The Influenza Pandemic Again
By James J. Walsh, M.D, Ph.D.
[The Independent, October 19, 1918]
INFLUENZA is with us once again as a pandemic disease, that is, as an infection which spreads thruout the world, affecting every people, especially in the routes of commerce. We say once again because the affection has occurred as a pandemic frequently since the sixteenth century, that is, as long as the records of such diseases have been kept. There is evidence of' outbreaks of it before that time, but without printing facilities, definite records are lacking. There were no less than four pandemic influenza periods in the nineteenth century, 1830-33, 1836-37, 1847-48, and the one that is recalled best, that of 1889-90. Most of these later, epidemics, if not all, have originated in the East, usually being, noted first in some European country, where it raged with virulence, and receiving the name of that country for a time. The epidemic before this, beginning in Russia, was at first called Russian influenza; this one is called for a similar reason Spanish influenza.
The duration of an epidemic in any one locality is usually under two months. During the time that it is particularly virulent, however, there is probably no disease which attacks so large a proportion of the inhabitants of a region. Some have suggested that as high as 50 per cent of the inhabitants of affected localities as likely to catch the disease and the conservative estimate is 40 per cent, Fortunately, the mortality rate is very low. In adult life, below fifty years of age, probably not more than one-tenth of one per cent die. In the general population, because of the number of weaklings and the old, the death rate is higher and yet it is estimated "to be less than one half of one per cent. Most of the deaths are due to a pneumonia complication.
The disease is probably always due to a specific bacillus of a microbe family described by Pfeiffer, some strains of which are much more virulent than others. Apparently, the bacillus gathers vigor and, virulence among some Eastern people who are of lower resistive vitality, or who for some special reason, war, famine, or a particularly hard winter, are run down in health, and then this particular strain of bacilli which have gathered strength in the weak subjects attacked, prove capable of overcoming whatever immunity may be present in even very healthy individuals.
The disease does not travel thru the air, but is conveyed directly from one individual to another and is a true contagion requiring contact, direct or indirect. The bacillus exists in the secretions of the nose, throat and lungs, and may be scattered thru the air by sneezing or coughing. Hence the necessity for all during an influenza epidemic, using, their handkerchiefs to cover mouth and nose whenever they cough or sneeze and avoid expectoration except under conditions where the sputum cannot be a medium for the communication of the disease. There is no doubt in the minds of physicians now that many of these respiratory diseases are caught not thru the respiratory tract but thru the digestive tract. This is surely true of tuberculosis in a great many cases. Hence the necessity for all in time of influenza epidemic washing the hands carefully before eating.
A great many people look around for medicaments that may protect them from the affection, but there are none. The mouth should be kept thoroly clean, but this should be done gently, for such hard rubbing of the gums as produces bleeding would rather predispose to the affection. Only very mild antiseptics should be used in the mouth and for gargling and the nose, otherwise the cells of the mucous membrane may be injured sufficiently to make them less capable of resisting invasion. Good, healthy living, plenty of outdoor air, especially in the sunlight, a sufficient amount but not too much sleep, for that is relaxing, the avoidance of crowds and careful cleansing, these are the best preventives that we have.
The attack usually begins with fever, some pains in the bones and usually some nasal catarrh. Just as soon as fever declares itself, the patient should get to bed and stay in bed until the fever comes down. There is always grave danger of severe complications setting up unless this rule is faithfully observed. The pains in the bones, which occur very often at an early stage of the disease, are an index of a special call being made on the blood making organs, of which the bone marrow is one of the most important. This tendency of the disease to impoverish the blood, predisposes to heart and other complications. It emphasizes the need for rest which should be continued until the extreme feeling of prostration, often associated with the disease, is relieved. The affection does not as a rule, even in its pandemic form, much increase the general mortality. It carries off those who would be taken by other affections during the season and a few more. With care it can be entirely avoided.
© J. Fred MacDonald, 2013
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THE HEADLONG FURY
A Novel of World War One
By J. Fred MacDonald