NoveMBER 8, 1918] 
affections to which the term influenza has been 
generally applied for the last twenty years. 
The leading symptoms in the typical cases 
are: severe headache; chills or chiliness; pains 
in the back and legs; temperature sometimes 
as high as 104; great prostration; drowsiness. 
Occasionally there are nervous symptoms; 
sometimes, but not always, the eyes and the 
air passages of the nose and throat are af- 
fected; there may be gastro-intestinal dis- 
turbances. The onset is sudden. The patient 
can often tell the exact moment of his attack. 
In the typical case he is very sick—wholly in- 
eapacitated for exertion. He lies curled up 
and can hardly be roused for food. In two or 
three days the fever usually disappears by 
crisis and the patient feels that he is rapidly 
recovering. It is highly important that he be 
well cared for and kept comfortably warm 
during the next week. Pneumonia occurs in 
about 18 per cent. of the cases; it proves fatal 
in over one third of those attacked. 
The fact that an epidemic existed in a camp 
has generally been recognized when the num- 
ber of new cases has amounted to 100 or more 
per day. The incidence then increases rapidly. 
Sometimes the records show a great number 
of cases at the start, and there are marked 
fluctuations in the daily incidence as the epi- 
demie continues. Striking irregularities do 
not represent the way in which the disease 
occurs but are to be accounted for by the 
stress and difficulty with which the returns 
are collected. The greatest number of new 
cases reported for any day has often consider- 
ably exceeded 1,500 in a camp. At Devens 
the maximum was 1,543. At Grant, 1,810 and 
Custer, 2,800. The high point has often 
been reached on about the tenth day of the 
epidemic. 
Epidemics commonly subside almost as rap- 
idly as they arise. Within from 16 to 20 days 
after the outbreak the number of new cases per 
day falls to 200 or less, after which there is a 
more gradual decline to the end. In its epi- 
demic aspect, as in the individual case, the dis- 
ease is characterized by sudden onset, great 
intensity, and rapid recovery. 
SCIENCE 
453 
Within about a week after the outbreak of 
the influenza there occurs an ominous preva- 
lence of pneumonia. The pneumonia does not 
exist as a separate epidemic, but is always a 
follower of the influenza. How the two dis- 
eases are related is not positively known. It 
is clear that the influenza paves the way for 
the pneumonia, if it does not actually produce 
it. Most of the pneumonia is of the lobular 
type and presents various unusual aspects. 
The time of greatest incidence is usually about 
a week after the greatest incidence of in- 
fluenza. 
SPREAD OF THE PANDEMIC 
The second camp to report an epidemic fol- 
lowing Devens, was Upton, on Long Island, 
N. Y.; the third was Lee, in Virginia. Dix, in 
New Jersey, and Jackson, in South Carolina, 
followed immediately. Hoboken, N. J., Syra- 
cuse, N. Y., Gordon, in Georgia and Humph- 
reys, in Virginia, all reported on the same 
day. Within a week from the start, nine large 
camps in widely separated parts of the coun- 
try were attacked. Others followed in rapid 
succession. The table on the following page 
gives the order in which the camps were at- 
tacked. In addition there were many epidem- 
ics reported from posts, aviation stations and 
other troop centers. 
THE OUTLOOK FOR THE FUTURE 
How far the pandemic will spread will ap- 
parently depend only upon the material which 
it can feed upon. It is too early to foretell the 
end or to measure the damage which will be 
done before the pandemic disappears. Enough 
is known to show that hereafter influenza is 
not to be ranked merely as an endemic disease 
of civil life, but an infection of first-class mili- 
tary possibilities. It is not improbable that 
the present pandemic may disappear as rap- 
idly as it came, although most persons hold 
the opinion that its final disappearance will be 
gradual, the extinction of the disease being 
postponed for many months. In the pandemics 
which sweep over the earth at long intervals, 
recurring waves of the disease in greater or 
less degree commonly occur. If this rule holds 
