- Email: [email protected]
PREPARATIONS FOR AN INFLUENZA EPIDEMIC.
270 this respect we are perhaps somewhat ahead of our American colleagues. Professor DREYER’S attempt to put the agglutination reaction on a quantitative basis is an example of the kind of work which, we take it, the American journal would like to see done. Perhaps the admirable series of reports now being issued by the Medical Research Com" mittee on the Standardisation of Pathological Methods" will lead to an improvement in the general reliability of laboratory work. The reports already issued by the Committee include one on the method of standardising bacteriological media-a matter obviously of first-rate importance-one on the laboratory diagnosis of gonococcal infections and the detection of spirochsetes, and two on the Wassermann reaction and its diagnostic value. They are written by experts in each subject and contain the detailed information which even the largest text-books omit for want of space. Incidentally, chemical manufacturers have an unrivalled opportunity of supplementing such work-and of reaping large profits—by supplying
chemicals of guaranteed purity. All this work is to the good, but it should not be forgotten how near it approaches to dangerous ground. Beyond certain limits we trench upon a question of fundamental importance in science, that of the foundation of authority. We may unify the simpler methods, which are based on precise knowledge, and no harm follows. Indeed, the general tendency is towards simplification as our knowledge of principles grows. But attempts to bring about complete uniformity in the technique of biological reactions, which are yet only partially understood, would hinder rather than help progress. Standardisation must have behind it work which has been often verified and is generally accepted; and original work must not be limited by any suggested rule. It is still beyond the wit of man, or of committees, to devise any scheme which shall absolve us from the necessity for critical reading and study. So in the endeach man must make his own choice out of the multiplicity of methods open to him.
Annotations. " Ne quid nimis. "
PREPARATIONS
FOR AN
INFLUENZA EPIDEMIC.
THE Ministry of Health has issued an intimation to the public of the possible recrudescence of influenza in this country, resuming a Memorandum issued in December last to Local Authorities. The facts reaching the Ministry from sporadic sources in England and Wales, as well as the prevalence of the disease in Japan and India in the east, and in the United States in the west-to say nothing of reports from Central Europe-make it probable that an epidemic Readers of may again develop in this country. THE LANCET will recall that early in November last Dr. John Brownlee, the Director of Statistics at the Medical Research Committee, suggested that an epidemic could be anticipated, by a right reading of the figures, somewhere about the end of January. The prediction was made tentatively, the capricious behaviour of epidemics being noted, and Dr. Brownlee tied himself down to dates in no close manner ; but he gave a warning which should not have been neglected, especially in view of the Memorandum of the Ministry of Health. The advice now given by the Ministry to the public, to the Local Authorities, and to those who will have charge of the sick will be found summarised below. It is in essentials an insistence upon counsel that has been previously issued; therefore we may trust that the warning is being addressed to enlightened hearers, who may have already considered in advance the procedure which should be adopted if the day of trial arrived. Under the heading of prophylaxis nothing very definite is said by the Ministry upon the value of inoculation, nor can medical science expect a pronouncement. We are dealing with a disease whose actual causal agent, or combination of agencies, is
though considerable evidence exists, from the 1918 epidemic, that inoculation has done good work in certain groups of cases. It is obvious that in this direction wide as well as concentrated research should be undertaken. The problem is a difficult one, and to stop out many of the sources of error which are present will require great industry and logical powers. Now is the time for their application, with past facts recorded recently and new ones arriving. Although the latest official returns do not THE Mary Putnam Jacobi Fellowship of$800 indicate any ominous or sudden increase of deaths (about £200) is offered by the Women’s Medical Association attributable to either influenza or pneumonia of an of New York City for post-graduate study in any country to infectious type, the Ministry of Health, drawing any woman physician for work in any medical science. For full particulars apply Dr. C. M. Murrell, 86, Porchester- special and public attention to its recent Memorandum, reminds us of the infectious nature of terrace, London, W. 2. influenza. The following advice, not for incipient UNIVERSITY OF CARDIFF.-Sir Edward Sharpey Schafer visited Cardiff recently and delivered an interest- the first time, is given to the public, the patients, ing address in the large lecture theatre of the new physio- and those who have charge of them :logical department. He discussed, very appropriately, the
construction of laboratories and hospitals of medical schools, and pointed out the inexpediency and folly of placing such buildings in great cities on confined and expensive sites with no room to expand, except at prohibitive cost. He advocated and illustrated the American method of obtaining, while land is reasonably cheap, a campus far beyond all immediate requirements. He pointed out that local authorities are longer lived than the men who at any time constitute them, and that they must plan ahead for 200 years or so, otherwise their reputations will suffer at the hands of future generations, who will have to shoulder their mistakes, instead of inheriting the fruits of their foresight. The address was listened to with interest by a receptive and representative audience.
