ReginaldH. Noott
1890 The Lancet  
1235 school kept up so much better than in the girls', yet in the <end nearly as large a proportion of boys was attacked as girls. At the large schools in Chelmsford exactly the contrary was experienced ; 60 per cent. of the 200 boys suffered, 33 per cent. of the 1C4 girls, and 40 per cent. of the 150 infants. At Danbury 60 per cent. of the children under mine years and only 40 per cent. of those over that age were attacked. At Latchingdon 50 per cent. of the elder children and only 30 per
more » ... nd only 30 per cent. of the infants were affected. At Runwell the influence of the epidemic was only felt by such of the elder children as came from a particular district. At Great Waltham the boys and girls suffered about equally, but the infection seemed to have spread more rapidly amongst the boys. The infants are said not to have been attacked until a week later than the elder children, but the epidemic more rapidly attained its acme here 'than in either of the other departments. In many schools no after-effects have been observed. Other teachers probably more observant noted "general weariness and lack of interest," "languid appearance," "chronic laxity," "pallor and low spirits," "greater susceptibility to colds," " coughs and bronchitis," sores about face and body," &c. All the teachers with whom I have conversed assert that the children when they returned to school were very restless, and quite incapable of fixing the attention upon any subject, making teaching for some weeks a most disheartening task. Effects upon the cleath-rate amongst children in the rural districts.—During the past three months the death-rate has been abnormally high, the excess being entirely due to the mortality from whooping-cough and lung affections. Total Deaths of Clt.ildren under ffteen in Chelmsford and Maldon Rural Districts for the three months ending March 3lst, 1889. During the year 1889 the deaths among children were distributed as under: That the mortality amongst children has been excessive during the past three months is obvious. The deaths from lung diseases for the quarter are almost as numerous as the total for the whole of the past year. At the last census the proportion of children under fifteen years of age to each 1000 of population was in my districts 395, and as the total population is in round numbers 42,000 we have at last 16,000children. Fully half of these, I believe, suffered from the influenza. As only three deaths have been attributed to the direct effect of the disease, the mortality would be about 4 per 10,000 cases. If, on the other hand, we attribute the whole of the excessive mortality to the indirect effect, the deaths would number 4'5 per 1000 cases. In conclusion, we may ask, Do any of the facts I have recorded help us in forming an opinion as to the origin and mode of propagation of the disease ? Would its dissemination by contagion only account for its appearance in twentyfive parishes in the same week ? To do so we must assume a very high degree of infectivity. The rapidity with which the epidemic spread in some of the schools, causing them to be closed for lack of scholars within a week of its first appearance, might be explained on some such hypothesis; but, on the other hand, the small number of children affected in other schools in which well-marked cases occurred indicates so slight a degree of infectivity that we may well doubt whether it is at all contagious. The very varied manner in which the schools were affected by the epidemic would necessitate our also having to assume that the susceptibility of children in different localities varied in a most extraordinary manner. Whether contagious or not, how can we account for the fact that in many parishes the adults suffered so much more, both in point of numbers and in severity, than the children, whilst in the majority of distrists quite as large a proportion of children were attacked ? What had caused the diminished susceptibility in certain areas? At Pleshey, for instance, was it the prior epidemic of November? And was this an epidemic of the same disease as that which subsequently returned, to affect only the adult population, the children having been rendered nonsusceptible by the previous visit? Is it possible that some almost universally diffused organism has, under changed conditions, the extent of that change varying in different localities, acquired more or less rapidly a disease-producing virulency which normally it does not possess ? As succeeding generations increased in activity in those areas where the development was comparatively slow and gradual, the children being more susceptible, would be first affected, and the disease being mild in form and indefinite in character, would escape recognition as influenza, but possibly confersome slight degree of immunity from subsequent attack when the virus had increased in potency. In other cases where development was more rapid, the children again, as at Pleshey, might be first affected, and the symptoms be such as to indicate the closest resemblance to the fully developed disease. In such a case we should also expect the children to escape when the disease at a later period assumed a more virulent type, which is exactly what did occur. In the other districts the conditions favourable to the rapid development of the virulency of the organism existed in such a high degree that young and old became almost at the same time susceptible to its influence. As to what the conditions above referred to are, if they exist, we are at present profoundly ignorant, but we must assume that they are abnormal and temporary; hence, after a period which may vary in different places, the organism would more or less rapidly revert to its original condition. This process of attenuation and the diminished number of susceptible individuals-diminished both on account of the decreased activity of the virus and the partial immunity conferred by an attack of the disease-would account for the gradual disappearance of the epidemic. With reference to the incubation period I dare not at present even offer an opinion. It has been asserted that, given a short incubation period and a very high degree of infectivity and susceptibility, everything in connexion with the epidemic could be accounted for. My investigations have led me to exactly the opposite conclusion. The theory I have just had the temerity to propound seems to me to explain much more satisfactorily the many varied and often apparently contradictory facts which I have observed. Whether it can as readily explain the observations of others I am not at present prepared to discuss. Chelmsford. THE following brief notes, contributed by permission of the Superintendent, refer to the influenza epidemic as observed among the patients, the staff, and others connected with the above institution during the first four months of the present year. The first case was observed on Jan. 8th, the last case on May 3rd, the epidemic reaching its height about Feb. 14th. During this time 206 individuals were attacked, of whom 176 were over eighteen years of age and 30 under; of these latter 24 were under twelve years of age, and of the 176 adults 141 were males and 35 females Of 416 male patients 74 were affected, or 17 7 per cent. ; of 151 female patients 20 were affected, or 13 2 per cent.; of 84 male attendants 46 were affected, or 54'7 per cent. ; of 34 female attendants 11 were affected, or 32 3 per cent. This accounts for 151 out of the total number, 206; the remaining 55 occurred in the families of members of the staff, and among those members of the staff who are not attendants. The average time during which the 46 male attendants were absent from duty was 11'2 days; the longest absence being 21 days and the shortest 6 days. It was noticeable that the length of absence from duty was in direct ratio to the age of the
doi:10.1016/s0140-6736(02)05867-1 fatcat:edwef3hmvjgtdevfqoqft45pfu