Influenza at Sea.

“In the plain of Catania, an open place, it is reported that from one of the clefts in the ground, narrow but very long and about four miles off the sea, the water was thrown forth altogether as salt as that of the sea, [as in Jamaica the year before]. In Syracuse and other places near the sea, the waters in many wells, which at first were salt, are become fresh again.... The fountain Arethusa for the space of some months was so brackish that the Syracusans could make no use of it, and now that it is grown sweeter the spring is increased to near double. In the city of Termini all the running waters are dried up.... It was contrary with the hot-baths, which were augmented by a third part.Darkness and obscurity of the air has always been over us, but still inferior to that on the 10th and 11th of January; and often these clouds have been thin and light, and of a great extent, such as the authors callrarae nubeculae. The sun often and the moon always obscured at the rising and setting, and the horizon all day long dusky....The effects it has had on humane bodies (although I do not believe they have all immediately been caused by the earthquake) have (yet) been various: such as foolishness (but not to any great degree), madness, dulness, sottishness, and stolidity everywhere: hypochondriack, melancholick and cholerick distempers. Every-day fevers have been common, with many continual and tertian: malignant, mortal and dangerous ones in a greatnumber, with deliria and lethargies. Where there has been any infection caused by the natural malignity of the air, infinite mortality has followed. The smallpox has made great destruction among children.”

Darkness and obscurity of the air has always been over us, but still inferior to that on the 10th and 11th of January; and often these clouds have been thin and light, and of a great extent, such as the authors callrarae nubeculae. The sun often and the moon always obscured at the rising and setting, and the horizon all day long dusky....

The effects it has had on humane bodies (although I do not believe they have all immediately been caused by the earthquake) have (yet) been various: such as foolishness (but not to any great degree), madness, dulness, sottishness, and stolidity everywhere: hypochondriack, melancholick and cholerick distempers. Every-day fevers have been common, with many continual and tertian: malignant, mortal and dangerous ones in a greatnumber, with deliria and lethargies. Where there has been any infection caused by the natural malignity of the air, infinite mortality has followed. The smallpox has made great destruction among children.”

Thus we find in Sicily a great disturbance of soil followed, as in Jamaica, by a great increase of local sickness, and by an atmosphere visibly charged with products of the earthquake for months after. This is a nearer source than the Jamaican for the British influenza of Oct.-Nov. 1693,—nearer in time, if that be any advantage for the theory, nearer also in place. There are, however, no intermediate stages to connect the influenza on the northern edge of the European continent with the disturbance of soil and the miasmata arising therefrom in Sicily and Calabria. If there had been any such dry fog as spread all over Europe from the Calabrian earthquake of January, 1783, it would have been a help at least to the imagination in bridging over a gulf of space and time.

As to the interval of time, it should at all events be kept in mind that the same difficulty has to be reckoned with in any hypothesis of influenza and in every great historic instance. In the instance still before us, the infection began in England, according to Molyneux, in October, 1693, and was in Dublin a month later. But we must assume it to have been in the air for some time before it became effective upon mankind. Influenza has been observed, with curious uniformity, to attack the horses, say of London, of Plymouth, of Edinburgh, or of Dublin (as on the occasion before this, 1688) two months or more in advance of the inhabitants of the respective places; and if it had waited, so to speak, for two months before it showed its effects upon men, it may have waited equally long, or longer, before it showed its effects upon horses. That would give at least four months; and then we know, from such an influenza as that of 1743, that there may be weeks, perhaps months, between its prevalence in Naples, Rome or Milan, and its prevalence in London or Edinburgh, and, from the influenza of 1693 itself, that it was a month later in Dublin than in London. An earthquake in Sicily on the 9th of January, 1693, with effects there for months after upon the water, the air, and the prevalent diseases, is not excluded by lapse of time from being avera causaof an influenza in England in October of the same year, and in Ireland in November. The sort of proof which most men desire, a proof such as we rarely get, and onethat is suspiciously neat when we do get it, would be to find an influenza in Sicily and Calabria following the earthquake, and to trace the same step by step over Europe. But the miasmatic sickness in the countries of the earthquakes was not influenza, so far as is known; and there was no epidemic catarrh, so far as is known, in any other part of Europe but the British Isles and the neighbouring shores of the North Sea.

Molyneux, who recorded with a good deal of circumstance the influenza of 1693, is the principal authority, along with Dr Walter Harris, of London, for another influenza in 1688, seemingly peculiar to the British Isles. Its effects can be discovered with the utmost certainty in the London bills of mortality for two or three weeks at the end of May and beginning of June, and it is mentioned as “the new distemper” in letters of the time. Is it possible to find an earthquake for it? Webster’s note is: “in the same year with an eruption of Vesuvius, after a severe winter and earthquakes”—which is somewhat general. Turning to Evelyn’s diary, where these matters are often recorded, we find, in the very weeks when the influenza was at a height in London, this entry: “News arrived of the most prodigious earthquake that was almost ever heard of, subverting the city of Lima and country in Peru, with a dreadfull inundation following it”—as if the influenza and the news of the earthquake had reached London at the same time. This was the earthquake of 20th October, 1687, which destroyed Lima, Callao and an immense district along the coast of Peru. The rocking of the earth was most violent, the sea retreated like a sudden immense ebb and filled again like a sudden immense flood, the effect of the commotion being felt on board ships a hundred and fifty leagues out in the Pacific. It was remarked that wheat and barley would not thrive in Peru after that earthquake[775]. Here was undoubtedly a great disturbance of soil and of subsoil, almost certainly attended with the discharge of effluvia or miasmata into the air, as in other great earthquakes. But the universal slight fever of the British Isles in the months of June and July, 1688, is remote from the earthquakeof Lima in place; and, if it be a question of earthquakes at all, there are others nearer to it both in place and time, such as that in the Basilicata province of Naples in January, 1688, and the Jamaica earthquake, felt through all the island, on the 1st of March, 1688. The greatest of them all, that of Smyrna, on the 10th of July, was a few weeks too late for the hypothesis.

