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FLU PANDEMIC: 1889-1890

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  • FLU PANDEMIC: 1889-1890

    Like cholera and plague, influenza reappeared in the last quarter of the 19th century, after an interval of many years, in epidemic or rather pandemic form. After the year 1848, in which 7963 deaths were directly attributed to influenza in England and Wales, the disease continued prevalent until 1860, with distinct but minor epidemic exacerbations in 1851, 1855 and 1858; during the next decade the mortality dropped rapidly though not steadily, and the diminution continued down to the year 1889, in which only 55 deaths were ascribed to this cause. It is not clear whether the disease ever disappears wholly, and the deaths registered in 1889 are the lowest recorded in any year since the registrar-general's returns began. Occasionally local outbreaks of illness resembling epidemic influenza have been observed during the period of abeyance, as in Norfolk in 1878 and in Yorkshire in 1887; but whether such outbreaks and the so-called "sporadic" cases are nosologically identical with epidemic influenza is open to doubt. The relation seems rather to be similar to that between Asiatic cholera and "cholera nostras." Individual cases may be indistinguishable, but as a factor in the public health the difference between sporadic and epidemic influenza is as great and unmistakable as that between the two forms of cholera. This fact, which had been forgotten by some since 1847 and never learnt by others, was brought home forcibly to all by the visitation of 1889.

    According to the exhaustive report drawn up by Dr H. Franklin Parsons for the Local Government Board, the earliest appearances were observed in May 1889, and three localities are mentioned as affected at the same time, all widely separated from each other-namely, Bokhara in Central Asia, Athabasca in the north-west Territories of Canada and Greenland. About the middle of October it was reported at Tomsk in Siberia, and by the end of the month at St Petersburg. During November Russia became generally affected, and cases were noticed in Paris, Berlin, Vienna, London and Jamaica. In December epidemic influenza became established over the whole of Europe, along the Mediterranean, in Egypt and over a large area in the United States. It appeared in several towns in England, beginning with Portsmouth, but did not become generally epidemic until the commencement of the new year. In London the full onset of unmistakable influenza dated from the 1st of January 1890. Everywhere it seems to have exhibited the same explosive character when once fully established. In St Petersburg, out of a government staff of 260 men, 220 were taken ill in one night, the 15th of November. During January 1890 the epidemic reached its height in London, and appeared in a large number of towns throughout the British Islands, though it was less prevalent in the north and north-west than in the south. January witnessed a great extension of the disease in Germany, Holland, Switzerland, Austria-Hungary, Italy, Spain and Portugal; but in Russia, Scandinavia and France it was already declining. The period of greatest activity in Europe was the latter half of December and the earlier half of January, with the change of the year for a central point. Other parts of the world affected in January 1890 were Cape Town, Canada, the United States generally, Algiers, Tunis, Cairo, Corsica, Sardinia, Sicily, Honolulu, Mexico, the West Indies and Montevideo. In February the provincial towns of England were most severely affected, the death-rate rising to 27.4, but in London it fell from 28 1 to 21 2, and for Europe generally the back of the epidemic was broken. At the same time, however, it appeared in Ceylon, Penang, Japan, Hong Kong and India; also in West Africa, attacking Sierra Leone, and Gambia in the middle of the month; and finally in the west, where Newfoundland and Buenos Aires were invaded. In March influenza became widely epidemic in India, particularly in Bengal and Bombay, and made its appearance in Australia and New Zealand. In April and May it was epidemic all over Australasia, in Central America, Brazil, Peru, Arabia and Burma. During the summer and autumn it reached a number of isolated islands, such as Iceland, St Helena, Mauritius and Reunion. Towards the close of the year it was reported from Yunnan in the interior of China, from the Shire Highlands in Central Africa, Shoa in Abyssinia, and Gilgit in Kashmir. In the course of fifteen months, beginning with its undoubted appearance in Siberia in October 1889, it had traversed the entire globe.

    The localities attacked by influenza in 1889-1890 appear in no case to have suffered severely for more than a month or six weeks. Thus in Europe and North America generally the visitation had come to an end in the first quarter of 1890. The earliest signs of an epidemic revival on a large scale occurred in March 1891, in the United States and the north of England. It was reported from Chicago and other large towns in the central states, whence it spread eastwards, reaching New York about the end of March. In England it began in the Yorkshire towns, particularly in Hull, and also independently in South Wales. In London influenza became epidemic for the second time about the end of April, and soon afterwards was widely distributed in England and Wales. The large towns in the north, together with London and Wales, suffered much more heavily in mortality than in the previous attack, but the south-west of England, Scotland and Ireland escaped with comparatively little sickness. The same may be said of the European continent generally, except parts of Russia, Scandinavia and perhaps the north of Germany. This second epidemic coincided with the spring and early summer; it had subsided in London by the end of June. The experience of Sheffield is interesting. In 1890 the attack, contrary to general experience, had been undecided, lingering and mild; in 1891 it was very sudden and extremely severe, the death-rate rising to 73.4 during the month of April, and subsiding with equal rapidity. During the third quarter of the year, while Europe was free, the antipodes had their second attack, which was more severe than the first. As in England, it reversed the previous order of things, beginning in the provinces and spreading thence to the capital towns. The last quarter of the year was signalized by another recrudescence in Europe, which reached its height during the winter. All parts, including Great Britain, were severely affected. In England those parts which had borne the brunt of the epidemic in the early part of the year escaped. In fact, these two revivals may be regarded as one, temporarily interrupted by the summer quarter.

    The recrudescence at the end of 1891 lasted through mid-winter, and in many places, notably in London, it only reached its height in January 1892, subsiding slowly and irregularly in February and March. Brighton suffered with exceptional severity. The continent of Europe seems to have been similarly affected. In Italy the notifications of influenza were as follow: 1891 - January to October, o; November, 30; December, 6461; 1892 - January, 84,543; February, 55,352; March, 28,046; April, 7962; May, 1468; June, 223. Other parts of the world affected were the West Indies, Tunis, Egypt, Sudan, Cape Town, Teheran, Tongking and China. In August 1892 influenza was reported from Peru, and later in the year from various places in Europe.

    A fourth recrudescence, but of a milder character, occurred in Great Britain in the spring of 1893, and a fifth in the following winter, but the year 1894 was freer from influenza than any since 1890. In 1895 another extensive epidemic took place. In 1896 influenza seemed to have spent its strength, but there was an increased prevalence of the disease in 1897, which was repeated on a larger scale in 1898, and again in 1899, when 12,417 deaths were recorded in England and Wales. This was the highest death-rate since 1892. After this the death-rate declined to half that amount and remained there with the slight upward variations until 1907, in which the total death-rate was 9257. The experience of other countries has been very similar; they have all been subjected to periodical revivals of epidemic influenza at irregular intervals and of varying intensity since its reappearance in 1889, but there has been a general though not a steady decline in its activity and potency. Its behaviour is, in short, quite in keeping with the experience of 1847-1860, though the later visitation appears to have been more violent and more fatal than the former. Its diffusion was also more rapid and probably more extensive.

    The foregoing general summary may be supplemented by some further details of the incidence in Great Britain. The number of deaths directly attributed to influenza, and the deathrates per million in each year in England and Wales, are as follow: - It is interesting to compare these figures with the corresponding ones for the previous visitation: - The two sets of figures are not strictly comparable, because, during the first period, notification of the cause of death was not compulsory; but it seems clear that the later wave was much the more deadly. The average annual death-rate for the nine years is 320 in the one case against 162 in the other, or as nearly as possible double. In both epidemic periods the second year was far more fatal than the first, and in both a marked revival took place in the ninth year; in both also an intermediate recrudescence occurred, in the fifth year in one case, in the sixth in the other. The chief point of difference is the sudden and marked drop in 1849-1850, against a persistent high mortality in 1892-1893, especially in 1892, which was nearly as fatal as 1891.

    To make the significance of these epidemic figures clear, it should be added that in the intervening period 1861-1889 the average annual death-rate from influenza was only fifteen, and in the ten years immediately preceding the 1890 outbreak it was only three. Moreover, in epidemic influenza, the mortality directly attributed to that disease is only a fraction of that actually caused by it. For instance, in January 1890 the deaths from influenza in London were 304, while the excess of deaths from respiratory diseases was 1454 and from all causes 1958 above the average.

