The Influenzas of 1889-94.
More than a generation had passed with little or no word of epidemic influenza in this country, when in the early winter of 1889 the newspapers began to publish long telegrams on the influenza in Moscow, St Petersburg, Berlin, Paris, Madrid and other foreign capitals. This epidemic wave, like those immediately preceding it in the Eastern hemisphere, in 1833, 1837 and 1847, and like one or more, but by no means all, of the earlier influenzas, had an obvious course from Asiatic and European Russia towards Western Europe[747]. In due time it reached London, and produced a decided effect upon the bills of mortality for the first and second weeks of January, 1890, but a moderate effect compared with that of 1847, which was the first to be recorded under the same system of registration. It spread all over England, Scotland and Ireland in the months of January and February, 1890, proving itself everywhere a short and sharp influenza of the old kind, but with catarrhal symptoms on the whole a less constant feature than in the epidemics of most recent memory. At the end of February it looked as if Great Britain and Ireland had got off lightly from the visitation which had caused high mortalities in many countries of Continental Europe. But this epidemic in the beginning of 1890 was only the first of four, and less severe than the second and third. It returned in the spring and early summer of 1891, in the first weeks of 1892, and in the winter of 1893-94. To understand this influenza prevalence as a whole, its four great seasons should be compared. The following tables show its incidence upon London on each occasion:
Four epidemics of Influenza in London, 1890-94.
1890
| Week ending | Annual death-rate per 1000 living | Deaths from all causes | Influenza | Bronchitis | Pneumonia | ||||||
| Jan. | 4 | 28·0 | 2371 | 4 | 530 | 215 | |||||
| 11 | 32·4 | 2747 | 67 | 715 | 253 | ||||||
| 18 | 32·1 | 2720 | 127 | 630 | 281 | ||||||
| 25 | 26·3 | 2227 | 105 | 468 | 193 | ||||||
| Feb. | 1 | 21·8 | 1849 | 75 | 339 | 145 | |||||
| 8 | 20·6 | 1749 | 38 | 369 | 117 | ||||||
1891
| Week ending | Annual death-rate per 1000 living | Deaths from all causes | Influenza | Bronchitis | Pneumonia | ||||||
| April | 25 | 21·0 | 1809 | 10 | 240 | 179 | |||||
| May | 2 | 23·3 | 2006 | 37 | 280 | 241 | |||||
| 9 | 25·6 | 2069 | 148 | 302 | 230 | ||||||
| 16 | 27·7 | 2245 | 266 | 352 | 207 | ||||||
| 23 | 27·6 | 2235 | 319 | 337 | 219 | ||||||
| 30 | 28·9 | 2337 | 310 | 353 | 189 | ||||||
| June | 6 | 27·0 | 2189 | 303 | 320 | 176 | |||||
| 13 | 23·3 | 1886 | 249 | 255 | 166 | ||||||
| 20 | 23·0 | 1865 | 182 | 248 | 159 | ||||||
| 27 | 19·0 | 1538 | 117 | 151 | 113 | ||||||
| July | 4 | 16·8 | 1363 | 56 | 108 | 103 | |||||
1891-92
| Week ending | Annual death-rate per 1000 living | Deaths from all causes | Influenza | Bronchitis | Pneumonia | ||||||
| Dec. | 26 | 21·9 | 1771 | 19 | 355 | 131 | |||||
| Jan. | 2 | 42·0 | 3399 | 37 | 927 | 256 | |||||
| 9 | 32·8 | 2679 | 95 | 740 | 246 | ||||||
| 16 | 40·0 | 3271 | 271 | 867 | 285 | ||||||
| 23 | 46·0 | 3761 | 506 | 1035 | 317 | ||||||
| 30 | 41·0 | 3355 | 436 | 844 | 255 | ||||||
| Feb. | 6 | 30·6 | 2500 | 314 | 492 | 215 | |||||
| 13 | 24·6 | 2010 | 183 | 368 | 140 | ||||||
| 20 | 20·7 | 1693 | 79 | 259 | 137 | ||||||
1893-94
| Week ending | Annual death-rate per 1000 living | Deaths from all causes | Influenza | Bronchitis | Pneumonia | ||||||
