Part 131

Influenza is mentioned in the Annals of the Four Masters as having prevailed in Ireland in the fourteenth century, and a disease characterized by similar symptoms is alluded to in early Gaelic manuscripts under the name of Creatan (creat, the chest). The disease is described also in an Irish manuscript of the fifteenth century under the terms Fuacht and Slaodan.

The earliest epidemic that prevailed in the British Isles of which any accurate description remains is that of the year 1510. The disease came from Malta, and invaded first Sicily, then Italy and Spain and Portugal, whence it crossed the Alps into Hungary and Germany as far as the Baltic Sea, extending westward into France and Britain. Its track widened over the whole of Europe from the south-east to the extreme north-west, and it is said that not a single family and scarce a person escaped it. It was attended by a "grievous pain in the head, heaviness, difficulty of breathing, hoarseness, loss of strength and appetite, restlessness, retchings from a terrible tearing cough. Presently succeeded a chilliness, and so violent a cough that many were in danger of suffocation. The first day it was without spitting, but about the seventh or eighth day much viscid phlegm was spit up. Others (though fewer) spat only water and froth. When they began to spit, cough and shortness of breath were easier. None died except some children. In some it went off with a looseness, in others by sweating. Bleeding and purging did hurt." Blisters were commonly employed--two each upon the arms and legs, and one to the back of the head. The description is sufficiently clear to place the nature of this epidemic beyond all doubt.

The epidemic of 1557, starting westward from Asia, spread over Europe, and then crossed the Atlantic to America. The malady broke out in England, after a season of unusual rain and great scarcity of corn, in the month of September. "Presently after were many catarrhs, quickly followed by a more severe cough, pain of the side, difficulty of breathing, and a fever. The pain was neither violent nor pricking, but mild. The third day they expectorated freely. The sixth, seventh, or at the farthest the eighth day, all who had that pain of the side died, but such as were blooded on the first or second day recovered on the fourth or fifth; but bleeding on the last two days did no service." "Some, but very few, had continual fevers along with it; many had {854} double tertians; others simply slight intermittent. All were worse by night than by day; such as recovered were long valetudinary, had a weak stomach, and hypped." Gravid women either aborted or died. This epidemic spread with frightful rapidity. Thousands were attacked at the same time. The entire population of Nismes, with scarcely an exception, fell ill of it upon the same day. It was extremely fatal. In Mantua Carpentaria, a small town near Madrid, it broke out in August, and so fatal were the bloodletting and purging which constituted the treatment at first, that, of the two thousand persons who were bled, all died. The disease raged in some parts till the middle of the following year (1558), and carried off, in Delft alone, five thousand of the poor. In all cases mild treatment was called for, with warm broths and speedy immersals, "to recall the appetite and keep the vessels of the throat open."

In 1580 a great epidemic of influenza spread from the south-east toward the north-west over Asia, Africa, and Europe. From Constantinople and Venice it overran Hungary and Germany, and reached the farthest regions of Norway, Sweden, and Russia. It spread into England, and has been described by Dr. Short. In Italy it prevailed during August and September, in England from the middle of August to the end of September, and in Spain during the whole summer. In most places its duration was about six weeks. As a rule, the termination was favorable, although the disease ran a somewhat protracted course. In the account of Dr. Short it is stated that "few died except those that were let blood of or had unsound viscera." In some places, on the contrary, the course of the disease was very severe. In Rome two thousand died of it, according to the author just cited, but Zuelzer informs us that the victims of this epidemic in the Eternal City were not less than nine thousand, and adds that Madrid must have been almost depopulated by it. This high mortality has been attributed to the bloodletting practised in the treatment of the disease. The symptoms were similar to those of the previous epidemics, with a greater shortness of breath, which continued in many cases for some time after the disappearance of the catarrhal trouble. There was great sweating at the end of the attack. The plague, measles, and small-pox prevailed also, and with considerable violence, during the year 1580.

