Part 23
The bacteriology of influenza is discussed in the article on PARASITIC DISEASES. The disease is often called "Russian" influenza, and its origin in 1889 suggests that the name may have some foundation in fact. A writer, who saw the epidemic break out in Bokhara, is quoted by him to the following effect:--"The summer of 1888 was exceptionally hot and dry, and was followed by a bitterly cold winter and a rainy spring. The dried-up earth was full of cracks and holes from drought and subsequent frost, so that the spring rains formed ponds in these holes, inundated the new railway cuttings, and turned the country into a perfect marsh. When the hot weather set in the water gave off poisonous exhalations, rendering malaria general." On account of the severe winter, the people were enfeebled from lack of nourishment, and when influenza broke out suddenly they died in large numbers. Europeans were very severely affected. Russians, hurrying home, carried the disease westwards, and caravans passing eastwards took it into Siberia. There is a striking similarity in the conditions described to those observed in connexion with outbreaks of other diseases, particularly typhoid fever and diphtheria, which have occurred on the supervention of heavy rain after a dry period, causing cracks and fissures in the earth. Assuming the existence of a living poison in the ground, we can easily understand that under certain conditions, such as an exceptionally dry season, it may develop exceptional properties and then be driven out by the subsequent rains, causing a violent outbreak of illness. Some such explanation is required to account for the periodical occurrence of epidemic and pandemic diffusions starting from an endemic centre. We may suppose that a micro-organism of peculiar robustness and virulence is bred and brought into activity by a combination of favourable conditions, and is then disseminated more or less widely according to its "staying power," by human agency. Whether central Asia is an endemic centre for influenza or not there is no evidence, but the disease seems to be more often prevalent in the Russian Empire than elsewhere. Extensive outbreaks occurred there in 1886 and 1887, and it is certain that the 1889 wave was active in Siberia at an earlier date than in Europe, and that it moved eastwards. The hypothesis that it originated in China is unsupported by evidence. But whatever may be the truth with regard to origin, the dissemination of influenza by human agency must be held to be proved. This is the most important addition to our knowledge of the subject contributed by recent research. The upshot of the inquiry by Dr Parsons was to negative all theories of atmospheric influence, and to establish the conclusion that the disease was "propagated mainly, perhaps entirely, by human intercourse."
He found that it prevailed independently of climate, season and weather; that it moved in a contrary direction to the prevailing winds; that it travelled along the lines of human intercourse, and not faster than human beings can travel; that in 1889 it travelled much faster than in previous epidemics, when the means of locomotion were very inferior; that it appeared first in capital towns, seaports and frontier towns, and only affected country districts later; that it never commenced suddenly with a large number of cases in a place previously free from disease, but that epidemic manifestations were generally preceded for some days or weeks by scattered cases; that conveyance of infection by individuals and its introduction into fresh places had been observed in many instances; that persons brought much into contact with others were generally the first to suffer; that persons brought together in large numbers in enclosed spaces suffered more in proportion than others, and that the rapidity and extent of the outbreak in institutions corresponded with the massing together of the inmates.
These conclusions, based upon the 1889-1890 epidemic, have been confirmed by subsequent experience, especially in regard to the complete independence of season and weather shown by influenza. It has appeared and disappeared at all seasons and in all weathers and only popular ignorance continues to ascribe its behaviour to atmospheric conditions. In Europe, however, it has prevailed more often in winter than in summer, which may be due to the greater susceptibility of persons in winter, or, more probably, to the fact that they congregate more in buildings and are less in the open air during that part of the year. No doubt is any longer entertained of its infectious character, though the degree of infectivity appears to vary considerably. Many cases have been recorded of individuals introducing it into houses, and of all or most of the other inmates then taking it from the first case. Difficulties in preventing the spread of infection are due to (1) the shortness of the period of incubation, (2) the disease being infectious in the earliest stages before the nature of the illness is recognized, (3) the milder varieties being equally infectious with the severe attacks, and the patient going to work and spreading the infection, (4) the diagnosis often being difficult, influenza being possibly confused with ordinary catarrhal attacks, typhoid fever and other diseases. Domestic animals seem to be free from any suspicion of being liable to human influenza. Sanitary conditions, other than overcrowding, do not appear to exercise any influence on the spread of influenza.
