Читать книгу Studies on Epidemic Influenza: Comprising Clinical and Laboratory Investigations - University of Pittsburgh. School of Medicine - Страница 5

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In the city of Boston during the week ending August 28, at the Naval Station at the Commonwealth Pier, 50 cases of influenza occurred and within the next two weeks more than 2,000 were reported in the naval forces of the First Naval District. Of these 5 per cent. developed broncho-pneumonia with a mortality of more than 60 per cent. From here it probably spread to Camp Devens and thence ran rapidly over the country. There can hardly be a question that it spread along the lines of traffic. Up to November 9 there were reported 3,339 cases among the civilian population of Boston. There were 3,430 deaths from influenza, the presumption being that these were due to bronchial pneumonia, although not reported as such. The deaths from all forms of pneumonia were reported as 942, making in all 4,372 deaths from September 7 to November 9. This discrepancy—that is more deaths than reported cases of influenza—is due to the fact that influenza was not made a reportable disease until the date of October 4, fully a month from the time the epidemic appeared. The weather conditions were generally fair and no noted abnormality is recorded as compared with other years. The statement of the Health Department of this city was that, after a practical disappearance of influenza in October, there was a slight recurrence in November and a more pronounced recurrence about the first of December, since which time the cases have slowly but steadily decreased, until at present—December 21—the fatalities attributable to influenza are about 20 daily.

In the city of New York the epidemic first appeared September 18. Up to and including December 27 there were reported to the Department of Health 136,061 cases of influenza and 21,388 cases of pneumonia. The number of deaths since September 18 was 11,725 attributed to influenza in the death certificates filed in the Health Department and 11,601 attributed to pneumonia. The epidemic reached its peak during the week of October 19, slowly subsided and was practically at an end on November 9. While the epidemic is reported as ending on this date, the mortality rate from influenza and pneumonia is still very much above normal. No particular features concerning the meteorological conditions were noted, except that in this city the weather was clear and delightful during the months of September and October when the epidemic was rampant.

In the city of Philadelphia on July 22 the Health Department issued its first health bulletin on so-called Spanish influenza, announcing the possible spread of this disease into the United States. On September 18 a warning was issued against an epidemic, the department starting a public campaign against coughing, sneezing and spitting. On September 21 the Bureau of Health made influenza a reportable disease. At this time the authorities stated an epidemic of influenza was recognized as existing among the civil population of similar type to that found in the naval stations and cantonments; that a large percentage of cases was accompanied by pneumonia; that patients should be isolated and attendants wear masks; that isolation be practiced for a period of ten days after recovery to prevent carriers; that patients be guarded against relapse and that the public be cautioned against large assemblages and crowded places, as well as to avoid coughing, sneezing and spitting. On October 3 the churches, saloons and theatres were closed, funerals were made private and food handlers were required to protect their wares. The number of cases reported from September 23 to November 8 was 48,131, but the Bureau states, from a rough estimate, the number of cases was probably 150,000. The total number of deaths reported was 7,915 from influenza and 4,772 from pneumonia in all its forms, the presumption being that the deaths during this period were due to influenzal pneumonia. The weather condition during this time is recorded as mild and fair.

The influenza cases began to be reported in Cleveland on October 5, and up to December 20, 22,703 cases had been recorded. Certificates recording deaths due to influenza alone numbered 2,497, while pneumonia amounted to 833. The epidemic was at its height in the latter half of October and the weather was spoken of as pleasant fall weather. During the week of October 26 the epidemic reached its greatest height, abated in the week ending November 23, increased later, but showed a drop for the week ending December 21.

