qTI)c Sljattnck lecture. TIIE SHATTUCK LECTURE. 
INFLUENZA IN MASSACHUSETTS. 
By GEORGE B. SHATTUCK, M.D. 
OF BOSTON. 
Read at the Annual Meeting of the Massachusetts Medical Society, 
June 10, 1890. INFLUENZA IN MASSACHUSETTS. 
Mr. President and Fellows of the 
Massachusetts Medical Society : 
As you well know the time-honored Annual Discourse 
takes place as usual to-morrow, on the last day of this 
meeting, just before the annual dinner, and is unques- 
tionably looked forward to this year with all of the usual 
interest. That an additional claim should he made upon 
your time and attention this evening is an innovation, and 
as such requires some words of explanation. 
At the annual meeting of the Society in the year 1858 
the Treasurer reported that, " the Society has come into 
the enjoyment of the Shattuck legacy, amounting to 
$9,168.87, the income from which will contribute largely 
towards meeting the expenses of publication to which it is 
especially designated.” Since that time this fund has re- 
mained with the Massachusetts Hospital Life Insurance 
Company, invested in one of that Company’s annuity poli- 
cies, and has yielded interest varying from 8.25% in 1866, 
during the period of inflation just after the war, which was 
the highest rate, to 4% which has been the rate annually 
during the last ten years. It appears from the Treasurer’s 
accounts, as your present Treasurer kindly informs me, that 
until 1872 the income was expended for printing, binding 
and distributing the " Annual Communications.” In 1872, 
however, the entire income is entered on the credit side of 
the funds as loaned to the Massachusetts Medical Society.” 
This arrangement was continued from year to year until 
1877, when, the unusual necessities of the Society appar- 4 
THE SHATTUCK LECTURE. 
ently having ceased, the former use was renewed and the 
income again paid for printing and distributing the Medical 
Communications. 
In 1878 a prize was offered by the Society for a prize 
essay, which was gained by Dr. Thomas Dwight by a very 
admirable piece of work on "Identification of the Human 
Skeleton ” ; and the income was devoted to the payment of 
the award and to the publication and distribution of this 
essay. During the subsequent years it has been expended 
as previously upon the annual Medical Communications, ex- 
cept in the years 1886, 1887 and 1888, when it was allowed 
to accumulate, and a prize of $1,000 was offered for com- 
petition at large for an essay worthy of a prize, " on the 
climate and its modifications as influencing health and 
disease, or on any of the diseases of the inhabitants of New 
England or on any kindred subject.” This prize failed to 
excite the interest and stimulate the competition which was 
anticipated from the offer of so considerable a sum of money, 
with such a wide range of subjects, and no award was 
made. A result which emphasized observations elsewhere 
made as to the diminished zeal for the capture of prizes, 
whether baited with a round sum of money or with a long 
established reputation stamped upon a medal. The time 
when the possession of a Boylston Prize was the almost 
necessary passport to subsequent professional advancement 
and reputation in this immediate community is in a some- 
what distant past. Perhaps the appearance on the scene 
of the professional prize-taker has had the same limiting 
effect as the professional influence has had in other contests. 
Be the reasons what they may, prizes seem no longer to 
attract as formerly. 
In the years 1806 and 1807 no less than three of the 
Boylston Prize Medals were secured by Dr. Shattuck’s pen, 
but in 1888 your committee came somewhat reluctantly to 
the conclusion that what our forefathers termed in 1807 the INFLUENZA IN MASSACHUSETTS. 
5 
" beneficent and laudable view of improving the art of 
medicine, and the excitation of practitioners to bring those 
talents to light which might otherwise be useless to the 
community,” were not best subserved by the offer of prizes, 
and accordingly your Council in 1888 voted : 
"That the Committee on Publications be instructed to 
provide for a lecture, to be called the Shattuck Lecture, 
on some subject in accordance with what is specified in the 
will of the late Dr. Shattuck, the lecture to be delivered at 
the annual meeting of the Society.” 
In accordance with this vote the Committee in charge 
proceeded to its execution, and, apparently, impressed with 
the feeling that it was not intended that only the sins of the 
fathers should descend upon the children, they appointed 
me to deliver the first Shattuck Lecture before the Society. 
I confess I should have been very glad for your sakes and 
for that of the Lectureship had the choice fallen on a more 
competent person, but neither my appreciation of the 
courtesy of your Committee nor my respect for the memory 
of the benefactor, after whom the Lectureship is named, 
would permit me to decline. 
You therefore see why it is that you are called upon to 
listen to a lecture on the evening of the first day of the 
annual meeting, as well as to the Discourse on the second 
day ; I hope the process will not serve simply to increase 
your respect for the more carnal provisions of the Cotting 
Fund. 
As the first to discharge the duties of this lectureship it 
may be thought proper and pardonable if I ask you to ac- 
company me a little while in a further brief consideration 
of the circumstances which gave rise to its foundation, and 
of the scope of its functions, thus leaving a clearer field to 
the legitimate and more important duties of my successors. 
The fund bequeathed by Dr. Shattuck to the Massachu- 
setts Medical Society was one of three equal funds left THE SIIATTUCK LECTURE. 
by his will to three different societies ; the other two being 
the Massachusetts Society for Promoting Agriculture and 
the Massachusetts Charitable Mechanic Association. The 
provisions of the bequest in behalf of this Society were that 
it " should apply the net interest and income of the same 
from time to time, in the discretion of the Society, or of its 
government, to the collection and publication, annually, by 
some suitable person or persons, of historical or other essays 
on the climate of said Commonwealth, on the diseases of 
its inhabitants, and on such other subjects as the said Society 
or its government may select.” 
The bequest to the Massachusetts Society for Promoting 
Agriculture—the oldest incorporated society but one in this 
State— provided that " the net income of its fund should be 
applied from time to time, in the discretion of the Society 
or its government, to diffuse a knowledge of the proper ad- 
mixture of soils, so as to raise the greatest quantity of food 
with the least labor and expense; to encourage the raising 
of trees for fuel and ship-timber ; and generally to disseminate 
a knowledge of practical agriculture.” 
The bequest to the Charitable Mechanic Association pro- 
vided that "it or its government should apply the net in- 
terest of the fund from time to time, at discretion, to en- 
courage improvements in Architecture, and especially in 
the mode of constructing cheap and convenient dwellings 
for the poor, and also in defraying the expense of instructing 
mechanics’ apprentices in the knowledge of the useful arts.” 
As has been shown by the hasty review of the uses to 
which this Society has put the income of its funds, the 
medical objects which the donor had in mind and at heart 
hafe been to a considerable extent realized. The Society 
for Promoting Agriculture, with a total fund of about 
$120,000, has done much for the farmer of the State of 
Massachusetts in improving the breeds of various domestic 
animals by the importation of foreign stock, and in other 7 
INFLUENZA IN MASSACHUSETTS. 
ways has disseminated a knowledge of practical agriculture ; 
but I cannot learn that it has caused studies to be made of 
the proper admixture of soils, so as to raise the greatest 
quantity of food with the least labor and expense, or has 
encouraged the raising of trees for fuel and ship-timber. 
The generation which has grown up to man’s estate since 
this bequest was made has solved those questions for itself 
in a different but a very practical way—by moving West to 
the plains, and to the forests of Michigan and Puget’s 
Sound ; but even there at no distant date, if things go on 
as they have done, if there is no rotation of crops and un- 
checked forest fires, such information as Dr. Shattuck 
thought desirable for Massachusetts in 1854 may not be 
superfluous. 
On the other hand, singularlyfenough, with the increased 
knowledge of the diseases of domestic animals and of their 
relation to those of man, and with the development of vete- 
rinary science, it has come to pass that this same Agricul- 
tural Society, through Drs. Peters and Ernst, is employing 
a portion of its income in an investigation of tuberculosis 
—a disease than which there is none more prevalent, none 
causing so many deaths in this State and throughout New 
England—and is thus doing work of a kind which thirty- 
five years ago could only have been expected to emanate 
from medical sources. 
The Charitable Mechanic Association has hitherto, I be- 
lieve, done little or nothing towards realizing the specific 
wishes expressed by the testator, and certainly nothing es- 
pecial towards encouraging improvements in the mode of 
constructing cheap and convenient dwellings for the poor. 
But other agencies have in a certain measure brought about 
this very desirable end, and capital, philanthropy and 
hygiene have all found a remunerative account therein. 
From the last annual report of the trustees of the Peabody 
homes for the poor in London, in which especial attention 8 
THE SHATTUCK LECTURE. 
was given to sanitary construction, it appears that the birth 
rate in these homes is 8.72 per 1000 above the average, 
the infant mortality is but a little over half the average, and 
the total death rate is 1 per 1000 below the average. Yet 
these buildings pay a moderate per centage upon the amount 
invested, although their construction can hardly be called 
cheap. Here in Boston there are now numerous tenement 
houses, which fairly deserve the name of apartment houses, 
occupied by poor people, where the sanitary conditions are 
good, the standard of health is high, there is no over- 
crowding, and which pay fair returns to the owners. There 
is also a Cooperative Building Association which aims to 
secure the ends sought for in this legacy, and thus indirectly 
lowers the death rate of the city. 
These bequests were not large—even for the day in which 
they were made, certainly not for ours—and were indi- 
vidually smaller than others proceeding from the same 
source, but they were eminently characteristic of the man, 
eminently indicative of his interests during life and of the 
direction which his hopes for the future took. He was not 
a sentimentalist, but nothing human was foreign to him ; he 
was at home with all sorts and conditions of men, he had a 
constant interest in and sympathy for humanity. He knew 
the farmer, he knew the mechanic, he knew the homes of 
the poor. His father, a graduate of Harvard, a man of 
large frame and powerful physique, spent his strength as a 
country doctor in the last century, going on horse-back over 
the hilly regions of the northern part of Worcester County, 
succumbed to the exposure and labor of his profession at 
the early age of fifty-one years, and leaving his son an 
orphan at the age of eleven years. Hence, he knew too 
what it was to make one’s own way ; he knew—to use his 
own quaint expression—the value of the "healthy stimulus 
of prospective want,” but he also knew the value of en- 
couragement and of a helping hand held out at the right 
moment. INFLUENZA IN MASSACHUSETTS. 
9 
He himself graduated at Dartmouth College. As a 
medical student part of his time was spent at the University 
of Pennsylvania, where he took his degree in 1807. lie 
obtained a knowledge of country practice by studying with 
Dr. Amos Bancroft in Weston, and of city practice in con- 
nection with Dr. Danforth in Boston. He had previously 
received a medical degree from Dartmouth, and subse- 
quently a third medical degree from Harvard. So that, 
although not having studied abroad, his medical education 
was for that time a broad one. 
While in Philadelphia, as his letters written from there 
show, he undoubtedly came under the influence, to some 
extent, of Dr. Benjamin Bush, who was then at the height 
of his reputation as a teacher, and who was a large figure 
in the Society of the time, and he was one of comparatively 
few from this neighborhood who came directly in contact 
with Bush. Of Bush, Dr. Holmes said, addressing this 
Society in 1860 
"If I wished a student to understand the tendencies of 
the American medical mind, its sanguine enterprise, its self 
confidence, its audacious handling of Nature, its impatience 
with her old-fashioned ways of taking time to get a sick 
man well, I would make him read the life and writings of 
Benjamin Bush. Dr. Bush thought and said that there 
were twenty times more intellect and a hundred times 
more knowledge in the country in 1799 than before the 
Bevolution. His own mind was in a perpetual state 
of exaltation, produced by the stirring scenes in which 
he had taken a part, and the quickened life of the time in 
which he lived. It was not the state to favor sound, calm 
observation. He was impatient, and Nature is profoundly 
imperturbable. ******* Dr. Bush must have been 
a charming teacher, as he was an admirable man. He 
was observing, rather than a sound observer; eminently 
observing, curious even about all manner of things. But 
he could not help feeling as if Nature had been a great deal 
1 Currents and Counter-Currents. Annual Meeting, May 30, 1860. 10 
THE SHATTUCK LECTURE. 
shaken by the Declaration of Independence, and that 
American art was getting to be rather too much for her— 
especially as illustrated in his own practice. He taught 
thousands of American students, he gave a direction to the 
medical mind of the country more than any other one man, 
perhaps he typifies it better than any other. It has clearly 
tended to extravagance in remedies and trust in remedies, 
as in everything else, etc. etc.” 
