Chapter III: Influenzas and Epidemic Agues (6)

But the most striking effect of the earthquake was that a dry fog began in Calabria in February, and overspread until autumn the greater part of Europe, extending even to the Azores. This fog, though not consisting apparently of moisture, was so dense that the sky was quite obscured, appearing a light grey colour instead of blue, while the sun became a blood-red disc. In Calabria the darkness was so great that lights were needed in the houses, and ships came into collision at sea. There was a most disagreeable odour[767]. The fog spreading over all Europe from Calabria was not at all mythical, as we are apt to suppose that similar recorded phenomena of the wonder-loving Middle Ages may have been. The phenomenon was independently reproduced in Iceland the same year, from the 1st to the 11th of June, causing the same darkness at sea, the same atmospheric effects at a distance, but not to so great a distance, and some amount of sickness, but seemingly not aguish or febrile, among the population[768].

Those two great convulsions of the year 1783, each of them the cause of a widely spreading dry fog, may have been conceivably the cause of pestiferous miasmata in the air, such as the corresponding hypothesis of influenza requires; but how little comparable or equivalent were the miasmata--in the one case from the ancient and well-peopled soil of Southern Italy, in the other from the inhospitable Danish colony just without the Arctic Circle! In any case, the earthquakes of 1783 were both too late for the great influenza of the period. The antecedent common alike to the influenza and the earthquakes was the extraordinary droughts, which caused famine and famine-fever in Iceland, and, according to old experience, was probably related to the epidemic prevalence of agues in Britain and on the continent of Europe.

IV.

What kind or kinds of epidemic sickness earthquakes may produce as an effect immediate and at the place, will appear from other instances. One of the most remarkable of earthquakes was that which destroyed Port Royal and nearly all the planters’ houses and sugar-works throughout the island of Jamaica on the 7th of June, 1692. Jamaica had been an English colony for little more than thirty years, during which time it had passed from its state of lethargy under the Spaniards into an emporium of commerce with a rapidly growing population of slaves and whites. The business capital was at Port Royal, wholly built since the British occupation. The site of it was a sandy key or shoal which was said to have risen perceptibly within the memory of original settlers; a writer in September, 1667, said of it: “wherever you dig five or six feet, water will appear which ebbs and flows as the tide. It is not salt, but brackish[769].” A quay had been built along this spit of land, at which vessels of 700 tons could lie afloat. It was here that the havoc of the earthquake was most complete.

Sloane, who had visited Jamaica a few years before, said that the inhabitants expect an earthquake every year, and that some of them were of opinion that they follow their great rains[770]. The year 1692 began in Jamaica with very dry and hot weather which continued until May: then came gales and heavy rains until the end of the month, and from that time until the day of the earthquake, the 7th of June, the weather was excessively hot, calm and dry. The shakes began at 11.40 a.m., and at the third shake, the ground of nearly all Port Royal fell in suddenly, so that in the course of a minute or two most of the houses were under water and the whole wharf was covered by the sea to the depth of several fathoms. The loss of life was, of course, greatest where population was densest; but in the interior of the island the effects on the soil were greater than at the shore: in the north a thousand acres of land sank and thirteen people with it; mountains on either side of a narrow gorge came together and blocked the way; wide chasms appeared in the ground, and on one mountain side there were some dozen openings from which brackish water spouted forth. The first effect in the streets of Port Royal was that men and women seemed all at once to be floundering up to the neck in the wet shifting sand, and were speedily drowned or floated away by the inrushing water. The shakes ceased for days at a time, and then began again, five or six perhaps in twenty-four hours; so that those who had escaped to ships in the bay remained on board for two months, being afraid to come ashore. The weather was hotter after the earthquake than before, and mosquitoes swarmed in unheard of numbers.

During the upheavals or subsidences in Port Royal, and the rushing of water into or from the gapings in the ground, “ill stenches and offensive smells” arose, so that “by means of the openings and the vapours at that time belcht forth from the earth into the air, the sky, which before was clear and blue, was in a minute’s time become dull and reddish looking (as I have heard it compared often) like a red-hot oven.” A very great mortality followed among those who had escaped the earthquake. Some of them settled at Leguanea, others at the place on the bay which became the Kingston of later history, enduring many hardships in their hastily built shelters, from the heavy rains that followed the earthquake, and from want of clothes, food and comforts.

