The Influenza of 1833.

The next year, 1832, which was the first great season of Asiatic cholera in Britain, is absolutely free from records of influenza in all Europe. It was in the spring of the year following, 1833, that the really serious influenza came. The continental literature of the epidemic of 1833 is immense, the English literature of it is all but non-existent: and yet it was a very severe influenza with us, just as with other European peoples. There was no collective inquiry in Britain on this occasion, such as had been made first by Fothergill in 1775, by the College of Physicians and another Society in 1782, by Simmons in 1788, and by Beddoes and the Medical Society of London in 1803, or such as was made in the next influenza, that of 1837, by a committee of the Provincial Medical Association. But enough is known of it to place it among the severer influenzas. In London the bills of mortality, which relate only to a part of London, showed the characteristic sudden rise and fall:

Baptisms Burials
Fourweeks,20 Feb. to 16 March 2310 2352
Five"17 March to 23 April 1955 2105
Four"24 April to 21 May 2016 3350
Four"22 May to 18 June 2070 1685

For a whole month the burials in London were nearly doubled, and for the two worst weeks they were nearly quadrupled. This mortality, by all accounts, fell most on the richer classes, to whom it was a much more serious calamity than the Asiatic cholera of the year before. The president of the Medical Society said, on the 22nd April, that he had “heard of nine lords or ladies who had been carried off by it or by its indirect agency, in the course of last week[716].” Its type in the month of May was worse than in April[717]. When it was first seen it was a somewhat short catarrhal attack, ending in a sweat after two, three or four days, with the usual head-pains, soreness of the ribs and limbs, languor and prostration. Later, it became a more “adynamic” illness, beginning indeed with slight catarrhal symptoms, but soon passing into subacute nervous fever which might last for three weeks, involving much risk to life[718]. Hence arose the warnings, just as in 1890-92, that the influenza was a much more serious thing than it had been thought when the epidemic began, and hence the delay, as it were, in the bills of mortality to show the effects of the epidemic until it had been two or three weeks prevalent. It is to the month of April, before the highest death-rate was reached in London, that the following, in the Gentleman’s Magazine, applies[719]:

“During the month a severe form of catarrhal epidemic, generally termed influenza, has been extremely prevalent in London. It has laid up at once all the members of many large households, and has attacked great numbers in several public offices, particularly the Bank of England and some divisions of the new police. The performers at the theatres have much suffered, and their houses have been closed for several nights. It commences suddenly with headache and feeling of general discomfort, attended or soon followed by cough, hoarseness, or loss of voice; oppression, and sometimes severe pain in the chest, tenderness about the ribs, and sense of having been bruised about the limbs or muscles.... The disease is generally attributed to the constant north-east winds; but by some of the learned is regarded as the epidemic influenza which has lately prevailed in the eastern parts of Europe, and that is travelling, like many of its predecessors, to the west.”

It would have been in this earlier stage of the epidemic, when it was laying up whole households, thinning workshops and closing theatres, that a practitioner was heard to say (as reported by the Lancet): “Best thing I ever had! Quite a godsend! Everybody ill, nobody dying!” The seriousness of the disease was, however, at length recognized, so that the members of the Medical Society debated the subject at three successive meetings. One of the questions was, whether the malady called for blooding—a question that had divided opinion as long ago as 1658[720]. On 13 May, the following passed at the Medical Society:

Mr Williams remembered the similar influenza of 1803, and said that depletion was then regarded as an injurious plan of treatment.

Mr Proctor:—Yes, but the Brunonian doctrines were then in full fling, and practitioners had not learned the full use of the lancet.

Graves states very fairly the reasons that induced them to take blood in the influenza of 1833, as well as the results of the practice[721]:

“The sudden manner in which the disease came on, the great heat of skin, acceleration of pulse, and the intolerable violence of the headache,—together with the oppression of the chest, cough, and wheezing—all encouraged us to the employment of the most active modes of depletion; and yet the result was but little answerable to our expectations; for these means were found to induce an awful prostration of strength, with little or no alleviation of the symptoms.”

The prostration, be it said, was probably as great and as frequent in the epidemics of 1890-93, when bleeding had gone out altogether; still it was not understood that all these signs of sthenic action in the attack were really paradoxical, as Whitmore, in the passage cited in the note, saw clearly two centuries before.

The epidemic became rapidly prevalent all over England, Scotland and Ireland in April and May, following no very definite order of progression. The Liverpool newspapers asserted that ten thousand were down with it in that town in one week. A doctor at Lincoln wrote, on 13 May, that few families there had escaped it[722]. Other towns in which it is said to have been “more or less” prevalent were Portsmouth, Sheffield, Birmingham, Leeds, York, Halifax, Glasgow, Edinburgh[723], Dublin and Armagh; so that we may fairly assume, although we are without the detailed evidence available for earlier epidemics, that it was ubiquitous in town and country.

At Birmingham[724], among the outpatients of the Infirmary, the cases of influenza were as follows, the 25th and 26th April being the days when cases came first in rapid succession, while the middle of May was practically the limit:

Cases of
Influenza		 Males Females
April 151 52 99
May 464 159 305
June 28 9 19
643 220 423

The great excess of females is remarkable, but was probably due to some local circumstances. Of the 643 cases, 122 were under ten years of age. Of the females, 9 died, of the males 3. But the deaths in Birmingham caused by the epidemic directly or indirectly were many; the burial registers of four churches and chapels showed a marked increase of burials above those of the corresponding months of 1832:

1832 1833
April 205 245
May 211 434
June 193 230
609 909

Medical opinion in 1833 was decidedly adverse to the contagiousness of influenza. The common remark was that it was just as little contagious as the cholera of the year before had proved to be. As in 1837 and 1847, when the doctrine of contagiousness was equally out of favour, the disease was observed to spread rapidly, in no very definite line, affecting most parts of the country in the same two or three weeks, affecting the population within a considerable radius almost at once, and the inmates of houses all together. These, it was said, are not the marks of a disease that persons hand on one to another, quasi cursores.