THE PANDEMIC

Dominion, Volume 12, Issue 227, 19 June 1919, Page 6

THE PANDEMIC

■fIOW IT CAME TO NEW ZEALAND I t-S.- REPORT OF THE COMMISSION 1. SHE; DEPARTMENT CONDEMNED ; .I.'. -, •■ ■-■ ————— j ■::■.: '■ ■■■... \ i HOUSING SCHEME RECOMMENDED

I The. report 'of the Eoyal Commission !'. which was oharged to make certain m- ■ . guides -regarding the influenza epidemic ! 'which swept New Zealand at the end of I ' last year has been made available for publication. The .Minister; of Public I Health (the Hon. G. W. Russell) makes I a statement in reply to the report. [ .The Commissioners were Sir John Deni niston (chairman), Hon. B. Mitchelson i (of Auckland), and Mr. D. Miaren I .(of .Wellington). The scope of the I /inquiry was extremely wide. It included I the questions of how the sickness came : to be introduced into New Zealand and ■ spread over the entiro country, how to f deal with' such outbreaks in futurej and '; whether the diseaso was introduced into j New Zealand by the e.s. Niagara. The j Commission was asked to report on the : administration of tho Public Health Dej jartmenl generally, and also with spei cial reference to the epidemic. [ • ' The Recommendations. I. / Following are the recommendations of !"' the Commission:— I tf) That various amendments be ; .made to the Public Health Law, as ji -'.indicated'in'report. I' •'■'-■■ (2) That the Public Health Law be ! consolidated,,and simpli- !■ ■■••fied. '■■•■•• I v (3) That clauses be added to the I Public Health Act making provision i for the'regulation cf prices of eqnipi' nient, goons, and services required in I ' ''combating an epidemic. j ■•■ ''■. (i). That a Business Directory be '' established in connection with the ! .. Health Department under the charge I of an expert business administrative j officer to be named tho Director of Public Health. ! (5) That a Chief Sanitary Inspector ! for the Dominion be appointed. I (6) That the powers, duties, and : . relations of all Public Health officers, I medical, sanitary, and administrative, ; be fully and clearly defined, and ! •■■ same' published for general informa- .' ..-.tion. •..-■■'■ ■ ■ • ■ , : •'.- ■'. ■■(■()• That an educational section be i' attached to tho Business Directory i ... for the. dissemination of knowledge ! to the public relating io -matters of public health. ■ , (8) That greater attention be given ■ 'in the primary and secondary schools ■ !. to domestic science, hygiene, first aid, 1 and home nursing as subjects for i girls; in the secondary schools these • : snbjecta to be niade compulsory. : (9) That the health of school childi. ■■ ■ Ten be given increased attention ' . through the establishment of school i • clinics under, the charge of ,qualified ■ medical officers. ' "- i (10) '.Chat we strongly recommend I for the favourable consideration of i, the Government the subsidising of ' i ■ organisations .teaching Just aid and '-. home nursing, and especially the St. j John; Ambulance Brigade and Assoi ciation, to enable it to extend its !■'■• .. most useful work. ■ ■£■■■"'• (11) That existing health- districts ; '."..beT divided -into sub : districts, and- ; *'!assistant health officers placed in '■ - : '''"'on'aTge under- the District , Health ; ■" Officer. . r ■••''■-■ ; ■ '■; . (12) That the cities and large towns, i ','• with contiguous' boroughs and town I ■; form the Local Health Dei T.'-partments under the supervision of i : the Public Health Department. ! '- "-.'.(13) That- health matters in other ; '■? koroughs and town districts than •■ ■'■■ those referred to in clause 12 bead- , ! -ministered by the Government Health ■■"'■"• Department I _'." (14)'TIjat special advisory commit ! :tee? be appointed to report, from ! ' time'to time, on the health condi- | ; tlons of the ports and shipping of J M ,,the,.Dominion. i 7. :-(15) ' Tljat constant inspection be ' j .''.'made of'the ships, wharves, and.adI .'"Juncis of the waterfronts inde; , dii' 'reotion ci a medical officer of health. ! (16) That combined action be taken • by the General Government and local I ~.„ authorities, to institute and carry into i . ■ ' effect schemes for lie provision of I ' /adequate housing accommodation and i, fhe renovation of localities at present

