MYSTERY OF INFLUENZA.

Taranaki Daily News, 16 April 1921, Page 10

MYSTERY OF INFLUENZA.

THE SCOURGE WHICH COST MILLIONS. CAUSE NOT YET DETERMINED. (By Sir James Crichton Browne.) The Report on the Pandemic of Influenza, 1918-19, just issued—one of the series of reports on public health and medical subjects prepared under the direction of the British Ministry of Health—is monumental, both as a record of a mass of admirable laborious and well co-ordinated scientific work and as commemorative of one of the greatest scourges of our time. The pandemic with which it deals damaged and distressed millions of men and women, destroyed in six months more human lives than did the European war of five years’ duration, and was responsible for 150,000 deaths in England and Wales alone. The report must be received with grateful recognition of the ability and pains that have been bestowed on it, with keen interest in its vivid portraiture of a terrible malady in all its phases and relations, and yet with profound disappointment, for, notwithstanding all that 'has been done, the mystery of influenza remains unexplained, and there seems to be but little prospect of immunity from it, in the near future, at any rate. TRUE CAUSE NOT YET DETERMINED. The true cause of influenza is not yet determined, although several organisms are under grave suspicion, and the probability is that until great social changes still remote have abolished tlie soil congenial to the seeds of the pestilence, we shall have visitations of it from time to time as in the past. What is the world’s outlook upon future pestilences or dangers of t'his pestilence? “The answer to that,” says Sir George Newman, in his singularly lucid and comprehensive introduction to the report, “is gloomy.” No instructed epidemiologist can say that the world may not have to endure during the next half century other outbreaks of influenza of the first order of severity. And yet there is no ground for despair. The Report affords a solid basis for further study and research. The lesson taught by it is the urgent need for more epidemiological and bacteriological investigation, especially in connection with what are called “common colds,” which often assume a highly infectious form and are so linked up with influenza. It may be long before we attain to a control over influenza, like that which we now possess, if we choose to exercise it, over smallpox, malaria, plague or typhus fever, but even now we can by appropriate administrative methods and by certain precautionary measures do much to restrict its propagation and ravages. MORTALITY AMONG ALL CLASSES. In the recent epidemic the mortality was as great amongst the well-to-do as amongst the poor, and it became clear that domestic overcrowding was not a principal factor in the spread of the disease; but it must not, therefore, be supposed that social conditions played no part in the matter, and it will be safe to hold that sanitary environment and the nutrition of the individual, with an improvement of the standard of health, will increase resistance to influenza. How to avoid influenza is the question which will chiefly interest the public in the event of its again becoming epidemic amongst us, and in that connection the main fact to be borne in mind is that the infection is apparently conveyed by the secretions of the respiratory surfaces. In coughing, sneezing and even in loud talking the virus is conveyed through the air for a considerable distance as spray, and it is through the respiratory passages—the mouth, nose and throat —that it affects a lodgment in the system. The spread of the disease is therefore favored by the crowding together of the healthy and the sick, and those desirous of escaping it should as much as possible, as the Report insists, avoid crowded rooms and assemblages and conveyances. Well ventilated rooms, schools and workshops afford some defence, and ther£ should be immediate destruction of all discharges from the nose and mouth, and prompt isolation of those who are taken ill. DOUBTS AND DIFFICULTIES. Influenza has always been surrounded on all hands by doubts and difficulties, and new doubts and difficulties have sprung up in the last pandemic. One of its peculiar features was its wave form, it presented itself in three great waves, Which differed greatly from each other. The first was short, sharp, and high; the second flatter, higher and more destructive; the third lower and prolonged in decline—a condition of things which suggests a biological factor modified by environment, but not unhappily directly controlled by human agency.

It has been suggested that the first wave in 1918 of the “three days’ fever type” was started a'nd disseminated by men on furlough from France, who came over suffering from influenza of a comparatively mild type, and that the second wave in October and November developed from the first, the virus having acquired an enhanced violence and power of diffusion on having been reinforced by some new infective agent, and the third wave in February and March, '1919, corresponded with a decline in the activity of the virus, perhaps derived from America. But all this is hypothetical, does not really explain the unJulatory advance of the disease, and the possible influence of meteorological conditions in promoting or arresting its progress must not be ignored. THOSE AFFLICTED.

The report is remarkably fair and cautious in weighing hypothesis, and gives no support to specious and uncorroborated theories, being content to leave the inexplicable unexplained. It does not, for instance, attempt to supply any authoritative solution of the changed type of age distribution which characterised the recent epidemic, merely setting forth the various explanations offered without committing itself to any one of them. What was the meaning of the change of age incidence? Was it that the older persons in the population enjoyed exemption owing to attacks in previous epidemics? No, that explanation will not do, because it does not apply to the young, and because the evidence is that the degree of .immunity conferred by attacks of influenza is slight, transient and incomplete. Was it due to the aggregation for war purposes of soldiers in eamps and barracks?'or of young men and women in munition works?

No, because the change of age incidence was the same in non-belligerent countries, not subject to new aggregations of population. Was it due to a debilitated condition of the adolescent ancT the adult population due to war strain and exposure? No, because populations not subjected to these unfavorable circumstances were affected in exactly the same way. Was it due to a new strain of infecting virus, to which adolescent and adult tissues were especially susceptible? No, because there is no evidence of the importation of such a new strain of virus, because the aggravated character of the disease which would be attributable to the assumed new strain of virus had manifested itself sporadically in England, France, and America in the years preceding the pandemic, and because the changed age incidence displayed itself in 'the mild three-day type as well as in the second and more severe wave of fatal septicaemia. The changed age incidence which was peculiar to the whole of the pandemic under diverse conditions of economic, social and racial environment remains unexplained. 151,146 LIVES SACRIFICED. It is desirable that the substance of this highly instructive report should be brought prominently and persisteintly before the public, for the terrible effects of influenza are even now very imperfectly realised. The last epidemic came at a time when the excitement, sorrows, and anxieties of the war were still reverberating, and the alarm it created Vas evanescent, but, it should always be borne in mind that in its three great waves 151,146 lives were sacrificed in England and Wales, and that it caused immeasurable suffering and disability. Df. French’s pictures of “heliotrope cyanosis” bring home to us its clinical terrors, and a grim touch in Dr. Niven’s contribution to the report recalls Defoe. “Duing the height of the epidemic in Manchester,” he says, “when there were as many as 46,273 cases in one Week, there was difficulty in getting the dead buried, partly because of the lack 61 gravediggers, and partly because of the difficulty in getting coffins. Bodies /Were left as long as a fortnight unburied.”