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Show INFLUENZA WARNING IS ISSUED By THE flUIHITIES The influenza epidemic which caused 5 thousands of deaths in the I nite,j States 1 last season, and which crippled bu In practically Ccry nook and corner of I the I'nlted Statc. das again started In c the east. Every precaution is being ta- c ken In an attempt to cheek the disease I and it Is expected that citizens will riid the public health officials In that work. C In Utah last year thousands of people f were confined to their beds for weeks C with the malady and business was ham- C pered for more than four months, r Schools were closed, theatres, flahces and C other phases of amusement were dlscon- v tmucd. and every step taken to prevent U the spread of the disease. n This season, with the disease ajrain c making Its appcrance. the fnited Slates ll Rovernment has sent out circulars to the n various health departments of the eoun- e try asking: that the health officials and e citizens co-op-rnto In Checking another An Official Statement? The official bulletin says: Will the flu return? Authoritative statement issued bv the rj, g, public health Ben l i Probably, but by no means certainly, i here will he a recurrence of the influenza influ-enza epidemic this year. Indications are, that should it occur, it will not be as severe as the pandemic pandem-ic of the previous winter. City officials state and city boards of health, should be prepared in the event of a recurrence. 1 lu- fact that a previous attack brings immunity in a certain percentage percent-age of cases .should allay fe.ir on the part of those afilictcd in the previous epidemic. Iufluenza is spread by direct and indirect in-direct contact. It is not yet certain that the grrni has been isolated or discovered and as a consequence there is yet no positive posi-tive preventive, except the enforce raent of rigid rules of sanitation und the avoidance of personal contact. A close relation between the influenza influ-enza pandemic and the constantly in-creasinc; in-creasinc; pneumonia mortality rate prior pri-or to the fall of 1918 is recognized. It is now believed that the disease was pretty widely disseminated throughout the country before it was recognized in its epidemic slate. This failure to recognize the early cases appears ap-pears to have largely been due to the fact that ever inter si iras ihen cen Hi' d on the war. Above are the important laets. developed devel-oped by the I nil ed Slates public h iltfl a . service after a careful survey and In vestigation of ihe influenza pandemic of 1918-19. carried on in every state and important city, and even in foreign for-eign countries. No one of the many experts of the service would make a more positive forecast of the all-important question, will there be a recurrence' All agreed, however, that a recurrence was not unlikely, un-likely, and in the face of the known facts, that It would be wise to be pre-pared, pre-pared, more with a view of being on the safe side than actually anticipating danger The following excerpts from the government gov-ernment report are published for the benefit of the public and health officers offi-cers in the hope that this v. ill serve to set at rest the dailv publication in the newspapers of statements, which on one hand are calculated to lull the public pub-lic into a sense of false security and on the other to unduly cause alarm Contrary to the opinion expressed i frequently during the early weeks of last year's pandemic by a number of observers, the studies of the U. S. public pub-lic health service indicate that the epidemic epi-demic was not a fresh importation from abroad Careful study of the tnortalitv statistics of the United States shows that there were a num ber of extensive though mild forerun ners of the pandemic during the previous pre-vious three or four years. In Chicago snd New York in the winter of 1915-1C 1915-1C for example, there were sufficiently K"oll marked to occasion considerable iublic momment at the lime, leadngi n the latter city, to a well organized! 'Don't spit, don't sneeze" campaign! m the part of the health authorities, rhe reports of the U S public health ' iervlce of January, 1916. show influ , nza to be epidemic in twenty two j1 itates, including practically all sec-ij ions of the United States. The epi-l: lemic was generally of a mild type and las since been almost forgotten. It iccasioned, however, a noticeable in- ' Tease in the recorded death rate from meuinonia. In the spring of 1918 there was an-ither an-ither sharp rise in the mortality rateM rom pneumonia. In the larger cities if the Atlantic seaboard these in- ' reases occurred during January, Feb uary and March. In the rest of the ountry, especially the central and ' western states, the increases occurred D April, a month during wihch pneu- j nonia mortality is generally on the de- 1 line This increase was sufficient to) adicate a strong departure from the. ormal The increased mortality rate