One writes: “Our people settled a town at Leguanea side; and there is
about five hundred graves already [20th September, 1692], and people
every day is dying still. I went about once to see it, and I had like
to have tipt off.” Another says: “Almost half the people that escaped
upon Port Royal are since dead of a malignant fever”: and another,
referring to the hasty settlement on the bay at Kingston, says “they
died miserably in heaps.” But the most interesting information is his
next sentence: “Indeed there was a general sickness (supposed to
proceed from the hurtful vapours belched from the many openings of the
earth) all over the island, so general that few escaped being sick:
and ’tis thought it swept away in all parts of the island three
thousand souls, the greatest part from Kingstown, only yet an
unhealthy place[771].”

That great mortality from a malignant fever after the earthquake of 7th June, 1692, is usually counted an epidemic of the yellow fever which became established at Kingston and Port Royal from that time for at least a century and a half. I have not found any contemporary medical account of it, but all the later writers on yellow fever at Kingston and Port Royal have accepted the tradition that it was yellow fever. But there was one peculiarity, which marks it off from all subsequent epidemics of yellow fever--the sickness was all over the island, so general that few escaped being sick, and was supposed to proceed from the hurtful vapours belched from the many openings of the ground in and near Port Royal. In all subsequent experience yellow fever has been almost confined to the shore or to the ships in the bay[772]. Certainly it has never been all over the island as in 1692, “so general that few escaped being sick”: that is rather in the manner of influenza, although there is nothing to show that the sickness of the interior was so different from that of the shore as to be counted an influenza, or that the mortality of the sick was other than that of a “malignant fever.”

The earthquake at Port Royal in 1692 produced “ill stenches and offensive smells.” The tidal waves, or the subterranean vibrations which caused them, in tearing up the mud at the bottom of the channel at Bridgetown, Barbados, in 1755, had in like manner sent forth a great stench which poisoned the fish. Such offensive vapours were supposed in former times to come, as in a figure, from “the bowels of the earth”; and undoubtedly the sulphurous fumes which have overhung the region of Sicilian earthquakes must have had a source as deep as the strange minerals or “fossils” of Boyle’s hypothesis. But, while the commotion of an earthquake is deep, it is also superficial; whatever miasmata issue from the ground in the ordinary alternations of wet and drought, would be discharged into the atmosphere in unusual quantity and with unusual force in such disturbances of soil as sunk Port Royal in 1692 or were felt at Barbados across the whole width of the Atlantic in 1755. Nor is that effect upon miasmata instantaneous or quickly past; in Jamaica the rumblings and shakes lasted for nearly two months, during which time the pressure upon the gases in the subsoil must have been such as to make them pass into the atmosphere in stronger ascending currents than the mere alternations of moisture and drought would have done. And just as the ordinary seasonal changes in the level of the ground-water are of little or no account for miasmatic-infective disease unless the soil in which they occur be full of organic impurities from human occupancy, so one may reason that the great cataclysmic changes of the earth’s crust are, in this hypothesis of influenza, of most account as touching the stratum of soil wherein lie organic impurities, and as touching those areas of the surface,--the sites of cities, the populous plains, the shores of bays, the bottoms of harbours or any other definite spots--in which the products of organic decomposition are present in largest amount and, perhaps, of somewhat special kind. Such impurities of the soil are indeed a _vera causa_ of infective disease, known to be capable of the effect which has to be accounted for; and, as discharged into the air in great volume and with great force by some upheaval, they would make a local beginning of that “aer inimicus” which the Roman poet figures as creeping like a mist from one region of the heavens to another so that it corrupts each successive tract of air with its own baleful qualities, “reddatque sui simile atque alienum.”

But, as soon as we begin to apply this formula to particular historic cases, difficulties and ambiguities arise[773]. To come back to the instance of Jamaica in 1692, did the general sickness of the island, manifestly miasmatic as it was, and due to disturbances of soil, become an influenza for other regions of the globe? About fifteen months after there was, indeed, a universal catarrh in Britain and Ireland, of no great fatality, which is said by Molyneux, of Dublin, to have prevailed also in the northern parts of France, Flanders, and Holland, but is not reported in the usual way from Europe generally nor from America. Let us suppose a miasmatic cloud formed over the island of Jamaica in June, July, August and September, a cloud of infective particles which might produce influenza at a distance from its place of origin, whatever disease the miasmata after the earthquake may have produced in Jamaica itself. Let this invisible cloud, or emanation, get into the warm atmosphere over the great oceanic current that sets out from the Gulf of Mexico. The vehicle lies ready to hand,--to receive the miasmata not far from their place of origin, to carry them far into the Atlantic, and to bring them, perhaps, to the shores of Britain. This may seem a sufficiently plausible source of the influenza of October and November, 1693, which appears to have been felt only in the British Isles and on the opposite shores of the North Sea. But Webster’s own choice is the volcanic eruption in Iceland in the same year as the influenza; and if we prefer, in this hypothesis, an earthquake to an active volcano, there is a rival source for the British influenza of 1693, nearer both in place and time than that of Jamaica in 1692, and not less important in respect of miasmatic disease in its own locality. This was the disastrous series of earthquakes in Calabria and Sicily, culminating on the 9th of January, 1693. The following extracts from the account sent to the Royal Society will show how great was the commotion of soil, of underground water, and of atmosphere, and how close the connexion of these with the sickness ensuing[774]:

