling of the springs, “the consequence of which has
been unusual diseases amongst several animals, and a great mortality
amongst mankind. It is true, this did not happen during the dry
weather.... The previous great drought must have been particularly
hurtful to mankind. Great droughts exert their effects after the
surface of the earth is again opened by moisture, and the perspiration
of the ground, which was long suppressed, is suddenly restored. It is
probable that the earth then emits several new effluvia hurtful to
human bodies: this appeared to be the case by the thick and stinking
fogs which succeeded the rain that had fallen before.”
Arbuthnot knew the progress of the influenza of 1732-33. Its worst week in
London was from the 23rd to the 30th January, 1733; but he tells us that
it had been at a height in Saxony from the 15th to the 29th November,
1732, had been earlier in Holland than in England, earlier in Edinburgh
than in London, in New England before Great Britain. Again, it appeared in
Paris in February, somewhat later than in London, and in Naples in March.
This progress, he says, was often against the wind. Nor does he assume a
progressive infection of regions of atmosphere. The effluvia, he says,
were of a substance that was common to every part of the surface of the
earth; they were exhalable substances that were common to every spot of
ground; the excessive drought of two years, followed by heavy rains in the
end of 1732, is also assumed to have been common, for, in Germany and
France, especially in November, 1732, the air was filled with frequent
fogs. It is clear that Arbuthnot traced the universality of influenza, the
uniform symptoms of which he recognized, to certain conditions of soil and
atmosphere common to all the countries visited by the epidemic.
Throughout the rest of the 18th century there were numerous and varied
experiences of influenza, in summer and winter, spring and autumn, coming
up from the south as if from Africa, or from the east as if from Central
Asia, or appearing in America sooner than in Europe--experiences which
made a theory of the disease difficult. Some inclined to Arbuthnot’s view
of unusual seasons and weather producing the same effects everywhere;
others favoured the hypothesis of contagion from a remote source, which
might be China or might be some other territory. Geach, a surgeon at
Plymouth who was a Fellow of the Royal Society, actually went back to the
astrological cause, pointing out that Jupiter and Saturn were in a certain
conjunction during the influenza of 1775. The only elaborate theory of the
strange disease that calls for notice, besides those of Boyle and
Arbuthnot, is that of Noah Webster, the famous lexicographer of Hartford,
Connecticut.
While Webster was a journalist in New York about the years 1794-6, the
subject of yellow fever, which was then of great practical moment, set him
reading and speculating about pestilences in general. Writing to
Priestley, he said that in the course of his inquiries he found the
American libraries ill supplied with books[755]; but he certainly made
diligent and skilful use of his literary materials, and produced in his
‘Brief History of Epidemic and Pestilential Diseases,’ a work which was
better than any before it in the chronological part, and remains to the
present time unique in its philosophical part for the boldness of its
generalities[756]. He saw that influenza was the crux of epidemiology, and
paid special attention to it.
In looking for the antecedents of influenza, he kept in view the greater
telluric changes and convulsions, such as earthquakes and volcanic
eruptions. He did not regard these as the cause of influenza, but as the
index of some hidden cause to which both they and the universal catarrh
were due.
“It is probable to me,” he says, “that neither seasons, earthquakes,
nor volcanic eruptions are the causes of the principal derangements we
behold in animal and vegetable life, but are themselves the _effects_
of those motions and invisible operations which affect mankind. Hence
catarrh and other epidemics often appear _before_ the visible
phenomena of eruptions and earthquakes[757].” As to influenza, he
found “reason to conclude the disease to be the effect of some access
of stimulant powers to the atmosphere by means of the electrical
principle. No other principle in creation, which has yet come under
the cognizance of the human mind, seems adequate to the same effects.”
And again: “It is more probable that it is to be ascribed to an
insensible action of atmospheric fire, which is more general and
violent about the time of eruptions, and which fire is probably
agitated in all parts of the globe, although it produces visible
effects in explosions in some particular places only.” It is due to
Webster to give his reason for preferring a physical force to an
organic poison: “If a deleterious vapour were the cause, I should
suppose its effects would be speedy, and its force soon expended, the
atmosphere being speedily purified by the winds. But if stimulus is
the cause, it may exist for a long time in the atmosphere, and the
human body not yield to its force in many weeks or months. This would
better accord with facts. For, although diseases appear soon after an
earthquake, yet the worst effects are often many months or years
after[758].”
Dr Blagden also saw a difficulty in “the prodigious quantity of matter
required in the air to infect the space not only of the Chinese land, but
to a hundred leagues of the coast, or, as in this instance [1782] all
Europe and the circumjacent sea,” and was accordingly driven to
Arbuthnot’s view of an origin in the unusual weather of each locality.
Webster drew up a chronological table of influenzas in either Hemisphere,
with the volcanic eruptions, earthquakes, comets, etc., to suit[759]. A
few instances from near the beginning may serve as samples:
1647. First catarrh mentioned in American annals, in the same year
with violent earthquakes in South America, and a comet.
1655. Influenza in America, in the same year with violent earthquakes
in South America and an eruption of Vesuvius. It began about the end
of June.
1658. Influenza in Europe after a severe winter: the summer cool.
1675. Influenza in Europe while Etna was still in a state of
explosion: the winter mild.
1679-80. Influenza in Europe during or just after the eruption of
Etna: the season wet: a comet.
1688. Influenza in Europe in the same year with an eruption of
Vesuvius, after a severe winter, and earthquakes: it began in a hot
summer.
1693. Influenza in Europe in the same year with an eruption in Iceland
and great earthquakes: the season cool.
1697-98. Influenza in America after a great earthquake in Peru: a
comet the same year: the winter severe.
In most instances the region of the earthquake is not specified in the
table; but it is sometimes named in the text of the annals under the
respective years. Volcanoes are on the whole made more of than
earthquakes, Webster’s object being to find evidence of “electrical
stimulus,” and not of material miasmata discharged into the air. Etna and
Hecla are much in request. Any earthquake suits, as if “earthquake” and
“volcano” were like algebraic symbols, always _a_ and _b_, and never
anything but _a_ and _b_, “influenza” being always _x_. One begins to
realize the difficulties of the volcano or earthquake theory of influenza
on turning to Mallet’s Catalogue of Earthquakes[760]. Here, indeed, is an
embarrassing choice between China and Peru, Asia Minor and North Africa,
Portugal and Sicily or Calabria, Iceland and Jamaica, the Azores and the
Philippines, Caracas or Acapulco and Valparaiso, Hungary and Savoy,
Kamtschatka and Amboina; between earthquakes great and small; between
earthquakes and volcanoes. Any influenza year might be suited with one or
more earthquakes, perhaps in either Hemisphere; but there are some long
clear intervals between the greater influenzas in Europe, for example the
interval from 1803 to 1831, which seem to occupy as many pages of the
catalogue of earthquakes as the years wherein influenzas came thickest,
for example from 1729 to 1743, or from 1831 to 1847.
None the less, Webster, like Boyle, obeyed a true impulse when he looked
for the cause of influenzas in something telluric, occasional, phenomenal.
