Chapter III · (continued 3)

Mr Williams remembered the similar influenza of 1803, and said that depletion was then regarded as an injurious plan of treatment.

Mr Proctor:—Yes, but the Brunonian doctrines were then in full fling, and practitioners had not learned the full use of the lancet.

Graves states very fairly the reasons that induced them to take blood in the influenza of 1833, as well as the results of the practice[721]:

“The sudden manner in which the disease came on, the great heat of skin, acceleration of pulse, and the intolerable violence of the headache,—together with the oppression of the chest, cough, and wheezing—all encouraged us to the employment of the most active modes of depletion; and yet the result was but little answerable to our expectations; for these means were found to induce an awful prostration of strength, with little or no alleviation of the symptoms.”

The prostration, be it said, was probably as great and as frequent in the epidemics of 1890-93, when bleeding had gone out altogether; still it was not understood that all these signs of sthenic action in the attack were really paradoxical, as Whitmore, in the passage cited in the note, saw clearly two centuries before.

The epidemic became rapidly prevalent all over England, Scotland and Ireland in April and May, following no very definite order of progression. The Liverpool newspapers asserted that ten thousand were down with it in that town in one week. A doctor at Lincoln wrote, on 13 May, that few families there had escaped it[722]. Other towns in which it is said to have been “more or less” prevalent were Portsmouth, Sheffield, Birmingham, Leeds, York, Halifax, Glasgow, Edinburgh[723], Dublin and Armagh; so that we may fairly assume, although we are without the detailed evidence available for earlier epidemics, that it was ubiquitous in town and country.

At Birmingham[724], among the outpatients of the Infirmary, the cases of influenza were as follows, the 25th and 26th April being the days when cases came first in rapid succession, while the middle of May was practically the limit:

Cases of Influenza Males Females

April 151 52 99

May 464 159 305

June 28 9 19

643 220 423

The great excess of females is remarkable, but was probably due to some local circumstances. Of the 643 cases, 122 were under ten years of age. Of the females, 9 died, of the males 3. But the deaths in Birmingham caused by the epidemic directly or indirectly were many; the burial registers of four churches and chapels showed a marked increase of burials above those of the corresponding months of 1832:

1832 1833

April 205 245

May 211 434

June 193 230

609 909

Medical opinion in 1833 was decidedly adverse to the contagiousness of influenza. The common remark was that it was just as little contagious as the cholera of the year before had proved to be. As in 1837 and 1847, when the doctrine of contagiousness was equally out of favour, the disease was observed to spread rapidly, in no very definite line, affecting most parts of the country in the same two or three weeks, affecting the population within a considerable radius almost at once, and the inmates of houses all together. These, it was said, are not the marks of a disease that persons hand on one to another, quasi cursores.

The Influenza of 1837.

Between the influenza of April-May, 1833, and that of January-February, 1837, it seems probable that there were minor catarrhal outbreaks, distinguishable from ordinary colds. One writer on the influenza of 1837 refers to those “who had it in 1834 or in the intervening period between the two epidemics.” The table of diseases of the outpatients at the Birmingham Infirmary for the year 1836 contains a large total of catarrhs, and, in another line, 24 cases of “epidemic catarrh” in the summer months. The Gentleman’s Magazine begins its notice of the epidemic of 1837 by calling it “an influenza of a peculiar character,” which shows that influenza of the ordinary kind was a familiar thing. Probably the name was a good deal misapplied in the years following every great epidemic from 1782 onwards: thus in ‘St Ronan’s Well,’ which was written in 1823, or twenty years from the last general influenza, a tradesman’s widow in easy circumstances and given to good living comes to the Spa on account of a supposed malady which she calls the influenzy. But our recent experiences of four great influenza seasons in succession from 1889-90 to 1893, although it is without precedent in the history, will incline us the more to credit what is recorded of influenza cases in the intervals between the years of great historical epidemics[725]. However that may be for the years following 1833, the influenza of January, 1837, was sudden, simultaneous, universal.

The first cases, which Watson compares to the first drops of a thunder-shower, were seen earlier in some places than in others; but from all parts of England it was reported that the influenza was at its height from the middle of January to the end of the first week of February. Possibly it was a few days earlier in London than in most other towns, inasmuch as the great increase of the deaths that is shown in the following table, in the second and third weeks of January, would imply a prevalence of the epidemic for at least a fortnight before.

Weekly Mortalities in London (by the old Bills).

