Influenza

by Warren T. Vaughan

The Health Officer at Bombay made report in July, 1918, on an influenza-like disease then spreading throughout India. It was stated that the disease was introduced into Bombay from overseas by a transport which arrived May 31, 1918; that by June 22d the disease had become epidemic at Bombay, and that it was present in July, 1918, at Calcutta and Madras.

The rapid spread from Europe to distant India may be accounted for with the same mechanism as that by which the disease was spread from America to France and from France to England, viz. by army transports. The occurrence of the disease in Porto Rico appears to have been definitely connected with the arrival of a ship from Spain. A very short notice in the Public Health Reports tells us that influenza was reported present at Santos, Brazil, June 16, 1918. We are not informed as to how it reached that place.

We have discovered no mention of influenza in China in June. It was reported present in Chungking, China, July 27th. and at that time one-half of the population was stated to be affected. Dengue was reported prevalent at Chefoo, China, during the two weeks ended June 15, 1918, and a report from Shanghai of the same date describes the prevalence of a disease resembling dengue and affecting about 50 per cent. of the population. The disease in these two latter places may have been influenza.

The epidemic made its appearance in Korea in September, 1918. Schofield and Cynn, who report the epidemic, believe that the infection came from Europe via Siberia. The disease spread from North to South along the line of the Southern Manchurian Railway.

In August the disease was re-introduced into the United States and by the end of that month it had acquired a foothold in Boston and vicinity and rapidly spread to other parts of the country. The pandemic had crossed the Atlantic in both directions in six months’ time.

In 1918 as in 1889 there are excellent descriptions of the conveyance of the disease by vessels. The transfer from Spain to Porto Rico has been mentioned. Escomel says that the outbreak in Rio de Janeiro was ascribed to infection from a steamship from Spain, the same boat which later visited Buenos Ayres and started the epidemic in the latter city.

According to a report to the Journal of the American Medical Association from Mexico the epidemic invaded that country from the North at Laredo and followed the course from North to South. From a similar source the same Journal reports that the influenza spread from Buenos Ayres as a primary focus to Paraguay and there acquired greater virulence.

Hernando reports from the Philippine Islands that influenza was estimated to have attacked forty per cent. of the total population of 7,000,000 the mortality being about 2.5 per cent. of those attacked. The epidemic really began in June, although it did not assume great severity until October. The group of ages that suffered most were those between ten and twenty-nine years. The disease did not seem to be imported, since cases were returned before any ships arrived from infected countries, although after the importation of cases it assumed a more severe form. The June epidemic seemed to confer a certain degree of immunity during the second outbreak of the disease in October.

Erlendsson reports that the influenza when it appeared in Iceland in November, 1918, corresponded in character with that in other portions of the world. Macklin gives an interesting description of the epidemic as it occurred in Lapland. The onset in that territory was probably in November. He found that many individuals recovered in two or three days and were about their work again feeling perfectly well. If, however, they contracted pneumonia, about fifty per cent. died.

“The Laplanders had a very thorough if unsympathetic way of dealing with their cases. The settlements were composed of wooden huts, small but generally well made and warm. A common type consisted of but one room, used by the family for all purposes. Better class Laps had better huts, with two or three rooms. In each settlement one of the single-room huts had been set apart, and into this each case of sickness as it arose was unceremoniously pushed; and none were permitted to return to their own huts until completely recovered. Whilst there they received practically no attention, and no healthy person ever entered to attend to their wants. Occasionally a bowl of water or reindeer milk was hastily passed in at the door, or a huge chunk of reindeer meat thrown in, uncooked and uncarved.