56

REPORT ON THE WORKING OF THE KING INSTITUTE, GUINDY

excess of last year's figure of 16, but the in-patient figure of 25 for last year, has a corres-
ponding nil admission this year. Again in February last year, there were ten out-patient
cases whereas in February this year the figure stood at 44 which is apparently high but not
really so when it is remembered that the out-patient cases of the previous month continue to
be treated during the following month.

     It is needless to amplify, as enough evidence has been advanced to show that the
incidence of malaria is not unduly high.

     The other important factor to consider is the nature of the infection and the possibility
of cerebral malaria. Evidence available as to the existing type of malaria points to a benign
infection as the great majority of cases diagnosed as malaria microscopically, were of the benign
type including the four cases of malaria among the cerebro-spinal fever cases. Two cases
of acute malaria reported sick in my presence and a blood examination revealed a benign
infection. These points together with the evidence of the Medical Officer who states that
malaria is not met with, in any but the mildest type remove the suspicion that the epidemic
of cerebro-spinal fever was influenced by an unduly heavy malarial infection. The disease
as a whole has had no influence or bearing on the occurrence of the cases of cerebro-spinal
fever.

     III. Source of the disease.—It will be seen from the report of the Medical Officer that
no possible connection could be traced between the cases; these had occurred in totally
different parts of the jail and outside the jail in the warder's lines. A close inspection of
the housing and working association of the affected convicts threw no new light either as
regards close association or association with a common group of convicts who might have
harboured a carrier amongst them. An enquiry into the existence of the disease outside the
jail showed that the disease is prevalent in the neighbouring parts and possibly to a large
extent unrecognized; owing to the rapid fatal termination and atypical characters.

     It is not improbable then that carriers are received into the jail from time to time who
cause an outbreak of the disease under favourable conditions, i.e. (1) suitable atmospheric
conditions and (2) overcrowding.

     From the report of the Medical Officer, it will be seen that both these conditions existed
at the time of the outbreak of the epidemic.

     IV. An examination of the methods adopted to arrest the spread of the epidemic
showed that both the Medical Officer and the jail authorities had acted in a prompt and
thorough manner. All precautions were taken and the disease which might have assumed
some magnitude was immediately arrested. Spacing out of the general jail population with
segregation and medication of all contacts was immediately done. No further action was
necessary at the time.