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LO06-01
6.2 Probabilities are computed by finding areas under the probability curve.
LO06-01
6.3 (1) f(x) 0 for all values x of the random variable; (2) the area under the curve equals 1.
LO06-01
6.4 The height of the probability curve is not a probability; it is the area under the probability curve
that is a probability. Since the area under a single point is always equal to zero, we only find
probabilities for intervals of x. The height of the probability curve at any given point represents the
relative likelihood that x will be near the given point.
LO06-01
6.5 The use of the uniform distribution is appropriate when the distribution of the variable x over a
certain interval has a rectangular shape. That is, when the relative likelihood that x will be near a
given point is the same for all points over an interval on the real number line.
LO06-02
b. f(x)
1
/6
1 2 3 4 5 6 7 8 x
μ
c. P(3 x 5) = (5 – 3)(1/6) = 2/6 = 0.3333
(𝑑−𝑐)2 (8−2)2
σ2 = = =3
12 12
σ =√ 3 = 1.7321
6-1
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Education.
Chapter 06 - Continuous Random Variables
LO06-02
6.7 Because the area under the rectangle must equal 1, we set (175 – 50) h = 1 and solve for h.
Therefore, 125h = 1, and so h = 1/125
LO06-02
b. f(x)
1
/6
0 1 2 3 4 5 6 x minutes
LO06-02
𝑐+𝑑 0+6
6.9 a. μ= = =3
2 2
(6−0)2 (6)2
σ2 = = =3
12 12
σ =√ 3 = 1.732
LO06-02
The figure is a triangle. The formula for the area is ½bh. The base of the triangle is b = 5 – 0 = 5.
½(5)k = 1 so k = 2/5
LO06-01
6-2
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Education.
Chapter 06 - Continuous Random Variables
b. f(x)
1
/20
LO06-02
𝑐+𝑑 120+140 𝑑−𝑐 140−120
6.12 a. μ= = = 130 σ= = = 5.7735
2 2 √12 3.4641
LO06-02
3 4 5 6 x inches 3 4 5 6 x inches
LO06-02
𝑐+𝑑 3+6 𝑑−𝑐 6−3
6.15 μ = = = 4.5 inches σ= = = 0.8660 inches
2 2 √12 3.4641
LO06-02
6-3
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
Chapter 06 - Continuous Random Variables
§6.3 CONCEPTS
6.16 There is not just one normal distribution, but rather an entire family of normal distributions, one for
each possible value of μ and σ.
The mean μ tells us where a specific normal curve is centered on the real number line.
The mean μ also tells us where the highest point on the normal curve is, as well as the value of the
median and the mode.
The standard deviation σ measures the spread of the values described by the normal distribution.
Approximately 2/3 of the values are within one standard deviation of the mean; 95% within two
standard deviations; and 99%within three deviations.
LO06-03
6.17 To find the z value corresponding to x, we subtract the mean from x and divide the result by the
standard deviation. This tells us the number of standard deviations that x is above or below the
mean.
LO06-03
0.10 0.10
Density
Density
0.08 0.08
0.06 0.06
0.04 0.04
0.02 0.02
0.00 0.00
0 10 20 30 40 10 15 20 25 30 35 40
X X
c. Distribution Plot
Normal
Mean StDev
0.04
100 10
200 20
0.03
Density
0.02
0.01
0.00
50 100 150 200 250
X
L06-03
6-4
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Education.
Chapter 06 - Continuous Random Variables
𝑥−𝜇 25−30
6.19 a. z= = = -1 x is one standard deviation below the mean.
σ 5
𝑥−𝜇 15−30
b. z= = = -3 x is three standard deviations below the mean.
σ 5
𝑥−𝜇 30−30
c. z= = =0 x is equal to the mean.
σ 5
𝑥−𝜇 40−30
d. z= = =2 x is two standard deviations above the mean.
σ 5
𝑥−𝜇 50−30
e. z= = =4 x is four standard deviations above the mean.
σ 5
LO06-03
6-5
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
Chapter 06 - Continuous Random Variables
LO06-03
b. z.05 = 1.645
c. z.02 = 2.054
d. -z.01 = -2.33
e. -z.05 = -1.645
f. -z.10 = -1.28
LO06-03
𝑥−𝜇 𝑥−1000
6.22 Restate each probability in terms of the standard normal random variable z = =
σ 100
Then use the table to solve.
1000−1000 𝑥−𝜇 1200−1000
a. P(1000 x 1200) = P( ) = P(0 ≤ z ≤ 2) = .9772 – .5 = .4772
100 σ 100
LO06-04
6-6
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
Chapter 06 - Continuous Random Variables
6.23 First find the z-value from the table that makes the statement true.
Then calculate k using the formula: k = z + = z(100) + 500
a. P(x k) = 0.0250 Distribution Plot
Normal, Mean=500, StDev=100
Density
0.002
0.001
0.025
0.000
500 696.0
X
0.004
k = 1.645(100) + 500 = 664.5
P(x 664.5) = 0.0500 0.003
Density
0.002
0.001
0.05
0.000
500 664.5
X
Density 0.002
0.001
0.025
0.000
304.0 500
X
0.002
0.001
0.015
0.000
283.0 500
X
0.002
0.001
0.000
500 717.0
X
0.95
P(x > 335.5) = 0.9500 0.003
Density
0.002
0.001
0.000
335.5 500
X
6-7
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
Chapter 06 - Continuous Random Variables
0.975
Density
0.002
0.001
0.000
500 696.0
X
Density
0.002
0.001
0.0228
0.000
500 699.9
X
0.9772
Density
0.002
0.001
0.000
300.1 500
X
LO06-05
6.24 a.