Influenza, unfelt for several years, reappeared in Germany in 1591; an epidemic extending from Holland through France and into Italy occurred in 1593. In 1610 catarrh is said to have prevailed throughout Europe. In 1626-27 epidemic catarrhal fever made its appearance in Italy and France; in 1642-43 in Holland; in 1647 in Spain and in the colonies of the Western World; and again, in 1655 in North America. According to Webster, this epidemic of 1647 was the first catarrh mentioned in American annals.

In 1658 and 1675 it again visited Austria, Germany, England, etc. The first of these two epidemics is described by Willis, and the second by Sydenham, as they occurred in England, and the accounts are to be {855} found in the Annals of Influenza. It is about this period that the disease began to be known as influenza, and it is not without interest to observe that the influence of the stars suggested itself, in connection with its sudden appearance and wide prevalence, to the minds of the physicians of this date. Willis writes that "about the end of April (1658), suddenly a distemper arose, as if sent by some blast of the stars, which laid hold on very many together; that in some towns in the space of a week above a thousand people fell sick together."

Epidemics are recorded as having occurred in Great Britain and Europe in 1688, 1693, and in 1709. The disease raged in 1712 widely over Europe from Denmark to Italy.

In 1729-30 a widespread epidemic swept over Europe. In five months it extended over Russia, Poland, Germany, Sweden, and Denmark. In Vienna sixty thousand persons fell ill of it. In the autumn it spread to England, and reached France and Switzerland; from there it extended to Italy, and by February it had reached Rome and Naples. Spain did not escape its ravages, and it is said to have found its way to Mexico. The symptoms did not differ in any important respect from those already described as characterizing previous epidemics. Pains in the limbs and fever marked the onset of the attack; catarrh, oppression, hoarseness, cough followed. In some cases delirium, drowsiness, and faintings occurred. A petechial eruption was observed, in some instances, between the fourth and seventh days. This renders it probable that typhus or cerebro-spinal fever prevailed at the same time. Turbid urine, copious sweats, bilious stools, and nose-bleeding were often noted. In Switzerland only children and old persons died. The disease was not very fatal.

Two years later (1732-33) an epidemic, starting from Saxony and Poland, overran Germany, Switzerland, and Holland, and invaded Great Britain in the month of December. Toward the end of January it spread in a south-easterly direction to France, Italy, Spain, and westward to North America, thence southward to the islands of the West Indies, and on to South America. The course of the disease in this epidemic was favorable. The attack terminated in from three to fourteen days, with sweating, bleeding from the nose, or an abundant discharge from the nasal passages. The aged and those suffering from chronic pulmonary diseases mostly perished. In Scotland three forms of the affection were described--namely, the cephalic, the thoracic, and the abdominal. The epidemic slowly spread over Eastern Europe and in a south-easterly direction, and may be said to have lasted till 1737.

Concerning this epidemic John Huxham of Plymouth wrote as follows: "About this time a disease invaded these parts which was the most completely epidemic of any I remember to have met with; not a house was free from it; the beggar's hut and the nobleman's palace were alike subject to its attacks, scarce a person escaping either in town or country; old and young, strong and infirm, shared the same fate." The malady had raged in Cornwall and the western parts of Devonshire from the beginning of February; it reached Plymouth on the 10th, which was on a Saturday, and that day numbers were suddenly seized. The next day multitudes were taken ill, and by the 18th or 20th of March scarcely {856} any one had escaped it. "The disorder began at first with a slight shivering; this was presently followed by a transient erratic heat and headache and a violent and troublesome sneezing; then the back and lungs were seized with flying pains, which sometimes attacked the heart likewise, and though they did not long remain there, yet were very troublesome, being greatly irritated by the violent cough which accompanied the disorder, in the fits of which a great quantity of a thin, sharp mucus was thrown out from the nose and mouth. These complaints were like those arising from what is called catching cold, but presently a slight fever came on, which afterward grew more violent; the pulse was now very quick, but not in the least hard and tense like that in a pleurisy; nor was the urine remarkably red, but very thick, and inclining to a whitish color; the tongue, instead of being dry, was thickly covered with a whitish mucus or slime; there was an universal complaint of want of rest and a great giddiness. Several likewise were seized with a most racking pain in the head, often accompanied by a slight delirium. Many were troubled with a tinnitus aurium, or singing in the ears; and numbers suffered from violent earaches or pains in the meatus auditorius, which in some turned to an abscess. Exulcerations and swellings of the fauces were likwise very common. The sick were in general very much given to sweat, which, when it broke out of its own accord, was very plentiful and continued without striking in again, and did often in the space of two or three days wholly carry off the fever. You have here a description of this epidemic disease such as it prevailed hereabouts, attacking every one more or less; but still, considering the great multitude that were seized by it, it was fatal to but few, and that chiefly infants and consumptive old people. It generally went off about the fourth day, leaving behind a troublesome cough, which was very often of long duration, and such a dejection of strength as one would hardly have suspected from the shortness of the time.

