During the period of the epidemic at Princeton that university had 1,050 students, and the first cases appeared shortly after the opening of the college term on September 24. As a precautionary measure, every case, when even only suspicious, was sent to the infirmary. In all, there were about 70 cases in the university and about 45 cases from the United States School of Military Aeronautics. Only one member in the latter school died of pneumonia. There were no deaths among the students at the university. In this part of the country the weather was most delightful all autumn, being warm and dry, very little rain having occurred since the end of July. At the date of the inquiry the epidemic had disappeared—that is, about December 21—there being only two very mild cases under suspicion. In the town of Princeton, outside of the university, the conditions were much more serious than in the university itself. Influenza appeared in the homes of many of the poor people of the immigrant class, so that it was not uncommon for four or five members of one family to be infected at once. In one family of seven, five serious cases of pneumonia developed. An emergency hospital was opened by the authorities and 40 cases of pneumonia were treated. Of these approximately one-half died. At the time this report was furnished the epidemic seemed to have disappeared.
The number of students enrolled at the University of Virginia was 957. The first cases occurred as early as September 24. There were 290 of these in number, and three died of broncho-pneumonia. The epidemic was reported as having abated on December 15, but a few cases appeared after that date.
1918 Epidemic at Pittsburgh
At the Army General Hospital No. 24, located at Hoboken, a few miles outside of the city of Pittsburgh, on September 28 two soldiers were taken ill and, with the disease unrecognized, they were removed to the cantonment hospital at Point Breeze, within the city proper. The men were found a few days later to be suffering from influenza, and from this presumable source an epidemic spread rapidly among the troops and student soldiers located here.
From September 28 until November 20, 1,392 cases of influenza occurred among the enlisted men. How the infection reached the first two cases at Hoboken is not known. The command here consisted of the Student Army Training Corps of the University of Pittsburgh, and Carnegie Institute of Technology, Motor Mechanics of the University of Pittsburgh and the Ordnance and Quartermasters’ Department on detached service. The strength of this command was approximately 7,000. The first case appeared on September 30 and the diagnosis was made on the following day. Beginning October 13, all soldiers of this group were inoculated with two 1 cc. doses of vaccine, obtained from the New York State Board of Health. At the height of the epidemic there were about 840 soldier patients in the several hospitals of the city at one time. Cubicles were used in the hospitals, and in the barracks a floor space of 50 square feet was allowed to each man. The men slept alternately head to foot, with paper screens intervening, which were changed daily. In company formation they were instructed to gargle their throats and clean their teeth morning and night under the supervision of their officers. Strict military quarantine was maintained throughout the entire camp, no congregating was allowed, classes were suspended and only open-air drills were permitted. For the entire command there were 220 cases of pneumonia, with 99 deaths, an average mortality of 44 per cent. The dishes were boiled in the hospitals, and sanitary dishwashers were used in all mess halls. The kitchen help and personnel were inoculated with influenza vaccine, with apparently good results. The Magee Hospital, with 375 beds, was under strict military control. When this was full, all others were treated in the civilian hospitals.
In the city of Pittsburgh the disease was not made reportable until October 5. However, one case was reported on October 1, and it was known that there were a few isolated cases in Pittsburgh previous to that date. During the months of October, November and up to December 21 there were 23,268 cases of influenza reported, and the deaths were 1,374 from lobar pneumonia and 678 from broncho-pneumonia. We cannot but feel that most of the deaths reported during the period of the epidemic as lobar pneumonia were broncho-pneumonia associated with influenza. It was well known among civilians that true lobar pneumonia was exceedingly rare and has remained so up to the present time. This is especially noticeable, as this is the time of the year when lobar pneumonia is usually widespread in Western Pennsylvania. This district was particularly favored with a mild fall and winter. On October 1 the first case was reported, on October 15 the epidemic reached its peak—on that day 957 persons being reported ill with the disease. From October 16 until October 28 it maintained an average of 600 cases daily; from October 29 until October 31 there was a sharp decline from 600 cases daily down to 200 cases daily. From November 1 until December 21 the decline has been uniform, and on this latter date 58 cases of influenza and 7 of pneumonia were reported. The height of the epidemic was reached between October 15 and October 29. During the period of the epidemic in Pittsburgh, from October 1 until December 15, 62 days were recorded as cloudy, or partially cloudy, and only 14 days as clear, although the cloudy days seemed distributed and not in decided groups. The mean temperature for October was 58 degrees, with normal 54.9; for November, 44 degrees, normal 42.9; for December, 41 degrees, normal 34.7. The precipitation in October was 3.08, as against a normal of 2.36; in November, 1.79, with normal 2.55; and in December, 3.50, normal 2.73. From a study of these weather reports we see that the epidemic occurred during a period of abnormally warm, cloudy and slightly more moist autumnal season than usual, but these variations were relatively slight and far from decided. The confusion of diagnosis between lobar pneumonia and broncho-pneumonia, associated with or following influenza, occurred in the Pittsburgh health reports as well as in other cities. The presumption that almost all, if not all, of the cases reported as pneumonia of different types were really cases of influenzal pneumonia, seems justified.
Epidemic Incidents in Institutions and Towns of Western Pennsylvania
During the time the epidemic was at its height in Pittsburgh the Western Pennsylvania Institution for the Blind was in session. This school is located in the heart of the educational center and was surrounded by the barracks of the Student Army Training Corps of the University of Pittsburgh and the Carnegie Institute of Technology. When the influenza was recognized as epidemic in this neighborhood, the attending physician at this institution advised a quarantine against the public. The children were refused visitors in the buildings, and the usual week-end trips home were forbidden. This school was continuously in session from September 24 until November 30. During this time there was not a single case of influenza in the school and the children were free from any infectious disease. On December 1 the pupils returned to school after the Thanksgiving holiday, and one week later, on December 8, the first case of influenza appeared. In a period of five days following 15 cases developed. It was considered wise to close the school, and all well children were sent to their homes. The institution was kept closed until January 1, since which time no cases have developed. Very few of these children had influenza at home, and only one death occurred.
A reliable report, subsequently confirmed by the health officer, stated that in Masontown, Pa., the start and course of the epidemic were very striking. A dance was held in the town and the musicians were brought from nearby cities. One of the musicians employed was not very well upon his arrival, and became so ill that after the dance he was put to bed in the hotel. He was found to be suffering from influenza when examined the following day, and from him as the primary case the town was swept by the epidemic.
In Mercer, Pa., the physician to the Board of Health reported that during September they had a general epidemic of coryza and sneezing, with slight fever, which lasted for three or four days. This was looked upon by the people as hay fever. In the midst of this, or about September 16, a man, 74 years of age, who had been away from home, developed true influenza, followed by pneumonia, from which he recovered about October 10. Another man, employed in Greenville, a nearby town, where influenza was already prevalent, returned to his family here suffering from the disease. The whole family and all who were exposed to this family were infected. From this family as a focus the disease spread rapidly in every direction. There were about 350 cases in the town of 2,000 inhabitants, and there were 9 deaths. Sporadic cases have occurred since, ranging in number from one to a dozen at a time. These numbers do not include scores of cases called colds by the people, but it seems that all these cases had an influenza element.