𝑥−𝜇 𝑥−100
b. z= 𝜎
= 16
(3) P(72 < x < 128) = P(–1.75 < z < 1.75) = .9599 – .0401= .9198
LO06-03, LO06-04
6-8
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
Chapter 06 - Continuous Random Variables
𝑥−𝜇 959−800
6.25 a. (1) P(x 959) = P( ≤ ) = P(z 2.12) = .9830
σ 75
𝑥−𝜇 1004−800
(2) P(x > 1004) = P( > ) = P(z > 2.72) = 1 – .9967 = .0033
σ 75
(3) P(x < 650) + P(x > 950) = P(z < –2) + P(z > 2) = .0228 + (1 – .9772) = .0456
L06-04, LO06-05
6.26 Restate each probability in terms of z. Then use the table to solve.
7−8 𝑥−𝜇 9−8
a. P(7 x 9) = P( ≤ ≤ ) =P(-2.0 ≤ z ≤ 2.0) = .9772 – .0228 = .9544
0.5 σ 0.5
d. P(x 8) = P(z 0) = 1 – .5 = .5
LO06-04
𝑥−𝜇 27−30
6.27 a. P(x 27) = P( ≤ ) = P(z -3.00) = 0.00135
σ 1
b. Claim is probably not true, because the probability is very low of randomly purchasing a car
getting no more than 27 mpg if the mean is actually 30 mpg.
LO06-04
6-9
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
Chapter 06 - Continuous Random Variables
𝑦−𝜇 0−5.2
b. P(y > 0) = P( > ) = P(z > -0.60) = 1 – 0.2743 = 0.7257
σ 8.6
𝑥−𝜇 10−12.4
c. P(x > 10) = P( > ) = P(z > -0.12) = 1 – 0.4522 = 0.5478
σ 20.6
𝑦−𝜇 10−5.2
d. P(y > 10) = P( > ) = P(z > 0.56) = 1 – 0.7123 = 0.2877
σ 8.6
𝑥−𝜇 −10−12.4
e. P(x -10) = P( ≤ ) = P(z -1.09) = 0.1379
σ 20.6
𝑦−𝜇 −10−5.2
f. P(y -10) = P( ≤ ) = P(z -1.77) = 0.0384
σ 8.6
LO06-04
15.95−16.0024 𝑥−𝜇 16.05−16.0024
6.29 P(in specification) = P(15.95 ≤ x 16.05) = P( ≤ ≤ )=
0.02454 σ 0.02454
LO06-04
6.30 Find the mileage k so that only 2% of tires have mileage less than k: P(x < k) = 0.02
LO06-05
6-10
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
Chapter 06 - Continuous Random Variables
6.31 a. By definition, the bottom 10% of the yearly returns are less than the tenth percentile and the
bottom 90% of the yearly returns are less than the ninetieth percentile.
Find the yearly return on common stocks such that the bottom 10% of the yearly returns are
below this number:
P(x < k) = 0.10
P(z < -1.28) = 0.10
𝑥−𝜇 𝑘−12.4
z= = = -1.28
σ 20.6
k = -13.968
b. Find Q1 the yearly return on common stocks such that the bottom 25% of the yearly returns are
below this number:
P(x < k) = 0.25
P(z < -0.67) = 0.25
𝑥−𝜇 𝑘−12.4
z= = = -0.67
σ 20.6
k = -1.402
Find Q3 the yearly return on common stocks such that the bottom 75% of the yearly returns are
below this number:
P(x < k) = 0.75
P(z < 0.67) = 0.75
𝑥−𝜇 𝑘−12.4
z= = = 0.67
σ 20.6
k = 26.202
LO06-05
𝑥−𝜇 63−μ
6.32 Student-1’s test score x1 = 63 and z score: z1 = -1 so z1 = = = -1.00
σ σ
𝑥−𝜇 93−μ
Student-2’s test score x2 = 93 and z score: z2 = 1.5 so z2 = = = 1.50
σ σ
μ = 1.00σ + 63 = 12 + 63 = 75
The test average is 75 with standard deviation 12.
LO06-03
6-11
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
Chapter 06 - Continuous Random Variables
𝑥−𝜇 2500−0
P(xB > 2,500) = P( > ) = P(zB > 0.25) = 1 – 0.5987 = 0.4013
σ 10000
d. Find k so that P(xB > k) = .3085 when process B is in control so use μB = $0 and σB = $10,000.
𝑥−𝜇 𝑘−0
P(z > 0.50) = .3085 implies that z = = = 0.50 Thus k = 5000, and we will
σ 10000
investigate Process B if the cost variance exceeds $5000.
