PNEUMONIA IN BOSTON 
DURING THE RECENT EPIDEMIC 
OF INFLUENZA. 
BY 
George B. Shattuck, M.D., 
Visiting Physician to the Boston City Hospital. 
'Reprinted from the Boston Medical and Surgical Journal of 
May 26, i8()2. 
BOSTON: 
DAMRELL & UPHAM, PUBLISHERS, 
283 Washington Street. 
1892. S. J. PARKHILL & CO., PRINTERS 
BOSTON PNEUMONIA IN BOSTON DURING THE RE- 
CENT EPIDEMIC OF INFLUENZA.1 
BY GEORGE B. SHATTUCK, M.D., 
Visiting Physician, Boston City Hospital. 
During the progress of the epidemic of influenza, 
with which, I think, we must acknowledge we have 
been visited this winter, I was impressed with the 
evident increase in the number of cases of pneumonia 
entering the City Hospital in my own service and in 
those of my colleagues, and also with the large number 
of deaths, especially among old people, as appearing in 
the daily papers and in the reports of the City Board 
of Health. Moreover, not a few of the pneumonias, 
as observed at the City Hospital, exhibited peculiari- 
ties or irregularities ; they w'ere less frank than usual 
in their development and in their resolution. 
As I had about this time fallen a victim to your 
President’s energy, and promised to occupy part of 
one of his evenings, it occurred to me I would look up 
these general points in a general way and give you the 
results, which might at least derive some interest and 
possibly some value from a comparison with those of 
a very recent previous epidemic of influenza, and those 
of an intervening non-epidemic year, sandwiched be 
tween the two. 
But upon re-reading the contributions to the expo- 
sition of the relations between pneumonia and influenza 
and the mortality-rate and influenza, I found them 
more elaborate than I had remembered them to be. 
I thought, however, it was desirable that any new 
statements in regard to the past two years should be 
1 Head at the meeting of the Boston Society for MedicalJjj+pjtrye- 
ment, 2 
put in a form comparable with those previously fur- 
nished with regard to the previous epidemic. Hence, 
instead of letting you off with a few simple, and per- 
haps vague statements, I come before you with some 
tables, a form of setting forth facts which it has been 
my duty as an editor to discourage in others. The 
immediate cause of this unfortunate result is the zeal 
of your President, as before said; the remote cause is 
the zeal of my predecessors. 
The Clinical Section of the Suffolk District Medical 
Society held a meeting January 15, 1890, for the dis- 
cussion of influenza then epidemic in Boston, a discus- 
sion which was opened by Dr. F. C. Shattuck and 
closed bv Dr. A. L. Mason ;2 at this meeting the 
relation of pneumonia to influenza was incidentally 
considered. The New York Academy of Medicine 
devoted its meeting April 7, 1890, to the discussion 
of the relation of pneumonia simply to influenza. Dr. 
E. G. Janeway occupied himself with New York, but 
his paper was not published ; Dr. Wm. Pepper gave 
the results for Philadelphia; 8 and Dr. F. C. Shattuck 
those for Boston.4 
As our subject was not only the same hut dealt with 
the same locality, it seemed better to follow tbe gen- 
eral plan of dealing with it adopted by my brother two 
years ago, and see how far the results would lead to 
similar conclusions reached by him then or formulated 
by Dr. Pepper from his figures and observations ob- 
tained in Philadelphia. Accordingly where there were 
tables — and I regret both for your sake and my own 
that there were so many — I have tabulated the same 
details for 1890-91, 1891-92, thus giving a compari- 
son of eight years instead of six, and of two epidemic 
2 Boston Medical and Surgical Journal, vol. cxxii, No. 7,1890. 
8 Remarks on the Frequency and Character of the Pneumonias of 
1890 ; Medical News, vol. lvii. p. 1, 1890. 