1837

Week ending Influenza All causes

Jan. 10 0 284

17 13 477

24 106 871

31 99 860

Feb. 7 63 589

14 35 558

21 20 350

28 8 321

March 7 4 262

This sudden rise in the deaths from all causes is a characteristic influenza bill, comparable with those already given from 1580 onwards. But the bill is far from showing the whole of the mortality in London in 1837. The London bills of mortality compiled by the Parish Clerks’ Company had fallen into the last stage of inadequacy, and were on the eve of being superseded by the general system of registration for all England and Wales[726].

The London bills, so long as they existed, never took in the great parishes of St Pancras, Marylebone, Kensington and Chelsea. The area “within the bills of mortality” was that of London about the middle of the 18th century. But, instead of becoming more and more crowded as time went on, it had actually become much less populous, especially in the old City and Liberties, owing to the erection of warehouses, workshops, counting-houses and other non-residential buildings where dwelling houses used to be; so that the decrease of mortality “within the bills” in the 19th century is in part due to the decrease of population within the same area. This has to be kept in mind when the above table is compared with one of those for former influenzas, such as that of 1737, exactly a hundred years before.

It was thought that the 1837 influenza in London was worse than that of 1833, but the figures show the contrary as regards the number of deaths from all causes[727]. Both of them, however, were in the first rank of severity, finding their nearest parallels in the three great influenzas of the 18th century, in 1733, 1737 and 1743, when the deaths from all causes during the influenza rose, indeed, to a much larger total within the bills, but rose from a much higher mean level.

In Dublin the great increase of burials from the influenza of 1837 fell at the same time as in London, according to the following comparison with the year before for Glasnevin Cemetery[728]:

1835-36 1836-37

Dec. 1835 355 Dec. 1836 413

Jan. 1836 392 Jan. 1837 821

Feb. " 362 Feb. " 537

Mar. " 392 Mar. " 477

1501 2248

At Glasgow the deaths from influenza were as follows[729]:

1837

Males Females Total

January 111 118 229

February 37 62 99

March 9 20 29

157 200 357

But the heading of “influenza” did not nearly show the full effects of the epidemic upon the mortality, which was enormous in Glasgow in January, as compared with the same month of 1836:

All causes Catarrh Aged Asthma Fever Decline

Jan. 1836 790 4 73 31 45 124

Jan. 1837 1972 229 274 185 201 247

There was also a great increase in the deaths of infants by bowel complaint. The only period of life which did not show a great rise of mortality was from five to twenty; the greatest rise was between the ages of forty and seventy, corresponding to the London experience in the epidemic of 1847.

At Bolton, Lancashire, the great rise in the deaths, as compared with the average of five years before, was in February:

Average of five years 1831-36 1837

January 111·2 115

February 79·0 205

March 97·8 100

288·0 420

At Exeter, the burials in the two chief graveyards were 227 in January and February, 1837, as compared with 125 in the same months of 1836. These mortalities, although large, were but a small ratio of the attacks. In 2347 cases enumerated in the collective inquiry, there were 54 deaths, a ratio of two deaths in a hundred cases being considered a full average. The attacks were mostly in middle life, and the deaths nearly all among the asthmatic, the consumptive and the aged. The ages of one hundred persons attacked at Birmingham were as follows[730]:

Ages 1- 5- 10- 20- 30- 40- 50- 60- 70- 80-90

Cases 3 2 12 23 21 19 12 7 0 1

At Evesham only five out of 93 were under five years. At Leamington, in a list of 170 cases, there were 26 under fourteen years, 119 from fourteen to sixty-five years, and 25 above the age of sixty-five[731]. In some places males seemed to be most attacked, just as at Birmingham in 1833 there was a great excess of female cases; but the collective inquiry showed that the sexes shared about equally all over. The type of the malady was on the whole catarrhal, as in 1833. Nearly all the cases had symptoms of sneezing, coughing, and defluxions; many cases had nothing more than the symptoms of a severe feverish cold; the more dangerous cases had dyspnoea, pneumonia and the like; while all had the languor, weariness, and soreness in the bones which mark every influenza, whether it incline more to the moist type of catarrhal fever or to the dry type of the old “hot ague.”

The influenza of 1837 having been remarkably simultaneous, sudden and brief, the doctrine of personal contagiousness found little favour, just as in 1833. The 12th query sent out by the committee of the Provincial Medical Association was: “Are you in possession of any proof of its having been communicated from one person to another?” The answers are said to have been nearly all negative; namely, that there was “no proof of the existence of any contagious principles by which it was propagated from one individual to another.” Shapter, a learned physician at Exeter, inclined to a certain modified doctrine of contagion by persons. Blakiston, of Birmingham, an exact mathematician, declared that the question as ordinarily stated did not admit of an answer.

