October i, 1891] 



NATURE 



515 



to be included among the diseases of which notification 

 is locally compulsory. The book is somewhat peculiar 

 in its arrangement, but in the essential qualities of im- 

 partiality and clearness leaves nothing to be desired. 

 .Many readers who do not require more than specimens 

 of evidence, will thank Dr. Sisley for compressing the 

 digest of " many thousands" of notes into such narrow 

 compass ; but other minds will require a chain of which 

 every link is massive, to guide them to the point of view 

 whence practical conclusions are palpable. If the manner 

 of statement is somewhat bare, and examples rather 

 scanty, in the exposition of a strong but disputed case, 

 the facts brought forward bear none the less value in 

 their neutral setting, and go far to justify the proposition 

 with which he confronts us at the outset, derived from a 

 study of the distribution of the disease and from its 

 pathological character. Valuable assistance from Dr. 

 Klein, Prof. Fleming, and many others, has enabled 

 him to include in his pages some interesting matter re- 

 lating to the microbic nature of the epidemic and its 

 relation to a similar disease in animals. After all that 

 has been conjectured on the latter point, it appears that 

 evidence of any unusual prevalence of influenza among 

 animals at the time is still wanting. 



The original scat of influenza, which has been ob- 

 scurely indicated in previous times as lying somewhere 

 " in the East," has now been discerned in Mongolian and 

 Chinese territory, for we have two independent accounts, 

 each speaking of influenza as not uncommon in some 

 parts of China. In Mongolia " it seldom proves fatal, 

 but travellers are careful to avoid it, and no one would 

 think of using the pot or ladle of a family suffering 

 from this sickness." If the disease is sporadic and 

 endemic in these countries, the population may be to 

 some degree protected against epidemic outbreaks, for 

 we have seen in Europe that the tendency to spread is 

 much less marked in a second invasion occurring within 

 one year, and least, on the whole, in those places where 

 it was previously most severe. 



The notes from Bokhara, translated in this volume, 

 are of great importance, for they show how a wet spring 

 had turned the neighbouring country into a perfect 

 marsh, from which, when the hot weather set in, poison- 

 ous exhalations were given forth, and how the people, 

 crowded together with horses, cattle, and sheep between 

 high walls, distressed and weak with starvation and 

 disease, were attacked much earlier than usual, in the 

 first heat of summer, with malaria, and how this was 

 quickly followed by an epidemic of influenza, reaching 

 its height in July 1889. The extension of the disease 

 westwards from Bokhara by the flight of convalescents 

 to Russia, and eastwards by caravans to post-stations in 

 Siberia, has been noticed in the official Report, and com- 

 pletes the evidence connecting the European epidemic 

 with the miserable condition of an Asiatic town. Upon 

 such a soil, influenza sprang into fatal activity, and ac- 

 quired, as we may fairly infer, a particular virulence. 

 In similar conditions, amid the filth, floods, and famines 

 of Asiatic countries, cholera and other plagues of men 

 and animals have been evolved and have set forth on 

 their destructive march. 



By reports from several medical officers, and by a 

 number of charts showing the curve of prevalence of the 

 NO. I 144. VOL. 44] 



disease in English and foreign cities, Dr. Sisley shows 

 that we have no experience of any sudden prostration of 

 a large population within a few days, such as was formerly 

 supposed to occur ; but that the rise is always gradual 

 from a few cases to hundreds and thousands, the maxi- 

 mum usually occurring from one to two months after the 

 first cases in the locality have been noted. Last century 

 Dr. Haygarth had been fortunate in discovering the 

 person who brought the infection to each place in his 

 district. If equal pains had been taken in 1890, when the 

 disease was on its way to us from Russia, the persons 

 who conveyed it from country to country might, no 

 doubt, have been identified. The author has not been 

 able to find a single instance in which there was a sudden 

 infection of a large number of people without the previous 

 existence of cases of the disease ; and wherever its 

 course was studied with care, it was seen to spread in 

 the same way as other infectious diseases. But the 

 " atmospheric " doctrine, though previously disproved 

 with regard to rabies, cholera, and pestilence in general, 

 still finds a stronghold in consumption and influenza. 



The classic examples of ships supposed to have been 

 attacked on the ocean by wind-borne influenza, as well 

 as those of towns supposed to have been prostrated " in 

 a single day," really bear testimony to the insidious 

 growth of the disease and to the necessity of early recog- 

 nition. Neither in this volume nor in others on the same 

 j subject is the fact sufficiently dwelt upon, that the geo- 

 I graphical distribution of this and of previous epidemics 

 1 in successive weeks and months was wholly unlike what 

 would have occurred if the germs had been largely 

 I spread, either by lower or by upper atmospheric currents. 

 I The total exemption of lighthouse-keepers, deep-sea 

 [ fishermen, and unvisited islands, is scarcely noticed by 

 I Dr. Sisley, but he considers the rarity of influenza among 

 prisoners to have been due to their removal from sources 

 j of contagion, and relates a very interesting case of 

 : apparent infection of a man on his way home from a 

 I light-ship through contact with the crew of a fishing-boat, 

 said to be in good health. 



Dr. Sisley concludes that there is no convincing proof 

 of transmission through unaffected persons, letters, &c.; 

 but a series of cases each of considerable weight surely 

 amounts to evidence strong enough to justify some 

 precautions, such as would be taken with the organic 

 dust from more serious diseases, e.g. scarlet fever 

 and diphtheria, which are so transmissible. There 

 is happily a great deal in common in the mode 

 of spread of most zymotic diseases, and disinfection 

 as usually practised could hardly be misapplied to in- 

 fluenza. The same may be said with regard to isolation, 

 for no attack, however trivial in itself, is a matter of in- 

 difference to the public, if it may result in widespread 

 illness, loss of work, and distress. A short retirement is 

 desirable in the interest both of the patient and of the 

 public. But Dr. Sisley can hardly desire that notification 

 should take place on exactly the same lines as that of 

 other diseases, for local authorities would with reason 

 wince at the expense ; and unless the notification were a 

 national undertaking, no district would be adequately 

 protected thereby from imported cases. Complete and 

 national measures of notification and isolation, with the 

 co-operation of local authorities, would be much more 



