Report. [1918]

64

per day) one can but hardly imagine what a big problem was
confronted by the Health Service in handling in an only fair
manner the epidemic situation.
Obviously, well-to-do classes were not a matter of great concern; but not so in the case of poor and indigent people to whom
the Service would have to furnish free attendance and care. In
a city with very limited hospital accommodation (both official
and private count less than ten with over 300,000 population)
hospitals soon became packed to the limit and a rigid rule had
to be drawn for the admission of only complicated cases of influenza most of them being pneumonic or broncho-pneumonic influenza cases.
The remainder, or uncomplicated cases, were all to be attended
and supplied with medicines at home by the medical officers of
the Service regardless of any limitation as regards places or
time of call at day as well as at night time.
In regard to preventive measures against influenza, a systematic disposal of patients through isolation, hospitalization
and quarantine of the cases proved unpractical as has been the
case here and abroad in localities where the epidemic appeared
with somewhat marked severity.
A bulletin containing prophylactic advice against influenza
was profusely distributed among university and school pupils,
shop-workers, tradesmen, laborers, and householders. It reads
as follows:
PHILIPPINE HEALTH SERVICE.
For the information and guidance of all concerned (school teachers,
business and workingshop managers and foremen, householders, and others)
the following rules are issued with a view to prevent as much as possible
the further spread of the present epidemic influenza (trancazo) in the city
of Manila:
HOW TO AVOID "TRANCAZO."
Personal measures.-Immediate contagion can be prevented by a thorough hygienic care of the mouth and throat; frequent cleanings with a
brush and toilet antiseptic (as a weak-solution of borax, oxygenated water,
etc.), and gargles several times a day. Avoid also and protect yourself
against the tiny drops of saliva or mucus contained in the breath which
are expelled on coughing, sneezing or talking excitedly. You should keep
a safe distance of four feet or more when talking with other persons and
protect your mouth and nose with a handkerchief, so as to prevent danger
to others and yourself. You should not spit promiscuously on the floor and
other places. The sputum and saliva of the patients should be deposited in
spittons provided with disinfectants.
All the tableware, especially that used by a patient, should be thoroughly
scalded (washed with hot water and soap). Also the fingers, when they
are used for eating.
It is a vicious and coarse habit at all times, and especially during an
epidemic of "trancazo," to put the fingers in the nose or in the mouth and
then shake hands with friends or infect with them things otherwise clean.