    We have seen above that the mortality was far greater in the second epidemic year than in the first, and this applies to all parts of England, and to rural as well as to urban communities, as the following table shows: Deaths from Influenza. In spite of these figures, it appears that the 1890 attack, which was in general much more sudden in its onset than that of 1891, also caused a great deal more sickness. More people were "down with influenza," though fewer died. For instance, the number of persons treated at the Middlesex Hospital in the two months' winter epidemic of 1890 was 1279; in the far more fatal three months' spring epidemic of 1891 it was only726. One explanation of this discrepancy between the incidence of sickness and mortality is that in the second attack, which was more protracted and more insidious, the stress of the disease fell more upon the lungs. Another is that its comparative mildness, combined with the time of year, in itself proved dangerous, because it tempted people to disregard the illness, whereas in the first epidemic they were too ill to resist. On the whole, rural districts showed a higher death-rate than towns, and small towns a higher one than large ones in both years. This is explained by the age distribution in such localities; influenza being particularly fatal to aged people, though no age is exempt. Certain counties were much more severely affected than others. The eastern counties, namely, Essex, Suffolk and Norfolk, together with Hampshire and one or two others, escaped lightly in both years; the western counties, namely, North and South Wales, with the adjoining counties of Monmouth, Hereford and Shropshire, suffered heavily in both years.

    It will be convenient to discuss seriatim the various points of interest on which light has been thrown by the experience described above.

    The bacteriology of influenza is discussed in the article on Parasitic Diseases. The disease is often called "Russian" influenza, and its origin in 1889 suggests that the name may have some foundation in fact. A writer, who saw the epidemic break out in Bokhara, is quoted by him to the following effect:- "The summer of 1888 was exceptionally hot and dry, and was followed by a bitterly cold winter and a rainy spring. The driedup earth was full of cracks and holes from drought and subsequent frost, so that the spring rains formed ponds in these holes, inundated the new railway cuttings, and turned the country into a perfect marsh. When the hot weather set in the water gave off poisonous exhalations, rendering malaria general." On account of the severe winter, the people were enfeebled from lack of nourishment, and when influenza broke out suddenly they died in large numbers. Europeans were very severely affected. Russians, hurrying home, carried the disease westwards, and caravans passing eastwards took it into Siberia. There is a striking similarity in the conditions described to those observed in connexion with outbreaks of other diseases, particularly typhoid fever and diphtheria, which have occurred on the supervention of heavy rain after a dry period, causing cracks and fissures in the earth. Assuming the existence of a living poison in the ground, we can easily understand that under certain conditions, such as an exceptionally dry season, it may develop exceptional properties and then be driven out by the subsequent rains, causing a violent outbreak of illness. Some such explanation is required to account for the periodical occurrence of epidemic and pandemic diffusions starting from an endemic centre. We may suppose that a micro-organism of peculiar robustness and virulence is bred and brought into activity by a combination of favourable conditions, and is then disseminated more or less widely according to its "staying power," by human agency. Whether central Asia is an endemic centre for influenza or not there is no evidence, but the disease seems to be more often prevalent in the Russian Empire than elsewhere. Extensive outbreaks occurred there in 1886 and 1887, and it is certain that the 1889 wave was active in Siberia at an earlier date than in Europe, and that it moved eastwards. The hypothesis that it originated in China is unsupported by evidence. But whatever may be the truth with regard to origin, the dissemination of influenza by human agency must be held to be proved. This is the most important addition to our knowledge of the subject contributed by recent research. The upshot of the inquiry by Dr Parsons was to negative all theories of atmospheric influence, and to establish the conclusion that the disease was "propagated mainly, perhaps entirely, by human intercourse." He found that it prevailed independently of climate, season and weather; that it moved in a contrary direction to the prevailing winds; that it travelled along the lines of human intercourse, and not faster than human beings can travel; that in 1889 it travelled much faster than in previous epidemics, when the means of locomotion were very inferior; that it appeared first in capital towns, seaports and frontier towns, and only affected country districts later; that it never commenced suddenly with a large number of cases in a place previously free from disease, but that epidemic manifestations were generally preceded for some days or weeks by scattered cases; that conveyance of infection by individuals and its introduction into fresh places had been observed in many instances; that persons brought much into contact with others were generally the first to suffer; that persons brought together in large numbers in enclosed spaces suffered more in proportion than others, and that the rapidity and extent of the outbreak in institutions corresponded with the massing together of the inmates.

    These conclusions, based upon the 1889-1890 epidemic, have been confirmed by subsequent experience, especially in regard to the complete independence of season and weather shown by influenza. It has appeared and disappeared at all seasons and in all weathers and only popular ignorance continues to ascribe its behaviour to atmospheric conditions. In Europe, however, it has prevailed more of ten in winter than in summer, which may be due to the greater susceptibility of persons in winter, or, more probably, to the fact that they congregate more in buildings and are less in the open air during that part of the year. No doubt is any longer entertained of its infectious character, though the degree of infectivity appears to vary considerably. Many cases have been recorded of individuals introducing it into houses, and of all or most of the other inmates then taking it from the first case. Difficulties in preventing the spread of infection are due to (1) the shortness of the period of incubation, (2) the disease being infectious in the earliest stages before the nature of the illness is recognized, (3) the milder varieties being equally infectious with the severe attacks, and the patient going to work and spreading the infection, (4) the diagnosis often being difficult, influenza being possibly confused with ordinary catarrhal attacks, typhoid fever and other diseases. Domestic animals seem to be free from any suspicion of being liable to human influenza. Sanitary conditions, other than overcrowding, do not appear to exercise any influence on the spread of influenza.

    Influenza has been shown to be an acute specific fever having nothing whatever to do with a "bad cold." There may be some inflammation of the respiratory passages, and then symptoms of catarrh are present, but that is not necessarily the case, and in some epidemics such symptoms are quite exceptional. This had been recognized by various writers before the 1889 visitation, but it had not been generally realized, as it has been since, and some medical authorities, who persisted in regarding influenza as essentially a "catarrhal" affection, were chiefly to blame for a widespread and tenacious popular fallacy.

    Leichtenstern, in his masterly article in Nothnagel's Handbuch, divides the disease as follows1) Epidemic influenza vera caused by Pfeiffer's bacillus; (2) Endemic-epidemic influenza vera, which occurs several years after a pandemic and is caused by the same bacillus; (3) Endemic influenza nostras or catarrhal fever, called la grippe, and bearing the same relation to true influenza as cholera nostras does to Asiatic cholera.

    The "period of incubation" is one to four days. Susceptibility varies greatly, but the conditions that influence it are matters of conjecture only. It appears that the inhabitants of Great Britain are less susceptible than those of many other countries. Dr Parsons gives the following list, showing the proportion of the population estimated to have been attacked in the 1889-1890 epidemic in different localities: - In and about London he reckoned roughly from a number of returns that the proportion was about 122% among those employed out of doors and 25% among those in offices, &c. The proportion among the troops in the Home District was 9.3%. The General Post Office made the highest return with 33.6%, which is accounted for partly by the enormous number of persons massed together in the same room in more than one department, and partly by the facilities for obtaining medical advice, which would tend to bring very light cases, unnoticed elsewhere, upon the record. No public service was seriously disorganized in England by sickness in the same manner as on the continent of Europe. Some individuals appear to be totally immune; others take the disease over and over again, deriving no immunity, but apparently greater susceptibility from previous attacks.