"On the whole, this disorder was rarely mortal, unless by some very great error arising in the treatment of it; however, this very circumstance proved fatal to some, who, making too slight of it, either on account of its being so common or not thinking it very dangerous, often found asthmas, hectics, or even consumptions themselves, the forfeitures of their inconsiderate rashness."

Arbuthnot also described this visitation of the disease. He regarded the uniformity of the symptoms in every place as most remarkable, and tells us that during the whole season in which it prevailed there was "a great run of hysterical, hypochondriacal, and nervous distempers; in short, all the symptoms of relaxation."

During the years 1737-38 influenza again swept over England, North America, the islands of the West Indies, and France; in 1742-43 it prevailed in Western Europe and the British Isles; in 1757-58 in North America, the West Indies, France, and Scotland. In 1761 it overran the North American colonies and the West Indies.

The epidemic of 1762 extended very generally over Europe and Great Britain. In Germany nine-tenths of the population were attacked by the disease.

Widely extended epidemics prevailed in Europe and America in 1767 {857} and 1775; in 1772 it raged in North America; in 1778-80, in France, Germany and Russia. Noah Webster found influenza prevalent in North America in 1781; the next year one of the most remarkable epidemics of this disease (described as the epidemic of 1782) appeared in Europe. It came from the East, from Asia into Russia. From St. Petersburg it spread during the winter and spring over Sweden, Germany, Holland, and France. In the autumn it was in Italy, Spain, and Portugal. The crews of Dutch and English ships were taken ill with the disease upon the high seas.

In Vienna three-fourths of the population fell ill of it with such suddenness that it got here for the first time its name of "Blitz Katarrh" (lightning catarrh). It was characterized by great pain in the back, breast, and throat, and by extraordinary enfeeblement. Relapses occurred, and inflammation of the lungs and bowels was common. Children remained relatively exempt from its seizure. This epidemic broke out in England about the end of April and raged until the end of June. "The duration of the malady in some was not above a day or two, but it usually lasted near a week or longer. In a few the symptoms seemed to abate in two or three days, but some returned and raged with more violence than at first." The disease was not regarded as in itself fatal, and few could be said to have died of it "but those who were old, asthmatic, or who had been debilitated by some previous indisposition."

Numerous recurring outbreaks took place in Europe and America during the years 1788-90. One of these, as it occurred in America, is well described by Dr. John Warren of Boston in a letter to Lettsom. This letter is dated May 30, 1790, and among other matters of great interest respecting the disease it is stated that "Our beloved President Washington is but now on the recovery from a very severe and dangerous attack of it in that city" (New York).

Webster mentions an epidemic in America in 1790, one in Europe in 1795, and another in Europe in 1797, but there seems to have been no general epidemic of sufficient importance to attract the attention of other writers upon the subject until 1798, when the malady again broke out in Russia and spread over the greater part of Europe, continuing to prevail in various regions till 1803, when it again appeared in England, and is described by several writers of that country.

From 1805 to 1827 influenza prevailed (according to Zuelzer, who tells us that few years during this interval were free from it) in frequently-recurring epidemics in Europe and America. Thompson mentions no visitation in England between 1803 and 1831.

