Armstrong – Table of Contents

keep track of the influenza outbreak of 1918 and 1919. In his oral autobiographical
interview (8), he stated that a major statistical observation that the PHS tried to
accumulate was the incidence of influenza among older patients and its relationship to
excess mortality in the community. This statistic is a currently accurate method used by
health authorities to chart outbreaks of influenza and to assess the outbreak’s severity.
Armstrong was of the opinion that the reporting of cases in 1918-1919 by the local and
regional health officers was insufficiently refined and accurate for reporting reliably the
occurrence and severity of outbreaks. Armstrong observed that local newspapers first
reported information about outbreaks quickly and accurately suggesting that early
reporting by the official health organizations required improvement. Epidemic
information and reporting has improved and become highly refined over the years; this is
exemplified by the current activities of the Public Health Service Centers for Disease
Control and Prevention (CDC) and its publications, especially the Morbidity and
Mortality Weekly Reports (MMWR).
After the completion of his leave in June 1919, Surgeon General Rupert Blue sent
orders to Armstrong on July 1, 1919 (5) directing him to report to the Bureau in
Washington, D.C. for a temporary period of about 10 days or 2 weeks for special duty
preparatory to being detailed to Columbus, Ohio as Epidemiological Aide to assist the
Health Officer of that State. At this particular time, the PHS was interested in improving
the collection and reporting of statistics for communicable diseases, and it detailed young
Commissioned Corps officers as epidemiological aides to many state health officers.
During this period at the bureau, the preparation undoubtedly included intensive
instruction supervised by Dr. W.H. Frost in the practices of epidemiology and the