254 
The N.Z. Journal of Science and Technology. 
[July 
an unusually large number of cases of influenza, and this was more marked in the 
month of October, but all this time the disease appeared to be of a particularly mild 
type. 
From the known fact that the serious cases of the disease appeared first during 
Carnival Week, and that they were most noticeable first in the big hotels, there was 
little doubt that, as far as Christchurch was concerned, the serious type of the pandemic 
was brought into the city by Carnival Week visitors, and quickly spread through the 
town and country districts ; but it was quite probable that the mild type would itself 
tend to become virulent, though the outbreak of this virulent type would have come 
to its maximum more slowly. 
In the winter months there were rather more than the usual number of influenza 
cases in the Canterbury District, but as far as he knew there were no serious cases—that 
was, cases complicated by pneumonia or blood-poisoning which were proved definitely 
influenzal in the first place. In October, for the first two weeks, the influenza was* 
very prominent, but the cases were still of a mild type, though the resulting weakness 
and depression were unusually marked. At the end of October patients were being 
admitted to the hospital with severe influenza, and some of those developed the 
pulmonary complications which were such a prominent feature during November. 
At that time the admissions were as follows : 28th October to 4th November, 4 ; 4th 
November to 11th November, 79 ; 11th November to 18th November, 241 ; 18th Novem¬ 
ber to 25th November, 218; 25th November to 2nd December, 60 ; 2nd December to 
9th December, 26. After the 9th December there were very few admissions, but from 
that time right up to the present patients had been coming in with other illnesses, 
noticeably empyema (inflammation of the pleural cavity, with pus formation), as a late 
complication of the influenza. From the record which he had been able to examine 
by the courtesy of the hospital authorities there were from the 1st November to 
the 16th December 638 cases of influenza, with 222 deaths. Taking into consideration 
the very evident fact that the very worst cases were sent to the hospital, he thought 
that the hospital resident physicians and nursing staff deserved very high praise for 
their efforts in keeping the death-rate to that comparatively low figure. 
In his own department there were very few requests for examination of material 
from the influenza epidemic at the beginning, and when the rush did come, about the 
15th November, his staff was reduced to half its usual number, as two of the members 
were afflicted with the epidemic illness. Later, by the courtesy of Dr. Chesson, he was 
fortunate in securing the services of Mr. Heriot Barker, late bacteriological assistant in 
the Wallaceville Laboratory. The examinations carried out were (1) microscopic and 
cultural examination of the sputum; (2) bacteriological examination of the blood; 
(3) microscopic examination of the blood to determine the number and percentage of 
the white cells; (4) preparation of vaccines from the bacteria isolated from the sputum 
and blood. 
Though the number of examinations was very small compared to the great number 
of admissions, the results showed that the medical and nursing staff had to deal with 
three types of illness :— 
(1.) True influenza : As far as the hospital was concerned those patients were 
limited to the sick members of the medical and nursing staff. After the 
rush started the whole hospital was reserved for the severe cases with 
complications. 
(2.) Patients with bronchitis and pneumonia : The great majority of admissions 
were of that nature. 
(3.) Patients with pneumonia and septicaemia : In many of those the pneumonia 
signs were very indefinite. These patients, like those of the second class, 
were desperately ill, and the death-rate was very high. In the majority of 
patients coming under the last two groups there was generally a definite 
history of influenza before the more serious features supervened. 
In group 1 very few bacteriological examinations were made. There were more 
urgent cases requiring examinations, and, unfortunately, the staff was too small to 
carry out many investigations. The sputum in those people did not exhibit the 
typical features of a true influenza. 
In group 2 the expectoration did not exhibit uniform features. Generally it was 
blood-stained and very frothy, and had not the characters seen in a primary pneu¬ 
monia. In others the sputum was purulent and very tenacious. In cultures the 
influenza bacillus was occasionally isolated, but organisms resembling it were generally 
noted in the preliminary microscopic examination. 
Group 3 : The cases were of the most desperate nature. The mortality was very 
high, and in the cases of patients recovering the convalescence was very slow. The 
sputum of those patients was generally of a marked purulent character, and not 
