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INFLUENZA
(flu,
grippe),
a
common
contagious
infection
of
the
upper-respiratory
system
caused
by
the
Orthomyxovirus
class
of
viruses.
Members
of
the
Orthomyxovirus
family
that
infect
humans
include
the
Influenza-A
Viruses
(isolated
in
1933),
the
Influenza-B
Viruses
(isolated
in
1940),
and
the
unusual
Influenza-C
(isolated
in
1946),
which
predominantly
infect
lower
animals.
The
first
flu
virus
was
isolated
in
1931
from
the
snouts
of
pigs,
a
discovery
that
led
to
the
coining
of
the
disease
as
"swine
flu."
Although
this
affliction,
usually
characterized
by
a
severe
cold,
is
ubiquitous
to
mankind's
experience
with
illness,
it
is
nevertheless
lethal
to
the
extent
that
it
can
lead
to
acute
complications
such
as
pneumonia
(i.e.,
bacterial
infections
by
Streptococcus
Pneumoniae
and
Hemophilus
Influenzae),
cardiac
involvement
(myositis),
and
neurological
syndromes
(i.e.,
Guillian-Barre‚
Syndrome,
encephalopathy,
encephalitis,
and
Reye's
Syndrome).
Clinical
features
of
influenza
include
exposure
to
and
transmission
via
inhalation
followed
by
an
incubation
period
of
one
to
four
days.
These
viruses
replicate
in
the
epithelium
of
the
upper
respiratory
tract
and
are
most
commonly
associated
with
symptoms
of
abrupt
fever,
severe
myalgia,
and
unproductive
cough.The
Orthomyxoviruses
are
enveloped
viruses
with
helical
symmetry
that
replicate
in
an
infected
host's
cell
nuclei.
These
viruses
contain
eight
single
stranded
RNAs
(ribonucleic
acid)
with
negative
polarity
coding
for
ten
genes,
each
of
which
specify
a
unique
aspect
of
the
influenza
viruses'
morphology.
The
two
most
important
antigens
coded
for
by
these
genes
are
hemagglutinin
(HA),
which
is
the
attachment
protein
for
the
viruses
and
neuraminidase
(NA)
that
acts
as
the
releasing
enzyme
for
influenza.
It
is
this
segmented
and
unstable
genetic
makeup
that
has
allowed
the
influenza
viruses
to
possess
a
remarkable
ability
to
mutate.
This
endowment,
which,
besides
bringing
forth
varying
levels
of
virulence,
has
also
made
it
difficult
for
the
human
body
to
mount
an
effective
immune
defense.
The
two
types
of
genetic
mutations
witnessed
in
the
influenza
viruses
are
genetic
drifts
and
genetic
shifts.
Genetic
drifts
are
point
mutations
within
the
genes
coding
for
HA
or
NA,
which
are
continuously
occurring
(2-3
years)
with
minor
antigenic
consequences.
Genetic
shift,
on
the
other
hand,
defines
a
re-assortment
of
RNA
segments
between
dissimilar
influenza
viruses
with
major
epidemiological
consequences
(occurring
in
roughly
10-year
cycles).
It
is
these
genetic
shifts
that
have
been
responsible
for
the
recurrent
bouts
of
deadly
influenza
pandemics
throughout
history.
The
20th
century
has
witnessed
nine
major
antigenic
shifts
including
two
major
shifts
between
1918
and
1919
[H3N2/H1N1],
which
led
to
the
single
deadliest
pandemic
in
the
annals
of
mankind.
It
is
estimated
that
there
have
been
seventeen
global
outbreaks
of
influenza
between
1175
and
1920.
However,
given
the
dearth
of
precise
historical
documentation
of
the
symptoms
associated
with
influenza,
there
is
every
reason
to
believe
that
pandemic
outbreaks
of
the
flu
predate
the
12th
century
(McNeill,
p.
329).
Ebn-al-At¯ir
mentions
a
virulent
epidemic
resembling
influenza
that
started
in
Central
Asia
(bela@d
al-tork)
in
241/855-856
and
spread
across
Persia
from
Sarakòs
to
H®ova@n,
killing
a
large
number
of
people
(Ebn
al-At¯ir,
Beirut,
VII,
p.
80).