    The symptoms were thus described by Dr Bruce Low from observations made in St Thomas's Hospital, London, in January 1890: The invasion is sudden; the patients can generally tell the time when they developed the disease; e.g. acute pains in the beck and loins came on quite suddenly while they were at work or walking in the street, or in the case of a medical student, while playing cards, rendering him unable to continue the game. A workman wheeling a barrow had to put it down and leave it; and an omnibus driver was unable to pull up his horses. This sudden onset is often accompanied by vertigo and nausea, and sometimes actual vomiting of bilious matter. There are pains in the limbs and general sense of aching all over; frontal headache of special severity; pains in the eyeballs, increased by the slightest movement of the eyes; shivering; general feeling of misery and weakness, and great depression of spirits, many patients, both men and women, giving way to weeping; nervous restlessness; inability to sleep, and occasionally delirium. In some cases catarrhal symptoms develop, such as running at the eyes, which are sometimes injected on the second day; sneezing and sore throat; and epistaxis, swelling of the parotid and submaxillary glands, tonsilitis, and spitting of bright blood from the pharynx may occur. There is a hard, dry cough of a paroxysmal kind, worst at night. There is often tenderness of the spleen, which is almost always found enlarged, and this persists after the acute symptoms have passed. The temperature is high at the onset of the disease. In the first twenty-four hours its range is from ioo? F. in mild cases to 105? in severe cases.

    Dr J. S. Bristowe gave the following description of the illness during the same epidemic: The chief symptoms of influenza are, coldness along the back, with shivering, which may continue off and on for two or three days; severe pain in the head and eyes, often with tenderness in the eyes and pain in moving them; pains in the ears; pains in the small of the back; pains in the limbs, for the most part in the fleshy portions, but also in the bones and joints, and even in the fingers and toes; and febrile temperature, which may in the early period rise to 104? or 105? F. At the same time the patient feels excessively ill and prostrate, is apt to suffer from nausea or sickness and diarrhoea, and is for the most part restless, though often (and especially in the case of children and those advanced in age) drowsy.... In ordinary mild cases the above symptoms are the only important ones which present themselves, and the patient may recover in the course of three or four days. He may even have it so mildly that, although feeling very ill, he is able to go about his ordinary work. In some cases the patients have additionally some dryness or soreness of the throat, or some stiffness and discharge from the nose, which may be accompanied by slight bleeding. And in some cases, for the most part in the course of a few days, and at a time when the patient seems to be convalescent, he begins to suffer from wheezing in the chest, cough, and perhaps a little shortness of breath, and before long spits mucus in which are contained pellets streaked or tinged with blood. ... Another complication is diarrhoea. Another is a roseolous spotty rash.... Influenza is by no means necessarily attended with the catarrhal symptoms which the general public have been taught to regard as its distinctive signs, and in a very large proportion of cases no catarrhal condition whatever becomes developed at any time.

    Several writers have distinguished four main varieties of the disease - namely, (1) nervous, (2)gastro-intestinal, (3)respiratory, (4) febrile, a form chiefly found in children. Clifford Allbutt says, "Influenza simulates other diseases." Many forms are of typhoid or comatose types. Cardiac attacks are common, not from organic disease but from the direct poisoning of the heart muscle by influenza.

    Perhaps the most marked feature of influenza, and certainly the one which victims have learned to dread most, is the prolonged debility and nervous depression that frequently follow an attack. It was remarked by Nothnagel that "Influenza produces a specific nervous toxin which by its action on the cortex produces psychoses." In the Paris epidemic of 1890 the suicides increased 25%, a large proportion of the excess being attributed to nervous prostration caused by the disease. Dr Rawes, medical superintendent of St Luke's hospital, says that of insanities traceable to influenza melancholia is twice as frequent as all other forms of insanity put together. Other common after-effects are neuralgia, dyspepsia, insomnia, weakness or loss of the special senses, particularly taste and smell, abdominal pains, sore throat, rheumatism and muscular weakness. The feature most dangerous to life is the special liability of patients to inflammation of the lungs. This affection must be regarded as a complication rather than an integral part of the illness. The following diagram gives the annual death-rate per million in England and Wales, and is taken from an article by Dr Arthur Newsholme in The Practitioner (January 1907).

    The deaths directly attributed to influenza are few in proportion to the number of cases. In the milder forms it offers hardly any danger to life if reasonable care be taken, but in the severer forms it is a fairly fatal disease. In eight London hospitals the case-mortality among in-patients in the 1890 outbreak was 34.5 per moo; among all patients treated it was i 6 per moo. In the army it was rather less.

    The infectious character of influenza having been determined, suggestions were made for its administrative control on the familiar lines of notification, isolation and disinfection, but this has not hitherto been found practicable. In March 1895, however, the Local Government Board issued a memorandum recommending the adoption of the following precautions wherever they can be carried out: -

    1. The sick should be separated from the healthy. This is especially important in the case of first attacks in a locality or a household.

    2. The sputa of the sick should, especially in the acute stage of the disease, be received into vessels containing disinfectants. Infected articles and rooms should be cleansed and disinfected.

    3. When influenza threatens, unnecessary assemblages of persons should be avoided.

    4. Buildings and rooms in which many people necessarily congregate should be efficiently aerated and cleansed during the intervals of occupation.

    There is no routine treatment for influenza except bed. In all cases bed is advisable, because of the danger of lung complications, and in mild ones it is sufficient. Severer ones must be treated according to the symptoms. Quinine has been much used. Modern "anti-pyretic" drugs have also been extensively employed, and when applied with discretion they may be useful, but patients are not advised to prescribe them for themselves.

    Sir Wm. Broadbent in a note on the prophylaxis of influenza recommends quinine in a dose of two grains every morning, and remarks: "I have had opportunities of obtaining extraordinary evidence of its protective power. In a large public school it was ordered to be taken every morning. Some of the boys in the school were home boarders, and it was found that while 4 j 2 the boarders at the school took the quinine in the presence of a master every morning, there were scarcely any cases of influenza among them, although the home boarders suffered nearly as much as before." He continues, "In a large girls' school near London the same thing was ordered, and the girls and mistresses took their morning dose but the servants were forgotten. The result was that scarcely any girl or mistress suffered while the servants were all down with influenza." The liability to contract influenza, and the danger of an attack if contracted, are increased by depressing conditions, such as exposure to cold and to fatigue, whether mental or physical. Attention should, therefore, be paid to all measures tending to the maintenance of health. Persons who are attacked by influenza should at once seek rest, warmth and medical treatment, and they should bear in mind that the risk of relapse, with serious complications, constitutes a chief danger of the disease.

    In addition to the ordinary text-books, see the series of articles by experts on different aspects in The Practitioner (London) for January 1907.

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  • #2

    "ENCEPHALITIS LETHARGICA (from Gk. eyx(paXov, a portion of the brain, and XilOapyos, forgetful), a specific infectious disease of the nervous system, of which the most frequent, though by no means invariable, symptom is drowsiness or lethargy, often associated with paralysis of the muscles of the eye, producing diplopia or double vision.

    In recent years this disease first appeared in epidemic form in Austria in the winter of 1916, and was described and named by C. von Economo in Vienna in 1917. It reappeared in the following winter, and was recorded in France in March 1918 by A. Netter. In England it was first recorded in April 1918, independently by Wilfred Harris and A. J. Hall. These earlier epidemics were all recognized by the combination of lethargy and diplopia. Subsequently the same seasonal incidence has prevailed, the number of cases diminishing in summer and increasing in winter and spring. In the United States it was reported in March 1919, the epidemic having spread from east to west.

    The literature of medicine has been ransacked to ascertain whether or not previous records exist of the occurrence of the characteristic combination of symptoms. In 1890 a small epidemic occurred in North Italy, and later in Austria and other countries, which may be accepted as Encephalitis Lethargica. At the time it was known as Noma. It attracted little attention. The evidence for sporadic cases since then is doubtful.

    Previous records are all doubtful. Hippocrates, Sydenham and other less-known authorities have described conditions which may or may not have been Encephalitis Lethargica. Stahl in 1779 recorded more fully an outbreak characterized both by lethargy and diplopia, and with other very suggestive symptoms. Franck in 1837 divided Encephalitis into various types, including a lethargic form which he stated occurred frequently as a result of epidemics of influenza.

