Sessional_Paper_1918 — Page 85

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In conclusion, the prevention of an epidemic does not rest on the swabbing of the entire population, nor the universal "atomizing" of all the inhabitants-both measures of great impracticability in the Colony and of questionable value, as demonstrated above. On the other hand, these means which aim at the removal of the causes of the great spread of the disease as, for example, overcrowding or those means which are directed against the decrease of susceptibility or the increase of the individual's resistance to infection, are to be recommended.

7.-Summary.

(a) A survey showed that the supply of antimeningococcic serum on hand consisted mainly of serum of questionable therapeutic efficacy: that the Colony is too far removed from a source of supply of reliable serum; that the necessity of serum is great, for, not only is the mortality. very high but there are possibilities of recurring outbreaks; that one type of meningococcus (para type) appears to prevail. On these grounds, it was advised that the Government, under its own supervision, undertake the preparation of antimeningococcic serum, especially active against the prevailing type.

To this end the laboratory has been re-fitted; horses are being immunized and it is hoped that in the future a constant supply of potent serum will be always available.

While the preparation is proceeding, an adequate amount of serum (1,125 doses) was supplied by the Rockefeller Institute. This serum shows a high antibody content against the prevailing type and may be regarded as therapeutically potent *.

(b) In respect to the method of treatment, it is advised that all cases be given the benefit of serum treatment. But to attain the best results, these factors are emphasized : the serum must be potent: it must be injected early and in sufficient quantity and, as shown above, intravenous as well as intraspinous injections may be given to advantage.

With an abundant supply of active serum on hand and with the full co-operation of the population, it is hoped the devastating effect of the disease will be in a great measure ameliorated.

(c) The facts which lead to the conclusion that onercrowding rather than the actual numbers of carriers determines the spread of the disease are: (1) The meteorological conditions. The colder the weather, the greater becomes the overcrowding, and as a consequence greater is the number of cases developed. (2) The relative incidence of the disease in crowded and uncrowded districts shows a pro rata decrease in the latter sections and a similar increase in the former. (3) The prevalence of a single type in many of the patients (although all the types of meningococci have been found in carriers) points to the possibility of the infection travelling from one to another by direct contact. crowded conditions of existence this contact is, of course, closer. (4) The gaol in which almost ideal conditions exist with regard to an absence of overcrowding, although harbouring 2461 per cent of carriers among 130 inmates, yielded no cases during the epidemic. (5) Furthermore, the extent of carriers among contacts was less than among the prisoners. Also (6) the number of European contacts was greater than Chinese although the disease was almost entirely limited to the Chinese.

In

Attention has also been called to the disregard of the principles of personal hygiene among the natives in respect to the nasal and mouth discharges, factors which serve to continue the development of cases.

Reference was also made to the conditions preceding the onset of the epidemic namely, an unusually cold winter and a prevalence of influenza and pharyngitis.

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(d) The prevention of epidemic meningitis has been shown to depend upon the active co-operation of the native with the health and sanitary officers.

* Since the arrival of the Flexuer serum, it was possible to treat with it only two cases; one injected with another serum for a long time but slowing no improvement; the other, a case with a Hopeless prognosis before trasą.

ment.

Both recovered.