xtended Into May and in some areas ven longer l l occurrence ha3, It Is believed, . .I unite significance in relation to I i It influenza epidemic. In the United 1 31 i In the spline of 1918. a number! ol .Minite local outbreaks of Influenza jj were observed: thus in Fort Ogle-j ( thorpe, near Chattanooga, Tenn., in March; in Chicago during March; in' San Quentin prison, California, in April, October and November. At Camp Fun ton recurrent outbreaks of pneu- 6 monla were observed in March April v and May of 1918, and were definitely ( associated with coincident epidemics r of a mild type of Influenza 0 The rhe in mortality from pneumo- . nia. this very similar type of disease, H In the sprlnc of 1918 is so sudden, soin marked and so general throughout the 0 United States as to ;olnt very clearly , to a definite relation. Everything in- n dlcatea that the increased mortnln , Irom pneumonia in March and April of 1918 was the consequence of a begin- j, r.ing and large! unnoticed epidemic of n influenza, the beginning in this coun h try of the pandemic which developed t; in the autumn of that year. ?i In the British cities the epidemic ;i manifested three distinct waves the l lirst and slightest in point of mortality mortal-ity occurring in June and July, the w recond and most severe in November, -n ihe third in February and March. Data 0 which need not be cited here in de- tl tail Indicate that the course of the Ci ipidemic In western Europe generally n was similar In cities of India the se- ti ciuence was similar, but the mortality s rar greater. In the I'nlted States the n epidemic developed more largely In a n :ingle wave during September, OctO- n ber and November. If, however, the h epidemic already mentioned as occir-nnir occir-nnir In tho spring bo considered the first phase and the explosive outbreak of the autumn the second, a third phase of recrudescence is quite evident evi-dent in many areas In general. 11 v inter recrudescence was less marked in those cities which suffered most severely In the autumn epidemic The prevalence of a serious epldt ! lie of influenza was first recognized in and around Boston in September ol 3918. Within about two weeks II was general in the Atlantic seaboard, de- eloping a little later among cities further fur-ther west. Rural districts were usually usual-ly attacked somewhat later than larce cities in the same sections. In the cities east of the line of Ihe Appalachians the excess mortalitj from pneumonia and influenza during the weeks ended September 14, 191S, to March 1, 1919 was approximately ;6 per 1,000; In cities between the Rock mountains and the Appalachians, Appalach-ians, 4 35: and in those of the Pacilic coast, 5.5 ') per 1,000 Notwithstanding this general geographic geo-graphic relation, there are notably wide differences in the mortality rat -Of individual cities in ihe same sec-lion, sec-lion, even between cities close together, togeth-er, differences which are not as yt explained on the basis of climate, density den-sity of population, character of preventive pre-ventive measures exercised, or auy other determined environmental fac tor. More details can be given only the briefest mention here In order to secure se-cure reliable statistics of morbidity the public health service has made special house-to-houso surveys in a number of localities, ascertaining 'lie rumber ol persons affected, the dates jf onse-t. and a few other simple fai tfi aaci urataly numerated groups representative repre-sentative of the general population. I'artlal analysis of the results ol th-e Airveys in eight localities, giving an iggregate of 112,958 persons canvassed, can-vassed, shows the following as the hief facts of interest: The percentage of the population at-ackeel at-ackeel varied from 15 per cent in LiOUlsvlUe to 53.3 per cent in San An-onio. An-onio. Texas, the aggregate for the hole group being about 28 per cent, rhis agrees with scattered observa-10ns observa-10ns in the first phase of the 1889-90 epidemic, when the attack rate seems o have varied within about these Smits. The case incidence was found to he inlfonnly highest In children from 5 0 14 years old, and progressive! low-:r low-:r in each higher age group It was illghtly higher in females than 'n! nales of corresponding age; usually ligher in the white than the colored topulation The. ratio of pneumonia cases to total lopulalion varied from 6.3 cases per 1000 n SparlnnburK. S C to 21.6 per 1000 In he smaller towns of Maryland. The neumon!a rate showed litlle correlation vlth the Influenza attuck rate. The ratio of deaths to population var-ed var-ed from 1.9 per 1000 In Spartanhurcr to R In Maryland towns. The death rate vas by no means parallel to the Influ-ma Influ-ma attack rate, but was closely cor-elated cor-elated with the pncumonl rate. In ther words, the case fatality rate ot neumonla tended to he fairly constant, round 30 per cent. The death rate wis otnbly hifrh in children under one yar Id, in adults from 20 to 40. und