“In forty-six American cities, having a combined population of only a little more than one-fifth the total for the country, the mortality resulting from the influenza epidemic during the nine weeks period ended November 9th was nearly double that in the A. E. F. from the time the first contingent landed in France until the cessation of hostilities.”
The mortality, even as the morbidity, has varied in different localities and at different periods. The low morbidity and mortality in the spring of 1918 has been frequently mentioned. Among the Esquimaux in Alaska the death toll was terrific. Whole villages of Esquimaux lost their entire adult population. It has been estimated that in British India the death roll totalled 5,000,000. “The central, northern and western portions of India were the worst sufferers. The hospitals in the Punjab were choked so that it was impossible to move the dead quickly enough to make room for the dying. The streets and lanes of the cities were littered with dead and dying people. The postal and telegraph services were completely disorganized; the train service continued, but at all principal stations dead and dying people were being removed from the trains. The burning ghats and burial grounds were literally swamped with corpses, while an even greater number awaited removal. The depleted medical service, itself sorely stricken by the epidemic, was incapable of dealing with more than a minute fraction of the sickness requiring attention. Nearly every household was lamenting death, and everywhere terror and confusion reigned. No part of the Punjab escaped.”
The Bureau of the Census estimates that 445,000 deaths from the epidemic of influenza occurred in the United States in the period between September 1st and December 31st, 1918. There is no doubt but that the total death toll for that epidemic exceeded 500,000 individuals.
According to Winslow and Rogers, the two highest annual death rates on record in Connecticut are both rates of 19.4 per 1,000 and these two rates are for the influenza epidemic years of 1892 and 1918. In the earlier of these two the normal general death rate was several points higher than it is today, so that the effect of the recent epidemic was much more serious than was that of its predecessor. For a single month the death toll of October, 1918, was absolutely unprecedented in Connecticut. They estimate that the epidemic between September, 1918, and January, 1919, cost the State 5.5 lives per 1,000 population, or, in all, 7,700 lives.
In the United States Army there was a total of 688,869 admissions for influenza. The total deaths ascribed to the disease are 39,731, which gives a rate of 15.64 per 1,000 for the acute respiratory diseases out of the total disease death rate of 18.81 for the year. In 1915 the per cent. of deaths from this group of infections was under 18 per cent. of the total from all diseases. During the last four months of 1918, 11,670 deaths from influenza and pneumonia occurred in the American Expeditionary Forces in France. There were approximately 1,600,000 officers and men in the United States and an equal number in France.
Carnwath gives the following comparison of the number of deaths in London and in certain American cities from influenza and all forms of pneumonia during the eight weeks of the 1918–19 epidemic.
| Deaths in London and in American cities. | ||
|---|---|---|
| Number of deaths. | Rate eight weeks per 100,000 of population. | |
| London | 13,744 | 341 |
| New York | 20,681 | 360 |
| Chicago | 8,785 | 343 |
| Philadelphia | 12,806 | 749 |
| Boston | 4,211 | 548 |
The cause of death in the vast majority of cases is some form of pneumonia. In fact it has been questioned whether influenza uncomplicated can cause a fatal issue. Postinfluenzal meningitis has been the cause of death in an appreciable number of cases. More remotely the disease has caused many deaths by hastening the fatal outcome of what were otherwise subacute or chronic conditions of the respiratory, cardiovascular, or renal systems.
Vaughan and Palmer record that, “The pandemic of influenza in 1918 seems to have been more closely associated with the pneumonias than appears in any previous pandemic. From the reports as sent to the Surgeon General’s Office, it appears that uncomplicated influenza was not by any means a fatal disease and that the high death rate was due to the pneumonias which followed. Pneumonia is a serious disease at all times. Recent records for the United States Army show that the case mortality rate for this disease has been as follows during the different periods of the last two years:
| Per cent. | |
|---|---|
| The year 1917 | 11.2 |
| 6 winter months, 1917–18 | 23.1 |
| 5 summer months, 1918 | 18.8 |
| 4 autumn months, 1918 (Influenza period) | 34.4 |