Rural Areas
69. The Director of Urban Services has statutory powers controlling sanitation, food hygiene, cleansing, amenities and the allied services of licensing of hawkers and premises where food is handied, with the exception of slaughter houses and offensive trades, which remain the responsibility of the District Commissioner, New Territories. The Medical and Health Department provides the curative and personal health services and the Principal Medical Officer of Health, New Territories, advises the respective authorities on all health matters affecting the area.
70. The Medical and Health Department is also responsible for environmental health in rural areas. The main emphasis is on health education stemming from the curative services and designed to stimulate self-help in the villages through the development of simple measures which will improve environmental sanitation.
EPIDEMIOLOGY
Quarantinable Diseases
71. The whole Colony was declared a cholera-infected local area in terms of the International Sanitary Regulations on the 28th of June following the laboratory confirmation of a case of cholera El Tor; it was declared free of infection on the 20th of December, 1963, 15 days after notification of the 14th case. A further case was notified on the 22nd of December and the Colony was declared re-infected on that dale. Seventeen days thereafter, on the 17th of January, 1964, the Colony was once more declared free of infection. The total number of cases in 1963 was 115 with four deaths attributable to the disease. Subsequently. a further case was notified on the 19th February, 1964, the Colony was declared infected on that date and declared free from infection eleven days after the notification.
72. No other quarantinable diseases occurred during the year,
Cholera
73. Following the outbreak in 1962 and in view of the continued incidence of cholera in the nearby countries, intensive preventive measures were taken throughout the year. These consisted of the bacteriological investigation for cholera vibrios of all specimens sent to the laboratory from cases of gastro-enteritis and of the routine sampling of night-soil, sea-water, well-water, and foodstuffs liable to be sources of transmission of the vibrios. Quarantine restrictions were maintained throughout the
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year in respect of all notified infected local areas in the Philippines and the whole of Kwang Tung Province. The restrictions were applied also to other areas as and when these were declared infected.
74. The usual environmental preventive measures were enforced: increased chlorine content in the public water supply, the chlorination of all wells in the urban areas, the vigorous inspections of public eating places, food premises, markets and the control of itinerant food hawkers. Particular attention was paid to the collection and disposal of nightsoil and the bacteriological sampling of nightsoil conservancy tankers. All inoculation centres remained open for cholera inoculation and over 3,100,000 doses of anti-cholera vaccine were administered during the year.
75. The first case of cholera, Ogawa strain, type El Tor, occurred on the 27th June, 1963 and was confirmed bacteriologically the next day. A further 114 cases were notified subsequently, the last one occurring on the 22nd of December, 1963. Of these. one was an imported case, 5 were from the New Territories, 50 from Hong Kong Island and 59 from Kowloon. Six deaths occurred, of which four were attributable to cholera; two of these were brought in dead and diagnosed at post- mortem, the third was a child aged 11⁄2 years and the fourth was a middle- aged man who, having recovered from cholera, succumbed to uraemia. The two non-attributable deaths were a female aged 74 who, having recovered fully from cholera, died a fortnight later from bronchopneumo- nia and a male of 70 who died of uraemia.
76. The incidence of the disease was 3.2 per 100,000 of population and the case fatality rate 3.48 per cent. Cases occurred sporadically and, apart from one episode, no common relationship or source of infection could be identified.
77. Most cases came from amongst the poorest classes, particularly from overcrowded tenements and congested resettlement estates. Incidence differed appreciably between the three major areas of the Colony, the approximate populations of which were respectively 500,000 in the New Territories, over 1,800,000 in Kowloon and over 1,200,000 on Hong Kong Island. The disease incidence was therefore 1.0 per 100.000 in the New Territories, 3.28 per 100,000 in Kowloon and 4.16 per 100,000 on Hong Kong Island.
78. In view of the experience of the past two years, a full scale mass inoculation campaign commenced in mid-May and, by the end of that month, 16% of the population had been immunized. A further 32%
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