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In general, it may be stated that very little if any progress can be made unless a thorough education of the Chinese is undertaken, particularly concerning the Western ideals of the treatment and prevention of epidemic meningitis. The conditions of life among the Chinese in the Colony tend to spread this disease almost exclusively among them. There are hopes that even the usual methods of instruction and enlightenment, as the cinema, pamphlets, advertisements, lectures in Chinese, exhibitions; and the awakening of interest among the native officials and physicians, may lead to active co-operation and the demolition of the barriers of the native's passive resistance.
In brief, the most important factor in the supervision of epidemic meningitis in the Colony is the prevention of overcrowding. Hence the greatest consideration should be given to this problem.
The other general preventive measures include the education of the native in the matter of personal hygiene. Those principles dealing with the care of the nasal aud pharyngeal mucosa and with the prevention of the spread of nose and mouth discharges from one to another are especially to be impressed.
Attention has also been called to the futility of conducting an epidemic campaign by means of a board or committee and it is recommended that the authority for managing preventive measures rest upon one individual.
Physicians, nurses and those forced to come in contact with great numbers of persons during the course of an epidemic are advised to employ a mask similar to that in use for the prevention of pneumonic plague.
An important general measure which has been recently developed is preventive inoculation. While this is still in the experimental stage, the outlook from preliminary work appears hopeful-indeed, so much so that the Government is advised to encourage its use generally. The laboratory is prepared at present to supply vaccine adequate to the needs of the Colony.
With respect to the patient and his environment, it has been shown that immediate isolation of the patient is necessary. The definite clinical knowledge of the disease and the more extensive use of lumbar puncture suggest themselves as aids in the detection of mild or missed cases. For their isolation is just as important.
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It is also recommended that the discharge of the patient from isolation should wait upon the freeing of the nasopharynx of the meningococcus.
The search for carriers among the contacts with the patient, is a necessary pro- cedure. The treatment of the contact carriers and the isolation and treatment of the dangerous carrier (one harbouring numerous meningococci, especially of the same type as found in the patient) are indicated. The treatment of persistent carriers has been shown to depend on a great measure on the restoration of the nasopharyngeal mucous membranes to its normal condition. In connection with the detection of carriers, the futility of swabbing great numbers or all of the population has been demonstrated.
In conclusion preventive measures are directed towards the prevention of the spread of the meningococcus from one nasopharynx to another, on the one hand, and increasing the resistance against infection, or decreasing the susceptibility, on the other. The first is accomplished by instituting those measures which seek the prevention of overcrowd- ing, the isolation of the patient, the control of the contact and dangerous carrier and the prevention of droplet infection; the second, by what is hoped will prove efficacious, preventive inoculation by means of antimeningococcic vaccine.
Conclusions.
1. The local production of potent antimeningococcic serum and the systematic specific treatment of patients will serve to allay the distress of an appalling mortality during an epidemic.
2. In four of ten moribund patients the meningococcus was found in the blood. This emphasizes the need of intravenous combined with the intraspinous methods of treatment.