    Whether or not the observed combinations of symptoms have ever occurred before, the question early arose whether the syndrome should be regarded as a clinical entity or as a special manifestation of some disease previously known in other forms. The three diseases with which its relations have been more particularly considered are botulism, influenza and acute poliomyelitis or Heine-Medin's disease. Botulism results from the consumption of infected meat or other food, usually ham, and is especially characterized by paralysis of the eye muscles. The disease is due to infection with a specific bacterium - the bacillus botulinus. Since the most careful search has invariably failed to detect the presence of this bacillus in Encephalitis Lethargica botulism can be finally excluded. With regard to influenza, the appearance of Encephalitis Lethargica, including Noma as such, has approximately coincided with epidemics of influenza in 1889 and at the present time. On the other hand, there is considerable evidence against their identity. Influenza is highly contagious, while the clinical appearance of Encephalitis Lethargica occurs in an irregular manner and has not attained any great magnitude as an epidemic. When Encephalitis Lethargica commenced in Austria influenza had not yet appeared. There are also histological differences, since in influenzal encephalitis there is marked oedema of the brain and an absence of the two special characteristics of Encephalitis Lethargica - vascular congestion and infiltration of the perivascular lymph spaces. Pfeiffer's bacillus, the so-called influenza bacillus, is not found in Encephalitis Lethargica.

    The relations of Encephalitis Lethargica to Heine-Medin's disease have led to much discussion. Unusual forms unquestionably occur in which the diagnosis is doubtful, both on clinical and pathological grounds, but, considering typical forms, there are striking differences between the two diseases. Heine-Medin's disease particularly attacks persons under 20 years of age, and tends to increase in frequency in summer. The onset of the general symptoms and of the paralysis is acute, the course is brief and the spinal cord is mainly affected. In Encephalitis Lethargica, on the other hand, persons of all ages are liable to attack, and the frequency is greatest in winter and spring. The onset is usually insidious, the course is lengthy, and the mid-brain is especially affected. Histologically there are also important differences. Microscopic haemorrhages are constant in Heine-Medin's disease, while perivascular infiltration is slight, the reverse being true of Encephalitis Lethargica.

    Table of contents
    1 Symptoms

    2 A. General Symptoms Due to Toxic Infection

    3 B. Nervous Symptoms

    4 Morbid Anatomy

    5 Prognosis

    6 Treatment


    Encephalitis Lethargica was primarily recognized by the occurrence of the combination of lethargy and double vision, the latter being due to paralysis of the muscle of the eye. While pathological drowsiness in varying degrees is probably present in 70 to 80 per cent of cases at some stage of their course, further observation has revealed the occurrence of numerous other manifestations. The disease is widespread through the nervous system, and the complexity of the structure of the nervous tissues, together with the high degree of specialization of the functions of its various parts, explains the protean nature of its symptoms. Numerous " types " have been described, but the value of these is slight, as a single patient in the course of a few days often exhibits the characteristics of many such types. The clinical manifestations are probably best classified as Walshe suggested, according to the broad scheme proposed for other nervous diseases many years ago by Hughlings Jackson. In the following description based on this system, " positive " symptoms denote exaltation of function, which may be due either to irritation of nervous tissue or to a loss of the control exercised normally by the higher centres of the brain, while " negative" symptoms denote depression or loss of function principally due to destruction of nervous tissue.

    A. General Symptoms Due to Toxic Infection
    These include weakness, headache, often occipital with some stiffness of the neck, shivering, vertigo, muscular pains and vomiting or other gastro-intestinal disturbances. The pulse may be rapid and eruptions, usually resembling measles, occasionally occur. The temperature is variable, and it has no characteristic course. It often rises after some days from lot ° to 105° F. for a short period, but may be more prolonged, or pyrexia may be absent throughout.

    B. Nervous Symptoms
    These are general and focal, the latter being due to affection of highly specialized portions of the brain.

    (I) General Nervous Symptoms. - Positive symptoms are delirium, mania, restlessness and various degrees of excitement, while the more common negative manifestation is the characteristic lethargy, in all grades from simple apathy to complete coma. Innumerable degrees occur of these two extremes, or even combinations. The patient may slowly drift into a somnolent state or may not uncommonly combine somnolence by day with insomnia or restlessness by night. Rarely an attack commences suddenly with the wildest delirium or mania.

    (II) Focal Nervous Symptoms. - The positive symptoms include the following
    (1) Convulsions, which are occasionally generalized, resembling the epileptiform fit.

    (2) Involuntary movements. These may develop during the attack or several months later in the course of convalescence. Numerous forms occur. The " myoclonic " type is characterized by short, rapid, rhythmic contractions of muscles, especially affecting the abdominal muscles and also the diaphragm, but the entire musculature or any group of muscles, or even a part of a single muscle may be affected. The contractions are 30 or 40 to the minute. Epidemic hiccough is possibly a variety of this type. Tremors, choreiform, athetoid and other movements of muscles may develop after the attack, some causing coarse spontaneous movements of lar e amplitude.

    3) Rigidity. This group includes the "Parkinsonian mask " and catalepsy, the latter being a condition of rigidity in which the limbs are retained for long periods in the position in which they are placed by an observer. The Parkinsonian mask, an expressionless facies, is common, and combined with rigidity produces the appearance of acute paralysis agitans, or Parkinson's disease.

    (4) Muscular pains.
    These may be severe.

    The negative symptoms are represented by paralyses. The commonest of these is the characteristic affection of the muscles of the eye, especially those innervated by the third pair of cranial nerves. The principal clinical symptoms are ptosis or drooping of the eyelids, double vision and paralysis of the muscles of accommodation. The pupils are often unequal and their reaction altered, the most common change being loss of reaction to accommodation while still reacting to light; but in rare instances the Argyle-Robertson reaction may be present. Optic neuritis is extremely rare, and never advanced. Less common are affections of the remaining cranial nerves, producing facial paralysis, difficulty in swallowing or in production of speech, etc. No portion of the nervous system is immune, and instances occur with paralysis of limbs and other parts, producing monoplegia, hemiplegia, diplegia, or aphasia. The sensory system is much less frequently affected. The deep reflexes are commonly but not invariably absent.

    Morbid Anatomy
    The small vessels of the brain and meninges are dilated, the congestion often being visible both to the eye and under the microscope, but the most characteristic change is infiltration with small round cells of the perivascular lymph spaces, surrounding the capillaries. Other less constant and less conspicuous changes include degeneration of the nerve cells and destruction of neurons, proliferation of the mesoblastic cells lining the vessel walls and of the glial cells, and the occasional occurrence of haemorrhages and of thrombosis of veins. The lesions are most common in the mid-brain and basal ganglia, but any portion of the nervous system or meninges may be affected.

    Excluding mild and abortive cases, and the so-called formes frustes, the mortality is about 33 per cent. Including all cases it is under 20%, but the exact figure is doubtful. Deaths usually occur within three weeks from onset. The duration may be many weeks or even months. Alteration of the mental functions may be prolonged, and paralyses, aphasia and other changes have persisted long enough in some instances to be regarded as permanent, but when recovery takes place, it usually becomes complete.

    This is on the general lines of treatment of acute febrile disease. Hexamine is usually administered. Netter strongly advocates the production of a local abscess by the injection of turpentine, 1-2 cc., into the thigh, but the value of this is not yet confirmed. (H. L. T.)

    Last edited by Jonesie; April 8, 2007, 08:31 AM.


    • #3
      Re: FLU PANDEMIC: 1889-1890

      Originally posted by Jonesie View Post

      According to the exhaustive report drawn up by Dr H. Franklin Parsons for the Local Government Board, the earliest appearances were observed in May 1889, and three localities are mentioned as affected at the same time, all widely separated from each other-namely, Bokhara in Central Asia, Athabasca in the north-west Territories of Canada and Greenland. ....

      Retrieved from
      Categories: I-IOL
      Bokhara in Central Asia


      Athabasca in the north-west Territories of Canada

      Map of the territory covered by Treaty 8
      The region included within Treaty 8 was commonly referred to as Athabasca. It was named after the region's major waterways -- the Athabasca River and Lake Athabasca -- and included most of the Provisional District of Athabaska of the old North-West Territories. In today's terms the treaty lands encompass much of what is now the northern half of Alberta, the northeastern quarter of British Columbia, the northwestern corner of Saskatchewan, and the area south of Hay River and Great Slave Lake in the present-day Northwest Territories.


