Page
THE CHINA MAIL, FEBRUARY 6,
PASTEURISATION OF H.K. MILK
Compulsory Order Recommended By Dr. Wellington
SHIGA DYSENTERY OUTBREAK INVESTIGATION
Compulsory vaccination of all locally produced milk is the principal recommendation of the Hon. Dr. A. R. Wellington, Director of Medical Services, in the course of a detailed report on the recent outbreak of Shiga dysentery in Hong Kong.
There is much comment in the report, which was officially released yesterday afternoon, upon the wide difference of opinion among medical practioners as to what constitutes dysentry. "There is little hope," it is stated, "of getting uniformity in. diagnosis.”
Date
Nevertheless, as notification do can do no harm and may "Nov. 8 good, especially during times of epidemic, notification of dysen- tery may be recommended.”"
Discussing the outbreak and course of the epidemic, the re- port says:
9
10
11
17
-12
+
13
14
17
15
*
16
*
Cases. Shiga
12
7'died. 0 -y
0 7
*
1
$1
1
0
71
1
0
77
5
3
1.
Forty Seven Cases
45
were
mic was in being and that the cases transported from the Pokfulam depot might have received infection from a to the depot in the City where it is
bottled.*
common source.
Conference Held
Pasteurisation
On the 13th the Director of Medi- The Government Bacteriologist re- cal Services, the Deputy Director, and ported that the results of pasteuksa- the Health Officers met in conference tion as shown in the bacterial counts to discuss matters and elaborate a of samples submitted were satisfac- scheme of enquiry. Thereafter there tory. Samples taken on the 13th in- were daily conferences where the instant showed a marked difference in formation gathered by different in- the bacterial count brought about by dis-the process. While the тат millk cussed. These conferences were fre- contained 192,000 organisms per c.c.
the Urban Council who throughout | only 700 per c.c. a result which easily
quired in England for Grade. A pas-
vestigators was compared and
quently attended by the Chairman of the pasteurised product contained the epidemic was kept informed of the brought it within the standard re- position.
Dairy Farm
Got.
The Government Bacteriologist re-teurised milk. ported that on the evidence before With regard to the water supply him the outbreak was due to the of the Dairy Farm the Government Bacteriam dysenteriae of Shiga, a Bacteriologist reported that routine had for much more virulent type of organism examination of this water than the Bacteria dysenteriae of Flex-years been carried out by his depart ner the common cause of dysentery in ment and that in the great majority Hong Kong
of cases the results of examination in- dicated water of a high degree of There being some indication that Termination the infection was milk borne the pub-parity. It was decided that the Gov-
lic were advised to boil all milk. The ernment Bacteriologist and the various dairies were visited by the ernment Analyst should make special
examinations. Health Officers and instructed to take
From the 9th to the 19th of Novem- special precautions. One of them the
ber specimens from 64 cases clinical- Dairy Farm decided to institute pas- teurisation of all milk and cream bely diagnosed dysentery were examin- fore issuing thus obviating any risked by the Government Bacteriologist. there might be of infection spreading Of these 16 were positive for Shiga, from this source. The other dairies for Flexner, 1 for Schmitz" and 41 cases where were were negative. In some not having pasteurising plants As defined by Manson-Bahr "dy-
unable to adopt this messure of safe the first specimen proved negative a From the 8th up to and including
second or a third was positive. Some sentery is merely a designation em 19th threre were forty-seven cases re-
ty."
practitioners were content -"with" "one- bracing a symptom complex "but not indicating some particular disease of ported all hut four of whom
It having been ascertained that all negative examination others submit- distinct etiology." It is in fact the European children under ten years of cases so far reported had partaken of ted further specimens.
By the 18th the reports from the The causative organism was in are. name of a symptom common to a
Bacteriologist showed twenty five cases proved to be the milk issued by the Dairy Farm Com number of diseases of very different
pany attention was directed to this Government origins and not that of one specific hacterium dysenteriae of Shiga,
four that of Flexner and in the re-organisation as a possible source of that the majority of positive speci-
infection disease as is so commonly believed.