Notwithstanding
the
similarities
of
the
illness
to
influenza,
the
lack
of
detail
in
Ebn-al-At¯ir's
descriptions
limits
the
identification
of
this
early
outbreak
to
the
realm
of
conjecture
(Tholozan,
p.
262).In
Persia,
the
first
established
evidence
of
influenza's
visitation
dates
back
to
the
summer
of
1833,
when
it
erupted
with
great
virulence
in
Tehran.
The
epidemic,
thought
to
have
arrived
there
via
trade
routes
from
Syria
and
Constantinople,
was
part
of
a
larger
global
pandemic
that
had
ravaged
thousands
throughout
Asia
and
Europe.
The
number
of
ill
people
among
the
British
diplomatic
corps
convinced
Sir
Robert
Campbell,
the
British
minister
in
Persia,
to
move
down
his
mission
from
its
summer
camp
in
the
foothills
of
ˆamira@n
to
Tehran.
Among
the
capital's
citizenry
dozens
daily
succumbed
to
the
ravages
of
the
scourge
and
the
dead
and
dying
lay
about
every
street
corner.
Even
Fathá-¿Ali
Shah
was
not
spared,
and
overtaken
by
the
flu,
he
struggled
with
severe
fever
and
chills
that
lasted
several
days.
The
Shah's
condition
fueled
rumors
that
the
incompetent
management
of
his
illness
by
the
royal
physicians
had
led
to
the
monarch's
worsening
state
of
health.
It
was
generally
believed
that
Fathá-¿Ali
Shah's
death
was
imminent;
however,
after
several
days
of
torment
the
Shah
recovered
(Elgood,
p.
466).
Although
there
can
be
no
doubt
that
influenza
had
plagued
Persia
on
numerous
occasions
prior
to
the
19th-century,
its
earlier
visitations
remains
hidden
in
the
annals
of
history.
The
lacuna
was
primarily
due
to
the
lack
of
a
specific
etiological
designation
for
influenza
in
the
Persian
lexicon.
In
fact,
Persian
physicians
classified
influenza
under
the
general
rubric
of
waba@,
a
term
used
to
designate
all
virulent
contagious
diseases
other
than
bubonic
plague
(tÂa@¿un)
and
smallpox
(a@bela).
In
1874,
Johanne
L.
Schlimmer,
a
Dutchman
and
professor
of
medicine
at
the
Da@r
al-Fonun
(q.v.),
designated
influenza
in
his
book
as
nazla-ye
waba@÷i-e
qasáabat-al-ria
(Schlimmer,
p.
306).
The
year
1889
marked
a
renewed
pandemic
of
influenza.
Beginning
in
Siberia
and
spreading
westward
through
Russia,
influenza
eventually
overtook
the
whole
of
Western
Europe,
and
by
September
of
that
year
reached
Persia
by
way
of
the
northern
port
city
of
Raæt
(Tholozan,
p.
261).
Before
long,
cases
of
the
flu
broke
out
in
Tabriz
and
by
the
end
of
November
the
citizenry
of
Tehran
were
once
again
in
the
grips
of
the
dreaded
illness.
On
the
14th
of
March
1890
the
epidemic
reached
the
southern
port-city
of
Buæehr
and
at
least
one-half
of
Persia's
population
had
contracted
the
disease
(Tholozan,
p.
251).
Persian
physicians
who
encountered
influenza
for
the
most
part
initially
diagnosed
the
illness
as
a
common-cold
distemper
and
as
a
result
were
caught
off
guard
in
the
face
of
mounting
fatalities
(Akòtar,
3
March
1890,
p.
221).
Even
younger
physicians
who
were
trained
in
Western
methods
of
prognosis
were
surprised
at
the
suddenness,
gravity,
and
quick
diffusion
of
the
disease
(Tholozan,
p.
251).
In
Tehran
alone,
fatalities
due
to
complications
arising
from
influenza
numbered
between
fifty
and
seventy
daily
and
even
the
notable
among
the
population
were
not
spared
(Akòtar,
3
March
1890).
On
the
21
January
1890,
Na@sáer-al-Din
Shah's
minister,
Yaháya@
Khan
Moæir-al-Dawla,
succumbed
to
a
pneumonic
complication
which
arose
from
the
visitation
(FO
60/532).