“In the plain of Catania, an open place, it is reported that from one
of the clefts in the ground, narrow but very long and about four miles
off the sea, the water was thrown forth altogether as salt as that of
the sea, [as in Jamaica the year before]. In Syracuse and other places
near the sea, the waters in many wells, which at first were salt, are
become fresh again.... The fountain Arethusa for the space of some
months was so brackish that the Syracusans could make no use of it,
and now that it is grown sweeter the spring is increased to near
double. In the city of Termini all the running waters are dried up....
It was contrary with the hot-baths, which were augmented by a third
part.

Darkness and obscurity of the air has always been over us, but still
inferior to that on the 10th and 11th of January; and often these
clouds have been thin and light, and of a great extent, such as the
authors call _rarae nubeculae_. The sun often and the moon always
obscured at the rising and setting, and the horizon all day long
dusky....

The effects it has had on humane bodies (although I do not believe
they have all immediately been caused by the earthquake) have (yet)
been various: such as foolishness (but not to any great degree),
madness, dulness, sottishness, and stolidity everywhere:
hypochondriack, melancholick and cholerick distempers. Every-day
fevers have been common, with many continual and tertian: malignant,
mortal and dangerous ones in a great number, with deliria and
lethargies. Where there has been any infection caused by the natural
malignity of the air, infinite mortality has followed. The smallpox
has made great destruction among children.”

Thus we find in Sicily a great disturbance of soil followed, as in Jamaica, by a great increase of local sickness, and by an atmosphere visibly charged with products of the earthquake for months after. This is a nearer source than the Jamaican for the British influenza of Oct.-Nov. 1693,--nearer in time, if that be any advantage for the theory, nearer also in place. There are, however, no intermediate stages to connect the influenza on the northern edge of the European continent with the disturbance of soil and the miasmata arising therefrom in Sicily and Calabria. If there had been any such dry fog as spread all over Europe from the Calabrian earthquake of January, 1783, it would have been a help at least to the imagination in bridging over a gulf of space and time.

As to the interval of time, it should at all events be kept in mind that the same difficulty has to be reckoned with in any hypothesis of influenza and in every great historic instance. In the instance still before us, the infection began in England, according to Molyneux, in October, 1693, and was in Dublin a month later. But we must assume it to have been in the air for some time before it became effective upon mankind. Influenza has been observed, with curious uniformity, to attack the horses, say of London, of Plymouth, of Edinburgh, or of Dublin (as on the occasion before this, 1688) two months or more in advance of the inhabitants of the respective places; and if it had waited, so to speak, for two months before it showed its effects upon men, it may have waited equally long, or longer, before it showed its effects upon horses. That would give at least four months; and then we know, from such an influenza as that of 1743, that there may be weeks, perhaps months, between its prevalence in Naples, Rome or Milan, and its prevalence in London or Edinburgh, and, from the influenza of 1693 itself, that it was a month later in Dublin than in London. An earthquake in Sicily on the 9th of January, 1693, with effects there for months after upon the water, the air, and the prevalent diseases, is not excluded by lapse of time from being a _vera causa_ of an influenza in England in October of the same year, and in Ireland in November. The sort of proof which most men desire, a proof such as we rarely get, and one that is suspiciously neat when we do get it, would be to find an influenza in Sicily and Calabria following the earthquake, and to trace the same step by step over Europe. But the miasmatic sickness in the countries of the earthquakes was not influenza, so far as is known; and there was no epidemic catarrh, so far as is known, in any other part of Europe but the British Isles and the neighbouring shores of the North Sea.

V.

