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INFLUENZA (syn. " grip," la grippe)
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See also:INFLUENZA (syn. " grip," la grippe) , a See also:term applied to an infectious febrile disorder due to a specific bacillus, characterized specially by See also:catarrh of the See also:respiratory passages and alimentary See also:canal, and occurring mostly as an epidemic . The Italians in the 17th See also:century ascribed it to the See also:influence of the stars, and hence the name " See also:influenza." The See also:French name grippe came into use in 1743, and those of petite poste and See also:petit See also:courier in 1762, while See also:general became another synonym in 1780 . Apparently the See also:scourge was See also:common; in 1403 and 1557 the sittings of the See also:Paris See also:law courts had to be suspended through it, and in 1427 sermons had to be abandoned through the coughing and See also:sneezing; in 1510 masses could not be sung . Epidemics occurred in 158o, 1676, 1703, 1732 and 1737, and their cessation was supposed to be connected with earthquakes and volcanic eruptions . The disease is referred to in the See also:works of the See also:ancient physicians, and accurate descriptions of it have been given by medical writers during the last three centuries . These various accounts agree substantially in their narration of the phenomena and course of the disease, and influenza has in all times been regarded as fulfilling all the conditions of an epidemic in its sudden invasion, and rapid and extensive spread . Among the See also:chief epidemics were those of 1762, 1782, 1787, 1803, 1833, 1837 and 1847 . It appeared in fleets at See also:sea away from all communication with See also:land, and to such an extent as to disable them temporarily for service . This happened in 1782 in the See also:case of the See also:squadron of See also:Admiral See also:Richard See also:Kempenfelt (1718-1782), which had to return to See also:England from the See also:coast of See also:France in consequence of influenza attacking his crews . Like See also:cholera and See also:plague, influenza reappeared in the last See also:quarter of the 19th century, after an See also:interval of many years, in epidemic or rather pandemic See also:form . After the See also:year 1848, in which 7963 deaths were directly attributed to influenza in England and See also:Wales, the disease continued prevalent until 186o, with distinct but See also:minor epidemic exacerbations in 1851, 1855 and 1858; during the next See also:decade the mortality dropped rapidly though not steadily, and the diminution continued down to the year 1889, in which only S5 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 See also:local outbreaks of illness resembling epidemic influenza have been observed during the See also:period of See also:abeyance, as in See also:Norfolk in 1878 and in See also: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 See also:Asiatic cholera and " cholera nostras." Individual cases may be indistinguishable, but as a See also:factor in the public See also:health the difference between sporadic and epidemic influenza is as See also: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 See also:home forcibly to all by the visitation of 1889 . According to the exhaustive See also:report See also:drawn up by Dr H . See also:Franklin See also:Parsons for the Local See also:Government See also:Board, the earliest appearances were observed in May 1889, and three localities are mentioned as affected at the same See also:time, all widely separated from each other—namely, See also:Bokhara in Central See also:Asia, See also:Athabasca in the See also:north-See also:west Territories of See also:Canada and See also:Greenland . About the See also:middle of See also:October it was reported at See also:Tomsk in See also:Siberia, and by the end of the See also:month at St See also:Petersburg . During See also:November See also:Russia became generally affected, and cases were noticed in Paris, See also:Berlin, See also:Vienna, See also:London and See also:Jamaica (?) . In See also:December epidemic influenza became established over the whole of See also:Europe, along the Mediterranean, in See also:Egypt and over a large See also:area in the See also:United States . It appeared in several towns in England, beginning with See also: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 See also:January 1890 . Everywhere it seems to have exhibited the same explosive See also:character when once fully established . In St Petersburg, out of a government See also:staff of 26o men, 220 were taken See also:ill in one See also: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 See also:British Islands, though it was less prevalent in the north and north-west than in the See also:south
.
