406
women in the population. There is, however, another circumstance that bears largely upon this question of the birth-rate among Chinese, namely, the fact that no less than 9 per cent. of the Chinese adult female population of the city of Victoria are prostitutes, residing in public brothels, while probably as many more are to be found in the private dwellings, especially of the poorest classes.
The addition of the above 805 unregistered births raises the total birth-rate for the colony to 9.3 per 1,000.
DEATHS.
With such a population as we have in this colony one would reasonably expect to find an abnormally low death-rate, but unhappily such is the condition of filth, of overcrowding, and of squalor generally in which these people have been allowed to live, that instead of this low death-rate, our rate has, during the past year, amounted to 22:04 per 1,000. The average death-rate during the past five years (excluding, for obvious reasons, 1894) has been 22-9 per 1,000, so that this year shows a very slight diminution upon the previous average.
The total number of deaths recorded was 5,400; of these only 191 were non-Chinese, re- presenting a death-rate of 17.6 per 1,000.
One of the most deplorable features of this high death-rate among the Chinese is its partial dependence upon the crass ignorance of the Chinese in regard to the remedial treatment of disease, for not only are they unaware of the use of such a drug say, as quinine in malarial fever, or of the simplest surgical operation for the relief of disease and pain, but such remedies as they do adopt are often, as I will show else- where, in reference to the alarming prevalence of tetanus neonatorum among Chinese infants, of a
most prejudicial and even dangerous character. So strongly has this aspect of our death-rate impressed me that I would urge the Board to represent to His Excellency the Governor the desirability of taking, at an early date, some active steps in the matter of the education of the Chinese in Western medicine, such as the endowment of a College of Medicine for the education of the Chinese inhabitants of this colony. At the present moment no restrictions whatever are placed upon the sale and administration of poisons by native quacks, and it is a notorious fact that many an ignorant coolie practises the divine art of heal. ing in this colony to the great benefit of his own purse, but to the serious health and even the lives of his credulous victims.
I am aware that it is no easy matter to induce the Chinaman to accept the teachings and practices of Western medicine, but there can be no question that something must be done, and that promptly, to check the waste of human life which unquestionably results from the ignorant practices of these so-called "doctors."
The pro- hibition of the sale or administration of poisons by other than registered persons, the registra tion of Chinese midwives, and the absolute pro- hibition of such Chinese methods of treatment as are admittedly dangerous to the lives of the patients (such, for instance, as the cauterization of the hodies of newly-born infants) are matters which demand the urgent attention of the Gov- ernment.
THE HONGKONG WEEKLY PRESS AND
Another of the consequences of this ignor ance of the Chinese respecting medical matters is that although the statistics of the Registrar- General respecting the total deaths may be accurate, yet any analysis of the causes of these deaths teems with inaccuracies, because causes of death are registered merely upon the state- ments made by the person registering the death, and these statements are, as I have already good reasons to know, often deliberate fabrications containing not an element of truth. Apart altogether from the question of the accuracy of our vital statistics, such a system as this must of necessity tend to encourage crime, by facilitating .the disposal of the dead body of any victim to foul play, and I would therefore suggest to the Gov. ernment the advisability of associating a medical man with the department of the Registrar- General, preferably the officer appointed to act as Government pathologist, or failing him, the Medical Officer of Health, so that all uncertified deaths may be properly enquired into and a more accurate diagnosis arrived at than is at present possible. It will be observed that in no less than 10 per cent. of the deaths no attempt
|
K
whatever is made to arrive at even aproximate diagnosis, the deaths being merely recorded as Ill-defined and undiagnosed. Surely there is a vast opening here for the utilization of well-trained students of the College of Medicine if only the Government can see its way to endow that most deserving but struggling in stitution, and offer employment to its alumni.
AGE DISTRIBUTION OF DEATHS.
[May 13, 1896.
year ordinary catarrhal affections appear to be as prevalent here as at home.
Deaths among the Chinese population
1.-Chest diseases.
:
The Chinese suffer considerably from diseases of the chest, no less than 1,136 deaths being recorded under this heading; this represents a death-rate of 48 per 1,000. The disease is more fatal among the boat population than among the land population, the rate among the former alone being 5.9 per 1,000. The causes of this high mortality from chest diseases, and notably from consumption, which accounts for more than one half of these deaths, and which alone represents more than 11 per cent. of the total death-rate among Chinese, are undoubtedly the same as have been found to operate elsewhere, namely, overcrowd- ing. back-to-back houses, and that want of efficient ventilation which is so marked a feature of the present class of Chinese dwellings, while au additional predisposing cause is to be found. in the damp and dark basement dwellings, many of which abut against, the hillside for the entire depth of one or more of their retaining walls. The operations of Ordinance 15 of 1894 will undoubtedly produce a marked reduction in the deaths from this cause, by reducing the mumber of these insanitary dwellings, but it will. I fear, be some years before the full bene- fits derivable from the provisions of this Ordin- ance are realized, for in many cases the faule It lies, not so much in the construction of tht dwelling, but rather in its misuse by ignorant and uncleanly tenants.
