SCIENCEFRIDAY, MAY 30, 1919

CONTENTSThe Lessons of the Pandemic: MAJOR GEORGEA. SoPER ........................... 501

The Freas System: DR. W. L. ESTABROOKE ... 506

Organization Meeting of the American Sectionof the Proposed International AstronomicalUnion: PROFESSOR JOEL STEBBINS ........ 508

Scientific Events:-War Researches at St. Andrews University;The Department of Bacteriology and PublicHealth at Yale University; Base Hospital,No. 21, of the Washington UniversitySchool of Medicine; The Chemical WarfareService; The Diision of Applied Psychologyof the Carnegie Institute of Technology .... 510

Scientific Notes and News ............... 513

University and Educational News ......... 515

Discussion and Correspondence:-Quantitative Character-measurements inColor Crosses: PROFESSOR H. F. ROBERTS.Surplus Bisons for Museums: DR. HARLAN I.SMITE. Information Service for Experi-mental Biologists: E. D. BRoWN .........516

Scientific Books:-Miller on the Mineral Deposits of SouthAmerica: DR. ADOLF KNoPr .............518

The Ecology of North American lymnride:DR. FRANK COLLINS BAKER ..............519

Special Articles:-Sound and Flash Banging: PROPESSOR Au-GUSTUS TROWBRiDGE ..................... 521

The American Mathematical Society: PRO-FESSOR F. N. COLE ....................5 23

MSS. intended for 'publication and books, etc., intended forreview should be7 sent to The Editor of Science, Garrison-on.Hudson, N. Y.

THE LESSONS OF THE PANDEMICTHE pandemic which has just swept round

the earth has been without precedent. Therehave been more deadly epidemics, but theyhave been more circumscribed; there havebeen epidemics almost as widespread, but theyhave been less deadly. Floods, famines, earth-quakes and volcanic eruptions have all writtentheir stories in terms of human destructionalmost too terrible for comprehension, yetnever before has there been a catastrophe atonce so sudden, so devastating and so uni-versal.The most astonishing thing about the pan-

demic was the complete mystery which sur-rounded it. Nobody seemed to know whatthe disease was, where it came from or how tostop it. Anxious minds are inquiring to-daywhether another wave of it will come again.The fact is that although influenza is one

of the oldest known of the epidemic diseases,it is the least understood. Science, which bypatient and painstaking labor has done somuch to drive other plagues to the point ofextinction has thus far stood powerless beforeit. There is doubt about the causative agentand the predisposing and aggravating factors.There has been a good deal of theorizing aboutthese matters, and some good research, but nocommon agreement has been reached with re-spect to them.The measures which were introduced for

the control of the pandemic were based uponthe slenderest of theories. It was assumedthat the influenza could be stopped by theemployment of methods which it was assumedwould stop the other respiratory diseases.This double assumption proved to be a weakreed to lean upon. The respiratory diseasesas a class are not under control. They con-stitute the most frequent cause of death, yetit is not known how they can be prevented.Three main factors stand in the way of pre-

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vention: First, public indifference. People donot appreciate the risks they run. The greatcomplexity and range in severity of the re-spiratory infections confuse and hide thedanger. The infections vary from the com-mon cold to pneumonia. They are not allseparate entities by any means. An attackwhich begins as a coryza or rhinitis maydevelop into a pharyngitis, tonsilitis, laryn-gitis, bronchitis or pneumonia. The gravityincreases with the progress toward the lungs.The infection sometimes seems to begin in thechest, sometimes in the throat, sometimes inthe head. It may stop where it started orpass through several phases. This is the storyof the common cold. It is generally morediscomforting than dangerous. Most peopleget well without skillful treatment, or indeedany great interference with business. Nospecific virus is known to produce it.There is another group of diseases, a more

unusual one, which is often at first confusedwith the foregoing. This includes the specificinfections such as diphtheria, measles andscarlet fever. Influenza is in this class. Thesymptoms at the beginning may be identicalwith those of the common cold and the truenature of the disease escape notice until thepatient shows unmistakable and alarmingsymptoms. By that time other persons maybe infected.The second factor which stands in the way