VI.

A continent so subject to earthquakes as South America might be expected, in this hypothesis, to have had some corresponding influenzas. It has indeed had influenzas, some of them peculiar to itself. The Western Hemisphere as a whole has, on several great occasions, had influenzas which were not felt in the Old World. Again, there are one or two instances in which the infection, while it spread widely over the table-lands of Bolivia and Peru, does not appear by existing testimony to have been carried north of the Isthmus. One of these was the influenza of 1720, as special to a region of South America as that of 1688 was to the British Isles. The account of it was given in an essay by Botoni ‘On the Circulation of the Blood,’ published at Lima in 1723[776]. He calls itcatarro maligno; it was popularly known asfierro chutoor “iron cap.” It appeared at Cuzco in the end of March, or beginning of April, 1720, and was over about November. Four thousand are said to have died of it in the diocese of Cuzco, and it is said to have made so great a scarcity of hands that the first harvest after it was imperfectly gathered. It had all the marks of an influenza, with the addition of bleeding from the nose and lungs. It had also the grand characteristic common to influenza and epidemic ague: “the symptoms were so diverse and even contradictory that no correct diagnosis, or curative plan, could be fixed.” The Lima writer of 1723 says that it followed an eclipse of the sun on the 15th of August, 1719, having begun on the eastern side of the Andes, in the basin of La Plata, about that time, and travelled northwards and westwards, as the South American influenza of 1759 did.

This is a localized influenza in a country of earthquakes. But the two great earthquakes in 1719 are not South American.They both happened in July: one along the coast of Fez and Morocco, which ruined many villages and a part of the city of Morocco (there is also a later disturbance in the Azores in December, followed by the upheaval of a new island), the other in North China. Here we have the choice of following the “aer inimicus” of Lucretius either from China or from the African coast; and if it be the case that the influenza began in the latter part of the year 1719 in the basin of the La Plata, to cross the Andes next year, it may seem, in this hypothesis, that a course from east to west, bringing the infection across the Atlantic from Africa, is to be preferred to a course from west to east, bringing it across the Pacific from North China. In either case there need be no difficulty in finding local clouds of miasmata. Some traces of the corresponding great earthquake in China were found in November of the following year, by Bell, an English traveller who crossed from Moscow to Peking:

“Jumy,” he says, “suffered greatly by the earthquakes that happened in the month of July the preceding year [1719], above one half of it being thereby laid in ruins. Indeed more than one half of the towns and villages through which we travelled this day had suffered much on the same occasion, and vast numbers of people had been buried in the ruins. I must confess it was a dismal scene to see everywhere such heaps of rubbish[777].”

The atmospheric effects of Chinese earthquakes have been pictured since medieval times, in obviously superstitious colours; and there are reasons why a great disturbance of soil in that country should produce remarkable miasmata. The surface soil of China is peculiar in having the bodies of the dead dispersed at large in it, insomuch that excavations for the foundations of houses, or for roads and railway cuttings, can hardly be made without the constant risk of exposing graves[778].

If the soil of China is peculiar in one way, that of the West Coast of Africa is peculiar in another. Without entering on the large question of “malaria” in each of them, I shall take an old illustration of the miasmata of the West Coast of Africa as acause of dengue-fever, a disease curiously like influenza in its symptoms, and like it also in its occasional wave-like dispersion over wide regions. The authority is Dr Aubrey, who resided many years on the coast of Guinea, saw much of the slave-trade, and wrote a very sensible book in 1729, called ‘The Sea Surgeon, or the Guinea Man’s Vade Mecum.’ He describes quite clearly the fever which was long after described by West Indian physicians as dengue, or three-days’ fever, or break-bone fever, including in his description the characteristic exanthems of it and the penetrating odour of the sweat. He gives also, in clinical form, a series of cases on board the galley ‘Peterborough’ in December, 1717, which are exquisite examples of break-bone fever. This disease, he says, “many times runs over the whole ship, as well negroes as white men, for they infect one the other, and the ship is then in a very deplorable condition unless they have an able man to take care of them.” But the original source of infection, he believed, was the fogs that hung at nightfall over the estuaries of the rivers; and he gives an experimental proof, remarkable but not quite incredible, of the poisonous nature of the miasmata:

“But to let you see the evil, malevolent, contagious, destructive quality of those fogs that fall there in the night, and how far they are inimical to human nature, I will tell you of an experiment of my own. I made a lump of paste with oat-meal somewhat hard, and about the bigness of a hen’s egg, which was exposed to the fog from twilight to twilight, i.e. from the dusk of the evening till daybreak in the morning; after which I crumbled it, and gave it to fowls, which we had on board, and soon after they had eaten it, they turned round and in a kind of vertigo dropt down and expired.”

