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In 1846 and 1847 a slight epidemic occurred in London, Paris, Nancy and Geneva. In France during the last week of 1857, and extending into January and February, 1858, there was a mild epidemic. During this period there alternated frequent frosts with soft weather, misty and humid. Among the numerous small epidemics between 1837 and 1889, one occurred on the continent of Europe in 1860, but little of value or interest was noted. In Paris in March, after great and sharp variations in temperature, a series of epidemics extended from 1870 to 1875. These were unimportant. Atmospheric modifications occupied first rank in the minds of some as a cause for the outbreaks. Rapid changes from hot to cold or from cold to hot were given weight. Other undetermined modifications of conditions were probably important.

In a recent article published by Loy McAfee (J. A. M. A., 1917, 72, 445) he discussed the confusion which existed between the diagnosis of cerebro-spinal meningitis and epidemic influenza in 1863. These were believed the same by some—that is, the same disease of varying degree. There was a great diversity of opinion among clinicians at this time, and the American Medical Association appointed a committee to make an investigation. McAfee quotes from the Medical and Surgical History of the War of the Rebellion that in 1861 and 1862 an epidemic existed among the troops called epidemic catarrh, which was afterward changed to read acute bronchitis. In September, 1861, there existed an epidemic of influenza in one of the regiments which lasted more than two weeks, and in another camp there was a similar epidemic at the same time. It is stated that there were in all 168,715 cases among the white troops, with a mortality of 650, and 22,648 among the negro troops, with a mortality of 255, making about 4 per thousand, and over 11 per thousand, respectively.