HISTORY of INFLUENZA EPIDEMICS* by JOHN F
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HISTORY OF INFLUENZA EPIDEMICS* By JOHN F. TOWNSEND, M.D. CHARLESTON, S. C. N tracing the history of the etiol- was “a gaseous emanation of telluric ogy of influenza one finds much of origin”19; and later it was thought to interest. For one can thus visualize be some volatile or fixed principle the history of the etiology of emanating from the bodies of men disease in general; from the belief inand animals.20 Baron de Tott claimed Iancient times of its origin in some immunity from these emanations by impending fate or superstitious dread, directing, with his cane, the removal on through the intervening stages to of the bodies that had died of the the more modern ideas of errors of plague in Constantinople.20 sanitation and infection by bacteria, In 1411 the French physicians for claimed that the cause was a contagion . the ravages of epidemics like the de Pair, in 1414a contagion de le bise or great cataclysms of nature have in all north wind.19 This epidemic and the ages appealed to the imagination and one of 1427 were supposed to be air- excited the terror of mankind. To the borne. simple savage of the earlier generations, as Dr. Johnson quotes Van Swieten among the savage tribes of the present who calls it “a malignant catarrh that day, an obvious similarity must exist arose as it were from a certain vapor, between the havoc wrought by the fury since thick clouds of an ill smell of the elements—and that no less fatal— preceded it for some days, then it accomplished by the sudden outbreak of suddenly broke out seizing almost some malignant disease spreading with instantly a thousand persons.”20 This inconceivable rapidity and making count- description resembles the disease that less victims. Earthquake and pestilence, meteors, recently occurred from some ill-smell- volcanic eruptions and storms being alike ing gas of unknown origin. It was abnormal and mysterious occurrences, called nebelsouch or fog plague in the direct intervention of some super- 1889-90, when the fog was supposed to natural agencies were deemed requisite to have caused many deaths.19 account for their apparent deviations Hildanus, becoming more concrete, from the settled order of the universe; all supposed that the cause of the Plague were attributed to the anger of an at Lausanne and the neighboring offended diety, as when Zeus, for an insult districts was not only a contagion, but to his priest, by his thunder, sent sickness also some vicious quality of the air, into the Argive camp. which travelled from the sick to the On mules and dogs the infection first began well “sitting near.”20 In the monthly And last the vengeful arrows fix’d in man. report of the Paris Faculty of Medi- As knowledge increased the medical cine in 1658 we find a paragraph men of ancient days assumed other stating that the disease was due to causes of influenza. Some held the “les variations de I’atmosphere.” In cause to be a morbid miasma that Italy, at the same time, the same floats in the air,20 others held that it view was held. The theory of its * Read before the Medical History Club, Charleston, S. C., October, 1931. causation from temperature variations contagion, as opposed to the miasma- received further support from Spren- tic cause, was clearly defined by gel, who, writing of the epidemics of Hay garth.4 1742 and of 1782, said that influenza Dr. Johnson, writing of the 1793 was due to a “sudden change from epidemic, gives instances of influenza sudden heat followed by sudden cold,” occurring on vessels that had left a while Muncio, writing of the 1762 healthy port with a healthy crew, and epidemic, expressed the same thought, weeks later had influenza break out. when he said that it was caused by He says that while the warship Atlas sudden cold followed by sudden heat.19 was in the China Sea influenza broke The chemical composition of the out on board ship, and that it was later air was again advocated as a cause in found to have started in Canton, 1742, when influenza was said to be China, at the same time. But as an due to a phlogistic gas, over-stimulat- argument against the theory of con- ing the weakened body, producing a tagion, he gives reports of influenza catarrh. And, when the chemistry of breaking out in isolated, widely sepa- the air was still better known, Most, in rated huts in the mountains with no 1820, becoming more specific, claimed communication between them. This that influenza was due to an excess of fact, and the instance of the warship oxygen in the air.19 Atlas, may lead one to believe in the But a real advance in the contagious Epidemic Constitution, which idea theory was made in 1762, when the