Other
notable
deaths
due
to
influenza
included
the
minister
of
the
army,
Mirza@
Ka@záem
Khan
Nezáa@m-al-Molk
(Akòtar,
3
March
1890).
The
outbreak
was
especially
severe
among
the
young,
and
over
six
thousand
children
passed
away
as
a
result
of
associated
illnesses
such
as
severe
throat
ailments
and
measles
(Akòtar,
10
February
1899).
Ignorant
in
the
face
of
this
lethal
and
highly
contagious
epidemic,
Persian
physicians
could
only
sanction
the
populace
to
keep
their
homes
warm
and
to
avoid
the
cold
air.
In
addition,
the
consumption
of
purgatives
was
recommended
as
a
means
of
depleting
the
body
of
its
various
"poisons."
Finally,
as
a
last
resort
for
lowering
fevers
and
chills,
Persian
physicians
prescribed
quinine
and
camphor
(Akòtar,
10
February,
p.
199).
The
outbreak
of
the
flu
in
1889
had
several
unforeseen
developments.
On
the
one
hand
detractors
of
Persian
government
used
the
high
mortality,
brought
about
by
the
visitation,
as
justification
for
their
call
in
favor
of
a
more
effective
sanitary
body
in
Persia
(Akòtar,
10
February
1890).
Concurrently,
Persian
physicians
came
under
fire
by
these
very
same
critics,
who
accused
medical
men
of
playing
a
role
in
the
high
mortality
by
misdiagnosing
influenza
as
the
common
cold
and
not
treating
it
aggressively
enough.
Another
outgrowth
of
this
visitation
was
that
the
term
a@nflua@nja,
borrowed
from
Europe,
came
to
replace
the
earlier
appellative,
waba@,
as
the
designation
for
this
contagious
illness.
The
1889
epidemic
also
played
an
important
role
in
the
propagation
of
the
germ
theory
of
disease
causation
among
the
literate
Persian
population.
Ironically,
this
development
was
facilitated
by
the
strange
and
lethal
nature
of
influenza
epidemic,
which
enhanced
public
interest
in
the
microorganisms
and
microbes
that
were
singled
out
as
being
responsible
for
the
global
scourge
(Akòtar,
24th
February
1890).The
influenza
epidemic,
which
had
broken
out
in
1889,
lasted
through
the
spring
of
1890
in
Persia
and
with
the
advent
of
summer,
the
disease
began
its
gradual
march
towards
extinction.
Influenza's
departure
was,
however,
temporary
and
in
1918
a
renewed
visitation
of
the
flu
returned
to
Persia
with
greater
fury,
making
it
the
most
lethal
and
widespread
pandemic
in
Persia's
history.
This
influenza
epidemic
invaded
Persia
from
several
different
directions,
probably
by
virtue
of
the
several
armies
fighting
within
its
territory
and
on
account
of
its
geographical
centrality
within
the
Eurasian
plateau.
One
of
the
earliest
points
of
entry
for
the
flu
was
via
the
Russian
City
of
Ashkhabad
(q.v.).
Ironically,
the
Russian
troops
who
carried
the
illness
to
Ashkhabad
had
themselves
contracted
the
disease
from
the
American
expeditionary
force,
which
had
landed
infected
troops
in
October
at
the
Baltic
port
of
Archangel
(Crosby,
pp.
145-46).
Having
contracted
the
disease
from
the
Americans,
the
Tsarist
troops,
in
retreat
from
the
Bolshevik
onslaught,
unwittingly
transmitted
the
disease
southwards
along
their
retreating
lines
through
Central
Asia
into
Persia.
Accordingly,
from
Ashkhabad,
the
flu
reached
the
northeastern
Persian
city
of
Maæhad
by
the
third
week
of
August.
Maæhad,
a
pilgrimage
center
on
the
supply
route
for
the
White
Russian
and
the
British
armies,
served
as
an
important
junction
for
the
dissemination
of
the
disease
throughout
the
country,
not
only
due
to
the
ubiquitous
presence
of
soldiers,
but
also
on
account
of
the
ever-present
hoards
of
pilgrims
from
all
parts
of
the
Shi¿ite
world.