i enennibered with buildiugs unsuitable I. for habitation. ! . ■ (17) That the Governinenf-take part ■ j-:>" with other Governments in establish-... I ing an international bureau for tho ! collection and dissemination of in- : formation bearing on the prevention , ■'"and , limitation of disease. i (18) That an annual conference of i .-.representatives from all health au- . i" ...'thoritieSj boards, and committees be 1 instituted as a means of public guid- . ance. ! , Praise for Hslpors. I The Commission add 3 to its report the '; • following paragraph:— . ' ' s 1 "The Commission desires to plnce on [ record its admiration of the high public ; spirit, devotion, and 6elf-sacrince dis-> i played.by, medical men and nurdes in ! ( combating the epidemic disease at very ! "great personal inemvenience, risk, . and i . "'even loss of liffl. The same commenda- ; tions apply to members of the Police ; ' Force and to members and officers of ; many public bodies,■ also the, numerous ! body of private citizens who laid aside ! their own private affairs and devoted ; themselves whole-heartedly to the work J of helping the Health authorities, both. ■ local and general, to save as many, ns ' possible of those" affected by the epii demic. 1 The report is a very big document. ■ The Commissioners apologise for the ' length of time the inquiry occupied, and i mention that this was int fo the fact ' that the Department of Public Health, I including the Minister', avowedly coiisidI ered the Department to be on trial, and i "in consequence prepared and presented I numerous reports on a great variety of I subjects. ; Nature of the Sickness. ].•-., The Commission rejects us "incredible" i , the suggestion, made by bacteriologists I and pathologists of the Department, that i cur epidemic influenza, admittedly iden- ,; tical -with the pandemic influenza sufI . fered in every part uf, the world, couM ; have developed from our ordinary simple' I ; influenza with the aid of some new or- ! ganism, into a more virulent form. If : it was introduced from without it must ; have been seaborne, and the question rej. maining was by what vessel or vessels ■ it came. ; The Niagara. The incident of the Makura is dismissed i as "of very minor importance." This 1 vessel arrived on November 30, after the : epidemic was raging, and was quaran--1 lined. Then the report goes on to discuss, in many page 3 of type; the incident of ! the Niagara. Much evidence is quoted, ; with but little comment. I .. Point in made of the wirelesa message ' received frdin the ship by the Naval 111i telligence Officer: "Please advise Health j Department, Spanish influenza cases on ;• board increasing daily. Present time over J 3, Tiundred crew down. Urgently required 1 hospital assistance and accommodation for : ,25 serious cases. Arrival echedule." This ■ »message was sent bv the master of'the i ship. It was forwarded immediately to ! tliß'TJnion,Company, and it readied Dr. ; Hughes, medical officer at Auckland, on i October-11. •. Prom the evidence cited it ' ■' appears"that two medical men on the ship i did-not consider the sickness virulent. ■ --The report-makes this comment; "It is

singular that throughout the whole ,ct tho proceedings (evidence) apparently hardly any mention is made of this ominous wireless with which all the persons interested must have been familiar. Apparently it was ignored, and no explanation asked or tendered as to the discrepancy between its description of the situation and that given in the evidence ; of the medical men on the ship and in the telegram finally forwarded to the Minister.;- The first step directed towards the disembarkation of passengers was stayed by tho Minister at a lato hour, and he then apparently, without any further information as to tho-condition' of matters on board, telegraphed to wis representative -to report, not on general terms, but by answering categorically two questions:' (a) Number of deaths, if any, on ship eince leaving Vancouver? (b) Whether disease is or is not pure influenza, presenting same indications as that which prevailed-in the Dominion for some time? To this telegram the Health Office (at Auckland) replied: ."On Niagara one death last night; broncho pneumonia after influenza. Disease purely simple influenza. Only two passengers for New Zealand on board with it." The Minister telegraphed at oncei "Ship may be cleared.-" Commission is Puzzled. Then the Commissioners say: "It is difficult to'see how the Minister could be satisfied by those communications in the face of the earlier official" information from the'ship as. to the condition of things which, if true, made her a menace to the health of the city. It is also difficult to understand how the health officers on board the vessel accepted tho diagnosis of the acting ship doctor as to the form, and character of the sickness without (as far as appears) any referenco to, or explanation of, the compromising telegram."

The evidence of Dr, Maguire, medical superintendent of Hie Auckland Hospital, and of Dr. Milsom is quoted regarding ■the condition of influenza patients in the hospital "on October 12." (A great deal rums on this .date.) Both medical men, and especially Dr. Milsom, said that the cases were very extraordinary, and from their evidence it would appear that they ■believed these cases came from the Niagara (on October 12). It is remarked that the membere of the crew who had been sick and who gave evidence "complained of the insanitary state of their surroundings, the foul air they had to breathe, and the unpalatable nature of the food provided, and the lack of necessities." e Not "Pure Influenza," •-• The report says: "It.is obvious that the condition of the Niagara patients on the morning of the 12th could not by liny reasonable imagination lie properly described as 'pure influenza,' especially as defined by tho Minister in his telegram, ■■ to which Dr. Hughes's was an answer, as presenting the same indications as that which has prevailed in tho Dominion, for somo time past." It does not, however, follow- that they were cases of epidemic influenza, which, has been popularly called Spanish influenza. . . . The explosivo outbreak of the epidemic influenza seems to have begun at a time which would practically, synchronise .with the admission of the Niagara patients, 28 on October 12, G on October 13, 1 on October 17, 2 nurses on October 21. The report states also: "There had beenjinfluenaa among the passengers who had landed and were potential carriers, although on this point we should mention that no instance of illness of any passenger after landing, or any outbreak referable to contact with any such patient, has been foand, notwithstanding- careful inquiries having been made." The Commissioners find rhnt although severe influenza existed in New Zealand prior to the coming of the Niagara the? are "not satisfied that any of these have been shown to be cases of the epidemio form of the disease." In support of tho contrary view the opinion of the Auckland branch of the British Medical Association is cited. The, Commission rejects the suggestion that the disease could have spread from the Narrow Neck Camp.