unknown,
emerging
Prophylaxis.
Infection may be guarded against by :-
Healthy and regular habits and avoidance of fatigue, chill, alcoholic excess, crowded meetings, hot rooms. and unnecessary travelling. There should be good ventilation in working and sleeping rooms, and warm clothing should be worn. Gargling is recommended from a tumbler of warm water, to which has been added enough permanganate of potash to give the liquid a pink colour. A vaccine against influenza has been prepared by the Ministry of Health and is available for general use. following the War Office procedure.
271 It is issued to medical officers of health for distribution free of charge among doctors, and any person who wishes to be vaccinated should apply to his own practitioner. To obtain its value the vaccine should be used before the epidemic occurs. The procedure is not necessarily protective, but it may lessen the risk of the dangerous ensuing complications.
the world. As regards the prevalence of the disease at home, information comes from the weekly returns of influenza mortality in the 96 great towns issued by the Registrar-General, and from returns of cases of acute influenzal-pneumonia, the notification of which is now obligatory on all medical practitioners in England and Returns of cases of influenza are also furnished every week by a number of schools, institutions, and representative industrial firms throughout the country. All data on the subject, statistical as well as scientific, come before an Influenza Committee, which is a Medical Standing Committee of the Ministry of Health, holding frequent meetings, and on which sit representatives of the various Medical Departments in Whitehall. A vaccine against influenza has been prepared by the Ministry and is now being issued on demand to medical officers of health for distribution, free of charge, among medical practitioners within their districts. It is not guaranteed that this vaccine will in all cases necessarily protect from attack, but the experience of the military authorities, and of the eminent bacteriologists consulted by the Ministry, justifies the belief that the use of this vaccine will, in many cases, actually protect from attack, and should such attack occur the person who has been vaccinated beforehand will be less exposed to the risk of complications. It should be added that steps have been taken -to protect the country as far as may be from the introduction of influenza. through the ports. The further activity of the Ministry may be conveniently grouped under the headings of education and research. The knowledge and experience accumulated during recent epidemics have been collected and issued to local authorities at various times in the last 12 months. Within the last few days a leaflet has been issued for popular use (see above), and setting out the best measures of guarding against infection, together with advice to patients as to the best known means of securing a speedy return of convalescence and the avoidance of those complications which constitute the special danger of infiuenza. Meanwhile, much active research continues by the medical officers of the Ministry into the causes of epidemics of influenza. Special inquiry is being made in selected districts into such questions as immunity, the effects of overcrowding, incidence according to age, and so on. The medical officers who are conducting these investigations are in close touch with the work which is being carried on by other investigators, and are making their inquiries in collaboration with the Medical Research Committee. Wales.
voluntarily
Advice to Patients and Nurses. In the event of an attack of influenza the patient is advised to adopt the following measures to secure rapid recovery without complications :— At the first feeling of illness, or immediately on a rise of temperature, the patient should leave his work, go home, and go to bed ; he should keep warm and should send for the doctor. On convalescence the patient should avoid meetingand places of entertainment for at least one week after his temperature has become normal. Recovery should be fully established before return to work.
places
Persons nursing influenza patients are instructed that the sick should occupy a screened-off bed or a room until the temperature is normal. warmth should be secured, ventilation Though should be free. Inhalation of the patient’s breath or contamination from sneezing or coughing should be avoided, and the hands washed after contact.
separate
Advice to Local Author°ities. Local Authorities are urged to consider in advance of an epidemic the advice issued in the Memorandum, stress being laid upon the following :The immediate appointment of an emergency committee. Scheme for cooperation with medical practitioners and voluntary health workers. Provision of nursing. Subdividing the district for anti-influenza work. Provision of home helps. The utilisation of the local authority’s staff.