If Process B is out of control we use μB = $7,500 and σB = $10,000. Thus the probability of
investigating an out of control Process B is:
𝑥−𝜇 5000−7500
P(xB > 5,000) = P( > ) = P(zB > -0.25) = 1 – 0.4013 = 0.5987
σ 10000
LO06-04, LO06-05
k = $2780
LO06-05
6-12
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
Chapter 06 - Continuous Random Variables
LO06-05
§6.4 CONCEPTS
6.36 Binomial tables are often unavailable for large values of n, and it can be very time consuming to
compute exact binomial probabilities when n is large.
LO06-06
6.37 We may use the normal distribution to approximate the binomial distribution when both np and
n(1 – p) are at least 5. That is, np ≥ 5 and n(1 – p) ≥ 5.
LO06-06
6.38 If we attempt to find P(x = i) for some integer i under any continuous probability distribution, the
answer will always be zero. We estimate P(x = i) by finding area under the continuous curve for
the interval i – 0.5 and i + 0.5.
When estimating probabilities for more general binomial events such as P(a ≤ z b), we subtract
0.5 from the smallest integer and add 0.5 to the largest integer and then find the area under the
normal curve of the new interval.
The correction is necessary because the binomial distribution, which is discrete, is being
approximated by a normal distribution, which is continuous.
LO06-06
6-13
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
Chapter 06 - Continuous Random Variables
6.39 a. np = (200)(.4) = 80 and n(1 – p) = (200)(.6) = 120 so both np and n(1 – p) are 5
(5) P(x > 100) = P(x 100.5) = P(z 2.96) = 1 – 0.9985 = 0.0015
LO06-06
6.40 a. np = (200)(.5) = 100 and n(1 – p) = (200)(.5) = 100 so both np and n(1 – p) are 5
LO06-06
6.41 a. (1) np = (1000)(.2) = 200 and n(1 – p) = (1000)(.8) = 800 so both np and n(1 – p) are 5
b. No. If the claim were true, the probability of observing this survey result is only 0.00005.
LO06-06
6-14
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
Chapter 06 - Continuous Random Variables
b. No. If the claim were true, the probability of observing this result is very small.
LO06-06
b. No
LO06-06
stk = 2.33(17.8885) + 400 = 441.7 Stock 442 items to be 99% sure of not running out.
LO06-06
§6.5 CONCEPTS
6.45 Explanations will vary.
LO06-07
LO06-07
6.47 If the number of events occurring per unit of time or space has a Poisson distribution with mean λ,
then the number of units of time or space between successive events has an exponential distribution
with mean 1/λ.
LO06-07
6-15
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
Chapter 06 - Continuous Random Variables
f. μ = 1/λ = ½ = 0.5
σ = 1/λ = ½ = 0.5
LO06-07
c. P(x 1) = .9502
d. P(.25 x 1) = .4226
e. P(x 2) = .0025
f. μ = 1/λ = 1/3
σ = 1/λ = 1/3
LO06-07
6-16
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
Chapter 06 - Continuous Random Variables
LO06-07
LO06-07
6-17
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
Chapter 06 - Continuous Random Variables
f. Probably not; the probability of this result is quite small (.0198) if the claim is true.
LO06-07
b. Probably not; the probability of this happening is .2212 (which is not terribly small).
LO06-07
§6.6 CONCEPTS
6.54 (1) Arrange the data in order from smallest to largest
(2) For each observation number i, compute the quantity i/(n+1)
(3) For each observation number i, compute the Standardized Normal Quantile Value
(4) Plot the data on the y-axis vs the Standardized Normal Quantile Value on the x-axis
LO06-08
LO06-08
6-18
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
Chapter 06 - Continuous Random Variables
c. Data are skewed because the normal probability plot is not approximately linear.
Normal Prob. Plot
200.000
150.000
Income
100.000
50.000
0.000
.43
.02
.74
.50
.29
.10
3
0.1
0.2
0.5
0.7
1.0
1.4
-1
-1
-0
-0
-0
-0
z-score
LO06-08
6.57 Since the normal curve plot below is not approximately linear, the data do not follow a normal
distribution.
12
10
8
Ratings
0
-3.0 -2.0 -1.0 0.0 1.0 2.0 3.0
Normal Score
LO06-08
6-19
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
Chapter 06 - Continuous Random Variables
6.58 Data are approximately normal because the normal curve plot below is close to a straight line.
33.5
33.0
32.5
32.0
MPG
31.5
31.0
30.5
30.0
29.5
-3.0 -2.0 -1.0 0.0 1.0 2.0 3.0
Normal Score
LO06-08
SUPPLEMENTARY EXERCISES
6.59 x = bottle fill in ounces
x is normally distributed with = 16 oz. and = 0.02 oz.
𝑥−𝜇 15.95−16
P(x < 15.95) = P( < ) = P(z < 2.5) = 0.0062 or 0.62%
σ 0.02
LO06-04
LO06-04
6-20
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
Chapter 06 - Continuous Random Variables
6.61 x = IQ
x is normally distributed with = 100 and = 16.
