Sessional_Paper_1918 — Page 83

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Important to note is the fact that the very mild case, the patient who is "missed" in diagnosis, may be quite as infective as the fulminating type of case. The number of missed cases in the Chinese community apparently is very large. It therefore behoves the Sanitary Department to strengthen that department, the activities of which include ho ise-to-house inspection. During an epidemic intelligent and trained inspectors should investigate every household and attempt to locate for subsequent investigation patients suffering from fever, headache, hyperesthesia, stiffness of the neck muscles, Kernig's sign, apathy and weakness. A non-fading rash, as well, is an important phenomenon, and herpes especially about the lips are suggestive symptoms.

The difficulties in isolating the patient and the mild or missed case in Hongkong are obvious. However, the establishment of a corps of sanitary police by the Govern- ment suggests itself. It is hoped however, that by a thorough system of education, the natives may be made receptive to these activities and co-operate with the Government for the benefit of their own welfare.

The patient is kept isolated not only during the course of the fever but also at least one week after the fever has subsided. The object is to avoid the discharge of a "dangerous" carrier. Cultures are taken from the nasopharynx and when there are no meningococci demonstrable for three examinations at five-day intervals it is reasonably safe to discharge the patient.

(b.) Establishment of hospitals. If the Kennedy Town and the Tung Wah Hospitals prove insufficient for the number of cases, it is advised that additional hospital facilities be provided. The isolation in a hospital is preferable; isolation at home (as it is con- stituted now) is to be avoided. The additional hospital space can be obtained by constructing matsheds, or other temporary structures, which need not be expensive hut should be comfortable and roomy. Camps or barracks serve the purpose when the necessity arises.

(c) Nurses and physicians attending to meningitis cases should protect themselves especially from droplet infection, by wearing masks while on duty. Those articles, whether eating or drinking utensils, toothbrushes, or bedding, which become contaminated with the nasopharyngeal secretions of the patient are thoroughly disinfected. The terminal disinfection comprises the thorough cleansing of all articles coming in contact with the patient.

(d.) Search for carriers among contacts. The families of patients as well as those who have been is contact with the patient are examined bacteriologically for the pre- sence of meningococci in the nasopharynx. In this way, carriers and especially the dangerous" carrier, that is, the one who harbours numerous meningococci and parti- cularly of the same type as the patient, can be recognised and their influence controlled. The former are treated (as will be indicated below) until the nasopharynx is free from the meningococci; the latter are, as well, isolated.

At this point, it is important to emphasize the futility of the bacteriological exami- nation of great numbers or all of the population (a method which has been suggested). In the first place even in the hands of skilled workers, many may escape detection; the technique of bacteriological examination is very difficult. Secondly, if the same number of the population is infected, as I have detected at the gaol, what disposition could be made of the hundred thousand or more individuals which would be classed as carriers? Thirdly, cases only very rarely develop amongst isolated carriers (as in the case of the gaol). Fourthly an attempt has been made to show that other factors, as the dense overcrowding of the population, are more important in the wide-spread dissemination of the disease than the presence of numerous healthy carriers.

Hence in the present state of our knowledge the detection of the contact carriers, especially the dangerous carrier, and the elimination of their influence, should suffice.

C.-The Means of Prevention of the Dissemination of Epidemic Meningitis to Distant Parts.

As Hongkong depends for its existence in a great measure upon the steamship traffic, import and export business, and as there is usually heavy migration of the popula- tion, the problem of limiting the spread of the disease to distant areas becomes important.