452 
CASES OF INFLUENZA AND PNEUMONIA AND DEATHS 
EACH WEEK AMONG ALL TROOPS IN THE UNITED 
STATES FOR THE PERIOD, SEPTEMBER 12— 
OcTOBER 18, 1918 
September October 
Influenza . ./10,094|37,493/88,478/90,393|48,287|274,745 
Pneumonia.| 758) 4,313} 8,655)17,882/14,768) 46,286 
Deaths .... 96| 951! 2,275} 6,005) 5,289] 14,616 
The foregoing table indicates that the pan- 
demic claimed the greatest number of victims 
in the week ended October 11; this was four 
weeks after the first local outbreak was discoy- 
ered. In this week, roughly one third of all 
the cases of influenza and pneumonia and 
deaths occurred. 
THE OUTBREAK OF THE PANDEMIC 
The first report that a serious epidemic ex- 
isted in any camp came from Devens, at Ayer, 
Mass. On September 16 the camp sanitary in- 
spector, reporting through the camp surgeon to 
the Surgeon General of the Army, announced 
that an epidemic of so-called “ Spanish influ- 
enza”’ had broken out at Devens as a part of a 
general epidemic which had attacked Boston 
and the neighboring states and towns some 
weeks before. 
The Devens epidemic is supposed to have 
commenced on September 7, 1918, in D Com- 
pany, 42d Infantry. On that date a case of 
supposed meningitis was sent to hospital from 
this company; on the following day twelve 
eases were sent for observation. These proved 
to be influenza. By the sixteenth 37 cases had 
gone from the same company. One death from 
pneumonia had occurred. Almost simultane- 
ously, other cases appeared in other organiza- 
tions. By September 12 the total number of 
eases which had been admitted was 599. The 
disease spread rapidly, in spite of the measures 
taken to check it. On September 20 the epi- 
demic reached its maximum intensity. On 
that day 1,543 new cases were reported as hav- 
ing been admitted to sick report. After reach- 
ing this high point the number of new cases 
SCIENCE 
[N. S. Von. XLVIII. No. 1245 
rapidly became less, so that by the end of the 
month there were less than 100 new cases re- 
ported per day. 
Meanwhile, pneumonia had become a fre- 
quent and fatal accompaniment of the influ- 
enza at Devens. Fifty new cases were reported 
September 19, less than three weeks after the 
influenza had broken out. The number rap- 
idly increased; on September 24, there were 
342 new cases. The number each day remained 
at about 200 for four days; then there was a 
decrease, until, before the end of the month, 
40 per day had been reached. Since October 
4 there have been less than five new cases 
daily. 
The Devens outbreak, so far as may be 
understood from the records at hand, could be 
divided into 4 parts as shown in the following 
table: 
THE RISE AND FALL OF THE pane 
EPIDEMIC AT CAMP DEVENS, AYER, MASSA- 
CHUSETTS, 1918 
avid cea Cases 
oy, | aa ||paeus ees 
Rise (Sept. 12-19) ..........] 8 | 3,283 43} 16 
Peak (Sept. 20-21).......... 2° |2,722| 205) 43 
Rapid decline (Sept. 22-29) ..| 8 | 3,141) 1,495) 298 
Slow decline (Sept. 30-Oct. 18)| 19 571| 571} 310 
It will be observed from the foregoing table 
that the rise of the epidemic covered a period 
of about 8 days; the peak 2 days; the rapid de- 
cline 8 days, and the slow decline 19 days. 
Half the deaths and nearly three quarters of 
the pneumonia occurred during the period of 
rapid decline or within less than three weeks 
of the outbreak. 
CHARACTERISTICS OF THE DEVENS EPIDEMIC 
The characteristics of the Devens epidemic 
have been described here because they repre- 
sent what has occurred at many camps. The 
earliest cases have often escaped identification. 
They may be taken for cases of food poisoning, 
meningitis, or one of the common exanthemata. 
The disease which is epidemic bears little re- © 
semblance to the coryzas and other respiratory 
