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DEFINITION.
Bubonic Plague is a specific infectious fever, characterised by the presence of a definite bacillus, primarily affecting especially the lymphatic system, and after- wards the cerebral and vascular systems. When considering the symptoms (if this definition is kept in mind) it will be found to embrace all the developments which take place in the disease.
CAUSE.
The existing cause of the disease is a bacillus, which was, so far as the Hong- kong epidemic is concerned, discovered first by Dr. S. KITASATO, of Tokyo, on June 14th, in the Kennedytown Barrack Hospital. The bacilli are found in the faces, in the contents of buboes, and in the blood.
Predisposing causes are, speaking generally, insanitary conditions, and of these Filth and Overcrowding ® must be reckoned as two of the most important factors. The district of Taipingshan supplied these factors in a marked degree at the begin- ning of the outbreak, the majority of the houses being in a most filthy condition, as owing to the uncleanly habits of the people the amount of what is generally termed rubbish accumulates in a Chinese house in a crowded city to an extent be- yond the imagination of most civilised people. When to a mixture of dust, old rags, ashes, broken crockery, moist surface soil, etc. is added fæcal matter, and the decomposing urine of animals and human beings, a terribly insanitary condition of affairs prevails; and that this is no overdrawn picture of what was to be met with in Taipingshan, many Europeans now know to their cost. The habits of the people are filthy, and their surroundings are correspondingly filthy if household scavenging is not looked after properly.
Overcrowding (2) was present also. The question as to how many people may go to the acre without overcrowding, must receive a different answer in every separate town according to the character and height of the houses, and the breadth of the streets. When, however, 30 to 40 people are huddled together with a cubic air space of less than 150 cubic feet per head, and that in a house which has no through ventilation, then one would suppose that it must be admitted that there is overcrowding; nevertheless one finds in Hongkong would-be sanitarians who will not admit the existence of overcrowding on any basis but that of how many go to
the acre.
Other insanitary conditions were not wanting. In May 1894 in Taipingshan, and in other districts of Hongkong a large proportion of the houses were damp and badly ventilated, with drains of a most primitive and insanitary description. Earthen floors or floors laid with chunks of stones were the general rule while in most houses light seemed to be looked upon as an enemy to be carefully shut out.
Basements and cellars have been allowed to be inhabited practically all over Hongkong. These have the most meagre provision of ventilation and light, more especially those to the west of the Civil Hospital, where the hill rises abruptly; and in Taipingshan in the neighbourhood of Tank Lanc. Dwellings in these districts are very damp indeed in the summer season, a large number of houses being built directly back to back, or with only a very narrow lane between them.
.(4)
(5)
In the infected areas the drainage arrangements within private premises are bad, a few houses only having been connected to the new system, whilst the majority have the old fashioned drains, square in section, badly constructed, leaking in all directious, and favouring deposit of solid matter--especially during the dry season- and directly connected with the old drains which have been relegated to the duty of conveying storm waters since the introduction of the new system. A few have no drainage at all.
The fond supply of Hongkong is fairly good but could be improved from a public health point of view if the wishes of the Colonial Veterinary Surgeon were inore carefully attended to. The Chinese here have entertained the idea that the
(1) In 1887 an Ordinauce entitled The Public Health Ordinance was passed which handed over the sanitary control of the Colony to a semi-representative body called the Sanitary Board. Much of the work so delegatoil to it has been carried out in an efficient manner. The external scavenging of the streets leaves little to bẻ desired, and many efforts have been made to encourage and foster a higher standard of cleanliness amongst the native population. Unfortunately the Chinaman resents strongly any attempts to interfere with his domestic privacy, and a little too much deference has probably been shewn to his prejudices in this respect. In uy case it must be admitted that the interior of the native houses was such as may fairly be described as a disgrace to a civilized community.
(2) The Health Ordinance provides for overcrowding, but its provisions were not put into effect owing to opposition
by the natives. (See section 67 of Ordinance)
(3) At the time of the outbreak of the Epidemic there was no restriction as to the use of basenizats as places for
habitation.
(4) There is no provision for back-to-back and badly ventilated houses.
(5) The Ordinance gives large powers in Drainage matters, Sections 49-51 dealing with the subject of drains,