Sessional_Paper_1918 — Page 71

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Lumbar puncture is an absolute essential in the treatinent and in the recognition of cases of epidemic meningitis. Due to certain objections on the part of the Chinese community the procedure is not favourably entertained.

It is desirable to swab the nasopharynx as well when the symptoms are suspicious and the spinal fluid removed is clear, for practically almost every case of epidemic men- ingitis harbours the organism in the post-nasal mucus. To this measure, as well, the Chinese resist.

If the resistance of the Chinese is maintained, it is obvious that an insurmountable difficulty will arise in the way of controlling the disease or reducing the appalling death- rate. Again, the Government is advised of the great importance of a systematic educa- tion of the natives so that the disease can be properly attacked.

4.--The Course of the Epidemie and the Factors Contributing to its Dissemination.

In the following, an attempt will be made to state the findings which resulted from an investigation on the course of the epidemic in the Colony, and the factors which con- tributed to its dissemination and continuance. In the next section these facts will be correlated to bring out the epidemiological conclusions.

(a) The course of the epidemic.----Epidemic meningitis is not a new disease in Hong- kong. There is evidence to believe that sporadic cases have occurred from time to time in the Colony. In the Philippines, of which Manila is the next port of call of the trans- Pacific steamships, seventy cases were detected three years ago.

lu two of these cases, the meningococcus was isolated in pure culture from the cerebrospinal fluid and is still preserved at the Bureau of Science, Manila. As epidemic meningitis was not a notifiable disease until the present epidemic, there are no recorded cases. However, Dr. Johnson, the Principal Civil Medical Officer has seen a case five years ago in the Colony. Again, one may assume that sporadic cases may have occurred in Hongkong especially in view of the fact that it is one of the largest coinmercial ports in the world and thousands of passengers from everywhere pass through annually. No epidemics, however, were known until this outbreak.

During January 1918, increased numbers of cases were reported at the mortuary but no actual diagnosis of epidemic meningitis was made until February 9th, 1918. As I have already stated, the assumption that the epidemic started at least a month before this time seems to be well grounded. During the rest of February the cases were increasing in number (six to eighteen were reported daily). During March there were as a rule ten to twenty-four cases per diem reported; during April, six to fifteen; during May, three to seven and during early June the average number was about three. The epidemic started in January, reached its height in March, and declined gradually in April, reaching its low level in June.

(b) The number of cases and the mortality.--Up to June 1st, 1918, there were 1,041 patients reported. Of these only four were European. The 1,037 cases include, with the exception of a few Portuguese, Chinese exclusively. For the purposes of epidemio- logical study the Portuguese and Chinese are grouped together on the basis that the former although living apart from the natives exist under very crowded conditions. This number, 1,041, does not represent the actual number of cases. Many of the patients were "missed". On account of the mildness of the disease in many individuals, the diagnosis may have been overlooked. On the other hand, many Chinese who sought native healers and subsequently recovered were never placed on record. The actual number is undoubtedly much greater but it is impossible to approximate the figures.

Therefore the total mortality which is computed at 761 per cent. for the first 1,000 cases, does not represent the actual mortality, which, of course, would be lowered in view of the number of missed cases.

(c) The influence of age and sex. From the Tung Wah Hospital records of 417 patients, it will be noted that the ages of patients ranged from 4 months to 59 years: the average age was 22.68 years. In this series it will be noted that the number of affected males was slightly over twice that of the females. In a series of the first 750