title: Overcrowding and Mortality During the Influenza Pandemic of 1918.
abstract: The influenza pandemic of 1918 killed more than 50 million people. Why was 1918 such an outlier? I. W. Brewer, a US Army physician at Camp Humphreys, Virginia, during the First World War, investigated several factors suspected of increasing the risk of severe flu: length of service in the army, race, dirty dishes, flies, dust, crowding, and weather. Overcrowding stood out, increasing the risk of flu 10-fold and the risk of flu complicated with pneumonia five-fold. Calculations made with Brewer's data show that the overall relationship between overcrowding and severe flu was highly significant (P < .001). Brewer's findings suggest that man-made conditions increased the severity of the pandemic flu illness.
authors.affiliation: C. Andrew Aligne is with the Hoekelman Center, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY.
authors.forename: C Andrew
authors.initials: CA
authors.lastname: Aligne
mesh_terms: D003441:Crowding; D049673:History, 20th Century; D006801:Humans; D007251:Influenza, Human / Q000453:epidemiology / Q000266:history* / Q000401:mortality; D008297:Male; D008889:Military Personnel / Q000266:history; D058873:Pandemics / Q000266:history*; D014481:United States / Q000453:epidemiology; D047828:World War I