The Findings. On this part of the inquiry the Commission finds:— (a) That the cause of the introduction of the recent epidemic of inlluenza in New Zealand was the conveyance by sea of the infective element of the epidemic influenza lately prevalent in Europe, Great Britain, South Africa, and America. . (b) That the extension of the epidemic from its first appearance in Auckland was largely the result of a general disregard of precautionary ~ measures in- the initial stages, due to want of knowledge regarding the nature of the disease. The infection , . was largely spread by the congregation of large crowds of people in tho various centres of population in connection with the armistice celebrations, race meetings, the carnival week in Christchurch (which large numbers of visitors from all parts of the Dominion attended), and the fact that no restriction was placed upon the movements of the people in travelling, even iriien they had been in contact with infected persons. And.in regard to the Niagara: ; (a) That althoiigh\the matter is. one capable of absolute ■ demonstration, the evidence, before us raises a • very strong presumption that n substantial factor in the introduction of the epidemic was the-- arrival in Auckland on October 12 of the s.s. Niagara, with patients infected with the epidemic disease. (b) Tho evidence does not exclude the possibility of other sources, such aa tho presence of infection from other vessels arriving! in Auckland at the same time or shortly before tho arrival of the Niagara. (c) The foregoing evidence proves, in our opinion, that the official action before, in, and about the release of the Niagara showed either non-recog-nition or a disregard of the gravity of the position described by the wire- ■ less message of October 11. Administration Faults. The next section of (he report deals with the Health Department administration ns relating to the epidemic. Some faults are found with tho administration, and with Ihc advice given in the beginning of October by medical officers of the Department. Dr. Watt, acting in Ihe absence of ecninr officers, gave advice on October 9, "tho practical substance", of uhich jvas ''that there was no absolute immunity from the di.seaeo to take steps towards allaying public anxiety, 'and to wait." On this the report remarks: "It is most difficult to understand why advice of this negative character was given at that time, in the face of the statement that 'influenza was present in its epidemic form, and that the disease spreads with great rapidity. This matter is cited for the reason that it is an example of the method of. delay that was

followed by similar actions on several occasions by more than cno officer of the Health Department. It is a course of action that should not be repeated in the future, because it weakens public confidence in the guidance of the Department, which is established to lead the country in regard to health matters." Insufficient Staff. Referenco is made to the understaffed condition of the Department, and the conclusion is made "that the Department oujrht to bo strengthened by additions or by providing some qualified reserve officers, who might be called upon in cnsD'Of the leading officers being temporarily disabled. . . . We find that the hospital boards, and much of the country, appear to have been more awake than tho Department itself." The Commission condemns treatment of communications regarding the epidemic menace a? "confidential," holding that the information should have been widely' distributed. Earlier Waves. The coming of earlier waves of catarrhal diseases, chiefly evident in- the military camps, ia referred to, and mention made of the severity of the sickness in these earlier waves. Then the report states: "If the Department was in receipt of the data respecting the camps, presented by Dr. Makgill, then the Department appe.irs to have lackedsound judgment in assuming, as it did, that the epidemic was merely 'simple infiunza," and basing its advico to the Minister and its earlier administrative acts on that assumption. If, on the other hand, the Department was not possessed or' this information in respect to the camps there was a want of co-ordina-tion, knowledge, and foresight which could not but cripple any attempts at sound administration." Tlio Chief Faults, The Commission finds that the chief faulits of tlio administration aroso from: (a) The local (Auckland) branch of the Department being understaffed, (b) The Chief Officer not having sufficient powers of direction, and (c) I'b.a official attitude towards t.'io disease in postulating a distinction between "simple influenza" and "virulent," as if only the latter were infectious or of clanger to the oonimuuity. ' It is also stated: "When the (rouble became serious in each diatrist the Health Officer had inoro to do than he could possibly accomplish, and in several districts the assistance of wymen from outside tho Department had' to be accepted in order to. carry on the administration. There is no doubt but that all officers worked unceasingly when the trouble became acute, but the Oepartment as a whole seemed to have lacked the foresight which should 'have impelled it to initiate general- organisation in October." Tho report advises more port precautions, better health inspection of the waterfront, including supervision cf shipping. The Local Bodies.

