Evidence is not lacking that influenza occurred in epidemic form in other widely separated camps in the United States during the spring of 1918. Vaughan and Palmer[[4]] state that a disease strongly resembling influenza became prevalent in the Oglethorpe camps about March 18, 1918, and continued three weeks; during this time the number sent to hospital or to quarters with this disease was 1,468 in a total strength of 28,586. Pneumonia does not appear to have followed this epidemic.
Miller and Lusk[[5]] found the ordinary type of pneumonia prevalent at Camp Dodge, Iowa, until March 18 to 20, 1918, when abruptly the streptococcus type predominated and there was a great increase in the rate of mortality. A mild tracheitis, they state, was widespread in the camp during March.
In March, 1918, one member of our commission saw an outbreak of influenza at Fort Sam Houston which was identical in its clinical characters with the disease which appeared as a pandemic in the fall of 1918.
The report of the Surgeon General[[6]] for 1919 shows that there was a sharp increase of the incidence of influenza in the army during March, reaching a maximum in April. The rate of influenza for 1,000 troops fell to its original level through May and June and finally rose to a great height in September and October.
Influenza in epidemic form made its appearance in the army camps of the United States during March, 1918. The symptomatology of the disease associated with its peculiar epidemiology as seen at Camp Funston make its recognition unquestionable. The disease had doubtless been present in this camp since its establishment in September, 1917, but did not assume epidemic proportions until the spring of 1919.
Pneumonia followed the epidemics of influenza which occurred in the spring of 1918 and exhibited characters similar to those of the pneumonias which followed the pandemic of September and October, 1918. In both instances the height of the outbreak of pneumonia has been one week after the maximum incidence of influenza.
Influenza became epidemic in Spain about the middle of May and in other countries received the name “Spanish influenza” which is not more applicable than the designation “Russian influenza” often applied to the disease during the pandemic of 1889–90.
The studies of MacNeal[[7]] have shown that the first epidemic of influenza in the American Expeditionary Force in France occurred about April 15, 1918, at a rest camp near Bordeaux, reached its height on April 22 and ceased May 5. The disease was of a mild character with few complications. Localized epidemics were reported from various camps and hospitals during May and June, when the disease, MacNeal states, had become widespread in all sections of the American Expeditionary Force in France and in the French and British armies as well. Influenza had become epidemic in the Italian navy in the first two weeks of May. The belief that the disease was introduced from America, the author thinks, is “probably completely disproved by the fact that the epidemic was subsequently introduced into America in August and September and found there a most fertile soil for its spread.” This view is disproved by the demonstration that influenza had appeared as scattered epidemics in the army camps in March, 1918. There is little reason to doubt that influenza in the American Expeditionary Force was brought from America.
At the end of August our commission was transferred from Camp Funston to Camp Pike, where throughout the history of the encampment pneumonia had been so prevalent that it had given the camp the rank of third in death rate from lobar pneumonia and fourth in death rate from bronchopneumonia among 32 camps established in this country. We arrived at Camp Pike September 5 and were stationed at the base hospital. Our work was facilitated by the hearty cooperation of the commanding officer, Major Morton R. Gibbons, who neglected no opportunity to promote the investigation. Our work was cordially aided by Major Carl R. Comstock, Director of the Medical Service, and by Major Henry H. Lissner, who later occupied this position. Work in the laboratory of the hospital received the valuable cooperation of Major Allen J. Smith, Director of the Laboratory, who placed at our disposal every facility available. Lieutenant James R. Davis, who was for a time in charge of the laboratory, effectively assisted the work.
The commission consisted of the following officers: E. L. Opie, Colonel, M. R. C.; Allen W. Freeman, Major, M. C.; Francis G. Blake, Major, M. R. C., James C. Small, Lieutenant, M. C. and Thomas M. Rivers, Lieutenant, M. C. Major Freeman acted as epidemiologist and will publish a report upon the epidemiology of influenza and pneumonia at Camp Pike. On October 11 the laboratory car “Lister” in charge of Lieutenant Warren H. Butz was assigned to the commission. Lieutenant Harry D. Bailey was attached to the commission on October 14 and later assisted in its work. Valuable technical assistance was given by Sergeant Charles Behre, by Wm. E. Hoy, detailed from the Army Medical Museum, and by Thomas Payne.