April 9, 1898.J
of this fact would be that no less than 1,800 Chinese die annually in Hongkong, as the result of gross insanitary conditions, many of which are at present permitted by the laws of the colony.
Deaths. The total number of deaths re. gistered during the year was 4,688, as compared with 5,860 during 1896; buť in that year there were no less than 1,078 deaths from bubonic | fever; discounting these latter deaths altogether however it will be seen that there has been a material reduction in the number of deaths recorded, and the death-rate for 1897 stands at 18.85 per 1,00 as compared with a average of 23 per 1,000 during the previous five years (exclusive of 1894). The total number of deaths among the Chinese was 4,484 which corresponds to a death-rate of 19.08 per 1,000, the rate during the previous year having been 24.73 per 1,000.
The deaths registered among the non-Chinese community were 204 as compared with 273 during 1896, and the mortality rate was there fore 14.89 per 1,000 as compared with 19 per 1,000 during 1896 and 17.6 per 1,000 during 1895.
The control of Chinese doctors is recom- mended.
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CHINA OVERLAND TRADE REPORT. port or vessel, in the manner provided for in the Regulations issued by the Local Govern ment Board, dated the 9th day of November, 1896."
Unfortunately, however, owing to a change in the constitation of the Board, and the tem- porary absence of the unofficial member, this decision was reversed, on the 19th day of August, of the same year, by a motion of the President, seconded by the Captain Superinten- dent of Police, opposed by the Acting Director of Public Works, and carried by the casting vote of the President, to the following effect:-
That the medical inspection of the shipping in this colony be carried on as at present, but, in order to bring the practice here more into accord with that at home, that Part II of the Regulations issued by the British Local Govern- ment Board on the 9th November, 1896, be in corporated, as far as practicable, into the present Quarantine Regulations, on officer of the Police Force or of the Harbour Department being substituted for an officer of Customs."
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them or crew, to assure himself that none of disease, but such examination would not be were suffering from any infectious deemed necessary if the master of the vessel produced a certificate (somewhat similar to that furnished to the Customs Officers at home) signed by himself and countersigned by the surgeon to the ship, to the effect that there had been no sickness of an infectious nature and no death during the voyage, and that the surgeon had examined every person on board during the 12 hours previous to the arrival of the vessel in British waters, and was satisfied that they were then all in good health Such Surgeon must in all cases be a person entitled to be registered in the colony as a medical practitioner under Or- dinances 6 of 1884 and 4 of 1893, and penalties should be provided to prevent the signing of such certificates by persons other than band fide medical practitioners. When it is remembered that all the mail steamers, including P. & O., Q. and O., N. P., C. P. R., M. M., N. D. L., and the Holt, Shire, Glen, and probably other It may be explained that "the medical in- spection of the shipping in this colony as carried
lines carry surgeons, it will be seen that not many of the thirteen steamers which on at present" permits of free communication enter this port daily, will need a very prolonged with the shore and the landing of passengers visit from the boarding medical officer, and before the risit of the Health Officer of the that the time of these officers will be largely Port, and is therefore, in my opinion, of abso. occupied in supervising the junk passenger lutely no value as a means of protection of the traffic which is generally admitted to be largely colony from the importation of infectious dis-responsible for the introduction of infectious ease. The only circumstances under which a disease into this colony. There is no reason vessel may not establish communication with why these boarding Medical Officers should not the shore before the visit of the Health Officer also carry out the medical inspection of Chinese is when such vessel arrives from a port or place emigrants which is required by section 41 of which has been declared by the Government of Ordinance 1 of 1889, or at least such of this this colony, by a proclamation in the Gazette, work as must be done afloat, for the number of to be infected-a procedure which is very rarely persons to be examined averages only 230 per adopted-or when the master of any vessel is day. so sure of the existence of a case of infectious diseese on board that he flies the Quarantine flag on arrival-an almost equally rare occurrence.
Age Distribution of Deaths.-The death-rate among the infant population still remains high, for these deaths represent no less than 20.7 per cent of the total mortality, as compared with 20 per cent during 1896 and 28 per cent during 1895. The infant death-rate among the non- Chinese inhabitants of this colony during the year was only 120 per 1,000 which does not exceed the rate in England, but amongst the Chinese population this rate was no less than 593 per 1,000, which although still very high shows a marked improvement upon former years for in 1896 this rate was 745 and in 1895 759 per 1,000. As stated in previous reports these infant deaths are mostly due to disease of convulsive type, induced by the foul atmosphere which they are compelled to breathe in the dark and ill-ventilated dwellings of the the poor, and although a material reduction in the number of these deaths has been effected by the sanitary improvements which have bening officers would be almost as great, whereas carried out in the colony during the past three or four years, yet a comparison of the infant death-rates of the Chinese and the non-Chinese communities will show that much yet remains to be done to improve the conditions of life under which the former are compelled to exist.
