CHAPTER IV.
Contents—Effect of Influenza on Man; Pulmonary Influenza or Influenza-Pneumonia; Immunity; Incubation; Salient Points; Quarantine; Cause of “Flu”; Why Microbes Created; Flu Preventatives; Hours When Flu Attacks; Salient Points.
Effect of Influenza on Man.When the Influenza Bacillus or Microbe has gained access to the system of man, it speedily produces an acute infectious toxaemia or blood poisoning, due to the toxin or poison liberated in the blood by the Bacillus; there are also other disease producing micro-organisms found in the sputum or spit of the Influenza victim; these are spheroid or bead shaped and called Cocci (kokkos, a berry, Greek), which apparently aid the B Influenza as allies of destruction to our systems.
The effects of the “Flu” poisoning on the human lung somewhat resembles the conditions seen in those who have died from inhaling strong Chlorine gas, Carbon mon-oxide or Nitrogen gases in an atmosphere devoid of Oxygen.
The type or general character of the “Flu” which has prevailed in Hawaii during the past two years, especially in Honolulu in the months of January, February, March and April, 1920, is the highest development of destructiveness to man, that the B Influenza is capable of. It was the true Russian Catarrh or Malignant “Flu,” and so called by the Italians Catarro Russo and not Influente or Influenza. This type of the “Flu” was reintroduced into the U. S. A. in the spring of 1918.
Pulmonary Influenza or Influenza-Pneumonia frequently complicates the “Flu” in some epidemics, but not in all of them; it is the main cause for the mortality due to that disease.
A century and a half ago the French physicians first demonstrated its peculiarities, and its difference from ordinary Pneumonia, which is as follows:
(a) It develops gradually and complicates the Bronchitis of Influenza.
(b) Its peculiar physical signs are: the respiratory murmur in the early stages of the “Flu” is diminished, and later completely disappears; then bronchial breathing begins without dullness or crepitant rales, like true Pneumonia.
In Hawaii as elsewhere, the complicating Pneumonia seldom appears before the second or third day; occasionally it comes tothe fore after the fifth or sixth; it is not always easy of detection in a mild case. In our epidemic in Honolulu last winter, 1920, some of cases considered as Pneumonia were in fact those of simple Pulmonary congestion and oedema, attended with expectoration of frothy blood-tinged mucus, resembling the swollen or drowned lung found in those who have been submerged and died from drowning.
The true Influenza-Pneumonia sputum or spit is “greenish-yellow,” this greenish color being due to the presence in the sputum of a green pigment excreted by the diplo-coccus or double coccus, like a necklace of beads, or sometimes resembling rounded small rods.
A tendency to T. B., softening of the heart muscle, nervous prostration, insomnia, restlessness and inability for brain work, depression of spirits and irritability of temper, neuralgias, middle ear disease, eye troubles, vertigo or giddiness from the ear disease or eye or heart; stomach disease after intestinal influenza, vomiting spells, etc., etc., emaciation, diarrhoea.
The open air life of the occupants of T. B. hospitals accounts for their freedom from epidemic “Flu”; but they are not immune to every epidemic. Residents of asylums, hospitals, and jails are not so fortunate, numbers of the inmates being attacked; daily rations of quinine should be given.
Paradoxical as the statement may appear, the mild and balmy climate of the Hawaiian Islands, or any other place, neither protects nor prevents any person from being attacked by the Influenza.
A mild climate is not a factor of prevention against any infectious or contagious disease: the dominant agent and king of protectors is an IMMUNITY inherited or acquired.
Climate cannot alter, change or prevent any person from being infected with Small-pox, Plague, Cholera, Scarlet Fever, Typhus or Influenza.
In the presence of King “Flu” all men are not equal, those who have had several attacks of the disease in former years, or have recently had it, are fairly Immune, not absolutely so; but others who have not recently had Flu are liable to become infected with it, and may be stricken at any time.