Thus,
from
Maæhad,
the
disease
spread
southwards,
overtaking
the
city
of
Birjand
by
the
fourth
week
of
August
and
the
provincial
capital
of
Nosárata@ba@d,
a
little
later.
By
the
second
week
of
September
the
whole
of
the
eastern
Persian
provinces
of
Khorasan
and
Sista@n
were
overrun
by
influenza,
and
in
the
following
month
the
more
central
provincial
capital
of
Yazd
succumbed
to
the
flu
as
well.
The
disease
also
followed
westward
Maæhad-Tehran
highway,
infecting
villages
and
towns
along
that
road.
The
first
wave
of
influenza
also
invaded
Persia
via
the
Caucasian
city
of
Baku,
where
it
overtook
the
Caspian
town
of
Anzali
(q.v.)
by
the
fourth
week
of
August
1918.
As
in
the
rest
of
the
world,
the
speed
of
modern
transportation
was
a
key
factor
in
the
rapid
propagation
of
the
"Spanish"
Flu,
as
the
1918
pandemic
came
to
be
known,
into
Persia.
In
fact,
to
reach
the
seaport
of
Anzali,
the
epidemic
had
followed
Caspian
steamship
routs
from
Baku;
and
the
Tiflis-Julfa
railway,
which
rapidly
carried
the
outbreak
through
the
otherwise
difficult
terrain
of
the
Caucasian
highlands,
facilitated
the
flu's
transmission
to
Tabriz
(FO
371/3892).
The
Persian
Gulf
ports
of
Bandar-e
¿Abba@s
and
Buæehr
(qq.v.)
were
other
points
of
entry
for
the
first
wave
of
the
epidemic
into
Persia.
The
carriers
of
the
infection
into
these
ports
were
British
and
Indian
troops
who
had
embarked
at
Bombay
as
part
of
the
British
expeditionary
force
into
the
Middle
East.
The
outbreak
in
Bandar-e
¿Abba@s
was
mild
but
it
took
over
three
months
to
extinguish.
Following
its
initial
outbreak
in
Buæehr,
the
flu
spread
to
Shiraz
by
the
third
week
of
October.
By
the
end
of
that
month,
the
epidemic
had
reached
Sa¿ida@ba@d
and
on
the
17th
of
November,
cases
of
the
illness
surfaced
in
Kerma@n
(FO
371/3892).
The
final
route
of
the
Spanish
flu's
first
wave
into
Persia
was
via
its
Mesopotamian
frontier,
where
the
British
troops
were
making
significant
headway
the
Ottomans.
Kerma@næa@h
was
attacked
on
the
fourth
week
of
August
followed
by
Hamada@n
on
the
second
week
of
September.
By
the
15th
of
September,
the
disease
was
transmitted
to
Qazvin,
by
all
accounts
brought
by
troops
arriving
from
Hamada@n.
From
Qazvin,
the
disease
spread
rapidly
along
the
motorcar
routes
northwards,
appearing
at
the
Caspian
town
of
Raæt
a
few
days
after
it
had
broken
out
in
Qazvin.
Because
Tehran
was
off
the
main
military
traffic
line
moving
north,
it
was
overtaken
by
influenza
on
the
relatively
late
date
of
22
September
1918.
The
infection
was
brought
into
the
capital
city
by
travelers
from
Qazvin
(FO
371/3892).
The
Spanish
Flu
broke
out
in
Tehran
unexpectedly,
a
shock
that
coincided
with
the
emergence
of
a
strong
western
wind
on
the
24th
of
September,
fueling
the
popularly
held
belief
that
the
outbreak
was
caused
by
"corrupt
winds."
So
strongly
was
this
belief
held
that
influenza
at
this
time
became
known
as
the
illness
of
the
wind
(na@kòoæi-e
ba@d).
Following
the
outbreak
of
this
first
wave
of
Spanish
Flu
in
Tehran,
the
epidemic
spread
down
the
country's
southern
arteries
reaching
the
central
city
of
Isfahan
by
the
third
week
of
October
and
from
there
spreading
farther
south
to
Yazd
(FO
371/3892).The
second,
more
virulent
form
of
influenza,
followed
in
the
heels
of
its
precursor,
moving
across
the
Baghdad-Kerma@næa@h
road,
once
again
and
catching
up
with
Tehran
by
the
end
of
September.