Dr. Weir Mitchell, his fellow-townsman, on the other 
hand (A Commemorative Address delivered at the Centen- 
nial Anniversary of the Institution of the College of Physi- 
cians of Philadelphia, 1887), says of Push : 
" With reverent doubt of my powers to do justice to the 
greatest physician this country has produced, I approach the 
task of recalling to your memories the vivid and emphatic 
personality of Benjamin Rush. His life invites a less hasty 
biographer, and is full of such seeming contradictions as 
can only be explained by the belief that the earnest, de- 
cisive, and mutinous nature of a man, proud rather than 
conceited, got the better of the principles by which he 
honestly strove to guide his conduct. * * * * How shall 
I briefly bring before you the career of this restless being? 
Relentless energy drove him through a life in which ardent 
sense of duty, large-minded philanthropy, love of country, 
devotion to ins art and its science, immense belief in him- 
self, were the motives to industry. * * * * He was a 
statesman, a scholar, an army surgeon, a punctual and 
careful physician, an actively religious man, a far-seeing 
and courageous philanthropist, and a sanitarian far in ad- 
vance of his day. These are what I might call four careers 
in all of which lie excelled, unaided by secretaries or modern 
means of condensing and regulating labor ; one such suffices 
most men.” 
Dr. William Pepper, another Philadelphian, says of 
Rush :1 
"Rush was evidently a perfectionist. His enthusiasm 
over the possibilities of human nature continually breaks 
1 Address delivered before the American Medical Association, June, 1889. INFLUENZA IN MASSACHUSETTS. 
11 
out intoexpressions of sincere exuberance. I fear he drew 
his inspirations more from the experience of his own nature, 
refined and elevated, which required no excitement but the 
claims of duty, and no pleasure but the pursuit of knowl- 
edge and truth, than from the observation and study of men 
as they actually exist. 
" The truth is that Rush was at all times and in all places 
and before all else a great physician. He had entered 
public life from a sense of patriotic duty ; he had labored 
for the improvement of society because he was irresistibly 
impelled by his large humanity ; but he threw himself into 
the service of medicine with passionate intensity. Ramsay, 
a favorite pupil and intimate friend, tells us that Rush 
wrote to him : ' Medicine is my wife, science is my mis- 
tress, books are my companions, my study is my grave.’ ” 
Dr. Shattuck shared to some extent the tendency of his 
day to polypharmacy ; he did not eschew remedies of large 
bulk, he did not always think it necessary to stoop to tickle 
the palates of his patients, he had confidence in medicines, 
as he had in other methods of interfering with disease, and 
used them with courage when he thought interference neces- 
sary. But I do not think, in his case and in that of many 
others in New England of whom he was a good type, that 
this was so much because he thought " there were twenty 
times more intellect and a hundred times more knowledge 
in the country in 1799 than before the Revolution”; so 
much because he "felt that Nature had been a good deal 
shaken by the Declaration of Independence, and that 
American art was getting to be too much for her ” ; in other 
words so much due to the influence of the teaching of Rush 
—as it was due to a mental and moral inheritance typical 
of his time. His father, as has been said, had carried on a 
guerilla warfare with disease over the hills and valleys of 
Worcester County for twenty-five years, until he fell before 
it himself; his grandfather, a farmer, at the age of sixty- 
five shouldered his gun and followed the British on the 19th 
of April, 1775, from Lexington to Cambridge, having 12 
THE SHATTUCK LECTURE. 
previous!}7 marched from Littleton ; and his great-grand- 
father, also a Harvard graduate, was an Orthodox clergy- 
man whose life was a contest with false doctrine, with the 
flesh and the devil. This was not a paternity for a con- 
templative offspring, for an expectant generation, for a 
hand-folding philosophy. It was in the blood to be up and 
doing, to wrestle with some antagonist and to strive to pre- 
vail over him : whether the antagonist took the form of a 
vigorous climate, of depravity of the spirit, of unjust taxa- 
tion or of weakness and error on the part of the flesh. It 
was just possible for the strong men of that generation to 
sit down and see nature lead, but not to restrain themselves 
from pursuing and taking hold of her when she led us it 
seemed to them astray. It was their duty to smite the 
Philistine, not to leave him to the chances of the slow cor- 
rective influence of time. 
The self-determining power of the will, which had accom- 
plished much in the preceding two hundred years, had not 
abdicated in the early part of this century, nor yet had it 
adopted the gentle disguises of Christian Science, of the 
mind cure or of hypnotism. Bad medicine was good for 
disease, as self torture was good for the erring. We take 
both our religion and our medicine more comfortably and 
less seriously. But then he who took a distasteful remedy 
had placed his comfort as a precious sacrifice upon the altar 
of health. The nose of the patient as of every one else 
must be kept to the grindstone. 
It was felt that the doctor’s duty was to stand between 
the patient' and the disease, but not always with the apothe- 
cary at his side, as appears from old letters of Dr. Shat- 
tuck’s which have been preserved. A young clergyman, 
whose first vigor was spent, is sent on a horseback journey 
with a companion. Another clergyman, whose delicate 
wife was suffering in 1825 from some early form of tuber- 
culosis, is advised : "If your wife can conform to rule in INFLUENZA IN MASSACHUSETTS. 
13 
diet and exercise and exposure she may be restored. If 
the trammels are too galling to her free agency she slackens 
the progress of the cure and renders her situation still pre- 
carious. Let her case terminate as it may I feel that I have 
honestly intended her service. I am sorry that instinct 
rather than reason governs one so elevated among the 
national tribes.” And a year later, after the death of this 
patient who lived at a distance : "I became quite convinced 
when I learned her impatience under the use of the only 
earthly means that could serve her (viz., warmth, rest, diet, 
good nursing, with the healing hand of time) that she could 
not attain health more.” 
To a College Professor, who asks as to his probable 
future health and ability to continue in the discharge of his 
duties, notwithstanding an impaired constitution, Dr. Shat- 
tuck wrote in 1826 : "Your diet, wearing apparel, exei*cise 
in the open air, warmth and ventilation of your apartment, 
bathing (medicated, warm and shower), attention to an 
easy state of bowels, and attention to a wholesome variety 
in your intellectual labor and to a healthful alternation 
between labor and rest, are in my opinion adequate remedies 
to secure you the possession of a working powrer equal to all 
the duties of your px’ofessorship. I would underwrite at a 
less rate at this time on your continued life and power to 
labor ten years to come, than I should have felt justified in 
doing it at when you were here a year ago.” 
In another letter of advice I find the following : " You 
must turn Quaker, and remain silent; give your lungs rest 
and they will l’ecover. After all, careful nui'sing is the 
most essential to you, pediluvium, friction, diet, &c.” 
Yet such expectancy, such appreciation of the circumfusa 
and ingesta, such recognition of self-limitation pi’oceeded 
from the same pen as : " Enquire of Mussey his opinion of 
the expediency of maintaining over your entire chest a 
pustular enxption for at least two or three months” ; or as a 14 
THE SIIATTUCK LECTURE. 
prescription for a thousand pills, three pills every day for a 
year,—a prescription the remembrance of which was treasured 
up unto the detriment of the third generation when applying 
for a hospital appointment. A compound prepared with 
unauthorized elegance for a rich and influential client at his 
request, found its way out of window instead of down the 
patient’s throat, and the genuine stuff wTas procured and 
submitted to. It is evident that the patient was held in 
view for treatment quite as much as the disease. Yet, when 
he wished to endow a professorship at the Harvard Medical 
School, it was a chair of Morbid Anatomy, not of Materia 
Medica and Therapeutics, which was selected. 
It is true that civil commotion stirs up thought and 
quickens mental activity ; but, in spite of this, I am con- 
strained to believe that the remote influence of Calvin had 
quite as much to do with the best of medical practice during 
the first half of this century in New England, as had the 
immediate teaching and example of Rush. 
At the time the bequest which gives rise to this lecture- 
ship was made, the study and description of disease as 
exhibiting itself in this Commonwealth and in New England 
was in some ways easier and in some ways more difficult than 
at the present time. There was a much more homogeneous 
population, habituated to its surroundings and to the climate. 
The pursuits were less varied, the effects of competition 
and nervous strain less great. There was less crowding and 
less movement of individuals to and fro. There was less 
division of medical practice ; there were more doctors, I 
think I may say—at least at the centres of population—who 
knew all about more people than now, and not merely 
about one member of a family or perhaps only about one 
organ of one member of a family. The trusted physician 
in the city was then, as is happily still the case in some 
parts of the country, the adviser, not merely the prescriber, 
for the family; he was in many ways the guide, the coun- INFLUENZA IN MASSACHUSETTS. 
15 
sellor, the friend. His memory and his note boohs furnished 
something nearer the theoretical bureau of domestic anth- 
ropometry than anything we have at present. 
On the other hand there were lacking the abundant facil- 
ities for rapid exchange of medical thought and observation 
all over the world which exists now ; and there were lacking 
altogether or only existing in a small way, the three great 
sources for the study of the development, the course and 
the variations of disease in a given population, viz., boards 
of health, hospitals, and a trustworthy registration of vital 
statistics. 
The Massachusetts Hospital was the only hospital for 
general diseases in New England ; our State Board of Health 
was not started until 1869, and the Registration of vital 
statistics, which has been enlarged and improved in recent 
years, was first undertaken by the State in 1842 and was 
much less perfect than now. 
Under the circumstances, therefore, which existed in 1854 
and the immediately preceding years, there was a raison 
d'etre and a promise for utility in a bequest like this of Dr. 
Shattuck’s, such as perhaps would not suggest themselves, 
at least not with as much force, to-day. Certainly to one 
who was fond of and somewhat sanguine about the compila- 
tion of facts and figures ; who for many years was President 
of the American Statistical Association ; who was a friend 
and supporter of Lemuel Shattuck—one of three Commis- 
sioners, as Dr. Walcott reminded you last year, appointed in 
1849 under the authority of this Commonwealth to make a 
sanitary survey of the State—to such an one the objects for 
which he designated this bequest, must in the early fifties 
have appealed with peculiar force. 
Every well regulated hospital may be regarded as a post- 
graduate school whose courses, if rightly followed, should 
make some additions to the reliable records of clinical 
observations and to the sum total of the knowledge of 16 
THE SHATTUCK LECTURE. 
disease, in its neighborhood at least. In comparison with 
the single hospital thirty-five years ago, one finds—in addi- 
tion to the large City Hospital of Boston, the Carney 
Hospital at South Boston, and to all the small incorporated 
special hospitals doing an admirable work in this city—that 
Lowell has two hospitals, one organized first as a Dispen- 
sary ( ?) in 1840, the other incorporated in 1867 ; Lynn 
one hospital, opened for patients in 1883 ; New Bedford 
two, one opened in 1873, the other in 1885; Cambridge 
one, incorporated in 1871, and opened for general patients 
in a new building in 1886 ; Newton one, opened in 1886 ; 
Newburyport one, opened in 1884 ; Haverhill one, opened 
in 1882 ; Salem one, opened in 1874; Quincy one, opened 
in 1890 ; Taunton one, opened in 1889 ; Fall River one, 
opened in 1888 ; Worcester, a City Hospital, opened in 
1871, and a Memorial Hospital opened in 1888 ; Clinton 
one, opened in 1889 ; Springfield, a City Hospital since 
1879 ; Pittsfield, a hospital since 1884; North Adams one, 
opened about the same time. In addition to these already 
opened and at work, plans are under discussion for hospi- 
tals in Malden, Marlboro’ and Plymouth. 
