Printed and Diatributed by The Colonial Mutual Life Assurance Society Limited
for the benefit of its Policyholders
L/lC) v 0 Pv
PRINTED AND DISTRIBUTED BY
THE COLONIAL MUTUAL LIFE ASSURANCE SOCIETY LIMITED FOR THE USE OF ITS POLICYHOLDERS
Influenza is a disease which is always with us, breaking out in various degrees of severity from time to time. The Colonial Mutual Life Assurance Society therefore issues this little booklet in the hope that the information contained therein will be of benefit to those who may happen to be stricken down with Influenza. Without desiring to unduly alarm the reader, the Society wishes to stress the danger that may ultimately attend even the mildest case of Influenza and the need for treating the case promptly. In every human being the germ of pneumonia (known as pneumococcus) lies dormant, and in health causes no trouble, but when vitality is lowered by reason of chill or some other condition, and the powers of resistance consequently weakened, the road is opened for the activities of the pneumococcus. This constitutes the underlying seriousness of Influenza. Prompt treatment will, at the least, reduce the time of illness to a minimum, and in all probability will ward off any complications.
In view of the fact that in most of our capital cities there is no machinery in the shape of emergency hospitals for dealing with any widespread epidemic, the Society has described at length, under the heading, “Community Effort in Combating Influenza,” an emergency organization created by a Melbourne municipality to cope with the Influenza scoui'ge of 1918-19 in its locality.
Prominence has been given to this excellent work in the hope that it may influence other municipalities and shires to have plans of action prepared for use in emergency.
Influenza, it seems very certain, smoulders in every community, breaking out regularly in isolated cases and occasionally in local epidemics. Suddenly, for no known reason, it becomes highly infectious and of a virulent nature, and spreads over the whole globe, bringing death and distress in its train. This was the case in 1918-19, the memory of which is still fresh. Fortunately the pandemic (world wide) instances of Influenza happen only, if past experience can be relied upon, at intervals of between, roughly, 20 and 30 years, but local epidemics are liable to break out in more or less severe form at any time.
The great danger to human life in Influenza lies in its close connection with broncho-pneumonia, which occurs so frequently as to be almost considered part and parcel of the disease. In some patients it develops almost at the outset; in others it may appear in the early days, but mostly begins from six to ten days after the onset.
It is the possibility of this condition being set up that removes Influenza from the ranks of minor illnesses, although many people persist in regarding it as a trifling affair. Taken in hand with promptitude, the chances of a speedy recovery are excellent. On the other hand, the person who adopts the heroic method of fighting the disease is simply inviting disaster, since sooner or later Influenza will get the upper hand.
THE ONSET OF INFLUENZA.
The symptoms of Influenza vary, but the attack is usually very sudden. The period between the time of infection and the breaking out of the disease is about 48 hours. Sometimes this period is marked by a sick feeling, slight headache and fatigue, but mostly there is an abrupt jump from health to sickness.
No one can be in doubt very long as to whether Influenza is present or not, for, generally with great suddenness, perhaps only a few, or sometimes many of the following symptoms appear:—Severe headache, backache, pain in eyes, dislike of light, pain in muscles and bones, dislike of food, sickness, bleeding from the nose or great mental and physical depression, chilliness, fever and cough.
The most frequent are:—Chilliness, headache, backache, pain in the limbs and prostration.
The temperature is generally high, 102° to 104°.
At the onset of Influenza the patient should at once go to bed and obtain medical attention.
In treatment one point should be noted and that is that the patient should be encouraged to take liquids in abundance. These liquids may consist of barley water, plain water or water flavored with natural fruit juices.
Soups, such as Beef Tea, Beefine, Bovril or Mutton Broth, well strained, may also be given. They are both refreshing and stimulating.
There is no medicine that of itself will cure Influenza. Good nursing and quiet rest in bed are the most valuable agents of cure. There are certain medicines that the doctor will prescribe to relieve certain conditions, but bed until the temperature is normal is essential.
Under no circumstances should there be any periods out of bed for the patient until his temperature has been normal for three days.
This, of course, means the use of the bed pan, feeding without disturbance, and bed making without the patient doing more than roll to one side of the bed.
This treatment, severe as it may seem, should be adopted even in mild cases. Remember, the object is mainly to ward off broncho-pneumonia, and the experience gained in 1918 seems to point to this method as the surest way to achieve it.