The minimum IQ required to attend public school would be 73.68 or 73 since IQs are integers.
LO06-04, LO06-05
b. f(x)
1.0
-0.5 -0.4 -0.3 -0.2 -0.1 0.0 0.1 0.2 0.3 0.4 0.5 x cents
(𝑑−𝑐)2 (𝑑−𝑐)2
σ2 = = =
12 12
.5−(−.5) 1
σ= = 3.4641 = 0.2887
√12
LO06-02
6-21
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
Chapter 06 - Continuous Random Variables
LO06-04
a. By definition, 10% of the individual forecasts fall below the 10th percentile, x10th, of the
distribution of forecasts. This means that 90% of the individual forecasts fall at or above the
10th percentile.
If the top 10% of the z-scores are above z.10 = 1.282, then, by symmetry, the bottom 10% of
the z-scores will be below -z.10 = -1.282.
𝑥−𝜇 𝑥10th −5
P(x x10th) = P( ) = P(z -1.282) = 0.10
σ 1.2
𝑥10th −5
= -1.282
1.2
𝑥−𝜇 𝑄3 −5
Since Q3 is the 75th percentile, P (x Q3) = P( ) = P(z ≤ 0.67) = 0.75
σ 1.2
𝑄3 −5
= 0.67 Q3 = 5 + (0.67)(1.2) = 5.804 percent
1.2
LO06-05
Find the test score k so that only 2.5% of test takers pass: P(x ≥ k) = 0.025
𝑥−𝜇 𝑘−200
P(z > 1.96) = 0.025 z.025 = = = 1.96
σ 50
k = 200 + 1.96(50) = 298 Set the lowest passing score to 298 points
LO06-05
6-22
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
Chapter 06 - Continuous Random Variables
6.66 x = lengths
x is normally distributed with = μ and = 0.02”
Find the mean μ so that only 0.4% of the parts will be shorter than 15”
P(x < 15) = P(z < -z.004) = P(z < -2.65) = 0.004
𝑥−𝜇 15−𝜇
-z.004 = = = -2.65
σ 0.02
LO06-04
LO06-06
6.68 y = # errors
y is Poisson with 4 errors per 1000 lines of code: μy = 4/1000 = 1/250
LO06-07
6-23
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
Chapter 06 - Continuous Random Variables
LO06-04
LO06-02
6-24
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
Chapter 06 - Continuous Random Variables
6.72 This problem can be solved by defining the random variable, its parameters and the probability to
be computed in time units of either minutes or hours.
x = waiting time in seconds
x is exponentially distributed with μ = 60 seconds and λ = 1/μ = 1/60 seconds
a. P(x ≥ 90) = e-λa = e-(1/60)(90) = 0.2231
LO06-07
𝑥−𝜇 4.40−4.15
b. P(x < 4.40) = P( < ) = P(z < 0.50) = 0.6915
σ 0.5
P(x > k) = 0.95 which is the same as P(x < k) = 0.05 P(z < -1.645) = 0.05
𝑥−𝜇 𝑘−4.15
z= = = -1.645
σ 0.5
LO06-04, LO06-05
LO06-06
6-25
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Education.
Chapter 06 - Continuous Random Variables
6-26
Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill
Education.
Another random document with
no related content on Scribd:
“Still, we must remember how singularly, of late years, the knowledge of the
introduction of cholera by persons coming from infected districts has increased, and
how very striking are the instances of this kind already recorded in several works on
influenza.
“In some cases, again, isolation or seclusion of a community, as in prisons, has given
immunity; or at least that community has not been attacked.”
The great rapidity of spread has caused even in 1918 some temporary doubt as to the
contagiousness of the disease. Thus, Zinsser wrote:
“The opinion of direct and indirect transmission from man to man is also well
supported by a detailed study of the epidemiology of individual outbreaks. In our own
experience with epidemics such as those at Chaumont, Baccarat and other places, the
suddenness with which the malady attacked large numbers of people at almost one and
the same time, caused me at first to be exceedingly skeptical of accepting transmission
by contact as the only means of conveyance. We considered food and insect transmission
as possibilities, and tried our best to find grounds for involving such agencies. But in
every case we were forced to return to the conclusion that direct and indirect contact
between men came nearest to doing justice to all observed facts.”
There have been many examples reported from personal experience to show that
influenza is transmitted from man to man. Two objections, however, have had to be met,
before this view was generally accepted. First, it has been claimed by some that the
disease spread more rapidly from an assumed focus than individuals could travel, and
second, that instances were on record of cases occurring spontaneously in isolated
communities. Yet a third argument formerly raised against the contagious character of
the disease was the claim that it broke out in mass attacks, that large numbers became ill
on the same day without the occurrence of isolated antecedent cases. The splendid work
of epidemiologists following the 1889 epidemic appears to have answered all of these
objections. Many, such as Leichtenstern, have gone into great detail on this subject. In
fact, at that time this was the question of greatest importance. Today we assume the
correctness of the hypothesis, and pass on to consideration of other subjects of more
recent development. We will, therefore, review very hurriedly some of the evidence
quoted to prove that influenza is transmitted only from man to man and only by human
intercourse.