of prevention is the personal character of themeasures which must be employed. Theenteric infections can be controlled by pro-cedures of a general sort which impose nogreat restriction upon the conduct of the in-dividual, but this is not true of the respir-atory infections. The waste products of in-fluenza containing the infective virus are notdeposited in a vessel or sewerage system wherethey can be properly dealt with as in typhoid.The excreta of the nose and throat areprojected into the air and allowed to pollutethe hands, the food, the clothing and, in fact,the entire environment of the infected person.This is done unconsciously, invisibly, unsus-pectingly. General methods directed against

this kind of germ distribution must neces-sarily be of limited value.

It is an epidemiological point of great in-terest that the kind of preventive measureswhich must be taken in order to control therespiratory infections devolve upon the per-sons who are already infected, while thosewho are liable to contract the disease can dolittle to protect themselves. The burden isplaced where it is not likely to be well carried.It does not lie in human nature for a manwho thinks he has only a slight cold to shuthimself up in rigid isolation as a means ofprotecting others on the bare chance that hiscold may turn out to be a really dangerousinfection.

Third, the highly infectious nature of therespiratory infections adds to the difficulty oftheir control. The period of incubation variescoiisiderably; in some infections it may be asshort as a day or two. And the disease maybe transmissible before the patient himself isaware that he is attacked.

This list of the obstacles which istand in theway of controlling the respiratory diseasesmay fittingly be closed by remarking thathealthy persons often carry about in theirpersons the germs of disease, thereby uncon-sciously acting as a continuing danger tothemselves and a menace to others. It is notto be wondered at, therefore, that of all thethings which were done to stop the spread ofinfluenza, nothing seems to have had anymaterial effect upon it.

This may all seem very discouraging but itneed not depress anybody. The control oftyphoid once seemed an impossible task. Torightly measure a difficulty is often the firststep toward overcoming it.What is said here of the influenza pandemic

is put forward only as the writer's view atthe present time. Nobody can now speakauthoritatively upon this subject. When allthe facts are brought together some of theideas which are held to-day may be found torequire modification. We are still too closeto the event to fully measure it. Individualresearches and the efforts of innumerableworkers, must be reported and evaluated. The

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mass of statistical data which has accumulatedin cities, towns, camps and hospitals must beassorted, tabulated and studied before it willbe possible to speak with anything like finalityas to the efficacy of the measures of controlemployed.

Until this is done, it will be impossible togive the number of persons attacked, theirage, sex, condition and race, the complicationsand sequelae of the disease, much less therelations which these facts bear to the pre-ventive measures. This work is now engagingthe attention of many experts. Public healthofficers, skillful workers in bacteriology andpathology and able clinicians who have had op-portunity to study the disease intensively aremaking their reports. It will be months andperhaps years before the records of all thescientific study connected with the pandemicare brought to a conclusion.A good deal may confidently be expected

of the work which has been done from somany angles and in so many places. Howfar the mysteries which have obscured thetrue nature of influenza for so many yearswill be cleared up must be left for time toshow.No disease is more difficult to study than

pandemic influenza. It comes, it spreads, itvanishes with unexampled suddenness. Itpossesses such terrific energy that little timeis afforded during its visitations in which tostudy it in a careful and painstaking manner.Both its total absence and its great prevalencestand in the way of its study.

But, it will be asked, is influenza entirelyabsent in the intervals between epidemics?Opinion is divided on this point. Some holdthat pandemic influenza is a separate infec-tion. Others think it is always with us. Itdoes not ordinarily manifest such a fatalaspect as that recently seen, but many of thesymptoms of the usual epidemic and the ex-traordinary pandemic influenza are the salme.Perhaps the recent pandemic is best explainedon the assumption that a particularly virulenttype of the common infection was to blame.

