Mat 31, 1919] 



SCIENCE 



505 



they are so mild. A pandemic of influenza 

 swept over the United States five months be- 

 fore the fatal wave but it attracted notice 

 only in a few places. 



The frequent presence of epidemics of colds 

 affords the ^oundwork upon which other re- 

 spiratory diseases shovdd be studied. It has 

 been well said by Sir Arthur Newsholme, 

 Medical Officer of Health to the Local Gov- 

 ernment Bo.ird of England, that imtil the 

 common respiratory infections are studied and 

 controlled, it will be impossible to \mderstand 

 and manage influenza. With this opinion the 

 present writer heartily agrees. The way to 

 study influenza is to study the common cold. 

 The place to study the common cold is a 

 village or other circumscribed environment. 

 The time to study it is now. 



The great lesson of the pandemic is to call 

 attention to the prevalence of respiratory dis- 

 eases in ordinary times, to the indifference 

 with which they are ordinarily regarded and 

 to our present inability to protect ourselves 

 against them. They are not amenable to con- 

 trol through sanitary works as are typhoid, 

 malaria and so many other diseases. They 

 must be controlled by administrative pro- 

 cedures, and by the exercise of appropriate 

 measures of self protection. 



Will there be another visitation? Nobody 

 can positively answer this question. Influenza 

 commonly sweeps in more than one wave over 

 a country. America experienced an unmis- 

 takable, but mild, wave before the great one 

 of September and October and since then 

 there have been local disturbances correspond- 

 ing to fresh outbreaks in many places. In 

 England a new and alarming prevalence has 

 been reported. It would not be surprising if 

 there should be another pandemic in the 

 United States. 



The steps which should be taken to suppress 

 the disease if it breaks out afresh are such 

 as seem best for the maintenance of general 

 health and protection from respiratory infec- 

 tions as a class. If doubt arises as to the 

 probable efficacy of measures which seem so 

 lacking in specificity it must be remembered 

 that it is better for the public morale to be 



doing something than notliing and the general 

 health will not suffer for the additional care 

 which is given it. 



First as to the things which it is desirable 

 not to do. It is not desirable to close theaters, 

 churches and schools unless public opinion 

 emphatically demands it. It is not desirable 

 to make the general wearing of masks com- 

 pulsory. Patients should not be masked ex- 

 cept when traveling from one point to another 

 — they need air. Suspects should wear masks 

 until their cases are positively diagnosed. In- 

 fluenza patients should be kept separate from 

 other patients. A case of influenza should be 

 dealt with as though it was as contagious as 

 a case of small-pox: there is danger in the 

 presence of the sick, in his eating utensils, in 

 his clothes and in the air into which he coughs 

 and sneezes, if indeed these respiratory symp- 

 toms are present. He is to be regarded as 

 much more seriously ill than his visible symp- 

 toms perhaps indicate. 



It is worth while to give more attention to 

 the avoidance of unnecessary personal risks 

 and to the promotion of better personal health. 

 Books have been written on the subject. The 

 vpriter's idea of the most essential things to 

 remember are embodied in the following 

 twelve condensed rules which were prepared in 

 September, recommended by the Surgeon- 

 General of the Army and published by order 

 of the Secretary of War to be given all 

 possible publicity : 



1. Avoid needless crowding — influenza is a 

 crowd disease. 



2. Smother your coughs and sneezes — others 

 do not want the germs which you would throw 

 away. 



3. Your nose, not your mouth was made to 

 breathe through — get the habit. 



4. Eemember the three C's — a clean mouth, 

 clean skin, and clean clothes. 



5. Try to keep cool when you walk and 

 warm when you ride and sleep. 



6. Open the windows — always at home at 

 night; at the office when practicable. 



7. Food will win the war if you give it a 

 chance — help by choosing and chewing your 

 food well. 