A wave of influenza comes up unexpectedly from a particular point of the
compass, passes quickly over many degrees of latitude and longitude,
lasting a few weeks at any given place, disappears in the distance, and
does not return again perhaps for a whole generation. Influenza has the
qualities of suddenness, swiftness, transitoriness; it has a certain
sameness in its symptoms; it can be identified as certainly in the brief
phrases of medieval chronicles as in elaborate modern descriptions; it has
had no season for its own, as plague and cholera have had the summer and
autumn, but has reached a height in Europe sometimes in midsummer,
sometimes in midwinter. No other epidemic malady can compare with it in
these respects; all the rest seem to have been provoked more or less by
the turns and changes in human affairs, some being of a medieval colour,
others of a modern, each in its own way admitting of explanation from
unwholesome living, or from famine, or from over-population, or from
something more recondite but still within the sphere of things insanitary
in an intelligible sense. Other plagues besides influenza were, it is
true, once reckoned mysterious, or associated in the popular mind with
earthquakes and comets. But several such plagues have disappeared from
among us, while their alleged causes, the earthquakes or comets, continue
as before. Influenza alone returns at intervals as of old, untouched by
civilization, by sanitation, by the immense differences between medieval
and modern, making the same impression upon England in the year 1890 as it
did in 1173, or 1427, or 1580, or, if changed at all, then changed for the
worse inasmuch as the epidemic came back more severely in 1891, and still
more severely in 1892. It is not surprising that for such a disease
something telluric or even cosmic should have been assigned as the cause,
something as occasional as itself, phenomenal, if not cataclysmic. It may
be proper, therefore, that we should try over again the philosophic
generalities of Boyle, Arbuthnot and Webster, peradventure a combination
of them may yield a true theory. From Boyle we may take the great
principle of a progressive infection through regions of air (or leagues of
ground), which was expressed once for all by Lucretius in the sixth book
of the ‘De Rerum Natura’:
... atque aer inimicus serpere coepit;
Ut nebula ac nubes paulatim repit, et omne
Qua graditur, conturbat et immutare coactat;
Fit quoque ut in nostrum quum venit denique coelum
Corrumpat reddatque sui simile atque alienum.
From Arbuthnot we may take the organic source and nature of the influenzal
miasmata, and the association with changes in the level of the water in
the soil. From Webster we may take the idea that the historic influenzas,
having been sudden, occasional or phenomenal, must have had phenomenal
causes somewhere in either Hemisphere. Instead of sketching a theory in
the abstract, and safeguarding it by following all its ramifications, I
shall proceed by the way of instances, choosing them so as to bring out
particular points in order.
The only generality which may be indicated at starting is one that has
presented itself time after time in the foregoing history, namely that
there is something more than accident in the association between epidemics
of influenza and epidemics of ague. So close was this association in
former times that both the influenza and the widely prevalent ague were
included together under such names as “the new ague,” “the new fever,”
“the new distemper.” As late as 1679, Morley did not distinguish the
epidemic of influenza from the epidemic agues in the midst of which it was
set, although the distinction was real, and was actually made by Sydenham
on that occasion, as it had been made by Willis and in a manner by
Whitmore on the occasion immediately preceding, and as it was made by
everyone on the last great occasion when an influenza made an interlude
among epidemic agues in the year 1782. It has often been suspected that
influenza was related to some other infection: at one time it was taken
for a volatile emanation of plague, in our own time it has been regarded
as a volatile emanation of Asiatic cholera. In a wider historical view the
question may arise, whether the real relation is not rather to those
remarkable agues which have been epidemic in company with influenza when
there was no plague and no cholera.
I come now to certain influenzas, as illustrating particular points of
theory, in order.
I.
It is probable that Webster’s theory of influenza as related to
earthquakes and volcanoes, first published in 1799, was suggested to him
by a communication to the Royal Society on the volcanic waves seen at
Barbados on the 31st of March, 1761, and on the epidemic of influenza
thereafter ensuing all over the island. At Bridgetown, in the afternoon of
the 31st of March, 1761, the water in the bay and harbour ebbed and flowed
to the extent of eighteen inches or two feet at intervals of eight
minutes, and continued to do so for the space of three hours, the
oscillation regularly decreasing till night when it was no more
observable. These tidal waves were due to volcanic upheavals somewhere;
and it was found that the centre of disturbance had been in the Atlantic
near the coast of Portugal, and the time some hours earlier than the waves
were felt at Bridgetown. The Barbados chronicler proceeds:
“It is very remarkable that since that time the island has been in a
very deplorable condition, having suffered under the severest colds
that have been ever known. The distress has been so general that I may
venture to assert (with confidence) that nineteen twentieths of the
inhabitants of the island have felt the effects of the contagion; and
to some it has been repeated several times. It has puzzled all the
adepts in pharmacy to find out the cause and cure of it. One
favourable circumstance has attended it, viz. few have died with it.
The Leeward Islands have not escaped, it having raged there more
violently and more fatal. His Majesty’s ships have severely felt the
effects of it, some of them not being capable of keeping the seas for
want of men fit for service. This happening at a season of the year
remarkably the healthiest, makes it the more surprising[761].”
This is as good an instance as we shall find, of explaining something
sudden, swift, and phenomenal, by something else sudden, swift, and
phenomenal, in a purely empirical way and without pausing to ask whether
the latter could have been a _vera causa_ of the former. That the
influenza came to Barbados in the wake, as it were, of the volcanic waves,
had been a common subject of talk among the residents; and that common
opinion of the colony had found expression in the paper sent to the Royal
Society. The influenza was not only in Barbados, in the Leeward Islands,
and in the ships on the West Indian Station, but also in New England and
“over the whole country” of the North American Colonies. Dr Tufts, of
Weymouth, New England, wrote to Webster that “it began in April, and in
May ran into a malignant fever which proved fatal to aged persons. It
spread over the whole country and the West India Islands[762].” It was not
until some nine months after that influenza appeared in Europe, at first
in the east of that continent,--Hungary, Vienna, Breslau, Copenhagen--in
February and March, 1762, in central Germany and Scotland in April, in
London about the first of May and all over England and Ireland thereafter,
but not in France until June and July.
Precisely the same order was followed by the influenza twenty years after:
it began in North America in March, 1781, and, says Webster, spread over
that continent; it appeared in the East Indies in October and November,
1781, and on the eastern confines of Europe in January, 1782, having been
traced from Tobolsk, made a slow progress westwards, and was at its height
in London about the end of May or beginning of June. Assuming, says
Webster, that the American influenza of 1781 had been continuous with the
European of 1782, it must have “passed the Pacific in high northern
latitudes,” traversed Siberia and Tartary, and so reached Russia in
Europe. In like manner, if the European influenza of 1762 were continuous
with the American of 1761, it must have made the circuit of the globe in
the same order, as if it were following the first impulse of the volcanic
waves across the Atlantic from the coast of Portugal westwards, and so
round the earth until it came back to Europe on its eastern frontier. So
much may be fairly advanced on the ground of a particular set of facts.
But then there were many other facts, both in 1761-62, and in 1781-82.
Meanwhile let us take another instance of volcanic waves felt at Barbados
six years before, on the same afternoon as the great earthquake of Lisbon.
II.
At Bridgetown, on the 1st November, 1755, Dr Hillary saw the peculiar flux
and reflux of the water in the harbour from 2.20 p.m. to 9 p.m. and
pronounced that there must have been an earthquake somewhere. The waves
came at first at intervals of five minutes, and at last at intervals of
twenty minutes. The day was calm, and the ships in the bay were not
touched; but small craft lying in the channel over the bar were driven to
and fro with great violence. There was no motion of the earth, and no
noise. The distance from Lisbon was 3400 miles, the vibrations having
taken seven and a half hours to reach Barbados. The one notable effect in
the harbour of Bridgetown was that the water flowed in and out with such a
force that it tore up the black mud in the bottom of the channel, so that
a great stench was sent forth and the fishes caused to float on the
surface, many of them being driven a considerable distance on to the dry
land where they were taken up by the negroes[763].