In reference to hospital boaids and other local bodies, tue Commission is highly commendatory. Inter alia, , it says: "The local authorities took very substantial liabilities, both financial and otherwise, and all of them spared rothing in order to cope with tho epidemic when its virulence became nianilest. In certain directions advantage was taken of the urgent demand for services ana commodities, so that in some instances higher charges had. to be paid than were ordinarily ' demanded. A recurrence of such excessive charging can be avoided by taking the course recommended by the Minister of Public Health in his evidence, that is, to amend the Public Health Act by adding what migat be termed 'epidemic clauses,' and waking regulations under these clauses to provide payment ,at specified rates for tho use of buildings for doctors and uurses, the uso of motor-cars, and other vehicles, or; for any services commandeered for the purpose required." Housing and Sanitation. Tho Commissioners speak also of housing nml sanitation. They say: "From our inspections and the evidence submitted we are confident that considerable improvements are required in respect to conditions in which large numbers of people in our cities are required to live. It was most evident that the bad conditions existing wers due to aa inheritance of wrong subdivisions of land; the continued habitation of old, dilapidated worm-eaten, vermin-iuiested, and in some instances, really rotten structures; the economic factors of short supply of decent houses, and excessively high raits, and the personal habits of uncleanliness of a proportion of the tenants. 'Whilst the borough councils, appear to give very.full attention to" the general Siini.tary requirements, there is no doubt that iu all centres groups of houses and in some places nearly whole streets stand as a constant menace to pubiic health, in that tho houses are quite unsuitable for habitation with proper regard to the health, particularly of the women and children."

It is admitted by the Commissioners that though more demolition should be done, the chief obstacle is the rehousing' of the displaced tenants and the municipalities have hitherto done "practically no.th.hls" in the way of carrying cut large improvement schemes. The Commission says: "We urge most strongly that there is need for the closest combination between the general Government and the local authorities towards the institution of completely national plans' for dealing promptly with this most serious national and municipal problem. ... As the general health of our people is undoubtedly the Dominion's greatest asset, refurin of existing. bad sonditions should be enteral, upon even if the initial , financial cost is great, as the added efficiency of a completely healthy people would replace, the expenditure entailed in. carrying out the much-delayed schemes of reconstruction." General. The third section of the report deals with general questions of public health,' and the refcpmmendiitions already given summarise quite fairly what the Commission requires. The interim report, presented somo time ago,, deals with measures to be taken in the event of a recrudescence of the epidemic. The re(i4in«ndatious ate not new interesting. Generally -peaking, the basis of tho proposed scheme is the organisation created to deal -with the former epidemic.

MINISTER RETORTS SOME SHARP CRITICISM WHOSE THE BLAME? THE PRE-NIAGARA SICKNESS CONDITIONS JN AUCKLAND The following is the text of the statement made by the Minister of Public Health (the Eon. G. W. Russell) on the report:— The delay in the publication of the Epidemic Commission Heport has been caused by the fact that the report was inferred bacl by the direction of His Excellency the Governor-General ir» consequence of an absolutely incorrect reference to the evidence given by me. On. page 17 of the report, as presented, .the following words appeared:— The Minister, in his evidence, says he "recoived warning in September to prepare for an epidemic." v Inference to my evidence showed that in two places exactly tho contrary was stated—namely, on "page 612 the following passage appears:— » 1 now wish In deal with the approach of 1 lie- Niagara, and I feel it ' duo to myself to say that no warning was given to me, as Minister of Public Health, that'it was necessary that New /calami should take stops to prepare for the possible inroad of this pandemic to this country. And, further, on page GlB the further statement appears:— I do not want, to labour.the matter, but 1 have now to Wad up to what was the position—first, that I recoived no warning to prepare for an epidemic. . _. . I am too experienced to allow a statement so contrary to my sworn evidence to be fathered upon me, and get the

proverbial twenty-four hours' start. Therefore the attention of the GovernorGeneral was directed by the • Government to the inaccuracy,' and the Commission wove directed to either justify their statement or correct it. They have now excised the sentence referred to from the report, which finally came into my hands yesterday afternoon on niv return from Auckland. The report was presented to Cabinet yesterday, and is now at the earliest, possible moment made available to the people of the Dominion.

The Commission was originally appointed on January 31, beirftr made returnable by March 31. Application was ninrle for an extension of time, and granted to April 30. The Commission concluded its sittings in Dunedin about April ■!, and proceeded, to Christchurch to prepare its report. At the end of April n further extension of time was asked to May 31. Cabinet declined to grant this further lengthened period, and the report was finally handed in on May IS. The delay which has since taken place rests entirely with the Commission. The primary object of the establishment of the Commission was to inquire into the responsibility of the Health Department for the pandemic in New Zealand last October, and,- in brief, to ascertain how far tho Niagara was responsible for the. dreadful ravages of the disease. Fairness Challenged. In dealing witii this matter, I regret to be compelled to challenge the fairness of tho Commission, particularly of its chairman. When I appeared before the Commission and came to deal with tho Niagara, I desired to quote from !he Auckland newspapers to show the existence, at the time the Niagara arrived, of a virulent form of influenza. The chairman refused to allow me. to place this information before the Commission, declaring this was "not permissible us evidence." In passing; ,1 may say that a Royal Commission is not bound by tho strict laws of evidence as is the Supreme Court, and this is proved by two facts:— 1. The Commission in their report, say: "The evidence was taken partially on oath, but no direct and relevant information was excluded because the person conveying tho in- : formation was not present or had not been sworn." So that, when it suited the chairman, evidence not on oath and actually given by persons not present was "permissible in evidence" t 2. In another part 'of . the report emphasis is laid upon the fact that a certain resolution wa3 passed by the Auckland branch of the British Medical Association, and this, which was neither sworn to nor even sent to tho Commission by resolution of that' branch, is accepted as evidence, and used for "the purpose intended by the Commission. Why, therefore, I should have been refused permision to quote from the daily newspapers nf Auckland, which are,probablv tho best current statements of fact that can be obtained, I am left to imagine. It is not a difficult task. My suggestion to the Commission that if they refused to allow me to put in tho newspaper reports -they should at least, take the evidence of the editors and reporters who published the information was disregarded.