With the growth and enlargement of some of these Hos- 
pitals, which the future is sure to bring, why may not fresh 
contributions be expected from their physicians as to the 
effect of locality, of certain occupations, of certain race 
admixtures upon health and diseases. The introduction of 
the Celtic element, which went on so vigorously during the 
middle third of this century, has had, as we all realize, an 
enormous influence upon the vital statistics of Massa- 
chusetts; the effect of the French Canadian and the Italian 
immigrations will probably be less, but just what the future 
alone can show. The race admixture at the Boston City 
Hospital is already so marked that a smattering of several 
foreign languages is by no means an unnecessary qualifica- 
tion on the part of those in attendance, and the behavior of INFLUENZA IN MASSACHUSETTS. 
17 
the Latin race under disease offers a marked contrast to that 
of the Anglo-Saxon. 
You are all aware how much our State Board of Health 
has done for and through the profession in its annual publi- 
cations in regard to the subjects provided for in this be- 
quest; with increased liberality on the part of the State its 
work is constantly increasing. As a new progressive step 
you will be glad to know there is in contemplation the 
appointment of a salaried inspector, whose duty it shall be 
to investigate and report on the causes and conditions of 
local epidemic outbreaks, in the manner in which this has 
been done by such men as Ballard, Buchanan, Thorne and 
Radcliffe, in the service of the English Local Government 
Board. Here is a field of honorable medical ambition for 
the right men. 
The registration of vital statistics has now been carried 
on long enough in this Commonwealth, is now sufficiently 
accurate and is compiled with such care as to make it of 
great service in any relative study of the past and present 
of diseases here. The statistics accumulated by the im- 
mense extension of life insurance, and the meteorological 
records of the United States Weather Bureau are other 
advantages of which the student can make use to-day. So 
that, notwithstanding the decreasing homogeneity and the 
increasing density of population, notwithstanding the com- 
plexity of pursuits and the exaggerated wear and tear of 
life, the task of one who seeks to investigate the climate of 
the Commonwealth and the diseases of its inhabitants is 
certainly simplified in some important particulars—at least 
over the time, not so long distant, when the inquirer’s main 
resource was a slow and precarious correspondence by letter 
with brother practitioners. 18 
TIIE SHATTUCK LECTURE. 
INFLUENZA. 
Some such thoughts undoubtedly occurred to many when 
the recent pandemic of influenza swept over the world. It 
seemed positively churlish to deny hope the impulse to 
spring once more eternal in the medical breast. With the 
aid of the telegraph and the submarine cable ; of rapid 
transit by sea and land ; of numerous weekly medical publi- 
cations as well as of the daily press ; of the facilities for col- 
lective investigation afforded by the frequent meeting of 
medical societies in Europe and the United States, by the 
machinery of central bureaus and local boards of health with 
mortality rates and registration of returns ; and above all 
with the aid of the entirely modern bacteriologist armed 
with his immersion lens, his culture tubes and his staining 
preparations—was it not legitimate to hope that, if with the 
cooperation of all these more or less modern appliances we 
searched out the secrets of Nature faithfully, we should be 
able to penetrate a little farther behind her mysteries in this 
particular disease? Was it not legitimate to trust that we 
should be able to bequeath to the future something more 
than we have received from the past, should at least defi- 
nitely determine some of the doubtful points which presented 
themselves after the preceding pandemics to puzzle or en- 
snare the Sydenham Society, and Sir Thomas Watson and 
Hirsch and other sources of previous wisdom? In short 
that we should be able to say to our successors something 
more than that an " influence ” coming from we knew not 
whence, disappearing we knew not whither, and making a 
large proportion of mankind ill we knew not why, had 
afflicted the world at a certain date? It is now more than 
six months since the influenza made its appearance as an 
epidemic in Western Europe, and more than four months 
since it ceased to be epidemic in this Commonwealth. 
In Berlin, in Munich, and in Paris, Committees of Medi- INFLUENZA IN MASSACHUSETTS. 
19 
cal Societies, aided by Government, and in London the 
Local Government Board, have been at work upon Col- 
lective Investigations of the epidemic; the Munich Com- 
mittee’s returns were to be in March 15th, and the Berlin 
Committee’s returns March 21st. The results have not yet 
readied us, though their probable tenor in each country may 
be guessed at from the reports of Society meetings, and 
communications to Medical Journals, all of which I have 
reviewed. 1 have been struck with the re-appearance of 
the same questions arising to perplex observers in turn in 
all affected regions ; with the inevitable tendency to make 
the disease fit the limited observation of the individual; 
with repeated proofs of the strength of the temptation to 
construct a theory upon what passes before one pair of eyes. 
I even think papers in Medical Journals will show that men 
who inclined to the explanation of contagion found a larger 
percentage of enlarged spleens than men who held to the 
miasmatic theory ! 
The time which has elapsed is not sufficient for the record 
and comparison of observations and experiences in different 
parts of the world ; the distance from the pre-occupations 
caused by the rapid succession of crowded days is not suffi- 
cient to afford the necessary perspective for so extended a 
field. 
I shall ask your attention then, during the time which 
remains, to a brief consideration of some points in regard to 
Influenza as exhibited in the last epidemic in Massachusetts. 
My own interest in the subject is derived from the experience 
of a large hospital service, of private practice, of personal 
illness in Boston, and of a general experience in Paris—all 
within the space of six weeks, from the middle of December, 
1889, to February 1st, 1890, and of a pretty careful review 
of the old and recent literature of the subject since the cessa- 
tion of the epidemic. 
So quickly do events succeed each other in our age and so 20 
THE SHATTUCIv LECTURE. 
rapidly are the scenes of life shifted, I do not doubt that to 
some of you the subject seems already old and threadbare. 
I fear I cannot offer a sure key to any of its mysteries, and 
I may not tell you anything new, and I may weary you ; 
but I shall, at least, protect myself from a repetition of the 
comment of an esteemed colleague who, when asked lately 
about a certain address before a Medical Meeting, exclaimed : 
fOh ! you know what it was like, some quotations from 
scripture, and not a word about medicine ! ” 
ORIGIN. 
Where did the Influenza have its origin, where did it 
come from? Europe first heard of it in Russia, where it 
was reported as epidemic about the middle of last October— 
hence it has frequently been spoken of since as the Russian 
Influenza;—a designation given for the same reason in 
several previous epidemics. At the same time that influenza 
exhibited itself in epidemic form at St. Petersburg ((10° N. 
Lat., 30° E. Long.), the middle of October, it was also 
active at Tomsk, 1800 miles to the eastward in Siberia 
(56° N. Lat., 85° E. Long.). A severe epidemic is re- 
ported1 to have run its course in Bokhara, a district of 
Chinese Tartary (40° N. Lat., 85° E. Long.), between the 
end of May and August, 1889. This is really about all 
the information which we have on the subject of origin up 
to date. For affording trustworthy epidemiological data the 
heart of Asia is about what it was in the middle ages or at the 
time of the Garden of Eden, and, although further time for 
corrected returns from these outlying districts may possibly 
produce something less vague, the probability is that our 
successors will learn from us as to the origin of this epidemic 
what we have learned from our predecessors as to some 
others—"that it came from the East.” 
Present information indicates that the epidemic began in 
1 Prof. Drasche, Wien. Med. Wochschrs. No. 6, Feb. 8th, 1890, p. 219. INFLUENZA IN MASSACHUSETTS. 
21 
Berlin the middle of November, in Hamburg about the first 
of December, in Leipzig about December 10th, in Cologne 
December 1st, in Paris November 26th. (November 26th 
was the date of the outbreak at the great Louvre Stores). 
In Southern Germany, in Austria, in Turkey it was later. 
In Wurzburg and Munich it began about the middle of 
December; in Vienna, December 12th; Pesth, December 
15th; Belgrade, December 16th; Bucharest and Sophia, 
December 24th. To the north of Paris, it began at Brus- 
sels December 12th, and Antwerp December 16th. At 
London it began the end of December ; Madrid, December 
14th; Malaga, December 12th; Lisbon, December 21st; 
Alexandria, December 25th; Cape Town, first week in 
January. 
Oar State Board of Health has again justified the position 
which it has made for itself, by sending out promptly in 
January circulars to physicians, public institutions, and 
factories and employers throughout the State, thus provid- 
ing for a Collective Investigation of this epidemic within the 
borders of Massachusetts. The board has very courteously 
allowed me to look over and collate the replies which have 
been received, and I am therefore enabled to give you more 
extended results than would otherwise have been possible, 
in anticipation of the Board’s Annual Report. 
The Secretary, Dr. Abbott, will work over these same 
returns for the Board’s report; but it is not amiss that re- 
turns as complicated and as difficult of interpretation as these 
are should be handled independently by more than one in- 
dividual, that possible errors or prejudices may be modified, 
on one side or on the other. 
The following is a copy of the circular. Those sent to 
physicians and public institutions were the same ; those sent 
to factories and employers varied as indicated in questions 
INFLUENZA IN MASSACHUSETTS 22 
THE SIIATTUCK LECTURE. 
numbered 1, 3, 4, 5 and 6. The question in regard to 
sex is somewhat ambiguous. 
© 
Commonwealth of Massachusetts. 
Office of State Board of Health, 
13 Beacon Street, Boston, 
January, 1890. 
Dear Sir :— 
In view of the general epidemic of influenza now prevail- 
ing, the State Board of Health desires to obtain such in- 
formation as is possible regarding its appearance in Massa- 
chusetts during the present season, and therefore respect- 
fully requests a reply to the following questions : 
1. What was the date of first appearance of the epidemic 
in your neighborhood? (or institution?) (or among your 
operatives?) 
2. In what week was it most prevalent? 
3. What estimated proportion or percentage of the popu- 
lation in your community was attacked? (or of persons em- 
ployed by you ?) 
4. What ages or periods of life were most affected? 
5. Which sex was affected most severely? 
(3. What was the average duration of the attack? (or 
length of absence from work?) in days.' 
7. What symptoms predominated in the cases under 
your observation ? 
8. What other diseases were increased infrequency or 
severity simultaneously with the epidemic of influenza? 
Manufacturer’s Circular. 
4. What proportion or percentage were obliged to leave 
their work in consequence of such illness? 
5. What was the average duration of the attack? 
6. Which sex was affected most severely ? 
Respectfully yours, 
Samuel W. Abbott, 
Secretary. 
From physicians 192 replies were received; from Public 
Institutions, 24; from factories and employers, 178 replies 
were received. 
1 In the Mercantile Circular Nos. 4, 7 and 8 were omitted. INFLUENZA IN MASSACHUSETTS. 
23 
The returns from nine of the principal hospitals of Boston, 
including the Marine Hospital at Chelsea and the Boston 
Lunatic Hospital at South Boston, cover about 2000 people, 
and indicate that the epidemic began in these institutions about 
December 21st, and was most active during the week from 
December 28th to January 4th. The City Hospital reports 
the earliest first case occurring December lfith, the New 
England Hospital the latest first case occurring December 
23d. The McLean Insane Asylum, Somerville, reports 
the smallest percentage of inmates affected, viz. : 10%. 
With 336 inmates there were 34 cases, of whom 16 were 
male and 18 were female ; only two patients were attacked, 
the other 32 cases being among the attendants or employees. 
The New England Hospital for Women reports the largest 
percentage (75%) of inmates affected. At the Children's 
Hospital 75% of officers and employees were attacked, 
and only 33% of the patients ; adults reported as somewhat 
more susceptible than children. At the Adams Nervine 
Asylum 45% of the inmates—30 out of 65—were attacked ; 
at the City Hospital 25% of the patients and 25% of officers 
and employees. At the Massachusetts Hospital, Dr. Pratt 
writes : " it seemed at one time that every one resident in 
the Hospital had symptoms of the disease,” and nurses and 
attendants were especially victims. At the State Prison, 
Charlestown, 40% of the inmates were attacked, the first 
December 21st; and Dr. Sawin writes, "there was not a 
single case of pneumonia at the prison, although I saw many 
cases in private practice”; on the other hand, 8% of those 
affected had diarrhoea, and bronchitis was as usual frequent. 
PUBLIC INSTITUTIONS SUFFOLK COUNTY. 