It so happened that there was an epidemic catarrh prevalent at that very
time all over the island of Barbados, chiefly among children, few or none
of whom, white or black, escaped it. It had begun in October, says
Hillary[764] (who chronicled the epidemiology very exactly), and continued
into November, so that it both preceded and followed the great convulsion
in the bed of the Atlantic, which destroyed Lisbon and tore up the mud in
the harbour of Bridgetown, disengaging a great stench therefrom and
poisoning the fish. Webster’s theory of a relation between earthquakes and
influenzas provides for such discrepancies in the dates of each: it is
probable, he says, that seasons, earthquakes and volcanic eruptions are
themselves the effects of those motions and invisible operations which
affect mankind, so that catarrh and other epidemics often appear _before_
the visible phenomena of eruptions and earthquakes. In like manner, the
chronicler of the earthquake of Lisbon in the _Philosophical Transactions_
drew attention to the fact that there had been a remarkable drought for
several years before, and that some of the springs near Lisbon were
actually dried up at the time. That droughts precede earthquakes is
perhaps the most instructive generality that has yet been reached as to
the cause of the latter.
Let us see, then, whether any such remote antecedents, in a possible
relation to the influenza epidemics, hold good for the island of Barbados.
Hillary’s chronicle is sufficiently full to let us answer the question.
Following the seasons and prevalent maladies backwards from the
influenza of children in October-November, 1755, we find a catarrhal
fever all over Barbados in February of the same year, which “few
escaped having more or less of.” The immediate precursor of that
influenza had been a very definite constitution, eighteen months long,
of a “slow nervous fever,” from February, 1753 to September, 1754,
which corresponds in every respect to the “remittent” fever of nearly
the same period in England and Ireland, described by Fothergill,
Rutty, Huxham and Johnstone, and to the famous Rouen fever described
by Le Cat. Hillary is clear that the “slow nervous fever” was not seen
again so long as he remained in the colony (1758). Just before it
began, there had been an influenza so general in December, 1752, and
January, 1753, “that few people, either white or black, escaped having
it,” and that, in turn, was preceded by a season of agues, which, says
Hillary, “are never seen in Barbados now [1758], unless brought hither
from some place of the Leeward Islands.”
So many influenzas in Barbados, and so many things possibly relevant to
them among their antecedents. So also in New England, the influenza which
seemed to follow the earthquake along the coast of Portugal on the 31st
of March, 1761, had the same remittent and intermittent fevers among its
antecedents.
In the winter and spring of 1760-61 there had been much fever in New
England, which was believed to be malarious. Webster, however, says:
“There is no necessity of resorting to marsh exhalations for the
source of this malady. The same species of fever [as at Bethlem]
prevailed in that winter and the spring following in many other parts
of Connecticut where no marsh existed. In Hartford it carried off a
number of robust men, in two or three days from the attack.... In
North Haven it attacked few persons, but everyone of them died. In
East Haven died about forty-five men in the prime of life, mostly
heads of families. The same disease prevailed in New Haven among the
inhabitants and students in college.” In Bethlem the sickness began in
November, 1760, and carried off about forty of the inhabitants in the
winter following. This was the fever, generally reckoned malarious,
which preceded the influenza of April and May, 1761[765].
III.
The next great influenza, twenty years after, which was in America in the
spring of 1781 and in Europe in the winter and spring following, will
repay the same kind of scrutiny. There had been influenza here or there in
Europe since the beginning of 1780, but no great epidemic of it; and in
England, as elsewhere, there had been epidemic agues and dysenteries since
that year, or the autumn before. The epidemic agues became worse in
England in 1783, 1784, and 1785, appearing in places which had never been
thought malarious. The whole period from 1780 to 1784 was remarkable for
hot and dry summers and great earthquakes. Italy and Sicily were troubled
by earthquakes to an unusual extent in 1780, 1781, 1782, and 1783; they
were so frequent in 1781 that the pope ordered public prayers. The great
earthquake of the period was in Calabria at half an hour after noon of the
5th of February, 1783, about six months after the great influenza of the
period was over. Sir William Hamilton, the British ambassador at Naples,
visited the numerous scenes of the earthquake in Calabria and Sicily in
the first fortnight of May, 1783, and sent to the Royal Society an account
of what he saw. At several places he found fever epidemic, part of it from
the overcrowding and filth of the temporary barracks in which the people
were living, part of it malarious from the damming of water by changes in
the river beds. At Palmi the spilt oil mixed with the corn of the
overthrown granaries, and the corrupted bodies, had a sensible effect on
the air, which threatened an epidemic; at the village of Torre del
Pezzolo an epidemical disorder had already manifested itself[766].
But the most striking effect of the earthquake was that a dry fog began in
Calabria in February, and overspread until autumn the greater part of
Europe, extending even to the Azores. This fog, though not consisting
apparently of moisture, was so dense that the sky was quite obscured,
appearing a light grey colour instead of blue, while the sun became a
blood-red disc. In Calabria the darkness was so great that lights were
needed in the houses, and ships came into collision at sea. There was a
most disagreeable odour[767]. The fog spreading over all Europe from
Calabria was not at all mythical, as we are apt to suppose that similar
recorded phenomena of the wonder-loving Middle Ages may have been. The
phenomenon was independently reproduced in Iceland the same year, from the
1st to the 11th of June, causing the same darkness at sea, the same
atmospheric effects at a distance, but not to so great a distance, and
some amount of sickness, but seemingly not aguish or febrile, among the
population[768].
Those two great convulsions of the year 1783, each of them the cause of a
widely spreading dry fog, may have been conceivably the cause of
pestiferous miasmata in the air, such as the corresponding hypothesis of
influenza requires; but how little comparable or equivalent were the
miasmata--in the one case from the ancient and well-peopled soil of
Southern Italy, in the other from the inhospitable Danish colony just
without the Arctic Circle! In any case, the earthquakes of 1783 were both
too late for the great influenza of the period. The antecedent common
alike to the influenza and the earthquakes was the extraordinary droughts,
which caused famine and famine-fever in Iceland, and, according to old
experience, was probably related to the epidemic prevalence of agues in
Britain and on the continent of Europe.
IV.
What kind or kinds of epidemic sickness earthquakes may produce as an
effect immediate and at the place, will appear from other instances. One
of the most remarkable of earthquakes was that which destroyed Port Royal
and nearly all the planters’ houses and sugar-works throughout the island
of Jamaica on the 7th of June, 1692. Jamaica had been an English colony
for little more than thirty years, during which time it had passed from
its state of lethargy under the Spaniards into an emporium of commerce
with a rapidly growing population of slaves and whites. The business
capital was at Port Royal, wholly built since the British occupation. The
site of it was a sandy key or shoal which was said to have risen
perceptibly within the memory of original settlers; a writer in September,
1667, said of it: “wherever you dig five or six feet, water will appear
which ebbs and flows as the tide. It is not salt, but brackish[769].” A
quay had been built along this spit of land, at which vessels of 700 tons
could lie afloat. It was here that the havoc of the earthquake was most
complete.