All attempts at excluding influenza from acommunity seem to have failed. There is

one and only one way to absolutely preventit and that is by establishing absolute isola-tion. It is necessary to shut off those whoare capable of giving off the virus from thosewho are capable of being infected, or viceversa. This is a very difficult procedure.First, it is difficult because it is impossibleto discover all the virus producers. Second,it is difficult because it is impossible to knowwho are and who are not immune. Completeisolation is not feasible for entire cities norfor parts of cities, nor for individuals incities. It is feasible for some small townsand villages, and some have tried it withsuccess. The fact that in many instances theattack has been merely postponed by no meansinvalidates the principle.

It is natural to suppose that a phenomenonof such general nature as the influenza pan-demic has had an equally general cause andthe only cause which most people can think(f as general enough to give rise to a worldpandemic is one which possesses an atmos-pheric or terrestrial character. This is a veryold conception and one which has survivedall others so far as the general public is con-cerned. In one of its forms it is known asSydenham's theory of epidemic constitution.In spite of the repeated statement that thistheory has been discredited, there are manywell-informed persons who believe as Syden-ham did that there are general conditions be-yond our knowledge which help to cause dis-ease to assume a different aspect and pre-valence in some years and at some seasonsthan at others.As late as the pandemic of 1889-90 it was

thought by many that the cause of the in-flutenza outbreak was in some way connectedwith world conditions and quite independentof human intercourse. To-day there are somewho think that the extraordinarily cold winterof 1917-18 followed by the hot summer waslargely responsible for the recent pandemic.Others believe that the great war precipitatedthe plague. Not a few think that the in-fection was spontaneously developed in manyplaces at about the same time. The argu-ments which have been made in support of

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these suppositions are often ingenuous if notconvincing. Unfortunately, they seldom standthe test of scientific analysis.The weight of evidence now available in-

dicates that the immediate cause of the greatpandemic of 1918 was an infective virus whichpassed from person to person until it hadspread all over the world. The method ofspread is believed to have been the same as inother respiratory infections. The reasons forthe belief that it was transmitted in thismanner lies chiefly in the fact that the pan-demic spread rapidly, and no more so, thanpeople traveled from point to point.Nobody so far has positively shown what

the virus is, nor how it leaves or enters thebody, nor at what period in the disease it maybe transmitted to others. Some hold that thePfeiffer bacillus is the causative agent, othersbelieve that there is a filterable virus whichacts independently or in conjunction with thePfeiffer bacillus. Nearly all agree that theinfluenza and pneumonia were independentdiseases and that the high fatality was dueto a very remarkable reduction of resistanceto the pneumonia brought about by the in-fluenza. Being of the respiratory type, it isbelieved that the virus leaves the body by wayof the nose and mouth. It is supposed toenter the body by way of the nose, mouthor eyes.

But, it may be asked, if the influenza andthe Pfeiffer bacillus are always with us, whyshould the disease suddenly become so differ-ent from its ordinary type in respect to sever-ity, infectivity and complications? Nobodyhas answered these questions.

There are various ways of replying to them.One is to assume that the infective poisoiiwas brought into civilized countries fromsome distant point where it originated. An-other is to suppose that it developed locally.It is not possible to follow these theoriesthrough all their details here. The argumentsare not convincing by any means. Certainlya complete explanation of the pandemic re-quires a demonstration of how the diseasedeveloped wherever that development tookplace.

The development of the disease was un-doubtedly a complicated biological phenom-enon. A virus was produced which wascapable of overcoming the resistance of alarge proportion of those who were exposedto it. Reductions in virulence are familiaroccurrences in connection with infective poi-sons. Controlled attenuations have been atthe foundation of a great deal of the beatwork in immunology since the time of Pas-teur. Increases are less often observed, butit is a well established fact that a virus whichhas practically lost its pathogenic propertiescan be exalted to a high state of virulence byinoculating it into susceptible animals. Thespontaneous recrudescences of virulent dis-ease in epidemics which sometimes appear tohave originated in mild epidemic infectionssuggest the same process.Reasoning by analogy it would appear not

