Pandemonium

“ In the history of influenza morbidity, as in that of its mortality, we must content ourselves for information prior to the nineteenth century with the very general estimates made by contemporary historians. During the last century the statistics have been more numerous and more nearly correct. As far back as the first recognized pandemic, 1510, the extremely high morbidity has been a recognized characteristic. Thomas Short in speaking of this pandemic says, “The disease ... attacked at once and raged all over Europe, not missing a family and scarce a person.” ”

“ By Oscar Jewell Harvey.
═══════ EARLY in September, 1918, the United States was invaded by a scourge of highly infectious and fatal disease, which spread with rapidity throughout the country. It was pandemic in its nature, and partook of many of the characteristics of influenza, grip and pneumonia. No one seemed to know much about the disease or its treatment, and medical science and public health agencies were alike unprepared to cope with it. ”

“ Epidemics of many kinds, typhus, ague, plague—all diseases which were caused more or less by bad air—devastated this land and Europe in those days with a horrible intensity, to which even the choleras of our times are mild. The back streets, the hospitals, the gaols, the barracks, the camps—every place in which any large number of persons congregated, were so many nests of pestilence, engendered by uncleanliness, which denied alike the water which was drunk and the air which was breathed ”

“ From the explanation that has been given of the instances of supposed contagion of the yellow fever, we are compelled to resort to certain noxious qualities in the atmosphere, as the exclusive causes of the prevalence, not only of that fever, but (with a few exceptions) of all other epidemic diseases. It is true, we are as yet ignorant of the precise nature of those qualities in the air which produce epidemics; but their effects are as certainly felt by the human body as the effects of heat, and yet who knows the nature of that great and universal principle of activity in our globe? ”

“ Or perhaps he should have said, or at least have added, that in cities where the atmosphere is charged with a load of smoke, and other heterogeneous vapours, epidemical poisons may be blunted, decompounded, or annihilated;{75} that likewise in cities, human bodies are more early seasoned and habituated to such noxious external impressions, and, like doctors and nurses, are in some degree fortified by habit: that besides, in every large metropolis, small-pox, measles, and, some other febrile epidemicks, are almost constant residents ”

“ May God comfort that torn up Southern home, and all the homes of this country, and of all the world, which have been swept by this plague of influenza, which has deepened sometimes into pneumonia and sometimes into typhus, and the victims of which are counted by the ten thousand, Satan, who is the “prince of the power of the air,” has been poisoning the atmosphere in all nations. ”

“ That universal epidemic, or pandemic, is usually counted as one of the great historical waves of influenza; and in the annals of that wonderful disease it stands the first which was well recorded by competent foreign observers, including Ingrassias, Gesner, Rondelet, Riverius, Dodonaeus, and Foreest. The corresponding sickness in England in 1557 (still more severe in 1558) , which carried off many of the wealthiest men, and made so great an impression that it is noticed by Stow and Speed, has missed being noticed by English physicians, with a single exception, and that a casual one. ”

“ A neighbour barricading himself within his house, at a few yards distance from infection, may escape unhurt. If pestilential contagion could be so suddenly and widely scattered over a kingdom as epidemical influenza, the earth, in a few months, would be converted into an enormous church-yard. It is not like some other exotick poisons of the exanthematous order, after enduring which once, mankind are rendered{120} invulnerable: the plague, as well as putrid fever, may attack the same person repeatedly. ”

“ If we suppose the plague, or any other epidemic disease, to arise from some general cause, let that cause be contagion or any thing else, it ought to operate upon all who come within its sphere of action, as Dr. Mosely observes of infection. If experience shows that it does not, the argument will hold equally against a constitution of the atmosphere, putrid effluvia, heat, cold, or any thing else ”

“ General Manner of Spread in Individual Localities. Having discussed the mode of propagation of influenza among individuals we will follow the disease as it attacks one person after another in a community and study the epidemiologic picture, drawn no longer with the individual as a unit, but with the community as the unit.
We must here distinguish between a primary epidemic, the first wave of a progressing pandemic, and the secondary type in which may be grouped those large or small recurrences which light up for a period of one to three or more years after the primary wave. ”