Sloane, who had visited Jamaica a few years before, said that the
inhabitants expect an earthquake every year, and that some of them were of
opinion that they follow their great rains[770]. The year 1692 began in
Jamaica with very dry and hot weather which continued until May: then came
gales and heavy rains until the end of the month, and from that time until
the day of the earthquake, the 7th of June, the weather was excessively
hot, calm and dry. The shakes began at 11.40 a.m., and at the third shake,
the ground of nearly all Port Royal fell in suddenly, so that in the
course of a minute or two most of the houses were under water and the
whole wharf was covered by the sea to the depth of several fathoms. The
loss of life was, of course, greatest where population was densest; but in
the interior of the island the effects on the soil were greater than at
the shore: in the north a thousand acres of land sank and thirteen people
with it; mountains on either side of a narrow gorge came together and
blocked the way; wide chasms appeared in the ground, and on one mountain
side there were some dozen openings from which brackish water spouted
forth. The first effect in the streets of Port Royal was that men and
women seemed all at once to be floundering up to the neck in the wet
shifting sand, and were speedily drowned or floated away by the inrushing
water. The shakes ceased for days at a time, and then began again, five or
six perhaps in twenty-four hours; so that those who had escaped to ships
in the bay remained on board for two months, being afraid to come ashore.
The weather was hotter after the earthquake than before, and mosquitoes
swarmed in unheard of numbers.
During the upheavals or subsidences in Port Royal, and the rushing of
water into or from the gapings in the ground, “ill stenches and offensive
smells” arose, so that “by means of the openings and the vapours at that
time belcht forth from the earth into the air, the sky, which before was
clear and blue, was in a minute’s time become dull and reddish looking (as
I have heard it compared often) like a red-hot oven.” A very great
mortality followed among those who had escaped the earthquake. Some of
them settled at Leguanea, others at the place on the bay which became the
Kingston of later history, enduring many hardships in their hastily built
shelters, from the heavy rains that followed the earthquake, and from want
of clothes, food and comforts.
One writes: “Our people settled a town at Leguanea side; and there is
about five hundred graves already [20th September, 1692], and people
every day is dying still. I went about once to see it, and I had like
to have tipt off.” Another says: “Almost half the people that escaped
upon Port Royal are since dead of a malignant fever”: and another,
referring to the hasty settlement on the bay at Kingston, says “they
died miserably in heaps.” But the most interesting information is his
next sentence: “Indeed there was a general sickness (supposed to
proceed from the hurtful vapours belched from the many openings of the
earth) all over the island, so general that few escaped being sick:
and ’tis thought it swept away in all parts of the island three
thousand souls, the greatest part from Kingstown, only yet an
unhealthy place[771].”
That great mortality from a malignant fever after the earthquake of 7th
June, 1692, is usually counted an epidemic of the yellow fever which
became established at Kingston and Port Royal from that time for at least
a century and a half. I have not found any contemporary medical account of
it, but all the later writers on yellow fever at Kingston and Port Royal
have accepted the tradition that it was yellow fever. But there was one
peculiarity, which marks it off from all subsequent epidemics of yellow
fever--the sickness was all over the island, so general that few escaped
being sick, and was supposed to proceed from the hurtful vapours belched
from the many openings of the ground in and near Port Royal. In all
subsequent experience yellow fever has been almost confined to the shore
or to the ships in the bay[772]. Certainly it has never been all over the
island as in 1692, “so general that few escaped being sick”: that is
rather in the manner of influenza, although there is nothing to show that
the sickness of the interior was so different from that of the shore as to
be counted an influenza, or that the mortality of the sick was other than
that of a “malignant fever.”
The earthquake at Port Royal in 1692 produced “ill stenches and offensive
smells.” The tidal waves, or the subterranean vibrations which caused
them, in tearing up the mud at the bottom of the channel at Bridgetown,
Barbados, in 1755, had in like manner sent forth a great stench which
poisoned the fish. Such offensive vapours were supposed in former times to
come, as in a figure, from “the bowels of the earth”; and undoubtedly the
sulphurous fumes which have overhung the region of Sicilian earthquakes
must have had a source as deep as the strange minerals or “fossils” of
Boyle’s hypothesis. But, while the commotion of an earthquake is deep, it
is also superficial; whatever miasmata issue from the ground in the
ordinary alternations of wet and drought, would be discharged into the
atmosphere in unusual quantity and with unusual force in such disturbances
of soil as sunk Port Royal in 1692 or were felt at Barbados across the
whole width of the Atlantic in 1755. Nor is that effect upon miasmata
instantaneous or quickly past; in Jamaica the rumblings and shakes lasted
for nearly two months, during which time the pressure upon the gases in
the subsoil must have been such as to make them pass into the atmosphere
in stronger ascending currents than the mere alternations of moisture and
drought would have done. And just as the ordinary seasonal changes in the
level of the ground-water are of little or no account for
miasmatic-infective disease unless the soil in which they occur be full of
organic impurities from human occupancy, so one may reason that the great
cataclysmic changes of the earth’s crust are, in this hypothesis of
influenza, of most account as touching the stratum of soil wherein lie
organic impurities, and as touching those areas of the surface,--the sites
of cities, the populous plains, the shores of bays, the bottoms of
harbours or any other definite spots--in which the products of organic
decomposition are present in largest amount and, perhaps, of somewhat
special kind. Such impurities of the soil are indeed a _vera causa_ of
infective disease, known to be capable of the effect which has to be
accounted for; and, as discharged into the air in great volume and with
great force by some upheaval, they would make a local beginning of that
“aer inimicus” which the Roman poet figures as creeping like a mist from
one region of the heavens to another so that it corrupts each successive
tract of air with its own baleful qualities, “reddatque sui simile atque
alienum.”
But, as soon as we begin to apply this formula to particular historic
cases, difficulties and ambiguities arise[773]. To come back to the
instance of Jamaica in 1692, did the general sickness of the island,
manifestly miasmatic as it was, and due to disturbances of soil, become an
influenza for other regions of the globe? About fifteen months after there
was, indeed, a universal catarrh in Britain and Ireland, of no great
fatality, which is said by Molyneux, of Dublin, to have prevailed also in
the northern parts of France, Flanders, and Holland, but is not reported
in the usual way from Europe generally nor from America. Let us suppose a
miasmatic cloud formed over the island of Jamaica in June, July, August
and September, a cloud of infective particles which might produce
influenza at a distance from its place of origin, whatever disease the
miasmata after the earthquake may have produced in Jamaica itself. Let
this invisible cloud, or emanation, get into the warm atmosphere over the
great oceanic current that sets out from the Gulf of Mexico. The vehicle
lies ready to hand,--to receive the miasmata not far from their place of
origin, to carry them far into the Atlantic, and to bring them, perhaps,
to the shores of Britain. This may seem a sufficiently plausible source of
the influenza of October and November, 1693, which appears to have been
felt only in the British Isles and on the opposite shores of the North
Sea. But Webster’s own choice is the volcanic eruption in Iceland in the
same year as the influenza; and if we prefer, in this hypothesis, an
earthquake to an active volcano, there is a rival source for the British
influenza of 1693, nearer both in place and time than that of Jamaica in
1692, and not less important in respect of miasmatic disease in its own
locality. This was the disastrous series of earthquakes in Calabria and
Sicily, culminating on the 9th of January, 1693. The following extracts
from the account sent to the Royal Society will show how great was the
commotion of soil, of underground water, and of atmosphere, and how close
the connexion of these with the sickness ensuing[774]:
“In the plain of Catania, an open place, it is reported that from one
of the clefts in the ground, narrow but very long and about four miles
off the sea, the water was thrown forth altogether as salt as that of
the sea, [as in Jamaica the year before]. In Syracuse and other places
near the sea, the waters in many wells, which at first were salt, are
become fresh again.... The fountain Arethusa for the space of some
months was so brackish that the Syracusans could make no use of it,
and now that it is grown sweeter the spring is increased to near
double. In the city of Termini all the running waters are dried up....
