John Oxford
British Journal of Hospital Medicine 68(2): 68
(Feb 2007)
The greatest outbreak of influenzas in history, the so-called Spanish pandemic of 1918, provides us with a number of lessons which could be learnt. Studies from pathologists working in the British army tell us that the influenza outbreak started in northern France a year earlier, in the vast sprawling British army camp at Etaples (Oxford et al, 2002). Suddenly a new disease emerged with a case fatality of 50%, attacking young soldiers but only in low numbers and inducing a unique clinical feature, heliotrope cyanosis. The reproductive number, being the number of contact infections from an index case (Ro), was low (probably <1) and the outbreaks appeared to be confined to Etaples and Aldershot barracks.
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