Good living, careful personal hygiene, fresh air in abundance, avoidance of over heated and poorly ventilated rooms, together with a general high standard of living, are excellent in theirway to prevent ordinary disease; but in so far as they can prevent any one from being infected by the Flu, the absolute protection is entirely lacking in them; none of these very essential hygienic principles can produce IMMUNITY, which is the SOLE protector from an attack, or more than one attack of Influenza, and it is Nature’s standby, and by means of which it braces up the system to convalescence and ultimate recovery.
Successful Vaccination against Small-pox will prevent or render mild an attack of that disease, in 95% of those who have been vaccinated and re-vaccinated. A baby in arms if successfully vaccinated is Immune and protected; whereas an unvaccinated giant living in a balmy climate, should he contract Small-pox, will probably be a candidate for a coffin or the furnace of a Crematory.
A mild climate cannot alter nor render less harmful to the system of man, the specific toxin or poison of Influenza once it is liberated into his blood; nor the toxin of any other micro-organism of the infectious type.
In the combat with disease, many of the advantages of our Hawaiian climate are to a certain extent neutralised by a lack of stamina and disease resistance (and also the neglecting to call in the services of a physician at an early stage of the illness) of some of our inhabitants.
Any person who is affected with symptoms of disease, such as fever, headache, nasal discharge, cough, sore and tickling throat, and lassitude, during the prevalence of Flu, epidemic or sporadic, should take to bed, and by so doing, it may mean and is in line with a quick recovery, and a mild case of that disease: whereas fighting off the disease and struggling to pursue one’s daily avocation may change a mild type of illness to a very grave and hopeless one. In this respect Influenza resembles Typhoid fever of the ambulatory type, the victim does not realize how sick he is, but when the hour comes that exhausted body and brain forces him to seek his bed, it is often too late, and death or prolonged sickness awaits him. Frequently the athlete and the physically strong, when stricken with Flu, refrain from early rest, struggle against the inroads of the disease, exhaust their recuperative powers, and when finally driven to bed, collapse and die: whereas a weaker individual being speedily overcome, gives up and takes early to bed and recovers.
The death rate amongst those who are attacked by the “Flu” varies in each epidemic and pandemic; as a fair average, approximately most recover, say 75%; incomplete recovery 15%; and in the late epidemic in Honolulu, the winter of 1920, the death rate was 8% to 10%; in the U. S. A. it was 4% to 6%; and in Europe 4½%.
INCUBATION.
Great discrepancies occur in the statements of different observers, but inasmuch as each epidemic varies in severity, a severe type of the “Flu” may have a shorter incubative period than a mild type, and therefore taking the variations in type into consideration, may reconcile the differences. If Influenza was accompanied with a facial eruption or exanthem, this would materially assist in the determination of its Incubative period. In Hawaii, two to three days is the most frequent period of Incubation; it may vary, however, from 24 hours to 72 hours, even to five days; in these long incubative cases, headache, aching eyeballs, and great languor are the indicating signs, and those persons so affected succumb slowly and offer great resistance to the overpowering toxins of the Bacillus Influenzae.
The Immunity which a person may possess in one Epidemic and not in another, may be accounted for by assuming that each Epidemic may have a difference in the strain or the species of the Influenza bacillus.
Period of Life. Most cases occur between 20 and 40 years.
In Schools. The older children are first attacked: open air schools are a positive, but not an absolute defense against Infection.
Indoor Schools. The ratio of prevalence amongst children of all ages is 40%.
Outdoor Schools. All ages, the ratio of prevalence is 10%.
Open Air Occupations. Such as workers in the fields, 12% are attacked.
Closed Rooms. Factory Operatives, 49% are attacked.
MAIN FACTOR OF SPREAD. Not the Weather, but HUMAN intercourse, especially Commerce; the greater the speed of Commerce, the greater and quicker is the spread of the Flu; it follows the path of HUMAN travel; it is a Contagion solely spread by HUMAN intercourse, viz. “The Influenza Carrier or Carriers.”
