64
The para type corresponds to Type I of Gordon's (English) classification; the normal, to Type II; the irregular para type possibly to Type III. The para type agglu- tinations ranged from 1:50 to 1:800; the irregular para types showed these reactions:-
Culture No.
021
030
052
Normal-type (Immune serum).
1:50
Para-type (Immune serum).
Polyvalent (Flexner serum).
1:400
1:800
1:100
1:50
1:400
1:400
1:200
1:200
From these tests it is obvious that about 95 per cent. of these patients have been infected with the same type of the meningococcus.
It has been definitely established that immune serum made with one type fails to afford protection to the other types of meningococci. Hence it is advisable to prepare a serum containing a high antibody content against this type, the parameningococcus. However, should the type in the future change, and to cover the exceptional case infected with another type, the Government Bacteriologist has been instructed to include in his antigen, the other types (although in smaller amounts), thereby making the serum polyvalent to a degree. He has also been instructed in the preparation of rabbit immune serum for 'type determination so that in the event it becomes desirable to change the antibody content of the serum to meet with the local conditions it will be easily accomplished.
(b) The examination of various antimeningococci sera for antibody content. A survey of status of the treatment of patients revealed that there were four sera from different sources in use. One serum was prepared by a commercial firm and three were prepared by Government laboratories.
Ten cultures of meningococci, isolated from patients in the Colony were submitted to agglutination tests with these sera.
The results are tabulated (with Flexner's serum used as a control) as follows:---
Serum.
Commercial laboratory .......... Government Laboratory A.
*
B. C.
Flexner's serum (control)...........
Number of cultures agglutinated.
5
2010 CO IN ∞
3
Number not agglutinated.
75782
7
5
7
8
2
The Flexner serum agglutinated the eight cultures in dilutions of at least 1:800 while the other sera agglutinated the cultures usually in dilutions of 1:50 with the limit in a few instances of 1:400.
Hence with the possible exception of the serum from Government Laboratory A, the antimeningococcic sera available in the Colony is low in antibody content. Furthermore, as it has been determined that the agglutinin content runs parallel with the therapeutic efficacy of a serum it may be stated that the Colony has had supply of inefficient serum.
Therefore another element in favour of producing serum under the supervision of the Government is added.
(c) The possibility of epidemics recurring. When a potent serum will have been made, will there be need for it? The occurrence of sporadic cases of epidemic meningitis. throughout the summer is quite possible. Although the weather is warm at present (a time when meningitis tends to disappear naturally) from three to five cases are still being reported daily (mid-June). This would lead one to believe that under the adverse con- ditions of the cold season, another epidemic may occur. Indeed, the amelioration of the recent epidemic is due to the fact that the susceptible element has been to a great extent affected, leaving a considerable number of insusceptible persons; but active migration of the population usually occurs into the Colony, thus bringing a new susceptible element in contact with the great number of carriers. Carriers in great number are undoubtedly developed as a result of an extensive epidemic, and, under adverse conditions, as over- crowding, the advent of new elements of the population may result in another outbreak.
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