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102
1899 ]
A few particulars concerning Influenza may be interesting,
more especially as I do not observe that anything regarding its
history or behaviour has been previously brought under your notice.
It is an epidemic disease, generally re-appearing at considerable
intervals, although at times only a few years may elapse. During
the century which ends with this year, there were five great
epidemics, namely in 1803, 1833, 1837-8, 1847-8 and 1889-90. In
the intervals between these years there have been casual or, as they
are called, sporadic cases, and indeed from 1848 to 1889 there has
not been a single year in which some deaths, however few, have not
been registered in England and Wales. In that interval they have
been as few as 55 in 1889, the year preceding the last great outbreak
and as many as 3,568. In London the number fell as low as
3 in 1888 but was as high as 354 in 1851. Thus it is seen that
the disease was really never absent. There is a great difference
between the fatality from influenza in the sporadic years and in the
epidemic years. In the former it is not so great; it is a milder
and altogether a more benign disease but it is more fatal to children
than adults, while in the latter it is a serious disease bringing
great danger of death to those whom it attacks, particularly adults,
and even more particularly to those adults who have passed their
fortieth year.
When influenza is epidemic there is generally an increase in
the deaths from diseases of the respiratory organs, and in this
respect its behaviour is not unlike epidemic measles, which I have
frequently noticed, and indeed, have so reported to you, is attended
by numerous deaths from bronchitis and pneumonia, and possibly
from a similar cause. This is the non-recognition of the disease,
and the consequent neglect of nursing and confinement to bed,
with the result that bronchitis or pneumonia intervenes. Then
when a physician is called in, nothing is said either by the patient
or his guardian about the earlier symptoms, and consequently
should the patient die, the primary cause of death is attributed
to those which are really only secondary.
Influenza, judging by the London returns since 1846 is invariably
more fatal in the first and fourth quarters of the year,