Emergency hospital provision. The prevention or mitigation of overcrowding, especially in public vehicles. Workers who are obviously ill should be sent or taken home at once.
vaccine, prepared by the Royal Army Medical College and supplied by the Government Lymph Establishment (Colindale-avenue, The Hyde, London, N.W. 9), is issued gratuitously to medical officers of THE STRUGGLE FOR EXISTENCE AMONG LOCAL health and through them to medical practitioners AUTHORITIES. who desire to use it. They are requested to keep DURING the careful notes in respect of each person inoculated, past few weeks portions of the of the name, address, sanitary district, age, sex, country have become the scene of an interesting dates of previous attacks of influenza, date of and significant struggle between local authorities, present inoculation, and subsequent history, so that some seeking to expand, and others, to maintain, trustworthy figures may be obtained as to the their civic boundaries. The storm-centre has been in Yorkshire, where some half-dozen of the larger results of inoculation. cities and boroughs are severally seeking powers Action in Advance. from Parliament to engulf adjoining districtsThe Ministry of Health announced on Thursday already in some instances flourishing communities by the same act to deprive the County morning that during the months in which the —and of the West Riding of an important Council country has been free from epidemic influenza the While this of its administrative area. portion investigations into the circumstances and conditions which lead to a spread of the disease have form of warfare is by no means a new phenomenon, been conducted, so that, should another epidemic the period of comparative quietude produced by occur within the next few weeks, it will find the concentration on a greater war, followed as it now fury of desire for a more concountry better equipped in respect both of theory is by this sudden spicuous place in the sun, has brought into and practice to meet the attack. They state:relief the issues underlying the moveThe Ministry keep a constant watch on the occurrence unexpected of influenza at home and abroad and have put them- ment. Let it be granted that the contest brings to selves in a position to observe closely the progress of light a number of unedifying traits ; that its aspect any epidemic wherever it may occur. Information is of self-aggrandisement, or so-called civic pride, derived from returns as to epidemics obtained from leaps to the eye ; that it is selfish in its lack of The
Consular Agents
and from other official
sources
all
over
consideration
for the needs and desires
of the
chemicals of guaranteed purity. All this work is to the good, but it should not be forgotten how near it approaches to dangerous ground. Beyond certain limits we trench upon a question of fundamental importance in science, that of the foundation of authority. We may unify the simpler methods, which are based on precise knowledge, and no harm follows. Indeed, the general tendency is towards simplification as our knowledge of principles grows. But attempts to bring about complete uniformity in the technique of biological reactions, which are yet only partially understood, would hinder rather than help progress. Standardisation must have behind it work which has been often verified and is generally accepted; and original work must not be limited by any suggested rule. It is still beyond the wit of man, or of committees, to devise any scheme which shall absolve us from the necessity for critical reading and study. So in the endeach man must make his own choice out of the multiplicity of methods open to him.
Annotations. " Ne quid nimis. "
PREPARATIONS
FOR AN
INFLUENZA EPIDEMIC.
