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The number of cases which have recently occurred among the coast and trans-Pacific steamships have with a very few exceptions been localized to the steerage passengers. Owing to heavy traffic and limited steamship space, there has been a tendency to over- crowd the passengers.
Besides the measures stated above the following is emphasized.
The first consideration is the prevention of both overcrowding and the lack of proper ventilation. This applies to railways as well.
During the prevalence of an epidemic, it is advisable to prohibit the departure. by rail or ship of any actual contact with a case especially those contacts shown by bacteriological examination to be dangerous carriers.
It is not necessary to restrict any trading with merchandise as goods or inanimate objects, have not as yet proven to be sources of infection.
D.--The Treatment of Carriers.
In general, it may be stated that in an individual who is lightly infected (designated above by "plus-minus" or "one plus" on plate cultures) the meningococcus has tendency to disappear. In others, however, the micro-organism tends to be persistent and requires energetic treatment before it disappears from the nasopharynx. Indeed in some cases, in spite of active treatment, the healthy carriers or convalescents are not freed of the meningococcus for a period of months.
At the present time the most efficacious treatment, as demonstrated by investigations. carried on under the direction of Dr. Flexner, is that which takes into consideration the condition of the mucous membrane of the nasopharynx, as well as the chemical disin- fection. In a heavily-infected carrier it becomes a very tedious process to destroy the meningococcus unless any pathological condition of the mucous membrane is remedied. Sinusitis, pharyngitis, tonsilitis and diseased adenoids must be treated and the mem- branes restored to normal; otherwise the meningococcus will have a tendency to persist (and sometimes in pure cultures) in spite of any disinfection.
The most effective chemical disinfection is the steam chamber devised by Gordon and Flack (British Medical Journal, November 18, 1916, page 673). The construction of the chamber is given in detail in their article. Chloramine-T, in a 2 per cent. aqueous solution is the chemical used for vaporization. One litre of the solution is sprayed by means of steam into a room of 750 cubic feet capacity in the course of 15 to 20 minutes. The carrier remains in this chamber for this length of time during which he inhales deeply through the nostrils. One treatment is given each day. If the carrier is lightly infected, he will be freed from the meningococcus in a few days; if heavily infected, it may take from one to several weeks. In any event, the restoration of the nasopharyngeal mucous membrane to its normal condition will hasten to a great extent the clearing up process.
These steam-chambers can be set up at the various hospitals in the Colony.
Should the steam-chamber prove inconvenient, hand sprays (or atomisers) may be substituted. The most efficacious of these means, is the use of dichloramine~ T, а 2 per cent. solution in chlorcosane, a bland, unirritating oil. The method of procedure is as follows: The nose is cleared with salt solution first, either by spraying or irrigating. Instead of salt solution chloramine-T in one-quarter per cent. aqueous solution may be used both as a cleansing agent and as a gargle. Having thus cleared the nose, the dichloramine-T, in chlorcosane, is sprayed thoroughly into each nostril, by means of an oil-atomizer. Four treatments are given a day at about three-hour intervals. Indiscriminate spraying should be avoided on the grounds that the mucous membrane may be damaged and a previously lightly-infected carrier may become heavily-infected.
The discharge of a carrier who has been subject to treatment, as free from the meningococcus, follows after three cultures taken at five-day intervals are found to be negative.