unlikely that an influenza virus which existedsomewhere, perhaps among persons who hadbecome accustomed to it and had consequentlygained a toleration to it, was introducedamong others to whom it was a stranger andwho were consequently particularly suscep-tible to it. This would naturally result in anoutburst which might attain pandemic pro-portions.The pandemic has shown among other

things how widely and how quickly respir-atory infections may travel. It has shownwhat an enormous interchange of germs takesplace in the respiratory apparatus of thosewho live in cities and towns and villages. Itis disquieting to find how readily and fre-quently the bacterial products of the sick gainentrance into the noses and mouths of otherpersons, but the facts must not be hidden ifto acknowledge them will do any good.The pandemic calls attention not only to

the fact that there is an interchange of mouthgerms wherever people meet, but it illustrateshow frequently respiratory infectious mayoccur to which little or no attention is given.Some people think that pandemics of coldsoccur from time to time which are almost asuniversal as was the recent influenza. Theirpandemic character is not suspected because

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they are so mild. A pandemic of influenzaswept over the United States five months be-fore the fatal wave but it attracted noticeonly in a few places.The frequent presence of epidemics of colds

affords the groundwork upon which other re-spiratory diseases should be studied. It hasbeen well said by Sir Arthur Newsholme,Medical Officer of Health to the Local Gov-ernment Board of England, that until thecommon respiratory infections are studied andcontrolled, it will be impossible to understandand manage influenza. With this opinion thepresent writer heartily agrees. The way tostudy influenza is to study the common cold.The place to study the common cold is avillage or other circumscribed environment.The time to study it is now.The great lesson of the pandemic is to call

attention to the prevalence of respiratory dis-eases in ordinary times, to the indifferencewith which they are ordinarily regarded andto our present inability to protect ourselvesagainst them. They are not amenable to con-trol through sanitary works as are typhoid,malaria and so many other diseases. Theymust be controlled by administrative pro-cedures, and by the exercise of appropriatemeasures of self protection.

Will there be another visitation? Nobodycan positively answer this question. Influenzacommonly sweeps in more than one wave overa country. America experienced an unmis-takable, but mild, wave before the great oneof September and October and since thenthere have been local disturbances correspond-ing to fresh outbreaks in many places. InEngland a new and alarming prevalence hasbeen reported. It would not be surprising ifthere should be another pandemic in theUnited States.The steps which should be taken to suppress

the disease if it breaks out afresh are suchas seem best for the maintenance of gerneralhealth and protection from respiratory infec-tions as a class. If doubt arises as to theprobable efficacy of measures which seem solacking in specificity it must be rememberedthat it is better for the public morale to be

doing something than nothing and the generalhealth will not suffer for the additional carewhich is given it.

First as to the things which it is desirablenot to do. It is not desirable to close theaters,churches and schools unless public opinionemphatically demands it. It is not desirableto make the general wearing of masks com-pulsory. Patients should not be masked ex-cept when traveling from one point to another-they need air. Suspects should wear masksuntil their cases are positively diagnosed. In-fluenza patients should be kept separate fromother patients. A case of influenza should bedealt with as though it was as contagious asa case of small-pox: there is danger in thepresence of the sick, in his eating utensils, inhis clothes and in the air into which he coughsand sneezes, if indeed these respiratory symp-toms are present. He is to be regarded asmuch more seriously ill than his visible symp-toms perhaps indicate.

It is worth while to give more attention tothe avoidance of unnecessary personal risksand to the promotion of better personal health.Books have been written on the subject. Thewriter's idea of the most essential things toremember are embodied in the followingtwelve condelsed rules which were prepared inSeptember, recommended by the Surgeon-General of the Army and published by orderof the Secretary of War to be given allpossible publicity:

1. Avoid needless crowvding-influenza is acrowd disease.

2. Smother your coughs and sneezes-othersdo not want the germs which you would throwaway.

3. Your nose, not your mouth was made tobreathe through-get the habit.

4. Remember the three C's-a clean mouth,clean skin, and clean clothes.

5. Try to keep cool when you walk andwarm when you ride and sleep.

6. Open the windows-always at home atnight; at the office when practicable.

7. Food will win the war if you give it achance-help by choosing and chewing yourfood well.

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8. Your fate may be in your own hands-wash your hands before eating.