Molyneux, who recorded with a good deal of circumstance the influenza of 1693, is the principal authority, along with Dr Walter Harris, of London, for another influenza in 1688, seemingly peculiar to the British Isles. Its effects can be discovered with the utmost certainty in the London bills of mortality for two or three weeks at the end of May and beginning of June, and it is mentioned as “the new distemper” in letters of the time. Is it possible to find an earthquake for it? Webster’s note is: “in the same year with an eruption of Vesuvius, after a severe winter and earthquakes”--which is somewhat general. Turning to Evelyn’s diary, where these matters are often recorded, we find, in the very weeks when the influenza was at a height in London, this entry: “News arrived of the most prodigious earthquake that was almost ever heard of, subverting the city of Lima and country in Peru, with a dreadfull inundation following it”--as if the influenza and the news of the earthquake had reached London at the same time. This was the earthquake of 20th October, 1687, which destroyed Lima, Callao and an immense district along the coast of Peru. The rocking of the earth was most violent, the sea retreated like a sudden immense ebb and filled again like a sudden immense flood, the effect of the commotion being felt on board ships a hundred and fifty leagues out in the Pacific. It was remarked that wheat and barley would not thrive in Peru after that earthquake[775]. Here was undoubtedly a great disturbance of soil and of subsoil, almost certainly attended with the discharge of effluvia or miasmata into the air, as in other great earthquakes. But the universal slight fever of the British Isles in the months of June and July, 1688, is remote from the earthquake of Lima in place; and, if it be a question of earthquakes at all, there are others nearer to it both in place and time, such as that in the Basilicata province of Naples in January, 1688, and the Jamaica earthquake, felt through all the island, on the 1st of March, 1688. The greatest of them all, that of Smyrna, on the 10th of July, was a few weeks too late for the hypothesis.

VI.

A continent so subject to earthquakes as South America might be expected, in this hypothesis, to have had some corresponding influenzas. It has indeed had influenzas, some of them peculiar to itself. The Western Hemisphere as a whole has, on several great occasions, had influenzas which were not felt in the Old World. Again, there are one or two instances in which the infection, while it spread widely over the table-lands of Bolivia and Peru, does not appear by existing testimony to have been carried north of the Isthmus. One of these was the influenza of 1720, as special to a region of South America as that of 1688 was to the British Isles. The account of it was given in an essay by Botoni ‘On the Circulation of the Blood,’ published at Lima in 1723[776]. He calls it _catarro maligno_; it was popularly known as _fierro chuto_ or “iron cap.” It appeared at Cuzco in the end of March, or beginning of April, 1720, and was over about November. Four thousand are said to have died of it in the diocese of Cuzco, and it is said to have made so great a scarcity of hands that the first harvest after it was imperfectly gathered. It had all the marks of an influenza, with the addition of bleeding from the nose and lungs. It had also the grand characteristic common to influenza and epidemic ague: “the symptoms were so diverse and even contradictory that no correct diagnosis, or curative plan, could be fixed.” The Lima writer of 1723 says that it followed an eclipse of the sun on the 15th of August, 1719, having begun on the eastern side of the Andes, in the basin of La Plata, about that time, and travelled northwards and westwards, as the South American influenza of 1759 did.

This is a localized influenza in a country of earthquakes. But the two great earthquakes in 1719 are not South American. They both happened in July: one along the coast of Fez and Morocco, which ruined many villages and a part of the city of Morocco (there is also a later disturbance in the Azores in December, followed by the upheaval of a new island), the other in North China. Here we have the choice of following the “aer inimicus” of Lucretius either from China or from the African coast; and if it be the case that the influenza began in the latter part of the year 1719 in the basin of the La Plata, to cross the Andes next year, it may seem, in this hypothesis, that a course from east to west, bringing the infection across the Atlantic from Africa, is to be preferred to a course from west to east, bringing it across the Pacific from North China. In either case there need be no difficulty in finding local clouds of miasmata. Some traces of the corresponding great earthquake in China were found in November of the following year, by Bell, an English traveller who crossed from Moscow to Peking:

“Jumy,” he says, “suffered greatly by the earthquakes that happened in
the month of July the preceding year [1719], above one half of it
being thereby laid in ruins. Indeed more than one half of the towns
and villages through which we travelled this day had suffered much on
the same occasion, and vast numbers of people had been buried in the
ruins. I must confess it was a dismal scene to see everywhere such
heaps of rubbish[777].”

The atmospheric effects of Chinese earthquakes have been pictured since medieval times, in obviously superstitious colours; and there are reasons why a great disturbance of soil in that country should produce remarkable miasmata. The surface soil of China is peculiar in having the bodies of the dead dispersed at large in it, insomuch that excavations for the foundations of houses, or for roads and railway cuttings, can hardly be made without the constant risk of exposing graves[778].