January witnessed a great See also:extension of the disease in See also:Germany, See also: 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 See also:scale occurred in March 1891, in the United States and the north of England . It was reported from See also:Chicago and other large towns in the central states, whence it spread eastwards, reaching New See also:York about the end of March . In England it began in the Yorkshire towns, particularly in See also: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 \Vales, suffered much more heavily in mortality than in the previous attack, but the south-west of England, See also:Scotland and See also:Ireland escaped with comparatively little sickness . The same may be said of the See also:European See also:continent generally, except parts of Russia, Scandinavia and perhaps the north of Germany . This second epidemic coincided with the See also:spring and See also:early summer; it had subsided in London by the end of See also:June . The experience of See also: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 See also:free, the See also:antipodes had their second attack, which was more severe than the first . As in England, it reversed the previous See also:order of things, beginning in the provinces and spreading thence to the See also:capital towns . The last quarter of the year was signalized by another recrudescence in Europe, which reached its height during the See also:winter . All parts, including Great See also:Britain, were severely affected . In England those parts which had See also:borne the brunt of the epidemic in the early See also: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 See also: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 . See also: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 t; 1892—January, 84,543; February, 55,352; Maroh, 28,046; April, 7962; May, 1468; June, 223 . Other parts of the world affected were the West Indies, Tunis, Egypt, See also:Sudan, Cape Town See also:Teheran, See also:Tongking and China . In See also:August 1892 influenza was reported from Peru, and later in the year from various places in Europe . A See also: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 See also: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 See also:variations until 1907, in which the See also: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 See also: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 See also:diffusion was also more rapid and probably more extensive . The foregoing general See also:summary may be supplemented by some further details of the incidence in Great Britain . The number of deaths directly attributed to influenza, and the death-rates per million in each year in England and Wales, are as follow: Year . Deaths . Death-rates Year . _se Death-rates per million . Deaths. per million . 1890 4,523 157 1899 12,417 389 1891 16, 686 574 1900 16, 245 504 1892 15,737 534 1901 5,666 174 1893 9,669 325 1902 7,366 223 1894 6,625 220 1903 6,322 189 1895 12,880 424 1904 5,694 168 1896 3,753 122 1905 6,953 204 1897 6,o88 196 19c6 6,310 183 1898 10,405 331 1907 9,257 265 It is interesting to compare these figures with the corresponding ones for the previous visitation: Death-rates Death-rates Year . Deaths. per million . Year . Deaths. per million . 1847 4,881 285 1852 1,359 76 1848 7,963 460 1853 1,789 99 1849 1,6n 92 1854 1,061 58 1850 1,380 78 1855 3,568 193 1851 2,152 120 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 See also:wave was much the more deadly . The See also:average See also:annual death-rate for the nine years is 320 in the one case against 162 in the other, or as nearly as possible See also: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 See also: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 189r . 554 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 See also:urban communities, as the following table shows: Deaths from Influenza . 1890 . 1891 . London . . . . . . 624 2302 24 Great Towns over 8o,000 See also:population . 439 2417 35 Towns between 20,000 and 80,000 186 765 21 Towns between io,000 and 20,000 46 196 6o Towns under io,000 62 196 85 Rural Sanitary Districts 317 841 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 See also:deal more sickness . More See also:people were " down with influenza," though fewer died . For instance, the number of persons treated at the See also:Middlesex See also:Hospital in the two months' winter epidemic of 1890 was 1279; in the far more fatal three months' spring epidemic of 1891 it was only 726 . 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 See also: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 See also:age See also: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, See also:Essex, See also:Suffolk and Norfolk, together with See also:Hampshire and one or two others, escaped lightly in both years; the western counties, namely, North and South Wales, with the adjoining counties of See also:Monmouth, See also:Hereford and See also:Shropshire, suffered heavily in both years . It will be convenient to discuss seriatim the various points of See also:interest on which See also:light has been thrown by the experience described above . The See also:bacteriology of influenza is discussed in the See also:article on PARASITIC DISEASES . The disease is often called " See also:Russian " influenza, and its origin in 1888 suggests that the name may have some See also: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 See also:cold winter and a See also:rainy spring . The dried-up See also:earth was full of cracks and holes from drought and subsequent See also:frost, so that the spring rains formed ponds in these holes, inundated the new railway cuttings, and turned the See also:country into a perfect See also:marsh . When the hot See also:weather set in the See also:water gave off poisonous exhalations, rendering See also:malaria general." On See also:account of the severe winter, the people were enfeebled from lack of nourishment, and when influenza See also:broke out suddenly they died in large See also: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 See also:fever and See also:diphtheria, which have occurred on the supervention of heavy See also:rain after a dry period, causing cracks and fissures in the earth . 
Assuming the existence of a living See also:poison He found that it prevailed independently of See also:climate, See also: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 loco-See also:motion 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 See also: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 See also:complete See also:independence of season and weather shown by influenza . It has appeared and disappeared at all seasons and in all weathers and only popular See also:ignorance continues to ascribe its behaviour to atmospheric conditions . In Europe, however, it has prevailed more often 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 See also: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 See also: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 See also:work and spreading the infection, (4) the diagnosis often being difficult, influenza being possibly confused with See also: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 " See also:bad cold." There may be some inflammation of the respiratory passages, and then symptoms of catarrh are See also:present, but that is not necessarily the case, and in some epidemics such symptoms are quite exceptional . This had been recognized by various writers 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 See also:peculiar robustness and virulence is bred and brought into activity by a See also:combination of favourable conditions, and is then disseminated more or less widely according to its " staying See also:power," by human agency . Whether central Asia is an endemic centre for influenza or not there is no See also:evidence, but the disease seems to be more often prevalent in the Russian See also: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 hypo-thesis 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 See also:recent See also: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 inter-course." 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 " See also:affection, were chiefly to blame for a widespread and tenacious popular See also:fallacy . Leichtenstern, in his masterly article in Nothnagel's Handbuch, divides the disease as follows:—(1) Epidemic influenza See also:vera caused by See also: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 See also:list, showing the proportion of the population estimated to have been attacked in the 1889–1890 epidemic in different localities: Per Per Place. cent .