The fact that thousands mens were Shiga infections. On that mainder the organism was not isolat- ed and identified though in the maj-f individuals had daily consumed milk day the Director of Medical. Services ority of the symptoms pointed strong from this dairy showed that the milk attended a conference at Government The principal forms of dysentery where the first
ly to Shiga infection. In some cases as a whole had not been at fault. It House where the situation so far as was inferred that one particular batch it was known was explained to the On that laboratory findings gaused by parasites are:-
were negative subsequent tests proved had in some accidental way become editors of the local press.
day notices were prepared for distri infected.
bution to all private practitioners ask- 1. Bacterial causing Bacillary positive for Shiga.
All twenty four cases taken ill on ng for particulars of cases coming Dysentery and due to the Flexner
From the list it will be seen that
under their care. bacillus, the Schmitz bacillus or the the fulminating part of the outbreak the 8th and 9th drew their milk from
Conditions At The Dairy Farm Shiga bacillus. Among the Flexner was confined to a few days and was the dairy farm and almost all had of the eight consumed a special kind designated
The Dairy Farm may fairly be de- group there are nearly one dozen varie- due to shiga. Seven
who "nursery milk which differed from
scribed as a high class institution ties each one of which is a specific deaths were those of children organism producing a specific disease were attacked with symptoms on the the ordinary in that cream had been where special precautions are taken to 8th of November and the remaining added sufficient to rise the butter fat IL Protozoal causing amoebic dysentery and due to the Entamoeba one on the 16th was that of a Chinese content from 3.5% to 4%. This produce a clean milk. It has its own dairy infant the son of a Chinese house boy brand was much used among Euros Veterinary Surgeon and several of the histolytica
engaged in one of the houses where eans as a food for infants and child- employees hold certificates in IIL Helminthic ---- caused by sev-two children had died of dysentery ren. It was prepared and bottled at
There are 1.200 cows housed in sam- eral varieties of Bilharzia.
and who had been given the clothes the Pokfulam depot.
The majority of the total cases tary cowsheds. All are subjected to In the majority of cases a diagnosis of the deceased. It is surmised that of dysentery is made when the symp this was a case of carriage of infec- came from Kowloon the remainder routine examination by the Veterinary with two exceptions from the Peak Surgeon and all are tuberculin tested. The Asiatic staff includes some 60, toms are those of a diarrhoea with tion through infected clothing.
among Dysentery not being a notifiable There were almost no cases mucus and blood in the stools. As a disease and no reports having been the considerable population living at milkers, 2 cooler attendants, 2 pasteur- rule no attempt is made to substanti-received from private practitioners or the eastern end of Victoria. The millising and separator attendants. 4 bot private hospitals of the occurrence of supplied to the Peak and Kowloon istlers. 7 attendants for can and bottle Both bacillary and amoebic dysen- cases it was not until the 12th that bottled at the Pokfulam depot, that washing and sterilizing, 18 distributors
Victoria is (Continued on. Page 3) teries are endemic in Hong Kong. Not suspicion was aroused that an epide supplied to the City of
I
Principal Forms
ate this by laboratory findings.
being notificable the total number of cases diagnosed clinically is unknown but from the return of the Govern- ment Hospitals and the Chinese hos pitals some indication of the preval- ence can be obtained. According to the Government - Hospital figures which are in many cases supported by bacteriological findings the number of bacillary cases exceeds that of amoe- hic cases by about five to one.
The Government Bacteriologist who carries out the thorough investigation of a large number of dysenteric stools each year is of opinion that the num- ber of bacillary cases exceeds the number of amoebic cases in the pro- portion of 8 to 1, and that clinical diagnosis is more often wrong than right. This opinion should be accept-
The symptoms produced by the Flexner group bacilli are as a rule comparatively mild and cases which receive proper treatment early "usual- ly recover. Shiza cases on the con- trary early develop severe symptoms of a fulminant nature which cause- grave concern and not unfrequently prove fatal
History of the Outbreak
The outbreak commenced on the 8th of November when twelve, Europera children developed symptoms of the disease so severe that seven of them subsequently died. On the following day twelve more European children went down
The following table shows in con densed form the course of the epide mic.
science.
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