THE PANDEMIC

Dominion, Volume 12, Issue 148, 18 March 1919, Page 5

THE PANDEMIC

M)RE ABOUT THE DISEASE ' A DOCTOR WITH DOUBTS THE PUBLIC HEALTH DEPARTMENT AN ILLUMINATING REPORT . Tho Influenza Epidemic Commission sat in Wellington yesterday. Sir. John Dennistoii presided, and-with him sat tho Hon. E. Alitehelson and Jlr. D. M'Liiren. Dr W. Barclay, medical superintendent •at Wellington Hospital, gave some statistics of the number and the age of patients treated for influenza in tho institution. Up to tho age of 30, he said, the mortality rate generally was under the standard, but after the age of 30 over tho standard. Elderly men were less liable to attack but moro likely to succumb. Amongst healthy young adults the death rate should not, under proper conditions, ho .thought, exceed 3 per cent. On the subject -of prophylactic inoculation- he said that all' tho information available was agile, and it was nowhere specially recommended or condemned. Directly after inoculation there was a considerable amount of risk. Patients were at a certain stago more susceptible to the disease. The epidemic in Wellington had not been a respecter of persons, and it did not seem to matter whether a person lived in a slum or in the best surroundgs. 'All were attacked alike, When the epidemic, was upon tho country it. did not appear that there was- any transition stago from tho mild to the severo type. The severe cases came within a few days.

ju answer to Sir John Denniston, ho said that the most valuable precautionary measure that could be taken would be tho training of a largo number of women -as many as possible—in home nursing. These women should be available to nurse sick people in. the patients' own homes, for in an.epidemic of such magnitude it was not. passible to treat all the patients in hospitals. •',

"Influenza"—New and Old. ' D. Lloyd Clay, medical practitioner, gave the clinical history of influenza as known before the last epidemic. Even in former pandemics, he declared, the death rats was low. With regard to this most recent epidemic of "so-called influenza" he expressed some doubt as to whether it was the disease formerly known as influenza, and in .support .of his opinion he quoted recent statements by medical men in Britain. The rapidity of infection and tho severity of the onset were, in his experience, only less virulent than in septicaemia plague! which ho once saw in Hong-Kong. Clinically, this severe epidemic of November was quite different from ordinary influenza. He described in detail the results of his own clinical observations, stating the symptoms as being of the utmost; severity.' In the fourth day of the disease he visited 152 houses in 22 houi'ft without a stop, travelling 150 miles. There would be an average of two cases in each house. His first patient with serious symptoms had been in contact with a returned soldier recently arrived from Auckland. The cases came so rapidly afterwards that he,had no time to inquire as to possible sources of infection.

Septicaemia Symptoms,

, The most startling feature of this disease was the serious' blood changes I that took place in patients. ' Those who 'died showed signs of general septicaemia. Patient 3 began to turn blue in colour before they had pneumonia at all. "While there were, still good breath sounds in the lungs this blueness appeared, showing that the blood cells were so affected with toxins that they were unable to take up oxygen from the air coming into the lungs. He had travelled'all over, the world and had been under quarantine conditions, and ho did not think sufficient precautions were-taken in any country to prevent the spread of the disease. He considered that the quarantine conditions in New Zealand ports should have been -stringent/when it was. known that the disease w r as already in America. A quarantine, officer should be a'man of experience in general medicine, and should be a man with special qualifications for the very important work required of him, To Mr. M'Laren: He. did not find in his experience that there were more cases or more virulent cases in congested parts of the city or in places where there was overcrowding. -i

A Committee Worker. Robert,. Wood, retired Presbyterian minister.' residing at Island Bay, said that ho was a member of the committee in his suburb.' He visited a great many people' in the suburb, and in a' small percentage of cases the trouble assumed a, very malignant character. Some ot the workers who came forward weio'knocked down themselves, and had suffered quite severe pecuniary loss. Those making house-to-house ivisits had found respectable, aober working people living under conditions verging on poverty.: so that when the father of the family went down- the family were in wait, and the epidemic workers had to pro.-i'le food for them* ■ In most cases the patient responded to treatment. Those people suffered merely from severe influenza, and in the morn malignant cases ■they suffered from influenza, phis something else. Mr. Wood urged, that there .should be provision made for the insurance of persons coining forward to assist thx 'community at a time of epidemic These people had lost much money by loss of working timo and loss of health. He spoke of the hard plight of working people as discovered in the epidemic.. He had found several families who, living without waste, without drink or drunkenness, wore yet on the verge of poverty.

