WEAPONS AGAINST INFLUENZA. Am J Public Health (N Y). 1918;8(10):787-788. doi:10.2105/ajph.8.10.787
"When you get back home, hunt up your wood-workers and cabinet-makers and set them to making coffins. Then take your street laborers and set them to digging graves. If you do this you will not have your dead accumulating faster than you can dispose of them."
WEAPONS AGAINST INFLUENZA.
Early in October a representative of a midwestern health department went East in order to secure information as to the best-known methods of combating influenza. A number of prominent sanitarians began with this advice: "When you get back home, hunt up your wood-workers and cabinet-makers and set them to making coffins. Then take your street laborers and set them to digging graves. If you do this you will not have your dead accumulating faster than you can dispose of them." They then went on to discuss the measures which had been tried with varying success for fighting the disease itself.
The object of the foregoing suggestion was not to appear sensational or to cause undue alarm; it was a sincere effort to point out a practical condition which would probably have to be met. Very few health officers, and no communities, appreciate the terrific devastation of the epidemic until it strikes them. It has been utterly unlike any plague which has yet visited this country.
Exact statistics concerning the prevalence of influenza among the general population are not available. It seems, however, that no less than 25 per cent of the population are taken ill in communities where the disease strikes. Very roughly, the fatality seems to range within 3 and 5 per cent of the cases.
Boston, with a total population of less than 800,000, has had about 4,000 deaths from the beginning of the disease early in September to October 19. In other words, .5 of 1 per cent of the population has succumbed. If the rest of the country is afflicted in the same proportion, it is not unlikely that there will be a half-million deaths from the disease; that is, about half as many as died from all causes last year; or far more than fifty times as many as have been killed in the American army in the present war.
If the rest of the country is afflicted in the same proportion, it is not unlikely that there will be a half-million deaths from the disease; that is, about half as many as died from all causes last year; or far more than fifty times as many as have been killed in the American army in the present war.
Among the prophylactic measures have been employed in the East: the conventional precautions against contact infection, the face mask, and anti-influenza vaccine.
Among the curative measures have been advocated: the open-air treatment, the use of serum from convalescent patients, and again, anti-influenza vaccine.
In the reduction of contact infection, the face mask, the stagger-hour system of transportation, the education of the public in personal hygiene, and the closing of schools, assemblies, etc., have probably helped somewhat. There seems to be little hope for controlling the epidemic along these lines, however, for the scourge is more communicable than measles.
In the reduction of contact infection, the face mask, the stagger-hour system of transportation, the education of the public in personal hygiene, and the closing of schools, assemblies, etc., have probably helped somewhat.
As for the vaccine, the Massachusetts scientific and statistical commissions have concluded that it has no therapeutic effect,* that the prophylactic effect merits further investigation, and that no ill effects follow the use of the vaccine. The South Department of the Boston City Hospital reports 46 vaccinations, none of which were followed by influenza; on the other hand, of the remaining 88 attendants and patients, 28 contracted the disease - about a third.
Another analysis from the same figures shows that of 32 vaccinated nurses none contracted influenza; 8, who had been incompletely vaccinated, contracted mild cases. The remaining 4 nurses refused to be vaccinated: of these, two developed influenza and died.
At Wrentham (Mass.) State School, 66 vaccinations are said to have been followed by 6 mild cases, and no fatal cases. One incompletely vaccinated individual developed a fatal case. Of the remaining 58, who were not vaccinated, 33 sickened, and one died.
The results which are available are interesting and suggestive, but not conclusive; for they all have the weakness that vaccination was not begun until influenza had developed in the institution, and had taken down a number, possibly the most susceptible, who might have taken the disease even if vaccinated. But while we wait for more conclusive statistics, the epidemic rages; any community is, therefore, justified in employing the vaccine, for it is safer to gamble with the cost of preparing and administering the vaccine than with the lives endangered. It will be well to emphasize to the public that the vaccination is experimental, and is not compulsory; otherwise, in the event of its ultimate failure, the whole system of vaccination may be discredited by the public, including that against smallpox, typhoid, etc.