THE Ministry of Health has issued an intimation to the public of the possible recrudescence of influenza in this country, resuming a Memorandum issued in December last to Local Authorities. The facts reaching the Ministry from sporadic sources in England and Wales, as well as the prevalence of the disease in Japan and India in the east, and in the United States in the west-to say nothing of reports from Central Europe-make it probable that an epidemic Readers of may again develop in this country. THE LANCET will recall that early in November last Dr. John Brownlee, the Director of Statistics at the Medical Research Committee, suggested that an epidemic could be anticipated, by a right reading of the figures, somewhere about the end of January. The prediction was made tentatively, the capricious behaviour of epidemics being noted, and Dr. Brownlee tied himself down to dates in no close manner ; but he gave a warning which should not have been neglected, especially in view of the Memorandum of the Ministry of Health. The advice now given by the Ministry to the public, to the Local Authorities, and to those who will have charge of the sick will be found summarised below. It is in essentials an insistence upon counsel that has been previously issued; therefore we may trust that the warning is being addressed to enlightened hearers, who may have already considered in advance the procedure which should be adopted if the day of trial arrived. Under the heading of prophylaxis nothing very definite is said by the Ministry upon the value of inoculation, nor can medical science expect a pronouncement. We are dealing with a disease whose actual causal agent, or combination of agencies, is
though considerable evidence exists, from the 1918 epidemic, that inoculation has done good work in certain groups of cases. It is obvious that in this direction wide as well as concentrated research should be undertaken. The problem is a difficult one, and to stop out many of the sources of error which are present will require great industry and logical powers. Now is the time for their application, with past facts recorded recently and new ones arriving. Although the latest official returns do not THE Mary Putnam Jacobi Fellowship of$800 indicate any ominous or sudden increase of deaths (about £200) is offered by the Women’s Medical Association attributable to either influenza or pneumonia of an of New York City for post-graduate study in any country to infectious type, the Ministry of Health, drawing any woman physician for work in any medical science. For full particulars apply Dr. C. M. Murrell, 86, Porchester- special and public attention to its recent Memorandum, reminds us of the infectious nature of terrace, London, W. 2. influenza. The following advice, not for incipient UNIVERSITY OF CARDIFF.-Sir Edward Sharpey Schafer visited Cardiff recently and delivered an interest- the first time, is given to the public, the patients, ing address in the large lecture theatre of the new physio- and those who have charge of them :logical department. He discussed, very appropriately, the
construction of laboratories and hospitals of medical schools, and pointed out the inexpediency and folly of placing such buildings in great cities on confined and expensive sites with no room to expand, except at prohibitive cost. He advocated and illustrated the American method of obtaining, while land is reasonably cheap, a campus far beyond all immediate requirements. He pointed out that local authorities are longer lived than the men who at any time constitute them, and that they must plan ahead for 200 years or so, otherwise their reputations will suffer at the hands of future generations, who will have to shoulder their mistakes, instead of inheriting the fruits of their foresight. The address was listened to with interest by a receptive and representative audience.
unknown,
emerging
Prophylaxis.
Infection may be guarded against by :-
Healthy and regular habits and avoidance of fatigue, chill, alcoholic excess, crowded meetings, hot rooms. and unnecessary travelling. There should be good ventilation in working and sleeping rooms, and warm clothing should be worn. Gargling is recommended from a tumbler of warm water, to which has been added enough permanganate of potash to give the liquid a pink colour. A vaccine against influenza has been prepared by the Ministry of Health and is available for general use. following the War Office procedure.
271 It is issued to medical officers of health for distribution free of charge among doctors, and any person who wishes to be vaccinated should apply to his own practitioner. To obtain its value the vaccine should be used before the epidemic occurs. The procedure is not necessarily protective, but it may lessen the risk of the dangerous ensuing complications.
the world. As regards the prevalence of the disease at home, information comes from the weekly returns of influenza mortality in the 96 great towns issued by the Registrar-General, and from returns of cases of acute influenzal-pneumonia, the notification of which is now obligatory on all medical practitioners in England and Returns of cases of influenza are also furnished every week by a number of schools, institutions, and representative industrial firms throughout the country. All data on the subject, statistical as well as scientific, come before an Influenza Committee, which is a Medical Standing Committee of the Ministry of Health, holding frequent meetings, and on which sit representatives of the various Medical Departments in Whitehall. A vaccine against influenza has been prepared by the Ministry and is now being issued on demand to medical officers of health for distribution, free of charge, among medical practitioners within their districts. It is not guaranteed that this vaccine will in all cases necessarily protect from attack, but the experience of the military authorities, and of the eminent bacteriologists consulted by the Ministry, justifies the belief that the use of this vaccine will, in many cases, actually protect from attack, and should such attack occur the person who has been vaccinated beforehand will be less exposed to the risk of complications. It should be added that steps have been taken -to protect the country as far as may be from the introduction of influenza. through the ports. The further activity of the Ministry may be conveniently grouped under the headings of education and research. The knowledge and experience accumulated during recent epidemics have been collected and issued to local authorities at various times in the last 12 months. Within the last few days a leaflet has been issued for popular use (see above), and setting out the best measures of guarding against infection, together with advice to patients as to the best known means of securing a speedy return of convalescence and the avoidance of those complications which constitute the special danger of infiuenza. Meanwhile, much active research continues by the medical officers of the Ministry into the causes of epidemics of influenza. Special inquiry is being made in selected districts into such questions as immunity, the effects of overcrowding, incidence according to age, and so on. The medical officers who are conducting these investigations are in close touch with the work which is being carried on by other investigators, and are making their inquiries in collaboration with the Medical Research Committee. Wales.
