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CHAPTER 3 Influenza provides a splendid illustration of the unity of medicine on two grounds: the exchange of knowledge of the disease as it affects both man and animals and the exchange of infection between man and animals. That is my justification for making it the subject of this chapter, but I must admit that there is also another more personal reason. I am one of those who have been fascinated by the story that has unfolded over the last half century. The growth of our knowledge in this field constitutes one of the most exciting stories in the history of medicine and there are still many intriguing mysteries to puzzleover. A group of specialists called together by the World Health Organization stated: "Influenza is one of the most important infectiousdiseases still unconquered." That was in 1952, but the statement is still true today. We are, of course, talking about "true" influenza which occurs mostly in epidemics, and not about sporadic respiratory infections that are often loosely referred to as influenza. 64 COMPARATIVE STUDY OF INFLUENZA Comparative Study of Influenza Epidemiological Behavior Epidemics recognizable from their description as probably influenza have been recorded since before the birth of Christ. During the 225 years from 1675 to 1900, twenty-twoepidemics were described in sufficient detail for us to be reasonably sure that they were influenza.That averages out at about one every decade, but actually the intervals were very irregular. The particular characteristics that lead one to identify an epidemic as influenzaare the clinical symptoms, especially the sudden onset, a high attack rate but relatively low mortality, short incubation period, and rapid spread of the disease in the country followed by its disappearance. It was only comparatively recently that the contagious nature of the disease was generally accepted. There is a good description of an epidemic in Philadelphia in 1793 by Robert Johnson (1806). He postulated that the disease was propagated at least to some extent by contagion, but the editor of Johnson 's publication added a footnote saying that he disagreed, as he believed the disease to be "exclusively of atmospheric origin . . . probably a deleterious gas." As recently as 1894 the eminent British epidemiologist Charles Creighton did not believe influenza was spread by contagion. Even in those days when few traveled faster than a horse could carry them, influenza spread so rapidly that people found it hard to believe it did not travel on the wind. Recent discoveries about the way virus diseases of animals spread from farm to farm suggest influenza may in fact spread on the wind. Now let us look more closely at the influenza calendar, as we may call it, over the last hundred years or so. There was an unusual period of thirty-four years from 1855 to 1889 during which no epidemics were reported. Then came a serious worldwide pandemic in 1889 arid recrudescences during the 65 Frontiers in Comparative Medicine next four years. At the time, that visitation was referred to as Asiatic influenza because it came from eastern Russia. During the twenty-eight years after 1890, lesser epidemics occurred every two or three years, and then the greatest of all epidemics swept around the world in 1918. The great pandemic of 1918-19 was called Spanish influenza , but there was really no justification for that name. It started as the First World War was ending, a time when there were movements of masses of people, many of them ill-nourished , poorly clothed, and living under crowded conditions. Influenza encircled the globe, killing an estimated 15 to 20 million people in twelve months, many more than were killed in the First World War during four and a half years. Never before or since has mankind suffered such a calamity. For the first time, influenza was associated with high mortality; moreover , it was people in the prime of life who were hardest hit. Another curious feature that was out of character, one Which still cannot be explained, was that there were three Waves separated by only a few months. In some places those people who had been affected in the first or second wave resisted the infection in subsequent waves, but in other places an attack during one wavegave no protection in the next. Not only did these waves spread with disconcerting swiftness but the disease struck people suddenly, and many died within a few days of becoming ill. I am old enough to remember fellow schoolboys collapsing suddenly without any warning. A proportion...


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