In the year 1830 began a series of epidemics remarkable for their wide diffusion and the rapid succession with which they followed one upon another. The disease began in China; in September it reached the Indian Archipelago; it swept into Russia, and invaded Moscow in November; in January, 1831, it was raging in St. Petersburg; March found it in Warsaw; April in Eastern Prussia and Silesia; in May it prevailed in Denmark, Finland, and a great part of Germany, and in {858} the same month it fell upon Paris; in June it affected England and Sweden; it was still creeping about Middle Europe and lingering in Great Britain at the end of July; in the early winter it swept southward into Italy, and westward across the Atlantic to North America, and was still harassing the inhabitants of certain regions of the United States in January and February, 1832. Meanwhile it continued in the East, spreading to Java, Farther India, and the Indian Archipelago. It continued in Hindostan after it had died out in Europe. But in January, 1833, it again visited Russia, and rolled thence southward and eastward over the most of Europe. It is recorded that by February it had reached Galicia and Eastern Prussia; in March it was in Prussia, Bohemia, and Warsaw, and had extended to Syria and Egypt; in April to many parts of Germany and Austria and to France and Great Britain. Midsummer found the disease yet prevailing in some districts of Germany and Northern Italy, and in the early autumn it was in Switzerland and Eastern France; in November it visited Naples.

Epidemics so frequent, so widespread, and so unsparing of individuals wherever the disease appeared could not fail to excite a deep and general interest. From this period the literature of the subject has been voluminous.

A brief period of repose ensued. For three years no epidemic occurred which was of sufficient importance to attract the attention of medical historians.

In December, 1837, influenza reappeared, and first, as so often before, in Russia; Sweden and Denmark were almost simultaneously affected; in January, 1837, it broke out in London, and rapidly swept over all England and into France and Germany. In January it appeared in Berlin, and shortly afterward in Dresden, Munich, and Vienna. The disease spread by February into Switzerland, and into Spain as far as Madrid by the end of March. In London almost the whole population was attacked, and the mortality was enormous. It is stated that the deaths were quadrupled during the prevalence of the disease. Large populations suffered most. This epidemic spread into the southern hemisphere, and prevailed at the same time, and consequently at exactly the opposite season that it prevailed north of the equator, in Sydney and at the Cape of Good Hope.

From 1837 to 1850-51 numerous epidemics of influenza occurred. Few years were exempt from them. The epidemic of 1847-48 has been described by many writers, and more particularly, as it occurred in London, by Peacock with great exactitude. It is estimated that one-fourth of the entire population of that city were more or less affected by the disease. The epidemic prevailed in London for six months, and, although the deaths registered for the entire period as from influenza amounted to only 1739, it is stated in the report of the registrar-general that during the six weeks the epidemic was at its height not less than five thousand persons died, in the metropolitan districts, in excess of the average mortality of the period, the excess showing itself in nearly every class of disease, the local maladies which had been the predominant affections being doubtless in many cases assigned as the cause of death. This {859} epidemic affected between one-fourth and one-half of the population of Paris, and in Geneva the proportion of those attacked was not less than one-third of the entire population.

More or less widespread epidemics of influenza are recorded as having occurred in 1857-58 and 1860; in 1864 in Switzerland; in 1867 in Paris in the spring; and at various times in the United States and Canada.

A mild epidemic occurred in 1874 in Berlin.

Influenza prevailed over a wide area in the United States during the early months of 1879. The characteristics of this visitation have been well described by Da Costa.

The disease, since the great epidemic of 1847-48, has affected a smaller proportion of the inhabitants of the localities visited, and has run a less dangerous course, than in the earlier epidemics. It has for this reason occupied a less conspicuous place in the medical literature of recent years. It is nevertheless true that even in the mildest epidemics, when a relatively small number of persons are seized and the symptoms are in most cases almost insignificant, cases do here and there occur which are of a serious or even fatal character, and that the death-rate from other diseases is for the time considerably increased.