      Here is a view looking down on the North Pole amd the geographic relationship of the three areas for the start of the 1889 epidemic. Perhaps an avian influenza traveling along or across the East Atlantic Flyway. see:



      • #4
        Re: FLU PANDEMIC: 1889-1890

        hmm, airborne ?

        Krakatoa eruption 535 (?) - Justinian plague 541
        Krakatoa eruption 1883 - pandemic 1889

        6 years

        BTW. how many estimated deaths in the 1889-1891 pandemic worldwide ?

        also volcano eruption 1815, with dark summer in Europe 1816 -
        next flu-pandemic 1830 = 15 years

        but cholera:
        From its home in the Gangetic basin, cholera has caused at least seven pandemics in the last 200 years. In 1817, the first major pandemic occurred.
        In this the disease spread from South Asia to South-east Asia and then to China. From China, it spread to Russia and the rest of Europe. The pandemic lasted until 1826 and killed millions.
        I'm interested in expert panflu damage estimates
        my current links: ILI-charts:


        • #5
          Re: FLU PANDEMIC: 1889-1890

          Originally posted by gsgs View Post
          hmm, airborne ?

          Krakatoa eruption 535 (?) - Justinian plague 541
          Krakatoa eruption 1883 - pandemic 1889

          6 years

          BTW. how many estimated deaths in the 1889-1891 pandemic worldwide ?

          Hey gsgs --

          Mount Pinatubo in 1991, first H5N1 cases in Hong Kong in 1997.

          6 years

          A correlation of pandemic starts with volcanic eruptions.
          Last edited by Laidback Al; April 8, 2007, 11:30 PM.


          • #6
            Re: FLU PANDEMIC: 1889-1890

            Hey, Laidback Al --

            and the largest volcanic eruption in North American history
            happened in ...

            I'm interested in expert panflu damage estimates
            my current links: ILI-charts:


            • #7
              Re: FLU PANDEMIC: 1889-1890

              Interesting correlation. Looking at Volcano World, theres eruptions somewhere almost every year, so its obvious an eruption alone isnt correlated.

              However, here's list of the known deadliest eruptions. Two of them occurred in 1951, and 1 in 1963. Intense eruptions can trigger global as well as local climate chages- notably reducing average temperatures. Significant amounts of sulfuric acid are released into the atmosphere, and all life forms are significantly stressed. I'd wonder if it affects migration routes in the area. Maybe the timing of its occurence is important in that regard?

              I don't know if the observation truly implies some causation, or if its just coincidental. But its very interesting, nonetheless. It would be neat to see if theres any real mathmatical relationship. Especially if theres any correlation with years in which there is high sunspot activity. I would anticipate that if enviormental conditions do actually encourage mutation and species jump, that there's high likelyhood that a multifactorial enviormental "perfect storm" at the bottom of it.

              The Deadliest Volcanic Eruptions
              Volcano Year Deaths Major cause of deaths
              Tambora, Indonesia 1815 92,000 Starvation
              Krakatau, Indonesia 1883 36,417 Tsunami
              Mount Pelee, Martinique 1902 29,025 Ash flows
              Ruiz, Colombia 1985 25,000 Mudflows
              Unzen, Japan 1792 14,300 Volcano collapse, tsunami
              Laki, Iceland 1783 9,350 Starvation
              Kelut, Indonesia 1919 5,110 Mudflows
              Galunggung, Indonesia 1882 4,011 Mudflows
              Vesuvius, Italy 1631 3,500 Mudflows, lava flows
              Vesuvius, Italy 79 3,360 Ash flows, falls
              Papandayan, Indonesia 1772 2,957 Ash flows
              Lamington, Papua New Guinea 1951 2,942 Ash flows
              El Chichon, Mexico 1982 2,000 Ash flows
              Soufriere, St. Vincent 1902 1,680 Ash flows
              Oshima, Japan 1741 1,475 Tsunami
              Asama, Japan 1783 1,377 Ash flows, mudflows
              Taal, Philippines 1911 1,335 Ash flows
              Mayon, Philippines 1814 1,200 Mudflows
              Agung, Indonesia 1963 1,184 Ash flows
              Cotopaxi, Ecuador 1877 1,000 Mudflows
              Pinatubo, Philippines 1991 800 Disease
              Komagatake, Japan 1640 700 Tsunami
              Ruiz, Colombia 1845 700 Mudflows
              Hibok-Hibok, Philippines 1951 500 Ash flows

              NOTE: All eruptions with more than 500 known human fatalities. Based on data in Volcanic Hazards: A Sourcebook on the Effects of Eruptions by Russell J. Blong (Academic Press, 1984).
              Source: Volcano World. Web: .

              (unfortunately, the infoplease site has many popups)
              Upon this gifted age, in its dark hour,
              Rains from the sky a meteoric shower
              Of facts....They lie unquestioned, uncombined.
              Wisdom enough to leech us of our ill
              Is daily spun, but there exists no loom
              To weave it into fabric..
              Edna St. Vincent Millay "Huntsman, What Quarry"
              All my posts to this forum are for fair use and educational purposes only.


              • #8
                Re: FLU PANDEMIC: 1889-1890

                There is a theory amongst some botanists that there is greater evolution at the edges of ecosystems such as the border between a swamp and a forest. I wonder if that theory can be applied here.


                • #9
                  Re: FLU PANDEMIC: 1889-1890

                  I didn't look for deadliest eruptions, but most powerful, most H2SO4,

                  even Agung 1963 and maybe your Hibok-Hibok 1951 would fit, but
                  no good matches before 1890 except maybe 536

                  name          country      date        *10^12kg *10^9kg  'C clima 
                                                         dirt     H2SO4     change
                  Toba          (Indonesia)   -71000,     2800    10000    -5.0
                  Santorin      Greece             -1628  63
                  Taupo         New Zealand        -1600  17   
                  Taupo         New Zealand          180  105     
                  Ilopango      El Salvador          450  25
                  Rabaul?,Krakatau?                  535? 100?
                  Baitoushan    China               1010  96
                  Quilotoa      Ecuador             1150  11
                  Kawae         Vanuatu             1452  36
                  Huaynaputina  Peru          17/02/1600  30      70       -0.8
                  Long Island   New Guinea          1660  30
                  Laki          Iceland       14/06/1783  0.4     100      -1.0
                  Tambora       Indonesia     10/04/1815  150     200      -0.6
                  Krakatau      Indonesia     27/08/1883  18      50       -0.3
                  Santa Maria   Guatemala     24/10/1902  20      20       -0.4
                  Katmai        Alaska        06/06/1912  28      20       -0.2
                  Agung         Indonesia     18/02/1963  1       15       -0.3
                  Fuego     Guatemala              1974     0.4              -0.4
                  El Chichon    Mexico        28/03/1982  0.4     15       -0.5
                  Pinatubo      Philippines         1991  11

                  0 Hawa&#195;&#175;en non explosif--------- < 100 m > 1000 m&#194;&#179; quotidien

                  1 Hawa&#195;&#175;en/Strombolien mod&#195;&#169;r&#195;&#169; 100-1000 m > 10 000 m&#194;&#179; quotidien

                  2 Strombolien/Vulcanien explosif 1-5 km > 1 000 000 m&#194;&#179; hebdomadaire, > 1000, 3477
                  Galeras, 14/01/1993, 2 500 000 m&#194;&#179;

                  3 Vulcanien (Sub-Plinien) s&#195;&#169;v&#195;&#168;re 3-15 km > 0,01 km&#194;&#179; annuel, 868
                  Nevado del Ruiz, 11/09/1985, 0,05 km&#194;&#179;