A$ to dates these returns agree pretty well with those of 
the mercantile companies, and those of the doctors, with 
Conclusions. 24 
THE SHATTUCK LECTURE. 
the natural difference that these first cases are reported, as 
a rule, a few days later. Of seven reporting the percentage 
of patients attacked, the average is 41%. I do not feel 
justified in drawing any positive conclusion as to sex. 
There is nothing which appears positively to indicate ex- 
posure to the atmosphere or contagion as a factor, unless in 
the case of the McLean Asylum, where only two patients 
were attacked, and of the Massachusetts Hospital where 
the attendants suffered more, one infers that the attendants 
were more out of doors. At the City Hospital, on the 
other hand, the percentage of the two classes was equal; 
and in regard to the Children’s Hospital, where 75% of 
officers and employees suffered but only 33% of patients, 
it is to be remembered that children were in general less 
susceptible to influenza. 
Of these institutions, the City and Massachusetts Hospi- 
tals are the only ones reporting pneumonia as a complication 
of or sequel to influenza. 
PUBLIC INSTITUTIONS—OUTSIDE OF SUFFOLK COUNTF. 
Outside of Suffolk County, 12 public institutions re- 
ported, of which five are Insane Hospitals, one (at Tewks- 
bury) an almshouse, and the others are schools or reforma- 
tories. Danvers is the most easterly and Northampton the 
most westerly point represented, and, strangely enough, 
each reports its first case as occurring on the same day, 
December 25th, and, contrary to what might be expected, 
the epidemic reached its height at Danvers Lunatic Hospi- 
tal as late as the third week of January, whereas at the 
similar Northampton institution it culminated the second 
week of January ; at Danvers 30% were attacked, but at 
Northampton only 10%. 
The Tewksbury Almshouse (North Middlesex), with its 
constant receipt of inmates from Boston, reports the earliest 
first case, December 18th, only two days later than the first INFLUENZA IN MASSACHUSETTS. 
25 
case of the Boston City Hospital; the Primary School at 
Monson (East Hampden) and the Lyman School for hoys 
at Westboro’ (West Worcester) come next with December 
19th, although the Homoeopathic Insane Hospital at West- 
boro’ and the Massachusetts Reformatory at Monson do not 
report their first cases until December 22d and December 
26th respectively. 
The latest first cases occurred at the Lancaster State In- 
dustrial School (Worcester) and the Worcester Insane 
Hospital, at each January 3d, but the most active week at 
the former was the third week of January, and at the latter 
the second week. The Taunton Insane Hospital (Bristol) 
reports its first case December 30th ; the State Farm, Bridge- 
water (Plymouth), December 31st; but the culminating 
week at the former was the third week of January, and at 
the latter the second week. 
The epidemic reached its height a week earlier at the 
Primary School at Monson than at the Lyman School, 
Westboro’, last week of December and first week of January 
respectively, although it first appeared at both on the same 
day. The largest percentage attacked was at the Primary 
School, Monson (56%) ; the smallest percentage (5%) at 
the Worcester, and the next smallest (10%) at the North- 
ampton Insane Hospital. The Lyman School for boys 
reports 50% ; the Lancaster Industrial School 42% ; the 
Reformatory Prison for Women, Sherborne, 40% ; the 
Tewksbury Almshouse 40% of its officers, and 33% of its 
inmates. 
The Danvers Hospital, with 30% of inmates attacked, 
reports an intercurrent epidemic of measles with nine cases, 
and one of erysipelas with six cases ; there were a few com- 
mittals in which the exciting cause seemed to be influenza; 
the senile were less frequently affected by influenza and 
females more than males. At the Westboro’ Hospital " more 
females were attacked, but the worst cases were males ”; THE SHATTUCK LECTURE. 
at the Worcester Insane Hospital more males were attacked. 
The Women’s Prison, Sherborne, is the only institution 
specifying insomnia as a complication. Only four of this 
group report pneumonia as a complication or sequel. 
Conclusions. 
In the reports of these 12 institutions it certainly does 
not appear that geographical position was an important fac- 
tor as influencing the date of the first case or the maximum 
week. How far contagion could have had an influence we 
have no data to decide; all these institutions are on more 
or less frequented lines of travel and all receive inmates 
from the outside world. 
The letter1 accompanying the report of the Lyman School 
for Boys, Westboro’, taken alone, suggests contagion. No 
very definite conclusions can be drawn as to the matter of 
sex. 
The average per cent of the affected at eleven institutions 
reporting was 32%, compared with an average of 41% in 
Suffolk County. 
MERCANTILE AND MEDICAL RETURNS. 
Returns were received from 178 manufacturers and 
mercantile houses, representing all the counties of the State 
except Dukes and Nantucket. Of these I have tabulated 
142, leaving out those which for one reason or another 
seemed too vague or unreliable. It cannot be said that all 
those, by any means, which have been included are entirely 
trustworthy ; some are evidently more careful than others ; 
but on the whole, perhaps, the errors to some degree tend 
1 “ The first case was a teacher in one of the Schools who had charge of thirty 
boys. About December 14th she spent a day in Boston, and was taken ill De- 
cember 19th, recovering in four days. In about five days the boys in her school 
began to be sick, and 28 had the disease in some degree within two weeks. I 
should say all were taken sick within one week and before the disease appeared 
in any other school. The disease then invaded the nearest school, and in a few 
days had reached all of the six which make up the institution. Out of 190 boys, 
132 had the influenza.” INFLUENZA IN MASSACHUSETTS. 
27 
to correct each other. I have endeavored to compare these 
returns from manufacturers with each other and with those 
from the doctors throughout the State, of which 192 were 
received and of which I have tabulated 179. I fear the 
success as to results is not proportionate to the amount of 
labor involved, but such as it is I will ask your attention to 
it. 
Beginning with south-eastern and eastern counties, I will 
pass to the western counties in order. 
Nantucket County.—This Island County, standing 
with its neighbor Dukes alone as outposts in the Atlantic, 
sends only medical returns, for the good reason that manu- 
factures do not exist. There are five medical returns from 
the town of Nantucket and vicinity. One places the first 
case December 20th, and the maximum week the first week 
of January ; the other four range the first case between 
December 30th and January 4th, three make the third 
week of January the maximum week and one the second 
week. 
Three think males were more affected, and two females. 
One reports pneumonia as increased, and two pulmonary 
diseases. The only return as to proportion of population 
affected states 25%. 
Dukes County.—From this Island County also there 
are only medical returns ; here, as at Nantucket, the popu- 
lation lives mainly by the sea. 
There are five returns. The earliest first case is reported 
from Vineyard Haven on the north shore December 25th, 
but this was one of several exotic cases brought in by the 
Revenue Cutter Gallatin, and another return from the same 
place dates the first native case January 2nd ; the other 
three returns from Edgartown, Cottage City and West Tis- 
bury date the first case January 1st; three returns, giving 28 
THE SIIATTUCK LECTURE. 
a maximum week, name first, second and third weeks of 
January; these same returns give 20%, 33% and 66% as 
the proportions of population affected. Average 40%. 
Two returns state that males were more affected, and one 
that females, " because males had greater power to throw 
off the disease quickly.” One return gives pneumonia and 
one pulmonary diseases as increased. 
Conclusions. 
The returns from these island counties indicate that in- 
fluenza invaded them two weeks later than the mainland 
farther east. In the winter months they have comparatively 
little communication with the mainland ; the population is 
thus less exposed to contagion, though freely open to 
atmospheric effects, especially those coming from the east- 
ward across the Atlantic. 
Before drawing the obvious conclusions in favor of con- 
tagion and against atmospheric miasm, I ask your attention 
to two interesting letters. 
Dr. Banks, Surgeon Marine Hospital Service, writes from 
Vineyard Haven, Jan. 25th :—" Dec. 25th I treated seven 
cases, seamen landed from the Revenue Cutter Gallatin 
which put in here in consequence of this trouble with her 
crew.1 This is the first record I have of the appearance of 
the epidemic here, and shortly after I was seized with an 
illness of a like character 
" In this connection, as showing the undoubted atmospheric 
influences in the propagation of the disease, read a report 
similar to mine comprising 17 cases on the Revenue Cutters2 
Woodbury and Dallas at Portland, Me., which occurred on 
board these vessels while at sea attending to their duties in 
cruising along the coast.” 
Dr. Luce writes from West Tisbury, Jan. 31st:—"I first 
1 Abstract of Sanitary Reports, January 3rd. 
2 « .< .. .< 17th# INFLUENZA IN MASSACHUSETTS. 
29 
observed the epidemic during the spring of 1889, when it 
appeared in its greatest severity during the months of March 
and April. It was not then epidemic in the State, so far 
as I know. I should think that at this time about one 
third of the inhabitants were affected. ... It was 
most frequent among males, especially among fishermen 
and those exposed to inclement weather. The symptoms 
in this epidemic were principally referable to the respiratory 
organs. 
" The present epidemic began about the first of January 
and is still upon us, affecting fully two thirds of the popu- 
lation. In some instances the schools have been closed, so 
many of the pupils were affected. It affects all ages, but 
is principally confined to males. 
" The symptoms are more variable than in previous epi- 
demics. I think I recognize three different forms of the 
disease. (1) Bronchial, or catarrhal. (2) Febrile, with 
a second rise in temperature after the drop in several cases. 
(3) Neuralgic. 
"I have seen only one case of supervening pneumonia, and 
that was in the spring epidemic. I have seen in connection 
with the present epidemic four cases of herpes zoster, more 
than I have seen here before in many years. Influenza 
seems to be a common disease here.” 
Dr. Lane writes also from Vineyard Haven : " There 
was no evidence of its being communicated by or from one 
person to another, even when occupying the same room or 
bed through severe cases lasting two weeks.” 
Barnstable County furnishes only one manufacturer’s 
return, and that from a shoe shop at Orleans on the arm of 
Cape Cod. The first case occurred January 14th, the 
greatest prevalence was during the fourth week of January, 
33% of 66 employees were attacked and absent from work 
on an average of four days. The return of the doctor at 30 
THE SHATTUCK LECTURE. 
Orleans, on the other hand, reports the first case as occurring 
in his neighborhood on December 27th, the greatest preva- 
lence during the first week of January, 33% of the popu- 
lation as affected, males the most severely affected, and 
pneumonia as increased. 
Mtdicul Returns. 
From physicians in Barnstable County there are fifteen 
medical returns from eleven towns, all the way between 
Truro on the northeast arm of the Cape to Sandwich at the 
southwest border. At Truro the first case is dated January 
1st, and the greatest prevalence the last week of January ; 
from Wellfleet, ten miles away, the first case is reported 
November 20th, and the prevalence the third week of 
January ; Chatham, December 22d and the second week of 
January ; Harwich, January 1st and second week of 
January ; Brewster about the same ; West Dennis, Decem- 
ber 20th and second week of January; but South Dennis 
December 1st and first week of December. Of two reports 
from Hyannis, one places the first case December 10tn, the 
other December 25th. Of four returns from Sandwich, one 
places the first case October 6th, two December 20th and 
one December 27th ; one gives the first week of January 
as that of greatest prevalence, two the second week, and 
one the third week ; one reports 50% of the population 
of Sandwich as mildly affected and 12% severely, another 
30%, and another 25%. 
Conclusions. 
The greatest percentage of affected (75%) is reported 
from Harwich, West Dennis and Osterville ; the least per- 
centage (10%) from South Dennis; of the two reports 
from Hyannis one gives 10% as affected, and the other 
25%. The average of thirteen towns is 37%. 31 
INFLUENZA IN MASSACHUSETTS. 
The only point which can be fairly well established from 
the Barnstable medical returns is, that males were more 
severely affected than females, and probably—as one doctor 
puts it—" because they were more exposed to the weather.” 
Ten out of fifteen report "males,” two females, one is 
doubtful, one says no difference. From Sandwich one 
return says "males,” one says "females,” one "rather 
more females,” and one says "no difference.” So that, on 
this point, Sandwich remains in doubt. 
Sex. 
Other Diseases. 
Six returns from this county report pneumonia as in- 
creased, and four pulmonary diseases. 
Bristol County.—I have tabulated 13 manufacturer’s 
returns from Bristol County covering about 7000 employees. 