A great mortality in Guinea in 1754 or 1755 was ascribed by Lind, the least credulous in such matters, to “a noxious stinking fog[779].”

What the alternations of heat and chill, of moisture and drought, produce ordinarily in the way of miasmata, the same, we may suppose, is produced on the great scale, as a phenomenon at some particular time and place, by one of those cataclysms which break the surface of the earth or the bed of the sea, lower or raise the level of wells and springs, and fill the air with particles of dust or vapour which may overhang the locality for months and visibly disperse themselves to a great distance. Nothing relating to miasmata in the air need be hardfor belief after the wonderful diffusion and permanence in the atmosphere of the whole globe, for two years or more, of finely divided particles shot up by the earthquakes and eruptions of Krakatoa in the Straits of Sunda on the 27th and 28th of August, 1883[780].

A theory of influenza constructed from such generalities as those of Boyle, Arbuthnot and Webster will have attractions for many over the theory that influenza is always present in some remote country and becomes dispersed now and then over the world by contagion from person to person: it will have superior attractions, for the reason that influenza is a phenomenal thing which needs a phenomenal cause to account for it. But if anyone were to attempt to fit each historic wave of influenza with its particular earthquake, or to find the precise locality where clouds of infective matter had arisen, or the particular circumstances in which they arose, he would certainly find his fragile structure of probabilities pulled to pieces by the professed discouragers and depravers. I make no such attempt; but I am not the less persuaded of the direction in which the true theory of influenza lies.

There is no point more essential to a correct theory of influenza than to find out in what circumstances it has occurred among the crews of ships on the high seas. If it be true that a ship may sail into an atmosphere of influenza, just as she may sail into a fog, or an oceanic current, or the track of a cyclone, then the possible hypotheses touching the nature, source, and mode of diffusion of influenza become narrowed down within definite limits.

One of the first observations was made in the case of a Scotch vessel in the influenza of 1732-33[781]. The epidemic was earlier in Scotland than in England; it began suddenly in Edinburgh on 17 December, 1732, the horses having been attacked with running of the nose towards the end of October. About the time when the disease began among mankind, in December, a vessel, the ‘Anne and Agnes’ sailed from Leith for Holland. One sailor was sick on this voyage. She sailed on the return voyage to Leith, with the other ten of her crew in perfect health. Just as she made the English coast at Flamborough Head on the 15th of January, 1733, six of the sailors fell ill together, two more the next day, and one more on the day afterthat, so that when the vessel anchored in Leith Roads there was only one man well, and he fell ill on the day following the arrival. The symptoms were the common ones of the reigning epidemic. The dates are not given more precisely or fully than as above. Influenza was prevalent in Germany and Holland somewhat earlier than in Scotland or England; the men may, of course, have imbibed the infection when they were in the Dutch port, just as it is almost certain that the crews of Drake’s fleet in 1587 had received during a ten days’ stay upon the island of St Jago, of the Cape de Verde group, the miasmatic infection of which they suddenly fell sick in large numbers together in mid-Atlantic some six days after sailing to the westward.

This early case of the ‘Anne and Agnes’ in 1733 may pass as an ambiguous one. The next occasion when influenza on board ship attracted much notice was the epidemic of 1782.

On the 6th of May, Admiral Kempenfelt sailed from Spithead with seven ships of the line and a frigate, on a cruize to the westward; on the 18th May, he came into Torbay, and sailed again soon after; on the 30th May he came again into Torbay with eight sail of the line and three frigates, and on 1 June sailed again to the westward. Sometime before his squadron put into Torbay for the second time, influenza had appeared among them at sea, it is said in the ‘Goliath’ on the 29th of May[782]. A letter from Plymouth, of the 2nd June, after referring to the violence of influenza in that town, at the Dock, and on board the men-of-war lying there, says that the ‘Fortitude’ of 74 guns, and ‘Latona’ frigate came in that afternoon with 250 sick men from the fleet under Admiral Kempenfelt, mostly with fevers. Another Plymouth letter two days later (4 June) says: “Kempenfelt is returning to Torbay: he could keep the sea no longer, on account of the sickness that rages on board his fleet. More than 400 men have been brought to the hospital this morning. Our men drop down with it by scores at a time. The ‘Latona’ frigate, that sailed the other day is returned, the officers being the only hands that could work the ship[783].”

This outbreak on board ships in the Channel was fully as early as the great development of influenza in 1782 on shore, whether in London or Plymouth; but there were almost certainly cases of it at the latter port before the ‘Latona’ sailed to join Kempenfelt’s squadron. Robertson, however, who was surgeon on the ‘Romney’ in the Channel service at that time, says that “hundreds in different ships, towns, and counties, which hadnocommunication with one another, were seized nearly as suddenly and so nigh the same instant as if they had been electrified.... The companies of many of the ships were very well at bed-time, and in the morning there were hardly enough able to do the common business of the ship[784].” This is confirmed by McNair, surgeon of the ‘Fortitude,’ who told Trotter that two hundredof her men, as she lay in Torbay, were seized in one night and were unable to come on deck in the morning[785].

There was another English fleet in the North Sea at the same time, under Lord Howe, watching the Dutch fleet or seeking to intercept the Dutch East Indiamen.