will be developed later. disease was traced to people coming We find that in 1782 the Medical from infected areas; and in 1782, to Council of Vienna declared that influ- persons, clothing and articles coming enza was caused by persons inhaling from infected districts. It was then air-borne or swallowing water-borne said “that it began in a town or city insects.19 The name la grippe was also and spread to the neighboring villages; said to refer to insects, which by con- that both on land and sea isolated taminating the air were supposed to imported cases invariably preceded cause the influenza. The same, with the general outbreak,” thus bringing respect to insects, has been said of forward prominently the contagious dengue.4 cause. From early ages, in 1529, food And so it went, miasma or conta- poisoning has been blamed as the gion, contagion or miasma, but actually cause of some of the manifestations of the miasmatists were hard pressed to influenza, as in Germany it has been explain the transference of influenza said to have been caused by eating observed clinically, and the contagion fish. In 1752 Swabian sausages were advocates were equally hard pressed thought to be the cause; or it was when confronted with records of whole thought to be due to ergot, causing communities succumbing in a night, Kriebelkrankheit; or to radish seed as was recently illustrated at Cape causing raphania. It was also said to Town in 1918.17 Therefore, as clini- be due to partaking of rye, peas, cians we might hold to the contagious chickens, and many other articles view, while as epidemiologists we turn of food or drink; all of which were to the miasmatic hypothesis.19 But it declared to have caused illnesses now was not until the 18th century that diagnosed as influenza, with this pecu- Iiarity, that many of the cases of food that the streptococcus in the epidem- poisoning were found to be nervous or ics was of an unstable variety, which cephalic in their symptomatology, on culture became stable; that it was “die Nervenkrankheit, as Haberkron a pleomorphic organism.9 That the in 1772 called it.” These epidemics disease is closely associated with a were also called Kreibelkrankheit pleomorphus streptococcus of the in Germany, and Raphania in pneumococcus group is now held by Sweden, Scandinavia and Russia until many; Donaldson thought that it 1800.7 belonged to type iv.3,17 The bacterial cause was, of course, This view was also held by Rajch- not understood in the early history of mann who predicted the 1918 influenza, but Seiffert in 1883 was pandemic.3,17 one of the first to study the bacteriol- Crookshank says that bacteriologi- ogy of this disease. He found a Strep- cally the pandemics of influenza are tococcus pyocyaneus to be the cause. due to some bacillus or filter-passing In the 1889 epidemic Klebs discovered virus,7 and that epidemics of special- the flagellata, while Rilbert, Vaillant ized! types are caused by association and Vincent found the cause to be a with other organisms; or that the streptococcus, but Weichselbaum, cause of the epidemic may be a pleo- Kruse, Pansini and Marmorek as- morphus coccus or some physical cribed influenza to the diplococcus of condition that actuates that pleo- pneumonia.19 morphus coccus.17 Others have held We have studied the parasites which that the prevalence, between the develop under laboratory conditions pandemics of influenza, depends upon and have held disease to be bound up some interaction between the “pri- with them. For instance, Creighton mary cause,” whatever that is, and claimed that “the bacillus influenza the various “satellite influences.” Into was the sine qua non of influenza,” this question symbiosis comes, “for but, says Hamer, “we forget that a the organism may be linked now with particular parasite may be merely one one and now with another ferment or of a series, and that it may in some enzyme. ” (Dixon.7) This doctrine may cases be replaced in that series by find application, for example, in the another parasite, and for the time connection between the tubercle bacilli being and under the local conditions of bovine or of human origin; or the in question cease to have any connec- parasite or associated parasites of tion with the disease at all. The smallpox and vaccinia; of scarlet records of epidemics suggest that some fever and diphtheria; (I have often such explanation must be looked for, seen these occur consecutively in the in order to reconcile the extraordinary same house but not necessarily in the persistence of disease types, with the same patient); of dengue and in- no less remarkable variability of the fluenza; of enteric fever and dysentery; organism to which the bacteriologist of typhus and relapsing fever.