in Kowloon only 10% presented this picture. Of the 8 cases that died in hospital, two were drug addicts in very poor physical condition, a third was an old lady of 79 years of age and a fourth a man of 27 years suffering from a ruptured pyelo-nephritis and peritonitis. The other four deaths were in adults, all of whom were over 60 years of age. The seven persons brought in dead to the Mortuaries had all been ill for less than 36 hours, the majority dying within 6 to 12 hours of the onset of symptoms. Three of these deaths occurred in children aged five, seven and twelve respectively.
Tregiment
95. The treatment of cases admitted to hospital was by the rapid replacement of Huid and electrolyte loss. Patients with clinical cholera coming to clinics in the New Territories were started at once on re- hydration with normal saline which was maintained during the journey by launch or ambulance to the relevant treatment centres maintained at the Lai Chi Kok Hospital, the old Victoria Mental Hospital and the Cheung Chau Hospital. Once admitted, patients were given rapid intravenous normal saline infusions-up to 2.000 mL were given in one case between the time seen at a clinic and 3 hour after admission to hospital. When more than 2 litres of saline had been given. 0.5 gm. of potassium chloride was given in 500 ml. of normal saline and after each 4 litres of saline, 500 ml, of 2% sodium carbonate was adminis- tered. After re-hydration had been achieved intravenous normal saline was given ml. for ml. of fluid lost through vomitus, stool and urine until convalescence had been established. The invisible loss from sweat- ing and respiration, amounting to one litre cach day, was also replaced. 96. To begin with. noradrenaline was added to the intravenous fluids when the blood pressure was below 70 nun Hg and until such time as the blood pressure was restored. However. after the first week the method of estimation of the specific gravity of plasma advocated by Philips et al (1950) was adopted and normal saline, given at the rate of 75 ml. per minute, obviated the need for noradrenaline which is not without its risks under such circumstances. Chloramphenicol was also given intramuscularly in doses of one gramme 8 hourly until the patient was able to take the drug by mouth when it was continued in appro- priate doses for five days. This is of doubtful value as the modern treatment of cholera is a process of tiding over a period of altered physiology during an apparently self limiting disease. Using precision methods to estimate the fluid and electrolyte losses and giving the
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essential replacements rapidly according to physiological requirements is all that is required in the form of therapy. In this way the fatality rate from cholera can be reduced to negligible levels provided that treatment is given early in the disease and that there is no severe under- lying chronic pathology which will tip the scales between life and death as it will do during any acute and severe clinical condition.
Control Measures
97. The most significant single measure which limited the outbreak is believed to have been the isolation of 96% of the immediate family or habitation contacts. In Hong Kong where whole families live in cubicle spaces with numbers of families in the same room, the segrega. tion of contacts is no mean problem. Fortunately, the Chatham Road Camp with accommodation for 3,000 persons was available as a quarantine centre. Once a clinical case of cholera appeared, the con- tacts were identified by a team consisting of a Health Visitor and a Health Inspector and all were removed to the quarantine centre. A police guard was placed on the premises, disinfection carried out and the living quarters scaled until the contacts returned. It is a high tribute to all concerned that there was virtually no opposition to the quarantine measures and no losses of personal property occurred.
98. In the Quarantine Centre, rectal swabs were obtained from all contacts and the 53 contact curriers detected were isolated within the Centre. Of this latter group, 41 were given treatment with an antibiotic to which the strains of vibrios cholerae were proved to be sensitive. Contacts who were not proved carriers were isolated for six days and then returned to their homes. The contact carriers were isolated until at least three successive negative rectal swabs had been obtained. It is of interest, if not significant, that no secondary case of cholera Occurred that could in any way be related to the contacts.
99. The first group of contact carriers which numbered 20 was treated with chloramphenicol. Later, two cases which did not respond to streptomycin were given chloramphenicol. The dosage for the adult was 1 gm. of chloramphenicol in 4 divided doses daily for a period of five days. la eleven cases, it took 96 hours before the first negative swab was obtained and the other 9 took 48 hours.
100. Oral streptomycin was given to a second group of 21 of the contact carriers in 1 gm. doses hourly for 8 hours, on an empty stomach. The dose was reduced appropriately for children. Rectal swabs taken daily indicated that this cleared the bowel of cholera vibrios within
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