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H.—l9b

For the last three days of convalescence all patients were sent to the spray-rooms for inhalation treatment twice daily, and were then discharged from hospital. During this epidemic there were no abnormal meteorological conditions observed. ( 'amp Precautions. Troops were kept in the open as much as possible, and were warned against crowding together in barrack-rooms, <feo. The picture-hall was limited to half its usual number —that is, to 300 men ; the institutes were kept open, and all means of ventilation were used. All church parades were held in the open. The men themselves soon realized the seriousness of the position and helped in every way they could to avoid infection. Spray-rooms were frequented. Two new sprayrooms were fitted up; twelve spray-jets were made and connected up with the steam-pipe at the power-house, so that sixty to eighty men could be treated at one time for three minutes. Though at first the spray was rather coarse and wet, this was remedied, and the air of the rooms could be kept nearly saturated and filled with a "cloud." This "cloud " is the only satisfactory way of carrying out inhalation work, and consisted of a 1-per-cent. solution of sulphate of zinc Sulphate-of-zinc solution, being an irritant, the "cloud " was used to secure as far as possible a topical application of the zinc-sulphate solution in a finely divided state to the naso-pharynx and upper respiratory passages. I cannot think that the inhalation at close quarters (especially through the mouth) of a coarse spray of sulphate of zinc would be good treatment during an acute catarrhal epidemic (see Bacteriologist's report). Used properly I think it should be of good service in a similar epidemic. That the treatment is of great use in destroying or at least markedly diminishing organism in the post-nasal space has been abundantly proved in this camp, but, of course, it has no immunizing powers, and fresh infection can practically occur immediately after. The reason why institutes, &c, were kept open was to avoid depressing the men by leaving their evenings unoccupied. Gargling was carried out by the troops, permanganate of potash being the gargle used, and in some cases washing of the nasal cavity by hand-douching was done. The camp was placed in quarantine, and no one was allowed in or out without sanction of the Principal Medical Officer. Troop-trains were stopped; the last troop-train ran on Saturday, 2nd November, 1918. Men on leave were not to report back to camp. The embarkation of the second part of the 43rd Reinforcements was cancelled, also the mobilization of the 51st Reinforcement. As regards this Reinforcement, however, mobilization was so far under way, and many recruits wishing to carry out their arrangements, that eventually 101 entered camp. The Auckland quota, however, was cancelled on account of the epidemic having such a hold in that province. That the precautions taken proved effective—at least, to some degree—seems to be borne out by the (act that out of 3,270 men (parade strength) only 1,566 contracted the disease. This I think should be considered fairly good for a population living in such close contact as was the population of Trentham Camp during the epidemic Demobilization began during the epidemic by the establishment of a segregation camp on the site of the Engineers' Camp. This camp was self-contained, and had a barbed-wire fence round it. The Soldiers' Club was used as a recreation-room, small canteen, &c. Here men were kept for seven days, and had spray treatment twice daily until the time for their leaving camp arrived. Their B.R. Form 201 was then filled in, and in every case the temperature was taken, and if above normal the men were sent to hospital. Medical Aspects of the Epidemic (November). Up to the end of October cases diagnosed as influenza and admitted to hospital were considered all to belong to the same class of disease, and it was not until about Monday, the 4th November, when the admission-rate suddenly increased and the symptoms became more pronounced, that realization came that the severe form of " influenza " had attacked the camp. The pneumonic signs in the chest were usually apparent on the fourth or fifth day. On account of the disorganization of the ordinary routine of military medical work caused hj the incidence of the disease among the N.Z. Medical Corps Staff complete statistics and notes are not available, but when the condition of affairs eased off there was a conference of Medical Officers who worked in Trentham during the epidemic, when all their impressions were put into report form. There were 109 men who suffered from both the September and November epidemics, and 3 died. Of course, many men who had the disease in September had left camp before the second epidemic arose. In common with the whole of the Dominion great difficulty was experienced in looking after the sick. Nursing sisters and orderlies were taken ill wholesale, and in some cases batches of relieving orderlies arrived suffering from the disease and immediately became patients. Many of the voluntary helpers suffered the same fate. Office staffs were depleted ; in my own office, of the whole staff only one lance-corporal remained on duty; and the work of the whole camp personnel became subservient to the medical requirements and rendered excellent help. Clinical Signs and Symptoms. Onset. —Usually characterized by headache and pain in back and limbs, with an initial temperature of 100 to 103. Headache was generally frontal, and usually persisted for forty-eight hours. In one case severe protracted headache was in evidence for five days, the only relief being given by morphia. Cases of severe headache were usually accompanied by complaint of most severe backache. Absence of coryza and cough at onset of disease was marked. Chilliness was often complained of, but rigor was rare. In some recorded cases headache and pain in limbs were present for at least forty-eight hours before pyrexia was recorded. With several patients persistent and excessive vomiting was a prominent symptom from the outset. Mode of onset was