It will be well to emphasize to the public that the vaccination is experimental, and is not compulsory; otherwise, in the event of its ultimate failure, the whole system of vaccination may be discredited by the public, including that against smallpox, typhoid, etc.
Turning to therapeutic efforts, the serum described in this issue by McGuire and Redden seems promising and should by all means be tried. As with vaccine, however, it is too early to make definite statements.
The open-air treatment of Brooks was found by the Massachusetts State Health Department to be the most valuable factor in reducing mortality. Apparently the fatality of hospital cases was reduced from 40 per cent to about 13 per cent by the treatment. An invaluable incident to this treatment is the fact that in the open air, the immunity of the nurses and physicians is enormously increased, leaving them to carry out the great amount of work confronting them.
What should health officers do in those communities where the disease has not yet struck? Shall they build fences to try to keep people from falling off the cliff or shall they invest in ambulances to take care of those who will have fallen?
It must be confessed that to date the preventive measures have not averted the epidemic. It would seem advisable for the health officer first to organise his open-air hospitals and relief agencies as far in advance as possible; let him organize for efficiency the doctors, nurses, social workers, teachers, and volunteers. Money and assistance will be easy to get, for the public has been aroused. With one in two hundred persons of the stricken populations dying, no community will criticise the health officer who may have prepared too thoroughly.
The health officer should also put into effect with great vigor all of the preventive measures at his disposal. Let him not neglect, however, to plan for those who are sure to become sick - and as pointed out to the investigator in the first paragraph - for those who will die.
Regrettable and discouraging as it is, we must nevertheless admit that in this specific catastrophe, the ambulance possibly will help more than the fence.
What should health officers do in those communities where the disease has not yet struck? Shall they build fences to try to keep people from falling off the cliff or shall they invest in ambulances to take care of those who will have fallen?
...
Regrettable and discouraging as it is, we must nevertheless admit that in this specific catastrophe, the ambulance possibly will help more than the fence.
* See the notes section of this issue, p. 802.
Massachusetts. - Influenza apparently first reached Boston about August 25, and by the middle of September had reached epidemic proportions. On October 4, the disease was made reportable over the state, and from 6,000 to 8,000 cases were reported daily. The fatality is very high - about 5 per cent. By October 12, influenza was on the decline in Boston, only about 120 deaths being reported daily from influenza and pneumonia, as opposed to 200 when the epidemic was at its height. However, the western part of the state, which was attacked later, was becoming more seriously involved about the middle of October.
The most credible available evidence tells us that our Leary, not widely recognized now, was the great uncle of the hallucinogen-loving, publicity-seeking younger namesake.
Dr. E. R. Kelley appointed two committees to study the value of an influenza vaccine prepared by Dr. Timothy Leary of Tufts Medical School. The Board of Scientific Investigation, consisting of Drs. M. J. Rosenau, D. W. McCoy and Frederick F. Gay, concluded as follows:
1. The evidence at hand affords no trustworthy basis for regarding prophylactic vaccination against influenza as of value in preventing the spread of the disease, or of reducing its severity. The evidence from the present epidemic, though meagre, suggests that the incidence of the disease among the vaccinated is smaller than among the non-vaccinated. The Board, therefore, concludes that further experimental evidence should be collected.
2. The evidence at hand convinces the Board that the vaccines we have considered have no specific value in the treatment of influenza.
3. There is evidence that no unfavorable results have followed the use of the vaccines.
The Board of Statistical Investigation reached substantially the same conclusions. It consisted of the following: Prof. G. C. Whipple, Dr. W. H. Davis, Dr. Frederick C. Crum. It was further pointed out that open air treatment and the use of face masks were effective in protecting exposed persons.
It is recommended that the distribution of influenza vaccine be encouraged for prophylactic use in order to obtain further experimental evidence,but that the State neither furnish nor endorse the vaccine at present for therapeutic use.
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