9. Don't let the waste products of digestionaccumulate-drink a glass or two of water ongetting up.

10 Don't use a napkin, towel, spoon, fork,glass or cup which has been used by anotherperson and not washed.

11. Avoid tight clothes, tight shoes, tightgloves-seek to make nature your ally notyour prisoner.

12. When the air is pure breathe all of ityou can-breathe deeply.

GEORGE A. SOPERSANITARY CORPS,

UJ. S. A.

THE FREAS SYSTEMPRoFEssoR THOMAS B. FREAS, of the depart-

ment of chemistry of Columbia University,has devised a scheme for the handling of ap-paratus and supplies that is not only noveland capable of indefinite expansion and adapt-ability to any chemical laboratory, but takesout of the hands of the instructional staff allhandling of students' apparatus and chemicals.The object of the Freas system is fourfold.

First, to save the st-udent's time by givinghim all the chemicals and apparatus he needsat his bench, second, to insre pure and cleanchemicals, third, to save of chemicals bygiving the student just the amount needed,and doing away with the wasteful and sloppyside shelf reagents bottle, and fourth, to re-lieve the instructor of those details, and thusto enable him to devote his entire time toteaching and research.

Professor Freas has been too busy to pub-lish an accunt of his scheme, and his extrememodesty prevents him undertaking the task,had he the time. As an interested outsiderwho has watched very closely how it works, atOolumbia, I am perhaps better qualified thaneven he to speak of what seems to me thebest scheme in America to handle this difficultproblem. This scheme has been in operationin all divisions of chemistry at Columbia forthe past seven years, and has given an everincreasing satisfaction to all concerned.

Many instructors spend most of their timehandling supplies, although they are hired toteach, but they are not allowed to do so by theshort-sighted and expensive policy of manyinstitutions, which compel them to do workwhich a moderately paid employee could dojust as well. One full professor of industrialchemistry of my acquaintance spencds a greaterpart of his time supplying his students withchemicals, when an organized system could doit immensely better, leaving him free to de-vote his time to instruction.In a modern chemical laboratory, and espe-

cially so in a large one, the problems are sonumerous and so complex, that modern busi-ness methods require a sharp line to be drawnbetween the pedagogic and administrativeaffairs from those of up-keep maintenance,purchase, and handling of supplies. Thiseventually demands that the head of the de-partment divest himself of all duties pertain-ing to the physical side of the laboratory, andturn that work over to the carefully selectedand specially trained curator of supplies. Ifthe administrative head has chosen wisely, heis not only relieved of an enormous burden,thus freeing himself for the instructional sideof his profession, but the laboratory studentsand instructional staff gain by having thiswork done by an expert.The success of the Freas system depends

upon having some one man in the department,who is interested, selected to be the curator ofsupplies. He must have recognition, both inrank and salary, to attract a man of character,ability and training in laboratory needs. Histime should be free for general guidance ofothers, by having several competent assistants,one in the office, one to handle chemicals andsuperintend the bottling, and one to handleall apparatus. In a small chemical depart-ment some of these divisions could be com-bined. The man or preferably a woman, incharge of the office, attends to all student ac-counts, keeps the books, takes dictation, andif the work is excessive has enough help toproperly handle the work. The salary is about$75 to $100 a month, with two weeks' vacation,and one week sick leave during the year. This

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THE LESSONS OF THE PANDEMICGeorge A. Soper

DOI: 10.1126/science.49.1274.501 (1274), 501-506.49Science 

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Advancement of Science. No claim to original U.S. Government Works.Copyright © 1919 The Authors, some rights reserved; exclusive licensee American Association for the

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