4 The Relation of Pneumonia to Influenza in Boston: New York 
Medical Journal, vol. li, p. 650, 1890. 3 
periods instead of one, For, whether or not there was 
a recurrence of influenza as an epidemic at any earlier 
period of the year 1891 than December, I think we 
may accept the months of December, 1890, and Janu- 
ary, 1891, as practically free from it. I have tabulated 
the records of the Boston City and of the Massachusetts 
General Hospitals, from December 10, 1890, to Feb- 
ruary 1, 1891, and from December 10, 1891, to Feb- 
ruary l, 1892, as a continuation of similar statistics 
for previous years. As arbitrary dates have to be 
adopted to represent the epidemic limits, these are, 
perhaps, as good as any others. It may be that some 
observers would fix an earlier or a later date for the 
beginning or the decline of this or of the previous 
epidemic, but for purposes of comparison, especially in 
regard to diseases of the respiratory organs, it is, of 
course, essential to take as nearly as possible the same 
season of each year. 
Deaths from Pneumonia reported at the Boston City Hall for the 
Months of December and January, 1884-85 to 1891-92, inclusive. 
Table I. 
Months. 
1884-85 
1885-80 
1880-87 
1887-88 
1888-89 
1889-90 
1890-91 
1891-92 
Decemb’r 
141 
74 
113 
95 
68 
105 
100 
223 
January, 
103 
83 
91 
183 
92 
332 
139 
240 
Total, 
244 
157 
204 
278 
160 
437 
239 
463 
Table I shows that the number of deaths returned 
in Boston as due to pneumonia, December and Janu- 
ary, 1891-92, was greatly increased over the previous 
six non-influenza years; that this increase was about 
as great for December as for January ; that the num- 
ber of deaths for the two months exceeded that of 
1889-90, by 26, though the distribution was different, 4 
there being 118 more deaths in December, 1891, and 
92 less deaths in January, 1892. 
Table II. 
Cases of Pneumonia admitted to the Poston City and Massachusetts 
General Hospitals from December 10th to February 1st, for the Years 
1884-85 to 1891-92. 
1884-85 
1885-86 
1886-87 
oc 
00 
oo 
00 
1888-89 
1889-90 
1890-91 
1891-92 
Total, 
33 
26 
80 
68 
40 
127 
48 
101 
Deaths, 
14 
4 
12 
26 
13 
38 
13 
39 
Mortality 
42+% 
15+% 
40% 
39% 
32J% 
30% 
27% 
38% 
Table II shows, from the hospital returns, that the 
mortality, as well as the number of cases, was largely 
increased, the per cent, being above the average 
of the previous six non-influenza years, whereas it was 
2below the average of those years for the same 
period 1889-90. It is a curious coincidence that 
twenty-six fewer cases of pneumonia entered the hos- 
pitals, and twenty-six more deaths were reported at 
City Hall. 
Table III shows by weeks that the increase in 
deaths from pneumonia began earlier and was more 
rapid this winter than last winter or the winter of 
the previous epidemic, and the same is true of bron- 
chitis comparing this winter with last. The week 
ending January 2d, was the week of greatest mortal- 
ity from pneumonia this winter, whereas last winter 
and the winter before it was a week later. The max- 
imum mortality from bronchitis occurred the same 
week this winter as last winter, and the number of 
deaths was, curiously, the same ; it was a week later 
than that for pneumonia. If the early increase in 
deaths from pneumonia was dependent upon epidemic 5 
influenza the epidemic this season should have mani- 
fested itself earlier than two years ago. Personally I 
Table III. 
Deaths from Pneumonia reported at the Poston Board of Health in 
December and January, 1889,1890, 1*91 and 1892, by Weeks. 
Deaths from Bronchitis December, 1*90, 1891, January, 1891, 1892. 
Date. 
Bronchitis. 
Pneumonia. 
Date. 
| Bronchitis. 
Pneumonia. 
Date. 
Bronchitis. 
Pneumonia. 
1889. 
1890. 
1891. 
Week eDding 
Week ending 
Week ending 
Dec. 7, 
9 
Dec. 6, 
11 
11 
Dec. 5, 
14 
26 
“ 14, 
13 
“ 13, 
11 
26 
“ 12, 
14 
41 
“ 21, 
17 
“ 20, 
11 
22 
“ 19, 
15 
31 
“ 28, 
36 
“ 27, 
10 
24 
“ 26, 
27 
57 
1890. 
1891. 
1892. 