If the soil of China is peculiar in one way, that of the West Coast of Africa is peculiar in another. Without entering on the large question of “malaria” in each of them, I shall take an old illustration of the miasmata of the West Coast of Africa as a cause of dengue-fever, a disease curiously like influenza in its symptoms, and like it also in its occasional wave-like dispersion over wide regions. The authority is Dr Aubrey, who resided many years on the coast of Guinea, saw much of the slave-trade, and wrote a very sensible book in 1729, called ‘The Sea Surgeon, or the Guinea Man’s Vade Mecum.’ He describes quite clearly the fever which was long after described by West Indian physicians as dengue, or three-days’ fever, or break-bone fever, including in his description the characteristic exanthems of it and the penetrating odour of the sweat. He gives also, in clinical form, a series of cases on board the galley ‘Peterborough’ in December, 1717, which are exquisite examples of break-bone fever. This disease, he says, “many times runs over the whole ship, as well negroes as white men, for they infect one the other, and the ship is then in a very deplorable condition unless they have an able man to take care of them.” But the original source of infection, he believed, was the fogs that hung at nightfall over the estuaries of the rivers; and he gives an experimental proof, remarkable but not quite incredible, of the poisonous nature of the miasmata:

“But to let you see the evil, malevolent, contagious, destructive
quality of those fogs that fall there in the night, and how far they
are inimical to human nature, I will tell you of an experiment of my
own. I made a lump of paste with oat-meal somewhat hard, and about the
bigness of a hen’s egg, which was exposed to the fog from twilight to
twilight, i.e. from the dusk of the evening till daybreak in the
morning; after which I crumbled it, and gave it to fowls, which we had
on board, and soon after they had eaten it, they turned round and in a
kind of vertigo dropt down and expired.”

A great mortality in Guinea in 1754 or 1755 was ascribed by Lind, the least credulous in such matters, to “a noxious stinking fog[779].”

What the alternations of heat and chill, of moisture and drought, produce ordinarily in the way of miasmata, the same, we may suppose, is produced on the great scale, as a phenomenon at some particular time and place, by one of those cataclysms which break the surface of the earth or the bed of the sea, lower or raise the level of wells and springs, and fill the air with particles of dust or vapour which may overhang the locality for months and visibly disperse themselves to a great distance. Nothing relating to miasmata in the air need be hard for belief after the wonderful diffusion and permanence in the atmosphere of the whole globe, for two years or more, of finely divided particles shot up by the earthquakes and eruptions of Krakatoa in the Straits of Sunda on the 27th and 28th of August, 1883[780].

A theory of influenza constructed from such generalities as those of Boyle, Arbuthnot and Webster will have attractions for many over the theory that influenza is always present in some remote country and becomes dispersed now and then over the world by contagion from person to person: it will have superior attractions, for the reason that influenza is a phenomenal thing which needs a phenomenal cause to account for it. But if anyone were to attempt to fit each historic wave of influenza with its particular earthquake, or to find the precise locality where clouds of infective matter had arisen, or the particular circumstances in which they arose, he would certainly find his fragile structure of probabilities pulled to pieces by the professed discouragers and depravers. I make no such attempt; but I am not the less persuaded of the direction in which the true theory of influenza lies.

Influenza at Sea.

There is no point more essential to a correct theory of influenza than to find out in what circumstances it has occurred among the crews of ships on the high seas. If it be true that a ship may sail into an atmosphere of influenza, just as she may sail into a fog, or an oceanic current, or the track of a cyclone, then the possible hypotheses touching the nature, source, and mode of diffusion of influenza become narrowed down within definite limits.

One of the first observations was made in the case of a Scotch vessel
in the influenza of 1732-33[781]. The epidemic was earlier in Scotland
than in England; it began suddenly in Edinburgh on 17 December, 1732,
the horses having been attacked with running of the nose towards the
end of October. About the time when the disease began among mankind,
in December, a vessel, the ‘Anne and Agnes’ sailed from Leith for
Holland. One sailor was sick on this voyage. She sailed on the return
voyage to Leith, with the other ten of her crew in perfect health.
Just as she made the English coast at Flamborough Head on the 15th of
January, 1733, six of the sailors fell ill together, two more the next
day, and one more on the day after that, so that when the vessel
anchored in Leith Roads there was only one man well, and he fell ill
on the day following the arrival. The symptoms were the common ones of
the reigning epidemic. The dates are not given more precisely or fully
than as above. Influenza was prevalent in Germany and Holland somewhat
earlier than in Scotland or England; the men may, of course, have
imbibed the infection when they were in the Dutch port, just as it is
almost certain that the crews of Drake’s fleet in 1587 had received
during a ten days’ stay upon the island of St Jago, of the Cape de
Verde group, the miasmatic infection of which they suddenly fell sick
in large numbers together in mid-Atlantic some six days after sailing
to the westward.