Positions in life, which require contact with Travelers, necessarily influence and spread the disease.
“Flu” is spread in the same ratio of speed as the Carrier of IT.
When the Flu is a weakling, his best Nurses and Foster-Mothers are Overcrowding and lack of Pure Air.
Where the Crowd is, there the Flu is: little crowding means little Flu; plenty of Crowding, plenty of Flu.
QUARANTINE AND ISOLATION.
Period of Isolation, for ordinary Flu patients: 12 days.
Period of Isolation, for Influenza-Pneumonia cases, until the end of Convalescence.
Quarantine and Isolation are beset with difficulties owing to the extraordinary contagious nature of the Flu, due to the multiplicity of Contacts, Carriers, and mild undetected cases.
It should be borne in mind that Influenza is a most refractory disease, and not at any time or season is it under our control, and to bring about this condition is as yet an unsolved problem.
It may attack us at any time, although its favorite period of appearance is the Autumn and Winter months.
Influenza is mainly a Respiratory disease, hence Isolation and Quarantine cannot be relied upon to prevent the spread of the Flu, and both of these restraints of personal liberty and hindrances of commerce must fail, besides being also unpractical and impossible.
People must meet to transact business in public places, must eat and drink in public, use telephones in public places, use public lavatories, and many other acts of public nature; all of these acts cannot be quarantined, nor can talking amongst crowds; even if rigid quarantine rules were enforced, the Flu has hitherto eluded them and spread outside of the quarantined limits.
In the absence of any alleged cause or theory, which can account for the erratic prevalence of the Flu, the Author advances the following:
(a) The Bacillus of Influenza normally cannot exist or thrive in our every-day ordinary atmosphere, constituted of 20% of Oxygen, and 80% of Nitrogen.
(b) Under certain atmospheric conditions, such as any fractional excess above 4–5 Nitrogen, the normal amount present in the air, the Bacillus of Flu can become acclimated and acquires new sources of vitality, viz., the means to exist in the presence of Oxygen, and to thrive and multiply in it, and propagate, in this temporarily changed atmosphere. It speedily becomes imbued with virulent disease producing properties, multiplies on a vast scale, and proceeds to attack and scourge man; hence an Epidemic of Flu is brought into our lives.
(c) Later when the normal atmospheric balance is restored, the Bacillus ceases to be pathogenic or disease producing, loses its power, Facultative or Potential, to multiply and live on a large scale, but certain of the most vigorous members of the Colony survive and remain dormant, and latent, and years or months laterunder the same favorable atmospheric conditions, Nitrogen excess in the atmosphere, become active and produce a New Epidemic of Flu.
Each Epidemic may be considered as a sprouting of the “seed” of the previous or past ones; such seed or microbe is not permanently nursed by any host, such as man or animal, as a carrier; but the Bacillus lies hidden in the dust of rooms, attics, books, packed away clothes, towels, non-sterilized fomites in general, especially blankets and handkerchiefs, wall paper, etc.; on premises which had been occupied by Flu victims or victim, or convalescents from the disease, weeks, months, or years before.
No disease producing microbe can develop itself anew, it must come from the seed of the old stock, whether it be Flu, Typhoid, Plague, T. B., or Small-pox. Like produces, and only can produce like, is an infallible law, and applies to every living microbe, malignant or harmless.
Anything with life, when the entire species is eradicated or destroyed, with no live members or parents surviving, is absolutely gone for ever, save and except the Supreme deity sees fit to regenerate it.
In Honolulu, how uncomfortable we all feel when the South wind prevails, with its excess humid atmosphere; Headaches, Sweats, Sneezing, Lassitude and loss of appetite, etc., affects many of us, and coughs and sore throats; this is the Sick wind or atmosphere, so called by the Hawaiian; a condition of mild Flu producing weather; akin to Nitrogen plus air, and Oxygen minus, which the Author has suggested as an explanation of the cause of dormant Influenza, developing into an Epidemic.
