THE WEATHEK, INFLUENZA, AND DISEASE. 587 



class is, by reason of its work, the first to be attacked among the community. On the 

 other hand, the numbers being limited, the end of the epidemic does not correspond 

 with the end of the attack when all classes are involved, as is the case in the Infirmary. 

 The data, then, derived from the Post Office returns are of value in arriving at the true 

 date of the onset, but not of the duration of the epidemic. In dealing with the records 

 of the Infirmary it must also be remembered that cases of influenza are rarely admitted 

 simply as influenza, as they are usually unsuitable for treatment in a hospital which 

 does not admit cases of infectious disease. In fact, most of the cases are admitted for 

 acute complications, of which the cause may not be found until after residence in 

 hospital, when a history of a preceding attack of influenza is elicited. 



Sir Arthur Mitchell and Dr Buchan, in the papers already quoted, point out that 

 the epidemics of influenza recorded in this country have usually occurred during the 

 winter months, and have then been accompanied by complications which were chiefly 

 respiratory and circulatory in type. In spring epidemics the nervous centres showed a 

 greater tendency to be implicated ; and in the only summer epidemic previously 

 recorded in this country during the nineteenth century, diarrhceal disorders were very 

 prevalent. These authors were unable to trace any connection between the weather, as 

 regards the element of temperature, and the epidemics of 1889-90. 



General Description of the Six Epidemics. 



In the records of the Edinburgh Eoyal Infirmary from 1888 to 1895, the first case 

 of influenza admitted into the hospital was registered in the week ending the 21st of 

 December 1889, one week later than the first death registered in London from that 

 disease. The first case diagnosed as influenza among the employees of the Post Office 

 occurred on 20th December, a fact which corresponds so closely with the Infirmary 

 records that the beginning of the first epidemic may be definitely stated to be the 

 week 15th-21st December 1889. The maximum in the Post Office occurred in the 

 following week, in the Infirmary not till the second week of 1890, a week earlier than 

 the maximum mortality from influenza in London. The Post Office epidemic had 

 practically ceased by the middle of January, but cases continued to be admitted into 

 the Infirmary until the week ending 15th February. The epidemic may therefore 

 be regarded as having lasted for nine weeks. Single cases were reported in the 

 Infirmary up to the end of June. 



No further entries were made in the books until the third week of November 1890, 

 when two isolated cases were admitted. Scattered cases continued to be taken in until 

 May 1891, when the numbers increased considerably, and only began to diminish early 

 in July. In the Post Office, patients were invalided owing to influenza in rather scanty 

 numbers throughout March and April, and in greater numbers in May and June. The 

 epidemic, however, never reached any great proportions. In London it started in the 

 middle of April. A glance at the numbers of respiratory cases treated at the Infirmary 



VOL. XXXVIII. PART III. (NO. 16). 4 M 



