Sessional_Paper_1918 — Page 70

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By the proper method of treatment is meant :-

1. The use of a potent serum.

2. The injection of the serum early in the disease.

3. The injection of sufficient amount in a systematic manner.

4. The intravenous injection combined with intraspinal.

Depending on the severity of the case and the amount of spinal fluid withdrawn, 30 to 60 cubic centimeters should be injected intraspinally. While the temperature remains high and the meningococcus is still present in the cerebrospinal fluid, the injections may be repeated every 12 hours. The next interval between injections should be 24 hours, then 48 hours as improvement ensues. In severe cases. however, the injections are persisted in at more frequent intervals. In one of two cases at Hongkong, a Portuguese patient, in whom the treatment could be properly followed, improvement followed the use of 600 cubic centimeters of the Flexner serum. This patient suffered from a very severe form of the disease and the prognosis was very unfavourable at the start.

In severe cases, it is also advised to give 50 to 100 cubic centimeters of serum intravenously. The intravenous injections should supplement the intraspinal. In four of ten moribund cases in the Tung Wah Hospital upon whom blood cultures were made, the meningococcus was found circulating in the blood. The same type of meningococcus (the parameningococcus in all four patients) was found in the blood as in the spinal fluid. The positive blood cultures serve to emphasize the necessity of injecting the antimeningococcic serum intravenously as well as intraspinally. The method is especially indicated where signs of a generalized meningococcic septicemia is in evidence as shown by skin hemorrhages or joint affections, and in fulminating cases.

The Government should use great efforts in attempting to overcome the prejudices of the Chinese to Western treatinent. The objections of the community to proper serun treatment is of course wholly responsible for the terrible mortality of almost $5 per cent. That this mortality is from three to five times as great as it is under proper treatment should be told the Chinese in a system of education and enlightenment. With the aid of influential members of their community, they may take a more rational view of specific treatment. The Government is therefore advised to take this matter under consideration.

Now with an ample supply of serum at hand, and with its systematic use, our hopes are that this disease will be robbed of its devastating effect in the Colony. The Superin- tendent of the Government Civil Hospital, Dr. C. W. McKenny, has been fully instructed with regard to this method of treatment and it is advised that he undertake this phase of the activities during an epidemic.

3. The Diagnosis of the Disease,

A survey of the course of the epidemic makes it certain that numerous cases of epidemic meningitis have occurred but have escaped detection.

The first reports showing diagnoses of epidemic meningitis were returned to the Medical Officer of Health, Dr. Gale, on February 9th. On February 11th, there were reported eight verified cases. Since then, cases were definitely diagnosed as epidemic meningitis. As this disease in epidemic form has a definite course and as a great number of cases of hemorrhagic smallpox were reported previously to February 9th, 1918, although no distinct epidemic of smallpox was evident at the time, it is logical to assume that some of these cases were that of epidemic meningitis. Indeed, on February 5th and 6th, four cases of hemorrhagic smallpox were reported; January 28th, to February 5th, eight cases were reported. With the greater number of subsequent reports of epidemic meningitis, hemorrhagic smallpox ceased to be a factor in the daily returns. The same assumption may apply to the several cases of a typical enteric fever reported during January.

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To this class of "missed cases, may be added another, still more important from the point of view of prevention, the mild and ambulatory cases. For these are the great sources of spreading the infection. They will be referred to later.