Place, cent
.
St Petersburg
.
50 Portugal
.
. 90
Berlin 33 Vienna 30-40
See also:Nuremberg 67 See also:Belgrade
.
. 33
See also:Grand-Duchy of See also:Hesse 25-30 See also:Antwerp
.
. 33
Grand-Duchy, other See also:Gaeta
.
.
.
. 50-77
Districts
.
50-75 See also:Massachusetts
.
39
See also:Heligoland 50 See also:Peking
.
.
.
. 50
See also:Budapest 5o St See also:
The proportion among the troops in the Home See also:District was 9'3%
.
The General See also:Post See also:Office made the highest return with 33'6%, which is accounted for partly by the enormous number of persons massed together in the same See also:room in more than one See also:department, and partly by the facilities for obtaining medical See also:advice, which would tend to bring very light cases, unnoticed elsewhere, upon the See also: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 See also:immunity, but apparently greater susceptibility from previous attacks
.
The symptoms were thus described by Dr See also:Bruce See also:Low from observations made in St See also: In the first twenty-four See also:hours its range is from too° 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 See also:pain in the See also: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 See also:joints, and even in the fingers and toes; and febrile temperature,'which may in the early period rise to toe or 105° F . At the same time the patient feels excessively ill and prostrate, is See also:apt to suffer from nausea or sickness and See also:diarrhoea, and is for the most part restless, though often (and especially in the case of See also: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 See also:discharge from the See also: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 See also:chest, cough, and perhaps a little shortness of breath, and before See also: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 See also:condition whatever becomes developed at any time . Several writers have distinguished four See also:main varieties of the disease—namely, (I) nervous, (2)gastro-intestinal, (3)respiratory, (4) febrile, a form chiefly found in children . See also: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 See also:direct poisoning of the See also: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 See also: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 See also:superintendent of St See also:Luke's hospital, says that of insanities traceable to influenza See also:melancholia is twice as frequent as all other forms of See also:insanity put together . Other common after-effects are See also:neuralgia, See also:dyspepsia, See also:insomnia, weakness or loss of the special senses, particularly See also:taste and See also:smell, abdominal pains, sore throat, See also:rheumatism and See also:muscular weakness . The feature most dangerous to See also: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 See also:diagram gives the annual death-rate per million in England and Wales, and is taken from an article by Dr See also: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 See also:I000; among all patients treated it was 1.6 per i000 . In the See also:army it was rather less . The infectious character of influenza having been determined, suggestions were made for its administrative See also:control on the See also:familiar lines of notification, See also:isolation and disinfection, but this has not hitherto been found practicable . In March 1895, however, the Local Government Board issued a memorandum recommending the See also: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 See also:household . 2 . The sputa of the sick should, especially in the acute See also:stage of the disease, be received into vessels containing See also: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 . 556 IN FORMA PAUPERIS INFORMER practice were incorporated into one See also:code and embodied in the rules of the Supreme See also:Court (0. xvi. rr . 22-31) . Now any See also:person may be admitted to See also:sue as a pauper, on See also:proof that he is not See also:worth £25, his wearing See also:apparel and the subject matter of the cause or matter excepted . He must See also:lay his case before counsel for See also:opinion, and counsel's opinion thereon, with an See also:affidavit of the party suing that the case contains a full and true statement of all the material facts to the best of his knowledge and belief, must be produced before the proper See also:officers to whom the application is made . A person who desires to defend as a pauper must enter an appearance to a See also:writ in the ordinary way and afterwards apply for an order to defend as a pauper . Where a person is admitted to sue or defend as a pauper, counsel and See also:solicitor may be assigned to him, and such counsel and solicitor are not at See also:liberty to refuse assistance unless there is some See also:good See also:reason for refusing . If any person admitted to sue or defend as a pauper agrees to pay fees to any person for the conduct of his business he will be dispaupered . See also:Costs ordered to be paid to a pauper are taxed as in other cases . Appeals to the See also:House of Lords in forma pauperis were regulated by the See also:Appeal (Forma Pauperis) See also:Act 1893, which gave the House of Lords power to refuse a See also:petition for leave to sue . |
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