Influenza has been shown to be an acute specific fever having nothing whatever to do with a "bad cold." There may be some inflammation of the respiratory passages, and then symptoms of catarrh are present, but that is not necessarily the case, and in some epidemics such symptoms are quite exceptional. This had been recognized by various writers before the 1889 visitation, but it had not been generally realized, as it has been since, and some medical authorities, who persisted in regarding influenza as essentially a "catarrhal" affection, were chiefly to blame for a widespread and tenacious popular fallacy.
Leichtenstern, in his masterly article in Nothnagel's _Handbuch_, divides the disease as follows:--(1) Epidemic influenza vera caused by Pfeiffer's bacillus; (2) Endemic-epidemic influenza vera, which occurs several years after a pandemic and is caused by the same bacillus; (3) Endemic influenza nostras or eatarrhal fever, called _la grippe_, and bearing the same relation to true influenza as cholera nostras does to Asiatic cholera.
The "period of incubation" is one to four days. Susceptibility varies greatly, but the conditions that influence it are matters of conjecture only. It appears that the inhabitants of Great Britain are less susceptible than those of many other countries. Dr Parsons gives the following list, showing the proportion of the population estimated to have been attacked in the 1889-1890 epidemic in different localities:--
+---------------------+---------+---------------------+---------+ | Place. |Per cent.| Place. |Per cent.| +---------------------+---------+---------------------+---------+ | St Petersburg | 50 | Portugal | 90 | | Berlin | 33 | Vienna | 30-40 | | Nuremberg | 67 | Belgrade | 33 | | Grand-Duchy of Hesse| 25-30 | Antwerp | 33 | | Grand-Duchy, other | | Gaeta | 50-77 | | Districts | 50-75 | Massachusetts | 39 | | Heligoland | 50 | Peking | 50 | | Budapest | 50 | St Louis (Mauritius)| 67 | +---------------------+---------+---------------------+---------+
In and about London he reckoned roughly from a number of returns that the proportion was about 12½% among those employed out of doors and 25% among those in offices, &c. The proportion among the troops in the Home District was 9.3%. The General Post Office made the highest return with 33.6%, which is accounted for partly by the enormous number of persons massed together in the same room in more than one department, and partly by the facilities for obtaining medical advice, which would tend to bring very light cases, unnoticed elsewhere, upon the record. No public service was seriously disorganized in England by sickness in the same manner as on the continent of Europe. Some individuals appear to be totally immune; others take the disease over and over again, deriving no immunity, but apparently greater susceptibility from previous attacks.
The symptoms were thus described by Dr Bruce Low from observations made in St Thomas's Hospital, London, in January 1890:--
The invasion is sudden; the patients can generally tell the time when they developed the disease; e.g. acute pains in the back and loins came on quite suddenly while they were at work or walking in the street, or in the case of a medical student, while playing cards, rendering him unable to continue the game. A workman wheeling a barrow had to put it down and leave it; and an omnibus driver was unable to pull up his horses. This sudden onset is often accompanied by vertigo and nausea, and sometimes actual vomiting of bilious matter. There are pains in the limbs and general sense of aching all over; frontal headache of special severity; pains in the eyeballs, increased by the slightest movement of the eyes; shivering; general feeling of misery and weakness, and great depression of spirits, many patients, both men and women, giving way to weeping; nervous restlessness; inability to sleep, and occasionally delirium. In some cases catarrhal symptoms develop, such as running at the eyes, which are sometimes injected on the second day; sneezing and sore throat; and epistaxis, swelling of the parotid and submaxillary glands, tonsilitis, and spitting of bright blood from the pharynx may occur. There is a hard, dry cough of a paroxysmal kind, worst at night. There is often tenderness of the spleen, which is almost always found enlarged, and this persists after the acute symptoms have passed. The temperature is high at the onset of the disease. In the first twenty-four hours its range is from 100° F. in mild cases to 105° in severe cases.
