INFLUENZA.

Manawatu Herald, Volume XLII, Issue 2087, 7 February 1920, Page 4

INFLUENZA.

VIEW'S OF EMINENT PHYSICIAN

The problem of influenza' and methods of preventive tri::iluieniwere discussed fully in n lecture. liy Sir Thomas • Horder, M.U., of St, Balholomew’s Hospital. Lomloii. helore the British Medic:)l Association recently. In disens.-dng what preventive measures could Ire adopted to ward off the disease or check'ds spread and its--severity, if it appeared, the eminent physician confessed that the medical profession was so much in the dark concern in" the factors which determined epidemics of disease, and influenza, that this 'branch of .medicine .was almost barren in results of a practical kind. Without knowledge, they could scarcely hope to pit I up a barrage against an epidemic wave of incidence of influenza. The question then rose as to what could be done to lover the susceptibility of the nation to infection by the influenza virus. There was litlle or no evidence to support the .supposition that the maintenance of a high standard of general health in the country was a safeguard against an epidemic of disease. The maximum morbiddy and (t;e maxibid) mortality fell npoiLyqiing adults and adults, and not upon children, and (he elderly. In Switzerland, where food and fuel were not so scarce, the mortality froia the dis f ease was higher than in Germany during the last epidemic. “I, do not, therefore, think,” said Sir Thomas, “it can be held that even if we sue- ( eed in converting a country of (?3 citizens into one the great majority of whose members would pass the medical boards as Af individuals, we should thereby protect ourselves a--gainst iullucnza and' its ravages. Some micro-organisms arc prone to attack and to infect persons of low .general resistance; bat in another group of micro-organisms intention depends much more up-on the virulence of their elements than upon the resistance of the host; the influenza virus certainly belongs to this group. As a barrier against the first class .of micro-organisms, there is no doubt that to keep a genera! standard of health at a high level is the best form of pvevneliou, hid for defence against in fee ling agents of the latter class ire need a much more specific means of prevention.” UNCERTAINTY AS TO CAUSE. “What can the individual do, and what can be. done to and for him, in this matter? .Inlluenza attacks the weakly'and the strong, as the rain-falls on the evil and-the good.' Indeed, since to be weakly carries will) it some protection against norma! routine and the conditions of life loading to contact wilh infected persons, (be robust individual is often more open to infection than his weakly brother. In the face of considerations like these it is dillicult to see what else than some metjunl of sped lie communication can really solve the problem, . . . This brings us at once to the biggest gap of all in our knowledge of the disease; we are still without any certainty as (o the essential causative agent in inlluenza. That it is a single agent, even, is not clear, though the argument, is strongly in favour of the view that it is. , . We are even farther away from exact knowledge than we thought we were eighteen months ago.” The physician added that the most carefully devised and thoroughly undertaken experiments witii i’fei tier’s bacillus had failed to. produce the disease in human beings, even when (ho bacilli had been quite freshly isolated and sprayed in enormous quantities iiilo the nose, eyes, and throats of volunteers. Virus Lakgu directly from inlluenza patients, sprayed in similar fashion, had failed also. It seemed (dear that the nature of the exact causative agent must be considered as nyl yet established. VALUE OF VACCINE.

“In the present slate of our knowledge,” continued Sir Thomas, “the available materials for preventive inoculation ‘against influenza’ are not very convincing in regard-to their specific value. And yet when I am asked my advice on Hie matter I generally favour the use of a prophylactic vaccine, not because I think it is a. specific preventive —like typhoid vaccine in typhoid fever, Jdr example — but because there is

some reason to consider llml a certain degree of prelection is conferred against serious grades of catarrh and secondary inlecliuns, and because the mure of such experiVienfs there are carried out with care and with proper records the better for the advance of our knowledge. P reven t i ve inoculation of single individuals, whatever results. teaches us little yr nothing, but similar treatment of collections of individuals in schools, in other institutions, in the navy .and in the army, -may teach us a great dead. Large stocks of vaccine, ot known and approved content,'should be at the disposal of the medical officers of health, who should co-operate with-medical ollieers in charge .of various institutions. It is noteworthy that the British authorities are now supplying vaccine free, according to a news item. SPECIAL HOSPITALS NEEDED. The lecturer then dealt with the question as to. what (gmld be done to control the epidemic when it had arrived. First, he emphasised efficient quarantine at the ports. Then came early diagnosis and, notification by medical men in the daily pursuit of their own practice. The careful observation and recording of the sporadic cases must be a valuable aid to the student of factorin epidemics. "But I have no doubt,” added the distinguished phy- ; sieian,‘*‘that the greatest of all the

cheeks to the spread of an epidemic woidd lx* a proper system of hospitalisation, adequate to*the peculiar features presented by the disease. A thorough scheme-should at once he drafted, by which several large bo.-pital units are established up and down the .country for prompt mobilisation in times of epidemic emergency. Each unit should jiave its base, consisting of a well-chosen -ml of .buildings-—a fever hospital, a large!) hud-: of schools, or ifn infirmary—its staff of doctors, bacteriologists, jind nurses, its laboratory aad dispensary. In (his matter the lesson of the-war should be utilised for.the exigencies ,of peace. . . . It would be possible to.„mobilise these units one by one, as required by the incidence.of'(ho disease, and have them running smoothly' within a .few 'days of their requirement. The staff would he a whole-time stall:.-during .the active services of the unit, and demobilisation would take place as soon as the epidemic subsided. . . . Transport arrangements could be systematically undertaken by the St? John Ambulance/’ FRESH AIR ABOVE ALL. After a reference to the value of fumigation with . N. 02 and 5.0.2 gases, and the difficulty of expressing a considered judgment on the subject of the inoculation treat immi of inlluenza, Sir Thomas laid great emphasis on the importance of proper ventilation of the .sick-room. “I regard the most important thing by far,” he said, “to ho a free current of fresh air. It has not only the most importau therapeutic value for the patient, it is also of great value as a preventive against ■spread of the infection. Winds apIpear to 'break up’ an epidemic .wave;-a current of fresh, air, it. skills quite certain, is our most potent menus of ’defence in the cause, of the individual patient. . . jf the work is so pressing, 1 should omit the medicine ami open the window. I should remove the superfluous blankets and rugs under which The patient is stewing. “Of (he various drugs recommended by the public and the press as preventives in lime of epidemics, there is little to say, except, perhaps, that the taking of them has a certain psychic value. I do not think either quinine or cinnamon internally or eucalyptus as a vapour maintained, during the more severe trials of 1918 and 1919, the prestige gained for them in 1889. In conclusion, wo must, I tear, conies.-: to a verv unsatisfactory position in the treatment of inlluenza. But to know' how little we know is an essentia! step in progress. The groat need is organised research and organised hospitalisation, and now is the time for these things, to he canned out. Let ns not (-ease to urge upon those responsible for the public health the importance of the problem, and the great uncertainty of our present knowledge, reminding them that economy here is of the falsest, and that tin.* country possesses no asset to be compared in value with the health of its citizens.”