Yet another drawback is the apparent wide susceptibility to the disease. Were individuals definitely immunized by one attack the proportion of susceptibles would be lessened, their concentration in a population would be decreased, and the probability of their being exposed would be proportionately diminished.
An additional difficulty is that after an epidemic has once become prevalent, we must combat not only the virus causing the disease but also the secondary invaders.
Epidemiologic work has shown that crowd gatherings are instrumental in the spread of influenza. The density of population has not been as definitely proven to be a factor. Crowding, however, does play a part. Close crowding in communities must facilitate the spread, but pandemics of influenza were known before the great metropoleis existed. Hygienic conditions play their part in the etiology. Finally, in the presence of every serious epidemic we must also combat the tendency to panic in the population.
Anticipatory or preventive measures.—It is erroneous today to speak of measures for the prevention of influenza in a community. We cannot prevent the disease. At most, we can anticipate the occurrence of an epidemic and take precautionary measures by which the spread and the severity of the disease may be minimized.
First and foremost comes education. Education of the public, of the medical profession and of health authorities. “Scare headlines” in the newspapers during epidemics should be discouraged. Health cartoons are of value, but when they express only partial truths they cannot but do some harm. General education in hygienic methods and in a knowledge of the spread of contagious diseases has already been most productive. Many methods by which the public intelligence could be reached are as yet untried. A daily paper in Boston devotes two columns a week to a discussion of public health problems, under the title of “The Clinic.” The statements appearing in these columns are nearly always the truth and are not exaggerations. There are discussions of recent scientific work of interest to the reading public. As has been emphasized by Carnwath, a page devoted to methods of maintaining the health of the community would probably be of more immediate value than are the many pages devoted to financial statements, “such as the price of Mexican Eagles or of Peruvian Corporation Preference.”
The organization of health services to combat unexpected epidemics would be of great assistance. In times of peace, prepare for war. In all but the largest cities the health authorities are generally so free from contact with epidemics and are so pressed with routine that they do not organize in readiness for an epidemic which may not come. There should be a closer co-operative organization between health officials and practising physicians, so that the latter may aid to a greater extent in the public health work. The physician co-operates in furnishing information required by the health officer, but too frequently takes little interest in what further is done with this information. The medical profession should be made to understand the importance of public health work, should have a general comprehension of the methods used in its execution and should particularly develop a sympathetic and co-operative mental attitude.
The medical societies of the country should be so organized that at a moment’s notice their membership can be mobilized for the defense of the community. There is much that the practising physician does not know about influenza. One of the leading internists in one of our largest cities, during the 1920 epidemic, refused to call his cases influenza and treated them as mild “grip.” It is stated that he lost an unusually large number of his patients. There are still many who believe that the two diseases are not identical. Not only is this detrimental to the patient, but as it results in failure to isolate the sick, it is detrimental to the community.
Nursing groups should be organized to aid at a moment’s notice.
Much work has been done and great experience gained by both the physicians and the nursing organizations during the last epidemic. Now is the time to prepare for the next epidemic or pandemic. With the remembrance of 1918 fresh in our minds we can establish a working system, while if we delay until the expected arrival of another epidemic much of our painfully acquired knowledge will have been forgotten.
Opinion differs as to whether influenza should be made a reportable disease. The added expense would be not insignificant. This particular malady presents the additional complication of being difficult of diagnosis. The records would at best be inaccurate. The author believes that certain experiments in reporting the disease even in interepidemic times should be carried out. This should be done by competent epidemiologists who could later formulate plans for the permanent reporting of the disease. We will discuss this further under the heading, “Constructive Research.”