We have an abundance of non-disease producing microbes dwelling in our bodies, and also many other harmless micro-organisms pervade the lower strata of our atmosphere; the upper strata of the air are devoid of microbes, say five miles from the surface of the earth, but inasmuch as human beings cannot breathe in comfort at such a high elevation, we cannot escape germs of disease by residing at great heights.
The harmless microbes inhabiting our bodies are good friends and protectors; disease producing microbes may have been created for the purpose of maintaining a bacterial balance, not too much of one kind nor too little of the other.
If Providence intended to decimate mankind and destroy him by microbic diseases, one species of a deadly and virulent microbe would suffice.
Micro-organisms, in order to live and exist, must find suitable surroundings and pabulum; if these are lacking, they mustperish. Man and animals, in the main, furnish the homes and food which enables a microbe to exist; and when death destroys the “host,” the parasitic microbe still lives in the body of its victim when buried in the ground; hence the necessity for cremation, which is the ideal and most efficient method of disposing of the corpses of those who have died of infectious diseases.
The Creator, by introducing microbic life to our globe, must have intended it to live and propagate; bacteria are provided with a wonderful defense against eradication; this is evident in the protection designed for the Spore or Re-productive element of Bacteria, whose coat or outer cell envelope is one of “the most resisting substances to destruction in the Organic world.”
Agents, that cause other forms of life to succumb, fail to destroy it; the average spore when subjected to a dry heat temperature of 300° Fahr. for one hour is apparently still alive; it requires this same temperature to be maintained for several hours in order to destroy it.
It is an unalterable law of life, that every living species grows old and ultimately perishes; even one day’s existence to a microbe may combine birth, infancy, maturity and old age.
It is impossible to believe or to think, that our Creator is always creating new or fresh supplies of Flu microbes or any kind of the disease producing ones; whether microbes survived the Deluge, or were post Pluvial creations is a moot point? if Noah took microbes into the Ark and preserved them by Divine order, for future liberation amongst mankind, he certainly did his work efficiently in so far as the species of the Influenza bacillus is concerned; it has lost none of its virulency or vigorousness in the year 1920, after living 6,000 years.
Are there any Influenza preventives? Serums, of late years have been the chief agents used for preventing and treating the Flu.
As a preventive remedy, the immunity (?) or protection afforded is very brief, and it ceases to be of value in a few weeks.
In Hawaii, the Author has not been greatly impressed with the value of Serums in the treatment of Influenza; the alleged great benefits and cures set forth in Medical papers, and publications of laboratory statistics by manufacturers of the Serums are not obtained here.
Serums after injection are supposed to aggravate all the symptoms of Flu, followed later by a great improvement in thepatient’s condition, but this prophecy is not always borne out; hence the increase of the headache, fever and pains in the limbs and aching bones, alarms and frightens the patient of the Asiatic, Hawaiian races and many of the Caucasians.
Amongst cases of Influenza, lying side by side, those treated by simple remedies recovered just as speedily and safely as those who had undergone the Serum treatment, and were attended with much less discomfort.
QUININE. The bi-sulphate of Quinine is one of the best haemal or blood microbicides that we have, and its daily use in times of epidemics of Influenza may prevent the user of it from being attacked. It is more a Preventive in some of the epidemics than in others, the ratio of prevention is 40–60, sometimes more, sometimes less; the remedy is easily taken, and in small doses has no drawbacks; it is best so administered; it is cheap and in the coated tablet form palatable, convenient; any person can take it and pursue his usual avocation.
After forty years of practice as a physician, the Author feels convinced of the value of Quinine; he learned its value in western Europe, even if the headache of Flu is very severe small trial doses may be given, as the Author knows from personal experience it is helpful; in a later stage of the disease, with excessive sweats, cold clammy skin and aching bones, all due to cadaveric bacilli circulating in the blood, give Quinine, and your patient or patients will soon respond to its beneficial effects, their condition will improve, and they will thank you and ask for the medicine.