The Position Before the Niagara Came,

What, then, was the position at Auckland before the Niagara arrived? Quoting from the newspaper reports, which were unjustly refused admission by tho Commission, no evidence of the existing state of things, I now -present the w>tunl position..

The Niagara arrived at Anckiand on October IS. On October 9 the "New Zealand Herald" stated: "Influenza in a rather virulent form is prevalent in Auckland, and the staffs of many business firms are more tfr loss disorganised as a result of tho epidemic. The attacks are said to be extremely l.vpid in actiou. On of the leading city them-, ists stated yesterday that the present epidemic appeared to be similar to the severe form of influenza that vasMirst known in New Zealand as 'la grippe.' Ho added that the epidemic . i.-ns increasing rapidly, and thrt all the city and suburban chemists were doing a rush business in influenza remedies."

On October 10 the same paper said: "Tho epidemic of influenza to which reference was made yestrday has attained widespread proportions iu Auckland. A number of medical practitioners, who were interviewed oi; the subject yesterday, stated that a' largo number of cases had cume under their notice. One doctor said that ho had had it mimuar of severe cases among his patients, and that in several instances the symptoms, to say the least, were alarming." On October 12 the report was: "The epidemic of influenza in Auckland is still prevalent." The following' day (October 13) tho Niagara arrived. On October U, the "Honvld" said the disease oi; Ike Niagara /'was of the common type, mild in character, and was not accompanied by any complications such as gaslric disorders. Tho outbreak commenced shortly after the vessel left Honolulu." ' On October 15 this report was published :—

"The medical men who were passen- ■ gers by the steamer stated yc-sterday that, contrary in reports which were- in circulation, the influenza on board was of the ordinary type, somewhat accentuated in severity by the heat of the tropics, it was practically confined to Hie crew, only a few of -the passengers being affected. The one member of lhe : c;ew who died on the voyage lmd his condition brought to a crisis by going en deck when he was in a highly-feverish" condition from tho complaint. The entlireak* of influenza in Auckland shows no signs of decreasing. An outstanding characteristic of the complaint is the suddenness of . attack, the victims in many cases having no warning of its developments. In addition to tn« patients from the Niagara, nine ■ others ;-re receiving treatment at the Auckland Hospital." <T On Octol>er 16 it was stated: Inquiries yesterday show that the epidemio of influenza in the 'city shows no sigua of abating. The staffs* of many business houses have been depleted to-a- greater or less extent. The chemists are still busily engaged in dispensing remedies, and yesterday over 300 cases were dealt with by one establishment." . . . This, then, was the position: that in Auckland at the very time thn Niagara arrived the epidemic was prevalent in n virulent form, that it gradually increased in severity, and that there were numerous "severe" and "alarming" eases. On October 17 the "Herald said the Hospital'' Board's Visiting Committeo "considered that .Dr. Hughes (District Health Officer) had adopted every tens, onable safeguard to protect tho health of the community. It was explained that influenza is not a disease notifiame under the Infectious Diseases Act,- and that in this circumstance Dr.' Hughes had taken precautions that were not compulsory mid had done more than might reasonably have been expected." It was also' stated that "the influenza patients on board the Niagara continue to mnko satisfactory progress. Yesterday the number of cases under treatment on the ship was ten. In addition there were two cases of pneumonia, i and two case.i of other complaints. The number ot Niagara patients at the Auckland Hospital yesterday was 28, some of them suffering* from pneumonia. Many are almost sufficiently recovered, however, tp permit their discharge. Speaking with reference to the influenza cases Dr. E. Graham Russell. Port Health Officer, stated yesterday that tho type was the mildest he has experienced." On Octobpr 21 the "Herald" stated: "Of the 26 Niagara patients who were in the hospital on Friday, ten were discharged on Saturday and eight are to be discharged to-day. A number are under the doctor's cave on board the vessel, and are reported to be improving this rapid recovery el the Niagara cases, on October 22 _ the papnr stated: "The influenza epidemic in Auckland is showing no signs or abatement, reports fo hand yesterday indicating on the contrary, that it is spreading. One new form that the influenza is taking is a very bad typo of neuralgia in the head. Cases are fairly frequent of eltoii" men being reduced to physical wrecks in a few days, as though the wholo system had been poisoned and the nerves shattered. The gastric form of i tho epidemic, is still prevalent. Of the I % patients from the Niagara who were admitted to the hospital, only seven now remain in tho institution, eight beiiir discharged yesterday. The condition of those still under treatment is improving. A few local cases have been admitted to the isolation ward," - .<