“ Our common epidemic influenza or grip, occurring practically isolated or in very small outbreaks, belongs to the same type of disease as the pandemic variety, but is due to a mitigated form of the causative organism, one of decreased virulence and of shorter viability. ”

“ Again, the ages at which pneumonia is both most common and most deadly, namely, under five and over sixty-five, are precisely those at which this feature of exposure to the weather plays the most insignificant part. ”

“ Even the eyes of the patient were considered as sources of contagion [24] , which had the power of acting at a distance, whether on account of their unwonted lustre or the distortion which they always suffer in plague, or whether in conformity with an ancient notion, according to which the sight was considered as the bearer of a demoniacal enchantment. Flight from infected cities seldom availed the fearful, for the germ of the disease adhered to them, and they fell sick, remote from assistance, in the solitude of their country houses. ”

“ Few escape this exotick contagion, especially in childhood and in cities. It attacks the same persons but once in life; and, with us, is said to be most epidemick in winter.
Morbillous symptoms are fever, impaired appetite, heaviness of the head and eyes, somnolency, catarrh, acrid defluxion from the fauces, nose, and eyes, with hoarseness, sneezing, and lachrymation; short dry cough, and some difficulty in respiration. Prior to the eruption, there is generally anxiety about the breast, palpitation of the heart, itching of the face, peevishness, and considerable fever. ”

“ For example, Papôn, in his work entitled ‘Epoques Mémorables de la Peste,’ considers the undoubted causes of plague to be uncultivated lands, marshy soil, corrupt lakes, filthy cities, concurring with occasional causes, such as intemperature of the seasons and famine, whilst the bent of his researches is evidently to prove that in every modern plague foreign contagion was the cause! ”

“ The singular career which a pestilential epidemic runs, having a beginning, height, and decline, can only be explained on the idea of the pestilential constitution of the air undergoing corresponding changes; and it is probable that the return of a plague is a revival of infection that has been latent, or dormant, until a particular state of atmosphere rouses it to action.
III. Can Filth and Animal Putrefaction generate Contagion? We have already made an allusion to some of those facts that must assist us in the solution of this problem, under the head of Public Health (see page 98.) ”

“ ALTHOUGH therefore, in the Beginning of epidemical Diseases, and during the Subsistence of their common Causes, particular Regard is to be had to these Causes, and the Manner whereby they affect the People; yet when it is come to this pass, that the Fever it self is productive of a Poison, or somewhat intirely disagreeable, that communicates the same Impressions upon others,273 without any Concurrence of the first Cause, then such a Fever is truly a Pestilence by Contagion, and all precautionary Regards ought peculiarly to be suited, to prevent its Infection or Spreading ”

“ That impure air, want of light, crowding together unwashed numbers, &c., will by predisposition contribute to the production and aggravation of disease, as we observe to be the case [210] in jails, hospitals, and in camp, I can fully understand; but that epidemic diseases, such, for instance, as plague, yellow fever, or cholera, are ever propagated by contact—contagion, I, after twenty-five years’ residence in pestilential countries, have no reason to believe ”

“ All we can say is, we know into what dwellings cholera and fever will not come, however 'epidemic' the year; we can put towns and districts into such a state that the epidemic, like the mediæval witch, is exorcised, so that it cannot come near them. ”

“ But to the subject of the causes,—the exciting and the predisposing of disease; it should be premised that when attributing epidemic pestilences or diseases to natural causes, it must not be supposed or inferred that any one of such causes, as heat, cold, moisture, drought, &c., will alone be sufficient to induce disease: to effect that, there must be a combination of these causes in continuance and succession, in occasion and variation, as also in circumstance and virulence. ”

