Not to be sneezed at, Rae Varcoe

Black November: The 1918 Influenza Pandemic in New Zealand
Geoffrey W Rice
University of Canterbury Press, $39.95,
ISBN 1877257354

Survive Bird Flu and Other Disasters
Bronwen King
Hazard Press, $14.99,
ISBN 1877393185

This week’s papers contain news of progress in the development of a vaccine against bird flu. Such a vaccine might mitigate that epidemic, but Geoffrey Rice’s history of the 1918 flu reminds us that flu viruses can mutate and spread globally, virtually in the space of a sneeze. And this before easy international travel.

It’s not the science but the sociology that is memorable in Dr Rice’s Black November. The science and speculation about the means of the virus’ introduction to New Zealand, then the spread of infection over the whole country within the next two weeks, are told in great detail, but it is the community and individual response to peril that keeps the reader engrossed.

The book’s layout, with individual oral histories inserted as vignettes every few pages into the background general story, keeps the historical and the personal in balance. Some of the stories are achingly poignant, all are understated, and leave me wondering what happened to the teller next? How did the 15-year-old’s experience of suddenly having to keep house for nine people affect the choices she made in the rest of her life? Who looked after the eight-year-old boy who asked the butcher how to cook meat, then said that his parents had been “asleep for two days”? And what became of those in the community who declined to help?

Politicians are shown to be important, both as objects of blame (did Bill Massey’s non-quarantined ship bring in the first flu? – probably not) and as directors of response to the crisis. The Minister of Health had enormous central authority which was complicated by both egotism and ignorance. He was late in devolving authority for quarantine and other public health measures to local officials. Hence pubs remained open, ships were able to enter port, and public gatherings continued. Armistice Day celebrations attracted large crowds, and with these the virus became expansive too.

The virus spread by droplet transfer through all social gathering points such as pubs, trains, army camps, factories, church meetings and any “crowded assemblage”. Local hospitals overflowed into makeshift facilities with ad hoc staffing. These were quickly set up and, of necessity, quick to function. That so much extempore organisation worked, presumably relates to residual civic wartime organisational skills and the general acceptance of direction and authority by the populace.

As the virus attacked the lungs, preventive treatment was directed to “inhalation therapy”. The substances inhaled (zinc, sulphur, eucalyptus, pine oil and even formalin) were ineffective and often irritant, and no doubt contributed to the virus’ passage, especially where inhalation stations were particularly efficient. The fumigation train carriage in which individuals walked through a mist of inhalant down the length of the carriage must have been a viral culture on wheels. Only in Milton did the local GPs oppose inhalation chambers, presumably contributing to the area’s low infection rate.

If prevention was ineffective, treatment was worse. The major cause of death was secondary bacterial pneumonia (with the associated clotting disorder causing nose bleeds, and bleeding under the skin which turned the patient black). There was no effective remedy until the advent of antibiotics in WWII. Hence Geoffrey Rice describes doctors prescribing morphine, cough mixture and other symptom control. Why such community reliance on doctors when their attentions were largely ineffective? That is a story in itself. The hospitals were full, the auxiliary hospitals inadequate and staffing ad hoc. Nursing and nutrition must have made the most difference, especially to those many people housed in slums or those already affected by the war.

What would make the difference if a similar virus were to arrive tomorrow? Isolation of each family in its home would minimise risk, but lead to the immediate collapse of most essential services. Electricity supply in Auckland is already fragile, and infrastructure in some cities is tottering. The antibiotic treatment of pneumonia is now effective and can be taken/given at home if life-threatening complications haven’t occurred, but, if 50 per cent of the population is affected, especially the 30-40 year-olds as in 1918, who will do the house visits, who will drive the ambulances and who will staff the hospitals? How would we organise ourselves when local leadership is lacking and local community is now a quaint notion?

Bronwen King’s Survive Bird Flu and Other Disasters does not address these issues. It assumes that families will need to live in isolation and mainly seeks to address the issues of food, water and cooking. It’s a tricky task. The author tries to steer a course between extreme scenarios. Will there be electricity? How long will isolation last? Days or weeks? Will family members and especially the usual cook succumb? Half the text is made up of recipes, and most of the remainder deals with buying and storage of food and water. It is less about how to survive than about how to maintain food and comfort.

The book is addressed to the middle-class family, as it assumes sufficient money and storage space to allow the accumulation of food assets. Do such people need recipes? The introduction tells us they do. Certainly the recipes provide variety where that is important, eg where there are children to feed. The book might have been better divided into those ?????? which assume continuity of electricity (for bread, ice cream, baked vegetables etc) and those which don’t (such as pulse dishes and pasta).

The recipe layout is troubling. Having to turn the pages of a tightly bound book mid-recipe is annoying and leads to calorific deposits on the pages. Similarly, the two-, four- or eight-person quantities in the recipes are intrusive. It does allow easy relation to the shopping lists provided, but most middle-class people could work that out for themselves. Would I buy this for the recipes/shopping lists above? Probably not. If flu strikes my neighbourhood, variety in food intake is not going to be my greatest problem. Tramping experience alone tells us all that if we’re hungry enough, any food will do.

It is the first section, particularly advice on how to purify and store water, advice on use-by dates and notions of products which can be stored indefinitely and ideas for storing them that seem most useful. Again, the author seems uncertain whom she is addressing. Advice such as “if food looks bad, don’t eat it”, “discard tins that are swollen or corroded” seems redundant, but details on water sterilisation are useful. Pet food is mentioned only en passant. How do you feed a Doberman once the fridge is off and the dog roll decaying? Medication supplies such as those for diabetes, asthma, epilepsy and psychiatric conditions might also have received more emphasis – particularly how to obtain an extra month’s supply, then how to store them safely.

There is a brave and appropriate effort to address the issue of sewage disposal if water/sewerage services are off. This is appropriately followed by a section on keeping up morale.

The new Disaster Research centre and the pandemic planning committees may be able to provide and publicise civic strategies for the next flu pandemic. Until then, for lessons from our history, Geoffrey Rice’s Black November is an interesting energetic engaging read and Bronwen King’s Survive Bird Flu and Other Disasters a useful and affordable tool to start you thinking about how to feed your family and cope domestically if a vicious virus fells our communities again.

In the meantime at home, Stan the Cat has grown globular by stealthily raiding his pandemic supplies and silently disposing of all his rations.

 

Rae Varcoe is an Auckland physician and reviewer.

 

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Posted in Health, History, Non-fiction and Review
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