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32
In all of the five cases the evidence at consultation was not in favour of any
notifiable condition as at first apprehended, and the opinions then expressed, with
one exception, were borne out by the subsequent course of events.
Influenza.
The total number of deaths attributed directly to influenza in 1925 was 1,082.
Influenza was prevalent during the winter months of the year and the mortality
reached a maximum in the sixth week, the deaths in that week numbering 92.
Influenza was also somewhat prevalent towards the end of the year when, during
several successive weeks, an abnormally low temperature was recorded.
The influenzal group of diseases.—During 1925, encephalitis lethargica (see
Table on p. 30) was less prevalent than in 1924, while cerebrospinal fever and poliomyelitis
showed no exceptional activity. During the year the Watsonian lectures, on
" The epidemic diseases of the central nervous system," were delivered by Dr. A. K.
Chalmers, before the Royal Faculty of Physicians and Surgeons of Glasgow. Dr.
Chalmers began by remarking concerning the group of diseases in question—" I have
been influenced by a desire to ascertain whether any common picture could be formed
of their origin and method of spread, rather than by any hope that I can add to the
clinical knowledge of their several forms." In a word, he studied the group from the
epidemiological rather than from the purely clinical point of view; regarding the
subject under examination as a mass phenomenon; as he himself expresses it, in
one of his final paragraphs, "It is the history of the symptoms as they develop
rather than the impression which they create at any given observation which counts
in their recognition." Sir William Jenner, when he set about a corresponding
attempt to classify the continued fevers proceeded mainly on clinical lines. He
begins, it is true, by an allusion to the beautiful emblem, that of Plato's "den," which
warns us that " though men live, indeed, in the view of the heavens, yet our minds
are confined in the caverns of our bodies." He elected deliberately, however, in his
study of the continued fevers to proceed in the main clinically, and on an understanding
that he would "neither divide, where Nature has drawn no line, nor
generalise where Nature has bestowed no unity."
In reporting upon "influenza" in London in 1918 in the Annual Report for that
year, it was felt to be essential, on the other hand, to adopt the epidemiological
point of view, and following Creighton, take account of "gradations, modifications,
affinities being careless of symmetry, of definitions or clean cut nosological ideas,
or the dividing lines of a classification." It has, it is true, undoubtedly been more
usual of late years to attach paramount importance to the purely clinical point of
view, or at any rate to give epidemiology only a second place, as in the formula
" when the object is to ascertain the nature of an illness, clinical and epidemiological
similarities between it and other diseases are of less value than differences." Emphasis
upon such a formula is, clearly, however, more justifiable in enquiring as to
the nature of individual illnesses than in studying an epidemic, particularly if this
should chance to be one of so protean a character as an epidemic of influenza.
Dr. Chalmers, as an epidemiologist, does not hesitate; he considers "the
setting in which the new diseases occurred"; he says, "all of them have been
associated in a way sometimes suggesting a causal relationship between them
he cites the pioneer work of the late Dr. Wallace Anderson, of Dennistoun, in tracing
relationship between sporadic cases of cerebrospinal fever right away back in the early
"nineties" and the later epidemic cases of 1906-08, and says that Dr. Anderson
correctly interpreted the position in regarding the disease as having been present
in Glasgow, at least, all through the "nineties" decade; he further considers the
"phases of the epidemic period"; he asks "under what nosological disguise does
the sporadic case lurk in the intervals "; and he suspects that it is in the guise of
"tuberculous meningitis"; he refers to Dr. Matthew Hay's report on the Aberdeen