The Pharmaceutical Journal
Vol 272 No 7295 p482
17 April 2004

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Influenza threat and the shadow of 1918 more
Morwenstow, the meeting of the poets and the mysterious footfalls more
Meeting the growing challenge of managing alcohol-related diseases more

Influenza threat and the shadow of 1918

At the moment, the threat of a deadly influenza epidemic seems to be hanging over the world, and reference has been made to the global pandemic of 1918, known as the “Spanish flu” and noted for its ferocity.

In Science for 19 March, Edward C. Holmes of Oxford University has commented on flu outbreaks. The 1918 incident was notable because its first wave in the spring did not result in unusual mortality, but a second wave which peaked in September, October and November of that year infected more than a third of the population of the US and globally killed between 20 and 40 million people. As a rule, influenza is most deadly in the elderly, but in 1918 the age group 15 to 45 was worst affected. Older people may have acquired protective immunity from an earlier outbreak.

Among factors determining the high mortality of the 1918 outbreak have been included poor living conditions in army camps and a lack of drugs to treat the secondary bacterial pneumonia. The most popular theory is that in 1918 influenza A virus had unique pathogenic properties, probably encoded within the haemagglutinin protein, which is a viral membrane glycoprotein critical for the virus to bind to host cell receptors and initiate membrane fusion.

According to Holmes, 15 subtypes of haemagglutinin have been identified in influenza A viruses causing avian and mammalian disease. Although all have been detected in wild waterfowl, only three have crossed species barriers and established themselves in humans, in 1918, 1957 and 1968.

Avian influenza viruses replicate in the host’s gastrointestinal tract, whereas human viruses replicate in the respiratory tract and produce the distinctive symptoms. It is a matter for argument whether in the 1918 epidemic the virus jumped from birds to humans or whether it found an intermediate host, possibly the pig.

Indeed, the role of birds in the process remains in grave doubt.

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Morwenstow, the meeting of the poets and the mysterious footfalls

In response to my piece on Robert Stephen Hawker (PJ, 17 January, p66), a correspondent has written claiming a special interest, since his son restored a small mansion at Boscastle that belonged to the Hawkers, and where the eccentric vicar and prolific poet met Thomas Hardy.

Hawker had visits from several distinguished people in the world of literature, although there are conflicting reports regarding circumstances. One outstanding event related by the vicar himself regards the poet laureate of the time. In 1848 Alfred Tennyson called on Hawker at Morwenstow. According to Sabine Baring-Gould in his book ‘The vicar of Morwenstow’, (1899), Tennyson presented himself at the vicarage, sent in his card, and was cordially received. However, Hawker had doubts about his visitor’s identity until he had taken him for a walk on the nearby clifftop. When they came to the cascade of the Tonacombe Brook, the vicar remarked, “Falling like a broken purpose”. Tennyson replied, “You are quoting my lines.” This convinced the vicar that he really was entertaining the poet laureate.

The alternative story is that Hawker was walking with his wife on those same cliffs when he spied a cloud of smoke emerging from his favourite observation hut. Investigating this, he found a long-haired man wearing a wide hat and a dark cloak, puffing away at a pipe. “Who are you?” the vicar asked. “Sir, my name is Alfred Tennyson,” came the reply. A subdued Hawker answered, “Alfred Tennyson, I must introduce you to my wife.”

A curious report from the 1930s states that on one occasion two ladies were walking their dog along the cliff path when they heard a distinct footfall behind them. Since the way was narrow, they stood aside and waited for the walker to pass by. The footfalls went on but no one passed them and the dog cowered in the bushes.

When they reached a friend’s cottage the two remarked on the queer experience. “’Tis nothing,” said their friends: “Parson Hawker often comes this way after being at the church.” So the famous eccentric still walked, by all accounts.

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Meeting the growing challenge of managing alcohol-related diseases

It appears from world-wide reports that alcohol in some form is the world's favourite drug and one that has evaded all attempts to restrain its ill-effects on society and individuals. According to the World Health Organization, in the year 2000 there were two billion alcohol imbibers, compared with 1.3bn tobacco smokers and 180 million users of other psychoactive drugs.

More than 90 per cent of adults living in the UK choose alcohol as their preferred recreational drug. Although no health and social problems arise from their habit for most of them, an increasing number suffer from excess, making alcohol the leading cause of disability in men. It has less impact on women. One grave problem is that in developing regions of the earth the threat is rising. A draft resolution of the WHO, to be adopted in May, states that “overwhelmingly, data show its high contribution to the global burden of disease through its damaging effect across all sectors of society as the direct or underlying cause of many illnesses and accidents, violence and impaired health”.

In particular, it is young people who are most likely to abuse alcohol, often through the habit of “binge drinking”, which has been defined as drinking more than twice the recommended daily quantity on at least one occasion in the week. Some 5.9 million adults in the UK, most of them younger than 25, can be reckoned as binge drinkers. In the US and Australia there are similar grounds for concern.

The primary care services, it is argued, are best placed to identify and manage problems related to alcohol abuse. Health professionals will have to accept and shoulder much of the responsibility. They need further training in obtaining information from drinkers and providing them with relevant advice. As usual, funding presents the big difficulty, but is essential for a co-ordinated strategy.

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