360
One of the most characteristic features of outbreaks of Bubonic Fever is that the disease almost invariably tends to run its course in some six or seven months, and then to disappear, only to reappear again however, if the infective material has not in the meantime been destroyed, and if the climate happens to be favourable, and this feature of the disease was frequently used, during the past year, as an argument against the necessity for the action taken by the Sanitary Board in cleansing and disinfecting Chinese premises. It was pointed out, and with great truth, that the disease ran a precisely similar course in the city of Canton to that experienced in Hongkong, and yet no action was taken in Canton to stay the epidemic, while in this Colony, no less than $42,000 was spent in combating its ravages, but it must be borne in mind that there are other features of an endemic to be regarded besides its duration, and the most important of these are its extent and the proba- bility of its recurrence. The action taken by the Sanitary Authority of this Colony was founded upon such knowledge as is already possessed by the scientific world of the nature of the disease. This knowledge comprises the facts that the disease is produced by a living germ or bacillus (the bacillus of Kitasato) which is capable of rapid growth and multiplication in damp and dirty situations, and that if this organism gains access to the human body or to the bodies of certain of the lower animals, it develops at an enormous rate in the blood of the victim and produces a specific febrile disease of high mortality, while from the body of the victim, great numbers of these germs or bacilli are thrown off again in the discharges and excretions of the bowel, lungs and other organs. It will thus be seen that every case of the disease is capable of acting as a centre for the production of other cases and also for the contamination of the soil and building in its immediate neighbourhood, and although we may not be able to curtail the duration of the epidemic to any great extent, owing to the impossibility of discovering and destroying all these fateful organisms, yet if our scientific knowledge is of any value at all, it behoves us to do all in our power to eradicate, as fast as they are discovered, these foci of infection, and thus at least to mitigate its extent.
These bacilli, moreover, do not unhappily cease to exist at the termination of an endemic, but remain quiescent in the soil and in other situations, until the next season shall come round, which is favourable to their growth, just as the seeds of plants may remain dormant for an indefinite period and yet retain their vitality and power of germination, and thus upon the thoroughness of our crusale against these germs will largely depend the probability and the extent of a recurrence of the disease.
The total number of cases of Bubonic Fever notified during the year was 1,204, while the number of deaths registered was 1,078; this is equal to a case mortality of 89.3 per cent. The rate of mortality was however not constant throughout the epidemic, for among the 342 cases which occurred during the first quarter of the year it was 82.4 per cent, while among the 727 occurring in the second quarter it, rose to 94 per cent, and fell again to 77.5 per cent of the 89 cases occurring in the third and fourth quarters.
The following table shows the distribution of the Chinese cases throughout the Colony, and their ratio to the populations of the various districts :—
District.
Per-
Total Total centage Cases. Deaths. Mortal-
No. of cases
among Chinese.
Estimated Population Chinese only.
Rate per 1,000 of populations.
ity.
City of Victoria No. 1,
41
7,250
6'6
48
38
79.3
No. 2,
178
20,440
9.3
191 164
85.9
""
No. 3,
20
2,610
9.9
26
18
69.2
71
No. 4,
147
24,390
6.0
155 142
91.6
>>
No. 5,
115
41,330
2.8
116 113
97.4
No. 6,
84
30,200
2.7
84
76
90.5
"
No. 7,
134
20,560
6.5
135
125
92.6
}}
No. 8.
22
7,620
2.8
23
20
86.9
39
Kowloon,
Victoria Peak,
181
32,200
5'6
189
160
84.6
10
1,600
6.2
10
10
100.0
Shaukiwan,
32
11,300
2.8
32
27 84.4
Aberdeen,...
10
8,060
1.4
11
11
100.0
Stanley,
2
1,610
1.2
2
2
100.0
Boats,
121
17,540
6.9
121
119
98.3
Quarantine Station,........
6
•
6
5
83.3
Merchant Steamers,
34
35
34
97.1
H. M. Navy,...
2
2
2
100.0
No address,
18
18
12
66.6
Totals,...
1,157
226,710
5.1
1,204 1,078
89.5
The cases which were reported from No. 3 Health District were mostly office coolies or coolies employed by European householders, and the presumption is strongly in favour of their having