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JAMA. 1918;71(26):2128-2130. doi:10.1001/jama.1918.02600520014007.
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Late in September and in the early days of October, a respiratory affection corresponding somewhat closely to the descriptions given of "Spanish influenza" appeared in Omaha. October 3 and 4, a large number of people congregated in the theaters, stores and streets, incident to the civic parades and other functions of the Aksarben festival, which yearly brings huge crowds to Omaha. October 5 and 6, the disease attained the proportions of an epidemic. We also have information that a considerable number of cases appeared among the troops in Fort Omaha on the second day following the Aksarben. The morbidity curve showing the influence of "crowds" on the outbreak of the epidemic is significant (Chart 1).

THE NATURE OF THE EPIDEMIC  Clinically, the disease was characterized by a more or less sudden onset, usually without definite prodromes. Headache, generally severe, was almost constant and commonly associated with backache, bone-ache and general


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