Isolated places.—Has it ever been shown that individuals completely isolated from
communication with communities where influenza is present have, during an epidemic,
developed the disease? Leichtenstern, after a comprehensive review, concludes as
follows: “We have not a single example on record where influenza has attacked
individuals in completely isolated localities, as on mountain tops and mountain passes.
Study of this has been undertaken in Switzerland by F. Schmid. The same has been true
of ships at sea, as has been shown chiefly from the English Marine Reports. There have
been reports of influenza occurring in mid-ocean and particularly in the earlier
epidemics, but the information has been insufficient.”
Parkes at even an earlier period observed: “I cannot but consider that we require
better evidence of ships being attacked in mid-ocean. In some of the quoted instances
the ships had been at a port either known to be infected or in which influenza was really
present, although it had not become epidemic. As we are ignorant of the exact period of
incubation some men may have been infected before sailing.”
Critical investigation into stories of spontaneous infection in isolated localities such as
ships at sea and island lighthouses will quite invariably demonstrate that these popular
reports have been distortions of the actual facts. One or two examples will suffice.
Abbott records an example: “An impression having gained some credence that influenza
had appeared on board the squadron of naval vessels which sailed from Boston in
December, 1889, while on their course across the Atlantic and before their arrival in
Europe, a letter was addressed by the writer to the Bureau of Medicine and Surgery of
the United States Navy for information upon this point, to which a reply was received, as
follows:
“The ‘Chicago,’ ‘Boston,’ ‘Atlanta’ and ‘Yorktown’ left Boston December 7, 1889, for
Lisbon, Portugal. The first three arrived at Lisbon on December 21st without having
touched at any port en route. The ‘Yorktown’ arrived at that port December 23d, having,
stopped about twenty-four hours at Fayal, Azores.... Influenza first appeared on the
‘Chicago’ December 23d, on the ‘Boston’ December 28th, on the ‘Atlanta’ December
30th and on the ‘Yorktown’ December 28th.
“Influenza was prevailing in Lisbon at the date of arrival of the squadron.”
In March, 1920, the author was notified of a somewhat similar story which he
undertook to trace. The results show well the inaccuracy of verbal transmission through
several individuals. A letter was first sent to the Quarantine Officer at Portland, Maine:
“It has been reported to us that in a lighthouse just outside of Portland, Maine, there has
been a rather interesting prank played by influenza. We are told that three men and one
woman live in the lighthouse; that during the 1918 influenza epidemic the woman
contracted the disease while none of the men became sick, and that in the present
epidemic all three of the men became sick with the disease and the woman remained
well. It was claimed that they had had no communication with the mainland for some
time before the men became ill,” etc.
The reply was as follows: “I have inquired of the Light House Inspector’s office in
Portland and they know of no stations to which the terms of your inquiry would apply.
“At the Boon Island station, there are three keepers with families. At the Half Way
Rock station, there are three keepers but no woman. The Inspector does not seem to
know of any station where there are three men and one woman.”
A second letter, sent to the Inspector of Lighthouses at Portland brought corroborative
information:
“The Boon Island Light Station was stricken by this epidemic in the following manner:
The keeper, his wife and five children were all stricken, the keeper himself having had
the hardest battle, having apparently been subject to same while ashore in Portsmouth,
N. H. after provisions, supplies, etc. The 2d assistant’s wife and two children were also
stricken, but the 2d assistant, himself, and the 1st assistant keeper did not contract the
malady in spite of the fact that they were all confined on a small island working together
at the station.
“During the year 1920 none of the keepers or their families, consisting of thirteen in
number, were affected. The Halfway Rock Light Station where three keepers are
employed did not contract this malady either in the years 1918 or 1920.
“For your information I might add that during the inspection trip in the months of
January, February and March, 1920, all of the light stations in this district were visited,
and it was found that they were all enjoying good health and had not been visited by the
epidemic, with the possible exception of three stations which are located either on the
mainland or close to where the keeper or his family were able to visit the nearby cities or
towns.”
Although it has not been shown that completely isolated places have been visited by
the disease, there is abundant evidence that such places have remained influenza free as
long as the isolation has remained complete. Islands and lighthouses, which have not
been in communication with the mainland, individuals living isolated on mountain tops,
and ships at sea remained free from influenza even in the presence of a pandemic, as
long as they did not come into communication with individuals sick with the disease.
The following places remained free from influenza throughout the 1889 epidemic: the
Isle of Man, several of the islands of the West Indies, particularly the Bahamas, Granada
and St. Lucia, also the British Honduras, British Guiana, and the Seychelle Islands.
Even in 1918, when the paths of commerce reached nearly every portion of the world,
we have examples of relative immunity of isolated places. Thus we know that the
Esquimaux were attacked late in the course of the pandemic, and we have the statement
of Barthélemy who traveled in 1919 to some of the oasis towns of the Sahara Desert, and
there discovered that there had not only been no influenza up to that time, but also that
they had not even heard of the pandemic.