Week ending 
Week ending 
Week ending 
dan. 4, 
89 
Jan. 3, 
16 
27 
Jan. 2, 
30 
85 
“ 11, 
117 
“ 10, 
10 
38 
“ 9, 
38 
79 
“ 18, 
93 
“ 17, 
12 
31 
“ 16, 
31 
74 
“ 25, 
38 
“ 24, 
6 
25 
“ 23, 
24 
55 
“ 31, 
18 
29 
“ 30, 
16 
39 
Table III bis. 
Total Tabulated Cases of Pneumonia at the Boston City Hospital and 
Massachusetts General Hospital. 
City Hospital. 
Mass. Hosp. 
Total. 
Dec. 10, 1890, to Feb. 1, 1891 , 
, . 36 
14 
50 
Deaths 
4 
13 
Mortality 
. . 25% 
28+% 
26% 
Dec. 10,1891, to Feb. 1, 1892 . 
. . 87 
20 
107 
Deaths 
6 
40 
Mortality 
■ . 39%% 
30% 
37% 
should have said it developed, if anything, a little 
later. The editorial column of the Boston Medical 6 
and Surgical Journal, probably upon good author- 
ity, under date of December 17, 1891, says: “It 
seems to be the general impression that epidemic in- 
fluenza has once more made its appearance in the 
United States, though as yet it has not assumed a 
serious aspect. The Boston Board of Health does 
not officially recognize its presence in this city, but 
admits the apparent increase of catarrhal troubles and 
pneumonia during the last month,” etc. The views 
of individual practitioners upon this point would be of 
value. 
Looking from another point of view at the returns 
to the city authorities of the deaths from pneumonia 
and bronchitis, I find the following: the average of 
deaths from pneumonia for the month of December in 
the five years 1884-88, was 104; in December, 1889, 
the deaths were 160; in December, 1890, 100; and 
in December, 1891, 223: the average for the five 
Januarys, 1885-89, was 118.6; in January, 1890, the 
number was 353; in January, 1891, it was 139; and 
in January, 1892, 240. 
In the same way for bronchitis, the average of five 
Decembers was 54.8; the number for December, 
1889, was only 43; for December, 1890, 49; and for 
December, 1891, 90. For the five Januarys the 
average was 53.2; for January, 1890, the number was 
89 ; for January, 1891, 48 ; and for January, 1892,109. 
Before tabulating the total cases of pneumonia 
(meaning thereby croupous pneumonia) entered at 
the two hospitals between December 10 and February 
1, 1890-91, 1891-92, I was curious to see the pro- 
portion of cases in each. I got the following result 
shown in Table III bis. which includes both croupous 
and catarrhal or broncho-pneumonias — the number 
of the latter being small — ten in all for the two 
years, at both hospitals. 
The great increase in the number of cases, as well 7 
as in the number and percentage of deaths this win- 
ter, comes largely, therefore, from the City Hospital ; 
and there also the proportion of males was larger — 
sixty-five males to thirty-two females, while at the 
Massachusetts there were twelve males to eight 
females. 
Table IV. 
Analysis of all Cases of Lobar Pneumonia admitted to the Boston City 
and Massachusetts General Hospitals, from Dec. 10, 1889, to Feb. 1, 
1890, with Reference to the Precedence of Grippe Symptoms, Localiza- 
tion, Complications, and Termination — Lysis or Crisis, or Death. 
Preceded by 
grippe 
! symptoms 
Not preceded 
by grippe 
symptoms. 
Doubtful. 
No history. 
Total, 
Total, number 
55 
36 
26 
10 
127 
“ per cent 
43 
29 
20 
8 
100 
Single "lobe, number 
39 
17 
14 
6 
76 
“ “ per cent 
71 
47 
54 
60 
60 
Unilateral, more than ( number . 
6 
11 
5 
4 
26 
one lobe . . . . ( per cent. 
11 
31 
19 
40 
20 
Double, number 
10 
8 
7 
25 
“ per cent 
18 
22 
27 
20 
Complicated, number .... 
13 
11 
14 
5 
43 
“ per cent 
24 
31 
53 
50 
34 
Recovery by crisis, number . . 
15 
7 
3 
25 
“ “ per cent. . . 
44 
44 
21 
36 
Recovery by lysis, number. . . 
19 
9 
11 
5 
44 
“ per cent. . . 