Dr J. S. Bristowe gave the following description of the illness during the same epidemic:--
The chief symptoms of influenza are, coldness along the back, with shivering, which may continue off and on for two or three days; severe pain in the head and eyes, often with tenderness in the eyes and pain in moving them; pains in the ears; pains in the small of the back; pains in the limbs, for the most part in the fleshy portions, but also in the bones and joints, and even in the fingers and toes; and febrile temperature, which may in the early period rise to 104° or 105° F. At the same time the patient feels excessively ill and prostrate, is apt to suffer from nausea or sickness and diarrhoea, and is for the most part restless, though often (and especially in the case of children and those advanced in age) drowsy.... In ordinary mild cases the above symptoms are the only important ones which present themselves, and the patient may recover in the course of three or four days. He may even have it so mildly that, although feeling very ill, he is able to go about his ordinary work. In some cases the patients have additionally some dryness or soreness of the throat, or some stiffness and discharge from the nose, which may be accompanied by slight bleeding. And in some cases, for the most part in the course of a few days, and at a time when the patient seems to be convalescent, he begins to suffer from wheezing in the chest, cough, and perhaps a little shortness of breath, and before long spits mucus in which are contained pellets streaked or tinged with blood.... Another complication is diarrhoea. Another is a roseolous spotty rash.... Influenza is by no means necessarily attended with the catarrhal symptoms which the general public have been taught to regard as its distinctive signs, and in a very large proportion of cases no catarrhal condition whatever becomes developed at any time.
Several writers have distinguished four main varieties of the disease--namely, (1) nervous, (2)gastro-intestinal, (3)respiratory, (4) febrile, a form chiefly found in children. Clifford Allbutt says, "Influenza simulates other diseases." Many forms are of typhoid or comatose types. Cardiac attacks are common, not from organic disease but from the direct poisoning of the heart muscle by influenza.
Perhaps the most marked feature of influenza, and certainly the one which victims have learned to dread most, is the prolonged debility and nervous depression that frequently follow an attack. It was remarked by Nothnagel that "Influenza produces a specific nervous toxin which by its
## action on the cortex produces psychoses." In the Paris epidemic of 1890
the suicides increased 25%, a large proportion of the excess being attributed to nervous prostration caused by the disease. Dr Rawes, medical superintendent of St Luke's hospital, says that of insanities traceable to influenza melancholia is twice as frequent as all other forms of insanity put together. Other common after-effects are neuralgia, dyspepsia, insomnia, weakness or loss of the special senses,
## particularly taste and smell, abdominal pains, sore throat, rheumatism
and muscular weakness. The feature most dangerous to life is the special liability of patients to inflammation of the lungs. This affection must be regarded as a complication rather than an integral part of the illness. The following diagram gives the annual death-rate per million in England and Wales, and is taken from an article by Dr Arthur Newsholme in _The Practitioner_ (January 1907).
The deaths directly attributed to influenza are few in proportion to the number of cases. In the milder forms it offers hardly any danger to life if reasonable care be taken, but in the severer forms it is a fairly fatal disease. In eight London hospitals the case-mortality among in-patients in the 1890 outbreak was 34.5 per 1000; among all patients treated it was 1.6 per 1000. In the army it was rather less.
The infectious character of influenza having been determined, suggestions were made for its administrative control on the familiar lines of notification, isolation and disinfection, but this has not hitherto been found practicable. In March 1895, however, the Local Government Board issued a memorandum recommending the adoption of the following precautions wherever they can be carried out:--
1. The sick should be separated from the healthy. This is especially important in the case of first attacks in a locality or a household.
2. The sputa of the sick should, especially in the acute stage of the disease, be received into vessels containing disinfectants. Infected articles and rooms should be cleansed and disinfected.
3. When influenza threatens, unnecessary assemblages of persons should be avoided.
4. Buildings and rooms in which many people necessarily congregate should be efficiently aerated and cleansed during the intervals of occupation.
