Читать книгу Studies on Epidemic Influenza: Comprising Clinical and Laboratory Investigations онлайн

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The next great epidemic, and the last until the present, occurred in the years 1889 and 1892, and was pandemic in its nature. The death rate during this time was lower in the cities than in the country. This was probably due to the fact that the greatest mortality was among children and old people, and as old people were generally left in the country, this explains the observation. The highest number of deaths was among males, believed to be due to the exposure and fatigue of work. Forty per cent. of the world’s population was said to have been attacked during this period. The yearly or seasonal repetition, as shown in this pandemic, had occurred in other epidemics. In the great pandemic of 1889 and 1890, five decades after the last important epidemic, it was stated that the medical profession found itself confronted by a new disease of which it had knowledge through medical history, so also in our time few physicians recognized at first the reappearance of influenza. This 1889 epidemic is extensively reported in the literature, and has been elaborately worked out by many observers. One important feature has been emphasized by Leichtenstern, which, although recognized by the profession after the last epidemic had been fully reported and recorded, is not appreciated by the profession during the present epidemic—namely, that while shortly after the last epidemic there were smaller relightings of the infection throughout various parts of the country, those diseases which we erroneously call grippe or influenza, occurring commonly in the spring and fall, are in no way connected with the disease with which we are dealing, and which occurs at rather long intervals. Any speculation in regard to these periods, which history has shown to be fairly wide apart, has very little basis. This pandemic, like many of former days, is believed to have originated in Asia, and from there to have spread over Europe and hence over the world. The disease spread rapidly over countries, affected probably about 40 per cent. of the world’s population, disappeared rapidly after several weeks, was thought to have had nothing to do with weather conditions, had a great morbidity but small mortality, and affected all ages and occupations. There is no doubt, as stated by some, that the development of traffic and travel was a large factor in the rapid and extensive spread of influenza during this pandemic. The course which the disease followed, springing from its supposed beginning in Asia, has been fully and amply described by writers after that period, but the great rapidity of its dissemination over all countries is the most remarkable feature in the epidemiology of any disease. This, during 1889, made many prominent physicians disregard the opinion that influenza spread by contagion and accept again the opinion expressed by observers of epidemics in former ages, that miasma as a pathogenic agent was responsible for its distribution; but anyone who reads closely the history of this epidemic, and in the light of modern medical science, must feel that the rapidity of distribution was nowhere greater than the most speedy means of transportation. This very necessary close connection was demonstrated also in regard to the mode of spread of the disease; the large cities and the commercial centers were affected earlier, smaller and country districts followed later, railroad towns were more frequently attacked than isolated villages, and even from jails, prisons and workhouses, where quarantine was immediately attempted, as well as from remote villages where the disease had been brought, there could be traced a zone of infection spreading into the country. One interesting point was raised at this time—namely, that in some places it seemed to spread by leaps and bounds, and at other places radiating as stated above.