It was contrary with the hot-baths, which were augmented by a third
part.
Darkness and obscurity of the air has always been over us, but still
inferior to that on the 10th and 11th of January; and often these
clouds have been thin and light, and of a great extent, such as the
authors call _rarae nubeculae_. The sun often and the moon always
obscured at the rising and setting, and the horizon all day long
dusky....
The effects it has had on humane bodies (although I do not believe
they have all immediately been caused by the earthquake) have (yet)
been various: such as foolishness (but not to any great degree),
madness, dulness, sottishness, and stolidity everywhere:
hypochondriack, melancholick and cholerick distempers. Every-day
fevers have been common, with many continual and tertian: malignant,
mortal and dangerous ones in a great number, with deliria and
lethargies. Where there has been any infection caused by the natural
malignity of the air, infinite mortality has followed. The smallpox
has made great destruction among children.”
Thus we find in Sicily a great disturbance of soil followed, as in
Jamaica, by a great increase of local sickness, and by an atmosphere
visibly charged with products of the earthquake for months after. This is
a nearer source than the Jamaican for the British influenza of Oct.-Nov.
1693,--nearer in time, if that be any advantage for the theory, nearer
also in place. There are, however, no intermediate stages to connect the
influenza on the northern edge of the European continent with the
disturbance of soil and the miasmata arising therefrom in Sicily and
Calabria. If there had been any such dry fog as spread all over Europe
from the Calabrian earthquake of January, 1783, it would have been a help
at least to the imagination in bridging over a gulf of space and time.
As to the interval of time, it should at all events be kept in mind that
the same difficulty has to be reckoned with in any hypothesis of influenza
and in every great historic instance. In the instance still before us, the
infection began in England, according to Molyneux, in October, 1693, and
was in Dublin a month later. But we must assume it to have been in the air
for some time before it became effective upon mankind. Influenza has been
observed, with curious uniformity, to attack the horses, say of London, of
Plymouth, of Edinburgh, or of Dublin (as on the occasion before this,
1688) two months or more in advance of the inhabitants of the respective
places; and if it had waited, so to speak, for two months before it showed
its effects upon men, it may have waited equally long, or longer, before
it showed its effects upon horses. That would give at least four months;
and then we know, from such an influenza as that of 1743, that there may
be weeks, perhaps months, between its prevalence in Naples, Rome or Milan,
and its prevalence in London or Edinburgh, and, from the influenza of 1693
itself, that it was a month later in Dublin than in London. An earthquake
in Sicily on the 9th of January, 1693, with effects there for months after
upon the water, the air, and the prevalent diseases, is not excluded by
lapse of time from being a _vera causa_ of an influenza in England in
October of the same year, and in Ireland in November. The sort of proof
which most men desire, a proof such as we rarely get, and one that is
suspiciously neat when we do get it, would be to find an influenza in
Sicily and Calabria following the earthquake, and to trace the same step
by step over Europe. But the miasmatic sickness in the countries of the
earthquakes was not influenza, so far as is known; and there was no
epidemic catarrh, so far as is known, in any other part of Europe but the
British Isles and the neighbouring shores of the North Sea.
V.
Molyneux, who recorded with a good deal of circumstance the influenza of
1693, is the principal authority, along with Dr Walter Harris, of London,
for another influenza in 1688, seemingly peculiar to the British Isles.
Its effects can be discovered with the utmost certainty in the London
bills of mortality for two or three weeks at the end of May and beginning
of June, and it is mentioned as “the new distemper” in letters of the
time. Is it possible to find an earthquake for it? Webster’s note is: “in
the same year with an eruption of Vesuvius, after a severe winter and
earthquakes”--which is somewhat general. Turning to Evelyn’s diary, where
these matters are often recorded, we find, in the very weeks when the
influenza was at a height in London, this entry: “News arrived of the most
prodigious earthquake that was almost ever heard of, subverting the city
of Lima and country in Peru, with a dreadfull inundation following it”--as
if the influenza and the news of the earthquake had reached London at the
same time. This was the earthquake of 20th October, 1687, which destroyed
Lima, Callao and an immense district along the coast of Peru. The rocking
of the earth was most violent, the sea retreated like a sudden immense ebb
and filled again like a sudden immense flood, the effect of the commotion
being felt on board ships a hundred and fifty leagues out in the Pacific.
It was remarked that wheat and barley would not thrive in Peru after that
earthquake[775]. Here was undoubtedly a great disturbance of soil and of
subsoil, almost certainly attended with the discharge of effluvia or
miasmata into the air, as in other great earthquakes. But the universal
slight fever of the British Isles in the months of June and July, 1688, is
remote from the earthquake of Lima in place; and, if it be a question of
earthquakes at all, there are others nearer to it both in place and time,
such as that in the Basilicata province of Naples in January, 1688, and
the Jamaica earthquake, felt through all the island, on the 1st of March,
1688. The greatest of them all, that of Smyrna, on the 10th of July, was a
few weeks too late for the hypothesis.
VI.
A continent so subject to earthquakes as South America might be expected,
in this hypothesis, to have had some corresponding influenzas. It has
indeed had influenzas, some of them peculiar to itself. The Western
Hemisphere as a whole has, on several great occasions, had influenzas
which were not felt in the Old World. Again, there are one or two
instances in which the infection, while it spread widely over the
table-lands of Bolivia and Peru, does not appear by existing testimony to
have been carried north of the Isthmus. One of these was the influenza of
1720, as special to a region of South America as that of 1688 was to the
British Isles. The account of it was given in an essay by Botoni ‘On the
Circulation of the Blood,’ published at Lima in 1723[776]. He calls it
_catarro maligno_; it was popularly known as _fierro chuto_ or “iron cap.”
It appeared at Cuzco in the end of March, or beginning of April, 1720, and
was over about November. Four thousand are said to have died of it in the
diocese of Cuzco, and it is said to have made so great a scarcity of hands
that the first harvest after it was imperfectly gathered. It had all the
marks of an influenza, with the addition of bleeding from the nose and
lungs. It had also the grand characteristic common to influenza and
epidemic ague: “the symptoms were so diverse and even contradictory that
no correct diagnosis, or curative plan, could be fixed.” The Lima writer
of 1723 says that it followed an eclipse of the sun on the 15th of August,
1719, having begun on the eastern side of the Andes, in the basin of La
Plata, about that time, and travelled northwards and westwards, as the
South American influenza of 1759 did.
This is a localized influenza in a country of earthquakes. But the two
great earthquakes in 1719 are not South American. They both happened in
July: one along the coast of Fez and Morocco, which ruined many villages
and a part of the city of Morocco (there is also a later disturbance in
the Azores in December, followed by the upheaval of a new island), the
other in North China. Here we have the choice of following the “aer
inimicus” of Lucretius either from China or from the African coast; and if
it be the case that the influenza began in the latter part of the year
1719 in the basin of the La Plata, to cross the Andes next year, it may
seem, in this hypothesis, that a course from east to west, bringing the
infection across the Atlantic from Africa, is to be preferred to a course
from west to east, bringing it across the Pacific from North China. In
either case there need be no difficulty in finding local clouds of
miasmata. Some traces of the corresponding great earthquake in China were
found in November of the following year, by Bell, an English traveller who
crossed from Moscow to Peking:
“Jumy,” he says, “suffered greatly by the earthquakes that happened in
the month of July the preceding year [1719], above one half of it
being thereby laid in ruins. Indeed more than one half of the towns
and villages through which we travelled this day had suffered much on
the same occasion, and vast numbers of people had been buried in the
ruins. I must confess it was a dismal scene to see everywhere such
heaps of rubbish[777].”
