link between the two Departments for the control of communicable disease through improved environmental sanitation, food hygiene and pest control. Medical and Health Officers are seconded to the Urban Services Department from the Medical and Health Department and work under the direction of an Assistant Director of Medical and Health Services who is posted to the Urban Services Department as Assistant Director. Hygiene. He is responsible for the guidance of the Health Inspectorate in particular and for advice to the Urban Services Depart- ment as a whole on the day to day management of environmental health problems.
69. Medical and Health Officers in the urban areas, in addition to their duties connected with the maintenance of satisfactory standards of environmental sanitation and food hygiene, are responsible for local co-ordination of all epidemiological measures to control the transmission of infectious diseases. Exceptions are tuberculosis, venereal disease. leprosy and malaria which are the concem of specialized branches of the Medical and Health Department. Through the media of the routine house inspections and the regular visits to licensed food premises carried out by the Health Inspectorate, much health education is possible in connexion with immunization campaigns and with the control of in- testinal infections. With the assistance of fully trained Health Visitors, the Health Officers maintain investigations into the sources of known cases of diphtheria, tetanus neonatorum, poliomyelitis, typhoid and certain other intestinal diseases.
70. These activities are closely co-ordinated with the activities of teams of inoculators of the Epidemiological Section of the Medical and Health Department which work under the immediate direction of area Health Officers and offer prophylactic immunization against smallpox, diphtheria and enteric fever.
Rural Areas
71. The Director of Urban Services has statutory powers controlling sanitation, food hygiene, cleansing, amenity and allied services in the townships and the more developed villages in the New Territories while the District Commissioner is the licensing authority for all hawkers and premises where food is handled. The Medical and Health Department provides the curative medical services and the Principal Medical Officer of Health, New Territories, advises the respective authorities on all health matters affecting the area.
16
72. The Medical and Health Department is responsible for environ- mental health in rural areas. The main emphasis is on health education slemming from the curative centres and designed to stimulate self-help through village schemes of environmental sanitation.
73. Active measures continue to control the illegal slaughtering of animals for food and the sale of unwholesome meat, but considerable difficulties are encountered in detecting offenders. Insanitary conditions in workmen's settlements around new development projects continue to be a health problem.
Quarantinable Diseases
EPIDEMIOLOGY
74. Prior to the outbreak of cholera in 1961, there had been no case of quarantinable disease notified in the Colony since 1952. On that occasion there were three cases of smallpox, two of which were imported.
Historical
CHOLERA
75. Cholera was first recorded in Hong Kong in 1858, Records are incomplete but it was reported that 'as many as fourteen hundred were destroyed by the disease in the fishing village of Aberdeen. Thereafter, cases were reported annually between 1862 and 1866 followed by a break of 19 years. Cases then appeared in 1885, 1888 and 1891 after which cases again occurred annually during the years 1894 to 1897. Four years later, in 1901 there was another five years of annual occurrence followed by a 3 years' interval. However, from 1908 to 1916 cholera again occurred each year; during 1913, in August, fifty cases occurred 'almost all of which were on board fishing and cargo boats belonging to the village of Shaukiwan'. Between 1919 and 1927, again a small number of cases was recorded each year with the exception of 1924.
76. Towards the end of April 1932, an epidemic of cholera started in Shanghai and spread throughout Southern China when it was estimated that 100,000 cases occurred with a fatality rate of some 50%. A total of 241 cases with 156 deaths was recorded in Hong Kong where two infectious disease hospitals were staffed and equipped to deal with The emergency,
77. The next episode was in August 1937 when the disease 'became epidemic with almost startling suddenness and nearly 1,000 cases were found, many refugees probably having brought the infection with them'. The measures taken included inspection and examination of all arrivals,
17