EXPERT ADVICE
ON EPIDEMIC
OF INFLUENZA
Disagreement among physicians at
the recent Chicago meeting of the
Public Health Association regarding
many important points in the charac
ter and treatment of influenza, is re
ported in the daily press. Neverthe
less a substantial agreement on some
other points quite as vital appears
clearly from a reading of the medical
journals, and practical suggestions
lor the home-care of patients will be
found in a statement issued by the
itrltish Royal College of Physicians,
quoted at the end of this article. Ex
perts would seem to be at one in look
ing upon the present epidemic as sim
ply a variety of a well-known disease
prevalent, with occasional outbursts
of violence, for hundreds of years.
They agree that it is a germ disease
and that it is very contagious at close
range, although probably not com
municable through air, water, or ma
terial objects; that its danger con
sists largely in the likelihood that it
will be accompanied or followed by a
peculiarly virulent type of pneu
monia, whoso occurrence is favored
by neglect or wrong treatment, and
finally that not all persons are equally
susceptible, those in weakened physi
cal condition usualy succumbing lirst.
I'oints still open to discussion are the
reasons for epidemics in general and
lor this one in particular, the nature
of the precise germ or group of germs
responsible lor it, and the efficiency
ot various forms of preventive and
curative treatment, including quaran
tine, as generally practiced, inocula
tion with serum, the "influenza
mask,' and the use ot various drugs.
Regarding the outbreak itself, whose
world-wide churcler has earned it the
name ul "pandemic, ' the writer ot a
leading cuitnrial in Tito Lancet (Lon
don, November 2a, speaks as follows:
"It ihose who leel ill would stay at
home; it those who are well would
avoid traveling in railway-carriages
with tlie windows closed, or in uuven
tilated trams and busses; and, above
all, if tlie public would forego picture
palaces or other crowded places ot
amusement so long as the epidemic
continues, much would be done u
limit the spread in populous centers.’
The. laci that the array camps havt
been excellent places to study tin
disc,,uiial’iected by local condition!
muses a recent article by l)r. Ueorgt
A. Hopei, major U. S A., one of tin
most inter.ling reports on its prog
rt'ss Dr. Soper, writing from tin
army's division of inlet nous disease:
and laboratories in Washington u
Tile Join n il of the American Medina
Association I Chicago. December 7|
states his lieltet that "had it not heel
tor tin iiieumonia, the pundetnii
would no nave attracted much at
tention.' I lie disease has come n
"waves, onen with the violence o
aii txphisi, a. iie goes on:
"Win, about a week after th
outbroa the influenza, there oc
ini: , inntis prevalence of pneu
nionia T: imeumonia does not exis
as a separate epidemic, but is ulway
a follower of intluenza. How the twi
diseases arc related is not positivel;
known. It Is clear that the influenzt
paves the way for the pneumonia, i
il docs not actually produce it."
Steps taken by the military author
ties to combat the disease fall unde
three heads, and apparently any el
forts elsewhere must be similarly clat
silled. Major Soper gives them a
"isolation, sanitation and education.
These he briefly explains as follows
"1. By isolation is meant any an
all procedures by which infectei
could he separated from the susee|
tible persons Included in this Ms
were steps for the prevention a
crowding, quarantine, head-to-foc
sleeping, the separation of heads a
mess, and the use of cubicles an
masks.
”2. Under sanitation may be inclut
ed the cleaning and airing of barrack
and bedding, the oiling of floors t
keep down the dust, the boiling c
mess-kits, and many other procei
urea.
"3. Education, always a predomii
ant motive in the army, was applie
as never before to the prevention of
disease among troopH. The medical
officers were taught what to expect
In the way of symptoms and what
principles of prevention to put into
effect The men were taught some
thing of the principles of disease
transmission and how to carry out
their part of the work of preven
tion."
As a result of these methods the
disease "is already practlcaly gone in
most army camps." Much can be done
in military camps, of course, that can
not be done in civil communities, but
their example points the way. It must
tie said that some physicians have
doubted the permanent efficacy of
any kind of quarantine measures and
have pointed out that in New York,
where they have been few, the dis
ease, on the whole, has been less vio
lent than in Boston, where, after the
first outbreak, they were exception
ally strict Still, such measures have
been chiefly relied on, although in
different degree, by most American
cities, and their necessity has not been
widely questioned. With regard to
means of transmission, Dr. Soper is
very clear. He says:
"It is a fundamental assumption
that influenza is produced when, and
only when, material from the mouth
or nose of infected persons gets into
the mouth or nose of some one who
is susceptible. As is plainly recog
nized in respect to intestinal infec
tions, the hand probably plays an im
portant part in the transmission of
influenza. Coughing and sneezing help
greatly to spread the Infection
"It has long been known that later
changes of bacteria occur commonly
from mouth to mouth under ordinary
conditions of social intercourse. Most
of these organisms are harmless
under normal conditions of health.
That their capacity for harm Is some
times increased, sometimes reduced,
according to various circumstances,
is highly probable.
“The conditions that govern sus
eeptlbllity to infleunza are not under
stood. Good general health, absence
j of fatigue and of cold and hunger
are methods of prevention which have
long been advocated by many and:
which in spite of scientific criticism
still have much to recommend them.
Whatever conduces to low bodily tone
is believed by most persons to favor
infection. Some, however, hold that
specific immunity either does or does
not exist, and that wet feet, insuffi
cient bedding, chill, hunger, and fa
tigue have nothing to do with sus
ceptibility.