The epidemic first reached Chicago on September 21, and from that date on it rapidly increased throughout the city for a period of 26 days until October 17, when it reached its maximum both in the number of deaths from influenza and from pneumonia. On that day the total number of deaths from influenza and from pneumonia reported was 2,395. From September 21 until November 16 there were reported 37,921 cases of influenza and 13,109 cases of pneumonia. On September 8 at the Great Lakes Naval Training Station, which is 32 miles north of the city, an extensive outbreak of influenza occurred. This was 13 days before the outbreak in the city of Chicago itself. Camp Grant, located at Rockford, 92 miles northwest of the city, suffered an outbreak on September 21. A suggestion of the likelihood that influenza was prevalent in this country in a mild and unrecognized form in the spring of this year is shown by the fact that numerous local outbreaks of acute respiratory diseases were brought to the attention of the Health Department of Chicago. These occurred especially in large office buildings and in industrial departments. The total number of deaths from influenza and pneumonia during 14 weeks was 51,915. This would indicate that a very great number of cases were not reported to the Bureau of Health until they died or else there must have been a large number of deaths due to lobar pneumonia. One naturally obtains from these figures the impression that the disease was not recognized for a long time, that the pneumonia must have been called lobar pneumonia, and that the actual figures gathered by this city, as well as others, must have been greatly confused at the onset of the epidemic. It is not unlikely that records from many of the army cantonments and naval stations may be considered from the same viewpoint. Weather conditions were considered normal at the height of the epidemic, the weather being dry. There has been a flare-up of influenza recently, but not in sufficient numbers to justify calling it epidemic.

In the city of Louisville, Ky., the epidemic started September 26, and the total number of cases up to December 21 is reported as being 9,445. Out of this number 772 deaths occurred from pneumonia. No distinction is made here between broncho-pneumonia and lobar pneumonia, but the presumption from the records of other cities at this time is that these were cases of broncho-pneumonia following influenza. The weather was described as being delightful fall weather. The statement is made by the authorities that while the epidemic is still prevalent, it is confined largely to children and is rapidly abating.

The first case in the city of St. Louis was reported about October 7, and up to December 23 there had been 31,531 cases reported to the Bureau of Health. They recorded 1,920 deaths with influenza given as a contributing cause. Preceding the time when the epidemic was at its height the weather was fair and warm, and the statement is made that, “without going into the matter exactly, we have been of the opinion that damp, rainy weather has been a help in controlling the disease.” The opinion was expressed by the Commissioner of Health that the disease had now abated.

No information could be obtained as to when the epidemic first reached the city of New Orleans, but during the months of October and November 43,954 cases of influenza were recorded. Of this number 2,188 died from a combination of influenza and pneumonia. They stated in their health report that during the period from January 1 to December 31 there were 239 deaths attributable to broncho-pneumonia. The weather was mild and on December 24 the epidemic was stated to have abated.

The city of Minneapolis recorded its first case on October 7, but the authorities expressed their belief that a few cases had appeared before that date. Up to December 21, 15,000 cases had been reported to the Bureau of Health and of these there had been 735 deaths from broncho-pneumonia. They had in their city a late, rainy fall and up to that period they had had no cold weather.

The record obtained from the city of San Francisco stated that the epidemic first appeared September 23 and that it was very widespread in that city early in October. There were two invasions and 53,260 cases reported. At the height of the epidemic more than 2,000 cases were reported in one week; 188 deaths occurred from influenzal pneumonia. The following week, after the institution of mask wearing, in which between 80 and 90 per cent. of the population concurred, it was stated that the number of cases decreased to about 200. It was stated that the weather was generally very fair during the epidemic.

From the city of Portland, Oregon, the following information was obtained: The epidemic first appeared October 11, with a second one toward the end of the year. There were 8,079 cases reported, with 658 deaths from influenza and 250 from pneumonia. Weather conditions were stated to be varied, but the health officer believed that during the worst wave the weather was clear and dry, with easterly wind. He believed that a decrease in influenza was noticed immediately after a Chinook wind and warm rain. Similar observations were made by Coutant in Manila.

A weather comparison of 12 large cities, well distributed over the United States, studied during this pandemic of influenza and checked with normal weather during that of many years, shows: Boston, fair with no abnormality; New York, clear and delightful, no abnormality; Philadelphia, mild and fair; Pittsburgh, mild and cloudy; Cleveland, pleasant fall weather; Chicago, normal and dry; Louisville, delightful fall weather; St. Louis, fair and warm-damp, rainy weather later seemed to control the epidemic; New Orleans, mild; Minneapolis, a rainy fall and no cold weather, which is unusual there; San Francisco, generally fair, and Portland, Oregon, clear and dry.