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19
gica without lethargy," or the " sore throat with glandular feveV described in Part II. of this report,
and the like.
An important Report on the Pandemic of Influenza, 1918-19, was issued at the close of last year
by the Ministry of Health.
Sir George Newman thus summarises the growing experience of the "setting" of an influenza
epidemic. He says the epidemiological records go far to establish—
"(a) That the epidemiological features of the cycle of years within which influenza explodes
are different from those of the influenza-free cycles."
"(b) That preceding epidemic influenza there is often a rise in general morbidity of the
population, an 'epidemic constitution' develops favourable to influenza, there are early
though often mild and typical forerunners of the disease, and parallel or allied clinical maladies
are seen."
"(c) That there are occurrences, similarities and inter-relationships between outbreaks of
cerebro-spinal fever, poliomyelitis and outbreaks of influenza, bronchitis and pneumonia."
Sir George refers, inter alia, to the evidence set out in the special report on London Influenza
made to the Council in June, 1919. In Part I. of the Ministry Report an interesting analysis by Dr.
Greenwood of the observations of Jno. Huxham of Plymouth is made, which establishes the proposition
that " the epidemiological features of the cycle of years within which influenza exploded once or more
were, apart from stick explosion, different from the characteristics of the influenza-free epochs." This
analysis materially adds to the evidence already collated by " such profound epidemiologists as Creighton
Hirsch, and Haeser," to the effect that " influenza does always cast a shadow before or behind." We
are led, moreover, irresistibly to entertain the suspicion that " Even in a world-wide pandemic the
problem of epidemic influenza may be largely an internal problem of each nation, a problem of social
relationship, of social factors of domestic habits and life. The materials of the conflagration come from
within. As the compilers warn us, the wolf is in the fold all the time. " His ravages depend as much upon
the disposition of the sheep within the fold as upon his appetite."
With the conviction that this view of the matter embodies the most important practical lesson
to be learnt from the epidemiology up to date, attention has been concentrated in London upon safeguarding,
wherever possible, the disposition of the sheep within the fold. It is quite clear that, whatever
may be done in the future, there is no sign up to the present time that prophylactic vaccination is of any
value whatever. The one plain indication is just to reduce as far as may be the danger to be apprehended
from badly ventilated and overcrowded places of assembly. Thus every effort should be made to secure
satisfactory mechanical means of ventilating rooms and passage-ways which are apt to be thronged
by large numbers of people. Every effort, too, should be made to resist curtailment of the very modest
requirements laid down in statutes and bylaws with regard to cubic and floor space and the height of rooms.
It was ascertained, on the instruction of the Public Health Committee, that so far as the Tube Railways
were concerned careful consideration was already being given to the problems involved. Under instructions
from the Theatres and Music Halls Committee renewed examination was made of the atmosphere
of theatres, etc., in which necessary works had been postponed during the war years. A deputation
from the Council attended upon the Minister of Health to deprecate any weakening of the requirement
in the Building Act as to the minimum height of rooms. In the existing state of knowledge it is in directions
such as these that the evil consequences of influenza prevalences can best be countered. There
can be no doubt that influenza has been far more widely spread than is generally realised in London
since the third considerable outbreak of the present series (that of Feb.-March, 1919), but the epidemic
influence has been in many instances cloaked in the guise of the gastro-intestinal, and nervous forms
which influenza is apt to assume. There is reason for thinking that some of the cases, at any rate, of
glandular fever and of anomalous scarlatinal sore throat, as well as much of the so-called epidemic hiccough,
epidemic lethargy, poliomyelitis and cerebro-spinal fever of 1920 were in fact of influenzal origin. Fortunately
the case mortality has remained quite low. Cerebro-spinal fever itself has, as is its wont, been
comparatively unobtrusive during the swell of the great influenzal wave which culminated in 1918 and
in the years immediately following.
The number of cases of cerebro-spinal fever notified during 1920 was 164, as compared with Cerebro199,
265, 430, 432 and 674 in 1919, 1918, 1917, 1916 and 1915 respectively. The disease has, therefore, spinal fever
been steadily declining in prevalence during the last five years, following upon increased prevalence
manifested in 1915. This behaviour follows that of earlier prevalences of cerebro-spinal fever, which,
as noted in the London Influenza Report of 1919, tend to fall into the background during a period of
some eight or ten years, of which the centre point is a year of pandemic prevalence of influenza. The
abnormal crowding of population, both civil and military, during the war undoubtedly, however, contributed
towards aggravating mortality from the disease. Of the 164 cases notified during 1920,
28 were not confirmed as cases of cerebro-spinal fever, whilst in 8 cases, in which the diagnosis was arrived
at post-mortem, no official notifications under the Act were received. The actual number of cases which
occurred during the year was, therefore, 144. Of these, 108 (75 per cent.) proved fatal. The monthly
distribution of these cases is set out in the following table :—
Month.
Jan.
Feb
Mar.
April.
May.
June.
July.
Aug.
.Sept.
Oct.
Nov.
Dec.
Total.
Total number notified 20 9 26 22 10 11 13 9 15 8 7 14 164
Cases notified but not confirmed 4 2 3 2 1 4 2 — 4 2 2 2 28
Cases not notified 2 1 — 1 — — — — 1 — — 3 8
Total number of actual cases 18 8 23 21 9 7 11 9 12 6 515 144
Number of deaths 14 5 17 15 7 7 9 6 8 5 3 12 108
61001 D 2