Should small doses upset the stomach, in very susceptible persons, then it may be given by hypodermic injection, using the more soluble salts of QUININE, the Lactate a white powder soluble in 1 to 5 of water, or the Acid Hydrochloride of the B P[2]; in the U S P[3]it is the Di-chloride, which is soluble in less than its own weight of water; if small doses of Quinine cause headache and ringing in the ears in a well person than the remedy is unsuitable and should not be taken, for it will not prevent an attack of the Flu in that person.
2. British Pharmacopeia.
2. British Pharmacopeia.
3. U. S. A. Pharmacopeia.
3. U. S. A. Pharmacopeia.
Professor Dittmar Finkler, M.D., of the university of Bonn, Rhenish Prussia, in his work on Influenza, cites the experiments carried out by Dr. Graser, Medical Army Corps, on duty at the cavalry barracks at Bonn, where five squadrons of German cavalry were quartered during an Epidemic of Flu; one of the squadrons, complement of men, was given daily rations of Quinine for several weeks during the prevalence of the epidemic, the other four squadrons received no Quinine; the results are here set forth:
It is reasonable to assume, that the food or pabulum of the bacillus of Influenza is poisoned by Quinine entering the blood, hence the microbe will avoid by instinct any person whose blood contains quinine in solution; if the bacillus has gained access to the system it is speedily destroyed, and becomes cadaveric as soon as it enters the zone of the quinine barrage.
Are there Hours of the day when the System is more susceptible to Invasion by the Bacillus Influenzae?
To determine this question requires careful study, time, a great deal of patient and tedious work and perseverance; yet it is possible to gain some information on this phase of the “Flu.”
At intervals, during the past twenty-one years, from more than 1000 cases of Influenza in adults, the Author has managed to collect 132 cases; wherein, it was possible to check and verify with some degree of accuracy, the time of contact with a known source of Flu; no subsequent contact being had with any other known source of that disease.
Material evidence was collected from isolated plantation camps, sparsely inhabited villages, and the suburbs of Honolulu at such times as there was no epidemic of Flu. A record of cases collected mostly in the autumn and winter months, from October to March, is hereunder set forth:
CROWDS in attendance at Social gatherings, Public meetings, Restaurants, Places of amusement; together with lack of pure Air in overheated and unventilated rooms and halls, plus lowered vitality after the day’s work, easily and clearly account for the great excess of cases in the above table, between the hours from 6 to 10 p.m.
Influenza has neither cosmic nor heliacal connections.
Care of the Flu patient. Ventilation of the sick room should be carried out with due regard to the wishes of the patient. What is a cooling agreeable breeze to the average Caucasian, may befelt as an Arctic blast by the Hawaiians and Asiatic races; this causes them to fret and worry.
There is a happy medium in ventilation of sick rooms, as in all things. If the patient has Pneumonia, encourage resting on the right or left side, changing from time to time; discourage any patient from lying on the back.
The Health of the Nurse. The Nurse must protect her own health, by regular hours for work, rest, sleep, meals and exercise; an overworked nurse is a non-efficient nurse, and it sends her along the road to a breakdown and makes her or him more subject to acquiring Flu from the patients.
Practise nose breathing. Use sign language in the sick room; keep the mouth closed; tightly closed lips are a better safeguard than a Flu mask; mouth breathing is an inviter of infection; anoint the lips and nostrils frequently with camphor vaseline, or Spirits of Camphor; use no sprays for the nose or throat containing alleged germ destroyers; gargle the throat with a little Listerine water; by so doing you do not kill your protective friends, the non-pathogenic Bacteria; these will get the best of Mr. Flu in due time; leave the nose alone; germ killing sprays, so-called, are useless and are a delusion; remember the “Flu” bacillus is enclosed in a spray-proof coat, almost as tough as Shark skin.