The atmospheric effects of Chinese earthquakes have been pictured since
medieval times, in obviously superstitious colours; and there are reasons
why a great disturbance of soil in that country should produce remarkable
miasmata. The surface soil of China is peculiar in having the bodies of
the dead dispersed at large in it, insomuch that excavations for the
foundations of houses, or for roads and railway cuttings, can hardly be
made without the constant risk of exposing graves[778].
If the soil of China is peculiar in one way, that of the West Coast of
Africa is peculiar in another. Without entering on the large question of
“malaria” in each of them, I shall take an old illustration of the
miasmata of the West Coast of Africa as a cause of dengue-fever, a
disease curiously like influenza in its symptoms, and like it also in its
occasional wave-like dispersion over wide regions. The authority is Dr
Aubrey, who resided many years on the coast of Guinea, saw much of the
slave-trade, and wrote a very sensible book in 1729, called ‘The Sea
Surgeon, or the Guinea Man’s Vade Mecum.’ He describes quite clearly the
fever which was long after described by West Indian physicians as dengue,
or three-days’ fever, or break-bone fever, including in his description
the characteristic exanthems of it and the penetrating odour of the sweat.
He gives also, in clinical form, a series of cases on board the galley
‘Peterborough’ in December, 1717, which are exquisite examples of
break-bone fever. This disease, he says, “many times runs over the whole
ship, as well negroes as white men, for they infect one the other, and the
ship is then in a very deplorable condition unless they have an able man
to take care of them.” But the original source of infection, he believed,
was the fogs that hung at nightfall over the estuaries of the rivers; and
he gives an experimental proof, remarkable but not quite incredible, of
the poisonous nature of the miasmata:
“But to let you see the evil, malevolent, contagious, destructive
quality of those fogs that fall there in the night, and how far they
are inimical to human nature, I will tell you of an experiment of my
own. I made a lump of paste with oat-meal somewhat hard, and about the
bigness of a hen’s egg, which was exposed to the fog from twilight to
twilight, i.e. from the dusk of the evening till daybreak in the
morning; after which I crumbled it, and gave it to fowls, which we had
on board, and soon after they had eaten it, they turned round and in a
kind of vertigo dropt down and expired.”
A great mortality in Guinea in 1754 or 1755 was ascribed by Lind, the
least credulous in such matters, to “a noxious stinking fog[779].”
What the alternations of heat and chill, of moisture and drought, produce
ordinarily in the way of miasmata, the same, we may suppose, is produced
on the great scale, as a phenomenon at some particular time and place, by
one of those cataclysms which break the surface of the earth or the bed of
the sea, lower or raise the level of wells and springs, and fill the air
with particles of dust or vapour which may overhang the locality for
months and visibly disperse themselves to a great distance. Nothing
relating to miasmata in the air need be hard for belief after the
wonderful diffusion and permanence in the atmosphere of the whole globe,
for two years or more, of finely divided particles shot up by the
earthquakes and eruptions of Krakatoa in the Straits of Sunda on the 27th
and 28th of August, 1883[780].
A theory of influenza constructed from such generalities as those of
Boyle, Arbuthnot and Webster will have attractions for many over the
theory that influenza is always present in some remote country and becomes
dispersed now and then over the world by contagion from person to person:
it will have superior attractions, for the reason that influenza is a
phenomenal thing which needs a phenomenal cause to account for it. But if
anyone were to attempt to fit each historic wave of influenza with its
particular earthquake, or to find the precise locality where clouds of
infective matter had arisen, or the particular circumstances in which they
arose, he would certainly find his fragile structure of probabilities
pulled to pieces by the professed discouragers and depravers. I make no
such attempt; but I am not the less persuaded of the direction in which
the true theory of influenza lies.
Influenza at Sea.
There is no point more essential to a correct theory of influenza than to
find out in what circumstances it has occurred among the crews of ships on
the high seas. If it be true that a ship may sail into an atmosphere of
influenza, just as she may sail into a fog, or an oceanic current, or the
track of a cyclone, then the possible hypotheses touching the nature,
source, and mode of diffusion of influenza become narrowed down within
definite limits.
One of the first observations was made in the case of a Scotch vessel
in the influenza of 1732-33[781]. The epidemic was earlier in Scotland
than in England; it began suddenly in Edinburgh on 17 December, 1732,
the horses having been attacked with running of the nose towards the
end of October. About the time when the disease began among mankind,
in December, a vessel, the ‘Anne and Agnes’ sailed from Leith for
Holland. One sailor was sick on this voyage. She sailed on the return
voyage to Leith, with the other ten of her crew in perfect health.
Just as she made the English coast at Flamborough Head on the 15th of
January, 1733, six of the sailors fell ill together, two more the next
day, and one more on the day after that, so that when the vessel
anchored in Leith Roads there was only one man well, and he fell ill
on the day following the arrival. The symptoms were the common ones of
the reigning epidemic. The dates are not given more precisely or fully
than as above. Influenza was prevalent in Germany and Holland somewhat
earlier than in Scotland or England; the men may, of course, have
imbibed the infection when they were in the Dutch port, just as it is
almost certain that the crews of Drake’s fleet in 1587 had received
during a ten days’ stay upon the island of St Jago, of the Cape de
Verde group, the miasmatic infection of which they suddenly fell sick
in large numbers together in mid-Atlantic some six days after sailing
to the westward.
This early case of the ‘Anne and Agnes’ in 1733 may pass as an ambiguous
one. The next occasion when influenza on board ship attracted much notice
was the epidemic of 1782.
On the 6th of May, Admiral Kempenfelt sailed from Spithead with seven
ships of the line and a frigate, on a cruize to the westward; on the
18th May, he came into Torbay, and sailed again soon after; on the
30th May he came again into Torbay with eight sail of the line and
three frigates, and on 1 June sailed again to the westward. Sometime
before his squadron put into Torbay for the second time, influenza had
appeared among them at sea, it is said in the ‘Goliath’ on the 29th of
May[782]. A letter from Plymouth, of the 2nd June, after referring to
the violence of influenza in that town, at the Dock, and on board the
men-of-war lying there, says that the ‘Fortitude’ of 74 guns, and
‘Latona’ frigate came in that afternoon with 250 sick men from the
fleet under Admiral Kempenfelt, mostly with fevers. Another Plymouth
letter two days later (4 June) says: “Kempenfelt is returning to
Torbay: he could keep the sea no longer, on account of the sickness
that rages on board his fleet. More than 400 men have been brought to
the hospital this morning. Our men drop down with it by scores at a
time. The ‘Latona’ frigate, that sailed the other day is returned, the
officers being the only hands that could work the ship[783].”
This outbreak on board ships in the Channel was fully as early as the
great development of influenza in 1782 on shore, whether in London or
Plymouth; but there were almost certainly cases of it at the latter port
before the ‘Latona’ sailed to join Kempenfelt’s squadron. Robertson,
however, who was surgeon on the ‘Romney’ in the Channel service at that
time, says that “hundreds in different ships, towns, and counties, which
had _no_ communication with one another, were seized nearly as suddenly
and so nigh the same instant as if they had been electrified.... The
companies of many of the ships were very well at bed-time, and in the
morning there were hardly enough able to do the common business of the
ship[784].” This is confirmed by McNair, surgeon of the ‘Fortitude,’ who
told Trotter that two hundred of her men, as she lay in Torbay, were
seized in one night and were unable to come on deck in the morning[785].
