This procedure is repeated at intervals of 24 hours until four doses have been given, which are usually sufficient with a potent serum. The cerebro-spinal fluid becomes clear and free from meningococci. Often two or three doses are sufficient. It is often wise to conclude the series with a lumbar puncture without the use of serum for the relief of pressure only. Curative vaccines have been used in pro- longed cases, where serum appears to be losing its effect. An autogenous sensitized vaccine should be used.
Another method of treatment used in cases where the patient does not react well to the curative horse serum, or where no curative serum is available, is to inject intrathecally 30 to 50 c.c. of the patient's own serum, separated under strictly aseptic conditions from blood drawn from his basilic vein.
This procedure, based upon the fact that anti-bodies are developed in greater extent in the blood than in the cerebro-spinal fluid, has in some instances appeared to do much good.
Serum sickness on the 8th to the loth day is often observed, but is not usually serious. Anaphalaxis is very occasionally seen. It is more liable to occur with intravenous than with intrathecal injec- tion. The principal complications met with are pneumonia, the supervention of a pneumococcal meningitis, arthritis, cystitis due to the meningococcus, hydrocephalus, panophthalmitis.
In patients who recover, complete nerve deafness is the most common (3 to 5 %) of the serious sequelae. Permanent mental change is unusual. A prolonged convalescence is essential.
The chief post-mortem findings in the majority of fatal cases are con- fined to the central and nervous system. Their macroscopic appear- ance is similar to those found in cases of other forms of meningitis. Fulminant cases may show little save injection of the dura mater, a lustreless arachnoid, a soft and swollen appearance of the brain together with a pink congestion of the pia mater. The cerebro-spinal fluid may only be slightly turbid in these fulminant cases.
The ordinary acute case shows a thick yellow purulent exudate mostly at the base of the brain extending along the main fissures, and down the cord. The bulb and the posterior surface of the cord are usually covered with marked accumulations of the exudate. Flaky and turbid fluid is found in the distended ventricles.
In chronic cases there is marked hydrocephalus. The convolutions are pale and flattened ; localized adhesions and thickenings are marked between the membranes, thus forming pockets in the cranium and theca. The various foramina, particularly that of Majendie, may be obliterated, interfering with the circulation of the cerebro-spinal fluid. Marked emaciation is usual.
The post-mortem appearances in other organs are not usually striking. Embleton has shown the frequency of empyema of the sphenoidal sinus. A broncho-pneumonia is almost invariable. Pur- puric and other haemorrhages are common in many organs, and have been especially described by some observers in the supra- renal capsules in fulminant cases. Arthritis, orchitis and pericar- ditis are described and a meningococcal cystitis may be found.
The chief point in the prophylaxis against cerebro-spinal fever is, of course, the prevention of overcrowding; this is of paramount importance. Ventilation and distance between the beds in sleeping quarters are of much greater importance than mere floor or cubic space. "Wall space" is essential.
The early isolation of cases of catarrhal disease is of great importance in preventing the increase in the carrier-rate for the reason that a carrier with a catarrhal sneeze or a cough will spray the meningococcus in a much more effective manner than the same carrier with- out a catarrh. As a rule the meningococcus itself does not give rise to catarrhal symptoms in the carrier.
Where overcrowding is unavoidable and spacing-out impracticable, steam spray treatment, using a. 2% solution of zinc sulphate, may be given for 10 minutes daily to the overcrowded community. In several instances this procedure appeared to check the incidence of cases during an actual outbreak of cerebro-spinal fever. This method of treatment should, however, never be used as a substitute for spacing-out and improved ventilation.
Prophylactic vaccination cannot be regarded as having been proved to afford protection, though at Salisbury and at Camp Funston it appeared to give promising results. (J. A. G.)
CEYLON (see 5.778). The pop. had increased from 3,578,333 in 1901 to 4,110,637 in 1911 and was estimated at 4,757,598 on
Dec. 31 1919, giving a density of 187 per sq. mile. The proportions
according to race, per 1,000 of the total pop., were: Europeans
1-5, Burghers 6-2, Sinhalese 628-3, Tamils 299-4, Moors 58-2,
Malays 3, others 3-4. European residents numbered 7,349 in
1919. The death-rate was 35-6 per 1,000 in 1919 the highest
yet recorded and was mainly attributable to the influenza
epidemic and an outbreak of cholera. The urban pop. represented
about 13% of the total, the chief towns being: Colombo, pop.
