ï~~ COPY) november 8,1918. y dear Dr.Biggs: The epidemic of influenza at the Home for Hebrew Infants began on October 17th in Ward 10. The head nurse of this ward had attended a function at an armory on October lth and was taken don with influenza three days later. This was one focus o f infection. Another probable source was a nurse who went to Perth Amboy at the time of the great explosion,and who developed influenza a few days later. It is difficult to say how many cases of influenza we have had in our inst itution,which accommodates about 375 children. under the age o f five and which is individed into fourteen wards. The disease has spread rapidly through each ward, and it seems to us as if from 80 to 90 of the children have been infected. Infants under the age of one year: have run a Milder course than the older children, evincing merely catarrhal symutoms with amoderate rise of temperature. The disease has been of special interest in '{Iird 10 vhere it originated. Here it spread like wild fi.re,but seemed comparatively mild at first. Soon many cases of pneumonia developed. However,nihe cases among the thirty children in the ward. Considering that we had in all but sixteen cases of pneumonia, this ratio is particularly high. Of these nine cases, five died. Here again the ratio was hi h,for in the entire epidemic we lost but nine children. This particularly high incidence of pnebmonis with its associated high mortality can hardly be accounted for by the age of these children,for they ranged from a year and a half to two years,being younger than the majority of children,but older than about seventy-five of the others who were less affected. There is no doubt that the mortality was highest among the poorly nourished and weakly children. In addition to influenza among the children,we had a considerable number of cases among the employees. I have found it impossible to gain an accurate idea of the total number. There were thirty-two who were sick enough to be admitted to the. infirmary. Of these,four nurses died,including the nurse of VWard 10 who died on October 2let,and the nurse who. developed the disease at perth Amboy who died on October 1Oth. In addition, one maid and a laundress died. All of the deaths, whether among children or adults, were due to pneumonia. There were no other complications, no- empyema, no 4titis, or s inus itis. The last death occurred on Oct.25th. The epidemic has passed after taking its toll of life,and at present all adults-in the' inst itution are well and there is not more than the average amount of sickniess among the children. I have not entered into the bacteriological aspect of the epidemic, because this was carried out by the Research ILaboratory and they will be able to give you the details better than I. I may say,however,that the influenza bacillus was found in very large numbers in the nasal and faucial secretions of both the children and the nurses,and that the lungs were in the majority of cases found at post mortem to harbor the pneumococcus. I hope that this little sketch will furnish the information which you desired. If there are any frther particulars you would like to learn,I 1Jarkbe d to write her to o-. i 'l. >t.J ~ ~. - a &rn 8tth i Mausr a Ac esd Yae Un er )t ar PD. Alfred 2W eC 16:Na St 86th Street (Sgd) Alfred F.Hess 0