voluntarily
Advice to Patients and Nurses. In the event of an attack of influenza the patient is advised to adopt the following measures to secure rapid recovery without complications :— At the first feeling of illness, or immediately on a rise of temperature, the patient should leave his work, go home, and go to bed ; he should keep warm and should send for the doctor. On convalescence the patient should avoid meetingand places of entertainment for at least one week after his temperature has become normal. Recovery should be fully established before return to work.
places
Persons nursing influenza patients are instructed that the sick should occupy a screened-off bed or a room until the temperature is normal. warmth should be secured, ventilation Though should be free. Inhalation of the patient’s breath or contamination from sneezing or coughing should be avoided, and the hands washed after contact.
separate
Advice to Local Author°ities. Local Authorities are urged to consider in advance of an epidemic the advice issued in the Memorandum, stress being laid upon the following :The immediate appointment of an emergency committee. Scheme for cooperation with medical practitioners and voluntary health workers. Provision of nursing. Subdividing the district for anti-influenza work. Provision of home helps. The utilisation of the local authority’s staff.
Emergency hospital provision. The prevention or mitigation of overcrowding, especially in public vehicles. Workers who are obviously ill should be sent or taken home at once.
vaccine, prepared by the Royal Army Medical College and supplied by the Government Lymph Establishment (Colindale-avenue, The Hyde, London, N.W. 9), is issued gratuitously to medical officers of THE STRUGGLE FOR EXISTENCE AMONG LOCAL health and through them to medical practitioners AUTHORITIES. who desire to use it. They are requested to keep DURING the careful notes in respect of each person inoculated, past few weeks portions of the of the name, address, sanitary district, age, sex, country have become the scene of an interesting dates of previous attacks of influenza, date of and significant struggle between local authorities, present inoculation, and subsequent history, so that some seeking to expand, and others, to maintain, trustworthy figures may be obtained as to the their civic boundaries. The storm-centre has been in Yorkshire, where some half-dozen of the larger results of inoculation. cities and boroughs are severally seeking powers Action in Advance. from Parliament to engulf adjoining districtsThe Ministry of Health announced on Thursday already in some instances flourishing communities by the same act to deprive the County morning that during the months in which the —and of the West Riding of an important Council country has been free from epidemic influenza the While this of its administrative area. portion investigations into the circumstances and conditions which lead to a spread of the disease have form of warfare is by no means a new phenomenon, been conducted, so that, should another epidemic the period of comparative quietude produced by occur within the next few weeks, it will find the concentration on a greater war, followed as it now fury of desire for a more concountry better equipped in respect both of theory is by this sudden spicuous place in the sun, has brought into and practice to meet the attack. They state:relief the issues underlying the moveThe Ministry keep a constant watch on the occurrence unexpected of influenza at home and abroad and have put them- ment. Let it be granted that the contest brings to selves in a position to observe closely the progress of light a number of unedifying traits ; that its aspect any epidemic wherever it may occur. Information is of self-aggrandisement, or so-called civic pride, derived from returns as to epidemics obtained from leaps to the eye ; that it is selfish in its lack of The
Consular Agents
and from other official
sources
all
over
consideration
for the needs and desires
of the