                  4 Plinien cataclismique-------- 10-25 km > 0,1 km&#194;&#179; &#226;‰&#165; 10 ans, 278
                  Reventador (Equateur), 3/11/2002, 0,4 km&#194;&#179;
                  Spurr (Alaska), 27/06/1992, 0,2 km&#194;&#179;
                  Augustine (Alaska), 27/03/1986, 0,1 km&#194;&#179;
                  Galunggung (Indon&#195;&#169;sie), 5/04/1982, 0,4 km&#194;&#179;
                  Fuego, 14/10/1974 (Guatemala), 0,3 km&#194;&#179;
                  Augustine (Alaska), 6/10/1883, 0,5 km&#194;&#179;
                  Cotopaxi (Equateur), 15/01/1877, 0,5 km&#194;&#179;
                  Merapi (Indon&#195;&#169;sie), 15/04/1872, 0,3 km&#194;&#179;
                  Asama (Japon), 9/05/1783, 0,4 km&#194;&#179;
                  Laki (Islande), 14/06/1783, 0,9 km&#194;&#179; (-1&#194;&#176;C par les a&#195;&#169;rosols soufr&#195;&#169;s)
                  Cotopaxi (Equateur), 4/04/1768, 0,6 km&#194;&#179;
                  Raung (Indon&#195;&#169;sie), 1638, 0,6 km&#194;&#179;

                  5 Plinien paroxysmal------------ > 25 km > 1 km&#194;&#179; &#226;‰&#165; 100 ans, -0,2&#194;&#176;C, 84
                  Hudson Cerro (Chili), 8/08/1991, 7,6 km&#194;&#179;
                  El Chichon (Mexique), 28/03/1982, 2,5 km&#194;&#179;
                  Mont Saint-Helens (Etats-Unis), 18/05/1980, 1,2 km&#194;&#179;
                  Agung (Indon&#195;&#169;sie), 18/02/1963, 1 km&#194;&#179;
                  Bezymianny (Russie), 30/03/1956, 2,8 km&#194;&#179;
                  Kharimkotan (Russie), 8/01/1933, 1 km&#194;&#179;
                  Ksudach (Russie), 28/03/1907, 2,4 km&#194;&#179;
                  Okataina (Nouvelle-Z&#195;&#169;lande) 10/06/1886, 2 km&#194;&#179;
                  Askja (Islande), 29/03/1875, 1,8 km&#194;&#179;
                  Shiveluch (Russie), 18/02/1854, 2 km&#194;&#179;
                  Chikurakhi (Russie), 15/12/1853, 1 km&#194;&#179;
                  Cosiguina (Nicaragua), 20/01/1835, 4,4 km&#194;&#179;
                  Galunggung (Indon&#195;&#169;sie), 8/10/1822, 1 km&#194;&#179;
                  Mont Saint-Helens (Etats-Unis), 15/01/1800, 1,5 km&#194;&#179;
                  Shikotsu (Japon), 19/08/1739, 2 km&#194;&#179;
                  Fuji (Japon), 16/12/1707, 2,1 km&#194;&#179;
                  Tongkoko (Indon&#195;&#169;sie), 1680, 1 km&#194;&#179;
                  Shikotsu (Japon), 23/09/1667, 3,4 km&#194;&#179;
                  Usu (Japon), 16/08/1663, 2,8 km&#194;&#179;
                  Parker (Philippines), 4/01/1641, 1 km&#194;&#179;
                  Vesuve (Italie), 15/12/1631, 1,1 km&#194;&#179;
                  Furnas (A&#195;&#167;ores), 3/09/1630, 2,1 km&#194;&#179;
                  Kelut (Indon&#195;&#169;sie), 1586, 1 km&#194;&#179;
                  Komaga-Take (Japon), 31/07/1640, 3,5 km&#194;&#179;
                  Mont Saint-Helens (Etats-Unis), 1480, 7,7 km&#194;&#179;
                  Vesuve (Italie), 24/08/79, 3,3 km&#194;&#179;
                  Etna (Italie), -122, 1 km&#194;&#179;

                  6 Plinien/Ultra-Plinien colossal > 25 km > 10 km&#194;&#179; &#226;‰&#165; 100 ans, -0,5&#194;&#176;C, 39
                  Pinatubo (Philippines), 12/06/1991, 11 km&#194;&#179;
                  Novarupta-Katmai (Alaska), 6/06/1912, 28 km&#194;&#179;
                  Santa Maria (Guatemala), 24/10/1902, 20 km&#194;&#179;
                  Krakatau (Indon&#195;&#169;sie), 27/08/1883, 18 km&#194;&#179;
                  Long Island (Nouvelle-Guin&#195;&#169;e), 1660, 30 km&#194;&#179;
                  Huaynaputina (P&#195;&#169;rou), 17/02/1600, 30 km&#194;&#179;
                  Kawae (Vanuatu), 1452, 36 km&#194;&#179;
                  Quilotoa (Equateur), 1150, 11 km&#194;&#179;
                  Baitoushan (Chine), 1010, 96 km&#194;&#179;
                  Ilopango (El Salvador), 450, 25 km&#194;&#179;
                  Taupo (Nouvelle-Z&#195;&#169;lande), -1600, 17 km&#194;&#179;
                  Santorin (Gr&#195;&#168;ce), -1628, 63 km&#194;&#179;
                  Mont Mazama (Etats-Unis, OR), -7 000, 35 km&#194;&#179;
                  Lvinaya Past (Russie), -7 480, 75 km&#194;&#179;

                  7 Ultra-Plinien super-colossal-- > 25 km > 100 km&#194;&#179; &#226;‰&#165; 1000 ans, -1,0&#194;&#176;C, 4
                  Tambora (Indon&#195;&#169;sie), 10/04/1815, 150 km&#194;&#179;
                  Taupo (Nouvelle-Z&#195;&#169;lande), 180, 105 km&#194;&#179;
                  Kikai (Japon), -4 350, 150 km&#194;&#179;
                  Mont Mazama (Etats-Unis, OR), -4 900, 150 km&#194;&#179;
                  Kurile Lake, -6 440, 160 km&#194;&#179;
                  Rockland (Etats-Unis, CA), -400 000, 120 km&#194;&#179;
                  Long Valley (Etats-Unis, CA), -740 000, 500 km&#194;&#179;
                  Valles Caldera (Etats-Unis, NM), -1 150 000, 300 km&#194;&#179;
                  Yellowstone Pk (Etats-Unis, WY), -1 270 000, 280 km&#194;&#179;
                  Valles Caldera (Etats-Unis, NM), -1 470 000, 300 km&#194;&#179;

                  8 Ultra-Plinien m&#195;&#169;ga-colossal--- > 25 km > 1000 km&#194;&#179; &#226;‰&#165; 10 000 ans, -5,0&#194;&#176;C, 2
                  Toba (Indon&#195;&#169;sie), -71 000, 2 800 km&#194;&#179;
                  Yellowstone Pk (Etats-Unis, WY), -620 000, 1 000 km&#194;&#179;
                  Yellowstone Pk (Etats-Unis, WY), -1 970 000, 2 500 km&#194;&#179;
                  Last edited by gsgs; April 9, 2007, 08:27 AM.
                  I'm interested in expert panflu damage estimates
                  my current links: ILI-charts:


                  • #10
                    Re: FLU PANDEMIC: 1889-1890

                    with the Laki eruption 1783 and massive amounts of H2SO4,
                    and SO2 in the atmosphere and the influenza pandemic of 1789
                    there is another 6-year candidate.
                    The 1789 pandemic is generally not counted, but Shope
                    called it a pandemic, and he explained what a pandemic is
                    in the same article. He should know.

                    I'm interested in expert panflu damage estimates
                    my current links: ILI-charts:


                    • #11
                      U.S.NAVY: FLU PANDEMIC: 1889-1890

                      Analysis of reports from ships and stations of the Navy during 1889 and 1890 show that from 20 to 75 per cent of the various complements were attacked. While most of the reports speak of the disease as mild, certain of them mention complicating pneumonia and nephritis, and the disease at the naval station, San Francisco, seems to have been associated with a case fatality rate of 4 per cent, all the deaths being caused by pneumonia.

                      It is significant that the annual death rate per thousand for disease in the Navy in 1889 was 10.7. In 1887 it was 7.6 and in 1888, 9.2. Since 1889 the rate has not reached that figure until the present pandemic. (1918)

                      The annual death rate per 100,000 for pneumonia is also very significant. This rate in 1887 was 62.38; 1888, 70.31; and in 1889, 178.26; 1890, 169.95, and thereafter it did not again reach 100 until 1917, when it was 102.20.