Of these three are from New Bedford, six from Fall River, 
three from Taunton—all in the southern half of the county— 
and one from Attleboro’ near the northern border. 
The earliest first case, December 14, is reported from 
Attleboro’ at the north, but two mills at Fall River report 
first cases December 15th ; the latest first cases are at Fall 
River and New Bedford—the southern extremity, but in 
close railroad communication with Boston—each January 
6th ; the largest mill at New Bedford, however, reports its 
first case December 31st, and the third mill January 1st. 
The three returns from Taunton agree substantially upon 
December 30th as the date of the first case. All the re- 
turns, except one from Fall River which names the last 
week of December, agree practically upon the second week 
of January as the maximum week. 
The percentage of affected varies from 60% to 5%, the 
average being 29% ; the absence from work an average of 
five days. 32 
THE SIIATTUCK LECTURE. 
The superintendent of the Granite Cotton Mill at Fall 
River writes a letter of some interest under date of Feb- 
ruary 4th : 
" The influenza made its appearance among our people 
December 27th, the day after the great gale which swept 
over the Eastern States. December 30th, when the tem- 
perature fell from 54° F. to 37° F., the number of victims 
increased rapidly, and reached a crisis a few days after 
January 1st, when there was another fall in temperature 
from 36° to 20°, followed by a cold wave, which those 
who dressed in holiday attire and engaged in New Year’s 
festivities were not prepared to meet, and the number of 
victims continued to increase until January 13th, when a 
large percentage returned to work, and since that time the 
number of those off work has steadily decreased, and to-day 
there are only seven cases among 836 employees.” 
The treasurer of a cotton mill at Taunton, 1200 em- 
ployees, sends very accurate figui’es, from which it appears 
that of 650 males, 221 were sick, an average of 4.73 days ; 
and of 550 females, 259 were sick, an average of 5.95 ; so 
that at this mill the females were sick in greater numbers 
and more seriously. 
Medical Returns. 
I have tabulated seven medical returns from this county, 
all from the southern half of the county, except one from 
Attleboro’. The earliest first case is, December 10th, from 
New Bedford ; the latest first case, December 28th, from 
Fall River near by. The next earliest case is from Attle- 
boro’, at the northern part of the county, December 18th. 
All the returns, except one, which gives the first week in 
January, name the second week of January as the maximum 
week. 
The percentage of affected varies from 60% in Attleboro’ 
to 10% in Fall River. Average 33%. 
Sex. 
Three state that males were most affected, one females. 33 
INFLUENZA IN MASSACHUSETTS. 
Other Diseases. 
Four returns state that pneumonia was most increased in 
frequency. 
Conclusions. 
I think we may conclude from the two classes of returns 
in this county that influenza was at least a week later here 
than in Boston (Suffolk County), and that where males and 
females were equally withdrawn from out-door exposure the 
females suffered more. 
From Plymouth County there are only three factory re- 
turns, all three from shoe shops in Brockton and its neigh- 
bor Campello, in the northwestern corner of the county. 
These returns cover nearly 1000 employees. 
The answers to question 1 are January 1st, 2d and 10th ; 
to question 2, the 3d of January, the second week and 
the third week ; that the climax was not reached any earlier 
in the shop where the first case occurred January 1st, than 
where it occurred January 10th. The percentages of 
affected were 60%, 20%, and 40% ; and the days of ab- 
sence from work 2, 7 and 5. The sexes are returned as 
affected alike. 
Medical Returns. 
There are four from Plymouth County. From Abington 
the answers to questions 1 and 2 are December 4th and the 
week from December 29th to January 4th ; from Brockton 
the answers to 1 and 2 are December 20th and second week 
in January ; to question 3 this return gives 50% of the 
population as attacked. From Middleboro’, farther south, 
the first case is reported as occurring on the same day as at 
Brockton, and the climax as occurring the same week, but 
only 10% of the population was affected. 
From Rockland, the next township to Abington, the first 
case is set down for December 22d, eighteen days later 34 
THE SHATTUCK LECTURE. 
than the first case at Abington ; the climax, however, was 
reached about the same time in the two towns ; at Rockland 
only 6% is returned as attacked. 
Three of the four answer the male sex to question 5 ; 
two specify pneumonia, and one pulmonary diseases as be- 
ing increased. 
Obviously no definite conclusions can be drawn from the 
returns from this county. 
The case in Abington December 4th was probably ante- 
cedent to the true epidemic; and the epidemic perhaps be- 
gan a little later and culminated a little later than in Suffolk 
County. 
From Norfolk County five factory returns, one silk, 
one woolen, one cotton, one straw, cover from 1500 to 2000 
employees. The earliest first case is December 16th, the 
latest December 28th ; in two returns the climax is reached 
the first week in January, in two the second week in 
January, in one the week January 4 to 11. 
The silk factory reports 60% of affected and of absentees 
an average of 5 days ; the straw factory 50% of affected 
and 20% of absentees, an average of 3 days ; the woolen 
mill 15% of affected and 10% of absentees, an average of 4 
days; the cotton mill 6% of affected and 3% of absentees, 
an average of 3 days. The first case at the woolen mill in 
Dedham was December 16th, and the first case at the cotton 
mill at Readville in the next township was December 25th, 
but the period of greatest activity at each was the first week 
in January. 
Medical Returns. 
There are thirteen from Norfolk County, representing 
twelve different towns. West Medway at the western bor- 
der of the county reports a first case as early as October 
20th—evidently a sporadic case of catarrhal fever ; Hingham INFLUENZA IN MASSACHUSETTS. 
35 
near the coast, and just north of Abington with its first case 
December 4th, reports its first case November loth ; 12 
" distinct cases ” are reported as occurring in Brookline 
November 17th—perhaps a local outbreak; Stoughton, on 
the southern border of the county and contiguous to Brock- 
ton with its first case December 20th, reports a first case 
November 20th ; Dedham’s first case is returned for Decem- 
ber 12th ; of two returns from Hyde Park, one gives the 
first case as December 7th, the other December 27th; the 
Medical Examiner at Brookline gives the date of the first 
case there as December 15th; the first case atFoxboro’ is 
the latest—December 25th. East Weymouth gives De- 
cember 21st; Braintree and Randolph (next to Stoughton 
with its first case November 20th) give December 20th. 
Eight towns return the first week in January, or the week 
from December 28th to January 4th, as the week of greatest 
prevalence. Two towns, West Medway with its first case 
October 20th, and Hingham with a first case November 15th, 
report the second week of January as the week of greatest 
prevalence, which indicates pretty well the character of the 
so-called first cases. The return from Hyde Park which 
dates the first case December 7th, puts the climax at the 
fourth week of December; that from Quincy which dates 
the first case December 1st, puts the climax the first week 
in January, the same week as those dating the first case 
December 20th. At Braintree and Wellesley Hills 75% of 
the population is said to have been attacked ; various per- 
centages are given for the other towns between this and 
20% for Hingham and 15% for Brookline at the other end 
of the scale. The average is 51%. 
Sex. 
Eight returns from as many different towns specify the 
male sex as having been most severely affected. The others 
make no return to this question, except one which states 
that the female population was the larger. 36 
THE SHATTUCK LECTURE. 
Medical Returns. 
Seven returns state that pneumonia was increased, and 
three others that pulmonary diseases were increased. One 
return mentions capillary bronchitis in connection with 
pneumonia. 
Suffolk County, the next on the north, is really the 
City of Boston with Chelsea ; from the small towns of Revere 
and Winthrop, also within the county limits, there are no 
returns. 
There are seven returns from the large Boston dry goods 
stores. One places the first case as early as December 1st, 
but reports the same week of greatest prevalence (December 
28th to January 4th) as another store which reports the 
latest first case of the seven, December 22d. Two date 
the first case December 10th, one December 16th, one the 
20th. Four give Christmas week as the climax, but this is 
partially explained by one return which says : " Our em- 
ployees were lightly touched, and there were no more 
absences than usual at Christmas time which is always the 
cause of much fatigue.” Two stores return 50% of em- 
ployees as affected and 45% as absent in consequence ; one 
returns 50% as affected but only 5% as absent—a singular 
discrepancy; one, 33% as affected and 25% absent; one, 
10% affected and absent. The average duration of absence 
varied from 2 to 7 days. Two stores report the male sex 
as most seriously affected. 
There are returns from nine banks and Trust Companies. 
Among the personnel of two banks no case of influenza 
occurred. One dates the first case December 10th, one 
December 13th, one December 16th, one December 17th, one 
December 20th, and one the 27th. The large banking house 
with 44 employees reporting its first case December 13th, 
gives the second week of December as the week of greatest INFLUENZA IN MASSACHUSETTS. 
37 
prevalence; 60% were attacked and 45% were absent—an 
average of four days. If this is a correct statement, and 
there is every reason to accept it, it indicates that the epi- 
demic exhibited an almost explosive character at this point. 
A Trust Company, with 26 officers and clerks, dating its 
first case December 17th, gives the immediately following 
week as that of greatest prevalence. 
Two banks report 75% of affected with 25% and 20% of 
absentees; one, 50% with 33% absent; one, 33% affected 
and absent; one, 25% affected and absent. The average of 
absences varied from three to six days. 
At the Trust Company with 26 employees, three had a 
second attack incapacitating for work ; and "the oldest” of 
the staff are reported to have had immunity. 
These bank returns, dealing with comparatively small 
numbers under immediate supervision, are probably pretty 
reliable. They indicate that the influenza began as an 
epidemic in Boston about the middle of December and was 
on the wane by January 4th: that at least 50% of the 
young and middle-aged male population was attacked, and 
that about 25% was incapacitated for work for four or five 
days. 
The return of the Central Boston Post Office, where there 
are 472 employees (clerks), dates the first case December 
15th, and the week of greatest prevalence December 28th to 
January 4, which corresponds pretty accurately with the 
hospital and medical returns; 29% were said to be affected, 
22% were incapacitated and absent an average of four days ; 
male employees were most severely affected, but only 25 
women are employed.1 
1 In response to my request, separate returns were made up for the letter 
carriers, 15-5 in number at the Central Station, who were naturally more ex- 
posed in the open air than clerks iu the building. The week ending December 
10th, a daily average of 6.34% were absent from duty, December 19th, 6.14%; 
December 27th, 6.64%; January 4th, 10.32%; January 12th, 11.67%; January 
22d, 9.48%; January 30th, 10.19%; February 8th, 10.44%. The percentage of 
daily absentees nearly doubled from the week ending December 19th to that 
ending January 12th. The maximum week was apparently a week later than 
among the clerks. 38 
THE SHATTUCK LECTURE. 
The North End Station of the Boston Gas Light Com- 
pany employs 320 men, and dates its first case December 
27th, and its week of climax is given as the first week in 
January; 55% were attacked and 18% absent an average 
of three days. The Superintendent writes a somewhat in- 
teresting letter, to the following effect: 
" At the South Boston works, where thirty men were 
employed, the first case appeared December 28th, and it 
prevailed unceasingly the first three weeks in January; 
64% of all men were attacked, and all were obliged to leave 
work about four days. The last case was cured January 
24th. Men who worked at the fires and were subjected to 
heat and chill, and men of sedentary habits were attacked. 
Every man in the retort houses and all the office men had 
it, while only one street laborer, and none of the yard men 
were attacked.” 
The Whittier Machine Company of the Roxbury District, 
employing 261 men, presents a singular return : its first case 
was December 22d, the week of climax the first in January, 
only 4|% were attacked and only 2£% absent an average 
of seven days. The Chelsea Dye House had its first case 
December 5th, its maximum week the fourth week in 
December, 40% of its 92 employees were attacked and 35% 
absent an average of seven days. 
The average percentage of affected in eight mercantile 
houses in Boston, employing males, almost exclusively, is 
50%. 
Medical Returns. 
There are twenty-three from Suffolk County—all from 
Boston except one from Chelsea—which I have tubulated. 
One first case is reported December 1, one December 5th, 
three December 12, but in each of these returns the maxi- 
mum week is given as the last week in December. The 
Chelsea return dates the first case as late as December 25th 
and the maximum week the first week of January. INFLUENZA IN MASSACHUSETTS. 