To enable those who are compelled to nurse patients in the home, we append instructions and illustrations on the subject of bed-making in illness.
Changing the Linen.—With the aid of the diagrams the method of changing the bed linen will be readily grasped. The first thing to do is to move patient over to one side of the bed and roll soiled sheet into the patient’s back. Now take the clean sheet, which should have been previously folded into a long roll, and, allowing for tucking, unfold till it lies against the soiled sheet. The position will then be as shown in Fig. 8.
Now move the patient over till she is resting on the clean sheet. Remove soiled sheet and unfold other half of clean sheet. (Fig. 9.)
It is very necessary that the bottom sheet be tucked in tightly, especially at the top. (There is a big pull from the top.) Cover the patient loosely, as shown (Fig. 10) and proceed to tuck in sheet by beginning with the side and proceed as in Figs. 11 and 12. When finished, the bed will look as in Fig. 10. Arrange the top clothes, tucking in if desired.
Convalescence, compared with the duration of the illness, is slow. Weakness and lack of energy last for a long time, despite the fact that no complications have followed the illness. Rest during this period is essential.
In times of epidemic this is practically impossible, since pei-sonal contact, and therefore contagion, cannot be avoided.
Precaution for the individual to take should be to avoid crowds, keep in the open air as much as possible, go to bed early, and eat simple, nourishing food.
Antiseptic nose and mouth washes, douches and sprays for people who are well, are of very doubtful value as preventive measures.
Although Influenza is a preventible disease, it seems to be one that we cannot prevent. In other words, it is so contagious that absolute quarantine is the only method of preventing it. However, in practice it has been found impossible (except temporarily, and that in small and isolated communities) to stop its spread, because of the difficulty in recognising it in the contagious stage, which is during the 48 hours preceding the attack and its rapid spread throughout the country. World wide Influenza epidemics, as far as our knowledge goes, commenced over 750 years ago, one of the first occurring in 1173. To show how rapidly a world wide epidemic of Influenza will spread that of 188990 may be quoted. This particular epidemic started in Turkestan in June, 1889. It travelled westerly until all Europe was invaded. It attacked London early in December. In the last week in that month it reached the United States. In the middle of January cases occurred in Honolulu and Capetown, and in February Melbourne and Sydney were aifected.
One of the most severe of the last twelve world wide visitations of this disease was that of 1918/19, which reached Australia in the early part of 1919. So great were the number of cases in the capital cities that the usual machinery for fighting epidemics and the whole-hearted work of the medical profession proved inadequate to cope with the emergency. Whilst previous experience has shown that epidemics such as the last come roughly in intervals of twenty to thirty years, the lessons learnt in 1919 are of the utmost value, since they provide an experience of organisation for coping with any variety of local epidemics.
One of the most interesting and valuable examples of organisation to combat this plague was conducted by the Municipality of Brunswick, Victoria, and its value lies in the fact that it was purely a community effort, and one which, in a similar emergency, might be well adopted by other communities.
Through one of its officials The Colonial Mutual Life Assurance Society, which had a large number of policyholders in the district, was kept closely in touch with the campaign during the whole period of its activities. The first fact which faced the Brunswick Councillors was the urgent necessity for getting prompt attention to cases in their earliest stages. An emergency hospital for cases that could not be treated in the home was established in the Central State School, and municipal inspectors were despatched throughout the district to impress upon the householders the absolute necessity of immediately notifying any case of Influenza that might occur in the family. The citizens were duly informed that the hospital treatment and care would be free of any charge whatsoever, and emphasis was laid on the fact that should the breadwinner of the family be stricken it was absolutely necessary, for his own sake and that of his family, also those with whom they came in contact, that he should immediately submit to treatment and not strive to fight against the disease. Despite the installation of the hospital and the spreading of information, the Council found themselves face to face with an economic problem which bid fair to nullify the excellent work to a large extent. Brunswick was an industrial suburb, populated by a community largely composed of wage earners, who, in the main, could ill afford to lose the services of the breadwinner through illness. The result was that the breadwinner, in fear of debt, in many cases endeavoured to fight off the disease in order that his weekly wage should not suffer. It was realised that such a condition of affairs would greatly check the Council’s objective of treating the disease in its early stages. Here was a problem requiring prompt solution, and to the lasting credit of the Brunswick Councillors it was promptly dealt with. The citizens of the district were informed that since it was imperative that the district should be protected, the Council would, where necessary, pay the house rent and meet the household bills during treatment and convalescence, and where the breadwinner was involved, provide a sum of money approximating a week’s wages to carry him to the first pay after resuming work.
