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Show "FLU'; EPIDEMIC WILL BE MILDER thruitgii innaiati n, It man nt pnt-ru bored that there are many oilier paths by w hich such genns are I nt nsmit I ed from person to person. Soiled hands, common drinking cups, improper!. cleaned eating and drinking utensils in restaurant, soda fountains, etc., roller towels, infoou-d food ihese are only a few of the common vehicles of , serin transmission. The use of face masks appears to make people neglect Ihese other paths of infection, and so the use of face masks has not been attended Willi the success predicted for I hem. If we would he mole successful suc-cessful in combating intlu.'iK-.a greater great-er al lent ion must he paid to the factors fac-tors just enumerated. The question of most practical and immediate interest is the probability of recurrence in the near future. I'e-currenees I'e-currenees are characteristic of inilu-enza inilu-enza epidemics; and the hislory of the Inst pandemic and previous ones would seem lo point to the conclusion that this one has not yet run its full course. On the other hand this epidemic epi-demic has already shown three more or less distinct phases and has been more severe, al least in mortality, lhan Hie three-year epidemic of "1 SSSl-O'J, facts which justify the hope, though not the conclusion, Unit It has run its course already. Recurrence Is Likely. It seems probable, however, that we may expect at least local recurrences in the near future, wilh an increase over the normal mortality from pneumonia pneu-monia for perhaps several years; and certainly we should he, as far us possible, pos-sible, prepared to meet them by previous pre-vious organization of forces ami measures meas-ures for attempted prevention, treat-men treat-men I", and scientific investigation. There should be no repetition of the extensive suffering and distress which accompanied last year's pandemic. ( 'ommunil ies should make plans now for dealing wilh any recurrence of the epidemic. The prompt recognition of (he early cases and their effective isolation iso-lation should he aimed at. Tn this connection, con-nection, adoption is called to the fact that the cases may appear to be .just ordinary colds. A recent extensive outbreak of what were regarded as "summer colds" in Peoria, Illinois, proved on investigation to be an epidemic ep-idemic of a mild type of influenza. Experience indicates that these mild epidemics are often the starting points of more severe visitations, deuce ev cry effort should be made to discover as early as possible any unusual prevalence prev-alence of "colds." For municipalities operating on a budget basis, it Is important that all delay in providing the necessary financial finan-cial support to the health authorities in dealing with a recurrence of the epidemic be avoided by setting aside an emergency epidemic fund. This may prove of the greatest value in carrying car-rying out Important preventive measures meas-ures in the early days of the epidemic, epidem-ic, at a time when their beneficial effect ef-fect is greatest. The most promising way to deal with a possible recurrence of the influenza epidemic is, to sum it up in a single word. "Preparedness." And now It is the time to prepare. first and slightest in point of morial-ily morial-ily occurring in June ami .Inly, the second and most severe in November, the third in February and .March. Dala, which need not be cited here in detail, indicate that the course of the epidemic in western Furope generally was similar. In the "oiled Slates the epidemic developed more largely in a single wave during September, Oc- tober and November. I The prevalence of a serious epidom- ! Ic of inlluenza was first recognized in i and around P.oslon in September of I'.n.s. YVjihin about two weeks it was. general in the Atlantic seaboard, developing de-veloping a lillle later among cities further fur-ther west. Rural districts were nsu- ! ally attacked somewhat later than large interests in the same, seclions. ; In the cities east of the line of the Appalachians the excess mortality from pneumonia and Inlluenza during : the weeks ended September 14, IMS, to March 1. 1010, was approximately o.G per F000; in cities between Ihe Kocky mountains and the Appalachians Appalachi-ans 4.."o ; and in those of the Pacific' Coast S.ri'i per 1.000. Concerning the important question of immunity conferred by an at lack of inlluenza, the evidence is nol con- , elusive, but there is reason to believe Hint an atlaok during Ihe earlier; stages of the epidemic confers a considerable, con-siderable, tint not absolute immunity in the later on! breaks. I Transmitted by Contact. j Tn general the pandemic of inlluenza was largely similar to that of 1880-90 in its development, first a mild form, later on a severe world-wide epidemic, in the rapidity of its spread and its i high case incidence. It has however been notably different in a much higher high-er mortality, especially among young adults. Such evidence as has been gathered conlinus the conclusion previously pre-viously reached that it is transmitted directly and indirectly by contact. It appears, probable, however, that Ihe infection was already widely disseminated dissem-inated in this country sometime be-I be-I fore a serious epidemic was recognized. recog-nized. Despite the fact that