39 
The latest first cases returned from Boston proper are 
those dated December 20th. The greatest number of 
returns (five) giving the same date for the first case are 
for December 17th, and there are three giving December 
16th. It would be fair to assume the middle of December 
as the date of the beginning of the epidemic in Boston. 
Ten returns give the last week of December as the maximum 
week, three the week from December 28th to January 4th, 
and three the first week of January. It is probably fair to 
assume that the epidemic began to decline in Boston about 
the end of the first week of January. 
It took, therefore, ten or twelve days to reach its climax, 
where it held probably five or six days. 
One return from Charlestown District gives 80% as the 
proportion of the population attacked, one from Brighton 
75%, one from Roxbury 70%, two from Boston proper 65%, 
two 50%—these must be estimates or guesses. One return 
says 44% of persons in families visited, one 25% in families 
visited. The lowest percentage from Boston proper is 20%, 
and the lowest of all, from Chelsea, 17%. The average is 
44%. 
Sex. 
Of those answering question No. 5 as to sex, five say 
male, three female, one "happened to be female in my 
practice.” 
Other Diseases. 
Twenty-three state that pneumonia was increased (one 
specifying fibrinous pneumonia) ; one states that pulmonary 
diseases were increased ; one mentions gastritis ; only one 
specifies insomnia as a complication. In the practice of one 
there was a general immunity from other diseases during 
the latter part of the epidemic. The mention of bronchitis 
is so usual in all these returns that I omit it. 
As to the question of sex or exposure in the open air, two 40 
THE SHATTUCK LECTURE. 
correlated factors as it seems to me elsewhere, it is difficult 
to draw any definite conclusions from the medical returns 
of Suffolk ; but it is pretty evident that pneumonia was 
increased. 
Essex County.—Extending along the coast and immedi- 
ately to the north of Suffolk, I take up Essex County next. 
I have tabulated 16 returns from manufacturing companies, 
etc., in this county, and 21 medical returns from 14 different 
towns. 
A Lynn shoe shop (the only one reporting on account of 
the fire), with 210 employees, reports its first case January 
1st, and its maximum week the second in January ; the first 
case at the Lynn Bank was December 28th. 
From Beverly, two shoe shops, each employing about 300 
men, report. One says its first case was "about November,” 
its maximum week the second week of December, 90% of 
the employees were affected and 75% were absent an 
average of ten days. The other reports its first case December 
20th, its maximum January 1st; 50% were attacked and 
absent an average of four days. These shops are very 
near each other, and it is impossible to reconcile the two 
statements unless we explain the first by a "strike” rather 
than by influenza. 
From Salem, a Bank reports its first case December 21st; 
five out of six were affected ; but the Nauiukeag Cotton 
Mills at Salem, with 1078 employees, reports the first case 
"about January 1st,” the maximum week January 4 to 11, 
40% attacked, 13% absent an average of five days. The 
Ipswich Cotton Mills, 552 hands, same date for the first 
case, January 11 to 18 for the maximum. Two mills at 
Newburyport, employing together 580 hands, report first 
cases January 3rd and 4th, maximum weeks January 4 to 
11 and the second week of January; 25% and 43% of 
affected and absent an average of seven days. INFLUENZA IN MASSACHUSETTS. 
41 
A Haverhill shoe shop, with 400 employees, reports its 
first case December 20th, its maximum week December 
28th to January, 4th, 75% affected, 25% absent. From 
Lawrence there are two returns. Of the Great Pacific 
Mills, with 4336 employees, very full, accurate and reliable 
returns may be found in the Boston Med. and Surg. Journal, 
Yol. cxxii. p. 251, to which reference will be made later. 
The first case at the Pacific Mills occurred December 
24th, the maximum week was January 4th to 11th, 40% 
were affected and absent an average of 6£ days, females 
were the most and the most seriously affected. 
The Pemberton Cotton Mills of Lawrence, with 676 em- 
ployees, report the first case December 17th, the maximum 
week January 4th to lltli, 41% were affected (lost time in 
consequence) and out an average of 5TV days ; females were 
most attacked, 49% of the females and only 29% of the 
males. The report from this mill also is apparently accurate 
and reliable, and agrees in the main with the Pacific report. 
A linen mill at Andover, 308 employees, reports first 
case December 14, maximum week second week of January, 
41% attacked, 38% out. A machine shop at North Andover, 
421 hands, all males, December 25th, January 5 to 12, 
40% attacked and out five days. 
One return from a coast town (Newburyport) and one 
from an interior town (North Andover) date the first case 
December 1st; but the return from Andover, next to North 
Andover, dates the first case December 21st, and gives the 
maximum week as the second week of January, and the 
other return from Newburyport names January 1 to 15 as 
the maximum period, so that these early cases may be con- 
sidered sporadic as similar ones have been in other counties. 
The latest returns of first cases are from Marblehead and 
Manchester on the coast and Methuen in the interior, all 
Medical Returns. 42 
THE SHATTUCK LECTURE. 
January 1st; the maximum week at Methuen is given as 
the third in January, at Manchester January 5 to 11. 
Lynn returns December 15th ; Peabody December 10th, 
with a maximum in the second week in January ; Danvers 
one return December 15th, one December 25th, with the 
third and second weeks of January as maximum weeks 
respectively; Gloucester December 18th and 24th, both 
returns naming January 5 to 11 as a maximum week; Ha- 
verhill December 20th and 28th, with the first and second 
weeks of January respectively as maximum weeks. 
West Newbury next to Newburyport gives December 
16th as the date of the first case. 
Lawrence December 20th,December 20th, December 23d, 
with the first week of January as a maximum week for the 
first two, and January 7 to 21 for the third return. 
Georgetown, in the northwestern corner of the county, 
gives December 16th as the date of its first case, and the 
middle of January as the maximum period. 
The percentages of population attacked range from 80% 
in Marblehead to 5% from one return from Haverhill, the 
other return from Haverhill giving 33%. One return from 
Danvers gives 60%, the other 10% ; one return from Law- 
rence gives 50%, one 25% and one 12%. The return from 
Andover says 50%, that from North Andover 15%. The 
average of twenty returns is 38%. 
Sex. 
Eleven returns specify the male sex in answer to question 
5 ; three returns say females, but in one of these the prac- 
tice is among females. 
Other Diseases. 
Eleven returns state that pneumonia was increased, three 
specify catarrhal and one croupous pneumonia. Four state 
that pulmonary diseases were increased. Two mention 
gastro-intestinal disorders as complications. A Medical INFLUENZA IN MASSACHUSETTS. 
43 
Examiner reports two deaths without treatment, "probably 
from congestive pneumonia.” One return from Lawrence 
states that influenza "drove out” diphtheria which had been 
prevalent. 
Middlesex County.—This county, lying next to Es- 
sex and Suffolk, brings us back from the northern border 
of the State to the neighborhood of Boston. It is almost 
wholly an interior county, and, except for a small though 
thickly-populated territory around Boston, we take leave of 
the immediate influence of the sea. It is a manufacturing 
population. I have tabulated 27 returns from factories, 
banks, machine shops, &c. 
From Lowell, in the northern part of the county, seven 
returns cover nearly 9,000 employees. The Lowell Cotton 
Mills, with 1,736 employees, report the earliest first case 
December 20th, with a maximum week the same as 
that in Boston, viz. : December 28th to January 4th. The 
Merrimac Woolen Mills report the latest first case January 
10th, with a maximum week the second week of January ; 
there are three first cases December 26th ; one, December 
30th ; two, January 1st: four mills give the second week of 
January as the maximum week, two mills January 4th to 
11th, one and the Bank (only five employees) December 
28 th to January 4th. 
The percentages of the affected and absent, at the mills 
in Lowell, varied very much, according to these returns, 
from "nearly every one” affected, and 50% absent an aver- 
age of four days at the Merrimac Cotton Mills and Print 
Works, to 10% affected and 8% absent an average of four 
days at the Merrimac Woolen Mills. The favorable re- 
turn, if accurate, from the Merrimac Woolen was probably 
due to something other than wool, for the Middlesex Wool- 
en Mills report 50% affected and 20% absent an average 
of five days. 44 
THE SHATTUCK LECTURE. 
The different departments of the same mill were as dif- 
ferently affected as the different mills. To this point I shall 
revert again later. Five days was about the average of 
absence from work. 
Sex. 
As far as the Lowell returns offer any reliable informa- 
tion upon that point, the female sex was the most affected. 
Careful calculations from the Merrimack Cotton, with 3200 
employees, in answer to a personal request, show that 
influenza "was more prevalent among women and boys than 
among men.” 
The Peppered Cotton Mills, 31G employees, in the north- 
western corner of the county and somewhat off the main 
line of travel though with railroad connection, report the first 
case January 9th, and the maximum week the third week of 
January. 
The North Billerica Cotton Mills, nearer Boston than 
Lowell and on the main line of travel, with 265 employees, 
report the first case "about January 1st,” and the maximum 
week the third week in January. Next to the south, a tan- 
nery at South Woburn, 180 employees, has its first case 
October 4th, its maximum week the second week in October, 
6% attacked and 5% absent an average of thirteen days— 
evidently a local predecessor of the great epidemic, for a 
Winchester factory a few miles away and still nearer Boston 
reports its first case December 26th, its maximum week the 
first week of January. The Malden Rubber Shoe Company, 
1255 employees, with dates agreeing pretty closely with 
those previously recorded in Suffolk County, had only 15% 
attacked and 12% absent an average of five days. The 
returns from manufactories in Cambridge, Watertown, 
Waltham, Newton, covering 4200 employees, vary but 
little from those given for Suffolk County, but the first cases 
are a few days later and the maximum weeks a few days INFLUENZA IN MASSACHUSETTS. 
45 
iates The Nonantum Worsted Company at Newton, 520 
employees, reports its first case December 30th, its maxi- 
mum week January 4 to 11, 17% of affected and absent 
an average of five days. 
The Waltham Watch Works, 2300 employees, reports 
males as most affected. Returns from two shoe shops at 
Marlboro’, 1100 employees, report first cases December 
22d and 26th and the maximum week the first week of 
January and January 4 to 11 ; from woolen mills at May- 
nard, 886 employees, the first case was December 20th and 
the maximum week January 4 to 11, Marlboro’ and May- 
nard are in the western part of the Middlesex near the 
Worcester line. 
Medical Returns. 
I have tabulated 20 medical returns from this county. 
Beginning again with Lowell near the northern line, there 
are two returns, one placing the first case December 10th 
and the maximum week the second week of January, the 
other December 21st. Billerica returns the first case 
December 12th and the maximum week the second week of 
January; from Ayer in the northwest, near the Worcester 
County line, the Medical Examiner of the District, Dr. 
Hartwell, returns the first case as December 21st and the 
maximum week the second week in January. He writes: 
" I go into four or five adjoining towns. Ayer is a large 
railroad centre. The epidemic began here and reached its 
height from one to two weeks earlier than in places off the 
line of travel, and, as far as my observation goes, affected 
a larger number of the inhabitants. 
"The only case I saw as Medical Examiner was one in 
Pepperell, said by the neighbors and thought by Selectmen 
to have died from influenza, but proved on examination to 
have died of acute alcoholism.” 
Returns from towns around Boston—Somerville, Med- 46 
THE SIIATTUCK LECTURE. 
ford, Melrose, Arlington, Cambridge, Waltham, Lexington, 
Concord, Newtonville, Newton—though varying consider- 
ably in the dates of first cases, and still more so in different 
returns for the same towns (Cambridge, for instance, return- 
ing November 15th, 24th, December 1st, 23rd, as dates of 
the first case), agree on the average with the Boston returns, 
as do those also of the date of the maximum week, lie- 
turns from Framingham and Hopkinton in the southwestern 
corner of the county agree as to dates with those from 
Boston. 
The percentage of the affected varies from 75% in five 
returns to 10% in two returns. It also varies within these 
same limits for different returns from the same place. The 
return of the Medical Examiner resident at Somerville esti- 
mated 75% of the population attacked, another return from 
Somerville names 10% as proportion. The average percen- 
tage of 24 returns tabulated is 44%. 