Howe sailed from St Helen’s on the 9th May, with twelve ships of the line. Towards the end of that month he had his fleet in the Texel; the men were in excellent health, “when a cutter arrived from the Admiralty, and the signal was given for an officer from each ship [to come on board the admiral]. An officer was accordingly sent with a boat’s crew from every vessel, and returned with orders, carrying with them also, however, the influenza”—which soon prostrated the crews to the same extraordinary extent as in the ships under Kempenfelt at the other end of the Channel. This was the oral account given to Professor Gregory of Edinburgh, by a lieutenant on board a sixty-four gun ship[786]. Another account says that the disorder first appeared in Howe’s fleet on the Dutch coast about the end of May, on board the ‘Ripon,’ and in two days after in the ‘Princess Amelia’; other ships of the same fleet were affected with it at different periods, some indeed, not until their return to Portsmouth about the second week of June. “This fleet, also, had no communication with the shore until their return to the Downs, on their way back to Portsmouth, towards the 3d and 4th of June[787].”

But, apart from the story of the Admiralty despatch-boat carrying the influenza to Howe’s squadron, it appears that both Kempenfelt and Howe were joined from time to time by additional ships, which might have carried an atmosphere of influenza with them[788]. Still, it was an influenza atmosphere that they had carried, and not merely so many sick persons. The doctrine of contagion from person to person would have to be so widened as to become meaningless, if all those experiences of the fleet in 1782 were to be brought within it. In the history both of sweating sickness and of influenza, there are instances of the disease breaking out suddenly in a place after someone’s arrival; but the new arrival may not have had the disease, it was enough that he came from a place where the disease was[789]. That was, perhaps, the reason why Beddoes, in his inquiry of 1803, framed one of his questions so as to elicit information about the dispersal of influenza byfomites.

It is not easy to prove that a ship may meet with an atmosphere of influenza on the high seas; but many have believed that ships have done so. Webster says: “The disease invades seamen on the ocean in the same [western] hemisphere, when a hundred leagues from land, at the same time that it invades people on shore. Of this I have certain evidence from the testimony of American captains of vessels, who have been on their passage from the continent to the West India Islands during the prevalence of this disease[790].” There are several instances of this, authenticated with times, places, and other data of credibility.

The best known of these is the voyage of the East Indiaman ‘Asia’ in September, 1780, through the China Sea from Malacca to Canton: “When the ship left Malacca, there was no epidemic disease in the place; when it arrived at Canton it was found that at the very time when they had theInfluenzaon board the Atlas (sic) in the China seas, it had raged at Canton with as much violence as it did in London in June, 1782, and with the very same symptoms[791].”

In the present century, the cases nearly all come from the medical reports of the navies of Great Britain, France, Germany and the Netherlands, and they relate to ships on foreign service—in the East Indies, the Pacific, Africa, or other foreign stations. In some of the instances influenza went through a ship’s company in port or in a roadstead, others are examples of outbreaks at sea:

1837: “The ship’s company of the ‘Raleigh,’ were attacked by epidemic catarrh—influenza—first in March, while at sea between Singapore and Manilla, and again, although less severely, in June and July while on the coast of China.... Influenza also made its appearance amongst the crew of the ‘Zebra’ in April while she lay at Penang; it was supposed to have been contracted by infection from the people on shore, as they were then suffering from it. No death occurred under this head[792].”1838: In the ‘Rattlesnake,’ at Diamond Harbour, in the Hooghly River, a large proportion of the men were suffering from epidemic catarrh. Intermittent fever made its appearance; “the change from the catarrhal to the febrile form was sudden and complete, the one entirely superseding the other[793].”1842: In the ‘Agincourt’ on a voyage from the Cape of Good Hope to Hongkong in August and September, the greater part of 102 cases of catarrh occurred; many of these were accompanied with inflammation of tonsils and fauces, and in some there was deafness with discharge from the ear. This is not claimed as an instance of epidemic influenza, but as an aggregate of common colds, due to cold weather in the Southern Ocean and to wet decks[794].1857: “Influenza broke out in the ‘Monarch’ while at sea, on the passage from Payta [extreme north of Peru] to Valparaiso. She left the former place on the 23d August, and arrived at the latter on the last day of September. About the 12th of the month [twenty days out], the wind suddenly changed to the south-west, when nearly every person in the ship began to complain of cold, although the thermometer did not show any marked change in the temperature. On the 12th and 13th seven patients were placed on the sick list with catarrhal symptoms; and during the following ten days, upwards of eighty more were added, but by the end of the month the attacks ceased. [She carried 690 men, and had 191 cases of “influenza and catarrh,” in the year 1857.] Some of the cases were severe, ending either in slight bronchitis or pneumonia, accompanied with great prostration of the vital powers. On the arrival of the ship at Valparaiso, the surgeon observes: ‘We found the place healthy, but in the course of a few days some cases of influenza made their appearance, and very soon afterwards the disease extended over the whole town. It was generally believed that we imported it, and the authorities took the trouble to send on board a medical officer to investigate the matter.’ He further observes that the whole coast, from Vancouver’s Island southward to Valparaiso was visited by the epidemic.” It made its appearance on board the ‘Satellite’ at Vancouver’s Island in September, and among the residents ashore, both on the island and mainland, at the same time[795].1857: Catarrh “assumed the form of influenza in the ‘Arachne’ [149 men, 114 cases] while the vessel was cruizing off the coast of Cuba, with which, however, she had no communication. There was nothing in the state of the atmosphere to attract special attention. A question therefore arises whether it might not have been caused by infection wafted from the shore.” It was prevalent at the time at Havana[796].1857: “Australian Station:—An eruption of epidemic catarrh occurred in the ‘Juno’ [200 men, 131 cases], but long after she left the station[797].”Whilst the influenza was on the American Pacific coast in September, 1857, it was on the coast of China three months earlier—on board the ‘Inflexible’ at Hongkong on the 18th of May, and in the ‘Amethyst’ and ‘Niger’ in a creek near Hongkong early in June[798]. But it had been on the Pacific coast of South America the year before, according to the following:“1856: Epidemic catarrh broke out in the ‘President’ when lying off the island of San Lorenzo in the bay of Callao, first on the 20th October, and the last cases were placed on the sick list on 1st November,—the usual period which influenza takes to pass through a frigate ship’s company. About sixty required to be placed on the sick list.” It had occurred on board English ships of war at Rio de Janeiro, on the other side of the continent, some two months before, in August, 1856[799].1863: The following, in the experience of the French navy, has been elaborately recorded[800]: The frigate ‘Duguay-Trouin’ left Gorée, Senegambia, for Brest, in February. There were no cases of influenza in Gorée when she left; but four days out, an epidemic of influenza began on board, the weather being fine and the temperature genial at the time. Another French frigate, which had left Gorée, on the same voyage to Brest, two days earlier, did not have a single case.

