re: the 3rd para, we have advanced greatly, but seem not to have learned much in 100 years
BRITAIN’s Ministry of Health was created in response to the influenza pandemic of 1918/19 and it commissioned a comprehensive report on the development of the epidemic, rates of mortality, and the effectiveness of various types of control measures, both in the United Kingdom and around the world.
“
Pandemic of Influenza 1918-19”, published in 1920, provides a compendium about what contemporaries thought about the epidemic and the lessons they tried to learn in its immediate aftermath.
If you’re not in the United Kingdom, there is probably a section on your country in Part II covering Europe and the Western Hemisphere (p 199 onward) and Australasia and Parts of Africa and Asia (p 349 onward).
Viruses were unknown so they attributed influenza to a bacterium or other unknown pathogen. But they had some understanding about infection transmission and how to reduce it, as well as the concept of immunity, including from previous outbreaks of influenza.
The extract below is taken from the chief medical officer’s introduction (pp xxi-xxii) and summarises the outlook immediately after the epidemic when policymakers and the public were worried about it returning in another deadly wave. The parallels and read-across to contemporary debates about how to control the coronavirus epidemic are clear, since public health officials in 1920 and 2020 were grappling with essentially similar problems:
“The problem of influenza is still unsolved,” write the compilers of this report; “its solution will be one of the great events in the history of medicine.” And they go on to ask the inevitable question which arises in men’s minds, What is the world’s outlook upon future pestilences or dangers of pestilence? The answer is that it is gloomy. The conclusion to which we are led is that the generation of a great pestilence such as influenza or pneumonic plague is dependent upon disturbance of social order involving for absolutely large numbers of human beings the endurance of conditions of insalubrity which afford for invading parasites a suitable field of modification. So soon as the new properties have been stabilised no barrier against the pandemic or epidemic extension will avail, nor will those individuals or nations who have not suffered the primary evils be more resistant to the disease than their fellows. No impartial spectator can doubt that at the present time, and almost certainly for a generation to come, there will exist in many nations and over wide tracts of country precisely the type of misery which we suspect to be the appropriate forcing house of a virulent and dispersive germ.
The prospect is not cheerful, but we must face it with equanimity and all the resourcefulness of the spirit of adventure and quest. One thing is certain, that the fundamental requirement to make us masters of our fate is a universal improvement in the standard of health and the conditions of life. No technical device, no narrow or specific remedy for pestilence, can ultimately triumph apart from a sanitary environment for the community and the sound nutrition of the individual. They are the bed-rock. Out of them spring the sources of national vitality. Hardly less certain is it that we require, and must seek till we find, more- knowledge. We have in substantial degree the means of controlling tuberculosis and syphilis, malaria and plague; we fail to control these four pestilences largely because we do not use the means; and education is perhaps the answer to that. But in the case of influenza and its allies we are not yet in possession of the means, and whilst we press forward with the improvement of sanitation, of nutrition, and of the conditions of life, we must apply ourselves anew to search and research into the causes of primary and secondary infections, into epidemic catarrh and the common cold, into carriers, and into immunity. That is perhaps the principal lesson which is taught us by our experience of the great pandemic.
Two other practical steps remain. First, we must fortify our administrative methods for dealing with such scourges as influenza, and secondly, we must instruct the whole population, child and adult, in the laws of preventive medicine. The administrative arrangements introduced in 1919 by the Ministry require to be consolidated and perfected, particularly in relation to (a) the development of a system of " intelligence," (b) the effective co-ordination of central and local agencies for the synthetic study and prevention of the disease, and (c) the provision of further means of adequate treatment and nursing. Lastly, there is public instruction in the practice of preventive methods. The infection of influenza and its allies appears to be conveyed by the secretions of the respiratory surfaces. In coughing, sneezing, and even in loud talking these are transmitted through the air for considerable distances in the form of fine spray. The channels of reception are also normally the respiratory surfaces of mouth, nose, and throat—though dust, unclean hands, and infected materials may be the means of conveying infection. It is manifest, therefore, that the closer the bodily contact the more readily will transmissions occur ; hence the paramount importance of persons abstaining thus directly to infect each other, and also of avoiding overcrowding and thronging of every sort, whether in places of public resort, public conveyances, or factories. Well-ventilated rooms, nourishing food, and an open-air life afford some defence ; and in times of prevalence of respiratory catarrh or sore throat the frequent use of an appropriate gargle (for example, 20 drops of liquor sodae chlorinataein a tumbler of warm water) and nasal wash may be recommended. In regard to individual prophylaxis, both the clinical experience of Dr. French and the epidemiological inferences drawn by the staff of the Ministry concur in supporting the belief that a simple hygiene of the mouth and nose is of more value than any specific medication. At the first feeling of illness, or rise of temperature, it is the private and public duty of the patient to go to bed at once, to remain at rest and in warmth, and to place himself under medical supervision, for it cannot be too clearly understood that it is the complications of influenza which disable or destroy life. Thus it seems probable that, though our knowledge of influenza is strictly limited, we are not wholly without means of reducing its incidence and mitigating its consequences.