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then, the measures against human plague resolve themselves into those that are ordinarily employed against an epidemic disease such as small-pox. These consist in arrangements for an early discovery of cases, the tracing out of their connection with previous cases, removal of the sick from the healthy, cleansing and disinfection of the infected house, and inoculation, if possible, of those persons who reside in loca- lities in which the disease prevails. These measures, it will be observed, are distinct from the everyday routine sanitary duties of an ordinary nuisance and conservancy inspectorial staff whose time in Hongkong is occupied in the morning in supervis- ing the removal by contractors of the nightsoil and refuse, and in the afternoon in making house to house inspections with reference to house nuisances. The inspect- ors usefully combine with their duties in the afternoon that of ascertaining whether there is any sickness in the house, but as they cannot possibly, in the few hours at their disposal, get over more than a few houses the number of sick persons they discover is necessarily very small. As a matter of fact a large number of the cases discovered are dead or dying. There is one trained disinfecting Inspector. For ordinary times when the Colony is free of epidemic diseases an establishment of this kind, with the Medical Officer of Health and Assistant Medical Officer of Health, may, possibly, be sufficient, but at times of emergency and particularly when an epidemic disease becomes endemic, recurring year after year, special officers and special establishments are required to contend with the special conditions that have arisen.
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11. The town and district should be divided into conveniently sized districts with a medical man and sanitary inspector in each, their work to consist in the discovery of cases, house to house visitation, and supervision of preventive measures. If they could be assisted by some of the more influential Chinese residing in the <listrict it would be a great advantage. Whenever a case of plague occurs in a house not only should the necessary measures be taken for that house but a zone of houses and buildings surrounding and adjacent to the infected house should be inspected daily by the medical man of the district to ascertain that the inhabitants are healthy and not suffering from any suspicious symptoms. The history also of every case should, as far as possible, be always traced out and recorded as it often gives the clue to the discovery of other cases and other unsuspected infected localities. Par- ticularly the whereabouts of relations and friends who have had communication with the sick or to whom clothes or other articles have been sent from the infected houses should be ascertained. A daily inspection should also be made of the houses within the zone in order to ascertain that all rats have been destroyed and that fresh rats have not taken their place. I understand that there is great difficulty in ob- taining trained medical men for this work. The same difficulty has arisen in other places and has been overcome by securing the temporary services of medical men from elsewhere.
12. Inoculation with Haffkine's prophylactic should be encouraged. If the protective effect of the prophylactic were carefully explained to the inhabitants in the immediate neighbourhood of a plague house, or to those who have come in contact with a person sick of plague, many, probably, could be persuaded to be inoculated, especially if some of the more enlightened residents in the district showed an example by being inoculated themselves. This prophylactic is very efficacious. In Poona, Bombay, and Capetown I found it gave a very great protection to those inoculated, the difference of attacks between those inoculated and not inoculated being nearly 80 per cent. The Plague Commission sent to India from England re- ported very favourably on the protective effect of Haffkine's prophylactic especially when two inoculations were carried out at intervals of one week from another. The prophylactic is not an absolute protection, but it diminishes the chances of attack iminensely, and, at the same time, if an inoculated person should be attacked it re- duces the chances of death. The inoculation is a very simple process more quickly
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