56 
56 
79 
100 
64 
Death, number 
11 
14 
8 
5 
38 
“ per cent 
20 
39 
30 
50 
30 
December 10, 1891, to February 1, 1892. 
Total, number 
28 
61 
1 
11 
101 
“ per cent 
27 
60 
1 
11 
100 
Single lobe, number 
22 
48 
1 
9 
80 
“ “ per cent 
80 
80 
100 
80 
80 
Unilateral, more than ( number . 
2 
8 
1 
11 
one lobe . . . . | per cent. 
7 
12 
10 
10 
Double, number 
4 
5 
1 
10 
“ per cent 
14 
8 
10 
10 
Complicated, number .... 
6 
20 
6 
32 
“ per cent 
21 
33 
50 
33 
Death, number 
11 
21 
i 
6 
39 
“ per cent 
40 
34 
100 
50 
38 8 
Table IV gives an analysis of the cases of pneu- 
monia in the two hospitals — the extent of the pro- 
cess, the complications and the mortality — with refer- 
ence to influenza antecedents as gathered from the 
records. 
I have not attempted to include recoveries by crisis 
and lysis, partly because the dividing line is very un- 
certain, and partly because the charts in many cases 
had not been entered and were not easily accessible. 
The results of this analysis differ materially in several 
important particulars — and especially as to the per- 
centage of pneumonias preceded by influenza-symp- 
toms— from those of a similar analysis of hospital 
cases in the previous epidemic published in Dr. F. C. 
Shattuck’s paper. 
The difference is probably due more to a dilference 
of record-keeping or record-interpretation than to so 
great an actual difference iu facts. Of the total 
pneumonias only 27 per cent, are recorded as pre- 
ceded by influenza; 60 per cent, were not entered as 
preceded by such symptoms, and one per cent, doubt- 
ful. This compares with 43 per cent, preceded by 
such symptoms in the previous epidemic, and only 
49 per cent, not preceded or doubtful. 
The percentage of complications was about the 
same for the two epidemics, and the only other marked 
difference appears in the mortality which has already 
been alluded to. 
Table V gives the age and sex of the 101 hospital 
cases. The percentage of males was rather less than 
in the previous epidemic, 70—f-% compared to 74-f-%, 
and of females 30% compared to 26%. There were 
no deaths under twenty years of age, and only five 
cases, all of which were in males. The mortality in- 
creased pretty constantly in the next three periods of 
twenty years. 9 
Lobar Pneumonia in Boston City Hospital and Massachusetts General 
Hospital, December 10,1889, to January 31, 1890. 
Table V. 
Age. 
Oases. 
Male. 
Female. 
Fatal. 
10 and under 
2 
2 
0 
0 
10 to 20 
14 
9 
5 
2(14%+) 
20 to 30 
41 
28 
13 
T (17%+) 
30 to 10 
31 
25 
6 
10 (32% +) 
10 to 50 
16 
12 
4 
8 (50%) 
50 to 60 
13 
9 
4 
7(51%-) 
60 to 70 
1 
1 
0 
1 
70 to 80 
1 
0 
1 
0 
Unknown 
8 
8 
0 
3 
Total 
127 
94 (74%) 
33 (26%) 
38 (30%) 
December 10,1891, to February 1, lt-92. 
10 and under 
1 
1 
0 
0 
10 to 20 
5 
5 
0 
0 
20 to 40 
53 
36 
17 
18 (34%) 
40 to 60 
23 
17 
6 
9 (39% +) 
60 . 
9 
5 
4 
5 (55 J%) 
Unknown 
9 
7 
3 
7 (s0% -) 
Total 
101 
71 
30 
39 (38% +) 
The upper half of this table shows the age and sex of 127 hospital 
cases. Nearly 75% were males, and the mortality increased with 
each decade up to the fifth, remaining stationary thence to the 
seventh. 
Table VI analyzes the deaths from pneumonia and 
broncho-pneumonia, as reported to the city authorities, 
with reference to age, and compares the deaths in De- 
cember and January, 1891-92, with the same months 
in 1889-90, and the average of the previous five 
years. 
There was an increase in deaths over the average 
deaths in December for every decade except one (10- 
20) up to 100, this increase culminating in the decade 
between 80 and 90 with 479 per cent. In December, 
1889, there was no increase under twenty or over 
seventy, at other ages there was a marked increase 10 
over the average, hut a less increase for every decade 
except two, 20-30 and 40-50, than in December, 
1691. 