This early case of the ‘Anne and Agnes’ in 1733 may pass as an ambiguous one. The next occasion when influenza on board ship attracted much notice was the epidemic of 1782.

On the 6th of May, Admiral Kempenfelt sailed from Spithead with seven
ships of the line and a frigate, on a cruize to the westward; on the
18th May, he came into Torbay, and sailed again soon after; on the
30th May he came again into Torbay with eight sail of the line and
three frigates, and on 1 June sailed again to the westward. Sometime
before his squadron put into Torbay for the second time, influenza had
appeared among them at sea, it is said in the ‘Goliath’ on the 29th of
May[782]. A letter from Plymouth, of the 2nd June, after referring to
the violence of influenza in that town, at the Dock, and on board the
men-of-war lying there, says that the ‘Fortitude’ of 74 guns, and
‘Latona’ frigate came in that afternoon with 250 sick men from the
fleet under Admiral Kempenfelt, mostly with fevers. Another Plymouth
letter two days later (4 June) says: “Kempenfelt is returning to
Torbay: he could keep the sea no longer, on account of the sickness
that rages on board his fleet. More than 400 men have been brought to
the hospital this morning. Our men drop down with it by scores at a
time. The ‘Latona’ frigate, that sailed the other day is returned, the
officers being the only hands that could work the ship[783].”

This outbreak on board ships in the Channel was fully as early as the great development of influenza in 1782 on shore, whether in London or Plymouth; but there were almost certainly cases of it at the latter port before the ‘Latona’ sailed to join Kempenfelt’s squadron. Robertson, however, who was surgeon on the ‘Romney’ in the Channel service at that time, says that “hundreds in different ships, towns, and counties, which had _no_ communication with one another, were seized nearly as suddenly and so nigh the same instant as if they had been electrified.... The companies of many of the ships were very well at bed-time, and in the morning there were hardly enough able to do the common business of the ship[784].” This is confirmed by McNair, surgeon of the ‘Fortitude,’ who told Trotter that two hundred of her men, as she lay in Torbay, were seized in one night and were unable to come on deck in the morning[785].

There was another English fleet in the North Sea at the same time, under Lord Howe, watching the Dutch fleet or seeking to intercept the Dutch East Indiamen.

Howe sailed from St Helen’s on the 9th May, with twelve ships of the
line. Towards the end of that month he had his fleet in the Texel; the
men were in excellent health, “when a cutter arrived from the
Admiralty, and the signal was given for an officer from each ship [to
come on board the admiral]. An officer was accordingly sent with a
boat’s crew from every vessel, and returned with orders, carrying with
them also, however, the influenza”--which soon prostrated the crews to
the same extraordinary extent as in the ships under Kempenfelt at the
other end of the Channel. This was the oral account given to Professor
Gregory of Edinburgh, by a lieutenant on board a sixty-four gun
ship[786]. Another account says that the disorder first appeared in
Howe’s fleet on the Dutch coast about the end of May, on board the
‘Ripon,’ and in two days after in the ‘Princess Amelia’; other ships
of the same fleet were affected with it at different periods, some
indeed, not until their return to Portsmouth about the second week of
June. “This fleet, also, had no communication with the shore until
their return to the Downs, on their way back to Portsmouth, towards
the 3d and 4th of June[787].”

But, apart from the story of the Admiralty despatch-boat carrying the influenza to Howe’s squadron, it appears that both Kempenfelt and Howe were joined from time to time by additional ships, which might have carried an atmosphere of influenza with them[788]. Still, it was an influenza atmosphere that they had carried, and not merely so many sick persons. The doctrine of contagion from person to person would have to be so widened as to become meaningless, if all those experiences of the fleet in 1782 were to be brought within it. In the history both of sweating sickness and of influenza, there are instances of the disease breaking out suddenly in a place after someone’s arrival; but the new arrival may not have had the disease, it was enough that he came from a place where the disease was[789]. That was, perhaps, the reason why Beddoes, in his inquiry of 1803, framed one of his questions so as to elicit information about the dispersal of influenza by _fomites_.