On
its
northbound
trek
from
Mesopotamia,
this
new
surge
of
the
Spanish
Flu
was
especially
virulent
in
cities
of
Kerma@næa@h
and
Hamada@n.
The
flu's
impact
on
the
inhabitants
of
those
cities
was
especially
acute,
due
to
the
immense
number
of
Armenian
and
Assyrian
Christian
refugees
who
had
escaped
Turkish
persecution
in
the
Caucases,
following
the
retreat
of
British
troops
from
Baku.
During
the
last
two
weeks
of
September,
Kerma@næa@h
alone
had
received
60,000
hungry
and
diseased
refugees,
a
number
equal
to
the
native
population
of
the
city
(FO
371/3892).
Under
these
conditions,
the
inhabitants
of
Kerma@næa@h
not
only
had
to
face
an
unusual
scarcity
of
food
and
lodgings,
but
they
also
had
to
grapple
with
a
renewed
and
much
deadlier
visitation
of
the
flu.
From
the
port
of
Buæehr,
the
second
wave
of
the
Spanish
Flu
spread
to
the
city
of
Shiraz,
keeping
true
at
all
stages
to
the
strength
and
virulence
associated
with
this
wave
of
the
outbreak.
The
whole
of
the
southern
province
of
Fa@rs
was
stuck
in
a
particularly
severe
manner;
and
this
territory
bore
the
greatest
share
of
casualties
among
all
Persian
regions
in
this
period
(FO
371/3892).
The
outbreak
spread
through
Fa@rs
at
a
time
when
British
forces
were
engaged
in
heated
combat
with
the
Qaæqa@÷i
tribal
confederacy,
which
had
sided
with
the
axis
camp
(Sykes,
p.
515).
In
Shiraz,
the
flu
was
extremely
severe
and
the
whole
province
was
caught
off-guard.
As
a
result,
just
as
in
Tehran,
the
response
to
the
outbreak
was
wholly
disorganized.
Moreover,
a
large
number
of
the
basic
services
were
paralyzed
because
medical
personnel,
transport
workers,
and
telegraph
and
postal
officials
succumbed
to
the
epidemic,
adding
to
the
difficulties
of
rendering
aid
where
it
was
needed
(FO
371/3892).
Not
even
the
nominal
governor
of
the
region,
¿Abd-al-H®osayn
Mirza@
Farma@nfarma@
(q.v.),
was
spared
from
the
pains
of
the
visitation.
He,
along
with
the
rest
of
the
residents
of
Shiraz,
was
gripped
by
the
flu
and
was
barely
able
to
recover.
This
wave
of
the
epidemic
continued
its
progress
up
and
down
the
country,
passing
through
the
town
of
Ka@zerun.
The
disease
struck
such
fear
among
the
population
of
this
town
that
inhabitants
took
flight
(as
they
had
the
habit
of
doing
during
cholera
and
plague
outbreaks)
and
it
was
said
that
doctors
treated
their
patients
with
prescriptions
handed
through
barely
opened
doors.
Influenza
also
reached
Sa¿ida@ba@d
at
the
end
of
October
and
the
city
of
Kerma@n
was
struck
severely
on
the
17th
of
November.
A
number
of
notable
Persians
figured
among
the
casualties,
including
Nosárat-al-Mama@lek,
who
had
acted
as
governor-general
of
the
province
from
the
17th
of
February
to
the
19th
of
July.
The
districts
of
Kerma@n,
especially
Jiroft,
Bam,
Narma@æir,
Rafsanja@n,
and
K¨abis,
were
particularly
hit
hard
by
the
flu,
and
by
all
accounts
the
mortality
in
this
region
ranked
as
the
highest
that
had
occurred
in
Persian
history
(Government
of
India,
pp.
24-25).
The
town
of
ˆuætar
in
Kkuzesta@n
was
also
attacked
severely
by
the
flu
in
November,
where
the
disease
was
presumably
introduced
by
the
British
troops
from
Basára.
The
epidemic
was
particularly
virulent
among
the
military
force
residing
there.
(FO
371/3892).
The
epidemic
continued
its
northward
trek
through
the
province
of
Sista@n
and
spread
throughout
the
province
of
Ma@zandara@n,
where
its
outbreak
in
the
Caspian
port
town
of
Maæhad-sar
was
particularly
severe
(FO
371/3892).