There was another English fleet in the North Sea at the same time, under
Lord Howe, watching the Dutch fleet or seeking to intercept the Dutch East
Indiamen.
Howe sailed from St Helen’s on the 9th May, with twelve ships of the
line. Towards the end of that month he had his fleet in the Texel; the
men were in excellent health, “when a cutter arrived from the
Admiralty, and the signal was given for an officer from each ship [to
come on board the admiral]. An officer was accordingly sent with a
boat’s crew from every vessel, and returned with orders, carrying with
them also, however, the influenza”--which soon prostrated the crews to
the same extraordinary extent as in the ships under Kempenfelt at the
other end of the Channel. This was the oral account given to Professor
Gregory of Edinburgh, by a lieutenant on board a sixty-four gun
ship[786]. Another account says that the disorder first appeared in
Howe’s fleet on the Dutch coast about the end of May, on board the
‘Ripon,’ and in two days after in the ‘Princess Amelia’; other ships
of the same fleet were affected with it at different periods, some
indeed, not until their return to Portsmouth about the second week of
June. “This fleet, also, had no communication with the shore until
their return to the Downs, on their way back to Portsmouth, towards
the 3d and 4th of June[787].”
But, apart from the story of the Admiralty despatch-boat carrying the
influenza to Howe’s squadron, it appears that both Kempenfelt and Howe
were joined from time to time by additional ships, which might have
carried an atmosphere of influenza with them[788]. Still, it was an
influenza atmosphere that they had carried, and not merely so many sick
persons. The doctrine of contagion from person to person would have to be
so widened as to become meaningless, if all those experiences of the fleet
in 1782 were to be brought within it. In the history both of sweating
sickness and of influenza, there are instances of the disease breaking out
suddenly in a place after someone’s arrival; but the new arrival may not
have had the disease, it was enough that he came from a place where the
disease was[789]. That was, perhaps, the reason why Beddoes, in his
inquiry of 1803, framed one of his questions so as to elicit information
about the dispersal of influenza by _fomites_.
It is not easy to prove that a ship may meet with an atmosphere of
influenza on the high seas; but many have believed that ships have done
so. Webster says: “The disease invades seamen on the ocean in the same
[western] hemisphere, when a hundred leagues from land, at the same time
that it invades people on shore. Of this I have certain evidence from the
testimony of American captains of vessels, who have been on their passage
from the continent to the West India Islands during the prevalence of this
disease[790].” There are several instances of this, authenticated with
times, places, and other data of credibility.
The best known of these is the voyage of the East Indiaman ‘Asia’ in
September, 1780, through the China Sea from Malacca to Canton: “When
the ship left Malacca, there was no epidemic disease in the place;
when it arrived at Canton it was found that at the very time when they
had the _Influenza_ on board the Atlas (_sic_) in the China seas, it
had raged at Canton with as much violence as it did in London in June,
1782, and with the very same symptoms[791].”
In the present century, the cases nearly all come from the medical reports
of the navies of Great Britain, France, Germany and the Netherlands, and
they relate to ships on foreign service--in the East Indies, the Pacific,
Africa, or other foreign stations. In some of the instances influenza went
through a ship’s company in port or in a roadstead, others are examples of
outbreaks at sea:
1837: “The ship’s company of the ‘Raleigh,’ were attacked by epidemic
catarrh--influenza--first in March, while at sea between Singapore and
Manilla, and again, although less severely, in June and July while on
the coast of China.... Influenza also made its appearance amongst the
crew of the ‘Zebra’ in April while she lay at Penang; it was supposed
to have been contracted by infection from the people on shore, as they
were then suffering from it. No death occurred under this head[792].”
1838: In the ‘Rattlesnake,’ at Diamond Harbour, in the Hooghly River,
a large proportion of the men were suffering from epidemic catarrh.
Intermittent fever made its appearance; “the change from the catarrhal
to the febrile form was sudden and complete, the one entirely
superseding the other[793].”
1842: In the ‘Agincourt’ on a voyage from the Cape of Good Hope to
Hongkong in August and September, the greater part of 102 cases of
catarrh occurred; many of these were accompanied with inflammation of
tonsils and fauces, and in some there was deafness with discharge from
the ear. This is not claimed as an instance of epidemic influenza, but
as an aggregate of common colds, due to cold weather in the Southern
Ocean and to wet decks[794].
1857: “Influenza broke out in the ‘Monarch’ while at sea, on the
passage from Payta [extreme north of Peru] to Valparaiso. She left the
former place on the 23d August, and arrived at the latter on the last
day of September. About the 12th of the month [twenty days out], the
wind suddenly changed to the south-west, when nearly every person in
the ship began to complain of cold, although the thermometer did not
show any marked change in the temperature. On the 12th and 13th seven
patients were placed on the sick list with catarrhal symptoms; and
during the following ten days, upwards of eighty more were added, but
by the end of the month the attacks ceased. [She carried 690 men, and
had 191 cases of “influenza and catarrh,” in the year 1857.] Some of
the cases were severe, ending either in slight bronchitis or
pneumonia, accompanied with great prostration of the vital powers. On
the arrival of the ship at Valparaiso, the surgeon observes: ‘We found
the place healthy, but in the course of a few days some cases of
influenza made their appearance, and very soon afterwards the disease
extended over the whole town. It was generally believed that we
imported it, and the authorities took the trouble to send on board a
medical officer to investigate the matter.’ He further observes that
the whole coast, from Vancouver’s Island southward to Valparaiso was
visited by the epidemic.” It made its appearance on board the
‘Satellite’ at Vancouver’s Island in September, and among the
residents ashore, both on the island and mainland, at the same
time[795].
1857: Catarrh “assumed the form of influenza in the ‘Arachne’ [149
men, 114 cases] while the vessel was cruizing off the coast of Cuba,
with which, however, she had no communication. There was nothing in
the state of the atmosphere to attract special attention. A question
therefore arises whether it might not have been caused by infection
wafted from the shore.” It was prevalent at the time at Havana[796].
1857: “Australian Station:--An eruption of epidemic catarrh occurred
in the ‘Juno’ [200 men, 131 cases], but long after she left the
station[797].”
Whilst the influenza was on the American Pacific coast in September,
1857, it was on the coast of China three months earlier--on board the
‘Inflexible’ at Hongkong on the 18th of May, and in the ‘Amethyst’ and
‘Niger’ in a creek near Hongkong early in June[798]. But it had been
on the Pacific coast of South America the year before, according to
the following:
“1856: Epidemic catarrh broke out in the ‘President’ when lying off
the island of San Lorenzo in the bay of Callao, first on the 20th
October, and the last cases were placed on the sick list on 1st
November,--the usual period which influenza takes to pass through a
frigate ship’s company. About sixty required to be placed on the sick
list.” It had occurred on board English ships of war at Rio de
Janeiro, on the other side of the continent, some two months before,
in August, 1856[799].
1863: The following, in the experience of the French navy, has been
elaborately recorded[800]: The frigate ‘Duguay-Trouin’ left Gorée,
Senegambia, for Brest, in February. There were no cases of influenza
in Gorée when she left; but four days out, an epidemic of influenza
began on board, the weather being fine and the temperature genial at
the time. Another French frigate, which had left Gorée, on the same
voyage to Brest, two days earlier, did not have a single case.
