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might be carried out. This is the least that ought to be done. On this occasion these Japanese were through passengers for Australia and the ship's people had the satisfaction of having heavy expenses in Australia saved by foisting the men on the Colony of Hongkong at a cost of practically nil. Fortunately for Hongkong vaccination is proceeding apace and although not by the greatest stretch of imagination can the Colony be called "protected" by vaccination yet in twenty-five or thirty years I expect that the entire Chinese population will have found out what a remarkable thing it is when they see that small-pox is practically harmless if proper measures are taken for efficient vaccination being carried out.
Tracheotomy was performed on one case, owing to obstruction in the larynx. The man was moribund at the time, but after the operation had been rapidly performed he rallied in a wonderful manner for twenty-four hours, but then sank. The more I see of some of these bad cases the more do I think that their extreme discomfort and anxiousness arise from the constant feeling of being choked and not so much as is sometimes supposed from the effect of the poison on the nervous system. I, therefore, think that in some cases tracheotomy or intubation (either by Dwyer's tubes or catheter) might be tried at an earlier stage. Morphia is of the utmost value in these cases during the first few days, but about the seventh or eighth day in the smallest doses it is a poison. The Bromides, Chloral, Paraldehyde, Sulphonal, &c. are practically useless. I am now alluding to these cases where the laryngeal symptoms although not extreme are well marked and where the dema and inflammation has rather more to do with the actual obstruction than spasm. Some European patients who have been in this condition have assured me both at the time (if able to do so) and after recovery that the feeling of being choked is what prevents them from getting any rest and that they would give anything for "a good breathful of fresh air." From what I have seen in the larynx post mortem I should say tracheotomy is preferable to intubation. An earlier tracheotomy in some of these cases I am convinced would give the patient a much better chance of recovery, if done as a remedial measure and not merely as a palliative one.
The
The suspected Army cases afford another proof of the necessity for an observation building. necessity for having good isolation wards at the Government Civil Hospital always ready for occupation is pressing, as no one can tell when small-pox and cholera may be present in the Colony at the same time and moreover there is no isolation possible on the Hygeia if small-pox is there. I also think that the Government Medical Officers should have full and absolute power as to whether cases are to be received on the Hygeia or not. My present instructions in this respect are unique in the history of infectious hospitals and I hope that it will be in your power to change these soon.
The ship is at present in first class condition. In October, owing to leakage through roof, &c., repairs were necessary. A new covering of canvas was put on the roof and the outside and inside of the vessel re-painted. Several minor improvements were also carried out.
One question at present which requires solution is that of communication with the vessel. As I have already informed you I consider that the continuous use of steam communication is absolutely necessary when small-pox patients are on board. This is expensive; but I think the cheaper way to do this is to have a small steam pinnace built for the purpose rather than hire a launch to be ready day and night. During the last few months this question has come up again in an aggravated form so far as I am concerned, as on several occasions when patients have been seriously ill I have been unable to obtain outside launches at night and have had to go over to Stonecutter's Island in
my own boat, which I submit I ought not to have to do. I trust you will see your way to get this matter settled in a proper manner. If the ship must lie over behind Stonecutter, surely proper communication ought to be provided. I see no reason why the Health Officer's launch should not be at my disposal from sunset to sunrise at least and something extra added to the wages of the crew when the services of the launch are wanted.
A considerable sum of money had to be spent at the beginning of the year for furniture, bedding, fittings, &c. which were not provided when the ship was launched. Had it not been for this the expense of keeping the ship open would have practically been covered by the amount received in fees $1,430.80. The few cases which we had during December proved expensive, especially the above mentioned army cases, which occasioned a considerable expenditure. When I say that the ship practically covered expenses I do not take into account the amount which it was necessary to expend in October on painting the ship and putting the roof in good condition; nor do I take into account the public vaccinator's salaries which ought not to be included under Hygeia expenses at all.
I would call attention to another subject, the question of removing Chinese patients suffering from small-pox from the Tang Wah Hospital to the Hygeia. I know this cannot be accomplished all at once, but I think that renewed efforts should be made by the Registrar General to bring about a better state of affairs. If the Registrar General has any influence with the Tung Wah authorities and the Chinese population of Hongkong it ought to be used to try and get these small-pox patients removed to the Hygeia. The Tung Wah Hospital is all right in a certain very small way and although small- pox patients are better in that place than running about the streets, still, they ought to be removed if possible to a properly isolated hospital. I don't know that Hongkong will ever be a modern Utopia from a sanitarian's point of view, but too much importance cannot be given to some of these so-called minor questions.