Oα October 23 the "Herald" report was thnt "one practitioner stated yesterday that laboratory tests made by himself showed that the germ of the prevailing disease was the same old-fashioned bacillus influenzae, but in n. very much more virulent strain." "The epidemic is not abating in Auckland," said this docUtt. "There have been many deaths Here directly attributable to it. When 1 say that I" mean that influenza supervening upon a chronic or old-standing complaint has led to complications which bavo caused death. In other words, had it not been for the influenza germ the patients might have remained in statu quo for an indefinite period. To quote an example: One of my patients whose chest had never been strong, but who lor years had enjoyed a moderate amount o fairly good health, suddenly contracted influenza. His vitality was lowered, hi.-: chest became a suitable nidu3 (nest) for infecting germs, bronchial pneumonia Tiinrlo its anDenrance, and within three days he died." Whsnce Came the Virulence? Other extracts of a similar character could be quoted, but sufficient has been copied to show the conditions at Auckland when the Niagara arrived, ami inrapid recovery of the patients from lie ship. It is admitted, of course, that the disease became much more deadly a wees or two after the arrival of the Niagara. But what are the facts?' "Only two patients from' the Niagara died, report the Commission, "a man admitted on October 12. Having been previously gassed he was therefore move liable to contract the virulent form of infection than another perron, as his lungs were not normal." The Commission quotes Dr. Maguire as saying: "The first influenza eases began to come into the hospital from the same date as the arrival of the Niagara." Yet no sane pSrso,n Would suggest these had been infected •from the ship. Dr. Hall, "in a letter to Dr. Milsom, which was not sworn to, 'but was of course "permissible in evidence," according to the learned but illogical chairman, statod: "The outset of the Niagara cases in hospital was the same in all cases, 'viz., headache, pains in limbs, feverishness, shivering, loss of appetite, vomiting." I compare this with the "Herald's" description of the disease on October 9: "Extremely rapid in action, gastric disturbance, swollen neck glands, violent headache, and a high temperature in the early stages." October 10: "Appeared to bo gastric. Very severe pains in the. head and various parts of the body. , ' October 12: "Other cases, which partake of the gastric form, are more severe, and are giving rise to much discomfort, severe pains in the head and body, with nausea, being among the most pronounced symptoms." It will thus be seen the pre-Niagara cases and those from the ship showed exactly the same symptoms. On the Niagara the disease was practically confined to the crew. The reason is obvious. Says Dr. Hall: ."On examination nearly all the men "complained of tho insanitary state of their suroundings, tho foul aid they had to breathe nnd tho unpalatable nature of the food provided and the lack of necessities." Disease "Worked Up" en Voyage.

The Niagara started from Vancouver a clean ship. There was no. epidemic in either Canada or the United States when she left. Two days after she started a woman was found with a slight touch of influenza. She recovered. The ( ship called at Honolulu. There was no influenza there. Before she reached. Suva the disease had become serious. It was stili more so when she reached Auckland. The plain fact is that the disease "worked up" en routo from nothing. How it came about, whence it came, no one knows. • Probably it "worked u.p" in Auckland in tho same way. The two most accurate statements in the report arc—(l) "The explosive outbreak seems to have begun at a time which would practically synchronise (mnrk the word!) with the admission ot- the Niagara patients"; and (2) "That the extension of the epidemic from the first appearance in Auckland was largely the result of a general disregard of precautionary measures in the initial stages, duo to want of knowledge regarding, the nature of the disease."

That sums Up the position—"Want of knowledge•■ of: the"disease." The same "want of knowledge of the disease" wdr. shown the world over, as witness the terrific_death-rate in other countries, as well as New Zealand.. This country had had no experience of such a pandemic. Tho Public Health .''stalf was weakened by two in its principal officers being with the Defence Department—one of them tho Chief Health Officer; our doctors nnd nurses went down like hay before the reaper's scythe, S-'till wo straggled through, and a great victory was accomplished, for the epidemic was practically beaten in throe weeks. Date of Arrival. The Niagara arrived at Auckland on Sunday, October 13, ami the position wns that on that date Auckland was practically in flames with the epidemic. 1 nni not prepared as a layman to suggest that the arrival of the Niagara die! not.accentuate the position. Possibly the arrival of that ship may hnve brought a more virulent form of the influenza bacilli, which in new hosts, and in an entirely fresh environment,, ilamed up into the scourge which spread over tho Dominion and resulted in so many deaths. On the other hand, seeing tho pandemic was world-wide, nud that the influenza wag slaying its hundreds of thousands in other countries of tho world at the same,time that the onslaught in New Zealand took place, it appears to nu> that there is no necessary connection between the arrival of the Niagara and the disaster which happened. All tbo Commission can find is "a very strong presumption" that tho Niasfaja was 'fa. substantial factor.' . When she left Vancouver she was an absolutely clean ship, and the influenza epidemic was not current at that place. ■ A few days after leaving a female passenger was found to be 6iiifering from a , mild>form of influenza; she recovered. In diie cotirse the vessel reached Tahiti. There also there was no disease,' and there was ,no sign of disease until some days after leaving Tahiti. By the time the vessel had arrived at Suva a number of tho stewards were ill, and practically between that port and her' arrival at Auckland a large number of cases 'broke out I have stated this for tho purpose of showing how, when once tho epidemic of influenza began upon that ship, it grew in , virulence until, on arrival at Auckland, there were no doubt some serious cases on board. The deaths of Niagara patients were very small in number, as is shown by the Commission's report.

