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47
the wave of infection spread rapidly from north to south, but
differed from previous epidemics in that certain tracts of country
escaped infection almost entirely. In Greater London no indication
of unusual incidence was observed until the week ended 31st
December, 1932.
Type.— The influenza was of the two familiar types, alimentary
and respiratory. Although the infection was generally of a much
milder type than in the pandemic of 1918-19 and the widespread
epidemic of 1929, it has taken a heavy toll of lives throughout the
country. An interesting feature of the 1933 epidemic was the
comparatively low fatality from associated pneumonia when
compared with previous widespread epidemics; and the fact that
recoveries were recorded in a few toxic pneumonia cases— a type
which had been invariably fatal previously.
Incidence.— Influenza is not one of the diseases which are
notifiable to the Medical Officer of Health under the Infectious
Diseases (Notification) Act. The only statistical criterion of the
extent and severity of the outbreak is, therefore, the weekly list
of deaths attributed to influenza. Even that list does not show the
full extent of the damage, because the chief danger in influenza
lies in the complications to which it gives rise, and it is generally
the complications (and not the initial attacks of influenza) which
figure in the death returns. Eor these reasons the extent of the
damage caused by an influenza epidemic is reflected in the mortality
from respiratory and circulatory diseases.