Another type of isolated place is the closed institution. As early as 1709, Lancisi
remarked that the prisons of the Inquisition in Rome remained free from influenza.
Twenty-one prisons in Germany in 1889–90 remained entirely free from the disease.
This was true of 39 prisons in England, some of which were in cities where the epidemic
was most extensive. Linroth, who observed this same phenomenon in Sweden, makes
the wise remark that, “the influenza conquers more easily the space of 500 to 1,000
kilometers than it does the small barrier made by a prison wall.” A convent in
Charlottenburg housing one hundred women remained entirely free during the 1889–90
epidemic.
As a rule institutions of this sort have been unable to maintain a complete quarantine
throughout the period of an epidemic, and the relative immunity has been demonstrated
more in late invasions, at a time when the restrictions have become somewhat lax. Thus,
in 1918, Winslow and Rogers, report that in an orphan asylum in New Haven,
Connecticut, which had completely escaped during the month of October when the
epidemic was at its height, one of the Sisters and the priest in charge came down with
influenza about December 15th. By the 27th of December 127 cases had occurred in the
institution within twenty-four hours, and by January 7th there had been 424 cases, with
seven deaths out of a total population of 464. The probable source of the sudden
outbreak of December 27th seems to have been the Sister first affected who, when
convalescent, resumed her duties in the kitchen, which included the inspection and
handling of the milk given out to the children.
Crowd gatherings.—Yet another phenomenon which would lead us to conclude that
human intercourse is the most potent factor in the transmission of influenza is the fact
that there is frequently a high increase in the influenza rate following crowd gatherings.
Parkes observed long ago that persons in overcrowded habitations, particularly in some
epidemics, suffered especially, and several instances are on record of a large school or a
barracks being first attacked and the disease prevailing there for some days, before it
became prevalent in the towns around.
In England, the weekly market played an important role in the spread of the disease in
1889. One frequently saw such reports as that: “The first case of influenza was a man
who went to London daily.” Or, “All the earliest cases were men going to London daily,
while their wives and families were later affected.”
In the epidemics at San Quentin Prison, it was noted that apices of incidence usually
occurred on Tuesday and Wednesday. During the first epidemic it was these days of the
second and third weeks. Stanley sees a direct connection between this fact and the fact
that every Sunday morning large groups of the men were crowded together in a
comparatively small auditorium where they saw moving pictures. On Sunday, October
20th, they sought to eliminate this source of spread by having a band concert in the open
air, but the prisoners crowded around the band and were loud in their cheers, and on the
following day there was a large increase in hospital admissions.
On November 24th after the second epidemic had apparently ceased the picture
shows were again started after having been closed for over six weeks. The following
Tuesday and Wednesday twenty-four well defined new cases were admitted to the
hospital. On Thanksgiving Day there was a field meet between the various departments
of the prison. About 200 prisoners took active part, while 1,600 prisoners were
spectators. The meet was held in the open air, but the prisoners were closely packed and
they cheered and yelled. For the three days following this celebration there were 9, 5 and
8 patients admitted respectively.
In discussing the recrudescence of influenza in Boston in November and December,
Woodward remarks as follows:
“Whether or not it may be more than a succession of coincidences it is certainly of
interest to note that the November outbreak of influenza showed itself three days after
the Peace Day celebration on November 12th, when the streets, eating places and public
conveyances were jammed with crowds; that the December epidemic began to manifest
itself after the Thanksgiving holiday, with its family re-unions and visiting; and that
reported cases mounted rapidly during the period of Christmas shopping, reaching a
maximum a week after the holiday.” That this may have been a coincidence is indicated
by the fact that, according to reports by Pearl and others this was not consistently true in
other large cities.
Dr. Meredith Davies records the case of a hostel in Wales accommodating 200
students. Infection was introduced on October 19th on the occasion of a dance attended
by some students from an infected institution in the neighborhood. Four cases occurred
on the 20th and within the short space of five days seventy-nine students out of the 200
were attacked.
Parsons found numerous similar examples in the epidemic of 1889. In 1918 it was
frequently observed that among American Soldiers in France, those troops quartered in
barracks suffered a much more rapid spread of the disease than those billetted out
among the houses of the towns.
Mass attack.—Another argument formerly raised against the contagious character
was the claim that it broke out in mass attack, and large numbers became ill on the same
day without the occurrence of isolated antecedent cases. The first cases of such epidemic
diseases as the plague and small pox became a matter of record because of the
accompanying high mortality, while in influenza, with its relatively low death rate the
record usually begins only after a comparatively large mass of individuals have been
attacked.
Watson in 1847 observed as follows: “Although the general descent of the malady is,
as I have said, very sudden and diffused, scattered cases of it, like the first droppings of a
thunder shower, have usually been remembered as having preceded it. The disorder is
most violent at the commencement of the visitation; then its severity abates; and the
epidemic is mostly over in about six weeks. Yet the morbific influence would seem to
have a longer duration. In a given place nearly all the inhabitants who are susceptible of
the distemper suffer it within that period, or become proof against its power. But
strangers, who, after that period, arrive from uninfected places have not, apparently, the
same immunity.”