Fifteen returns specify the male sex as suffering either 
most numerously or most severely. Of these, one reads : 
"Males who were most exposed to weather and hard work”; 
one return says : in numbers females suffered more ; in sever- 
ity sexes alike ; one return says : more cases among females, 
more complications among males ; one return says : females 
more frequently attacked, in the proportion of 3:2. 
/Sex. 
Other Diseases. 
Eleven returns state that pneumonia was increased, and 
eight that pulmonary diseases were increased ; one return 
states that there was less pneumonia than usual; one reply 
affirming an increase of pneumonia expresses doubt whether 
"the pneumonia had any direct connection with the influenza, 
or whether it was an independent disease attacking those 
already debilitated ” ; and another reply is accompanied by INFLUENZA IN MASSACHUSETTS. 
47 
this comment: "Most cases of so-called pneumonia follow- 
ing influenza are in reality cases of congestion, not croupous 
pneumonia.” Another return states : " no diarrhoea, no 
constipation, no diseases increased in frequency or severity.” 
A member of the Board of Health of Lowell writes : 
"Scarlet fever, which had been rapidly increasing for four 
weeks, with the first week in January (the maximum week 
of influenza) suddenly decreased, and the same is true of 
diphtheria, though in a less degree.” This coincides with a 
return from Lawrence previously alluded to. 
Worcester County.—This county occupies the heart 
of the Commonwealth and stretches across it from north to 
south. Though studded with manufacturing towns, it has 
a larger agricultural population proportionately than the 
counties previously considered. It may be regarded as a 
more homogeneous area than such counties as Barnstable or 
Bristol or Essex or Middlesex. I have tabulated 27 re- 
turns from manufacturing companies, banks, &c., covering 
11,405 employees. 
The returns indicate that the epidemic affected Worcester 
County in general later than those counties we have already 
gone over to the east of it. The earliest first case is re- 
turned from Clinton, the Bigelow Carpet Works, Decem- 
ber lbth, but the maximum week was the second week of 
January, and the Lancaster Mills at the same place reports 
the first case December 26th, with the same maximum 
week ; West Upton reports a first case December 21st, but 
as a maximum week the third week in January, and a 
factory in the contiguous town of Grafton reports its first 
case January 9th, with the third week of January also as 
the maximum week. A shoe shop in Worcester reports a 
first case December 23d, and a maximum week January 
4th to 11th ; but the first case at the Bank which reports 
was December 30th, and at the Loom Works, 500 em- 48 
THE SIIATTUCK LECTURE. 
ployees, January 1st; a Worsted Company in Fitchburg re- 
ports its first case December 20th, but its maximum week 
the second week of January; and another company in 
Fitchburg dates its first case January 1st, and its maximum 
week the third week of January. Fourteen first cases are 
dated between January 1st and 10th, and the others in the 
last days of December. Eight returns give the third week 
of January as the maximum week, and fourteen the second 
week ; one gives the fourth week. 
The percentages of those attacked vary from 60% to 5%, 
and of those absent from work from 60% to "very few”— 
that is, less than 5%. 
The Cotton Manufacturing Company of West Boylston, 
with 226 employees, reports " only one case and that early 
in January.” The average absence from work was between 
five and six days. 
I have tabulated 16 medical returns from 13 different 
towns. The earliest first case, December 15th, is from 
Grafton, where the manufacturing company dated its first 
case January 9th, but the maximum week was the second 
week of’ January. Five returns—one each from Westboro’, 
Worcester, Clinton, and two from Fitchburg—date the first 
cases December 20th ; the other returns vary from Decem- 
ber 22d to January 3rd—this latter another return from 
Fitchburg. Ten returns name the second week of January 
as the maximum week, and four the third week. 
The estimates of the percentage of population affected 
vary from 90% to 10%. Of two returns from Worcester 
one says 90% and one 50% ; of three returns from Fitch- 
burg one says 65%, one 25%, one 10% ; the Medical 
Examiner at Gardner, near Fitchburg, estimates 80% for 
his district. The average is 48%. 
Medical Returns. 
Sex. 
Twelve reply males, and two females. INFLUENZA IN MASSACHUSETTS. 
49 
Other Diseases. 
Twelve say that pneumonia was increased, one that pul- 
monary diseases were increased, and one that whooping 
cough was more fatal. 
The next belt of the State to the westward may be re- 
garded for our purposes as made up of three counties, 
Hampden, Hampshire and Franklin—in that order from 
south to north. The centre of these counties is traversed 
by the rich farming lands of the Connecticut River Valley, 
and the abundant streams from the hills are utilized for 
manufactures. 
Hampden County.—I have tabulated twelve returns 
from factories and banks in this county, employing between 
four and five thousand people. A Springfield Bank and a 
Holyoke Bank (the only banks sending returns) report 
"no sickness”; the Holyoke Blanket Company reports, 
" few sick at any time and did not interfere with work ” ; and 
the Germania Mills (Cotton), Holyoke, report "no loss of 
time from influenza ” ; but two thread companies at Hol- 
yoke report first cases December 24th and 26th, and the 
second week of January as the maximum week. A Fire- 
arms Manufacturing Company at Springfield, 213 em- 
ployees, reports its first case January 1st, its maximum the 
second week of January ; 10% affected, 5% absent an 
average of nine days. 
No return from this county gives any earlier maximum 
week than the second week of January ; but there is a re- 
port of a first case from near Palmer, December 18th, one 
from Ludlow a little farther west, December 20th, one 
from Chicopee—again a little farther west—December 24th, 
but the other return from Chicopee gives January 1st as the 
first case. 50 
THE SHATTUCK LECTURE. 
There are some apparently more than usually accurate 
and interesting returns from a Duck Company at Palmer in 
the eastern part of the county, employing 325 hands. The 
first case in the dressing shop is reported December 30th, 
and the maximum week the second week in January ; but 
the first case in the Bleaching Department did not appear 
until January 7th, and the maximum week in that depart- 
ment was the 4th week of January. In all the departments, 
except the dressing, the first case was some time during the 
first week of January, and the maximum week was in seven 
departments the second, in one the third, and in one the 
fourth week of January. In the Bleaching 87% were 
affected and 75% absent an average of five days; in the 
Dyeing 80% were affected and 35% absent an average of 
6 days ; in the Iron Repair shop 75% were affected and 
absent 7 days; in the Weaving 66% were affected and 
absent an average of 6 days ; in the other departments 
there were considerably less, and least, with 25% an average 
of 4 days, in the Spinning. 
Medical Returns. 
I have tabulated thirteen medical returns from eight dif- 
different towns in Hampden County. The dates given for 
first cases range all the way from October 6th in Monson at 
the south-east extremity of the county, to December 26th at 
West Springfield and Holyoke in the north-west, and are so 
varied and unreliable that no conclusion can be based on them. 
One return from Palmer gives the date of the first case De- 
cember 1st, but states that influenza did not become general 
until after Christmas. This agrees with the factory returns 
and is probably the true interpretation of the medical re- 
turns ; the maximum weeks given indicate the same thing; 
as do three different Holyoke returns dating first cases De- 
cember 1st, December 20th, December 26th, but all giving 
the first week of January as the maximum week. 51 
INFLUENZA IN MASSACHUSETTS. 
Seven returns name the second week of January as the 
maximum week, five the first week, one the third week. 
The percentages of affected vary from 75% to 20%, and 
the average of eleven returns is 44%. One practitioner 
profited, apparently, but little by the epidemic, as he reports 
that only one-fourth of 1% among his clients were affected. 
Sex. 
In this county eleven returns state that males were most 
affected. One return says : "especially out-door laborers” ; 
one says : " male, those out-doors ” ; one says : " the careless, 
and those who tried to keep going every day about their 
business and work.” 
Other Diseases. 
Eight returns state that pneumonia was increased and 
one that pulmonary diseases were; three (one from Spring- 
field and two from Holyoke) report malarial complications ; 
one return from Holyoke says it resembled "dengue.” 
Dr. A. F. Reed, of Holyoke, writes: "Bronchitis was 
common in most cases, but the most prominent influences 
seemed to be a union of rheumatic and malarial forces in a 
hybrid action, and in my experience quinine failed to give 
as good effects as salicin.” 
Hampshire County.—From this county I have tabula- 
ted thirteen returns from manufacturing companies, employ- 
ing about 4,000 people. There is one return of a first 
case, " about December 1st,” one December 9th, one De- 
cember 13th, one December 15th : but the maximum week 
in all of these returns is the second or third week in Janu- 
ary. A factory in Northampton reports its first case Janu- 
ary 1st and its maximum week immediately thereupon—the 
first week of January ; but the first case at the Northamp- 
ton Bank did not occur until January 5th. A silk com- 52 
THE SIIATTUOK LECTURE. 
pany at Florence reports the first case December 9th ; but 
a braid company at the same place reports its first case Jan- 
uary 6th and its maximum week the second week of Janu- 
ary ; the same maximum week as that given by the silk 
company. From the silk mill 20% were affected and absent 
an average of eight days, and from the braid mill 25%, an 
average of four days. Eight returns give the first case 
between December 25th and January 7th; nine returns 
name the second week of January as the maximum week, 
and three the third week. The percentages of those absent 
from work vary from 60% to 5% and the time about six 
days. 
Medical Returns. 
I have tabulated eleven medical returns from seven dif- 
ferent towns in Hampshire County. The dates of first cases 
vary from December 15th to January 1st. From Ware three 
returns date the first case December 20th, 27th, 28th. 
From Northampton three returns date the first case De- 
cember 15th, December 18th, December 29th. One return 
names the first week of January as the maximum week, but 
all the others name the second week. One Northampton 
return gives 10%, one 25%, and one 75% as the propor- 
tion of the population attacked. One Ware return says 
10%, one 33%, and one 40% as the proportion of the 
population affected. The Easthampton medical return says 
60% of the factory employees, but 40% of other popula- 
tion. The average of ten returns is 39%. 
Sex. 
These returns throw little light on sex. One return says, 
both sexes were most affected. 
Other Diseases. 
Six returns say pneumonia was increased, one specifying 
lobular pneumonia. One return from Northampton says : INFLUENZA IN MASSACHUSETTS. 
53 
"there was no pneumonia, and all other diseases appeared 
to be abolished ; there was one death from delirium.” In 
regard to this Dr. Seymour, Medical Examiner, reports the 
following : 
"A man, 32 years of age, had influenza at his home in 
Springfield. He got out of bed, dressed and came to his 
parents’ home here in a state of delirium. He left their 
house at 2 a.m., and was found wandering: about the 
streets by a policeman, who took him to the station house. 
There he remained in a wild delirium until 8 a.m., when, 
as he became silent, the keeper went to visit him and found 
him dead. I viewed the body and these were all the facts 
I could ascertain.” 
Fiianklin County.—This county, the most northern of 
the three occupying the breadth of the State, is somewhat 
less thickly settled and less traversed by railways than the 
two preceding. The manufacturing returns are scanty, and 
I have only tabulated one as apparently accurate. 
The Russell Cutlery Company at Turner’s Falls, at about 
the centre of the county on the Connecticut River, returns 
its first case January 6th, its maximum week the second of 
January, and 33% of its employees were affected and absent 
an average of 6 days. 
I have tabulated five medical returns from five different 
towns. Three returns from the eastern part of the county, 
from Orange in the centre, Cooleyville at the south and 
Northfield at the north, give the first cases December 26th, 
January 1st and December 23d respectively, and the maxi- 
mum weeks as the second for the first two, and the third 
week of January for the last respectively. The medical re- 
turn for Turner’s Falls reports the first case December 26th, 
the return for Shelburne Falls farther to the west reports 
Medical Returns. 54 
THE SIIATTUCK LECTURE. 
the first case November 15th ; both of these returns name 
the second week of January as the maximum. 
The percentage of populations affected according to these 
five returns varies from 75% to 50%, the average is 66%. 
Sex. 
Three returns state that males, and one that females suf- 
fered the more. 
Other Diseases. 
