TABLE V.-Number of deaths from influenza in Continental European and Indian cities by weeks, from Sept. 7, 1918, to Mar. 15, 1919-Continued.. TABLE VI.-Number of deaths from influenza and other acute respiratory discases in cach week from June 2, 1918, to Feb. 22, 1919, and in corresponding weeks of 1917-18 in London, Dublin, and Paris. A further analysis of the influence of deaths from influenza, pneumonia, bronchitis, and other respiratory diseases (excepting pulmonary tuberculosis) in contributing to the excess death rates in London, Paris, and Dublin, is shown in Tables VII and VIII, in which also are included statistics for New York City compiled from the Weekly Bulletin of the New York City Department of Health (4)'. From Table VIII it is seen that excess deaths from influenza are 74.3 per cent, and the excess deaths from pneumonia (all forms) are 50.6 per cent of the excess deaths from all causes in New York, the combined total of excess deaths from influenza and pneumonia thus being approximately 25 per cent greater than the excess deaths from all causes.2 The London statistics differ from those of New York in showing a relatively larger percentage of excess deaths returned under the diagnosis of influenza, a much smaller percentage, 7.3 per cent, returned as due to pneumonia, and a considerable proportion, 13.7 per cent, returned as due to bronchitis, the sum of the excess from these causes being approximately equal to the total excess. The Paris statistics are generally similar in respect to the propor tion of deaths from influenza and pneumonia, but have a negligibl proportion, 0.2 per cent, attributed to bronchitis and a notably large proportion, 20.1 per cent, attributable to "other diseases of the respiratory system." This difference is readily accounted for by the fact that in the Paris statistics deaths from broncho-pneumonia are included in the group of "other diseases of the respiratory sy tem," whereas in the statistics of New York and British cities these deaths are included under the diagnosis of "pneumonia, all forms." TABLE VII.-Number of deaths from all causes and from influenza, pneumonia (all forms), bronchitis, and other respiratory diseases,' for the period June 2, 1918, to Feb 1919, and for the corresponding period in 1917-18, and number of excess deaths from thư causes in 1918 over 1917, in New York, London, Paris, and Dublin. 1 Numbers refer to reports cited. See page 1376. 2 * In letting the number of excess deaths be represented by 100 per cent, an algebraic rather than an sich metical sum is used, and, whereas the excess deaths from influenza and pneumonia (all forms are les sented by plus quantities the excess deaths from certain other diseases are minus quantities. This that the indicated death rates in these latter diseases are below rather than in actual excess of the rat the comparative period. Except pulmonary tuberculosis. • Decrease. TABLE VIII.-Ratio of the excess deaths from influenza, pneumonia (all forms), bronchitis, and other respiratory discases during the period June 2,1918, to Feb. 22, 1919, to excess deaths from all causes in this period as compared with the corresponding period in 1917-18, in New York, London, Paris, and Dublin. The Dublin statistics show a relatively smaller proportion of deaths attributable to influenza and a larger proportion to pneumonia than do the London and Paris statistics. Whether the differences in relative prominence of these various assigned causes of deaths are due to actual clinical differences in the disease as manifested in the several cities, or only to differences in nomenclature and classification, is uncertain. While this paper was in process of publication the report of the Influenza Commission of the Union of South Africa was received, from which Tables IX and X have been abstracted. These figures are of special interest because of the enormous case incidence-42.8 per cent; also because of the notably higher incidence and death rates in the native as compared with the European population. With reference to this difference the Commission makes the following comment: "As to the reasons for these variations, the Commission can express no definite opinion. The well-established susceptibility of the native and colored population of South Africa to diseases of the respiratory tract, inhygienic housing and lack of even the most rudimentary knowledge of caring for the sick, and, in many cases, prejudice against medical help and against admission to hospitals, undoubtedly played very important rôles in causing heavy mortality." TABLE IX.-Number of cases and number of deaths from influenza in Union of South Africa during the period Aug. 1 to Nov. 30, 1918. T Report of the Influenza Epidemic Commission, Union of South Africa, 1919. 