1. There should be laws against the use of common cups, and improperly
washed glasses at soda fountains and other public drinking places, which
laws should be enforced.
2. There should be proper ventilation laws, which laws should be
enforced.
Since the disease is probably largely a group or crowd problem, the
three following sub-heads are especially important.
3. CLOSING.—Since the spread of influenza is recognized as due to the
transmission of mouth and nasal discharges from persons infected with
influenza, some of whom may be aware of their condition but others
unaware of it, to the mouths and noses of other persons, gatherings of
all kinds must be looked upon as potential agencies for the transmission
of the disease. The limitation of gatherings with respect to size and
frequency, and the regulation of the conditions under which they may be
held must be regarded, therefore, as an essential administrative
procedure.
Non-essential gatherings should be prohibited. Necessary gatherings
should be held under such conditions as will insure the greatest
possible amount of floor space to each individual present, and a maximum
of fresh air, and precautions should be taken to prevent unguarded
sneezing, coughing, cheering, etc.
Where the necessary activities of the population, such as the
performance of daily work and earning of a living, compel considerable
crowding and contact, but little is gained by closing certain types of
meeting places. If, on the other hand, the community can function
without much of contact between individual members thereof, relatively
much is gained by closing or preventing assemblages.
SCHOOLS: As to the closing of schools there are many questions to be
considered.
(a) Theoretically, schools increase the number and degree of contacts
between children. If the schools are closed, many of the contacts
which the children will make are likely to be out of doors. Whether or
not closing will decrease or increase contacts must be determined
locally. Obviously, rural and urban conditions differ radically in
this regard.
(b) Are the children in coming to and going from school exposed to
inclement weather or long rides in overcrowded cars?
(c) Is there an adequate nursing and inspection system in the schools?
(d) Is it likely that teachers, physicians and nurses can really
identify and segregate the infected school child before it has an
opportunity to make a number of contacts in halls, yards, rooms, etc.?
We suggest that children suspected of having influenza and held in
school buildings for inspection should be provided with and required
to wear face masks.
(e) Will the closing of schools release personnel or facilities to aid
in fighting the epidemic?
(f) If schools are kept open, will the absence of many teachers lower
the educational standards?
(g) If a number of pupils stay at home because of illness or fear,
will they not constitute a heavy drag upon their classes when they
return?
(h) If schools are closed, is there likely to be an outbreak in any
case when they are reopened?
CHURCHES: If churches are to remain open, services should be reduced to
the lowest number consistent with the adequate discharge of necessary
religious offices, and such services as are held should be conducted in
such a way as to reduce to a minimum intimacy and frequency of personal
contact.
THEATRES: As regards theatres, movies, and meetings for amusement in
general, it seems unwise to rely solely or in great part upon the
ejection of careless coughers. In the first place it is difficult to
determine who is a careless cougher, and after each cough, danger has
already resulted. It seems, too, that the closing of theatres may have
as much educational value as their use for direct educational purposes,
etc. Discrimination as to closing among theatres, movies, etc., on the
basis of efficiency of ventilation and general sanitation, may be
feasible.
SALOONS, ETC.: The closing of saloons and other drinking places should
be decided upon the basis of the probability of spread of the disease
through drinking utensils and the conditions of crowding.
DANCE HALLS, ETC.: The closing of dance halls, bowling rooms, billiard
parlors and slot-machine parlors, etc., should be made effective in all
cases where their operation causes considerable personal contact and
crowding.
STREET CARS, ETC.: Ventilation and cleanliness should be insisted upon
in all transportation facilities. Over-crowding should be discouraged. A
staggering of opening and closing hours in stores and factories to
prevent overcrowding of transportation facilities may be cautiously
experimented with. In small communities where it is feasible for persons
to walk to their work it is better to discontinue the service of local
transportation facilities.
FUNERALS: Public funerals and accessory funeral functions should be
prohibited, being unnecessary assemblies in limited quarters, increasing
contacts and possible sources of infection.
4. MASKS.—The wearing of proper masks in a proper manner should be made
compulsory in hospitals and for all who are directly exposed to
infection. It should be made compulsory for barbers, dentists, etc. The
evidence before the committee as to beneficial results consequent upon
the enforced wearing of masks by the entire population at all times was
contradictory, and it has not encouraged the committee to suggest the
general adoption of the practice. Persons who desire to wear masks,
however, in their own interest, should be instructed as to how to make
and wear proper masks, and encouraged to do so.
5. ISOLATION.—The isolation of patients suffering from influenza should
be practised. In cases of unreasonable carelessness, it should be
legally enforced most rigidly.
6. PLACARDING.—In cases of unreasonable carelessness and disregard of
the public interests placarding should be enforced.
7. HOSPITALIZATION.—The theory of complete hospitalization is that, if
all the sick were hospitalized the disease would be controlled. In
certain somewhat small communities where hospitalization of all cases
was promptly inaugurated the disease did come quickly under control. It
must be recognized, however, that unless every infective person can be
detected and identified as such and removed to the hospital before he
has infected others, hospitalization cannot be depended upon to
eliminate the disease.
In general, home treatment is to be advocated where medical, nursing and
other necessary facilities are adequate, and where home treatment is not
directly contra-indicated by the danger of infecting others. The
hospitalization in any case, mild or severe, should be undertaken only
when facilities for home treatment are inadequate with respect to
medical and nursing care or otherwise. The objection to routine
hospitalization of mild cases lies in the fact that patients not already
suffering from secondary infections may acquire them by exposure to
hospital cases already so infected. The objection to the routine
hospitalization of severe cases lies in the danger to the patient
necessarily incident in the transfer from home to hospital.
8. COUGHING AND SNEEZING.—Laws regulating coughing and sneezing seem to
be desirable for educational and practical results.
9. TERMINAL DISINFECTION.—Terminal disinfection for influenza has no
advantage over cleaning, sunning and airing.