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Not only should the prevention of overcrowding be directed against the living quarters, but the Government should also consider the overcrowding of tram-cars, schools, theatres or places of public assembly and workshops.
(d) The prevention of pharyngeal infections and influenza is necessary especially since these diseases have been generally found to predispose to attacks and dissemination of epidemic meningitis. The means of prevention of nose and throat infections are, in the inain, practically those indicated above for the prevention of contamination with the nose and throat discharges.
(e) Employment of masks.-During the height of an epidemic extraordinary pre- cautions should be taken by the physicians, nurses and sanitary staff (especially the sanitary inspectors) when coming in contact with numbers of natives or patients. In- deed, for those of the inhabitants of the Colony who are forced to come in close contact with a number of natives or Europeans, the mask offers a good means of prevention of droplet infection. The best mask is the one used in North China for prevention of pneumonic plague: a pad of cotton contained within two layers of gauze and tied by three tails, one over head, two in back of the head, over and under the ears.
(f) Preventive inoculations (prophylactic vaccination). At the present time a gre at deal of work is being done with the view of decreasing the susceptibility of an individual to epidemic meningitis. It is logical to assume that when the individual resistance against infection is heightened that the disease cannot gain headway.
Immunization by repeated injection of saline suspensions of dead organisms has been attempted elsewhere on large scales. The results up to the present indicate that hopes may be entertained as 'to the efficacy of this method. Indeed, the initial success warrants the advice to the Government to encourage generally these preventive inocula- tions. As this work is still experimental, the vaccination need not be made. compulsory. Time, however, will tell whether the method will offer a practical preventive against epidemic meningitis, as typhoid vaccination against typhoid fever.
The Bacteriological Institute has been provided with all the means of preparing the vaccine and is ready, at a short notice, to supply vaccine for the needs of the Colony.
It is advised that complete records of the vaccination be kept by the Medical Officer of Health, who will supervise the injections and follow the vaccinated individuals with the view of adding any information of value for future reference. The most advanta- geous time to start the vaccination is at the end of August or beginning of September.
This methed of preventive inoculation has proven experimentally to be practically harmless. It consists in the subcutaneous injection of saline suspensions of meningococci killed by heat. The dosage is 2 billion bacteria for the first, 4 billion for the second and third injections (or as it is prepared, one half cubic centimeter for the first and one cubic centimeter for the second and third injections). The injections are given at weekly intervals. There may result in slight local or general reactions (headache, malaise, etc.) for one to two days after the injections; otherwise there are no serious consequences.
Finally, preventive inoculations by means of a vaccine while still in an experimental stage have been proven to give rise to antibodies in the blood against the meningococcus. This, together with the fact that results thus far show a degree of protection and that the inoculations are practically harmless, should make as many persons as possible submit to the procedure.
B.-Preventive Measures with Reference to the Patient and His Environment.
(a) Isolation of the patient.-Isolation of the patient so as to remove his area of influence, with regard to his infectivity, is the prime consideration. Before this can be done, it is obvious that the patient must be recognised first. It becomes necessary then for the local physicians to be trained in the recognition of the clinical symptoms especially of the milder cases. At all times the clinical symptoms should be confirmed by microscopic and bacteriological examination of the cerebro-spinal fluid, and where indicated, by the bacteriological examination of the nasopharyngeal secretions.