The Sphinx of Epidemic Diseases Pt.1

The parallels between Covid-19 and the "Russian influenza" of the 1890s are becoming increasingly apparent. Was that pandemic also due to a coronavirus and what lessons might it hold for the present?

“Influenza is the very Proteus of diseases, a malady which assumes so many different forms that it seems to be not one, but all diseases epitome”.

—Sir Morell Mackenzie, Fortnightly Review, 1891.

The fourth wave of the pandemic, like the three that preceded it, was marked by a dry cough, intense frontal headache, and what one medical correspondent described as “a feverish malaise”. By February 1895, both the British Prime Minister, Lord Rosebery, and the leader of the opposition were confined to their sickbeds, and several London hospitals were struggling to cope with the influx of patients.

The disease felled both burly policeman and clerks at the Bank of England, and by all accounts was extremely infectious. At a wedding party attended by 100 guests, it was reported, all but three had fallen ill.

Contemporary observers attributed the wave of illness to the “Russian influenza” – so-called because the first reported outbreak had occurred in St Petersburg in November 1889. But though some of the symptoms, such as fever, chills and muscular aches and pains, were consistent with flu, few patients reported runny noses or other signs of catarrh.

In all, some four million people in England and Wales were sickened during the first wave of the pandemic in the winter of 1889-90, with the Registrar General recording 27,000 excess deaths from respiratory diseases. A year later, in the spring of 1891, there was a second, more severe wave of Russian influenza, which accounted for nearly 58,000 excess respiratory deaths. The winter of 1892 saw a third wave of illness and 25,000 excess deaths, including that of the Duke of Clarence, Queen Victoria’s 28-year-old grandson and the second-in-line to the throne. Taking into account a revival of the disease in 1893, the Registrar General estimated that at least 125,000 Britons had perished in the pandemic – a total which approaches the mortality of the better-known “Spanish” influenza pandemic of 1918-1919, which accounted for 228,000 excess deaths in England and Wales.

But, in truth, the Russian influenza – if influenza it was – never went away. “It seems only too clear that we must reckon an outbreak of influenza among our regular yearly visitations”, remarked The Times in February 1895 at the height of the fourth wave. The Lancet medical journal concurred: “Like a flickering fire it has at times almost died out, and at others burst into flame, causing in each renewed outbreak an amount of sickness and death that will not be readily forgotten.”

Indeed, England and Wales would suffer further outbreaks in 1898 and 1889-1900, and by the turn of the century relapses were so common that many English medical commentators had abandoned the Italian Latinate term, influenza, preferring the more descriptive French term “grippe”, meaning “to grip” or “to seize”. Some, alarmed by the excess mortality and peculiar symptoms, which included searing pains in the eyeballs, labelled the disease a “fiend”.

“The London Police and the Influenza Fiend”, Fun, 18 March 1892, p. 2.

As with COVID-19, the disease caused by the coronavirus, the majority of infections were mild, but in around one percent of cases the virus provoked severe disease and frequently proved deadly, particularly to the elderly and those with pre-existing health conditions, such as asthma, diabetes and coronary disease. “Influenza”, observed one writer in Outlook at the turn of the century, has become a “regular Christmas annual”, adding that:

“A pair of blankets and a pillow, properly applied, still form a complete protection against ninety-nine attacks out of a hundred. But in that hundredth case it will detect and advertise some latent flaw, add the last straw that breaks the back of some overloaded heart or pneumo-gastric with fiendish ingenuity and deadly effect, and such myriads does it attack that even one percent of serious results mounts up to an alarming total.”

Labelling the ailment “the sphinx of epidemic diseases”, the writer observed that “whole families have been prostrated at once, hospitals have been deprived of two-thirds of their staff in one day… and the demands for nurses has produced a literal ‘famine’”.

Could the Russian influenza pandemic have been due to a coronavirus? Certainly, following another Christmas blighted by SARS-CoV-2 – in this case, the omicron variant – and with hospitals in London and other international cities reporting a shortage of nurses due to surging community infections, the parallels are becoming increasingly apparent. And I have lost count of the number of people who have told me that Covid-19 has aggravated pre-existing conditions, such as arthritis or arrhythmia, or left them with peculiar inflammatory conditions, such as “Covid toe”.