In a disease like influenza, so intimately connected with human intercourse and commerce, whose germs are carried with the utmost rapidity to all quarters of the compass by innumerable persons, provisions for general prophylaxis are practically impossible. By no known measures could a people be safeguarded against an influenza epidemic. Only shipping can, under some circumstances, be put in effective quarantine. The prohibition of landing from ships which had influenza patients on board is said to have prevented the introduction of influenza into Australia in 1891, and into the harbors and coast cities of several West Indian Islands in 1890.
On account of the observations made in several countries, especially in England, that the fairs and markets were evidently the points from which the pestilence was carried into all directions, it was proposed to prohibit officially, at the time of an epidemic, all large meetings, exhibitions, fairs, markets, pilgrimages. The "world pestilence influenza" will not be in the least diminished by such precautions. The prophylactic closing of schools is also of no use, as the children remaining at home or playing in the streets have ample opportunity of acquiring influenza as easily as at school, even admitting that the schools are the principal points from which the disease is spread. (Compare p. 570.)
The adherents of the miasmatic theory, who cling to the idea that the atmosphere is the focus and the medium of transmission of influenza, justly discarded, from their standpoint, all measures of isolation and disinfection. "To do such things," says Ruhemann, "is merely beating the air." But when these "miasmatics" gave the "natural advice " that" the individual should expose himself as little as possible in the open air, since those were first and most affected who were compelled by their occupation to remain for a long time in the open air," they revealed a remarkable conception of the nature of the air contained in our living rooms, as if it were hermetically, or at any rate microbically, sealed from the air outside.
It was only after recognition of the contagious nature of influenza that the question of individual prophylaxis could be more closely approached. The answer was simply as follows: He who is able to isolate himself from human intercourse, to prevent every contact with influenza patients, or with persons having to do with influenza patients, has to some extent a guarantee, similar to those inmates of certain prisons and strictly closed convents, of escaping influenza. Since these conditions are scarcely possible to the ordinary mortal, the only course left for the " influenzaphobe " is flight into a district free from influenza. In isolated local epidemics these precautions may lead to the desired end; pandemic influenza will pursue and surely overtake the fugitive.
In the household and in the family the attempt may be made, by strict isolation of the patient, by disinfection of his sputum, his handkerchiefs, his body- and bed linen, eating utensils, floors, and furniture, to render the germ which has found its way in harmless for the rest of the family. But at the height of a pandemic such prophylactic measures have not the slightest hope of success, because the members of the household are exposed to numerous other opportunities for infection.
In closed institutions, prisons, lunatic asylums, hospitals, especially upon ships, such isolation and disinfection measures have better opportunity to achieve a result and are often of actual use. For barracks too the order of the French Ministry of War, "especially to isolate every slightly affected patient from communication with the other soldiers," is fully justified.
In order to disperse the indifference and slight attention paid to influenza at the beginning of the pandemic, an attempt was made to give "public instruction" on the subject. A circular from the Minister of the Interior in Baden of December 19, 1889, not only described the manifestations of influenza and its dangers by the association of pulmonary inflammation, but also gave details regarding the treatment, and advised affected persons to keep in bed, to observe a restricted diet, to employ diaphoretic teas, to take a purgative, to abstain from cold compresses, and to envelop the head in warm cloths or cotton wool. "If the symptoms become more severe, one should not delay to call in medical assistance."
From the fact that the upper portion of the respiratory tract is the principal point of location of the influenza germs, it was advised, in order to prevent infection, to employ disinfecting washes several times a day for the mouth and throat, and also nasal irrigations or sprays, insufflation of menthol, etc. For inhalation many English physicians strongly recommended oil of eucalyptus; others advised creolin, camphor, and oil of peppermint. Cleansing of the mouth and throat can do no harm, but nasal irrigations may give rise to irritation of the mucous membranes and hyperemia, and thus create a predisposition to a successful invasion by the influenza germs. Ruhemann even believes that the nasal mucus acts as a "trap for influenza bacilli," and that the underlying mucous membrane may thus be protected from the germs, and, therefore, the mucus is not to be forcibly removed. It is unfortunate for this theory that the influenza bacilli thrive so excellently upon mucus.
Finally, proposals were not wanting to fortify, or even immunize, the body against the influenza germs by the use of certain drugs, etc.
The harmless cocl liver oil recommended by Ollivier, the calcium sulphid so praised as a prophylactic by Green, and many other panaceas have been rightly discarded.
Graser in Bonn, in the beginning of the epidemic of 1889-1890, upon the basis of very doubtful theoretic assumptions, asserted and maintained, even subsequently, that "quinin given at the proper time and in proper doses is capable of preventing the outbreak of an attack of influenza."