                      Influenza in the Navy, 1889-90.

                      Influenza was not prevalent in the Navy in 1888.
                      The following summary of the influenza during the years 1889-90 is taken from the annual report of the Surgeon General of the Navy for the year 1890:

                      REPORT OF INFLUENZA

                      Prepared by Passed Assistant Surgeon Frank Anderson, United States Navy.

                      In response to the circular issued by the Bureau of Medicine and Surgery, requesting information relative to the recent influenza pandemic, replies have been received from 41 medical officers stationed as follows:
                      European Squadron 4
                      Atlantic coast of North America 23
                      Gulf coast of North America 1
                      Vessels cruising in the West Indies 3
                      Atlantic coast of South America 1
                      Pacific coast of North America 7
                      Hawaiian Islands 1
                      China 1

                      These reports embrace a period extending from the first appearance of the disease in December, 1889, to April 10, 1890, and will be considered in the order indicated above.

                      EUROPEAN SQUADRON.

                      The Chicago, Boston, and Atlanta arrived at Lisbon, Portugal, on December 21, 1889, the Yorktown on the 23rd.

                      Influenza had already been epidemic at this port for some weeks; more than 600 cases had been reported, and the number was daily increasing. The first case observed in the fleet occurred on the Chicago on December 23, two days after arrival, in an officer who had been on shore 36 hours previous to being attacked. Other cases followed each day in persons who had been on shore from 24 to 36 hours previous to being taken sick, and it was not until December 30 that a case occurred in a man who had not been out of the ship. The disease made its first appearance on the Boston and Yorktown on December 28, but did not break out upon the Atlanta until December 30, nine days after arrival. In regard to these last three vessels the reports do not state whether the first cases occurring on board were in persons who had been on shore, as was the case on the Chicago.

                      The following table shows the number of men on each ship, the dates of appearance of first and last cases, the time when the epidemic reached its maximum, the duration of the epidemic on board, and the percentage of persons attacked:

                      The crews of these vessels are composed chiefly of young and middle-aged men, and there is nothing to report as to a particular susceptibility manifested at any one period of life. All were subjected to much the same influences; and officers, sailors, marines, and engineers' force all suffered from the disease, with a somewhat smaller percentage of cases perhaps among the firemen and coal heavers.

                      The following symptoms are recorded as prominent in the cases that occurred on these vessels:

                      (a) Of the nervous system. Mental depression, melancholia, utter prostation, and wakefulness. Frontal headache, pain in the orbital regions, back, and limbs. Vertigo and tendency to syncope were experienced in some cases.

                      (b) Of the respiratory and circulatory organs. Fever preceded by chill. Temperature, 100.5&#176;-104&#176;. Catarrhal inflammation of respiratory passages in nearly every case. Difficulty in taking deep inspiration. Suffocative feeling. Little or no expectoration. Irregularity of heart beat in one case. Pulse ranging from 105 to 115 (in some cases it reached 120) slowly subsiding to normal and remaining weak for some days.

                      (c) Of the digestive organs. Loss of appetite, furred tongue, foul breath, nausea, occasionally vomiting during the chill. At times diarrhea. The derangement of digestion generally continued several days and was not readily amenable to treatment.

                      (d) Of the skin. Skin generally moist, often profuse perspiration. No eruptions were observed other than herpes labialis in two cases.

                      The following complications were observed: Pneumonia, pleuritis, and acute rheumatism. Empyema, phlebitis, persistent diarrhea occurred as sequelae in rare instances; but marked debility and bronchial catarrh commonly followed an attack.

                      Pneumonia occurred in five cases (one lobar) one of them proving fatal. There were 21 cases of relapse of the disease, as follows: Chicago, 13; Boston, 5; Atlanta, 3; Yorktown, 2.

                      Patients recovered quickly as a rule. The acute symptoms passed off rapidly, but patients were apt to remain debilitated for some time. Nine days was the longest time that a man remained on the sick list and one day the shortest, the average time upon the list being 2.8 days. There were of course many cases so mild that the patient did not go upon the list at all. The above figures refer to those who were sick enough to be excused from duty.

                      The disease did not have a marked influence upon other cases of sickness except in a case of emphysema and chronic bronchitis, in which a fatal termination was brought about.

                      Out f 486 cases of influenza occurring in the fleet there was but one death, a mortality of about one-fifth of 1 per cent. In this instance croupous pneumonia, involving the entire left lobe, was the cause of death.

                      Treatment.--Antipyrine and quinine were administered when a sedative action was desired. Salicylate of soda was given with marked benefit when rheumatism existed. Stimulants were administered only in complicated cases or where there was unusual debility.

                      It is the opinion of one medical officer only that the disease was positively contagious. One considers it probably so. Another believes it to be not contagious. The opinion of the fourth medical officer on this question is not expressed.

                      ATLANTIC COAST OF NORTH AMERICA.

                      From the Atlantic coast of North America reports were received as follows: The table gives the localities taken in order from north to south, and shows the dates of first and last cases observed, and the time when the disease seemed to have reached the maximum of intensity; also the duration of the epidemic in each place.

                      These reports are from various medical officers stationed at the above places and on different duty, some referring to navy yards and receiving or training ships and some to hospitals. The earliest and latest cases reported are taken as showing the extreme range of the epidemic at each locality.

                      The estimates as to the percentage of population attacked necessarily vary widely and can only be approximate, as the observations in some cases apply to only a small number of persons in a ship or barracks and in others to the population in the neighborhood of the station.

                      In Portsmouth, N.H., 32 per cent of the persons connected with the naval station were attacked. This includes women and children.

                      In Boston 8 per cent of those living on the receiving ship and 25 per cent of those living on shore and connected with the station suffered from the disease.

                      At Newport 21 per cent of the boys upon the training ship and 20 per cent of the population of the town, including both sexes and all ages, were attacked.

                      In New York 8 per cent of the complement of the training ship and 20 per cent of the marine garrison and officers of the yard, including families, were taken sick.

                      In Philadelphia 331/3 per cent is about the average of the various estimates formed. This applies to all ages and sexes.

                      At Annapolis, out of 450 officers, cadets, and enlisted men, 56 per cent were attacked. The percentage of sickness among the cadets alone was 75.

                      At Washington 20 per cent of the marine garrison were attacked, but taking into consideration all persons living in or around or employed in the navy yard, it is estimated that 70 per cent suffered from influenza.

                      At Richmond, Va., the disease did not become epidemic upon the vessels stationed there, but a few mild cases occurred.

                      At Norfolk, Va., from 20 per cent to 25 per cent of all ages and sexes were attacked. On the receiving ship 75 per cent of the ship's company were taken sick.

                      The majority of these observations apply to men in early adult or middle life, and therefore do not justify conclusions as to a greater susceptibility at any particular period of life or on the part of one sex more than the other. But at the Naval Academy 75 per cent of the cadets were attacked, while at the home for aged sailors at Philadelphia only 2 cases are recorded among the 196 inmates, which tends to show that early life suffered more than old age.

                      In the above series of observations the following symptoms are recorded as prominent:

                      TO READ THE ENTIRE REPORT GO TO:

                      Last edited by Jonesie; May 5, 2007, 05:44 PM.


                      • #12
                        Re: FLU PANDEMIC: 1889-1890

                        death rate per 1000 ? moo ?


                        In February the provincial towns of England were most severely affected, the death-rate rising to 27.4, but in London it fell from 28 1 to 21 2,

                        In eight London hospitals the case-mortality among in-patients in the 1890 outbreak was 34.5 per moo; among all patients treated it was i 6 per moo. In the army it was rather less.

                        Analysis of reports from ships and stations of the Navy during 1889 and 1890 show that from 20 to 75 per cent of the various complements were attacked. While most of the reports speak of the disease as mild, certain of them mention complicating pneumonia and nephritis, and the disease at the naval station, San Francisco, seems to have been associated with a case fatality rate of 4 per cent, all the deaths being caused by pneumonia.