1838: In the ‘Rattlesnake,’ at Diamond Harbour, in the Hooghly River, a large proportion of the men were suffering from epidemic catarrh. Intermittent fever made its appearance; “the change from the catarrhal to the febrile form was sudden and complete, the one entirely superseding the other[793].”

1842: In the ‘Agincourt’ on a voyage from the Cape of Good Hope to Hongkong in August and September, the greater part of 102 cases of catarrh occurred; many of these were accompanied with inflammation of tonsils and fauces, and in some there was deafness with discharge from the ear. This is not claimed as an instance of epidemic influenza, but as an aggregate of common colds, due to cold weather in the Southern Ocean and to wet decks[794].

1857: “Influenza broke out in the ‘Monarch’ while at sea, on the passage from Payta [extreme north of Peru] to Valparaiso. She left the former place on the 23d August, and arrived at the latter on the last day of September. About the 12th of the month [twenty days out], the wind suddenly changed to the south-west, when nearly every person in the ship began to complain of cold, although the thermometer did not show any marked change in the temperature. On the 12th and 13th seven patients were placed on the sick list with catarrhal symptoms; and during the following ten days, upwards of eighty more were added, but by the end of the month the attacks ceased. [She carried 690 men, and had 191 cases of “influenza and catarrh,” in the year 1857.] Some of the cases were severe, ending either in slight bronchitis or pneumonia, accompanied with great prostration of the vital powers. On the arrival of the ship at Valparaiso, the surgeon observes: ‘We found the place healthy, but in the course of a few days some cases of influenza made their appearance, and very soon afterwards the disease extended over the whole town. It was generally believed that we imported it, and the authorities took the trouble to send on board a medical officer to investigate the matter.’ He further observes that the whole coast, from Vancouver’s Island southward to Valparaiso was visited by the epidemic.” It made its appearance on board the ‘Satellite’ at Vancouver’s Island in September, and among the residents ashore, both on the island and mainland, at the same time[795].

1857: Catarrh “assumed the form of influenza in the ‘Arachne’ [149 men, 114 cases] while the vessel was cruizing off the coast of Cuba, with which, however, she had no communication. There was nothing in the state of the atmosphere to attract special attention. A question therefore arises whether it might not have been caused by infection wafted from the shore.” It was prevalent at the time at Havana[796].

1857: “Australian Station:—An eruption of epidemic catarrh occurred in the ‘Juno’ [200 men, 131 cases], but long after she left the station[797].”

Whilst the influenza was on the American Pacific coast in September, 1857, it was on the coast of China three months earlier—on board the ‘Inflexible’ at Hongkong on the 18th of May, and in the ‘Amethyst’ and ‘Niger’ in a creek near Hongkong early in June[798]. But it had been on the Pacific coast of South America the year before, according to the following:

“1856: Epidemic catarrh broke out in the ‘President’ when lying off the island of San Lorenzo in the bay of Callao, first on the 20th October, and the last cases were placed on the sick list on 1st November,—the usual period which influenza takes to pass through a frigate ship’s company. About sixty required to be placed on the sick list.” It had occurred on board English ships of war at Rio de Janeiro, on the other side of the continent, some two months before, in August, 1856[799].

1863: The following, in the experience of the French navy, has been elaborately recorded[800]: The frigate ‘Duguay-Trouin’ left Gorée, Senegambia, for Brest, in February. There were no cases of influenza in Gorée when she left; but four days out, an epidemic of influenza began on board, the weather being fine and the temperature genial at the time. Another French frigate, which had left Gorée, on the same voyage to Brest, two days earlier, did not have a single case.

