n, Kansas, U.S., in early March 1918. American troops that arrived in western Europe in April are thought to have brought the virus with them, and by July it had spread to Poland. The first wave of influenza was comparatively mild; however, during the summer a more lethal type of disease was recognized, and this form fully emerged in August 1918. Pneumonia often developed quickly, with death usually coming two days after the first indications of the flu. For example, at Camp Devens, Massachusetts, U.S., six days after the first case of influenza was reported, there were 6,674 cases. The third wave of the pandemic occurred in the following winter, and by the spring the virus had run its course. In the two later waves about half the deaths were among 20- to 40-year-olds, an unusual mortality age pattern for influenza.