there is still some uncertainty ivs to the nature of ! the micro-organism causing pandem- j ic influenza, one thing is cerlain, that the disease is communicable from per-; per-; son to person. Moreover, judging ! from experience in oilier diseases, it j is probable that the germ, whatever its nature, is carried about not: only by those who are ill with influenza, but by persons who may be entirely ; well, Everything which increases per- i sonal contact, therefore, should be re- j garded as a factor in spreading i n flu- ; en 7.?.. j Much was heard hist winter of the: use of face masks. Though the use of ' suitably constructed masks will reduce i the interchange of respiratory germs If There Is Recurrence It Will Not Be as Severe as Last Winter. HO POSITIVE PREVENTIVE Previous Attack Brings Immunity in Percentage of Cases Enforcement Enforce-ment of Sanitation and Avoidance Avoid-ance of Personal Contact Necessary Precautions. (Authoritative Statement Issued by United States Public Health Service.) w Probably, bill by no means cer- K talnly, there will be a recurrence 7Z Z ul the influenza epidemic this ii .v,'"r. z Indications' are, that should z it occur, it will not lie as severe as the pandemic of the previous il winter. ? 2 Cily officials, slate and city S jy hoards of heallli, should he pre- n pared iu the event of a recur- rence. K K The fact that a previous at- J 8 tack brings immunity In a cer- K lain percentage of cases should allay fear on the part of those U 2 afflicted in the previous epidem- ? Inlluenza is spread by direct S and indirect contact. ft S It is not certain that (he germ S g has been Isolated, or discovered, ? and as a consequence there is A yet no positive preventive, ex- ti cept the enforcement of rigid ? rules of sanitation and the avoid- t ance of personal contact. n S A close relation between the H ?J influenza pandemic and the con- J ?z stantly increasing pneumonia K 7& mortality rate prior to the fall 4? of 101S is recognized. ? It is now believed that the dis- ? 8 ease was pretty widely dissem- a i? inated throughout the country before it was recognized in its ? 8 epidemic state. This faiture to ft recognize the early cases appears to have been largely due to the y il fact that every Interest was then ?z centered on the war. Above are the important facts developed de-veloped by the United States health service after a careful survey and investigation in-vestigation of the inlluenza pandemic of I91S-1910, carried on in every state and important city, and even In foreign for-eign countries. JST6 one of the many experts of the ssrrlco would make a more positive forecast of the nll-intportant question. Will there be a recurrence? All agreed, however, that a recurrence was not unlikely, and I',: the face of the known facts, that It would be wise to be prepared, pre-pared, more with a view of being on the safe side than actually anticipating anticipat-ing danger. The following excerpts from the government report are published for the benefit of the public and health officers in the hope that this will serve to set at rest the daily publication in the newspapers of statements, which on one hand are calculated to lull the public into a sense of false security and on the. other to unduly cause alarm. Contrary tn the opinion expressed frequently during the early weeks of last year's pandemic by a number of observers, the studies of the United States public health service indicate that the epidemic was not a fresh importation im-portation from abroad. Careful study of the mortality statistics of the United Uni-ted States shows that there were a number of extensive though mild forerunners fore-runners of the pandemic during the previous three or four years. The epidemic ep-idemic was generally of a mild type and has since been almost forgotten. It occasioned, however, a nolieeable. Increase in the recorded death rate from pneumonia. Rise in Mortality. In the spring of 1018 there was an-nthe" an-nthe" sharp rise In the mortality rate fron; pneumonia. In the larger cilies of the Atlantic seaboard these Increases Increas-es occurred during January, February and March. In the rest of the country, coun-try, especially the central and western west-ern stales, the Increases occurred in April, a month during which pneumonia pneumon-ia mortality is generally on the decline. This Increase was sufficient to indicate indi-cate n strong departure from the normal. nor-mal. The Increased mortality rate extended ex-tended into May and In some areas longer. This occurrence has. It Is believed. 4 definite, significance In relation to the influenzn epidemic. In the United States in the spring of 101S, a number num-ber of definite local outbreaks of influenza in-fluenza were observed : The rise In mortality from pneumonia, pneumon-ia, this very similar type of disease, In the spring of 10TS is so sudden, so marked and so general throughout the United States as to point very clearly to a definite relation. Everything indicates in-dicates that the Increased mortality from pneumonia In March anil April of 191,8 was the consequence of a beginning be-ginning and largely unnoticed epidemic epidem-ic of Influenza, the beginning In this counlry of (he pandemic which developed devel-oped in the autumn of that year. In Ihe P.rltish cities the epidemic manifested three distinct waves the |