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happened to us. In the G.C.H., there was most probably, high percentage of deaths amongst the convalescents. The symptoms were those of acidosis and in all cases the blood chemistry showed high blood urea. Once the blood urea rose to 100 mms per cent, there was nothing we could do to suve the patient; our problem therefore was either to prevent the onset of this condition or to detect its onse earlier. The routine method of prevention is of course Rogers bicarbonate transfusion but all these cases had already had that, and we felt the addition of more salts to the blood was adding an additional load to the already failing kidneys. By this time the epidemic as on the wane and we were able to spend more time on the fewer cages and the next important step arose, it is interesting to note, not out of a laboratory finding but out of 2 simple clinical observation; we found all these cases had supression of urine. I shall refer to another aspect of this point later.
AL
Owing to the fact that vitamin B1 has been shown to increase the utilization of oxygen in the kidneys of avitam- inotic animals and also t the fact that these patients showed Bi definciency as explained above, we began treating the se cases with large doses of Betuxin intravenously, and the results were very encouraging. number of cases with blood urea of over 100 and in some cases 200 which before were cert in to aie, started passing urine again and recovered. Infortunately by this time the epidemic was almost over and we had to cease our intense labours, so that the scientific proof afforded by large numbers and by controls was not forthcoming, but a prima facie case has been made out for this treatment and I personally think that this finding alone made our work worth while; and it is to be hoped that Government, who gave us a grunt which was largely used for buying Betuxin will agree that it was money well spent.
If figures are of any use in de scribing this work it migh be added that this biochemical investigation was carried out on about 175 patients and involved many thousand separate tests all told.
There are a few general observations that I feel I should like to make and in so doing I hope it will be realised that they are not made in any critical or fault-finding spirit, but in the hope that if and when another epidemic visits us, we shall benefit by our experience of 1937.
1. Mortality was high compared with epidemics in other places such as Shanghai; but I think the reason is that in Hong Kong quite rightly, the patients were kept in hospital till they had negative rectal swabs and were not discharged as in other places as soon as the acute stage is over. large percentage of our deaths were the se anuric cases occur- ing during convale se cence, and it was with all the se cases that our best scientific work was done.
2. No thing but praise can be given to the way in which the doctors and nursing staff carried out their extreme ly arduous tasks in the face of large numbers of patients and a
deplorably equiped hospital. You will remember that the sim- ple clinical finding of suppression of urine and not an abstru- se laboratory investigation gave us the clue to what we think were important findings; but under the conditions prevailing early in the epidemic, the doctors and nurses could not begin to treat cases as ordinary patients are treated; not & be d no te could be made, or even a temperature taken; they were too busy with mere rule of thumb treatment; but under such circumstances how can any doctor be expected to give anything but the merest routine treatment or how can any nurse give but the most meagre attention to her patient? Such conditions are not fair to the medical service, nor to the colony and
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