H.—3l

24

have occurred at ports playing the largest part in dealing with overseas shipping Thus at Glasgow (he pneumonic type of epidemic appeared about 21st September, and similarly at Portsmouth cases showing a specially severe infection were reported about this time. The outbreak of fatal pneumonia on the transport "Tahiti" and other ships of the same convoy began on 28th August, showing thai- the virulent type of infection was early prevalent, among shipping. Europe. Alt-hough the pandemic of 191.8 was known as "Spanish influenza" Spain was not the firstcountry in which the epidemic appeared. Probably the name "Spanish" was attached because tins country was one of the first to show influenza widely among the civil population; but prior to this it had developed among the armies of the western front, probably first among the German soldiers in March and April. In the latter month if was epidemic among the French, Italian, and British troops. This first- wave was not specially severe, and comparatively few deaths occurred, but all observers agree that there was a tendency to increased severity as the epidemic progressed. It varied somewhat in different countries in Europe, for in Italy by July influenza hail practically disappeared from among the troops, while in Switzerland at the same time it was causing a number of deaths both in the army and among the civil population. In the latter country it waned during August and September, and then burst- out again more violently than before. In September generally the, epidemic began to show a- tendency to increase, and by the end of that month a secondary wave of great virulence had developed' in Paris, Spain, and Portugal. In October it reached Italy, Greece, Denmark, Holland, and Sweden. In Greece it was at its highest in the first weeks of November. In Switzerland in October. The explosive nature of this outbreak is shown by the following figures relating to the British Expeditionary Forces in France : September—Twenty-four deaths from pneumonia and influenza. October—l,46s deaths from pneumonia and influenza among 27,596 admissions to hospital for these diseases. The date of this recrudescence in the Army in France is given as the Bth October. America. In the early part of 1918 there appears to have been a widespread epidemic of influenza throughout the States, though not of a severe type, and doubtless this constituted the primary wave. It was present on the California!) coast in April, and in July was prevalent in the eastern States. The American authorities date the secondary epidemic from the first two weeks in September, when influenza, began to show itself in localized outbreaks in the military camps in Massachusetts, but was at first only mild in character. from here it, spread westward, and was fairly universal throughout the States by the last week in September, but yet not of an alarming nature, since the official bulletins at that time adopt a warning tone as regards the, possibility of pneumonic complications " in the coming winter months." The first indications that the epidemic was already showing unusual features were noticed in I he first week in October, when Health officials all over the States were directed to send daily bulletins as to the condition in their districts. About this time the pneumonic features appear to have become prominent in the eastern States. In the western States the appearance of the pneumonic complication was considerably later. In San Francisco, for example, the epidemic began to appear on the 26th September, but it was not till the 21st October that the pneumonic type of the disease was reported. The crest of the wave was reached on the 2nd November, and then it declined rapidly, and towards the end of November disappeared. The following figures represent the dates of the peak of the second wave in different towns in America: Boston, sth October; Washington, 19th October; New York, 26th October; San Francisco, 2nd November. The spread from Boston is here apparent, as also the delay before the wave reached the west coast. The average date for the wave peak for the twelve chief cities in the States was tho 26th October. The wave lasted at each centre from eight to ten weeks. Canada. In Canada influenza spread from east to west in the first two weeks of October, beginning apparently in Quebec about, the 28th September. The first notification from British Columbia appears to have been made during the week ending the 12th October, but here the pneumonic complications were manifest from the first. In Ontario the wave peak was in October. South Africa.. During September the South African States were visited by an epidemic of influenza which, I hough very widespread, was not, productive of a high, mortality. Even so far on as the 27th September the visit of N.Z. troopships at Durban and Cape Town did not result in infections of more than average severity appearing on board these boats, though no special preventive measures to exclude contact with infection were taken. The secondary wave seems to have developed with explosive suddenness in the first week in October in Cape Town, and about the 12th October in Natal. The Native population, as might be expected, were the first to show the severity of the disease, and suffered most heavily throughout, their death-rate being treble that of the Europeans. Australia. Influenza of non-virulent type was fairly prevalent throughout- Australia from August onwards. This we may regard as the primary influenzal wave seen in other countries. It was accompanied by a heightened death-rate, but not abnormally high. It is of great interest to note that- during 1918 the definite secondary wave did not develop in Australia, and it was not, till well on in January, 1919, that cases of the severe pneumonic type began to be frequent, Mcl-