This was the case in the City Hospital at Cologne, which has 700 beds. Altogether there were 439 influenza patients; the maximum daily number in the hospital at the height of the epidemic was between 132 and 144 influenza patients, yet only 13 patients became affected in the hospital, whereas one half of the doctors and one third of the nurses were affected. Conditions similar to these were seen in the Jacobs Hospital in Leipsic, in the Friedrichshain Hospital in Berlin, in the Municipal Hospital at Meissen, in the City Hospital at Halle, in the Aller heiligen Hospital at Breslau, in the Garrison Hospital at Kolmar, in the hospitals at Pirmasens, Fulda, Schongau, Blankenheim, in the hospitals and maternity institution at Giessen, in the University Hospital at Zurich (Eichhorst), in the General Hospital at Nottingham, Warrington, Bridgend, in the hospital "Sabbatsbergen," and in other hospitals of Sweden (Warfvinge). "The character of the influenza in my wards," says Drasche, "had not the slightest semblance to an infectious disease."
In strong contrast to these hospitals which remained immune, several others might be mentioned where influenza took root and where the inmates of the hospital showed a considerable morbidity.
In the hospitals at Heidenheim, Cologne, Coburg, Buxtehude, Schopf heim, Miinsingen, nearly all the inmates were attacked. In some hospitals "the progress of the disease could be traced from bed to bed, or the transmitters from ward to ward identified"(?), as in the Medical Clinic at Wiirzburg, in the Garrison Hospital at Stuttgart, in the hospitals of Nuremberg, Bamberg, Charlottenburg, and in the Kensington workhouse and infirmary.
We find the same contrast as regards morbidity, and we might add, as regards the duration of the epidemic, if we examine the distribution of influenza in other relatively closed institutions, as, for instance, orphan asylums and reformatories, although in the German institutions of this kind, as the statistics of P. Friedrich show, an enormous morbidity was so much the rule that in order to study the rarer but not less striking exceptions, we must turn to the English statistics. Only a few examples will be quoted here:
In the Forest Gate District School (London), from the twenty ninth of November,. 1889, to the ninth of January, 1890, among 576 children only 29, that is to say, 5 per cent., were attacked, whereas in the South Metropolitan District School (Sutton), which was made up of a like class of children, in which the epidemic lasted only twelve days, among 1850 children, 615, or 33 per cent., were affected. In the King Edward's School (242 scholars), in an eleven day epidemic, 177 boarders, or 73 per cent., were affected.
On the training ship "Boscawen," from the nineteenth of January to the tenth of February, among 500 boys varying in ages from twelve to eighteen years, only 13, i. e., 2.6 per cent., were affected. On the training ship "Exmouth," among 528 boys during a thirteen days' epidemic, 381, or 75 per cent., were affected. Numerous similar examples showing these strong contrasts could be quoted.
If we then take a survey of the behavior of influenza in families, upon ships and mountains, and in closed institutions, we see that there is a considerable number of facts to demonstrate conclusively the contagious nature of influenza. But we have also seen numerous remarkable exceptions to this rule. We must not close our eyes to these facts, nor act like the supporters of the contagium theory, who quote only those facts which suit their theory, while omitting any antagonistic observations. The exceptions are too frequent to be accidental, and many of them are very important. Even if in the question of the contagiousness of the disease one positive case proves more than numerous negative ones, we must, nevertheless, try to inquire into the reasons for the apparent contradictions existing in many cases, to discover the concealed ways of the infection, and to ascertain the conditions which determine at one time rapid communicability and dissemination, at another, true fixity and sterility. At the present time we are very far from an exact knowledge of the more intimate nature of the contagion, which would enable us to take more effective measures of prophylaxis and disinfection.
I can only explain these opposite conditions by the assumption that there are two principal kinds of contagion-a slowly spreading form, in which the disease germs remain adherent to the mucous secretions of the patients, and in this way are disseminated only slowly and gradually, and occasionally may be rapidly destroyed; and an explosive form, in which the dried secretions which carry the germs are wafted as dust into the air, and in this way may simultaneously reach all the inhabitants of a house, a ship, or an institution. I find that many English and French contagionists consider that "upon the concentration of the infective principle in the air" depends the sporadic or epidemic character of the disease.