Infectious Diseases and the Medical Inspec- tion of Shipping.-A table is given showing the number of cases of infectious disease, the totals being as follows:-Bubonic fever 21, smallpox 293, enteric fever 65, diphtheria 2, puerperal fever 7, scarlet fever 1. The remarks on the medical inspection of shipping we reproduce in full:-
Of the above 389 cases, 67 are known to have been imported into the colony from the mainland or by the shipping, but in most of the cases of smallpox no information whatever could be obtained concerning their origin, owing to the desertion of the sick and dead by their relatives. I regret to say, moreover, that nothing has been dono during the past year to protect the colony from the introduction of infectious diseases, by the shipping, as recommended in my annual report for 1896, although a striking illustration of the danger to which the colony is exposed from this cause was afforded by the cases of smallpox arriving with the Willison Circus Troupe in the month of February, and which were landed and distributed in various hotels in the city, before the disease was officially re- cognized.
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It is in my opinion absolutely necessary, colony so situated as this, that every vessel arriving in British waters should be boarded by a medical man and all persons thereon inspected before any communication is permitted with the shore, and this was also the opinion of the Sanitary Board as evidenced by the following motion, which was moved by the late President, and carried unanimously at a regular meeting held on April 8th, 1897-
"That a letter be addressed to the Colonial Secretary pointing out the desirability of ar- rangements being made, at as early a date as practicable, for the medical inspection of all vessels entering the waters of the colony, and for the notification of the intended place of destination of those landing from an infected'
The not unnatural result of the action of the Board has been that the question has remained since then in statue quo, the last paragraph of the later resolution not having been carried into effect, probably because the cost of providing Police boarding officers in lieu of medical board-
the results would be most unsatisfactory and the delay to shipping would be far greater. It must be remembered, of course, that there are no Customs dues in Hongkong, and hence there is uo staff available for the assistance of the Port Medical Officers as at home.
My own scheme for the proper working of the medical inspection of the shipping, without auy unnecessary delay, is that there should be three Assistant Medical Officers of Health, appointed exclusively for duties afloat, that they should form part of the Sanitary Board staff, and act generally under the instructions of the Medial Officer of Health for the colony. Two residences should be provided, one at Kennedy Town and the other at North Point, both close to the shore, and these officers, who should be young single men, should be required to reside therein-that is to say, two of them at Kennedy Town and one at North Point, or vice versi. From sunrise until 9 a.m. there would be a boarding medic- al officer on duty at either end of the harbour; from 9 a.m. until 3 p.m. the third medical officer would be on duty and would deal with all vessels entering the harbour between these hours; from 3 p.m. till 5 p.m. one of those who had been no duty in the early ming would take charge while the other would be on duty from p.m. until an hour after sundown. In practice it would probably be found that these hours of duty would need some modification to accord with the seasons, for they merely suffice to show that three boarding medical officers could readily accomplish the necessary in spection of the vessels without any undue interference with the shipping interests of the port. A boat with four Chinese boatmen would have to be provided at either station, while the launch already in use would be needed during the time that one officer only was on duty.
The function of each of these boarding medical officers would be to board every vessel, whether steamer, sailing ship or native craft, entering the waters of Victoria Harbour while he was on duty and make a sufficient examina- tion of all persons on board, whether passengers'
It would be necessary for a Chinese Inter- preter to accompany each of the Medical Officers on his visits, and accommodation should be pro- rided for them also, at the residences at East and West Point,
The Quarantine Regulation proposed by me to provide for this medical inspection of all vessels was as follows:-
"All other vessels arriving at the port of Victoria, or entering the waters of the colony on the north side of the island of Hongkong shall remain outside the following limits, namely, on the East, the Eastern boundary of the Har bour of Victoria, and on the West, a line drawn due North and South from the West end of Stonecutter's Island, and shall not communicate otherwise than orally with the shore, until a general medical inspection of the passengers and crew aud of all other persons on board such vessels, has been made by the Boarding Medical Officers; and the master of every such vessel shall not permit any person to leave such vessel, or any cargo to be landed therefrom until he has obtained a certificate granting pratique from the said Boarding Medical Officer.
The master of every vessel shall furnish the Boarding Medical Officer with all such in- formation as he may require, and if, in the opinion of such Medical Officer, there has been during the voyage, or there is at the time of. his visit any case of, or any death from, an in- fectious or contagious disease on board, or any person whom he suspects to be suffering from any such disease, he may require the master to at once proceed to the quarantine anchorage; and any such vessel shall be deemed to be "a vessel arriving in the waters of this colony having at the time of arrival, or having had during the voyage, a case of any infectious or contagious disease on board' and shall comply with all the Quarantine Regulations relating
to such vessels.
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Provided always that Her Majesty's Mails may be landed from any vessel at any time-after her arrival in the waters of the colony, and that such mails may be accompanied ashore by a mail officer or officers, but the names of all such officers must be given to the Boarding Medical Officer by the master of the vessel, at the time of his visit of inspection.
"And provided also that the Boarding Medical Officer may, in his discretion, omit such general medical inspection of the passengers and crew and of all other persons on board, upon the production of a certificate in the form set forth in the Schedule attached hereto, duly signed by the Master of the vessel and countersigned by the Surgeon to the effect that there has been no case of sickness of an infectious nature during