10
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then followed up by a very careful inquiry by a medical man with the object of tracing out the causes of the disease, i.e., whether it is due to infection from another case, to infected clothing, to an infected house, to infected rats, or to other causes, aggravated by the conditions under which the patient was living. As pointed out in my last memorandum there is no organization for acquiring the second portion of this intelligence, and for that purpose I recommended the appointment of medical men in districts.
19. As regards the first portion I find that the system for acquiring early in- formation of all cases, which is adopted in England, has been bodily transferred to this Colony without relation to the differing conditions. What is admirably adapted for the conditions of England does not apply to the conditions of Hongkong. Any one reading the Ordinances of Hongkong in regard to infectious diseases without being cognizant of its inner life would consider the bye-laws most excellent. They impose notification on medical men, lodging-house keepers and on householders. But, with the exception of the few European medical men who may be called in occa- sionally by the Chinese or other Asiatic to attend on them, the bye-laws so far as they relate to the Chinese population are a dead letter. It is the Chinese and Asiatics that are chiefly attacked with plague, and as the Chinese and Asiatics practically comprise over 90 per cent. of the Hongkong community, the value of such bye-laws can be estimated accordingly. The method fails, as has been repeatedly pointed out by the Medical Officer of Health in his plague reports,
20. More serious even than the non-reporting of cases, is that a large propor- tion of the cases are found dead in the street or floating in the harbour. The dead bodies are conveyed at night from the houses and are thrown into the street or harbour. In 1898, no less than 36 per cent. were thus found, in 1899, 40 per cent., and in 1900, 37 per cent., and this occurred notwithstanding the employment of special constables—soldiers, police and others--for the express purpose of preventing it. Until this is put a stop to, there is no chance of plague being effectually dealt with. The throwing of dead bodies into the street is much worse than leaving the dead body in the house, and all the inmates abandoning the house. In the latter case, it is known at least where the infection is, but in the former case when the dead body is thrown into the street, all trace of the infected house and clothes is lost and an unknown centre of disease remains with probabilities of infecting others, either then. or in the next year's season for plague.
21. My professional duty lies in pointing out the fact that, while this continues, plague will not be got rid of in Hongkong. It is for the Government to devise an efficient method to prevent it, or to check it to a minimum extent and which shall not have any more serious drawback than the plague itself. I may, however, be permitted to suggest a method for consideration which seems to me more likely to be attended with success than those hitherto tried. I have very carefully considered the question and have consulted others on the subject, and I have come to the conclusion that the Chinese in Hongkong must be treated in this respect more in accordance with Chinese customs. The responsibility should be thrown on them- selves. I would recommend that the City of Victoria and Kowloon be divided into districts and sub-districts, and each sub-district into streets, and if there is a long street sub-divide this again. Then, that each householder be served with a notice pointing out the importance to his own welfare of the plague being prevented and the necessity of his complying with the law and notifying to the Central Sanitary Office, or office of the medical officer in the district, or the police office, any case of sickness or death in his house, and also warning him that, in the event of a dead body being found in his street, that not only he but all the householders in that street, will be subjected to a fine which will be placed in a common fund to defray the expenses of providing watchmen, blocking up the street and of taking other measures to prevent the spread of plague. There is, I understand, a register of Chinese householders kept by the Registrar General.