Sessional_Paper_1918 — Page 67

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T the request of the Colonial Government of Hongkong that the Rockefeller Institute for Medical Research, New York, send one of its staff to advise the Government of Hongkong with reference to the epidemic of cerebro-spinal meningitis and the prepara- tion of antimeningococcic serum, Lieutenant Colonel Simon Flexner, N.A., Director of the Rockefeller Institute instructed me to proceed to the Colony. I arrived in Hongkong on May 5th, 1918.

During my stay in Hongkong every facility was afforded me by the Government of Hongkong to establish a complete organization for the production of antimeningococcic serum and to investigate thoroughly the various aspects of the nature of the epidemic.

Since my arrival in the Colony, the following communications were sent to the Prin- cipal Civil Medical Officer, Dr. J. T. C. Johnson, for the information of the Government.

May 9th, 1918.-A report advising the preparation of antimeningococcic serum in the Colony.

May 9th, 1918.-A request to cable the Rockefeller Institute to discontinue sending further supplies of serum.

May 16th, 1918.-A report on the therapeutic efficacy of the various types of anti- meningococcic sera in use at Hongkong.

May 16th, 1918.-A report on the type of meningococcus prevailing in the epidemic. May 17th, 1918.-A report on the advisability of preparing a vaccine for the pre- vention of epidemic meningitis, stating therein, however, the experimental nature of the vaccine.

May 18th, 1918. A request for permission to study the inmates of the Victoria Gaol with reference to the presence of carriers.

May 25th, 1918.--A statement of intention to address the laity at the Helena May Institute on May 27th on "Infection how contracted and how avoided, with special reference to Epidemic Meningitis"; and the medical profession on the recent advances in the therapy and prevention of this disease on June 20th.

May 26th, 1918: A communication informing the Government that four horses have been started for the production of antimeningococcic serum.

June 13th, 1918: Report on the fact that 2461 per cent. of 130 inmates of the Victoria Gaol harbour in the nasopharynx meningococcus-like organisms. *

I shall endeavour to correlate these communications, tracing the subsequent develop- ments of the investigations started so that in the end the principles underlying the treatment and the prevention of epidemic meningitis in the Colony will be emphasized.

1.-The Production of Antimeningococcic Serum in the Colony.

The conclusion to produce serum was arrived at as a result of (a) determination of the type prevailing amongst the patients in the Colony; (b) the examination of the various sera for treatment, in use during the epidemic; (c) the possibility of epidemics recurring in the future and (d) the inability of the Colony to procure reliable serum promptly.

(a) The prevailing type of meningococcus.-Up to the present time, there were isolated from the spinal fluids of 59 patients as many pure cultures of meningococci. These 59 cultures were tested for type with the following results :

normal type (regular or ortho meningococci) para type (parameningococci of Dopter) irregular para type

0:

.56:

3.

* An additional communication was sent July 2nd, 1918, advising that no diagnosis of epidemic meningitis be accepted

from mortuary cases unless both a macroscopic and microscopic examination of the brain and meninges are made.