'A most protean disease': aligning medical knowledge of modern influenza, 1890-1914

Abstract

This article reconstructs the process of defining influenza as an infectious disease in the contexts of British medicine between 1890 and 1914. It shows how professional agreement on its nature and identity involved aligning different forms of knowledge produced in the field (public health), in the clinic (metropolitan hospitals) and in the laboratory (bacteriology). Two factors were crucial to this process: increasing trust in bacteriology and the organisation of large-scale collective investigations into influenza by Britain's central public authority, the Medical Department of the Local Government Board. These investigations integrated epidemiological, clinical and bacteriological evidence into a new definition of influenza as a specific infection, in which a germ - Bacillus influenzae - was determined as playing a necessary but not sufficient role in its aetiology, transmission and pathogenesis. In defining 'modern influenza', bacteriological concepts and techniques were adapted to and selectively incorporated into existing clinical, pathological and epidemiological approaches. Mutual alignment thus was crucial to its construction and, more generally, to shaping developing relationships between laboratory, clinical and public health medicine in turn-of-the-century Britain. While these relationships were marked by tension and conflict, they were also characterised by important patterns of convergence, in which the problems, interests and practices of public health professionals, clinicians and laboratory pathologists were made increasingly commensurable. Rather than retrospectively judge the late nineteenth-century definition of influenza as being based on the wrong microbe, this article argues for the need to examine how it was established through a particular alignment of medical knowledge, which then underpinned medical approaches to the disease up to and beyond the devastating 1918-19 pandemic.

Figure 1:

Deaths from influenza (London), 1840–90. Source: H.F. Parsons, Report on the Influenza Epidemic of 1889–1890 (London: HMSO, 1891).

Figure 2:

Annual influenza death rate per million in England and Wales, 1847–1905. Source: A. Newsholme, ‘Influenza for the Public Health Standpoint’, The Practitioner, LXXVII (1907), 118.

Figure 3:

Henry Franklin Parsons (1846–1913). Source: BMJ, 8 November (1913), 1263.

Figure 4:

Questionnaire on the Origin and spread of influenza, 1890. Influenza is in scare quotes. Source: Henry Parsons, Report on the Influenza Epidemic of 1889–1890 (July 1891), 120.

Figure 5:

Global Map of 1889–90 Influenza Epidemic. Bokhara, in the Russian steppe, was identified as the geographical origin of the epidemic. Source: Henry Parsons, Report on the Influenza Epidemic of 1889–1890 (July 1891).

Figure 6:

‘Uncomplicated influenza’. Fever chart of Bedford Pierce, 28, and Rosina Hounslow, the first recognised case at Barts, 30 December 1889. Source: S. West, ‘The Influenza Epidemic of 1890’, St. Bartholomew’s Hospital Reports, XXVI (1890), 212.

Figure 7:

Relapsing fever. A standard reference was Otto Frentzel, ‘Zur Kenntnis des Fieberganges bei Influenza’, Centralblatt fur klinische Medicin (11 January 1890), who characterised three types of fever epidemic in the Municipal General Hospital at Friedrichshain. Type II, shown here, was a relapsing fever that could last for a week, with significant temperature fluctuations, in which the patient might appear to recover, only for the fever to return. Source: J.W.S. Moore, ‘Influenza’, in J.W. Ballantyne (ed.), Encyclopaedia Medica (Edinburgh: Green & Son, 1919), 517

Figure 8:

Apyretic fever. From Otto Frentzel, ‘Zur Kenntnis des Fieberganges bei Influenza’, Centralblatt fur klinische Medicin (11 January 1890). Type III ‘apyretic’ fever, marked by a sudden fall in temperature below normal, indicative of the onset of serious secondary complications, especially pneumonia. Source: J.W.S. Moore, ‘Influenza’, in J.W. Ballantyne (ed.), Encyclopaedia Medica (Edinburgh: Green & Son, 1919), 517

Figure 9:

Edward Emanuel Klein, MD, FRS (1844–1925). Source: Wellcome Library.

Figure 10:

Walter Hall’s Pfeiffer bacillus. Cover-glass specimen showing ‘an almost pure culture of the specific bacillus’. Source: E. Klein, ‘Report on influenza in its clinical and pathological aspects’, in Parsons, Further Report and Papers on Epidemic Influenza, 1889–92 (London: HMSO, 1893), 120

Figure 11:

Aetiology of influenza. Micrococcus Catarrhalis identified by M.H. Gordon as the cause of ‘influenza’ in Hertford, January 1905. Source: R.A. Dunn & M.H. Gordon, ‘Remarks on Clinical and Bacteriological Aspects of an Epidemic Simulating Influenza which Recently Occured in East Herts district’, BMJ, 26 August (1905), 425.