Sessional_Paper_1918 — Page 81

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6.--Means of Prevention.

The means of prevention of epidemics of this disease may be classed into two groups general measures and measures referring to the patient and his environment. The first have for their object the prevention of the spread of the meningococcus from one nasopharynx to another and the decrease of the individual susceptibility to the disease; the second, the limiting of the infectious influence of the patient and contact carriers.

A.--General Measures.

(a.) Education of the Chinese. In the Colony epidemic meningitis proved to be a great devastating disease of the Chinese, the danger to the Europeans only arising from the great numbers of sources of infection which arose and the chance contact with them inside or outside the home. Yet the objections to any preventive measures will arise among the Chinese. Furthermore, unless their resistance is overcome, very little may be hoped for in either preventing the disease or in ameliorating the appalling death-rate.

However, it is apparent that much may be done by educating the Chinese people, including officials, by the demonstration that these methods are meant for their own welfare. The methods which suggest themselves are public lectures, preferably by native officials or physicians, the cinema, advertisements in native newspapers, issuing bulletins, pamphlets in plain and non-technical language and the systematic instruction of school children--in other words, doing whatever will conduce to a helpful co-opera- tion of the natives with the sanitary authorities.

In this connection stress should be laid on the superiority of the Western methods of treatment and diagnosis over the Chinese. The quoting of the statistics of the Tung Wah Hospital should prove convincing information.

The lack of knowledge of modern sanitation should be dealt with in this system of education, especially as it applies to the general habit of expectoration; the use of com- mon eating and drinking utensils, towels and toothbrushes; the exposure of food to infection by placing it directly on soiled streets. As this disease is transmitted by contact with the discharges from the nose and mouth the principles of personal hygiene which are directed against infection by these means, should be emphasized. These include above all the avoidance of "droplet" infection: the coughing or sneezing directly in one's face; hawking or talking loudly at

person.

(b.) The management of the epidemic. The placing of the control of the epidemic of epidemic meningitis in a board has not resulted in any active preventive work. There is much to criticise upon the ineffectiveness of this method. To quote Rosenau: "In the conduct of an epidemic it is very important that all authority should center in one person. To conduct an epidemic with a board of health or a health committee or a com- mission of any kind invites failure. It would be just as foolish to have a board of gene- rals to fight a battle. Those who have been through many epidemics realize that it is no figure of speech to compare an epidemic campaign to a battle. It is a fight carried on at high tension and, although the foe is invisible, it is a battle in every sense of the word."

The Government is therefore advised to place authority not on a board or committee but upon one individual, who may receive advice from a board, in event this necessity

arises.

(e) Overcrowding. An attempt has been made to demonstrate the importance of overcrowding of the population upon the wide spread dissemination of the disease. Indeed, it may be stated, that as long as the overcrowding continues, under additional adverse conditions of life, as, a cold winter season, the occurrence of infections of nose and throat mucous membranes, thus increasing the spraying capacity of individuals, and a migrating population, outbreaks may occur in the Colony from time to time.

It is beyond the scope of this investigation to state how this great social and econo- mic problem of delocating, as it were, the enormous numbers of Chinese from the small area of their community may be accomplished. Reclamation of land and colonizing the adjacent New Territories by improving transit facilities suggest themselves. But this question is left for solution by the Government.