POINTS NOTICEABLE IN THE EPIDEMIC OF 1889-1890.* 
By Benjamin E. Cotting, M.D. 
The affection recently and, in many places, still upon 
the people, demonstrates on a grand scale the doctrines 
frequently heard in this Society within the last thirty or 
forty years,—namely, that any disease, though ordinarily 
sporadic, or, in occasional outbreaks, usually confined to 
limited localities, may from time to time spread out with 
greater or less violence, cover large territories, and some- 
times nearly or quite encircle the globe; and that this 
takes place from apparently inherent causes of which little 
or nothing is as yet known—the affection passing over 
land and sea unrestrained and unmodified—starting up as 
unexpectedly perhaps and pursuing its zig-zag course, 
avoiding one spot and seizing upon another, as arbitrarily 
as the tempest or the hurricane. Sanitary cordons 
and governmental edicts seem to have as little influence 
in such cases as danger signals on the gale or the tornado. 
If the learned meteorologist, when asked the cause of 
storms, could with propriety answer “the sun,” with equal 
propriety may the sanitarian, mindful of Nature’s Plan, 
attribute diseases and their movements to humanity. 
However originating or propagated, all epidemics must 
appear where there are human beings, sedentary or in 
motion ; and if the morbific influence (micro-organis- 
mic ?) pass out beyond habitable regions, as quite likely, 
its presence there can be shown only by attacks on casual 
passers into such places. Ships, which after having left 
unaffected ports have had their crews attacked in mid-ocean, 
afford conspicuous evidence of the diffusive tenden- 
* Desultory remarks at a meeting of the Norfolk District Medical Society, 
Jan. 28,1890,—on being called upon by the President for an “ oral communication ’ 
bn this subject. cies of epidemics.* Other like proofs are not wanting. 
So far, this time (without hindrance to science) the 
“ traditional trunk ” has not been brought into requisition ; 
raiment and rags have not been charged with spreading 
the infection; and the postal-card has escaped with only 
an occasional or mild imputation.! The “authorities,” 
here and elsewhere, seem to have contented themselves 
with noting the coming and progress of the affection, 
numbering its victims, and counting up and tabulating 
the casualties. 
Whether the epidemic originated in the Philippines, or 
started from North-eastern Russia, or elsewhere, is of 
interest chiefly to the medical historian. It is noticeable, 
however, that it has gone on its own way apparently with- 
out any attempt to arrest it, and seems to be disappearing 
through laws of its own. 
Thus in departure as in onset, this epidemic has differed 
little, if any, from those of former times; or, indeed, 
from epidemics of other diseases. That of 1658, accord- 
ing to Willis, “ceased of itself,” like so many others. 
Some few years ago a London authority said of a small- 
pox epidemic of considerable duration, but then suddenly 
come to an end, “ whence it came no one can tell, why it 
has disappeared no one knows”—a conclusion worthy of 
commendation for truthfulness and candor. 
* In 1837, on board H .M.S. Thunderer, “ at sea,” the epidemic “ suddenly made 
its appearance while she was on her homeward passage from [unaffected] Malta, 
four days before she arrived in Plymouth,” her destined port. Syd. Soc. Infl., p. 359. 
In November, 1848, cholera broke out, nearly simultaneously, in two vessels in 
mid-ocean, about a thousand miles apart, one sixteen days out and the other 
twenty-seven, from an unaffected port.—Br. Med-Chir. Rev., No. 72, p. 444. 
The curious searcher may find probably many similar instances; but these 
are enough for examples. 
In 1837, a professor told me, a medical student, of a case (with names and 
dates) wherein after a long passage from an unaffected port in the East Indies, a 
passenger, the day after arrival home, without known exposure, was taken down 
with scarlet fever. The infection must have been far off-shore, or the attack 
culminated without incubation. There was not the slightest chance to attribute 
the disease to any kind of luggage whatever. 
t The weather, which, while it may occasion multifarious discomforts and dis- 
orders even, probably has little or nothing to do with the rise and progress of 
epidemics, if indeed of ordinary diseases, generally comes in for its share of blame. 
