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according to records existing from the years 1173.1875," commented upon the gross
imperfections of this survey, not only so far as past centuries were concerned, but
even for years of comparatively recent date; he laments especially the sparsity of
material descriptive of the pandemics of 1857.58 and 1874.75, in this country.
Some filling in it is true of the more obvious lacunae existing a few centuries back,
has been effected ; for example, by annexing the sweating sicknesses of the 15th
century ; and later a good deal has been accomplished by including the great dengue
prevalences of the 18th and 19th centuries; for, at any rate, the widespread
" dengues," occurring in India, the West Indies and other parts of the tropics, at the
very identical times when the temperate regions were affected with " influenzas,"
must be held to belong, epidemiologically speaking, to one and the same disease
category. Dr. Shuman of Los Angeles has recently observed (Jour. Amer. Med.
Assoc. 1st March, 1924, p. 737) that " in any modern textbook in which dengue is
written up, if the reader supplies influenza for dengue the subject matter will not have
to be greatly changed." Between July and October, 1923, a considerable prevalence
of "dengue" in Calcutta and, indeed, throughout India, coincided in time of
prevalence with a recrudescence in London of influenza.
A further step can, perhaps, be taken by accepting such a series as the Picardy
sweats as belonging to the influenza family; and this inclusion is an important one,
for it brings influenza into place among endemic diseases, freeing it from the fetters
of a supposedly necessary pandemicity, with which, at one time, it was shackled.
A somewhat similar generalisation was, half apologetically, made by Hirsch, when
he referred to the " alleged endemicity of influenza in several countries situated within
the cold zone "(vol. I. p. 26); and the doctrine, that the embers of pandemic
influenza are kept alive in interpandemic periods by " influenza colds," found some
favour in this country when, on the occurrence of the 1890 pandemic, it was
attempted, by making use of catarrhal prevalences, to bridge over the gulf between
the 1890 pandemic and that of 1847.8. The would.be bridge builders, however,
received scant support at that time, for the discovery of Pfeiffer's bacillus had then
just been made, and hence all schools of opinion were disposed to ignore such details
as the missing arches of the bridge, the ruins of which now stare us in the face in
the shape of those very outbreaks, of 1857.58 and 1874.75, to which Hirsch
himself had pointedly called attention.
A great further advance was made by Creighton, when, following up the teaching
of Sydenham and Willis, he linked the influenzas of pandemic type with preceding
and succeeding "agues." This suggestion has since been confirmed, enlarged, and
in recent years successfully welded with the thesis, to which Parsons refers and for
which he gives the credit to Bezly Thorne, viz., that influenza is essentially a disease
of the nervous system. In Bezly Thome's own words " Influenza is an infectious
and febrile affection of the cerebro.spinal nerve centres." In our own day many
epidemiologists have fastened upon this hypothesis as their sheet anchor, and have
claimed that Creighton's "agues" must be held to cover poliomyelitis, polioencephalitis
and cerebrospinal meningitis, and perhaps the whole domain mapped
out in the Heine.Medin generalisation ; if they do not include, indeed, something
even more comprehensive than this. It is of interest, by the way, to note that a
Heine.Medin outbreak occurred last year in Tubingen. (Medical Science, Oct., 1923
p. 27), " The principal feature," it is stated, " of the epidemic was the influenza.like
nature of the initial symptoms." . . . "In abortive cases the diagnosis from
influenza was impossible."
The problem was necessarily again examined from a fresh angle and in a new
light when in 1917 and 1918 "encephalitis lethargica" was newly " discovered."
In London cerebrospinal meningitis had been made notifiable as long ago as 1907. In
1912 it was decided by the London County Council that the disease poliomyelitis,
which produces paralysis in young children, should also be made a notifiable disease,
and Sir Shirley Murphy with, as now appears, remarkable foresight, advised that