The following instance, here published for the first time, belongs to the
most recent pandemics of influenza, 1890-93. It relates to only a single
case of influenza, in the captain of a merchantship; it would have been a
more satisfactory piece of evidence, if there had been several cases in
the ship; but among the comparatively small crew of a merchantman, the
same groups of cases are not to be looked for that we find on board
crowded men of war; and in this particular case the only other occupants
of the quarter-deck were the first mate and the steward.
The ship ‘Wellington,’ sailed from the Thames, for Lyttelton, New
Zealand, on the 19th December, 1891. The epidemic of influenza in
London in that year had been in May, June and July; the mate of the
‘Wellington’ had had an attack of it ashore, on that occasion, but not
the captain nor the steward. On the 2nd of March, 1892, when
seventy-four days out and in latitude 42° S., longitude 63 E., near
Kerguelen’s Land, the captain began to have lumbago and bilious
headaches, for which he took several doses of mercurial purgative
followed by saline draughts. The treatment at length brought on
continual purging, which, together with three days’ starving from the
22nd to the 24th of March, caused him a loss of weight of eight
pounds. The navigation had meanwhile been somewhat difficult and
anxious, owing to a long spell of easterly head winds. Quite suddenly,
on the 26th March, when the ship was in latitude 44 S., longitude 145
E., or about two hundred miles to the south of Tasmania, he had an
aguish shake followed by prolonged febrile heat, which sent him to his
berth. The symptoms were acute from the 26th to the 30th
March,--intense pain through and through the head, as if it were being
screwed tight in an iron casing, pain behind the eyeballs, a
perception of yellow colour in the eyes when shut, a feeling of
soreness all over the body, which he set down at the time to his
uneasy berth while the ship was ploughing through the seas at about
twelve knots, and a pulse of 110. The head pains were by far the worst
symptom, and were so unbearable as to make the patient desperate. This
acute state lasted for four days, and suddenly disappeared leaving
great prostration behind. The captain, who had long experience with
crews and passengers, and a considerable amateur knowledge of
medicine, summed up his illness as a bilious attack, passing into
“ague” with “neuralgia of the head.” While the acute attack lasted the
ship had covered the distance from Tasmania to the southern end of New
Zealand, and on the 31st of March the captain by an effort came on
deck to navigate the vessel in stormy weather up the coast to
Lyttelton, which was reached on the 2nd of April. The pilot coming on
board found the captain ill in his berth, and on being told the
symptoms, at once said, “It is the influenza: I have just had it
myself.” The doctor who was sent for found the captain “talking
foolishly,” as he afterwards told him, and had him removed to the
convalescent home at Christchurch, where he remained a fortnight
slowly regaining strength. The doctor[801] could find no other name
for the illness but influenza, although he had not supposed such a
thing possible in mid-ocean. They had just passed through an epidemic
of it in New Zealand, and it is reported about the same time in New
South Wales, afterwards in the Tonga group, and still later in the
summer in Peru. The symptoms of this case are sufficiently
distinctive: the intense constricting pain of the head is exactly the
“_fierro chuto_” or “iron cap” of South American epidemics; the pain
in the eyeballs, the soreness of the limbs and body, and the
unparalleled depression and despair, are the marks of influenza
without catarrh. The patient was of abstemious habits, and had made
the same voyage year after year for a long period without any illness
that he could recall. He had reduced himself by purging and starving,
on account of a bilious attack during a fortnight of foul winds from
the eastward, and had doubtless become peculiarly susceptible of the
influenza miasm before the ship came into the longitude of Tasmania on
the 26th March.
The Influenzas of Remote Islands.
The full and correct theory of influenza will not be reached by the great
pandemics only. On the other hand some very localized epidemics may prove
to be signal instances for the pathology, although they do not bear upon
the source of the great historic waves of influenza. The instances in view
are the influenzas started among a remote community on the arrival of
strangers in their ordinary health. This phenomenon has been known at the
island of St Kilda, in the Outer Hebrides of Scotland, since the year
1716, when it was recorded in the second edition of an essay upon the
island by Martin. Some thought these “strangers’ colds” mythical, so much
so that Aulay Macaulay, in preparing a work upon St Kilda, was advised to
leave them out; he declined to do so, and Dr Johnson commended him for his
magnanimity in recording this marvel of nature. There is now no doubt
about the fact. H.M.S. ‘Porcupine’ visited the island in 1860; a day or
two after she sailed again, the entire population, some 200 souls, were
afflicted with “the trouble,” and another visitor, who landed ten days
after the ‘Porcupine’s’ visit, saw the epidemic of influenza in progress.
The same thing happened in 1876, on the occasion of the factor landing,
and again in 1877 on the occasion of a crew coming ashore from a wrecked
Austrian ship. A medical account of this epidemic catarrh was given in
1886: The patient complains of a feeling of tightness, oppression and
soreness of the chest, lassitude in some cases, pains in the back and
limbs, with general discomfort and lowness of spirits. In severe cases
there is marked fever, and great prostration. A cough ensues, at first
dry, then attended with expectoration, which may go on for weeks[802].
In the remote island of Tristan d’Acunha, in the South Atlantic midway
between the River Plate and the Cape of Good Hope, the same thing happens
“invariably” on the arrival of a vessel from St Helena[803]. It is
reported also as a common phenomenon of the island of Wharekauri, of the
Chatham Group, about 480 miles to the eastward of New Zealand. Residents,
both white and coloured, suddenly fall into an illness, one symptom of
which is that they feel “intensely miserable.” It lasts acutely for about
four days, and gradually declines. It resembles influenza in all respects,
and is known by the name of _murri-murri_, which is curiously like the old
English name of _mure_ or _murre_. “The mere appearance of murri-murri is
proof to the inhabitants, even at distant parts of the island, which is
thirty miles long, that a ship is in port, insomuch that, on no other
evidence, people have actually ridden off to Waitangi to fetch their
letters[804].”
About equally distant in the Pacific from Brisbane, as Wharekauri from
Christchurch, lies Norfolk Island, originally colonized by the mutineers
of the ‘Bounty.’ A writer in a newspaper says:
“During a seven years’ residence in Norfolk Island, I had
opportunities of verifying the popular local tradition that the
arrival of a vessel was almost invariably accompanied by an epidemic
of influenza among the inhabitants of the island. In spite of the
apparent remoteness of cause and effect, the connexion had so strongly
impressed itself on the mind of the Norfolk Islanders that they were
in the habit of distinguishing the successive outbreaks by the name of
the vessel during whose visit it had occurred[805].”
Something similar has long been known in connexion with the Danish trade
to Iceland, the first spring arrivals from the mother country bringing
with them an influenza which the crews did not suffer from during the
voyage, nor, in most cases, during the progress of the epidemic in
Reikjavik. The experience at Thorshaven, in the Faröe Islands, has been
the same[806].
These are important indications for the pathology of influenza in general.
They point to its inclusion in that strange class of infections which fall
most upon a population, or upon those orders of a population, who are the
least likely to breed disease by anything that they do or leave undone.
Veterinary as well as human pathology presents instances of the
kind[807]. In seeking for the source of such an infectious principle, we
are not to look for previous cases of the identical disease, but for
something else of which it had been an emanation or derivative or
equivalent, something which may have amounted to no more than a disparity
of physical condition or a difference of race. And as the countries of the
globe present now as formerly contrasts of civilized and barbarous, nomade
and settled, rude and refined, antiquated and modern, with the aboriginal
varieties of race, it may be said, in this theory of infection, that mere
juxtaposition has its risks. But, in the theory of influenza, the first
requisite is an explanation of its phenomenal uprisings and wave-like
propagation, at longer or shorter intervals, during a period of many
centuries.