View report page

11
Gothenberg; a week later in Chicago, the rest of the large German towns mentioned above, Stockholm
and Paris; thereafter in Christiania, Copenhagen and Amsterdam, London being the last of the towns
mentioned to reach the maximum of total mortality, with the exception perhaps of Calcutta.
In America as much as six weeks separates the period of maximum in different towns. For 44
of the largest cities as a whole, the maximum mortality for influenza and pneumonia occurred in the two
weeks ended 26th October. There is a vague indication of progression from North East to South West.
Generally the mortality in the American towns exceeds that of London and other large English towns.
The summer epidemic apparently terminated with the prevalence at Amsterdam in August.
Influenza was reported present at the end of August in Salonica and other places in the Mediterranean,
but this was probably the beginning of the autumn epidemic which, by the end of the year, had practic-
ally become world wide. The autumn epidemic cannot be traced successively in point of time from one
locality to another, as could that of the summer. Press reports show epidemic influenza to have been
present in September in places as far apart as Canada, Honduras, Bermuda, Portugal and Korea. It is
of course, possible that the Korea prevalence was actually the tail end of the summer epidemic, but the
fact that influenza was reported in China in the following month, suggests rather that the autumn
influenza was widespread throughout the temperate zone and was transmitted therefrom along the main
line of international communication southwards and northwards In October influenza was reported
from Archangel to Peru, in China, South Africa and New Zealand. It seems to have taken longer to
make its way to some of the islands lying off the main routes of ocean traffic, since it was not reported
in Asuncion, the Society Islands, San Domingo and Samoa until December. In January it was reported
in Australia (Melbourne). Recently it has raged in Labrador, where about 20 per cent, of the population
have perished. In some of the more remote localities the fatality, especially among the natives, was
excessively high. In the Society Islands, Moorea with a native population of about 1,200 had 200
deaths in a few days, and Makatea and Raiatea lost 10 per cent, of their population. In Bombay the
death rate reached 257 per 1,000.
The occurrence of epidemic influenza in distant seaport towns has been associated with the
arrival of ships in several instances. In Rio Janeiro, where 70 per cent, of the population (of about one
million) are stated to have been attacked in the autumn (15.000 deaths occurring in six weeks), the arrival
of the s.s. Demerara from Europe was thought to have originated the epidemic. The outbreak in
Bombay in the summer was associated with the arrival from overseas of a transport on 31st May.
PART II.
Study of Previous Prevalences of Influenzal Diseases.
The history of the recent epidemic is, as has been seen, one of gradual development over a series
of five or more years of epidemic prevalence of varying types of disease, culminating at length in the
appearance of successive waves of influenza which attained maximum severity at the end of 1918. It is
important to learn whether light is thrown by study of earlier prevalences upon these recent experiences,
and also whether any notion can be formed as to what may be expected in the future.
The earliest date at which enquiry can profitably be made as to association between outbreaks
of influenza and closely related types of disease (e.g., cerebrospinal fever) is at the time when the presence
of, at any rate one of the two, can first be fixed, viz., at that of the occurrence of the English Sweats,
1485-1551. The five sweats were undoubtedly influenzas and they were accompanied by outbreaks
of cerebritis, encephalitis, hauptkrankheit, etc., carefully described by Hecker, and a tabular statement
prepared from his data, was made and published in the Milroy Lectures, 1906. Creighton, more-
over, refers to the occurrence during the sweat years of "other forms of epidemic fever in the same
pestilential class." Thus he describes the gaol fever at Cambridge in 1522 (and here at the outset
question arises as to the diagnosis between typhus and cerebrospinal fever). A similar outbreak occurred
at the Oxford Assizes in 1577, and this was followed (says Cogan), by "the same kind of agues," which
"raged in a manner all over England." Anthony Wood remarks "some thought that this Oxford
mortality was the same that Leonard Fuchsius styles Sudor Anglicus." Again, in 1539, "divers and
many honest persons died of the hot agues and of a great laske throughout the realm"; the former
Creighton d clares were "febrile influenzas," the laske he thinks was dysentery, but it may have been
influenza assuming the gastro-intestinal form ? In 1558 the troops at Southampton and Portsmouth were
affected and here, as in many later military outbreaks also, question again arises as between typhus
and cerebrospinal fever.
The widespread epidemic of 1580-82 was, once more, influenza, though all over Europe it had "so
much of a sweating character that in some places they said the English sweat had come back." Creighton
is not, however, quite happy as to the nature of these influenzas; thus in speaking of the gaol fever of
Exeter in 1586, which he surmises was typhus, but which spread all over Devon, he distinguishes between
"the Devonshire diffusion (which) was like the spreading circles in a still pool, (and) the spread of
influenza (which) was like the flying ripples on a broad surface of water." And he adds, when we come
to the 18th century "we shall find the same diffusiveness associated with the clear type of disease which
we now call typhus. Influenza is the only sickness familiar to ourselves which shows the volatile
character, and we are apt to conclude that no other type of fever ever had that character. . ."
Hence, in giving the name influenza to the " hot agues" of 1540, 1557-58 and 1580-82, he does so with
the qualification that he regards them as embracing the types of fever (closely resembling typhus fever)
which "prevailed from time to time over wide districts of country in the centuries following." His
difficulty as regards the resemblance of these sweats and agues to both influenza and typhus would be
50129 I 2
The worldwide
range
of the
Autumn
epidemic.
The sweat
hot agues,
spotted
fevers
and "new
diseases" o
influenzal
type in the
15th, 16th
and early
17th centuries.