It is not easy to prove that a ship may meet with an atmosphere of influenza on the high seas; but many have believed that ships have done so. Webster says: “The disease invades seamen on the ocean in the same [western] hemisphere, when a hundred leagues from land, at the same time that it invades people on shore. Of this I have certain evidence from the testimony of American captains of vessels, who have been on their passage from the continent to the West India Islands during the prevalence of this disease[790].” There are several instances of this, authenticated with times, places, and other data of credibility.

The best known of these is the voyage of the East Indiaman ‘Asia’ in
September, 1780, through the China Sea from Malacca to Canton: “When
the ship left Malacca, there was no epidemic disease in the place;
when it arrived at Canton it was found that at the very time when they
had the _Influenza_ on board the Atlas (_sic_) in the China seas, it
had raged at Canton with as much violence as it did in London in June,
1782, and with the very same symptoms[791].”

In the present century, the cases nearly all come from the medical reports of the navies of Great Britain, France, Germany and the Netherlands, and they relate to ships on foreign service--in the East Indies, the Pacific, Africa, or other foreign stations. In some of the instances influenza went through a ship’s company in port or in a roadstead, others are examples of outbreaks at sea:

1837: “The ship’s company of the ‘Raleigh,’ were attacked by epidemic
catarrh--influenza--first in March, while at sea between Singapore and
Manilla, and again, although less severely, in June and July while on
the coast of China.... Influenza also made its appearance amongst the
crew of the ‘Zebra’ in April while she lay at Penang; it was supposed
to have been contracted by infection from the people on shore, as they
were then suffering from it. No death occurred under this head[792].”

1838: In the ‘Rattlesnake,’ at Diamond Harbour, in the Hooghly River,
a large proportion of the men were suffering from epidemic catarrh.
Intermittent fever made its appearance; “the change from the catarrhal
to the febrile form was sudden and complete, the one entirely
superseding the other[793].”

1842: In the ‘Agincourt’ on a voyage from the Cape of Good Hope to
Hongkong in August and September, the greater part of 102 cases of
catarrh occurred; many of these were accompanied with inflammation of
tonsils and fauces, and in some there was deafness with discharge from
the ear. This is not claimed as an instance of epidemic influenza, but
as an aggregate of common colds, due to cold weather in the Southern
Ocean and to wet decks[794].

1857: “Influenza broke out in the ‘Monarch’ while at sea, on the
passage from Payta [extreme north of Peru] to Valparaiso. She left the
former place on the 23d August, and arrived at the latter on the last
day of September. About the 12th of the month [twenty days out], the
wind suddenly changed to the south-west, when nearly every person in
the ship began to complain of cold, although the thermometer did not
show any marked change in the temperature. On the 12th and 13th seven
patients were placed on the sick list with catarrhal symptoms; and
during the following ten days, upwards of eighty more were added, but
by the end of the month the attacks ceased. [She carried 690 men, and
had 191 cases of “influenza and catarrh,” in the year 1857.] Some of
the cases were severe, ending either in slight bronchitis or
pneumonia, accompanied with great prostration of the vital powers. On
the arrival of the ship at Valparaiso, the surgeon observes: ‘We found
the place healthy, but in the course of a few days some cases of
influenza made their appearance, and very soon afterwards the disease
extended over the whole town. It was generally believed that we
imported it, and the authorities took the trouble to send on board a
medical officer to investigate the matter.’ He further observes that
the whole coast, from Vancouver’s Island southward to Valparaiso was
visited by the epidemic.” It made its appearance on board the
‘Satellite’ at Vancouver’s Island in September, and among the
residents ashore, both on the island and mainland, at the same
time[795].

1857: Catarrh “assumed the form of influenza in the ‘Arachne’ [149
men, 114 cases] while the vessel was cruizing off the coast of Cuba,
with which, however, she had no communication. There was nothing in
the state of the atmosphere to attract special attention. A question
therefore arises whether it might not have been caused by infection
wafted from the shore.” It was prevalent at the time at Havana[796].

1857: “Australian Station:--An eruption of epidemic catarrh occurred
in the ‘Juno’ [200 men, 131 cases], but long after she left the
station[797].”