On "Advice" Accepted. In tho renort the Commission blames me, as Minister, for accepting tho reports of the Public Health Officers as to the conditions on the Niagraa. They ..say that I did not aek for a report,"in general terms," but did ask for <\ report on two specific questions. These questions were—(l) Number of deaths on the ship; and (2) "whether the disease is or is not simple influenza, presenting the same indications ae that which has obtained for some time past in New Zealand." The reply of the health officer was that there had been one death the day before the arrival of the ship, and that the disease was "purely simple influenza." On.this I gave authority for the ship to be cleared. The Commission refers to what it describes as the "ominous" telegram received from the captain of the ship on the Saturday. The captain did, it is true, mention a number of cases of Spanish influenza on board the vessel, nnd that twenty-five would require to go to hospital. "Spanish influenza" is not a scientific term.. It means nothing When the disease'broke out in Spain it was in a very mild form. On the other hand, it is clearly shown in the evidence that tho health officer at Auckland, Dr. Hughos, and the port health officer, Dr. Russell, both .visited the ship. They discussed matters with the two doctors on board who had been stfending the eases, Drs. Mackenzie and Barnett, nnd it was after they had seen the cases and obtained the diagnoses of the doctors on board that they replied Hint the disease was purely simple influenza. ■ Would any body of rational men suggest that u lav Minister in charge of a Department should refuse to accepl I he advice of his responsible- experts and officers, and place more reliance upon a telegram from the captain of a shin than upon four doctors, two ol whom were on board throughout tho voynge, nnd the other two of whom hntl made a perfect!*- independent diiigonsia i of the cases? The suggestion is too preposterous for words, ret that is thf suggestion of the Commission. As 1 told the Commission in my evidence, "it I

is very easy to be wise- after the event," and I also said that "he would be a foolish Minister of Health who had not learned from the experience of the pandemic." Whether the virulent epidemic which appeared in Auckland would without the arrival of the Niagara have attained such tremendous proportions as it did attain, is a matter upon which ■I cannot give an opinion. I can only say that after the experience we have hnd I would be prepared to accent no risk in future, but that is a different j matter to endeavouring to go back to what was thu position when the Niagara actually arrived, when, in the words of the Commission, wo suffered from "a want of knowledge regarding the nature of the disease." Another Statement Challenqed. The Commission finds that the action taken showed "either non-recognition or a disregard nf the gravity of the position described by the wireless message of October 11" (from the captain). 1 absolutely challenge this statement, on the. following grounds:— (1) Full information of the wireless was sent to the health officer at Auckland, wlin was instructed to make the uecesfar, - hospital arrangements. (2) The health officer and port health officer were ordered not to rrrant nratinue until information was wired to the Minister as to (a) The number of deaths, and (l>) "Whether the disease is or is ■ not pure influenza, nresentine the same indications as that which has ursvailetl in the Dominion for some time, past." (31 The Governor-General was ailvisc'J that if the replies were unfavourable he would be asked to at once declare influenza a ciuarantinnble disease, and agreed to do so. Where, then, was the m- disrfsnrd of the urnvitv nf the position described by the wireless message"? t roneat that on the authority of h--o doctors on the ship and two" from the shore, the disease was diagnosed ps "purel- simnle influenza, nnd on that report Hw shin wns cleared. The questions submitted by me to vv> health ofFw dealt with the crnx of Jie matter. Had there been replies that ■were in any w> - unsatisfactory or doubtful or the slightest recommendation for quarantine, it would have b?en ot once ordered M.T oniiion is that the doctors save an absolutely honest renori- on the information before them, ikvl their examinations of the cases, and I accepted it aS eUC \Vhore the Report is Silent,

