View report page

14
The influenza
pandemics
of the
nineteenth
century.
waves of epidemic agues, 'hot agues' or intermittents, the whole being called by the people the 'new
disease' or the 'new ague,' while by physicians such as Willis and Sydenham they were taken to be
distinguishable constituent parts of one and the same epidemic constitution. The last period in which
epidemic agues were so recognised and named in England was from 1780 to 1785; and in the midst of
that also there occurred an epidemic catarrh—the ' influenza' of the year 1782."
The period now approaching is that of the great pandemics of influenza of the 19th century, those
of 1803,1833,1848, 1874 and 1890. They may be taken seriatim and it will be seen how "spotted fever,"
" typhus," or " cerebrospinal fever " precede and follow the influenzas.
(a) 1803 pandemic.—There was spotted fever in Dublin in 1801 and Creighton notes that a crop
of typhus reports is forthcoming in Flintshire, 1801-3; in Meath, where "influenza superseded typhus
in 1803," at St. Neots and at Clifton. Then (after the pandemic) followed the first recorded outbreak of
cerebrospinal fever, that at Geneva in 1805, and outbreaks were reported in 1807-08 in America.
(b) 1833 pandemic.—From 1827 to 1830 cerebrospinal fever was active in the old and new
worlds. Later follow outbreaks in France (1837-42), Italy (1839-45), Germany (1834-35) and the
United States in 1842. Badham's note on infantile paralysis appeared in 1835, and Heine's work
in 1840.
(c) 1848 pandemic.—Ureighton notes that in 184(5-47 ague and remittent lever were more
in evidence than usual. Dr. Peacock writes that in 1847 "intermittent fevers were common and in
March, April and May, purpura was frequently met with," he adds "that these several affections are not
merely coetaneous but correlative and types and modifications of one disease with which they have a
common origin." Furthermore, outbreaks of cerebrospinal fever are recorded in France (1846-48),
Algiers, Denmark, Spain, Ireland and Westphalia and in the United States (1845-48). In some of these
countries, outbreaks were reported during the pandemic period, and following upon it in Sweden 185458)
and from 1856 onwards in the United States.
(d) 1874 pandemic.—Outbreaks of cerebrospinal fever were reported in Germany from 1864
onwards, and also in Austria, Hungary, Russia and Greece. In 1866-67 the disease prevailed in Ireland
and was reported near Lincoln. In Italy it appeared in 1873 and in Jerusalem in 1872. In the United
States from 1866 onwards numerous epidemics were reported. Duchenne's first paper on infantile
paralysis appeared in 1855; he was, however, seeing many more cases in 1872. A few years after
the 1874 prevalence, the great period of cerebrospinal fever epidemics in the United States came for
a time to an end. There were groups of cases in Birmingham, Bath, Plymouth and Oxford in 1876
and somewhat later in Scotland, Galicia, Germany, Poland and other parts of Europe. From that
time until shortly before the next pandemic cerebrospinal fever was remarkably quiescent.
(e) 1890 pandemia.—In 1887, in Vienna,Weichselbaum demonstrated the meningococcus, but from
1885 onwards there are accounts of "spotted fever," for instance among troops at Devonport and Chester,
1885-86. About this time several obscure illnesses resembling typhus were reported upon by Mr.
Spear to the Local Government Board. Cerebrospinal fever occurred in Ayrshire in 1884 and in Dublin
1885-86. Also in France, 1885-86 and in Denmark from 1888 onwards. In Norway there was increased
prevalence in 1887. There was a similar recrudescence in Sweden in 1887 and 1888. The researches
of Dr. Medin, of Stockholm, into poliomyelitis, began about this time. In Silesia there was an outbreak
of cerebro-spinal' fever in the Oppeln district in 1887. In Austria—Dalmatia, Istria and Styria suffered in
1688-89. From Russia precise information is not obtainable, but it is alleged that Silesia was from time
to time infected from Russian Poland. The occurrence of cerebrospinal meningitis in the Mediterranean
was the subject of a report by Sir Richard Thorne to the Local Government Board in 1888; it appeared
in Sicily in 1883 and in Sardinia from 1883-88. In 1888 it was present in Syria.* In 1883 it was reported
in Cape Colony and in 1884 "there was a severe outbreak, cases continuing to occur up to 1890." An
epidemic occurred in the Fiji Islands in 1885. In India statistics show increase in the later eighties.
In the city of New York an outbreak occurred in 1881 and deaths were registered each year
throughout the period ensuing. From 1886 onwards there was increase in the registered mortality
from the disease in Chicago. In reports from 1884 and onwards deaths were recorded in Montreal.
A review of the period preceding the pandemic of 1889-90 thus shows that there was great diversity
as regards recognition of cerebrospinal meningitis in various parts of the world. It was, for instance,
comparatively commonly recorded in the State of New York and elsewhere in North America, but was
practically ignored in most countries, save when a considerable outbreak forced itself upon attention.
It is, however, quite clear that over the whole of the thickly populated globe, and even in places such
as the Fiji Islands and South Africa, there was a notable extension of cerebrospinal meningitis prevalence
from 1885 onwards. It may be added that in this country there was probably much more cerebrospinal
meningitis than was recognised, and further it is of interest to refer to certain mysterious epidemic
pneumonias at Middlesbrough, Scotter, etc., and to apecial prevalences of sore throat and gastro-intestinal
disturbance, such as were chronicled in the spring of 1887 in the Proceedings of the Society of Medical
Officers of Health. These outbreaks, as also the dengue prevalences of Southern Europe, stand in very
interesting relationship with the great pandemic outbreak of influenza at the end of 1889.
On tu ning now from the years preceding to those succeeding the great pandemic the records of
cerebrospinal menignitis become much more complete; moreover, as Dr. Bruce Low observes, the suspicion
arose that "cases regarded locally as cerebrospinal fever were really instances of epidemic poliomyelitis
and vice-versa"; further, he notes that though there is no characteristic rash, as in some other specific
fevers, "spots of one or another kind, purpuric, petechial, herpetic or other may be present , and,
again, as M. Colin said in 1905, it began to be suspected that cerebrospinal meningitis " had a close
* It is of interest to remember in connection with this outbreak—in which Gozo was affected—that Malta fever
was at this time exciting some attention and, indeed, its "causal organism" was discovered in 1886. Moreover, dengue
was prevailing in the Levant about the same time.