| Nov. | 4 | 20·2 | 1695 | 8 | 191 | 125 | |||||
| 11 | 21·4 | 1679 | 20 | 220 | 137 | ||||||
| 18 | 24·4 | 2016 | 22 | 318 | 228 | ||||||
| 25 | 26·5 | 2190 | 36 | 384 | 215 | ||||||
| Dec. | 2 | 27·1 | 2235 | 74 | 426 | 248 | |||||
| 9 | 31·0 | 2556 | 127 | 491 | 266 | ||||||
| 16 | 29·1 | 2401 | 164 | 421 | 232 | ||||||
| 23 | 26·3 | 2170 | 147 | 387 | 203 | ||||||
| 30 | 23·3 | 1920 | 108 | 306 | 157 | ||||||
| Jan. | 6 | 24·5 | 2040 | 87 | 342 | 169 | |||||
| 13 | 29·5 | 2462 | 75 | 490 | 211 | ||||||
| 20 | 23·7 | 1975 | 69 | 320 | 172 | ||||||
| 27 | 19·8 | 1655 | 41 | 232 | 152 | ||||||
It will be seen that the third epidemic, that of Jan.-Feb. 1892, had the highest maximum weekly mortality from influenza (506) as well as the highest maxima from bronchitis and pneumonia not specially associated in the certificates with influenza; that the second epidemic, of 1891, had the next highest maxima, and that the first and last of the four outbreaks were both milder than the two intermediate ones. All but the second, which fell in early summer, are strictly comparable as regards season (mid-winter). But although the second, in 1891, had the advantage of falling in some of the healthiest weeks of the year, it was more protracted than the original outbreak, much more fatal than it in the article influenza, more fatal also in the article pneumonia, and less fatal only in the article bronchitis. The third outbreak was not only more protracted than the first, in the same season of the year, but much more fatal in all the associated articles. As to the deaths referred to influenza (whether as primary or secondary cause), the numbers are not strictly comparable in all the outbreaks; they are probably too few in the first table, more nearly exact in the second, third, and fourth, the diagnosis having at length become familiar and the fashion of nomenclature established. It is undoubted that many of the deaths from bronchitis and pneumonia in January, 1890, were due to the epidemic; for, “while the ordinary rise of mortality in cold seasons is mainly among the very aged, the increased mortality in this fatal month was mainly among persons between 20 and 60 years” (Ogle).
While the first epidemic of the series was universal and of short duration all over the kingdom, the second and third were more partial in their incidence and more desultory or prolonged. The second, which began in Hull (and at the same time on the borders of Wales), produced the following highest weekly death-rates per annum from all causes among 1000 persons living:
Highest Weekly Death-rates in the Second Influenza.
1891
| Week ending | Annual death-rate from all causes per 1000 living | ||||
| Hull | Apr. | 11 | 42·5 | ||
| Sheffield | May | 2 | 70·5 | ||
| Halifax | " | 2 | 42·1 | ||
| Leeds | " | 9 | 48·5 | ||
| Manchester | " | 9 | 43·6 | ||
| Bradford | " | 16 | 56·7 | ||
| Huddersfield | " | 16 | 54·5 | ||
| Leicester | " | 16 | 44·6 | ||
| Oldham | " | 23 | 50·4 | ||
| London | " | 30 | 28·9 | ||
| Salford | " | 30 | 45·9 | ||
| Blackburn | June | 6 | 48·5 | ||
The third was heard of first in the west of Cornwall and in the east of Scotland, in the last quarter of 1891. It was in the following English towns that it produced the maximum weekly death-rates per annum from all causes:
Highest Weekly Death-rates in the Third Influenza.