\ accinauon against pneumonia is
practicable; but such preventive
treatment is in the experimental
singe as respects influenza. As to
natural immunity, one attack is be
lieved to protect against another, and
some people seem to be immune with
j out ever having experienced an at
1 tack."
"If low bodily tone" conduces to tile
disease, as I)r. Soper thinks, evident
ly his second point -"sanitaion"— -13
1 of vital importance. Municipal action
■ in tiiis direction is hardly noticeable.
ruing to the stress placed on isola
i tiun. Such attention as is paid to It
is individual, under the advice of the
; medical profession. When we come
to tup third head, "education,1 we find
- j that more is probably lining done by
.' public bodies than in any previous
:j epidemic. Leaflets have been scat
i tered broadcast, through the medium
, j of public and educational bodies,
r schools, public libraries and associa
, lions of all kinds, to enlighten the
public regarding the disease, its
symptoms, and the methods of pre
. venting anil fighting it. From the sup
. plcments to the United States public
health reports by Surgeon-Geuerul
Lupert Blue, we quote the following
< paragiapiis, which not only show the
1 extent of these efforts at popular
education, but will serve to give our
1 readers seme idea of the devices 'ind
i methods approved by government ox
- ports fays General Blue:
t "it is very important that every
f person who becomes sick with influ
t enza should go home at once and go
t to bed. This will keep away danger
1 ! ous complications and will, at tin
same time, keep the patient from
- scattering the disease far and wide
s It 1e highly desirable that no one be
o allowed to sleep in tho same room
f with the patient. In fact, no one bu
1- he nurse should bo allowed in !h<
room.
i- "If there are cough and sputum oi
d running of the eyes and nose, cari
should bo taken that all such dis
charges are collected on bits of gauze
or rag or paper napkins and burned.
If the patient complains of fever and j
headache, he should be given water j
to drink, a cold compress to the fore- j
head, and a light sponge. Only such
medicine should be given as is pro
scribed by the doctor. It is foolish to I
ask the druggist to prescribe and may j
be dangerous to take the so-called \
‘safe, sure and harmless' remedies ad-j
vertised by patent-medicine matin >
facturers.
"If the patient is so situated that |
he can be attended only by some one I
who must also look after others in !
the family, it is advisable that such ■
attendant wear a wrapper, apron, or |
gown over the ordinary house clothes
while in the sick room, and slip this i
off when leaving to look after the
others
“Nurses and attendants will do well
to guard against breathing in danger
otts disease germs by wearing a sim
ple fold of gauze or mask while near
the patient.
"In guarding against disease of all
kinds, it is important that the body
be kept strong and able to tight off
disease germs. This can be done by j
having a proper proportion of work,!
play, and rest, by keeping the body;
well clothed, and by eating sufficient.;
wholesome and properly selected
food. In connection with diet, it is
well to remember that milk is one ot
tile best all-around foods obtainable,
for adults as well as children. So far
as a disease like influenza is concern-'
ed health authorities everywhere rec
ognize the very close relation be
tween its spread and overcrowded
homes. - While it is not always pos
sible. especially in times like the,
present, to avoid such overcrowd jug.
people should consider the health
danger and make every effort to re
duce the home overcrowding to a
minimum. The value of fresh air,
through open windows can not be)
overemphasized.
“Where crowding is unavoidable,!
as in street-cars, care should be tak
en to keep the fare so turned as not j
to inhale directly the air breathed
out by another person.
"It is especially important to be
ware of the person who coughs or
sneezes without covering his mouth
and nose. It also follows that ene
should keep out of crowds and stuffy
places as much as possible, ktep
homes, offices, and workshops will
aired, spend some time out of dotfs
each day, walk to work If at all pu£
tleable—In short, make an effort SW
Kmotha a a miinh frflah filr n« no A
sible.''
A statement issued by the British
Royal College of Physicians, and pub
lished in the London Times Weekly
(November 15), declares that "this
outbreak is essentially identical, both
in itself and in its complications, In
I eluding pneumonia, with that of
i 1890," and "has no relation to plague,
j as some have suggested." The. tol
| lowing timely advice is given to the
public:
"Well-ventilated, airy rooms pro
i mote well-being, and to that extent,
j at any rate, arc inimical to infection;
j drafts arc due to unskillful ventila
tion, and arc harmful; chilling of the
! body surface should be prevented by
| wearing warm clothing out of doors,
j Good, nourishing food, and enough of
it, is desirable; there is no virtue In
more than this. Alcoholic excess in
vites disaster; within the limits of
moderation each person will be wise
to maintain unaltered whatever habit
experience has proved to be most
agreeable to his own health. The
throat should be gargled every four
to six hours, if possible, or, at least,
morning and evening, with a disin
fectant gargle, of which one of the
most potent is a solution of twenty
drops of liquor soda chlorinate in a
tumbler of warm water. A solution
of common table salt, one tcaspoonful
to the pint of water, is suitable for
tlte nasal passage; pour a little into
the hollowed palm of the hand and
snuff up the nostrils two or three
times a day.
"Since we are uncertain of the pri
mary cause of influenza, no form ol
inoculation can he guaranteed to pro
tect against the disease itself. Pron
what wo know as to the lack of en
during protection after an attack, it
might in any case he assumed thai
no vaccine could protect for more
than a short period. But the ehtel
dangers of influenza lie in Its com
(Continued on Page Three)
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