“ The effects of this rain upon the disease shall be mentioned hereafter. On the 10th the weather became cool, and on the nights of the 12th and [11] 13th of the month there was a frost accompanied with ice, which appeared to give a sudden and complete check to the disease.
The reader will probably expect an account of the effects of this distressing epidemic upon the public mind. The terror of the citizens for a while was very great. Rumours of an opposite and contradictory nature of the increase and mortality of the fever were in constant circulation. ”

“ The excessive disparity of seasons with respect to the spreading of epidemic diseases, the long cessation of them at some times, and their sudden revival, as if with redoubled fury, at others, indicate the operation of some cause invisible to us; but whether that cause resides in the earth or in the air, cannot easily be known. ”

“ Except in the case of the relatively rare pneumonic form, plague, though " catching," is not nearly so contagious as are scarlet fever, measles, or small-pox. Medical men, and even nurses, in clean airy hospitals rarely contract the disease, provided they have no open wounds and do not remain too long in close proximity to their patients. In cities the cleanly districts are generally spared. ”

“ Again, contagious diseases are recognizable by the determinate periods of their phenomena, especially as regards specification, as also by their mode of propagation, whilst, if epidemic pestilences were dependent on, or caused by, contagion, they would never cease until whole communities became extinct!
A period of one hundred and sixty years has elapsed (up to the year 1832) since the occurrence of any plague or aggravated pestilence in this our own country, notwithstanding [211] our intercourse with countries where awful pestilence may be said always to exist. ”

“ With the beginning of the modern period we come to more frequent pandemics, not of plague, but of minor or milder forms of pestilential infection. On the continent of Europe these were in part related to the state of war, which may be taken as beginning with the invasion of Italy by Charles VIII. of France in 1494. Typhus-fever, or war-fever with famine-fever, now begins to be a familiar form of sickness—in 1498, 1505, 1510, 1528, and so on. Other forms are putrid sore throat, dysentery, and varieties of fever included under influenza. ”

“ Others said they granted that heat in the climate might propagate infection, as sultry hot weather fills the air with vermin, and nourishes innumerable numbers and kinds of venomous creatures, which breed in our food, in the plants, and even in our bodies, by the very stench of which infection may be propagated; also that heat in the air, or heat of weather, as we ordinarily call it, makes bodies relax and faint, exhausts the spirits, opens the pores, and makes us more apt to receive infection or any evil influence, be it from noxious, pestilential vapors, or any other thing in the air ”

“ Experience has taught us that the phenomena of epidemic pestilences or diseases are various and dissimilar, observing no regular course or succession, but commencing and ceasing at periods influenced by certain changes of the seasons, and modified by various circumstances, especially such as locality and habit of body. ”

“ An influenza pneumonia may show the general prostration and cardiac weakness of plague. In influenza pneumonia we have an onset with the features of ordinary influenza, which, however, in the influenza epidemic in 1918 was often short. In plague pneumonia we have pneumonia from the start. The pulse in plague is early weak and rapid and the tendency to a stuporous state more marked. The early appearance of thin watery sputum, which quickly becomes blood-tinged and always contains plague bacilli is noted in plague pneumonia. ”

“ The severe epidemics which have occurred from pneumonia have occurred in camps where sanitary conditions are grossly violated. Under such conditions pneumonia has become a most alarming epidemic, sometimes called the black death. ”

“ It is true that, as several physicians told my Lord Mayor, the fury of the contagion was such at some particular times, and people sickened so fast and died so soon, that it was impossible, and indeed to no purpose, to go about to inquire who was sick and who was well, or to shut them up with such exactness as the thing required, almost every house in a whole street being infected, and in many places every person in some of the houses ”

“ In dirty and neglected ships, in damp, crowded, and filthy gaols, in the crowded wards of ill-ventilated hospitals filled with persons labouring under malignant surgical diseases or bad forms of fever, an atmosphere is generated which cannot be breathed long, even by the most healthy and robust, without producing highly dangerous fever.
3. The evidence is just as indubitable that exhalations arise from the bodies of the dead, which are capable of producing disease and death. Many instances are recorded of the communication of small-pox from the corpse of a person who has died of small-pox. ”