in per-oii.s per-oii.s over 60, hifiher in males thon in fc-lales fc-lales of comparable nccs: higher among ic whites than the colon I Concerning the Important question of nmunlty conferred by an attuck of ln uensa, the evidence Is not conclusive, s.it there is reason In believe that an at-irk at-irk durlnp the earlier staqcs of ihe pldemlc confers a considerable, but not bsoluto immunity in the later out-reaks. out-reaks. in Rcneral the pandemic of influenza as lagejy similar to that of 1889-1890 1 Its development, first a mild form, ter In a severe world-wide epidemic, in le rapidity of Its spread and its hli;h lse incidence. It has. however. le. r Dtably different In a much hisher mor-ilit.v, mor-ilit.v, especially among young adults, uch evidence as has been gathered con-rni.s con-rni.s the conclusion previously leached iat It Is transnutlert directly und Indl-ctly Indl-ctly by contnci. Ii appear probable, owever, that the Infection was already 8HV wldelv disseminated in this country sometime some-time before a serious epidemic was recognized rec-ognized Despite the fact that there I still some uncertainly as to the nature of the microorganism micro-organism causing pandemic Influenza, onu thing Is certain, that the disease Is communicable com-municable from person to person Moreover. More-over. Judging from experience In other diseases, it is probable that the germs, whatever its nature, is carried about not only by those who are III with Influenza, but by persons who may be entirely well. Everything which lncrca ses personal contact, con-tact, therefore, should be regarded as a factor in spreading influenza. Much was heard last winter of the uo of face masks. Though tho use of suitably suit-ably constructed masks will reduce thb Interchange of respiratory germs through inhalation it must be remembered remem-bered that there are many other paths by which such germs are transmitted from person to person. Soiled han Is, common drinking cups. lmproperl cleaned eating and drinking utensils !n restaurants, soda fountains, etc. roller' towels, infected food these are only a few of the commpn vehicles of gcrro transmission. The use of face masks appears ap-pears to make people neglect these other paths of infection, and so the use ot face masks has not been attended with the success predicted by them. If wa would be more successful In combating Influenza greater attention must be pain to the factors just enumerated The question of most practical and Im- m mediate Interest Is the probability ol recurrence in the near future. Recur- 'j i i A n BCM are characteristic of influenza ept- ll! . I 1 demies; and the history of th last pan- , R. j V li mlc and previous ones would seem 'O ' iS, h point to the conclusion that this one has not yet run its full course. On the , ' other hand this epidemic has already i'f Iff shown three more or less distinct phas?& and has been more severe, at least In .2', p L 4 mortality lbin the three-ye:ir epidemic of I m ts whi.-h Justify the hope, !, i i though not the conclusion, that It has tri lls run Its course already. J&t W It seems probable, however, that w 1 X . J may expect at least local recurrences in the n m future with :in inerea.se over lh I normal mortality from pneumonia for I ' '. perhaps several years, and certainly wc fSf should be as far as possible preired r( le t them b;. j.r.- organization of , , 1 !cn. ;ind measures for nUemp'.ed pr---ventlon. treatment and scientific invcsti-gatfoa invcsti-gatfoa There should be no repetition of Ihe ct- IU- 1 i tensive suffering and distress which ac 1 1 companled last year's pandemic Com- rWsjL'rf munltles should make plans now for deal- ' HhH ing with anw recurrence oi the e-piriemlc ' The prompt recognition of the carl; cases 1 t , nnd their effective isolation should ho 'i it all ted at In this connection, attention i '1 is iall(.l lei the fuct that t lie eases may V ippear ! be just ordinary colds A re ' , j cent extensive outbreak of what wus re- 1 ' garded as ' summer colds ' in Peoria. III., ! . ! 1 front Inued on Page 8) inn in (Continued from Page 7) I proved on Investigation to an epidemic oi a mild type of infiiionza. Experience in- I ' dicales that thr.T mild opromi-3 are of- ' ten the starting points of more sever visitations. Hence every efforts should be made to discover as early as possible I any unusual prevalence of "colds." For municipalities operating on a budget bud-get basis. It Is Important that all delay I in providing the necessary financial aup- I port to tbe health authorities in dealing ' I with a recurrence of the epidemic be I avoided by setting aside an emergem . I epidemic fund This may prove of th? J greatest value in carrying out Important preventive measures in the early days of the epidemic, at a time when their I beneficial effort la greatest. The most promising way to deal with a possible recurrence of the influenzal epidemic is. lo sum It up in a single word. "Preparedness." And now it is h. lima In npanar |