Fatal Pneumonia and Broncho-pneumonia reported at the Boston City 
Hall. Comparison between December, lss9, and January, 1S90, and 
the average of the same months during the previous five years, with 
reference to age. 
Table VI. 
Age. 
Avge. 
deaths, 
Dec., 
1884-8. 
Deaths, 
Dec., 
1889. 
Per ct. 
of in- 
crease. 
Avge. 
deaths, 
Jan., 
1885-9. 
Deaths, 
Jan., 
1890. 
Per ct. 
of in- 
crease. 
10 and under . . 
36.2 
37 
36 
56 
55 
10 to 20 .... 
2.6 
3 
1 
14 
250 
20 to 30 .... 
8 
26 
225 
8.8 
43 
388 
30 to 40 .... 
10 
22 
120 
17 
54 
218 
10 to r>o .... 
11.8 
28 
137 
15 0 
57 
265 
50 to 00 .... 
11.4 
18 
58 
11 8 
50 
324 
00 to 70 .... 
11.2 
15 
34 
1£ 
38 
192 
70 to ro .... 
9 
8 
10.2 
28 
175 
80 to 90 .... 
3.8 
3 
2.2 
13 
500 
Comparison between December, 1891, and January, 1892. 
Deaths, 
Per cent. 
Deaths, 
Per cent. 
Age. 
Dec., 
of in- 
Jan., 
of in- 
1891. 
crease. 
1892. 
crease. 
10 and under . . . 
60 
65 
44 
22 
10 to 20 
2 
0 
20 to 30 
13 
624 
22 
150 
30 to 40 
23 
13C 
29 
71 
40 to 50 
22 
86 
32 
105 
50 to 00 
21 
81 
26 
120 
GO to 7 0 
32 
186 
41 
215 
70 to so 
28 
211 
31 
204 
80 to 90 
22 
479 
14 
530 
90 to 100 
1 
1 
In January, 1892, there was a large increase over 
the average for every decade except one, 10-20— 
when there were no deaths—culminating in an in- 
crease of 536 per cent, in the decade 80-90, which 
compares with 500 per cent, increase for the same 11 
decade January, 1890; for the earlier decades the in- 
crease was smaller for January, 1892, than for Janu- 
ary, 1890, but it was larger for the very old, that is 
the three decades 60-70, 70-80, and 80-90. 
Fatal Bronchitis reported at the Boston City Hall. Comparison be- 
tween December, 1889, and January, 1890, and the average of the 
same months during the five previous years, with reference to age. 
Table VII. 
Age. 
Average 
deaths, 
Dec., 
1884-8. 
Deaths, 
Dec., 
1889. 
Average 
deaths, 
Jan., 
1885-9. 
Deaths, 
Jan., 
1890. 
Per cent, 
of in- 
crease. 
10 and under . . 
37.2 
23 
36.8 
29 
10 to 20 . . . . 
0.0 
1 
0.4 
3 
650 
20 to 30 . . . . 
0.2 
2 
900 
30 to 40 . . . . 
i 
3 
1.4 
3 
114 
40 to 50 . . . . 
1.4 
1.4 
5 
256 
50 to 60 . . . . 
4.8 
4 
2.4 
8 
233 
60 to 70 ... . 
6 
5 
3.4 
13 
282 
70 to 80 . . . . 
2.4 
4 
5 
13 
160 
80 to 90 . . . . 
1.4 
3 
2.6 
13 
400 
Comparison between December, 
1891, and January, 1892. 
Deaths, 
Per cent. 
Deaths, 
Per cent. 
Age. 
Dec., 
of in- 
Jan., 
of in- 
1891. 
crease. 
1892. 
crease. 
10 and under . . 
42 
13 
0 
10 to 20 . . . . 
1 
83 
0 
20 to 30 . . . . 
2 
3 
1,406 
30 to 40 . . . . 
1 
0 
G 
329 
40 to 50 . . . . 
0 
329 
4 
186 
50 to GO . . . . 
9 
87£ 
9 
275 
60 to 70 . . . . 
12 
ioo 
13 
282 
70 to 80 . . . . 