The most important feature in regard to the age distribution of the registered deaths is the enormous mortality among Chinese infants under one year of age, for in spite of the fact that the total birth-rate is only 93 per 1,000, yet no less than 28 per cent. of the total deaths occurred in infants, and nearly two-thirds of these were at ages under one month. The number of infant deaths registered during the year was 1.519, representing a total infant death-rate of 680 per 1,000, while the infant death-rate among the European civil community was only 116 per 1,000, and among the Portu- guese community it was 197 per 1000. I have made some enquiries into the causes of this high infant death-rate among the Chinese, and find that it is largely due to diseases of a convulsive type, many of which jare doubt-, less produced by the foul atmosphere which these infants breathe in the ill-ventilated dwellings of the poor, but I am of opinion that not a few are the direct result of the forms of treatment to which these infants are subjected by the native midwives and quack doctors. appears to be a Chinese medical ensting to ` cauterize the face or body of an infant, as a re- medial measure in the treatmennt of flatulence or other trivial ailment, and I am shre that the sores and scars thus produced are one of the most fruitful causes of these convulsive deaths. The disregard of the value of female lives by the Chinese has also to be reckoncil with, for it is a significant fact that the death-rate among infant girls is double that among infant boys, and under these circumstances consider that the Government should. without delay, in troduce a Bill for the registration and licensing of all Chinese midwives practising in this colony, so that some control may be exer siset over them, in this respect, and also in respect to the number of deaths from puerperal fever. further reference to which will be found in this report.
i
RACIAL DISTRIBUTION OF DEATHS.
†
The number of deaths which occurred among the non-Chinese community during the year was 191; of these, 30 are debited to the army and S to the navy, leaving 153 deaths to be accounted for among the British and foreign civil com- munity, which is equal to a date-rate of 21-07 per 1,000; if the naval and military establish ments are included, the date-rate stands at 175, per 1,000.
.
i
2.- Deaths from Nervous diseases. Diseases of the nervous system bulk largely in the death returns for the Chinese population, owing to the enormous infant mortality from convulsions; the deaths from these causes total 1.192, and no less than 6:25 per cent. of them veen-red in infants under one month old, while the number of deaths from convulsions, tetanus, and trismus was 1.107 or 92.8 per cent. of the total death-rate from diseases of the nervous system.
Twenty-four deaths, mostly adults, were due to meningitis. probably the result of insolation in most cases, while various forms of paralysią gerunt for other 56 deaths; three deaths were
due to epilgey and two to manis.
-Deuths from Malarial diseases.
The Chinese suffer severely from malaria, no less than 757 deaths being recorded from this cause alone; this represents a death rate of 3% 1. Lo, It is noteworthy to observe that the death-rate from this disease among the boat population is almost double as great as among the land population. The ignorance of the Chinese respecting the value of such drugs as quinine in the treatment of malarial diseases no doubt largely accounts for this high death-rate, for the rate among resident Europeans, who should he at a great disadvantage in comparison with the native population, is only 0.75 per 1,000. *** The deaths among the non-Chinese community Bri-beri, which is classed with the malarial comprise persons of the most varied nationalities, į diseases, claims 06 per 1,000 of the Chinese for of the 191 deaths, only 92 were Europeans, | population, but the disease is apparently not and 22 of these were non-residents belonging to recognized in the villages, as only one death is the mercantile marine and foreign baries, while recorded as having occurred outside the city, 30 others have already been accounted for as while 19 occurred within it; four deaths from belonging to the two British services, so that 40 this disease are debited to the non-Chinese com- only were European residents, and taking 2.680 nunity, none of which were, however, Euro- as the estimated resident European population. peans, three being Japanese sailors and the this equals a death-rate of 14.9 per 1,000,
fourth a lascar.
[Details are given of the cases of death in the army. the navy, and the non-Chinese com- : munity].
Intestinal diseases are apparently the most to be feared here, as in all tropical climates, and greatcare is needed to avoid unripe fruit or un- wholesome food and contaminated drinking water which are probably the two most potent factors in the production of these diseases,
The risks of pregnancy are also very great, owing apparently to a marked susceptibility to septic infection, and I would strongly advise residence in a detached house at the Peak as the safest course to adopt during such a critical period as the puerperium.
Malarial fever is only responsible for two European deaths, one of them being au infant under one year of age. The dangers of chill are exemplified by the six deaths from diseases of the liver and kidneys, while a too liberal dietary may also have had something to do with the causation of these deaths. Diseases of the chest are more common than might have been expected, although rapid changes of temperature are not uncommon, and at certain seasons of the
|
|
|
1.--Deaths from Dysentery. There were ninety-nine deaths from this disease among Chinese during the year, seven among Europeans (already referred to), and thace among the foreign community, one being an Indian soldier, one an Indian police con. stable, and one a Japanese,
The high mortality among the Chinese is doubtless due more to that ignorance of effec- tive remedial measures, of which I have already spoken, than to any extensive endemicity of the disease.
INFECTIOUS DISEASES.
At the latter end of the year the Sanitary. Board largely extended the scope of its by-laws relating to the notification of infectious diseases aud brought them more into line with the provisions of the Imperial Infectious Diseases Notification Act of 1889. Prior to November the special by-laws upon the subject related only to smallpox and bubonic plague, and the onus of notifying the diseasé fell upon the
1 2 — +c4 འི༩
Page 10Page 11