The following instance, here published for the first time, belongs to the most recent pandemics of influenza, 1890-93. Itrelates to only a single case of influenza, in the captain of a merchantship; it would have been a more satisfactory piece of evidence, if there had been several cases in the ship; but among the comparatively small crew of a merchantman, the same groups of cases are not to be looked for that we find on board crowded men of war; and in this particular case the only other occupants of the quarter-deck were the first mate and the steward.

The ship ‘Wellington,’ sailed from the Thames, for Lyttelton, New Zealand, on the 19th December, 1891. The epidemic of influenza in London in that year had been in May, June and July; the mate of the ‘Wellington’ had had an attack of it ashore, on that occasion, but not the captain nor the steward. On the 2nd of March, 1892, when seventy-four days out and in latitude 42° S., longitude 63 E., near Kerguelen’s Land, the captain began to have lumbago and bilious headaches, for which he took several doses of mercurial purgative followed by saline draughts. The treatment at length brought on continual purging, which, together with three days’ starving from the 22nd to the 24th of March, caused him a loss of weight of eight pounds. The navigation had meanwhile been somewhat difficult and anxious, owing to a long spell of easterly head winds. Quite suddenly, on the 26th March, when the ship was in latitude 44 S., longitude 145 E., or about two hundred miles to the south of Tasmania, he had an aguish shake followed by prolonged febrile heat, which sent him to his berth. The symptoms were acute from the 26th to the 30th March,—intense pain through and through the head, as if it were being screwed tight in an iron casing, pain behind the eyeballs, a perception of yellow colour in the eyes when shut, a feeling of soreness all over the body, which he set down at the time to his uneasy berth while the ship was ploughing through the seas at about twelve knots, and a pulse of 110. The head pains were by far the worst symptom, and were so unbearable as to make the patient desperate. This acute state lasted for four days, and suddenly disappeared leaving great prostration behind. The captain, who had long experience with crews and passengers, and a considerable amateur knowledge of medicine, summed up his illness as a bilious attack, passing into “ague” with “neuralgia of the head.” While the acute attack lasted the ship had covered the distance from Tasmania to the southern end of New Zealand, and on the 31st of March the captain by an effort came on deck to navigate the vessel in stormy weather up the coast to Lyttelton, which was reached on the 2nd of April. The pilot coming on board found the captain ill in his berth, and on being told the symptoms, at once said, “It is the influenza: I have just had it myself.” The doctor who was sent for found the captain “talking foolishly,” as he afterwards told him, and had him removed to the convalescent home at Christchurch, where he remained a fortnight slowly regaining strength. The doctor[801]could find no other name for the illness but influenza, although he had not supposed such a thing possible in mid-ocean. They had just passed through an epidemic of it in New Zealand, and it is reported about the same time in New South Wales, afterwards in the Tonga group, and still later in the summer in Peru. The symptoms of this case are sufficiently distinctive: the intense constricting pain of the head is exactly the “fierro chuto” or “iron cap” of South American epidemics; the pain in the eyeballs, the soreness of the limbs and body, and the unparalleled depression and despair, are the marks of influenza without catarrh. Thepatient was of abstemious habits, and had made the same voyage year after year for a long period without any illness that he could recall. He had reduced himself by purging and starving, on account of a bilious attack during a fortnight of foul winds from the eastward, and had doubtless become peculiarly susceptible of the influenza miasm before the ship came into the longitude of Tasmania on the 26th March.

The full and correct theory of influenza will not be reached by the great pandemics only. On the other hand some very localized epidemics may prove to be signal instances for the pathology, although they do not bear upon the source of the great historic waves of influenza. The instances in view are the influenzas started among a remote community on the arrival of strangers in their ordinary health. This phenomenon has been known at the island of St Kilda, in the Outer Hebrides of Scotland, since the year 1716, when it was recorded in the second edition of an essay upon the island by Martin. Some thought these “strangers’ colds” mythical, so much so that Aulay Macaulay, in preparing a work upon St Kilda, was advised to leave them out; he declined to do so, and Dr Johnson commended him for his magnanimity in recording this marvel of nature. There is now no doubt about the fact. H.M.S. ‘Porcupine’ visited the island in 1860; a day or two after she sailed again, the entire population, some 200 souls, were afflicted with “the trouble,” and another visitor, who landed ten days after the ‘Porcupine’s’ visit, saw the epidemic of influenza in progress. The same thing happened in 1876, on the occasion of the factor landing, and again in 1877 on the occasion of a crew coming ashore from a wrecked Austrian ship. A medical account of this epidemic catarrh was given in 1886: The patient complains of a feeling of tightness, oppression and soreness of the chest, lassitude in some cases, pains in the back and limbs, with general discomfort and lowness of spirits. In severe cases there is marked fever, and great prostration. A cough ensues, at first dry, then attended with expectoration, which may go on for weeks[802].

In the remote island of Tristan d’Acunha, in the South Atlantic midway between the River Plate and the Cape of Good Hope, the same thing happens “invariably” on the arrivalof a vessel from St Helena[803]. It is reported also as a common phenomenon of the island of Wharekauri, of the Chatham Group, about 480 miles to the eastward of New Zealand. Residents, both white and coloured, suddenly fall into an illness, one symptom of which is that they feel “intensely miserable.” It lasts acutely for about four days, and gradually declines. It resembles influenza in all respects, and is known by the name ofmurri-murri, which is curiously like the old English name ofmureormurre. “The mere appearance of murri-murri is proof to the inhabitants, even at distant parts of the island, which is thirty miles long, that a ship is in port, insomuch that, on no other evidence, people have actually ridden off to Waitangi to fetch their letters[804].”