(1911) 211,274, Jaffna 40,441, Galle 39,960 and Kandy 29,451.
Both immigration and emigration figures showed a general de-
crease from 120,354 and 90,374 respectively in 1911 to 47,296
1917.
It is estimated that 2,182 Ceylon men (Europeans 1,573, a "d Sinhalese 609) joined the army during the World War and a further 1,204 were recruited for service as clerks and mechanics. The " Ceylon Sanitary Company," raised in 1917, rendered conspicuously valuable service in Mesopotamia.
The Constitution. Under the constitution embodied in the Letters Patent of 1910, Ceylon was administered by a governor aided by an executive council of seven members, including the officer commanding, the colonial secretary, attorney-general, controller of revenue, colonial treasurer, Government agent of the western province, and one member nominated by the governor j and a Legislative Council of 21, including the 7 members of the executive, 4 other official, and 10 unofficial members, of whom 6 were nominees of the governor and 4 elected to represent separ- ate communities.
On Oct. i 1920, with a view to giving a larger measure of popular control over administration, changes in the constitution which had been for some time under consideration received the approval of the King. The provisions were as follows:
As regards the executive council, the governor is instructed to appoint an additional three unofficial members; and, as to the Legis- lative Council, the modification's will (i) involve a considerable exten- sion of the principle of popular election and (2) give the unofficial members a substantial majority over the official vote.
The reformed Legislative Council will number 37 members (exclu- sive of the governor who will preside), viz., 14 official and 23 unoffi- cial members. Of the unofficial members, 16 in the first place and, as soon as arrangements can be made 19, will be elected by various constituencies II on a territorial basis (the franchise and qualifi- cations for candidates following the proposals of the Ceylon National Congress), two to represent the European community, one the Burgher community, one the Chamber of Commerce, one the Low Country Products Association, and (until the registers for the Kan- dyan and Indian communities can be undertaken) two members will be nominated to represent these communities. Of the remain- ing four members, one member will be nominated (as before) to represent the Mohammedan community it being thought impos- sible owing to the wide distribution of Mohammedans in the island to introduce any system of election for this community and the governor will have power to appoint not more than three unofficial members to represent interests inadequately provided for.
By this arrangement, the unofficial members of the Legislative Council will be in a majority of nine over the official, but the governor will have both an original and a casting vote if he should choose to exercise it, and, in order to prevent a deadlock, it is provided that he may declare the passing of any measure to be of paramount importance to the public interest and, in such case, the measure may be carried by the votes of the official members. Somewhat similar reserve powers are contained in the Government of India Act.
The reforms have been opposed by certain sections and, in Oct. 1920, the Ceylon National Congress unanimously resolved to boy- cott the scheme as " utterly inadequate and reactionary."
For purposes of general administration, Ceylon is divided into nine provinces, presided over by Government agents. There are 3 municipalities and 21 local government boards. A Local Govern- ment bill, providing for a wide extension of the principle of local government was under consideration in 1921.
Education. A new ordinance, constituting a Board of Education, which came into force in 1919, enacts that new regulations must be laid before the Legislative Council for disallowance or amendment before being confirmed by the governor in executive council. The board consists of not less than 16, or more than 20, members nominated by the governor, of whom the director and assistant director are ex officio members while the others hold office for three years. In 1919 there were 884 Government vernacular schools, with an attendance of 97,819 boys and 32,570 girls; 1 ,855 Government aided schools, with 129,027 boys and 78,649 girls; 256 aided estate schools, with 9,061 boys and 1,247 girls; and 265 English and Anglo-vernacular schools attended by 36,526 boys and 10,462 girls a total of just under 400,000. The total sum expended by Government on vernacular education in 1919 was Rs. 1,434,264 of which approximately two-fifths were spent on Government and three-fifths on aided schools. The total number of pupils attending secondary schools was 8,065 in !919- The Government training college (1919) had 39 men and 41 women in training in the English side, 8 men in the Anglo-vernacular, and 40 men and 40 women in the Sinhalese. A scheme was on foot in 1919 for affiliating Ceylon University College to Oxford University. The building of a new Royal College was begun in 1920.