15 
525 
17 
240 
80 to 90 . . . . 
3 
114 
14 
438 
90 to 100. . . . 
1 
The very small number of deaths from pneumonia 
and bronchitis between the ages of 10 and 20 years 
in the city returns for any year is very striking. 
The city returns, it may be remarked incidentally, 12 
show five deaths from bronchitis and pneumonia be- 
tween the awes of ninety and one hundred in Decem- 
ber. 1890-91, and January, 1891-92. 
Table VIT analyses bronchitis reported to the city, 
as Table VI did pneumonia, with reference to age. 
Deaths from bronchitis in December under ten years 
were increased slightly, in January there were none 
under twenty years ; in December and January, 1889, 
1890. under ten years they were less than the average, 
for all the other decades, except one, for both months 
there was irregular but considerable increase. The 
numbers, however, in all three years were too small 
to be of much value. 
Having compared my figures for the present epi- 
demic and the one free year with those published in 
my brother’s paper for the previous epidemic and for 
the five free years, we will see how the conclusions to 
which my figures lead, compare with those to which 
his figures lead him. 
He says : “Conclusions can be drawn, but they do 
not seem to me of such a nature as to throw any really 
new light on influenza pneumonia.” With this state- 
ment I fear I must agree. The conclusions are as 
follows: 
“ (1) Pneumonia was unusually prevalent in Boston 
during the height of the influenza epidemic, about the 
middle third of the visitation.” My figures indicate 
that it was unusually prevalent this winter, too, but 
reached its culmination a week earlier. 
“ (2) The statistics of the Pacific Mills indicate 
that less than a half per cent, of those severely attacked 
bv influenza acquired pneumonia. 
“ (3) Broncho-pneumonia was rare in the hospitals.” 
I find onlv six cases in both hospitals this winter. 
“ (4) The pneumonia mortality rate was probably 
not increased, perhaps diminished, as compared with 
that of the five previous years.” For this epidemic it 13 
was increased eight per cent, over the previous epi- 
demic and five and one-half per cent, as compared with 
the average of six free years. 
“ (5) The number of cases of pneumonia not pre- 
ceded by grippe symptoms was about the same as the 
number of pneumonias in an average year.” The 
number was apparently greater than thfe number in an 
average year. 
“ (6) Pneumonia followed grippe in so large a num- 
ber of cases as to show some sort of connection be- 
tween the affections.” In a sufficiently large number 
of cases. 
“ (7) In sixty per cent, of the cases a single lobe 
only was involved.” In eighty per cent. 
“ (8) Two-thirds of the cases terminated by lysis.” 
“ (9) Pneumonia was three times as frequent in 
males as in females, and the mortality rate increased 
with each decade.” Two and one-third times. 
“ (10) The most striking increase in the urban 
deaths from pneumonia was, on the whole, between 
the ages of twenty and sixty and eighty and ninety. 
The increase under ten was slight.” The increase in 
the urban deaths from pneumonia was greatest be- 
tween the ages of sixty and ninety ; it was striking, 
but evenly distributed between twenty and sixty ; 
under twenty it was slight. 
“(11) The gross appearances in nine cases exam- 
ined after death were not specially noteworthy.” 
Autopsies not considered. 
Dr. Pepper's estimate from returns made to him by 
a large number (272) of practitiouers in Philadelphia, 
of the relative proportion of croupous and catarrhal 
pneumonias, differs greatly from the results afforded by 
our hospitals. These returns indicate that the catarrhal 
were almost twice as frequent as the croupous. He 
further states that Dr. DaCosta and he saw about an 
equal number of catarrhal and croupous pneumonias 14 
in consultation. He notes as a peculiarity of the pneu- 
monias during the epidemic season 1889-90 the large 
preponderance of cases affecting the right lung, which 
he estimates was affected twice as often as the left. 
Of 101 hospital cases in Boston from December 10th 
to February 1st, this winter, the right lung alone was 
affected in the left alone in 32-)-% ; but I find 
that of 44 cases for the same period last winter, when 
there was no epidemic of influenza, in 53% the right 
alone was affected, the left alone in 33%. Osier re- 
ports that in 100 pneumonia autopsies at the Montreal 
General Hospital, not made during an influenza epi- 
demic, the right lung was affected in 51%, the left in 
32% and both iu 17%. Of last winter’s hospital cases 
in Boston 14% were double, aud this winter’s only 10%. 
