Sessional_Paper_1918 — Page 69

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(d) The great distance of the Colony from the sources of supply of reliable serum adds another factor in favour of its production locally.

On these bases, the report was submitted to the Government advising the prepara- tion of antimeningococcic serum in the Colony.

In order that a supply of a potent serum be on hand until the horses at Hongkong are sufficiently immunized the Rockefeller Institute for Medical Research has presented to the Government 625 doses of antimeningococcic serum, which I have brought with me, and 500 doses which were shipped subsequently, making a total of 1,125 doses.

In testing the Flexner serum with all the cultures of meningococci which are on hand at the Bacteriological Institute it was found that of 59 cultures, the serum aggluti- nated 54. The Government having subsequently agreed to produce serum locally, four horses were started in an attempt to have them yield serum approaching as nearly as possible this standard.

It is believed that the yield from these horses will be adequate to the needs of the Colony.

2.Treatment of the Patient.

The marked success of specific treatment of epidemie meningitis needs no commeu- tary. The results of over 1,300 cases treated with serum supplied by the Rockefeller Institute have been summarized by Flexner (Jour. Exper. Med., 1913, Vol. XVII, page 553) in these words: "It is our belief that the analyses of histories of cases of epidemic meningitis which have been presented, furnish convincing proof that the antimeningo- coccic serum, when used by the subdural method of injection, in suitable doses and at proper intervals, is capable of reducing the period of illness; of preventing, in large measures, of chronic lesions and types of the infection; of bringing about complete restoration to health, in all but a very small number of the recovered, thus lessening the serious, deforming and permanent consequences of meningitis, and of greatly diminishing the fatalities due to the disease.”

Notwithstanding these facts it appears that only very few of the great numbers of Chinese received serum treatment. The records of the Tung Wah Hospital (presented by Dr. Thomas, House Physician) show these results (from February 2nd to May 20th, 1918:-

Total number of patients treated...

Number of patients receiving Western treatment Number of patients receiving Chinese treatment

417

85

332

Of the 85 patients receiving Western treatment, 14 patients were treated by lumbar puncture only. In this series the mortality was 57·1 per cent., 71 received 1 to 5 lumbar punctures and were injected incom- pletely and with sera of low antibody content. In this series the mortality was 45 per cent.

Of the 332 patients receiving Chinese treatment, 228 received at least one lumbar puncture. The mortality in this series was 511 per cent.

The remainder, 104 patients received no serum nor lumbar punc-

The mortality in this series was 846 per cent.

tures.

These figures should be compared with those stated by Flexner.

Serum Injected.

No. of cases.

From first to third day.

199

From fourth to seventh day...

346

Later than seventh day...........

666

Died.

36

94

243

Died per cent.

18.1

27.2

36-5

From the Tung Wah Hospital statistics one may note, as well, that the series in which repeated lumbar punctures were made while showing an improvement over that in which no treatment whatever was given, is far from a satisfactory procedure. The mortality in a series of 346 patients treated in this manner was 54'1 per cent. Compared with the brilliant results obtained by proper serum treatment, it is certain that no other method but the latter is indicated at all times.