The 'Russian' influenza in the UK: lessons learned, opportunities missed.

This paper describes British efforts to map the Russian influenza outbreaks of the early 1890s and describe the timing and course of the epidemic waves. Drawing on two surveys conducted by Britain's Local Government Board (LGB), the paper shows how, in a pre-virological era, the board was able to establish that influenza was an intensely infectious disease. Its key observation, however, was that Russian influenza had taken the form of three, and possibly four, distinct waves of infection, with the second wave in the spring of 1891 proving more lethal than the first wave, and the third wave in the winter of 1892 proving almost as lethal again. Most of this mortality was due to excess deaths from respiratory disease, particularly in the middle age ranges, but while these insights could and, arguably, should have aided the public health response, British health authorities preferred to advocate cautious preventive measures that did little to alleviate the pandemic's impact. The policy would prove especially costly in 1918-1919 when the LGB missed the opportunity to provide extra nursing cover for influenza convalescents following the initial summer wave of the 1918 Spanish influenza pandemic.