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The report, in the light of the statistics for these six countries, reverts to the problem presented
by the somewhat paradoxical rates in the three groups A, B and C at lower and higher ages. The figures
are as follows in the case of males ; those for females, speaking generally, follow on the same lines :—
Sex and age.
Pennsylvania.
New York.
A.
B.
C.
A.
B.
C.
Males—
25—44 6.2 12.3 9.1* 6.9 14.3 8.7*
45—64 16.8 25.7 25.7 18.8 28.2 28.0
65—84 75.2 91.4 91.5 77.3 89.9 90.4
From this table it will be seen that the rates marked with an asterisk in column C are distinctly
lower (in both Pennsylvania and New York) than those in column B ; while at the two higher age periods
the rates in columns B and C are in fairly close correspondence.
Thus the "first generation Americans" of column B compare unfavourably with the foreign-born at
ages 25—4, but not at the two higher age periods.
The Report explains this by pointing out that—"In the age period 25-44 the predominating
stocks which make up the native-born of foreign parentage are the Germans, British and Irish whose
death rates we have found are high. The foreign-born group at the same age period, on the other hand,
has large proportions of Italians, Russian Jews and Hungarians. It is the low mortality of these races
which at ages 25-44 offsets the very unfavourable conditions among the Germans, British and Irish
elements of the foreign-born, and gives a net rate lower than that for the native-born of foreign or mixed
parentage, which contains no such reducing factor. But here this influence stops. The foreign-born
at 45-64 and 65-84 are predominantly Germans, British and Irish ; we see that their rates are almost
identical with those for the native-born of foreign or mixed parentage composed at these ages of similar
stock."
This explanation doubtless contains a certain element of truth, but the following facts must not
be lost sight of—
(a) The age distribution of the Austrians, Russians and Italians in the 25-44 age group
must differ considerably from that of the Germans, British and Irish in that age group ; partly
because of the differing dates at which emigration commenced and partly because the former
nations at the present time emigrate more largely by families than do the latter.
(b) Strict requirements as to medical inspection on landing have only been in force for
15 or 20 years, and this fact must have made a difference in the quality of the more recent
arrivals as compared with earlier entrants to the U.S.A.
(c) It does not seem safe to assume that the quality of the emigrants of British, Irish and
German origin respectively in years gone by and at the present time can be looked upon as
absolutely invariable ; indeed, there are good reasons for thinking that changes have occurred.
The conclusions of the pamphlet are deserving of close study, as they throw fresh light upon the problem
of migration in its influence upon phthisis death-rates.
Influenza, cerebrospinal fever, acule poliomyelitis and polioencephalitis, encephalitis lethargica,
epidemic hiccough.
Influenzal group of diseases.—Advances in knowledge find most unexpected application in actual
practice. Thus, the discovery of the telephone has had notable influence upon the prevention of diffusion
of smallpox by facilitating prompt dealing with suspects. Similarly improved facilities for the spread
of news, the world over, have worked quite a revolution in the science of epidemiology in connection
with the diseases of the influenzal group. It is possible now, within the course of a day or two, to come
across news of a dengue prevalence in Australia, of trench fever investigations on the Western front
and of a poliomyelitis outbreak in New York ; and then in a like short space of time to learn from
Dr. Bassoe how the Epidemic Encephalitis of Chicago appears to be connected with influenza, and how
Dr. Crookshank has made a like observation in London ; just as the "nona" of 1889-90 followed the
pandemic of influenza of the time ; and as similar phenomena were noted by Camerarius of Tubingen
in 1718 ; by Lepecq de la Cloture in 1768 ; and by Ozanamas occurring in Germany in 1745, in Lyons
in 1800 and in Milan in 1802. The " little endians," of course, discountenance any such attempted
surveying of mankind from China to Peru, and complain that the " new epidemiologists renounce the
laborious accumulation of facts." But the " big endian " retort is, of course, that there is room for
everybody, for there are so many facts to explain. The big-endian facts are not quite the same as the
little-endian facts, but both may prove to be facts, for what they are worth. While we must all bear
one another's burdens, even to the extent of trying to make out the meaning, for example, of the
American Red Cross Trench Fever experimental work, or that of the results of the inoculation experiments
with dengue blood in Australia, yet it is incumbent upon epidemiology also to bear its own
load, and to note, for example, the correspondence in time of both these last-named sets of inquiries
with the development of the world epidemic of influenza, and the absence of any display of ability on
the part of either this particular dengue virus or the trench fever virus to accomplish anything appreciable—away
from Australia or from the trenches—i.e., when regarded from an epidemiological point
of view. Moreover, the fact cannot be overlooked that the Australian dengue was speedily engulfed
by the great pandemic influenza, and trench fever, though sedulously hunted for on this side of the
Channel, failed altogether to put in any appearance—unless, of course, we are expected to run it to
earth among some of the mysterious P.U.O.'s which have recently been ticketed as " encephalitis lethar-