This year it is its variable mildness. Fortunately for those attacked there have 
not been any very low degrees of cold. Of the epidemic of 1698, one English 
writer says there was in January “ a very stinking fog" ! If the outbreak of a disease is mysterious, its continued 
absence occasionally from a place is equally so—abundance 
of material apparently always remaining. For some 
years, not long ago, typhoid fever was unobserved in a 
neighboring town, but now and for some time past the 
locality cannot boast of such exemption. A curious 
confirmation of our general doctrine has been given, ap- 
parently unintentionally, in a recent statement of an 
eminent specialist, that, without any apparent alteration 
in the condition or habits of the people, scabies had in his 
experience been more than once absent, for years at a 
time, so as to render it then impossible to obtain speci- 
mens enough to demonstrate adequately the affection to 
the students at the Medical School. 
Abroad, one of the principal questions under discussion 
appears to be whether this disease is itself or something 
else,—whether it is the same as, or akin to, the French 
“la grippe,” the tropical “dengue,” the English “influ- 
enza,” or “the grip” of this country; whether, in short, 
anything like it ever occurred before. This question also< 
is of no very great importance (our concern being with 
the exigencies of the present), since no two epidemics 
have been exactly alike any more than two individual 
cases of any common disease are absolutely identical. 
Moreover, the terms used in descriptions vary so 
much from generation to generation that exactness of 
meaning is rendered often difficult if not impossible. 
The passing epidemic may be peculiar, perhaps, in 
suddenness of attack, rapidity to a crisis, quick subsidence 
of urgent or distressing symptoms, disproportionate de- 
bility or lassitude in lengthened convalescence,—though 
not without parallel instances in the epidemics of old or of 
those within our own time. 
Of course, such a rushing disease must have an “ap- 
propriate treatment,” and many are the plans suggested; 
but it is doubtful whether any better can be devised than 
that recommended in past times (e. g. by Rainey)— namely, rest in bed, warmth, mildly modified diet, and 
very careful avoidance of over-exertion or exposure dur- 
ing the long convalescence. Such a procedure, according 
to most authorities, seems sufficient for even the severest 
cases. The French, judged by their journals, now put 
their chief reliance upon antipyrine and opiates ; but a 
writer from Paris states that there “ the symptoms put 
down as influenza are in many cases those described as 
due to overdoses of antipyrine really due to the 
action of the remedy.” The English methods are very 
varied ; and, of course, sufficiently disturbing. The 
rapidity of the symptoms seems to puzzle those intent on 
“ a course of treatment.” A last dictum, with a caution 
against antipyrine, suggests a return to the old fashion of 
treating symptoms, and, omitting venesection and mercu- 
rials once considered essential, offers as agents therefor 
“diaphoretics, anodynes, stimulants, and tonics,”—i-arange 
of medication one would think sufficient for the onset, 
progress and termination of this or any other disease. 
Although much good has been attributed hereabouts to 
some of the above mentioned drugs, antipyretics especially, 
some of the cases, now as of old, where the onset was of 
the most severe and painful form, have passed to a crisis 
and to a happy termination without any medication what- 
ever,—the severest pains disappearing spontaneously in 
less time than usually required for the effect of an opiate. 
If imaginary doses have been followed by the lucky re- 
sults blatantly attributed to their agency, surely “ expecta- 
tion ” may be resorted to without fear of unpleasant con- 
sequences. 
The total number of deaths directly or indirectly from 
the present disease (however named) will doubtless prove 
to be very large, as large perhaps as that in any epidemic 
of cholera, again unwisely foreboded, or of yellow fever ; 
yet no epidemic of like extent ever caused so little alarm 
among the people, chiefly because before its appearance 
it was not proclaimed a fatal affection,—the moral of 
which is self-evident.