Parkes in 1876 observed that, “When the disease enters a town it has occasionally
attacked numbers of the inhabitants almost simultaneously. But more frequently its
course is somewhat slower; it attacks a few families first and then in a few days rapidly
spreads; the accounts of thousands of persons being at once attacked at the onset of the
disease are chiefly taken from the older records, in which the suddenness of the
outbreak is exaggerated. Frequently, perhaps always, in a great city the outbreak is made
up by a number of localized attacks, certain streets or districts being more affected than
others, or being for a time solely affected, and in this way it successively passes to
different parts of the city. It has generally occurred in a great city before appearing in the
smaller towns and villages round it and sometimes these towns, though in the
neighborhood, have not been invaded for some weeks.
“In some cases and perhaps a large number, it breaks out after persons ill with
influenza have arrived from infected places.
“The decline in any great town is less rapid than its rise, and usually occupies from
four to six weeks, or sometimes longer.”
Detailed studies of the Munich epidemic of 1889 and numerous similar studies of the
recent epidemic, which will be referred to later, have shown a period of two or three
weeks of steadily increasing numbers of cases before the height of the epidemic was
reached.
Droplet infection and spread through inanimate objects.—The actual mode of spread
of the virus of influenza from one individual to another is unknown. The more generally
accepted explanation is that the infecting agent leaves the body through the respiratory
tract, usually in the spray of coughing or talking; contagion is by droplet infection, as is
sometimes the case in other respiratory infections. Thorne and others have called
attention to the capillary congestion of the conjunctivae very early in the disease. They
suggest that possibly the mucous membrane of the eye is the site of infection.
There has recently been considerable discussion concerning the spread of influenza
through inanimate objects.
Leichtenstern reviews the reports of 1889–93 in which influenza was supposed to
have been transmitted through wares, merchandise and other inanimate objects. He
concluded that the evidence in all of the cases cited was insufficient for conclusive proof.
Such an example was the supposed importation of the disease in goods sent from Russia
to the Grands Magazins du Louvre at Paris. In one day 100 people became ill and in a
few more 500 were sick with influenza. The explanation was that the germs had been
imported in goods sent from Russia to the store. Detailed investigation showed that this
could not have been the case because no goods had been received from Russia for a
period of three years. Another example is that of one of the two winter caretakers at the
St. Gothard Hospice. One of the two men went down into the valley where he purchased
supplies. Ten days after his return the man who had remained in the Hospice fell ill with
influenza while his comrade remained well. It was stated that influenza was introduced
into Basel by goods shipped to that place from the Magazins du Louvre in Paris. The first
case occurred in a man who had been working at unpacking these goods.
Lynch and Cumming believe that droplet infection plays but a minor role in the
spread of sputum-borne diseases, but that insanitary methods of washing dishes and
eating utensils was the chief cause for the high rates of “sputum-borne” infections both
in army and civilian life in 1918. They found that among 31,000 troops eating from
tableware which was cleaned by kitchen police, the influenza rate was 51 per 1,000,
while among 35,000 eating from mess kits which each individual washed himself the
rate was 252 per 1,000. “Eighty-four per cent. of the cases occurred among those whose
hands were contaminated by washing their own eating utensils.”
Among 17,236 employees of hotels, restaurants and department stores, who ate from
machine washed dishes, there occurred 349 cases of influenza, while among 4,175 who
ate from hand washed dishes there were 429 cases. The rate was but 20 per 1,000 in the
former, while in the latter group it reached 103 per 1,000. Here again the chances of
infection between the two groups were as one is to five.
These authors have records covering 252,186 individuals in scattered institutions in
the United States. Among those eating from machine washed dishes the rate was 108 per
1,000 while those eating from hand washed dishes suffered at the rate of 324 per 1,000.
The ratio was 1 to 3 between the two groups. Seventy-five per cent. of the cases occurred
in that group which ate from dishes not disinfected with boiling water. They do not state
the number of individuals in each of the two groups.
Lynch and Cumming claim that in the act of coughing only a few organisms are
expelled from the mouth, rarely over 1,500, and conclude that transmission by direct
contact through the air route but rarely, if ever, takes place. While about 1,500
organisms are expelled onto the floor by an act of coughing, a sterile glove wiped across
the lips may pick up nearly 2,000,000 organisms. Such organisms may be readily
transferred to inanimate objects which are handled by many people.
Hemolytic streptococci and pneumococci may be isolated with great regularity from
the hands of carriers or patients, from table ware, inanimate objects touched by these
patients, and from floor dust. Diphtheria and tubercle bacilli have been isolated from the
hands and eating utensils of patients. The average count of a large number of restaurant
dishwater specimens was 4,000,000 bacteria per c.c. The temperature of this water
averaged 43° C. and the dishes were practically never scalded. The water was often so
highly polluted, “that the dishes are more highly contaminated after they are washed
than before washing begins. The spoon or fork is often freer from organisms just after
being used by the restaurant patron than when taken from the restaurant’s polluted dish
water.”