The following is an example of the working of this system. On the afternoon of one day the father of a family entered the hospital, the next morning the mother was admitted, and a competent housekeeper installed to care for the five children. The following day the children were admitted suffering from the disease. The whole of this family of seven were caught in the early stages and, consequently, were able, within a fortnight, including a week’s convalescence, to return home thoroughly cured and without the spectre of debt looming over them. The total cost of saving these seven people, we understand, was in the neighbourhood of £15 (excluding hospital expenses)—a little over £2/2/- per head.
The emergency hospital and organisation to cope with the first wave of the epidemic took some little time to organise, and treated 171 patients, of whom 10% died. Of those admitted, 30% were of the severe pneumonic type, 30% of the severe influenzic type, and 40% of the moderate or early stage type. Not one death occurred amongst the latter class.
With the advent of the serious second wave of the disease, the Council were faced with the necessity for more extensive accommodation than they had, and by arrangement with the Defence Department, opened an emergency hospital at Broadmeadows equipped with 150 beds. The speed at which this hospital was equipped was the outcome of the combined efforts of the staff of the municipal employees (who deserve very high praise for their unselfish and steadfast efforts throughout) and the Councillors of Brunswick, and forms a valuable instance of what can be accomplished by properly co-ordinated effort. On the Saturday night, permission to instal the hospital was granted by the Defence Department, on the Sunday morning the approval of the Health Department was obtained and the work commenced, and by Monday morning the staff was installed in their quarters and patients were being received. In that brief 24 hours a hospital calling for 150 beds, three shifts of nurses, “voluntary aid” girls, orderlies, ambulance transport, commissariat, medical stores and clothing, had been equipped to the last detail. Three doctors resided at the hospital and gave their fud time, night and day, to the work. Their answer on the instant to every call played a powerful part in the success of the work.
Though the prime object of the Council was the care of their own citizens, of whom 356 were treated, they also took from the Board of Health patients from all quarters of Melbourne and suburbs, 202 coming under their care from this source.
The Brunswick cases were very rapidly attended to, all medical men in the municipality co-operating. On a telephone ring to the Town Hall that a case was a hospital one, either the Council’s own ambulance or that of one of the many citizens who placed their motors and their own services at the call of the Council picked up the patient and drove out the eight miles to Broadmeadows. Dozens of cases were in bed and under attention at the hospital within an hour of the call.
Those from the Board of Health were chiefly those whom the over-taxed hospitals elsewhere could not accommodate, and consequently delays in domiciling them caused them to be more advanced and serious cases. Of the Brunswick patients 5i% succumbed, whilst of the patients from elsewhere 13% died. The mortality amongst Brunswick citizens in both the first and second waves of the epidemic was largely confined to strong and healthy men who had foolishly fought against the disease, and the organiser of the Hospital Campaign for the Council was convinced that had they been informed at the onset of the attack in every case, they would have saved practically every life.
Whilst it is not the province of this booklet to discuss the advisability or otherwise of the erection of epidemic hospitals, it can, and does, advocate that all Municipal Councils should have a well considered and properly drawn up plan of action to cope with the emergency produced by any epidemic.
So far as an Influenza epidemic is concerned, Brunswick’s experience goes to show that the economic factor looms largely in the solution of the problem of effective treatment. The fear of losing a billet and running into debt through illr.ess has caused, and probably will always cause, many a breadwinner to fight against Influenza in its early onset and thus run the risk of death. Whilst it may not be possible to adopt Brunswick’s system of monetary assistance in every respect, there should be some co-ordination between the authorities and employers to minimise the risk of a breadwinner losing his job during his cure and convalescence, which should not, when taken early, be more than a fortnight. This assurance to the breadwinner that his loss in wages would be confined to two weeks should help to encourage him to go to bed at the onset of Influenza instead of running the grave risk attendant on neglected Influenza.
If the 1919 epidemic taught nothing else, it taught that the risk of death was very slight in those cases which received proper attention in the early stages of the attack.
Printed and Distributed by The Colonial Mutual Life Assurance Society Limited
for the benefit of its Policyholders
PRINTED AND DISTRIBUTED BY THE COLONIAL MUTUAL LIFE ASSURANCE SOCIETY LIMITED
FOR THE BENEFIT OF ITS POLICYHOLDERS