The Glasgow courier. [volume] (Glasgow, Mont.) 1913-current, 1919-09-26
epidemic in western Europe generally

eplueIllc Ill WESTERN EUROPE SeueIdlly
was similar. In the cities of India
the sequence was similar but the NOR
tally far greater. In the United
States the epidemic developed more
largely in a single wave during Sep
TENDER, October, November. If, how
ever, the epidemic already mentioned
as occurring in the spring be consid-
cred the first phase and the explosive
outbreak Of the autumn the second, a
third phase Of recrudescence is quite
evident in 32any areas. In general,
this winter rlcrudescence was less
marked in those cities which suffered
most severely in the autumn epidemic.
The prevalence of a serious epldem-
ic of influenza was first recognized
in and around Boston in September
of 1918. Within about two weeks it
was general on the Atlantic s%eaboard,
developing a little later among cities
further west. Rural districts were US
ually attacked somewhat later than
large cities in the same sections.
In the cities of the line of the Apa-
lachians the excess mortality from
pneumonia and influenza during the
weeks ended September Ia, 1918, to
March l, 1919, was approximately Sc
per 1000; in cities between the Rocky
mountains and the A~ppalachians 4.35;
and in those of the Pacific coast $50
per 1000.
Notwithstanding this general geo
graphic relation, there are notably
wide differences in the mortality rates
of individual cities in the same sec
ton, even cities close together, diff
]ferences which are not as yet explain
ed on the basis of climate, density of
population, character of preventive
measures exercised, or any other de-
termined environmental factor.
More details can be given only the
briefest mention here. In order to
secure reliable statistics of mortality
the public health service has made
special house-to-house surveys in a
number of localities, ~ascertaining the
number of persons affected, the dates
of onset, and a few other simple facts
in accurately enumerated groups rep
resentative Of the general population.
Partial analysis of the results of these
surveys in eight localities giving an
aggregate Of 1858 persons canvas
sed, shows the following as the chief
facts Of interests:
the percentage of population attack
ed varied from Is per cent in Louis
vile to 1913 per cent in San Antonio,
Texas, and the aggregate for the whole
group being about % per cent. This
agrees with scattered observations in
the first phase of the 18S9-9O epidem-
ic, when the attack rate seems to have
varied within about these limits.
The case incidence was found to be
uniformly highest in children from
5 to IA years old, and progressively
lower in each higher age group. 1t
was slightly higher in females than
in males of corresponding age; US
ually higher in the white than in the
colored population.
The ratio of pneumonia cases to to-
tai population varied from 5.3 cases
per 1000 in Spartanburg, S. c., to
24.6 per 1000 in the smaller towns of
Maryland. The pneumonia rate show
ed little correlation with the influenza
attack rate.
The rate of deaths to population
varied from 10 per 1000 in Spartan
burg to 6.8 in Maryland towns. The
death rate was by no means parallel
to the influenza attack rate, but was
closely correlated with the pneumon-
rate. In other words the cast fatality
rate of pneumonia tended to be fairly
constant, around 80 per cent. The
death rate was notably high in chill.
dren under one year old, in adults from
20 to 40 and in persons over 60; high.
err in males than in females of com
parable ages, higher among the whites
than the colored.
Concerning the important question
of immunity conferred by an attacl
of influenza, the evidence is not con
elusive, but there is reason to believe
that an attack during the earlier stag
| es of the epidemic confers a consider
= able, but not absolute immunity in tn
: later outbreaks.
In general the pandemic of influ
= enza was largely similar to that o
lSS9-90 in it's development, first a mil
C form, later in a sever worldwide epi
e demic, in the rapidity of it's sprea
and it's high case incidence. 1t ha!
e however been notably different in
much higher mortality, especial
among adults. Such evidence as ha
n been gathered confirms the conclr
Ie sion previously reached that it
!. transmitted directly and Indirectly b
contact. 1t appears probable, how
ever, that the infection was alread
widely disseminated in this countr
some time before a serious epidem