About equally distant in the Pacific from Brisbane, as Wharekauri from Christchurch, lies Norfolk Island, originally colonized by the mutineers of the ‘Bounty.’ A writer in a newspaper says:

“During a seven years’ residence in Norfolk Island, I had opportunities of verifying the popular local tradition that the arrival of a vessel was almost invariably accompanied by an epidemic of influenza among the inhabitants of the island. In spite of the apparent remoteness of cause and effect, the connexion had so strongly impressed itself on the mind of the Norfolk Islanders that they were in the habit of distinguishing the successive outbreaks by the name of the vessel during whose visit it had occurred[805].”

Something similar has long been known in connexion with the Danish trade to Iceland, the first spring arrivals from the mother country bringing with them an influenza which the crews did not suffer from during the voyage, nor, in most cases, during the progress of the epidemic in Reikjavik. The experience at Thorshaven, in the Faröe Islands, has been the same[806].

These are important indications for the pathology of influenza in general. They point to its inclusion in that strange class of infections which fall most upon a population, or upon those orders of a population, who are the least likely to breed disease by anything that they do or leave undone. Veterinary as wellas human pathology presents instances of the kind[807]. In seeking for the source of such an infectious principle, we are not to look for previous cases of the identical disease, but for something else of which it had been an emanation or derivative or equivalent, something which may have amounted to no more than a disparity of physical condition or a difference of race. And as the countries of the globe present now as formerly contrasts of civilized and barbarous, nomade and settled, rude and refined, antiquated and modern, with the aboriginal varieties of race, it may be said, in this theory of infection, that mere juxtaposition has its risks. But, in the theory of influenza, the first requisite is an explanation of its phenomenal uprisings and wave-like propagation, at longer or shorter intervals, during a period of many centuries.

SMALLPOX.

The history of smallpox in Britain is that of a disease coming gradually into prominence and hardly attaining a leading place until the reign of James I. In this respect it is unlike plague and sweating sickness, both of which burst upon the country in their full strength, just as both made their last show in epidemics which were as severe as any in their history. In the former volume of this work I have shown that smallpox in the first Tudor reigns was usually coupled with measles, that in the Elizabethan period the Latin namevariolaewas rendered by measles, and that smallpox, where distinguished from measles, was not reputed a very serious malady[808]. From the beginning of the Stuart period, smallpox is mentioned in letters, especially from London, in such a way as to give the impression of something which, if not new, was much more formidable than before; and that impression is deepened by all that is known of the disease later in the 17th century, including the rising figures in the London bills of mortality.

An early notice of a particular outbreak of smallpox is found in the Kirk Session records of Aberdeen in 1610, under the date of 12 August: “There was at this time a great visitation of the young children with the plague of the pocks[809].”In 1612 there are various references to deaths from smallpox in London in rich houses. In 1613, the Lord Harrington, who is said in a letter of Dr Donne’s to be suffering from “the pox and measles mingled,” died of smallpox (probably haemorrhagic) on the Sunday before 3 March, at which date also the Lady Burghley and two of her daughters were sick of the same disease. Those two years were probably an epidemic period. Another epidemic is known from a letter of December, 1621: “The smallpox brake out again in divers places, for all the last hard winter and cool summer, and hitherto we have had no sultry summer nor warm winter that might invite them. The Lord Dudley’s eldest son is lately dead of them, and the young Lady Mordaunt is now sick.” On 28 January, 1623, “the speech that the smallpox be very rife there [Newmarket] will not hinder his [James I.’s] journey.” The years 1623 and 1624 were far more disastrous by the spotted fever all over England; but smallpox attended the typhus epidemic, as it often did in later experience, the two together having “taken away many of good sort as well as mean people.”

The first epidemic of smallpox in London, from which some figures of the weekly mortalities have come down, was in 1628: this was the year before the Parish Clerks began to print their annual bills, but they had kept the returns regularly since 1604, and appear to have made known in one way or another the weekly mortality and the chief diseases contributing thereto. The smallpox deaths in London in the week ending 24 May, 1628, were forty-one, in the following week thirty-eight, and in the third week of June fifty-eight[810]. Such weekly mortalities in a population of about 300,000 belong to an epidemic of the first degree; and it is clear from letters of the time that the London smallpox of 1628 made a great impression. Lord Dorchester, in a letter of 30 August, calls it “the popular disease[811].” Several letters relating to a fatal case of smallpox in June in the house of Sir John Coke in the city (Garlick Hill) bear witness to the dread of contagion through all that circle of society[812]. One of the letters may be cited:

“It pleased God to visit Mrs Ellweys [Coke’s stepdaughter] with such a disease that neither she nor any other of her nearest and dearest friends durst come near her, unless they would hazard their own health. The children and almost all our family were sent to Tottenham before she fell sick, and blessed be God are all in health. Mrs Ellweys was sick with us of the smallpox twelve days or thereabouts.” Before she was out of the smallpox, she was taken in labour on 15 June, and died the next morning at five o’clock, being buried the same night at ten, with only Sir Robert Lee and his lady of her kindred at the funeral. The letter proceeds: “God knows we have been sequestered from many of our friends’ company, who came not near us for fear of infection, and indeed we were very circumspect, careful, and unwilling that any should come to us to impair their health.” Lady Coke was fearful to go to Tottenham because of the children who had been removed thither.