Two returns state that pneumonia was increased. 
Berkshire County.—This county occupies the extreme 
western belt of the State from south to north. It also is 
less thickly settled than other counties, and communication 
between many townships is less immediate and direct than 
is the case in some of the other counties. There are, how- 
ever, a good many manufactories within its borders. 
I have tabulated returns from 16 factories, employing 
nearly 5000 people. A company at Housatonic in the 
southern part of the county, and one at Adams in the 
northern part, return the earliest first cases, December 25th 
and December 30th respectively; the maximum week for 
the former being the first, and for the latter the third week 
of January. Seven first cases are dated January 1st, two 
January 6th, one January 7th, one January 8th, one Jan- 
uary 15th, one January 18th. One return names the first 
week of January as the maximum week, four the second 
week, nine the third week, and one the fourth week. No 
conclusions as to sex can be drawn from returns in this 
county. One return says " neither or both.” 
The percentages of the affected vary from 75% to 5%, 
with an average of 45%, and of those absent from work 
from 50% to 3%, with an average of 22% for an average 
of 5§ days. INFLUENZA IN MASSACHUSETTS. 
55 
The Arnold Print Works at North Adams reports " the 
epidemic did not cause any serious annoyance ” among its 
146 employees. This is striking, for of the two other 
manufactories reporting from North Adams one had 50% 
of its employees absent an average of six days, and the 
other 25% an average of four days. 
Medical Returns 
I have tabulated 16 medical returns from nine different 
towns in Berkshire County. I am obliged to conclude that 
they are not of much value in determining the time when 
influenza assumed an epidemic character in this part of the 
State. The dates of first cases vary all the way from Octo- 
ber 14th at Montville to January 8th at Otis, neighboring 
towns in the southeastern corner of the county. At Mont- 
ville the maximum week is reported to have been the third 
week of November ! Evidently again a local outbreak. 
Two returns from North Adams each give December 15th 
as the date of the first case, the second week of January as 
the maximum and 50% as the percentage of population 
attacked. Of three returns from Williamstown, next to 
North Adams, two date the first case January 1st, and one 
December 19th ; the maximum week of one of the first two 
and of the last being the second week, the maximum week 
of the other being the third week of January. But the re- 
turns from Pittsfield are still more perplexing : of five re- 
turns, one dates the first case November 20th, one Decem- 
ber 15th, one December 17th, one December 27th (this 
return mentions having seen a case November 27th), one 
January 5th, and the maximum weeks vary almost as much. 
From Sheffield in the southwestern corner of the county 
the first case is reported December 15th, but the maximum 
week did not arrive until the fourth week of January. 
The percentage of population affected vary from 87% to 
10%, with an average of 60%. 56 
THE SIIATTUCK LECTURE. 
Sex. 
Eio-ht returns state that males, and three that females 
were nxoi’e affected ; one return says : " men complained the 
most, because it was their nature to, but women were ideally 
as sick.” 
Dr. S. C. Burton, Chairman Pittsfield Board of Health, 
writes January 2fith :—"In our House of Correction, of which 
I have medical charge, there were 105 prisoners ; of these 
96 males, 9 females. Ventilation to the male pi'isons by 
windows on the North and South side, to the female prison 
by windows on the East and West side. The windows in 
the male prison were open most of the time. The hall man 
was the first taken sick January 11th, the following day 24 
men were sick, the next morning eight were too sick to go 
to the shop. Januai’y 14th twenty more were taken sick, 
and one or two a day afterwards until the number reached 
56, all males—not a single case in the female prison.” 
Other Diseases. 
Nine returns state pneumonia was increased ; two that 
pulmonary diseases were increased ; one that capillary bron- 
chitis was increased. 
SUMMARY OF GENERAL CONCLUSIONS. 
Some of these returns are evidently quite accurate, and 
some mercantile returns and those of some public institu- 
tions, as well as a much smaller proportion of those of 
physicians, are based upon carefully kept records; other 
returns are only approximately correct; and still a third and 
not small class are mere guesses, which gain such value as 
they possess from the probability that the errors counter- 
balance each other. 
In drawing conclusions I have considered the date of INFLUENZA IN MASSACHUSETTS. 
57 
maximum weeks of more importance than the dates of first 
cases. 
The data furnished for Suffolk County by such sources 
as the Massachusetts and City Hospitals, the State Prison, 
the Post Office, the two large private banks quoted, are 
probably pretty accurate ; as are the returns from the Pacific 
Mills (Cotton and Prints) Lawrence, Essex County, 4200 
employees, and from the Pemberton Cotton Mills at the 
same place, and from the Merrimack Mills (Cotton and 
Pri nts) Lowell, Middlesex County, 3200 employees, and 
from the Bigelow Carpet Mill, wools, Clinton, Worcester 
County, 1050 employees ; and from the Palmer Duck Com- 
pany, Hampden County, 325 employees. 
From these, collated with the mass of less evidently re- 
liable returns which I have tabulated but not read, one may, 
perhaps, conclude that: 
I. —Influenza appeared first in epidemic form at Boston 
and its immediate vicinity ; that the epidemic dates there 
from the middle of December, although there were sporadic 
cases earlier ; that it culminated during the week between 
December 28th and January 4th ; that it began to decline 
pretty rapidly from that date, although its after effects still 
exhibit themselves in many forms. 
II. —That the epidemic was from ten days to two weeks 
later at the Island Counties (Nantucket and Dukes) than at 
Boston ; that it was about a week later in Barnstable and 
Bristol Counties ; and a fewr days later, perhaps, in Ply- 
mouth and distant parts of Norfolk Counties. 
III. —In the northern parts of Essex and Middlesex 
counties the epidemic was from five days to a week later 
than at Boston. Most of the towns reporting in these 
counties—especially in Bristol, Essex and Middlesex—are 
in constant, rapid and easy communication with Boston by 
frequent and crowded daily trains. 
IV. —It is difficult to explain why these counties were 58 
THE SHATTUCK LECTURE. 
attacked later than Suffolk, and at the same time why Nan- 
tucket and Dukes were attacked still later than these 
counties. Neither a miasmatic wave, nor contagion, nor 
yet the two combined—as we understand them—cover all 
the observations. 
V.—The epidemic, apparently to some extent, radiated 
out from Boston as a first centre. That it behaved in the 
same way with regard to the surroundings of other centres 
of population—notwithstanding the suggestive report of the 
Medical Examiner at Ayer Junction, and notwithstanding 
similar propositions made elsewhere—I cannot satisfy my- 
self from these returns. Except as a larger centre of popu- 
lation it is not apparent why Boston should have been at- 
tacked before other points as far east on the coast; as a 
centre of population it is not apparent why it should have 
preceded New York ; and neither geographically nor as a 
centre of population why it should have anticipated London. 
YI.—With many puzzling local variations, backward and 
forward, and many contradictions, the returns indicate a 
later development as we proceed westward in the State, 
until in Berkshire County we find the epidemic developed 
fully two weeks later than in Suffolk ; several days (4 to 
5 days) later than in Worcester; and about as much later 
than in the two Island Counties to the extreme east. 
VII. —To judge from the returns of public institutions 
and of manufacturers, at least forty per cent, of the adult 
population was seriously enough affected to have occupation 
interfered with. The medical returns, which necessarily 
are often guesses, agree with this. A considerably larger 
percentage probably was attacked. 
VIII. —The returns from two maritime counties indicate 
that exposure to atmospheric influences was an important 
factor, and men were more affected. On the other hand, 
whei’e men and women were equally confined within doors 
by their work, as in mills, the women were both more 
seriously and more numerously affected. 59 
INFLUENZA IN MASSACHUSETTS. 
IX. —Returns from the McLean Asylum, the Massa- 
chusetts Hospital, the Boston Children’s Hospital, the 
Tewksbury Almshouse, indicate that officers and nurses 
were more attacked than patients, an observation which cor- 
responds with others elsewhere, here and in Europe. 
X. —In studying the returns of different mills one meets 
with singular cases of immunity from or predisposition to 
the epidemic. It is a curious anomaly, that one cotton 
mill should have less than half of one per cent, of its em- 
ployees affected, and another 60% ; that a silk mill should 
have 60% affected, a woolen mill in a contiguous township 
15%, and a cotton mill in the next township 6%. The per- 
centage of affected at several of the woolen mills is quite 
small, but this is not invariable, at others it was as high as 
40%. 
At Print Works there was a great variation in the per- 
centages in different departments. From the Merrimack 
Manufacturing Company of Lowell, which kindly sent me 
special figures, I learn that the "departments having a hot, 
moist atmosphere were subject more severely to the effects 
of the disease, which was also more prevalent among the 
women and boys than among the men. The high per- 
centage of the color shop (16%J was due more to the un- 
healthy nature of the room (which is cold and very draughty) 
than to the noxious influence of the chemical fumes. Such 
places as the print room (one case out of 55), indigo dye 
house (no case out of 20), laboratory (no case out of 12), 
where the fumes from the drugs and chemicals are most 
conspicuous, were, comparatively speaking, free from any 
attack by the epidemic.” 
At the paper mills, where many operatives are exposed 
to a warm, moist atmosphere, the percentage of affected 
was, as a rule, low. How far this was accidental, or how 
far due to chloride of lime or other materials used in bleach- 
ing, may be queried. At the bleachei’ies of Print Works 60 
THE SHATTUCK LECTURE. 
about 30% were attacked/ At the bleaching room of the 
Palmer Duck Company 87% of the employees were 
attacked. 
The Arnold Print Works at North Adams reports that 
the epidemic "did not cause serious annoyance”; whereas 
the Greylock Mills (woolen) at the same place reports 
75% attacked, and 50% absent from work an average of 
6 days. 
The Merrimack Print Works (all departments included), 
Lowell, had 18% affected; the Pacific Mills Print Works, 
Lawrence, had 29.50% affected; the American Print 
Works, Fall River, had 33% affected. 
XL—Pneumonia was undoubtedly much increased in 
frequency during the influenza period all over the State. 
As to the character of the pneumonia—whether lobular or 
lobar; croupous, fibrinous or catarrhal; whether mistaken 
for capillary bronchitis—these returns give little information, 
and one must consult special papers—such as those read 
April 17, 1890, before the New York Adademy of Medi- 
cine by Drs. F. C. Shattuck, E. G. Janeway and William 
Pepper. 
XII. —Some of the returns indicate that the presence of 
epidemic influenza was inimical to (" drove out ”) other forms 
of disease—as diphtheria and scarlet fever. 
In the Connecticut River Valley, as might have been an- 
ticipated, it seems to have taken a malarial character. 
XIII. —To fit the mode of progression of the atmos- 
pheric disease wave—if the epidemic was dependent upon a 
miasmatic poison—with recorded observations in Europe 
and America, will tax the utmost ingenuity of the scientific 
meteorologist. 
XIV. —The epidemiologist will be quite as much per- 
plexed if he seeks to explain all the phenomena by contagion. INFLUENZA IN MASSACHUSETTS. 
61 
I have endeavored to collate carefully returns as made, 
and to follow honestly where they seemed to lead without 
prejudice and without regard to previous mental predis- 
positions. When the returns seemed to offer no exit I have 
said so. Some errors have doubtless crept in, and some 
obvious lessons may have been overlooked. The picture, 
however, has not been varnished at the expense of truth. 
The results are meagre enough, but they have yet to be 
compared with others 'before we quite despair of reaching 
some definite knowledge of epidemic influenza. The bac- 
teriologist has failed to help us, and we must still struggle 
with the intricate problems presented without the aid of a 
specific micro-organism. 
Under date of January 5, 1890, Hirsch, the distinguished 
Berlin epidemiologist, writes in answer to the editor of the 
Deutsche Medicinische Wochensehrift: 
"I am persuaded that the present epidemic 
differs in no essential particular from those hitherto described. 
The great interest which the outbreak of this disease has 
excited is to be explained simply by the indifference of the 
great mass of the medical public to every thing taught by 
history 
" Whatever I had to say about Influenza I have said in 
the second edition of my historico-geographical pathology, 
and nothing new has presented itself.’’