Apex 
Broncho-pneumonia, 
Whole of one lung . 
Double 
Left lung alone . . 
Right lung alone . . 
Amount of Lung in- 
volved and region 
affected. 
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at 
to 
Apex. 
© t-1 
00 
© 
© 
© 
Delirium. 
p 
J_k £ 
4- 
© 
to 
© 
Alcoholic Habits. 
o 
tO 4* 
00 
© 
4* 
It 
© 
Mortality. 
p* 
Table YIII. 
Dec. 10, 1890, to Feb. 1, 1891, 44 cases'. Dec. 10,1891, to Feb. 1, 1892, 
101 cases. Both jears, 147 cases, including two of doubtful location. 15 
Though not coming strictly under my subject, curios- 
ity and a desire to make use ot' my figures led me to 
look into the question of apex pneumonia,— especially 
as I have for some time been sceptical of the current 
statement that it is more apt to be accompanied by 
delirium. In 18 apex pneumonias (T7% of the total) 
of the influenza period, there were 9 deaths, or 50% ; 
but 6, or 33%, were of markedly alcoholic habits, 
and only 5, or 28%, exhibited delirium. One case, 
notwithstanding the apex and the alcohol, was not 
delirious and got well. One case of double apex died 
two days after entering the hospital, this is not included. 
Last winter in 10 apex cases (23% of the total), five 
died, five had alcoholic habits, and six were delirious; 
that is, one only was delirious without beino; alcoholic. 
Jn regard to his returns for the 1889-90 epidemic. 
Pepper says : “ There was also an unusual proportion of 
cases of apex pneumonia where the entire upper lobe 
was completely consolidated without implication of 
any other part. As usual in such cases, there seemed 
to be a special predominance of cerebral symptoms.” 
Among the complications were inflammations of the 
ear of various degrees of severity, erysipelas, rheuma- 
tism, tuberculosis, empyema, cardiac lesions and peri- 
carditis, melancholia, acute mania, meningitis, alcohol- 
ism, cerebral embolism, erythema, etc. 
One young woman entered my service at the City 
Hospital with undoubted influenza. She developed 
an erythema of the face, then a pneumonia; she then 
miscarried at the fifth month; she then developed 
diphtheria; and she subsequently recovered her health 
perfectly. 
I had intended to sav something about the vague 
symptoms and ill-defined physical signs observed in 
some cases of so-called pneumonia during the influenza, 
but I have already taken up too much of your time. 
I hope some of you will favor us with your personal 16 
experiences as practitioners; some T know have seen 
comparatively little pneumonia this winter and others 
more than usual. 
To sum up briefly, I should incline to the opinion that 
true pneumonia was a sequel rather than a concomitant 
or complication of influenza. Though I acknowledge 
that the tables presented do not offer alone sufficient 
support for this view. 
Pepper takes this position in the following words : 
“ The vast majority of pneumonias occurred as a sequel, 
rather than a complication, and they were clearly trace- 
able to exposure to damp and raw weather while the 
patient had a relaxed system and while slight pyrexia 
persisted after the subsidence of the more marked 
symptoms of his influenza. Experience furnishes 
many instances of this fact.” 
Osier, in his “ Practice of Medicine,” just published, 
speaks of pueumonia as a complication, and the most 
serious and fatal one of influenza; but at the same 
time states that there is, as far as his observation goes, 
nothing special or peculiar in the character of the 
pneumonia. 
Through the courtesy of Drs. Mason and Folsom at 
the City Hospital and of Drs. F. C. Shattuck and W. 
W. Gannett at the Massachusetts General Hospital, I 
have had access to their cases; and I have to thank 
Dr. A. C. Jelly and my house-officers, Drs. Dudley 
and Towle and Mr. Edson, for assistance in abstract- 
ing the records, and the Boston Board of Health for 
figures furnished. My use of Dr. F. C. Shattuck’s 
tables speaks for itself. As they were originally pub- 
lished elsewhere, their reproduction here commends 
itself additionally. Two Volumes yearly, beginning' with the first Nos. in January and July. But 
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