There is no routine treatment for influenza except bed. In all cases bed is advisable, because of the danger of lung complications, and in mild ones it is sufficient. Severer ones must be treated according to the symptoms. Quinine has been much used. Modern "anti-pyretic" drugs have also been extensively employed, and when applied with discretion they may be useful, but patients are not advised to prescribe them for themselves.
[Illustration]
Sir Wm. Broadbent in a note on the prophylaxis of influenza recommends quinine in a dose of two grains every morning, and remarks: "I have had opportunities of obtaining extraordinary evidence of its protective power. In a large public school it was ordered to be taken every morning. Some of the boys in the school were home boarders, and it was found that while the boarders at the school took the quinine in the presence of a master every morning, there were scarcely any cases of influenza among them, although the home boarders suffered nearly as much as before." He continues, "In a large girls' school near London the same thing was ordered, and the girls and mistresses took their morning dose but the servants were forgotten. The result was that scarcely any girl or mistress suffered while the servants were all down with influenza."
The liability to contract influenza, and the danger of an attack if contracted, are increased by depressing conditions, such as exposure to cold and to fatigue, whether mental or physical. Attention should, therefore, be paid to all measures tending to the maintenance of health. Persons who are attacked by influenza should at once seek rest, warmth and medical treatment, and they should bear in mind that the risk of relapse, with serious complications, constitutes a chief danger of the disease.
In addition to the ordinary text-books, see the series of articles by experts on different aspects in _The Practitioner_ (London) for January 1907.
IN FORMÂ PAUPERIS (Latin, "in the character of pauper"), the legal phrase for a method of bringing or defending a case in court on the part of persons without means. By an English statute of 1495 (11 Hen. VII. c. 12), any poor person having cause of action was entitled to have a writ according to the nature of the case, without paying the fees thereon. The statute of 1495 was repealed by the Statute Law Revision and Civil Procedure Act 1883, but its provisions, as well as the chancery practice were incorporated into one code and embodied in the rules of the Supreme Court (O. xvi. rr. 22-31). Now any person may be admitted to sue as a pauper, on proof that he is not worth £25, his wearing apparel and the subject matter of the cause or matter excepted. He must lay his case before counsel for opinion, and counsel's opinion thereon, with an affidavit of the party suing that the case contains a full and true statement of all the material facts to the best of his knowledge and belief, must be produced before the proper officers to whom the application is made. A person who desires to defend as a pauper must enter an appearance to a writ in the ordinary way and afterwards apply for an order to defend as a pauper. Where a person is admitted to sue or defend as a pauper, counsel and solicitor may be assigned to him, and such counsel and solicitor are not at liberty to refuse assistance unless there is some good reason for refusing. If any person admitted to sue or defend as a pauper agrees to pay fees to any person for the conduct of his business he will be dispaupered. Costs ordered to be paid to a pauper are taxed as in other cases. Appeals to the House of Lords _in formâ pauperis_ were regulated by the Appeal (Formâ Pauperis) Act 1893, which gave the House of Lords power to refuse a petition for leave to sue.
INFORMATION (from Lat. _informare_, to give shape or form to, to represent, describe), the communication of knowledge; in English law, a proceeding on behalf of the crown against a subject otherwise than by indictment. A criminal information is a proceeding in the King's bench by the attorney-general without the intervention of a grand jury. The attorney-general, or, in his absence, the solicitor-general, has a right _ex officio_ to file a criminal information in respect of any indictments, but not for treason, felonies or misprision of treason. It is, however, seldom exercised, except in cases which might be described as "enormous misdemeanours," such as those peculiarly tending to disturb or endanger the king's government, e.g. seditions, obstructing the king's officers in the execution of their duties, &c. In the form of the proceedings the attorney-general is said to "come into the court of our lord the king before the king himself at Westminster, and gives the court there to understand and be informed that, &c." Then follows the statement of the offence as in an indictment. The information is filed in the crown office without the leave of the court. An information may also be filed at the instance of a private prosecutor for misdemeanours not affecting the government, but being peculiarly flagrant and pernicious. Thus criminal informations have been granted for bribing or attempting to bribe public functionaries, and for aggravated libels on public or private persons. Leave to file an information is obtained after an application to show cause, founded on a sworn statement of the material facts of the case.
