Andrewes versus Influenza: Discussion Paper

Epidemics resembling influenza can be found throughout recorded history, but there can be no confidence ofthe diagnosis before the descriptions of the epidemics occurring in the seventeenth century. Opinion has always been divided as to the mechanisms by which these epidemics are produced. As at present, most of the physicians of olden times favoured the concept that an infectious agent was spreading directly from the sick patient to his susceptible companions who promptly developed influenza, but many careful observers, August Hirsch' and Charles Creighton2 for example, found it impossible to explain the epidemic behaviour of influenza in such simple terms. It seemed that a solution to the epidemiological difficulties must await the discovery of the causal organism. The first isolation of a virus causing human influenza was achieved during the 1932/33 epidemic by Smith, Andrewes and Laidlaw3, but, far from explaining the epidemic mechanism, the identification of the causal parasite initiated a chain of discoveries that multiplied the problems demanding explanation. Andrewes (Figure 1), naturalist and physician, with an enquiring and ingeniousmind and a felicitous turn of phrase, has occupied himself with the problems presented by influenza, and it is fascinating