Whilst the influenza was on the American Pacific coast in September,
1857, it was on the coast of China three months earlier--on board the
‘Inflexible’ at Hongkong on the 18th of May, and in the ‘Amethyst’ and
‘Niger’ in a creek near Hongkong early in June[798]. But it had been
on the Pacific coast of South America the year before, according to
the following:

“1856: Epidemic catarrh broke out in the ‘President’ when lying off
the island of San Lorenzo in the bay of Callao, first on the 20th
October, and the last cases were placed on the sick list on 1st
November,--the usual period which influenza takes to pass through a
frigate ship’s company. About sixty required to be placed on the sick
list.” It had occurred on board English ships of war at Rio de
Janeiro, on the other side of the continent, some two months before,
in August, 1856[799].

1863: The following, in the experience of the French navy, has been
elaborately recorded[800]: The frigate ‘Duguay-Trouin’ left Gorée,
Senegambia, for Brest, in February. There were no cases of influenza
in Gorée when she left; but four days out, an epidemic of influenza
began on board, the weather being fine and the temperature genial at
the time. Another French frigate, which had left Gorée, on the same
voyage to Brest, two days earlier, did not have a single case.

The following instance, here published for the first time, belongs to the most recent pandemics of influenza, 1890-93. It relates to only a single case of influenza, in the captain of a merchantship; it would have been a more satisfactory piece of evidence, if there had been several cases in the ship; but among the comparatively small crew of a merchantman, the same groups of cases are not to be looked for that we find on board crowded men of war; and in this particular case the only other occupants of the quarter-deck were the first mate and the steward.

The ship ‘Wellington,’ sailed from the Thames, for Lyttelton, New
Zealand, on the 19th December, 1891. The epidemic of influenza in
London in that year had been in May, June and July; the mate of the
‘Wellington’ had had an attack of it ashore, on that occasion, but not
the captain nor the steward. On the 2nd of March, 1892, when
seventy-four days out and in latitude 42° S., longitude 63 E., near
Kerguelen’s Land, the captain began to have lumbago and bilious
headaches, for which he took several doses of mercurial purgative
followed by saline draughts. The treatment at length brought on
continual purging, which, together with three days’ starving from the
22nd to the 24th of March, caused him a loss of weight of eight
pounds. The navigation had meanwhile been somewhat difficult and
anxious, owing to a long spell of easterly head winds. Quite suddenly,
on the 26th March, when the ship was in latitude 44 S., longitude 145
E., or about two hundred miles to the south of Tasmania, he had an
aguish shake followed by prolonged febrile heat, which sent him to his
berth. The symptoms were acute from the 26th to the 30th
March,--intense pain through and through the head, as if it were being
screwed tight in an iron casing, pain behind the eyeballs, a
perception of yellow colour in the eyes when shut, a feeling of
soreness all over the body, which he set down at the time to his
uneasy berth while the ship was ploughing through the seas at about
twelve knots, and a pulse of 110. The head pains were by far the worst
symptom, and were so unbearable as to make the patient desperate. This
acute state lasted for four days, and suddenly disappeared leaving
great prostration behind. The captain, who had long experience with
crews and passengers, and a considerable amateur knowledge of
medicine, summed up his illness as a bilious attack, passing into
“ague” with “neuralgia of the head.” While the acute attack lasted the
ship had covered the distance from Tasmania to the southern end of New
Zealand, and on the 31st of March the captain by an effort came on
deck to navigate the vessel in stormy weather up the coast to
Lyttelton, which was reached on the 2nd of April. The pilot coming on
board found the captain ill in his berth, and on being told the
symptoms, at once said, “It is the influenza: I have just had it
myself.” The doctor who was sent for found the captain “talking
foolishly,” as he afterwards told him, and had him removed to the
convalescent home at Christchurch, where he remained a fortnight
slowly regaining strength. The doctor[801] could find no other name
for the illness but influenza, although he had not supposed such a
thing possible in mid-ocean. They had just passed through an epidemic
of it in New Zealand, and it is reported about the same time in New
South Wales, afterwards in the Tonga group, and still later in the
summer in Peru. The symptoms of this case are sufficiently
distinctive: the intense constricting pain of the head is exactly the
“_fierro chuto_” or “iron cap” of South American epidemics; the pain
in the eyeballs, the soreness of the limbs and body, and the
unparalleled depression and despair, are the marks of influenza
without catarrh. The patient was of abstemious habits, and had made
the same voyage year after year for a long period without any illness
that he could recall. He had reduced himself by purging and starving,
on account of a bilious attack during a fortnight of foul winds from
the eastward, and had doubtless become peculiarly susceptible of the
influenza miasm before the ship came into the longitude of Tasmania on
the 26th March.

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.