Sessional_Paper_1906 — Page 217

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Preventive Measures adopted.

These cases baving occurred, though they only numbered eight up to now, led to measures being taken for the thorough and complete disinfection of the buildings. This was carefully done by the staff of the Sanitary Board, and the walls were completely lime-washed thereatier, and the floors scrubbed with a solu- tion of strong carbolic acid.

Inefficacy of these Measures: Spread of the Disease.

These measures did not prove effective, for after 25 days cases began to break out again, and apparently followed each other with some rapidity. Four cases occurred in July-on the 17th, 19th, 25th and 31st. In August fourteen cases occurred two on the 9th, seven on the 15th, and five on the 30th. In September three cases occurred on the 7th, two on the 19th, and one on the 27th. Then there was a lull.

Further Steps to stay the Outbreak.

Early in September this outbreak was represented to the Hon. The Principal Civil Medical Officer, and its gravity pointed out. Upon his recommendation His Excellency The Governor was pleased to appoint us a Commission to investigate this outbreak, and also to make such investigations into the disease as might tend towards elucidating certain points, notably its causation. On our re- commendation the Committee of the Po Leung Kuk conferred with the Committee of the Tung Wah Hospital, and were able to arrange to transfer all the inmates from the former to the latter institution, where they were accommodated in two large airy well ventilated and sunlit wards. Upon this transfer taking place the premises of the Po Leung Kuk were handed over to us for purposes of investiga- tion. On the completion of the greater part of the experimental portion of our work, the building was again disinfected on three several days, was lime and colour-washed, painted, and then handed over for occupation.

Symptoms of the Disease.

The disease as it affected these patients was of a very mild nature. The earliest symptom noticed was numbness of the legs, which generally extended from the dorsum of the foot upwards as high as the knee. The numbness was seldom evenly distributed, and did not always exactly follow the distribution of the cutaneous nerves of sensation. Soon after this, or almost coincident with its onset, there occurred pain and tenderness on pressure over the calf muscles, and then weakness of the legs set in. This was of varying degree, in some cases shewn only by slight difficulty in walking, in others reaching such an extreme degree as to render the patient completely bedridden. Between these extremes there occurred almost every degree of interference with locomotion. In the slighter degrees there was only slight paresis of the calf muscles-in the severer cases there was paralysis leading to ankledrop. Together with this there was loss of ankle clonus, and generally in all the cases loss of knee-jerk. The muscles of the thigh sometimes manifested tenderness on pressure. Generally there was some oedema perceptible over the tibia, but this seldom reached any great degree. In three cases there was some numbness over the hands and fingers. Apart from these cases the upper extrem- ities did not shew any sign of being affected, nor was any part of the trunk affect- ed. The weakness in the legs which the patients complained of was noticeable in the gait. Where the weakness was slight she would, shuffle along planting the feet somewhat widely apart and taking deliberate steps, watching the floor carefully to avoid a fall. In more severe cases she would try to obtain assistance by guid- ing herself along the wall, or by holding on to the bed. In still more severe cases she would use one or two crutches, and the steps would be taken with an equine, high-stepping gait, the legs being helpless and out of control-resembling a pair of flails and planted with care and deliberation though accompanied with some amount of inco-ordination. The action now was practically only confined to flexion of the thigh by the Psoas and Iliacus muscles. In the worst cases-and there were only four such-the patients were completely bedridden, and apparently to them only remained the power of flexion of the thigh on the abdomen. In such cases the accompanying anesthesia was profound and extended as high as the groin.