Part 4

11. SPRAYS AND GARGLES.—Sprays and gargles do not protect the nose and throat from infection, for the following reasons:

(a) So far as the knowledge of the committee extends, no germicide strong enough to destroy infective organisms can be applied to the nose and throat without at the same time injuring the mucous membranes.

(b) Irrigation of the nose and throat to accomplish the complete mechanical removal of the infective organism is impracticable.

(c) Their use tends to remove the protective mucus, to spread the infection and to increase the liability of actual entrance of the infective organisms.

(d) Their domestic use is liable to lead in families to a common employment of the same utensils.

(e) The futility of sprays and gargles has been demonstrated with respect to certain known organisms such as the diphtheria bacillus and the meningococcus.

MISCELLANEOUS CONSIDERATIONS.

1. Colleges, asylums and similar establishments may with advantage enforce rigid institutional quarantine against the outside world, if they begin in the early stage of an epidemic, provided they are so located and conducted as to render the procedure reasonably likely to be effective, even temporarily; for even temporary success will postpone the appearance of the disease, if it appears at all, to a time when the patients will be more likely to be able to have adequate medical and nursing care.

2. The recommended measures for control, even if they do not accomplish the desired end, should at least be instrumental in distributing the epidemic over a longer period of time, which in itself is highly desirable.

3. The statistics of the disease and the keeping of proper records are extremely important. The lack of knowledge regarding innumerable factors in reference to the disease makes all the more desirable complete case records, etc.

4. The committee wishes to emphasize the need for the complete statistical study of the collected data on the mortality, morbidity, case fatality, duration, economic aspects, and therapeutics of the disease. Through the collection of the facts in a uniform manner, and through the analysis of such tabulated data, especially mathematical graduation, and testing and study of the figures, important contributions to the natural history and typical characters of the disease may be expected. General principles as to the etiology, fatality and practical management of influenza may follow from the extensive survey of the epidemic in the statistical laboratory as well as from the intensive bedside observation of single cases of the disease.

5. The measures recommended are calculated to be effective in the promotion of respiratory hygiene in general and particularly in the control of pneumonia and other respiratory infections.

ADMINISTRATIVE MEASURES FOR RELIEF.

The committee on administrative measures for relief would submit the following considerations as constituting a summary of the important measures for meeting epidemic conditions:

I. General Rules.

1. Compulsory reporting.

2. Isolation by co-operation and education, to a point where it does not diminish the willingness of the physician to report.

3. Placarding would seem to be subject to the same limitations as is isolation.

4. The closing of schools, prohibition of funerals, etc., being preventive measures, are not touched upon in this report, except to mention that the closing of many agencies will release medical, nursing, and volunteer services for special influenza work.

5. It may be necessary to grant authority and power to the health authorities to administer relief.

II. Preliminary Measures.

1. The listing and distribution of resources, including physicians, nurses, social workers, nurses’ aids, clerks, domestics, laundresses, automobiles, chauffeurs, mask makers, and volunteers of all kinds.

All available publicity channels should be used to promote volunteer service.

An appeal should be made for voluntary donors of human blood serum from convalescent influenza patients, to be held in readiness for use in treatment.

2. The centralization of resources, under one control, with central and branch headquarters, the city being districted for medical, nursing and other work.

The central headquarters should be ordinarily under the supervision of a board representative of the most important agencies concerned, the board’s work to be administered through a manager (presumably the health officer) selected for his fitness.

3. The service should be maintained on a 24–hour basis, and a system of outgoing and incoming telephone service is essential.

4. The local authorities should get and keep in touch with state and national agencies.