3,257 25,397 28,664 9,737 362 13,600 13,962 11,726 127,745 139, 471 2 Preliminary figures. 491, 448 632.057 79,532 150,492 230,024 42, 475 510,989 553, 461 TABLE X.-Case incidence, case fatality, and death rates from influenza in Union of South 1 Report of the Influenza Epidemic Commission, Union of South Africa, 1919 References. (1) Weekly Return of Births and Deaths Registered: London and Ninety-five Other Great Towns. By authority of the Registrar General. H. M. Stationery Office, London. Vols. 51 (1917), 52 (1918), and 53 (1919). (2) Bulletin Hebdomadaire de Statistique Municipale, Ville de Paris. Masson & Cie., Paris, 1917, 1918, 1919. (3) Weekly Return of Births and Deaths Registered in the Dublin Registration Area and in Eighteen of the Principal Urban Districts of Ireland. By authority of the Registrar General. Alex. Thom & Co. (Ltd.), Dublin. Vols. 54 (1917), 55 (1918), and 56 (1919). (4) Weekly Bulletin of the Department of Health, City of New York. Vols. VI, VII, and VIII. (5) Report of the Influenza Epidemic Commission, Union of South Africa. Cape Times (Ltd.), Cape Town, 1919. CLOSING OF SCHOOLS AND THEATERS DURING INFLUENZA EPIDEMIC. ARIZONA SUPREME COURT DECIDES THAT LOCAL BOards of heaALTH CAN ORDER 1 In a recent Arizona case the supreme court of that State decided that a local board of health can order the schools to be closed during an epidemic to prevent the spread of the disease. The board of school trustees of the city of Globe sought to enjoin the enforcement of regulations of the city board of health closing tre schools during the epidemic of influenza. It was contended that it was beyond the power of the health board to take such action. The regulations in question declared certain things to be nuisances, among these being holding sessions of schools during the influenza epidemic, and prohibited the same. The court treats very fully o 1 Globe School Dist. No. 1, of Globe, Gila County, a Board of Health of City of Globe, 179 Fac 7 the powers of local boards of health and declares that the action of the health board, in so far as defining and declaring what were nuisances, was void, as being an exercise of the legislative power. The power of the board of health, however, to close the schools during the epidemic was conceded. In treating of this the court said: * * * The local boards of health are granted the power to determine the fact whether the emergency exists for the making of rules and regulations and the adoption of health measures, but such powers are administrative-not legislative. The adoption by the city local board of health of section 11, the order closing the public schools during the rage of the said epidemic of Spanish influenza, for the purpose of preventing the spread of such epidemic, was a valid measure, adopted within the power of the local city board under the authority of subdivision 3 of paragraph 4370 and on the approval of the State superintendent of public health. Necessity is the law of time and place, and the emergency calls into life the necessity for the operation of the law. The emergency calls forth the occasion to exercise the power to protect the public health. Regarding the powers of the educational authorities and the board of health, respectively, it was said: While school trustees and educational administrative officers are invested with power to establish, provide for, govern, and regulate public schools within their respective jurisdictions, they are in these respects nowise subject to the direction or control of the State or county or city boards of health, yet when the necessity arises to close the schools for the protection of the public health such emergency, while it exists, is a superior power to that given the school administration officers, and the law of necessity controls the situation during the existence of the emergency giving rise to the power. In concluding the court said: I am of the opinion that the measure adopted by the local board of health, closing the schools of the Globe school district, was, at the time adopted, a valid, enforceable order and regulation for the purpose of reasonably protecting the public health, under authority of chapter 1, title 41, paragraph 4370, subdivision 3; that during the existence of said disease in epidemic form in said community said regulation was binding upon the educational administrative officers, and continued binding so long as such epidemic continued in such form, and no longer. In another case decided a little later by the same court, it was held that the local board of health had the power to order the closing of motion picture shows during the epidemic. The opinion is short and refers to the previous case as deciding the matter. 1 Alden v. State, 179 Pac. 646. |