Carnwath gives the following comparison of the number of deaths in London and in certain American cities from influenza and all forms of pneumonia during the eight weeks of the 1918–19 epidemic. _Deaths in London and in American cities._ Number of deaths. Rate eight weeks per 100,000 of population. London 13,744 341 New York 20,681 360 Chicago 8,785 343 Philadelphia 12,806 749 Boston 4,211 548 The cause of death in the vast majority of cases is some form of pneumonia. In fact it has been questioned whether influenza uncomplicated can cause a fatal issue. Postinfluenzal meningitis has been the cause of death in an appreciable number of cases. More remotely the disease has caused many deaths by hastening the fatal outcome of what were otherwise subacute or chronic conditions of the respiratory, cardiovascular, or renal systems. Vaughan and Palmer record that, “The pandemic of influenza in 1918 seems to have been more closely associated with the pneumonias than appears in any previous pandemic. From the reports as sent to the Surgeon General’s Office, it appears that uncomplicated influenza was not by any means a fatal disease and that the high death rate was due to the pneumonias which followed. Pneumonia is a serious disease at all times. Recent records for the United States Army show that the case mortality rate for this disease has been as follows during the different periods of the last two years: Per cent. The year 1917 11.2 6 winter months, 1917–18 23.1 5 summer months, 1918 18.8 4 autumn months, 1918 (Influenza period) 34.4 “It is not strange that once pneumonia has secured a foothold in patients already weakened by influenza their chances of recovery were lessened.” Woolley reports that for the troops stationed at Camp Devens, Mass. there were no fatalities from uncomplicated influenza. In every fatal case but two a diagnosis of pneumonia was made, and in these two cases pure cultures of pneumococcus were obtained from the blood after death, so it appears that they were cases of pneumococcus septicemia. Up to October 29, 1918, 19 per cent. of the total number of influenza cases reported developed pneumonia and of these there was a case mortality of 27.9 per cent. The mortality rate among the influenza cases was 5.4 per cent.