The public will notice that on some important matters the report is ominousl.r silent. The first is that when the Niagara arrived, the Health Department had no quarantine stations available. They were held b> the Defence Department as camps for German internees, i say the silence is omiuous-but *hy.?. TJe path Department; before 1 joined the bo\ eminent, handed over its quarantine stations to Defence, and I leave it at that \Vtlier is reference made to the tact that the Auckland Hospital Board.Had no infections diseases hospital, the result being that the .Niagara patients had to bo taken to the infectious diseare. ward of the ordinary hospital, as a reeuft. we could only have quarantined in Niagara, patients and passengers on the ship itself-and that must have ended disastrously. Un those matters the Commission is ominously silent. Still more ominous is its silence as to the manner in which the Health Department led the country in dealing with the epidemic. No expense or laboui «a spared. The Government encouraged the local bodies to establish emergency lanitals everywhere. It agreed in ewrj Zl to Wth« entire bill, and has toe bo. Yet the Commission makes the re kl«sly incorrect statement that the local authorities took very substantial liabilities both financial and otherwise, and all ot them .pared nothing in onto to cope with the epidemic when its wiuwho took six weeks to prepare this ieport (whereas the monumental report ot the Deionce Commission, presided ovci bv Sir Hubert Anderson, was prepared in e ght da have Koneso tar lrom the truth as not to know that the Government paid the entire cost oi Uβ omergeucv hospials. doctors, nurses, iood, etc., amounting in all to approximately .£200,000, whilst the local autuontics vwho undoubtedly most ably assisted) bore not a copper 01 the expense. Neither is recognition made of the uptory achieved. New Zealand was h t hard but this country-thanks to the atriotism and self-sacrifice of *11 classes, under the guidance of the Health Dcp ftnent-creaned up thei disease in a littlo over three wecKs. We are now * "lean country. The disease has been beaten. Thank God up to.date there, has been no recrudescence. r \ot the, dite w is still coin? strong in South Ainwi, and our Yustralian cowins. whoso immunity we envied in October, November-and JJucember, .-.re still duli'eriug badly, and aie ■."kin- us to assist them with. advice and material. I fear the Commission was less concerned to be just than to trj and prove the Health Department lacking. . The Rest of the Report. Kβ to the remainder of the report but little need be said. Suggestion-., tor tho reorganisation of the jjepunmeui-p".-viously rendered impossible by war dilioiw iirisins out ot want of money ami want of men-were stated by mo as Minieler, and by tbo Chief Health ObVrer tn the Commission, and statements were made as to what is already being «oue on these matters, including the breaking up of the present large health district!., appointment of more health officers, separation of the lay and tho medical starts, consolidation of the laws regarding publie health, and many others. All ol these have been coolly appropriated by he Commission. Where taey have departed from the settled programme <f the j)epartmeut, as laid before them in evidence, they have floundered into a hopeless morass of impossibility. <i>ne spark of genius is shown. It is the suggestion that-a caretaker should be appointed ior each quarantine.station who would be » combined carpenter, plumber, painter!

, EPIDEMIOLOGICAL ASPECTS GROWTH OF VIRULENCE Dr. H. -UakgiU, District - Health Officer, submits some observations oil the epidemiology of the disease/ mentioning several points not referred to by the Commission. Inferring to the origin ot the epidemic, ho says:"The have failed to grasp the somewhat obscure epidemiology of the outbreak of influenza of last November. This is not in the least surprising since such imowledge as sanitary experts possess on the subject is incomplete and dependent on conjecture. Only those who have a working Knowledge ot bacteriological phenomena can appreciate fully the different factors which must have been at work in producing the particular degree of virulence which the emdeinic developed. Obviously the chief stumbling-block the Commission has met is the difficulty of grasping the fact that an infinite variety of symptoms can l-e produced by the snnie effective agent at ■varying degrees of virulence. The report seeks to account for tho epidemic by assuming that a particular organism must "have been introduced from ovor6eas at a particular time. This assumption is not supported by scientific data. The Commissioners find it incredible that tho organisms in New Zealand should attain tho necessary virulence to produce tlve epidemic of November coincidently with the attainment of the same degree of virulence by organisms in/many other parts of the world. To the bacteriologist this is not incredible, since war .preparations had produced in so many countries the\onditions necessary for exaltation of virulence and during the same length of time. In every country visited by tins epidemic we find tno same two waves of infection; the same massing of susceptible persons; the same constant addition of fresh strains of infection from overseas,-mid the same unusual cycle of meteorological conditions. There is nothing then unreasonable in assuming that (he same summation of stimuli should produce like results about tho same period throughout the world. Tho report appears to hang weight on the use of the word 'Spanish' in the original wireless message from the Niagara. It is obviously not realised that (his word conveyed no scientific meaning whatsoever. The' influenza which had ravaged New Zealand siuco July, 1918, was actually wliat was originally called 'Spanish influenza.! It is fjenei'nlly ;ii/cppted that the epidemic which was first noticed in Spain in May was similar in virulence- to (he first pandemic wave, which wae not particularly fatal. The attribute 'Spanish' wa,s 'a journalistic

touch consequent ou Spain being thu first country :ii which the primary wive was reported to have attained epidemicproportions.

"The report fails to account lor the method by which this assumed special type of infection was conveyed to tho Niagara. Vet this point is of vital interest to the •inquiry. If we arc to assume that the infection came by the Niagara, and knowing that no epidemic of such malted virulence obt.uned in the ports touched at by the Niagara, ive must conclude that during the voyage an ordinary type of infection worked up m virulence on board, so thai it was able to cause in October the disastrous epidemic in New Zealand. If it could po increase in virulence on board a ship coincident!,!" with the development of this secondary wave in other countries, then also il could do so in New Zealand itserr —without assistance from overseas, agencite. No effort is made to account for the almost complete immunity of the p.isfiengers on the Niagara—an inimimiry which it is hard to believe would obtain had the disease been of so high a decree of virulence as was experienced on 6hore in November.

"The evidence of Dr. Watt, regarding the epidemic of pneumonic influenza in the Danne-nke district and in Cuck County two months before the arrival of the Niagara is ignored. Yet there is every evidence that these localised epidemics were of exactly the same type as the pandemic of Nevember."