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3. A more extensive use of the diagnostic methods especially in relation to the cere- bro-spinal fluid will aid in the detection of mild or missed cases.

4. The Victoria Gaol, where the prisoners are kept isolated from each other, has shown an incidence of 2461 per cent.* of carriers but no cases of epidemic meningitis.

5. This and the other facts stated above, have led to the conclusion that the dense overcrowding of the population, rather than the actual number of healthy carriers of various types of meningococci, is the cause of the great spread of the epidemic.

6. With regard to prevention, the important measures have been shown to be:-

(a.) The education of the Chinese in order to effect an active co-operation with

the health and sanitary authorities.

(b.) The prevention of overcrowding.

(c) The prevention of droplet infection, the infections of the nose and throat, by the instruction of the principles of personal hygiene and, under the conditions indicated above, the employment of masks.

(d.) The detection and treatment of contact carriers, including the isolation of those carriers who harbour numerous meningococci (especially of the same type which is present in the patient).

(e.) The isolation of the patients, including the mild and ambulatory types. (f.) The discharge of patients and carriers after three examinations at five-day

intervals show the absence of meningococci.

(g.) Although still in an experimental stage, the use of preventive inoculations

of anti-meningococci vaccine.

2145/1918.

GOVERNMENT HOUSE, HONGKONG, 16th July, 1918.

SIR,-The grateful thanks of this Government to the Rockefeller Institute for Medical Research for detailing Lieutenant Olitsky to visit the Colony in connection with the recent epidemic of cerebro-spinal meningitis will have already been conveyed to you by the courtesy of His Majesty's Ambassador at Washington.

Lieutenant Olitsky has completed his investigations and is now about to return to America having assisted this Government with most useful advice and having left with me a very valuable and instructive report.

I enclose a copy of the official letter which has been addressed to him, in which this Government has endeavoured to express its lively appreciation of his services. He has worked in perfect harmony with all those with whom he has been brought into contact and his industry, tact, and courtesy have at all times enhanced the power of assistance with which his expert knowledge endows him.

On behalf of this Colony I ask you and the Institution you represent to accept our warmest thanks for the prompt and generous manner in which you have come to our assistance.

I have, &c.,

F. H. MAY,

Governor, die.

Lieutenant-Colonel SIMON FLEXNER, N.A., U.S.A.,

Director of the Rockefeller Institute for Medical Research,

66th Street and Avenue A,

New York, U.S.A.

* No attempt is made here to interpret the various types of meningococci found among the healthy carriers of the

gaol. This is left for further laboratory investigations.