The Influenzas of Remote Islands.
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 arrival of 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 of murri-murri, which is curiously like the old English name of mure or murre. “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 well as 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.
CHAPTER IV.
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 name variolae was 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].
| Year | Smallpox deaths | Deaths from all causes | ||
| 1629 | 72 | 8771 | ||
| 1630 | 40 | 10554 | ||
| 1631 | 58 | 8532 | ||
| 1632 | 531 | 9535 | ||
| 1633 | 72 | 8393 | ||
| 1634 | 1354 | 10400 | ||
| 1635 | 293 | 10651 | ||
| 1636 | 127 | 23359 |
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:
| Year | Smallpox deaths | |
| 1647 | 139 | |
| 1648 | 401 | |
| 1649 | 1190 | |
| 1650 | 184 | |
| 1651 | 525 | |
| 1652 | 1279 | |
| 1653 | 139 | |
| 1654 | 832 | |
| 1655 | 1294 | |
| 1656 | 823 | |
| 1657 | 835 | |
| 1658 | 409 | |
| 1659 | 1523 | |
| 1660 | 354 | |
| 1661 | 1246 |