Certain suits might also be filed in Chancery by way of information in the name of the attorney-general, but this species of information was superseded by Order 1, rule 1 of the Rules of the Supreme Court, 1883, under which they are instituted in the ordinary way. Informations in the Court of Exchequer in revenue cases, also filed by the attorney-general, are still resorted to (see _A.-G._ v. _Williamson_, 1889, 60 L.T. 930).
INFORMER, in a general sense, one who communicates information. The term is applied to a person who prosecutes in any of the courts of law those who break any law or penal statute. Such a person is called a common informer when he furnishes evidence on criminal trials or prosecutes for breaches of penal laws solely for the purpose of obtaining the penalty recovered, or a share of it. An action by a common informer is termed a _popular_ or _qui tam_ action, because it is brought by a person _qui tam pro domino rege quam pro se ipso sequitur_. A suit by an informer must be brought within a year of the offence, unless a specific time is prescribed by the statute. The term informer is also used of an accomplice in crime who turns what is called "king's evidence" (see ACCOMPLICE). In Scotland, informer is the term applied to the party who, in criminal proceedings, sets the lord advocate in motion.
INFUSORIA, the name given by Bütschli (following O.F. Ledermüller, 1763) to a group of Protozoa. The name arose from the procedure adopted by the older microscopists to obtain animalcules. Infusions of most varied organic substances were prepared (hay and pepper being perhaps the favourite ones), the method of obtaining them including maceration and decoction, as well as infusion in the strict sense; they were then allowed to decompose in the air, so that various living beings developed therein. As classified by C. G. Ehrenberg in his monumental _Infusionstierchen als volkommene Organismen_, they included (1) Desmids, Diatoms and Schizomycetes, now regarded as essentially Plant Protista or Protophytes; (2) Sarcodina (excluding Foraminifera, as well as Radiolaria, which were only as yet known by their skeletons, and termed Polycystina), and (3) Rotifers, as well as (4) Flagellates and Infusoria in our present sense. F. Dujardin in his _Histoire des zoophytes_ (1841) gave nearly as liberal an interpretation to the name; while C. T. Van Siebold (1845) narrowed it to its present limits save for the admission of several Flagellate families. O. Bütschli limited the group by removing the Flagellata, Dinoflagellata and Cystoflagellata (q.v.) under the name of "Mastigophora" proposed earlier by R. M. Diesing (1865). We now define it thus:--Protozoa bounded by a permanent plasmic pellicle and consequently of definite form, never using pseudopodia for locomotion or ingestion, provided (at least in the young state) with numerous cilia or organs derived from cilia and equipped with a double nuclear apparatus: the larger (mega-) nucleus usually dividing by constriction, and disappearing during conjugation: the smaller (micro-) nucleus (sometimes multiple) dividing by mitosis, and entering into conjugation and giving rise to the cycle of nuclei both large and small of the race succeeding conjugation.
[Illustration: FIG. i. Ciliata.
1. _Opalinopsis sepiolae_, Foett.: a parasitic Holotrichous mouthless Ciliate from the liver of the Squid. a, branched meganucleus; b, vacuoles (non-contractile).
2. A similar specimen treated with picrocarmine, showing a remarkably branched and twisted meganucleus (a), in place of several nuclei.
3. _Anoplophrya naidos_, Duj.; a mouthless Holotrichous Ciliate parasitic in the worm Nais. a, the large axial meganucleus; b, contractile vacuoles.
4. _Anoplophrya prolifera_, C. and L.; from the intestine of _Clitellio_. Remarkable for the adhesion of incomplete fission-products in a metameric series. a, meganucleus.
5. _Amphileptus gigas_, C. and L. (Gymnostomaceae). b, contractile vacuoles; c, trichocysts (see fig. 2); d, meganucleus; e. pharynx.