The Department's Knowledge. Lieutenant-Colonel Makgill gave additional evidence. He gave evidence as to the- earliest dates on which the newsnaj.rs announced.the prevalence of influenza in the West Indies and the Eastern States of America. During the months March to April there was an occurrence of the so-called Spanish in(lnenrfa on the Continent among the belligerent armies. Erom May to July the first wave affected Britain and India, but Hi'- mortality was low. Prom Au.gnst to September the first wave declined generally in Britain, and it affected New Zealand and Australia severely, but without high mortality. In September there was a serious outbreak among children i;.i Glasgow. Then on September 2(i there was tho serious outbreak on the transport Tahiti at; Sierra Leone, thought at the time to be similar in type to the epidemic in New Zealand camps in lfllfi. During the last week in September the disease appeared in more serious form in America, in camps, and. at Boston, but was not at first very virulent. In the 'irst week in October there was the outbreak of pneumonic influenza at Capo Tu'-vn. e.-iiccially affecting natives. On f/ciubcr 7 there was un outbreak among native soldiers at Narrow Neck camp— slim:) but not fatal. At this timo tho epidemic was spreading in the Eastern Stn'es of America, and had reached Chicago. ' It was also spreading in Canada. Then, in the second week in October there was the second wave in Prance, and influenza was prevalent all over the I'nhcd Stales, but not generally very fatal. The disease was notified in British Columbia on October 12. In Honolulu there were a few mild cases, and on October'U the disease in San Francisco, began to show pneumonic, symptoms. The pneumonic epidemic reached Nalal on October 12. During the third week of October the height of llu intensity of lli.-i .-i-cond wave was reached in 'San Krarcisco, and there was a mild outbreak in progress. To I he last week in OrlnhiT the snroad of the disease in America, and Great Britain was very rapid, with many fatal cases, and in Kuglatel the second wave leacned i(< cr.'si on N'ovember !). The height of intensity in New Zealand'' was between Nmember 7 and Novimber 11. Theory and Practice, Dr. Makgill went on to discuss the present strength of tho Public Health | Department, and the measures which ' might bo needed to strengthen the ad- , ministration of public health. One might I take up flip attitude, he said, that the occurrence of the epidemic of last, November and tho,severity of its incidence in tho Dominion were in themselves a confession

of failure on the part of tho Department. Theoretically this was doubtless correct. Influenza was a prevcntiblo disease- in that by extreme measures its spread could be slopped. In practice, however, it was known that in no country had it been found possible to avoid tho pandemic, even in those, such as Australia, which took every known measure within the sphere, of practical administration. It was truo that in New South Wales the recent .outburst had been apparently very promptly checked, but the caso was scarcely parallel to that of New Zealand in October last. It had come upon Australia, in summer, when pdoplo could bo induced to live out of doors, and tho seasonal tendency to pneumonic infections was absent. In "New' Zealand the weather was exceptionally favourable to catarrhal troubles. 'Australia has yet to face tho effects of a winter epidemic. Also, authorities in New South Wales had" the experience of other countries, including New Zealand, to guide them, and, being forewarned, were forearmed. Thou again, the.preponderance in New Zealand of the unprotected rural population must _be considered as also the highly .susceptible Native dement. When such nn eminent authority as Nowsholmo declared that ho •knew of' no practical measures by which a pandemic such as influenza could lw checked they were justified in denying the assertion of tho theorist that tho existence of tho epidemic was a sufficient indication of incompetent administration, and could narrow down the inquiry to tho question of whether reasonable precautions could bo and had been taken.

1 Taken Unprepared. The' New Zealand authorities wore faced with a series of events, all of a. more or less abnormal nature, preceding and surrounding the origin of tho epidemic. The unusual conditions were: (1) Tho unforeseen nature of the secondary wave and tilt absence of information as to _ its eixstence elsewhere. Save for the localised outbreak on tho transport Tahiti and the epidemic in South Africa at the beginning of October, no knowledge of the violent type of infection was in possession ot the Department when the epidemic began in New Zealand. There was at first nothing to distinguish it from the disease already existing in the Dominion. (2) The depletion of the normal staff of tho Department. (3) Very early in the epidemic the staff was further weakened by illness, more particularly of Dr. Watt, District Health Officer at Wellington, leaving no medical officer at the head office at the very time that strong action was necessary, (i) The quarantine stations were all in occupation for Defence purpose, so that the administratimi of the quarantine clauses of.the Public Health Act was well-nigh impossible. ■' With such difficulties the public health administration was handicapped, and one could say emphatically that the stafiini: was .riot sufficient to cope fully ■with the epidemic. Housing. Dr. Mitkgill went on to discuss the poivo'rs of the Department over' housing, with special reference to the powers of Henkh Officers and local authorities to order tiia removal of dilapidated houses. One of the chief difficulties was the unwillingness of some local authorities to comply with the notice of the District Health Officer. But the greatest difficulty of all was the housing of tenants displaced from houses about to be demolished. It would do no god to drive people from poor house into poor lodginghouses. Until a comprehensive scheme for providing workers' dwellings was undertaken ,unsightly, degraded, and unwholesome habitations must continue to exist in all our larger towns. He declared that there was need for regulation of the quarters of seamen on ships. The existing conditions on some ships were a danger not only to the seamjn, but to the general public health. 'About Local Control, The, proposal that public health within cities should bo the sole concern of the city council required careful consideration. This was the system in England, but one of tho defects of the English system had been the power of tho reactionary influences on the local governing body to hamper the work of the health officer, and even ,to secure his dismissal if he showed too much activity in defiance of vested interests'. This became so serious" that an amendment of -the Heal Hi Act was recently adopted, making such dismissal subject to the approval of the local governing board. There was no reason to hope that wo should be without such prejudicial influence h New Z-ealand. His conclusion, affc:ir an exhaustive' survey of the subject, was that the burden of sanitary provision should be placed only on those lo:al bodies able to bear it, but on such the duties should be extended beyond those at present in existence, for they are not at present in a position to carry out sanita t duties to the extent which seems desirably. Why? . When Dr. Makgill had concluded his vorv full dissertation on public health matters, be- was most cordially thanked bv Sir John Denniston and members of the Commission. Sir John Denniston said: What do yon want a commission for? Why not hand the thing over to a body of experienced men who have all the facts at their finger ends? Mr. Mitchelsnn said with a smile "Beuort accordingly," and suggested to Dr. Makgill: You ought to spend the nextthree months in the Law Draughtsman's Office, and get a Bill ready." Hi Commission sits this afternoon.