[4] In March 1788, influenza broke out in Saint Petersburg and in Kherson (at the time part of Russia), as well as in Warsaw, where even the King of Poland was afflicted.
For example, Luigi Careno, an Italian doctor based in Vienna, details a "very epidemic catarrh"[a] that prevailed in the city during the winter of 1789;[6] William Eden, then Ambassador to Spain for George III, describes "a new influenza of colds" prevailing in March 1789 in Madrid, where his ambassadorship was at that time coming to an end;[7] and, according to the College of Physicians of Philadelphia, influenza was epidemic in that city in April 1789.
[15][24] On the other hand, Benjamin Rush, another eminent doctor of Philadelphia, suggested that members of the 1st Congress, arriving in the city from New York after the close of the first session on 29 September, might have played a part in introducing the disease.
They were, perhaps not surprisingly, "much indisposed with colds", and though they attributed their general sickness "to… fatigue and the night air", the immense and rapid spread of the disease shortly thereafter made it clear that it must have been the one "so well known of late years, by the name of the Influenza.
[33] Similarly, in St. George's, it "indiscriminately" infected both whites and blacks, with "very few" escaping it;[31] and, in Westmoreland Parish, it "seized great numbers of all ages, colours, and sexes", even among the young and healthy.
[34] In Boston, where the disease "rag'd universally", felling entire families, normal business faltered in the middle of the month on account of the outbreak; bread production, for example, declined to less than a quarter of its typical output.
[35][36] On 1 November, John Adams wrote to his wife Abigail from Braintree that "[t]he Influenza is here as general as it was at N. York", informing her that their youngest son, Thomas, had come down with it there but was improving.
[37] Abigail would later receive word from her sister, Mary Smith Cranch (with whom Thomas was staying at this time), that the whole household was "much indisposed with colds but nobody quite sick".
According to the land surveyor Andrew Ellicott, influenza struck those in the Niagara region "with peculiar force"; they apparently considered the attendant cough of the illness to be "so new and so irritating" that they attributed it to "witchcraft.
While earlier in the fall it had been a more catarrhal (i.e., coldlike) affliction, it soon took on a more inflammatory character, marked "by the violence, obscurity, and insidious nature of its symptoms" when it first appeared on some estates.
[31] A similar shift was noted around this time in Virginia, where over the winter an inflammatory ailment began to appear, associated with symptoms so much more severe that there was some uncertainty whether it was influenza at all.
It was once again "universal" in Hartford;[44] it was "raging" in Norwich, where it was noted to have assumed "redoubled violence";[45] and in Boston, it had reportedly already stricken one-third of its citizens.
[51] Late in April, influenza again invaded the estate of Richmond Hill, which Abigail Adams described as "a mere Hospital", each member confined to a different chamber with some sort of affliction; the vice president, however, again evaded infection.
It reappeared "with additional violence" in the Maryland and Virginia counties situated upon those states' "fertile rivers" and, similarly, was reported to be "mortally dangerous" in Delaware around this time.
[57][56] In New Hampshire, the disease crippled normal business operations in Portsmouth, where it had broken out the month before; it prevailed in Exeter (the state's capital at this time) and neighboring towns, with some mortality reported.
"[53] Sarah Livingston Jay made a similar observation around the same time in a letter to her husband, describing the disease as "as prevalent here at present as it was last Autumn" and informing him of illnesses in the family, including that of his brother and sister-in-law.
He promised her that nothing would delay his return to her and stated his expectation of their reunion by mid-June, for he remained as yet well, despite the unfortunate timing of his circuit that spring: "The whole Country has been sick, and indeed is much so yet.
"[60] Responding to her sister in a letter dated 30 May, Abigail Adams expressed her "dread" surrounding a disconcerting piece of news that had come to public light earlier that month: The president had fallen mortally ill.[54] It is unclear when exactly Washington contracted the influenza.
The first indication of illness from the president himself was recorded in his diary, in which he wrote for Sunday, 9 May 1790, "Indisposed with a bad cold, and at home all day writing letters on private business."
[60] In these first days of Washington's more severe condition, an effort was made to conceal his illness from the public, "as a general allarm may have proved injurious to the present State of the government", as Abigail Adams explained to the Massachusetts physician Cotton Tufts.
[60] During this time, Washington was attended mainly by the eminent New York City physician Samuel Bard, who had previously tended to the president in June 1789 during another period of severe illness, which ultimately required the removal of a tumor from his left leg.
News of the president's recovery inspired universal relief, including among "friends to America" in Paris, and the press reported on this positive development.
Although thankful for how much he had improved, he could "still feel the remains of the violent affection of my lungs—The cough, the pain in my breast, and shortness in breathing not having entirely left me.
Some of these include: This epidemic came at the beginning of what has been termed a "pandemic era" (starting in 1788), in which global influenza activity remained apparently elevated for nearly 20 years (i.e., until 1806).
[23] During its initial prevalence in the fall, the influenza was frequently noted to be mild, albeit utterly pervasive, with fatalities generally only rarely reported.
[13] In Philadelphia, it was deadly mostly only to older people, as well as those "previously debilitated by consumptive complaints" (i.e., lung diseases, or pulmonary tuberculosis in particular); alcoholics seemed also to be a risk group.
[83][72] On the other hand, Webster attributed the prevalence of the disease to "insensible qualities of the atmosphere", based in part on his own experience with it, and considered the notion of its being spread mainly by infection as "very fallacious".
[4] Richard H. Grove, of the Australian National University, Canberra, explored the potential role of the Great El Niño of the 1790s on global events, with reference to these aforementioned weather states in a 2006 study.
He notes an association between this period and the incidence of influenza and concludes that "the very hot summers and mild winters which characterise El Niño conditions in much of North America appear to have encouraged the spread of epidemics in several different diseases, and not least in 1788–94.
A medical student in Berkshire County, Massachusetts, describes the use of venesection, emetics, cathartics, antimonials and niter, and antiphlogistic drinks as common forms of treatment.