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and Puerperal Fever, and a fee of. one dollar is payable to legally qualified and registered medical practitioners for every such certificate, while in the absence of a medical attendant, the occupier or keeper of the premises, or in default the nearest male adult relative, or the attendant upon the sick person is required to notify the existence of any of the following diseases, namely, Small-pox, Cholera, and Bubonic Plague. A penalty of $50 is recoverable for any contravention of these bye-laws, but in practice, it is found, as at home, that where a medical practitioner is not in attendance, the case is rarely notified, and as it is almost impossible to prove, in a court of law, that any of the above named persons actually knew that the disease was either small-pox, cholera or bubonic plague, a prosecu- tion is seldom undertaken.
It will be noticed that, actuated by experience of the working of the Imperial Act, I recom- mended the omission of Erysipelas from the list of the notifiable diseases.
DEATHS FROM THE INFECTIOUS DISEASES.
1. Bubonic Fever.
The statement made by Dr. Lowson, in his able report upon the epidemic of Bubonic Fever (so-called Plague) in 1894, that the public latrines were one of the most potent factors in the spread of the disease, is of serious moment to the health of the Colony, for if this assertion can be substantiated by facts the Sanitary Board must, without delay, devise some other means of conser. vancy than that in vogue at present. None of the Chinese houses in the Colony are provided with any latrine or closet accommodation, and it is the custom for the men to visit a public latrine, for this purpose, while the women almost invariably use pots which are kept in the backyards or kitchens of their houses; both the pots and the latrines are emptied daily by night-soil coolies, and the night-soil is removed from the Colony at once by boats. For a city such as Victoria, with a tropical climate, and a limited water supply, this appears to me a perfect system, but if the use of public latrines by the men can be proved to be the main cause of spreading such a disease as Bubonic Fever throughout the Colony, then the sooner they are abolished the better. I contend, however, that there is no evidence to justify such an assertion, and in support of this contention I would point, in the first place, to the relative incidence of the disease during 1894 upon the two sexes; the Registrar General's report for that year shows that, out of 2,508 deaths, 1,565 were men and 943 were women, that is to say, the proportion of cases in the two sexes was as 17 to 1, and as I have already pointed out that the population of the Colony is composed of thrice as many men as women, it would appear that the women suffered from this disease to about double the extent that the men did, and as it is the men alone who use the public latrines, I fail to see how these can be held in any way responsible for the spread of the disease. It is true that the disease was more prevalent in the neighbourhood of these public latrines than elsewhere, but it is also true that the latrines are, for reasons of convenience, invariably located in the most densely populated quarters of the city, and as the predisposing causes of Bubonic Fever are undoubtedly, as in Typhus, overcrowding, want of ventilation, filth, debility and privation, we have here far more potent factors in the causation of an epidemic, than the mere location of the public latrines. I do not wish to assert that Bubonic Fever cannot be communicated by the excreta, although our information as to the existence or non-existence of the specific bacilli in the ⚫intestinal canal is not as positive as one could wish, but I am most strongly of opinion that the infec- tion is disseminated chiefly by the emanations from the breath and skin, and only to a minor extent by the excreta.
Much has been written about the preponderance of femoral buboes, and Dr. Lowson, in his report, explains this by asserting that in the Chinese, who usually go barefooted, infection by inocu- lation was the usual condition, but he fails to explain why the men of the Shropshire regiment also had femoral and inguinal buboes. To my mind the explanation of their occurrence, in either case, is a very simple one; the disease is essentially one of the lymphatic system, and post-mortem examina- tions have abundantly shown that all the lymphatic glands of the body are more or less implicated, ' and all exhibit a greater or less tendency to enlargement; therefore any special source of irritation will be sure to produce marked enlargement of certain glands, and such irritation would naturally occur in men, whether barefooted or booted, by much walking, especially if carrying heavy weights at the same time, and by climbing up and down narrow flights of stairs, as was done by the soldiers; women on the other hand exhibit mostly enlargements of the axillary glands consequent upon their ordinary household avocations, while the femoral and inguinal glands are not usually very enlarged, for the ordinary Chinese woman, except of the lowest class, does very little walking. It is an admitted fact that patients suffering from Bubonic Fever are able to walk about, and even in some cases to follow their usual employment, for the first day or two of their illness, and then succumb rapidly from heart failure, so that there is ample time for the development of the irritative enlargement of any special chain of glands.
Yet another argument against this theory of infection by inoculation is that wound reaction is not present, in ordinary cases of the disease, but that when we get a genuine case of accidental inocu- lation as from a post-mortem wound, it is most marked, both at the seat of the wound and along the 'track of the lymphatic vessels. This is well shown in the case of Professor Aoyama as described on
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