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Enclosure E.
METHOD OF DEALING WITH OUTBREAKS OF BUBONIC
FEVER (PLAGUE).
1. Notification.--All cases of infectious disease should be reported at once to the nearest Police Station or to the Sanitary Board (Telephone No. 257), or to the Medical Officer of Health (Telepone No. 120). This is compulsory on "all persons knowing or having reason to believe that any person has been attacked by or is suffering from" Bubonic Plague, Cholera or Small-pox (Bye-law 17, Ordinance 15 of 1894); but it is universally evaded by the Chinese and even by the Chinese "Doctors." The penalty for its evasion is $25.
2. Detection of the Sick.--In the absence of notification this can only be effected by means of house-to-house visits. The Sanitary Board has power to institute such house-to-house visits in any district in which the disease may prevail and must define the limits of such district (Bye-law 25, Ordinance 15 of 1894).
3. Removal of the Sick.-Ambulances for the removal of the sick are kept at the various Police Stations, at the Canton Wharf, and at the Board's matsheds at Praya East, Taipingshan, Yaumati and Hunghom, and sick persons are removed in these ambulances to the Tung Wah Hospital on application to the Sanitary Board, the Medical Officer of Health, or the Police, and are there examined by a Chinese Doctor trained in Western medicine and are either drafted at once by Lim to the Plague Hospital or detained under observation in case of doubt.
In making any such application care should be taken to state distinctly whether the patient is alive or dead, for in the case of dead bodies, a dead-box is forwarded for the removal. The ambulance is attended by a Chinese constable who conveys the details concerning the case to the Hospital Authorities.
Heavy wooden boxes, with rubber washers fitted to the lids are used for the removal of dead bodies to the Government Mortuary; these are kept at the various Police Stations and at the Board's matsheds, and information concerning the death is forwarded on a card attached to the body.
4. Treatment of the Sick.-This is entirely in the hands of the Medical Department. The Government Hospital at Kennedy Town is supplemented by a series of Matsbed Hospitals, also at Kennedy Town, which are managed by the authorities of the Tung Wah Hospital but are under the supervision of the Medical Department.
5. Disinfection f infected Premises.--This is carried out by a European officer assisted by eight coloured foremen, a Chinese foreman and a varying number of coolies. As soon as it is known that a case of the disease has occurred at any house, a Chinese constable is sent from the nearest Police Station to detain all persons found therein (Bye-law 22, Ordinance 15 of 1894), and the officer in charge of the disinfection proceeds to the house to ascertain how many persons are detained there. He then procures, either from the matshed at Praya East or from the Disinfect- ing Station, as many suits of Government clothing as are needed for the persons so detained, and having thus provided these persons with clothing he removes their own clothing, bedding, curtains, and carpets, to the Steam Disinfecting Station, the clothing being tied up in sheets dipped in a solution of Jeyes' fluid and conveyed through the streets in baskets; persons who are able to obtain new or cleau clothing from some uninfected premises are however not detained after they have discarded their infected clothing and banded it to the Inspector for disinfection. New goods, silk clothing which has not been recently worn, furs and leather goods are not removed to the Steam Disinfector, but must as a general rule remain on the premises until they have been fumigated. When the clothing, etc. is returned (in the course of some two hours) from the Disinfecting Station, the persons who have been detained are required to put on their own clothing and must then leave the premises for some 5 or 6 hours while it is disinfected and cleansed. The Government clothing is returned to the Disinfecting Station to be steamed before it is again used. The people so displaced from their homes are at liberty to make use of the Board's matshed shelters until the processes of disinfection of the premises are complete.
The disinfection of the premises consists in the spraying of the walls with a solution of perchloride of mercury (1 in 1,000) or fumigation with free chlorine obtained by the addition of diluted sulphuric acid to chlorinated lime (1 quart of a 1 in 8 solution of the acid to each lb. of