1892
| Town | Week ending | Annual death-rate from all causes per 1000 living | |||
| Portsmouth | Jan. | 16 | 57·0 | ||
| London | " | 23 | 46·0 | ||
| Norwich | " | 23 | 44·7 | ||
| Brighton | " | 23 | 60·9 | ||
| Croydon | " | 30 | 47·2 | ||
These highest death-rates in the third successive season of influenza were all in the southern or eastern counties; in the latter, Colchester also had a maximum death-rate during one week of about 80 per 1000 per annum. Liverpool, among the northern great towns, appears to have had most of the third influenza. The fourth outbreak, in the end of 1893, was noticed first in the Midlands (Birmingham especially), and was afterwards heard of in the mining and manufacturing districts of Staffordshire, South Wales, Lancashire, Yorkshire and Durham, as well as in Scotland and Ireland, London, as in the table, having a share of it. The tables given of the London mortality in each of the four outbreaks, from influenza and the chest-complaints which were its most usual secondary effects, are a fair index both of the period and of the severity of the disease all over the kingdom in each of its successive appearances[748]. Everywhere the first and the fourth were the mildest, the second and third the most fatal. Deaths from “influenza” were reported from all the counties of England and Wales in the first and second epidemics, the highest rates of mortality per 1000 inhabitants in the corresponding calendar years having been in the following counties, while in all the counties the greater fatality of the second epidemic is equally marked:
| 1890 | 1891 | ||||||
| Cumberland | ·35 | Rutland | 1·36 | ||||
| North Wales | ·28 | Lincolnshire | 1·19 | ||||
| Herefordshire | ·28 | North Wales | 1·09 | ||||
| Salop | ·28 | Westmoreland | 1·02 | ||||
| Wilts | ·28 | Monmouth | 1·00 | ||||
| Somerset | ·26 | E. Riding Yorks | ·98 | ||||
| Dorset | ·25 | Herefordshire | ·98 | ||||
| Bucks | ·25 | Northamptonshire | ·95 | ||||
In London the entry of influenza is in the weekly bills of mortality throughout the whole period, with the exception of a few weeks; but the deaths were often reduced to unity, and there was perhaps only one occasion, besides the four great outbursts, namely the months of March and April, 1893, when cases were so numerous or so close together in households or neighbourhoods as to constitute a minor epidemic.
The type of the influenza of 1890-93 was not quite the same as on the last historical occasions. When it was announced as approaching from the Continent, everyone looked for “influenza colds”; but the catarrhal symptoms, although not wanting, were soon found to be unimportant beside the nameless misery, prostration and ensuing weakness. Some, indeed, contended that the disease was not influenza but dengue, so pronounced were the symptoms of break-bone fever[749]. Many cases had a decided aguish or intermittent character. The name of ague itself was once more heard in newspaper paragraphs, and more freely used in private talk; but, as we have long ceased to write of epidemic agues, equally as of marsh intermittents, in this country, it is not probable that there will remain any record of agues in Britain accompanying the influenzas of the years 1890-94. On the other hand the complications and after-effects of our latest influenza, more especially as affecting the nervous system, have been very fully studied[750].
That which chiefly distinguishes the influenza of the end of the 19th century from all other invasions of the disease is the revival of the epidemic in three successive seasons, the first recurrence having been more fatal than the original outbreak, and the second recurrence more fatal (in London at least) than the first. The closest scrutiny of the old records, including the series of weekly bills of mortality issued by the Parish Clerks of London for nearly two hundred years, discovers no such recurrences of influenza on the great scale in successive seasons. It is true that several of the old influenzas came in the midst of sickly periods of two or more years’ duration, such as the years 1557-58, 1580-82, 1657-59, 1678-80, 1727-29 and 1780-85. But in those periods the bulk of the sickness was aguish, the somewhat definite episodes of catarrhal fever having been distinguished from the epidemic agues by Willis in 1658, by Sydenham in 1679, by several in 1729, and by Baker, among others, in 1782. It is probable, indeed, that there were two strictly catarrhal epidemics in successive years in the periods 1657-59 and 1727-29, just as we know that, in New England, there was a catarrhal epidemic in the autumn of 1789 and an equally severe influenza, less catarrhal in type, in the spring of 1790[751]. But history does not appear to supply a parallel case to the four successive influenzas in the period 1889-94, unless we count the seasonal epidemic agues of former “constitutions” as equivalent to influenzas for the purpose of making out a series.