                        It is significant that the annual death rate per thousand for disease in the Navy in 1889 was 10.7. In 1887 it was 7.6 and in 1888, 9.2. Since 1889 the rate has not reached that figure until the present pandemic. (1918)

                        The annual death rate per 100,000 for pneumonia is also very significant. This rate in 1887 was 62.38; 1888, 70.31; and in 1889, 178.26; 1890, 169.95, and thereafter it did not again reach 100 until 1917, when it was 102.20.
                        I'm interested in expert panflu damage estimates
                        my current links: ILI-charts:


                        • #13
                          Re: FLU PANDEMIC: 1889-1890

                          Laidback Al:

                          One migratory bird species to be considered is the Northern Wheatear. There are two subspecies, both wintering together in Northern Africa. One (Isabella) travels north along the coast of Spain, then UK, Iceland, Greenland and far eastern Canada. The other travels across Turkey, Armenia, probably Bokara, then on to Athabascan areas of Alaska, Yukon, & NW Territories.

                          Not all migratory species travel simply north/south.

                          "The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation


                          • #14
                            Re: FLU PANDEMIC: 1889-1890

                            Am J Public Health. 1918 November; 8(11): 845?848.


                            W. A. Evans and M. O. Heckard

                            Get a printable copy (PDF file) of the complete article (385K).

                            Articles from American Journal of Public Health are provided here courtesy of
                            American Public Health Association

                            TO READ THE ARTICLE, GO TO THE LINK ON THIS PAGE:

                            (Does someone know how to post it here? It has some interesting charts)


                            • #15
                              Re: FLU PANDEMIC: 1889-1890

                              ALTHOUGH the present epidemic
                              of influenza began in Europe
                              several months ago cablegrams
                              informing us of the continued or recurring
                              prevalence of the disease in England,
                              France and Germany are received from
                              day to day. This prompts an inquiry
                              into the history of past epidemics of this
                              disease with a view to determining what
                              we may expect in the next few years.
                              Hirsch's "Handbook of Historical and
                              Geographical Pathology" records almost
                              one hundred epidemics occurring in the
                              eight hundred years prior to 1889. It is
                              clearly set forth that practically each of
                              these epidemics lasted longer than one
                              year or else recurred several times during
                              the course of two or more years. Consideration
                              of this fact led us to study the
                              record of the pandemic of 1889-93 as it
                              exhibited itself in Chicago. The material
                              for the'study was found in the yearly
                              reports of the Chicago Health Department
                              for the years 1888 to 1894 inclusive.
                              In 1890 Dr. S. Wickersham, health
                              commissioner, said in his annual report:
                              "Influenza beginning in our city early
                              in January reached its height the last
                              week in January at which time my belief
                              is that over 100,000 of our citizens were
                              sufferers from that cause alone. It continued
                              to prevail during February, March
                              and April in a modified degree. Its duration
                              was about four months. In the
                              week having the highest mortality there
                              were 694 deaths."
                              In 1891 the disease recurred for we find
                              Dr. J. D. Ware, then health commissioner,
                              saying in his annual report, " During
                              March and April there were 3,400 deaths
                              in each month largely due to pneumonia
                              and influenza which seemed to be epidemic.
                              No mention is made of influenza in the
                              annual reports of 1892-93, but Dr. A. R.
                              Reynolds, health commissioner at that
                              time, tells us that the disease prevailed as
                              late as 1893.
                              The influenza bacillus was not discovered
                              until the epidemic was well under
                              way and as a means of general diagnosis
                              bacteriologic examinations were not employed.
                              Diagnosis was by clinical symptoms.
                              Inviewofthewell-known influence
                              of publicity on diagnosis our judgment is
                              that the best basis for judgment as to the
                              effect of influenza in 1889 to 1893 is the
                              curve for deaths from all causes.
                              Diagram 1 shows the monthly distribution
                              of deaths from all causes in

                              Between 1889 and 1893 the population
                              of Chicago increased 5.2 per cent a year.
                              This diagram is shown for two reasons.
                              In the first place it indicates the distribution
                              of deaths throughout the year
                              under normal conditions in the year
                              just prior to the onset of the epidemic.
                              In the second place we use the deaths per
                              months in 1889 as a basis for the chart
                              showing the great increase in mortality
                              during the late Winter and the Spring.
                              During this period the population of
                              Chicago grew at the rate of 5.2 per cent a
                              year. To get the number of deaths
                              normally to be expected in January, 1890,
                              we added 5.2 per cent to the number of
                              deaths which occurred in January, 1889.
                              This process was repeated for each of the
                              twelve months. To get the number of
                              deaths expected in January, 1891, we
                              added 5.2 per cent to the number of expected
                              deaths for January, 1890. This
                              process was repeated for each month.
                              The same plan was followed in arriving at
                              the expected deaths for the months of
                              1892 and 1893. In this way we established
                              outr base line for Diagram 2.
                              Diagram 2 shows how much the deaths
                              each month rose above or fell below the
                              base line. The death-rates were heavy in
                              the respiratory disease months and light
                              in the late Summer, Autumn and early
                              Winter. We think that this diagram
                              proves that the effect of influenza was
                              felt each late Winter and Spring until and
                              including 1893.
                              The gross death-rates for the several
                              years were: 1889, 18.12; 1890, 19.87;
                              1891, 24.16; 1892, 21.85; 1893, 21.61;
                              1894, 18.26; 1895, 17.72; 1896, 16.29.

                              Diagrams 3 and 4 are reproductions of
                              sections of charts found in the Report of
                              the Chicago Health Department for 1911.
                              They show that the pneumonia and bronchitis
                              death-rates rose sharply in 1890
                              and continued high until 1893. After
                              1893 the prevalence of these diseases was
                              markedly decreased. We need scarcely
                              add that between 1890 and 1893 physicians
                              habitually made many clinical diagnoses
                              of influenza and many deatbs from
                              this disease are recorded each year.
                              Nevertheless it is our opinion that the
                              gross deaths reflect the effect of the epidemic
                              even more than do the records as
                              to pneumonia, bronchitis and influenza.



                              Diagram 5 shows a part of the age distribution
                              of excess deaths over normal
                              from all causes in 1890-93. The base line
                              was established in the same way as in the
                              case of Diagram 2. This diagram shows
                              that influenza-pneumonia, caused the
                              largest excess of death over the expected
                              in the group "over 60".* (* Although the excess deaths orer normal were more numerous
                              in the age group "over 60", the total deaths were
                              greater in the age group "20-40".)

                              The most significant showing on this
                              diagram is the line for children 5 to 10.
                              This group was picked out for entry on
                              the diagram because it more nearly represented
                              school children than any other

                              age group in the classification. This line
                              indicates that the disease has a distinct
                              ,tendency to spare children of school age.
                              .It furnishes an argument against the closing
                              of schools as a means for controlling an
                              epidemic of influenza.

                              First: Pandemics of influenza usually
                              continue for several years.
                              Second: The epidemic in Chicago in
                              1890 contintied to recur or else to otherwise
                              increase the mortality rate of Chicago
                              up to and, through 1893.
                              Third: The principal increases in deaths
                              were due to pneumonia, bronchitis and
                              Fourth: The number of deaths was
                              highest among persons 20 to 40. The
                              greater increase above the expected was
                              in death of persons over 60. Chart 5
                              shows that children' of school age seem to
                              enjoy some relative immunity.
                              Fifth: This study indicates a probability
                              either that influenza will recur several
                              times during the next few years or that
                              there will be an increase in pneumonia,
                              or both.
                              Sixth: This study plainly indicates a
                              need for, continued work to control the
                              acute respiratory diseases during 1918,
                              1919 and for several years thereafter.

                              Diagram No. 5-Deaths for four years in certain
                              age groups as compared with expected deaths on
                              basis of deaths in 1889 plus 5.2 per cent each year
                              for increase in population. The zero line represents
                              expected deaths. The horizontal lines above zero
                              line indicate numbers of death above the expected.
                              Those below zero line indicate numbers of deaths
                              below the expected. Chicago.
                              Last edited by Sally Furniss; June 13, 2007, 10:44 PM.