February 1, 1919: Article in Municipal Journal. Declares Influenza Cause Is Unknown. "Albany, N. Y.-According to a statement by Dr. Hermann M. Biggs, state commissioner of health, in this state in the month of October alone approximately 32,000 lives were lost, while in the country as a whole 400,000 people are believed to have died of so-called influenza during the months of September, October and November. "It is questionable," says the statement, "if any recorded epidemic has produced in a similar space of time such disastrous results, yet, despite the efforts of an army of research workers both here and abroad, the definite causative agent of the disease remains today unknown. Until proof to the contrary is forthcoming it must be assumed that the epidemic represented a very virulent form of the same disease which has spread throughout the world from time to time for many centuries, and numerous excellent records of which are available for study in medical literature. At the present time there is no exact diagnostic procedure which may be relied upon positively to differentiate epidemic influenza from severe 'colds' accompanied by fever, cough and prostration, and frequently followed by pneumonia, such colds being due to a variety of well-known organisms. Nevertheless there are certain fairly characteristic symptoms in typical cases of epidemic influenza which at present justify a clinical diagnosis of that disease."

Commentary: While influenza is not transmitted by water, the occurrence of articles like this in the engineering literature of the times shows how devastating the disease was in the U.S.