By
the
fall
of
1919,
the
Spanish
Flu
had
run
its
course
in
Persia,
leaving
a
trail
of
death
and
misery
in
a
country
already
blighted
by
war,
famine
and
other
contagious
diseases.
Since
deaths
were
not
registered
in
Persia
at
this
time
and
an
accurate
population
census
was
nonexistent,
mortality
figures
from
various
sources
only
roughly
indicate
the
severity
of
the
disease
in
the
towns
in
question.
However,
one
irrefutable
observation
of
fatalities
during
the
visitation
of
influenza
is
that
the
disease
was
much
more
virulent
among
the
people
living
in
the
countryside
than
among
those
inhabiting
urban
areas.
Another
definite
appraisal
is
that
mortality
was
considerably
higher
among
those
with
chronic
malaria.
Furthermore,
cases
of
the
flu
were
much
more
prevalent
among
indigenous
Persians
than
among
Europeans
residing
there
and
the
illness
was
markedly
more
lethal
among
the
natives
of
India
as
compared
to
either
Persians
or
Europeans
(FO
371/3892;
Hale,
p.
237).
Estimates
would
indicate
that
Persia
potentially
lost
a
population
ranging
from
902,400
to
2,431,000
inhabitants
to
the
flu.
The
true
number
of
casualties
probably
stands
somewhere
in
between
the
two
extremes.
These
numbers
are,
however,
very
significant,
for
they
indicate
that
Persia's
losses
were
anywhere
from
8.0%
to
21.7%
of
its
population;
and
hence,
it
would
stand
near
the
top
of
the
1918-1919
influenza
pandemic's
international
mortality
ladder
(Patterson
and
Pyle,
pp.
14-15).
Following
the
great
pandemic
of
1918-1919,
variants
of
the
influenza
virus
continued
their
cyclical
visitations
to
Persia
throughout
the
20th
century.
However,
these
epidemics
were
a
far
cry
from
the
virulent
outbreaks
that
were
observed
during
1889
and
1918
pandemics
and
their
demographic
impact
have
been
marginal.
Bibliography:
Alfred
W.
Crosby,
America's
Forgotten
Pandemic:
The
Influenza
of
1918,
Cambridge,
1989.
Cyril
Elgood,
A
Medical
History
of
Persia
and
the
Eastern
Caliphate:
The
Development
of
Persian
and
Arabic
Medical
Sciences
from
the
Earliest
Times
until
the
Year
A.D.
1932,
Cambridge,
1951.
FO
60/532
Letter
(n.
38)
From
Sir
F.
Lascelles
to
the
Marquis
of
Salisbury,
Tehran,
February
18th,
1892.
FO
371/3892
Percy
Cox
to
George
N.
Curzon,
Tehran,
March
8th
1920;
Insert
no.
1,
Anthony
R.
Neligan
to
Percy
Cox.
Government
of
India,
Administration
Report
of
the
Persian
Gulf
Residency
for
The
Year
1918,
Delhi,
1920.
F.
Hale,
From
Persian
Uplands,
New
York,
1920.
"Na@kòoæi-e
g@arib
wa
ya@
in
ke
anflua@nja@,"
Akòtar
19
Joma@da@
1307/23
February
1890.
William
H.
McNeill,
Plagues
and
Peoples,
New
York,
1979.
K.
David
Patterson
and
Gerald
F.
Pyle,
"The
Geography
and
Mortality
of
the
1918
Influenza
Pandemic,"
Bulletin
of
the
History
of
Medecine
65,
1991,
pp.
14-15.
Johanne
L.
Schlimmer,
Terminologie
me‚dico-pharmaceutique
et
anthropologique
français-persane,
avec
des
traductions
anglais
et
allemande
des
termes
français,
Tehran,
1874,
repr.,
1971.
Percy
Sykes,
A
History
of
Persia,
2
vols.,
London:
1921.
Joseph
Desire‚e
Tholozan,
"La
grippe
en
Perse
en
1889-1890,"
Bulletin
de
l'Acadeàmie
de
Medecine
26,
1891,
pp.
250-62.
(AMIR
ARSALAN
AFKHAMI)
20
August
2003
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