Major John S. Billings, epidemiologist at Camp Custer, reported that one of the larger
organizations did not properly observe the regulation requiring that all mess kits and
table equipment be properly sterilized. The disease appeared early and spread unusually
rapidly in this particular organization.
In summarizing the subject of transmission through utensils, we may say that the
evidence is suggestive but inconclusive. It is possible, even probable, that this is one
mode of transmission. That it is the most important has not been proved. Lynch and
Cumming do not take into consideration that the regiments with more sanitary methods
of cleansing the dishes are apt to be those regiments with more sanitary habits
throughout their daily routine. Those restaurants using mechanical dish washers are
usually the cleaner restaurants.
Pontano in Italy is quoted by the Office International d’Hygiène Publique as having
observed in his epidemiological study that there was a constant connection between the
living conditions and the severity of the complications. Notable differences were
observed in neighboring houses according to the hygienic conditions of the various
households.
Healthy carriers and convalescents.—Leichtenstern, who apparently accepted the
Pfeiffer bacillus as the cause of influenza, did not believe that the disease could be
transmitted by healthy carriers. He based this assumption on the statement, made by
Pfeiffer, that the influenza bacillus was only found in acute influenza cases. In the past
few years it has been abundantly shown, however, that the influenza bacillus can and
does exist on the mucous membranes of healthy individuals.
The outbreak in an orphan asylum in New Haven has been previously described.
There the probable source of the sharp outbreak of December 27th seemed to be the
sister who, on convalescence, resumed her duties in the kitchen. There she inspected
and handled the milk served to the children. This suggests the possibility of infection
being propagated by convalescents and by food.
At present we do not know whether or not a patient remains infectious after the acute
symptoms have subsided; we are ignorant as to whether a convalescent patient can
transmit the disease; and we are not certain whether the organism found in healthy
carriers is virulent or not. The information at hand strongly indicates that apparently
healthy individuals may transmit the infection, but the wide distribution of the disease,
with multiple possible sources of infection for each individual, and the relative
insusceptibility of experimentally exposed individuals has made it impossible so far to
answer these questions satisfactorily.
General Manner of Spread in Individual Localities.
Having discussed the mode of propagation of influenza among individuals we will
follow the disease as it attacks one person after another in a community and study the
epidemiologic picture, drawn no longer with the individual as a unit, but with the
community as the unit.
We must here distinguish between a primary epidemic, the first wave of a progressing
pandemic, and the secondary type in which may be grouped those large or small
recurrences which light up for a period of one to three or more years after the primary
wave.
Primary type of epidemic.—One of the first important statistical studies on this
subject was that of P. Friedrich who charted the influenza morbidity in Munich between
the months of December, 1889, and February, 1890. Similar observations have been
made by Parsons, Raats, Linroth, and H. Schmid, following the 1889 epidemic.
Between the occurrence of the first known case of influenza and the time of the first
very definite increase in influenza incidence in a community, which interval may be
termed the invasion period, there is as a rule two weeks. During this period, of course,
more and more cases are occurring, but remain usually sufficiently isolated to attract no
public notice. From this point the epidemic develops very rapidly and reaches its peak,
usually within two or at most three weeks. In another two or three weeks the incidence
has fallen away nearly to normal. The epidemic period comprises from four to six weeks,
or, including the invasion period, an entire duration of six to eight weeks. This is the
picture produced in a community by a primary uncomplicated epidemic of influenza.
Greenwood well describes the salient features of a primary epidemic as “first a rapid and
quasi-symmetrical evolution, and second, a frequency closely concentrated around the
maximum.” In other words the duration is short, the rise to a peak rapid, and the
subsequent fall equally rapid. He showed that in the July and August, 1918 epidemic in
Great Britain nearly 80 per cent. of the total incidence in the localities studied was
grouped within three weeks time. His curve corresponds so well with that of the Munich
epidemic that he is able to superimpose them (Chart I). The rapid rise to a peak, almost
explosive in character, more characteristic of this disease than of any other, is to be
explained by the high degree of invasiveness of the organism, by the short period of
incubation, by the fact that many of the sick continue at their work, thus spreading the
disease, and by the non-immunity of large masses of people, together with the fact that
the transmission of a respiratory infection is accomplished much more easily than is any
other type of infection.
The author holds that the infrequency of immunity is a most important factor in the
production of this type of outbreak. The mode of transmission of influenza is the same
as that of other respiratory diseases. The infectivity is probably no greater than that of
measles, although that indeed is relatively great. The means of transmission are
presumably the same in each. Were we able to develop an immunity for influenza of as
high degree and permanence as we possess against measles, pandemics of influenza
would disappear. We wish to emphasize that the primary type of curve is a phenomenon
not peculiar to influenza, but that under certain circumstances it may be found in other
infectious diseases, and that it would be found more frequently in the other diseases if
the immunity developed against them was of as short duration as it appears to be
against influenza. If, for example, measles were to break out in a large group of
individuals, none of whom had had the disease, the type of curve would be the same. We
will produce evidence supporting our theory under another subject. Of course, other
factors such as short incubation period and unusual opportunities for spread through
mildly ill individuals play a not unimportant role.
CHART I.