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METHOD OF DEALING WITH OUTBREAKS OF BUBONIC FEVER (PLAGUE).
1. Notification. Cases of infectious disease are required to be reported at once to the nearest Police Station (Telephone No. 15) or to the Medical Officer of Health (Telephone No. 120) or to the Sanitary Board (Telephone No. 257). 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 5 of the Bye-laws governing Notification of Infectious disease contained in Sche- dule B. of Ordinance 13 of 1901); but it is almost universally evaded by the Chinese and even by the Chinese "Doctors." The penalty for its evasion is $50.
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, in addition to the visits of the District Inspectors, such special house to house visits in any district in which either of the abovenamed diseases may prevail, and must define the limits of such district (Bye-law 8 of the Bye-laws governing "Disinfection of Infected Premises' contained in Schedule B. of Ordinance 13 of 1901).
3. Removal of the Sick and Dead: -Ambulances for the removal of the sick are kept at the various Police Stations, at the Canton Wharf, at the Board's matsheds at Praya East, Praya West, Yaumati and Hunghom, and at the Steam Disinfecting Station in Taipingshan, and sick Chinese 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 him to the Plague Hospital or detained under observation in case of doubt. Non-Chinese cases are almost invariably reported, in the first instance, by a registered medical practitioner and such cases are, on the certificate of the medical attendant, removed direct to the Kennedy Town Hospital. Should such medical attendant certify, however, that the patient "is being lodged and cared for without danger to the public health," he is not removed to Hospital. In making any application for removal, care should be taken to state distinctly whether the patient is alive or dead, for in the case of dead bodies, a coffin or a dead-box is forwarded for the removal. The ambulance is attended by a Chinese constable, or a coloured foreman, who conveys the details concerning the case to the Hospital Authorities. Light well made coffins, contained in closed hand-carts, are now used for the removal of dead bodies to the Government Mortuary; these are kept at the various Police Stations, at the Board's matsheds and at the Steam Disinfecting Station, 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 Govern- ment Hospital at Kennedy Town is supplemented by a series of Matshed Hospitals, also at Kennedy Town and by a Matshed Hospital at Mongkoksui (Kowloon), which are managed by the authorities of the Tung Wah Hospital but are under the supervision of the Medical Department.
5. Disinfection of infected premises.-This is carried out by European officers assisted by coloured foremen, Chinese foremen, trained coolies and a varying number of carrying 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 3 of the Bye-laws governing disinfection of infected premises contained in Schedule B. of Ordinance 13 of 1901), and the officer in charge of the disinfection proceeds to the house and having provided these persons with Government clothing (if they are unable to provide un-infected clothing for themselves) he removes their own clothing, bedding, curtains, and carpets, to the Steam Disinfecting Station, the clothing being tied up in coarse unbleached calico sheets soaked in a solution of chloride of mercury, and conveyed through the streets in closed baskets. 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 fumi- gated. When the clothing, etc., is returned (in the course of some two hours) from the Disinfecting Station, it is handed to the owners who have already vacated the premises, and the Government clothing is returned to the Disinfecting Station to be steamed before it is again used. The people displaced from their homes during the disinfection and cleansing of the premises, (which usually occupies some 5 or 6 hours in all) are at liberty to make use of the Board's matshed shelters until this is complete, but usually proceed with their ordinary avocations or seek shelter in the street or in a neighbour's house. The disinfection of the premises consists in the spraying of the walls with a solution of perchloride of mercury (1 in 1,000) followed by fumigation with free chlorine, obtained by the addition of diluted sulphuric acid to chlorinated lime (1 pint of a 1 in 3 solution of the crude acid to each tb of the chlo- rinated lime). Floors and furniture are then scrubbed with a solution of one of the coal tar preparations of carbolic acid, and the walls are then lime-washed, chlorinated lime being added to the lime-wash in the proportion of 1 lb. to the gallon.
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6. Burial of the dead. This is carried out under the superintendence of one of the Board's European Officers, all bodies being buried at the Kennedy Town Plague Cemetery, unless a special permit has been granted for burial elsewhere.
7. General sanitary precautions.—Chlorinated lime is supplied to all the public latrines for use in the buckets, and the officers of the Board are instructed to see that it is freely used.
A staff of Chinese rat-catchers is maintained who receive a monthly wage of five dollars and a reward of 3 cents for every rat brought in by them; they are supplied with rat-traps and all the ne- cessary apparatus, and towards the end of the year they were bringing in as many as 1,800 rats a week in the city of Victoria alone the total number of rats paid for during the year 1901 was 77,301.
FRANCIS W. CLARK,
January, 1902.
Medical Officer of Health.
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