All the indications, whether from letters of the time, from poems and plays, or from statistics, point to the two first Stuart reigns as the period when smallpox became an alarming disease in London among adults and in the upper class. The reference to smallpox at Aberdeen in 1610 is to the disease among children; and so also is an unique entry, opposite the year 1636, on the margin of the register of Trinity parish, Chester: “For this two or three years, divers children died of smallpox in Chester[813].” In London, the disease had not yet settled down to that steady prevalence from year to year which characterized it after the Restoration. On the other hand, the periodic epidemics were very severe while they lasted. The epidemic of 1628 was followed by three years of very slight smallpox mortality in London; then came a moderate epidemic in 1632 and a severe one in 1634, with again two or more years of comparative immunity, as in the following table from the earliest annual printed bills:

Smallpox deaths in London, 1629-36[814].

For the next ten years, 1637-46, the London figures are lost[815], excepting the plague-deaths and the totals of deaths from all causes, but it is known from letters that there was a great epidemic of smallpox in one of them, the year 1641: the deaths were 118 in the week ending 26 August, and 101 in the week ending 9 September[816], totals seldom reached a century later, when the population had nearly doubled. In those weeks of 1641, it was second only to the plague as a cause of dread, and was, along with the latter, the reason that “both Houses grow thin,” for all the political excitement of the time. The next London epidemic was in 1649, when the annual bill gives 1190 deaths from smallpox. Willis says that the epidemic was also at Oxford that year, not so very extensive, “yet most died of it” owing to the severe type of the disease[817]. Five years after, in 1654, “at Oxford, about autumn, the smallpox spread abundantly, yet very many escaped with them.” The London deaths from smallpox for a series of years were as follows:

The period which must now concern us particularly, from the Restoration onwards, opens with two deaths from smallpox in the royal family within a few months of the return of theStuarts. When Charles II. left the Hague on 23 May, 1660, to assume the English crown, his two brothers, the Duke of York and the Duke of Gloucester, accompanied him in the fleet. In the first days of September, the Duke of Gloucester was seized at Whitehall with an illness of which various accounts are given in letters of the time[818]. On 4 September, “the duke hath been very sick, and ’tis thought he will have the smallpox.” On the 8th “the doctors say it is a disease between the smallpox and the measles; he is now past danger of death for this bout, as the doctors say”; or, by another account, “the smallpox come out full and kindly, and ’tis thought the worst is past.” On the 11th the duke is “in good condition for one that has the smallpox.” But a day or two afterwards his symptoms took an unfavourable turn; the doctors left him, apparently with a good prognosis, one evening at six o’clock, but shortly after he bled at the nose three or four ounces, then fell asleep, and on awaking passed into an unconscious state, in which he died. When his body was opened, the lungs were full of blood, “besides three or four pints that lay about them, and much blood in his head, which took away his sense.” Pepys says his death was put down to the great negligence of the doctors; and if we can trust a news-letter of the time, their negligence was such as would have been now approved, for “the physicians never gave him anything from first to last, so well was he in appearance to everyone[819].” Three days after his funeral, the king and the Duke of York went to Margate to meet their sister, the princess Mary of Orange, on her arrival from the Hague. Her visit to the Court extended into the winter, and about the middle of December she also took smallpox, of which she died on the 21st. Pepys, dining with Lady Sandwich, heard that “much fault was laid upon Dr Frazer and the rest of the doctors for the death of the princess.” Her sister, the princess Henrietta, who had come on a visit to Whitehall with the Queen-mother in October, was removed to St James’s on 21st December, “for fear of the smallpox”; but she must have been already sickening, for on the 16th January it is reported that she “is recovered of the measles.”

These deaths at Whitehall of a brother and sister of Charles II. happened in the autumn and winter of 1660; butit was not until next year that the smallpox rose to epidemic height in London, the deaths from it having been only 354 in 1660, rising to 1246 in 1661, and 768 in 1662. In 1661 it appears to have been epidemic in other parts of England: Willis, who was then at Oxford, says that smallpox began to rage severely before the summer solstice (adding that it was “a distemper rarely epidemical”), and there are letters from a squire’s wife in Rutlandshire to her husband in London, which speak of the disease raging in their village in May and June[820].

There was much fever of a fatal type in London in 1661, which is more noticed than smallpox itself in the diary of Pepys. The town was in a very unhealthy state; and it would have been in accordance with all later experience if the “pestilential constitution” of fevers, which continued more or less until the plague burst forth in 1665, had been accompanied by much fatal smallpox. The occasion was used by two medical writers to remark upon the fatality of smallpox as something new. The second of the two essays (1663), was anonymous, and bore the significant title ofHactenus Inaudita, the hitherto unheard of thing being that smallpox should prove so fatal as it had been lately. The author adopts the dictum of Mercurialis, with which, he says, most men agree: “Smallpox and measles are wont for the most part to terminate favourably”; and he makes it clear in the following passage that the blame of recent fatalities was laid, justly or unjustly, at the door of the doctors, as, indeed, we know that it was from the gossip of Pepys:

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