At Liverpool there was an interesting observation made, exactly parallel with those made at Gravesend in 1782 and Portsmouth in 1788. The influenza of 1837 was practically over by the first or second week of March; but “that the atmosphere of Liverpool was still contaminated by the epidemic influence up to the middle and latter end of April was apparent from the fact that many of the officers and men of the American ships, and generally the most robust, were violently attacked shortly after their arrival in port,”—the same being the case also with black sailors on ships arriving from the Brazils and the West Coast of Africa[732]. At the naval stations of Sheerness, Portsmouth, Plymouth and Falmouth, every one of the ships of war had been attacked in January, the ships cruising on the south coast of Spain, or lying at Barcelona, in February, the ships at Gibraltar in April, and those at Malta in May. The ‘Thunderer,’ on the passage from Malta to Plymouth, had the first cases of influenza at sea on the 3rd of January, four days before reaching Plymouth[733], as if she had sailed into an atmosphere of it somewhere near the coast of Brittany.

For fully ten years, from March or April 1837 to November 1847, there was no great and universal influenza in England. But there were several undoubted minor, and perhaps localized, outbreaks of an epidemic malady which was in each case judged to be truly the influenza, and not a common cold. The earliest of these was in the spring of 1841. It was recognized by the Registrar-General to have been in London from 20 February to 24 April, the mortality having been little affected by it. It was also recognized in Dublin in March, and remarked upon by two physicians to the Cork Street Fever Hospital; it was characterized by the usual languor, weariness, and pains in the head, by defluxions of the eyes, nose and throat, but not by any affection of the lungs, and was in all respects mild[734]. Exactly a year after, in March, 1842, influenza was described as epidemic at York[735]: it was noted also in London in March[736], and is mentioned as having been again in Ireland in 1842[737]. The next undoubted influenza is reported from a rural part of Cheshire (Holme Chapel) in January, 1844, in the wake of an epidemic of scarlatina; it continued in all kinds of weather until June, and had a remarkable intercurrent episode, for some weeks from the middle of March, in the form of an epidemic of pneumonia among young children, which passed into mild bronchitis in the cases last attacked[738]. Coincidently with the influenza in Cheshire, there is a report of a series of catarrhal cases in Dublin about the beginning of January, 1844, in which the sense of constriction and suffocation under the sternum and the paroxysmal character of the attacks seemed to point to influenza[739]. Two years after, a Dublin physician in extensive practice among the rich wrote, at the request of a medical editor, an account of an epidemic of influenza in January and February, 1847; he had sixty cases among children under fourteen in his private practice, usually several children in one house, and sometimes the adults in the house[740]. This was in the midst of the great epidemic of relapsing fever in Dublin and all over Ireland, due to the potato famine. The same prevalence of influenza to a slight extent is recorded also for London at the end of 1846 and beginning of 1847[741]. It is easy to object that these “influenzas” between 1837 and 1847 were but the ordinary catarrhal maladies of the seasons. But the physicians who took the trouble to record them—probably more might have done so—were, of course, aware of the distinction that had to be made between many common feverish colds concurring in the ordinary way, and a truly epidemic influenza, however slight.

The Influenza of 1847-48.

The great influenza of 1847 began in London about the 16th or 18th of November, was at its height from the 22nd to the 30th, had “ceased to be very prevalent” by the 6th or 8th of December, but affected the bills of mortality for some time longer, as in the following table:

Weekly Mortalities in London.

1847

Week ending All causes Influenza Pneumonia Bronchitis Asthma Typhus

Nov. 20 1086 4 95 61 12 86

27 1677 36 170 196 77 87

Dec. 4 2454 198 306 343 86 132

11 2416 374 294 299 78 136

18 1946 270 189 234 52 131

25 1247 142 131 107 14 83

Jan. 1 1599 127 148 138 26 74

In the thirteen weeks of the first quarter of 1848 the influenza deaths declined as follows: 102, 102, 89, 56, 59, 47, 27, 33, 18, 11, 10, 16, 8.

This was the first great epidemic of influenza under the new system of 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 (Ancoats) Sheffield (West) York (Walmgate) Places in 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

Week ending Annual death-rate per 1000 living Deaths from all 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

Week ending Annual death-rate per 1000 living Deaths from all 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

Week ending Annual death-rate per 1000 living Deaths from all 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

Week ending Annual death-rate per 1000 living Deaths from all 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

Week ending Annual death-rate from all causes per 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

Town Week ending Annual death-rate from all causes 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 1891

Cumberland ·35 Rutland 1·36

North Wales ·28 Lincolnshire 1·19

Herefordshire ·28 North Wales 1·09

Salop ·28 Westmoreland 1·02

Wilts ·28 Monmouth 1·00

Somerset ·26 E. Riding Yorks ·98

Dorset ·25 Herefordshire ·98

Bucks ·25 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’:

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: