802
within the precincts of the city, I regret to note that nothing has yet been done to consider or carry out my suggestion.
MARKETS. Central-The building is in a good state of repair and amendment, and most of the shops and stalls are let.
The Western Market is an old, insanitary structure, does not at all meet present require ments, and is altogether unfitted to be used as a public market.
On pointing this out in my annual report for 1890 a Committee of the Board considered the question, and in a report dated May 19, 1891, recommended that the market be re-built; but no steps appear to be taken to carry out their re- commendation.
Saiyingpoon. My remarks upon the Western Market apply equally to this one.
THE HONGKONG WEEKLY PRESS AND
violent reaction among the oppressed, as it has happened and is still happening in British India And it was for this reason that I read with the greatest indifference the assertion put for ward by the Captain Superintendent of Police. They knew the slack way they did things at Macao. They had no house to house visitation." But if those reasons are not sufficient to justify my indifference, the fact alone will do that this assertion was gratuitously put forward by a layman, whose opinion may be highly ap- preciated in the respectable police corporation, but has not the slightest importance in the scientific world.
Of all the members of the Board who took part in the discussion only one-and unfortnn- ately, I believe, he is not a physician-showed always an uncommon good sense, and a desire to sift the truth and only the truth, without The building is old and incouvenient and far fear. It was Mr. Ede, who proved not to bo blind- too small to meet the wants of the districted by the wish of lowering of Macao to utmost which it supplies. Shektongtsui, Wanchai, discredit in which the colony of Hongkong is Sokonpoo, Yanmati, and Hung Hom Markets plunged with regard to hygienic conditions, nor are all in a good state of repair and meet all by withdrawing the attention of the public in present wants,
trying to make people believe that it is Macao -and not Canton, nor Amoy, nor Sw tow, nor Pakhoi, nor Bombay, the crigin of the epide mic of the plague in Hongkong.
Shaukiwan. This building is in a good state of repair, but is too small. In my annual re- port for 1889 I pointed this out, and recom mended that accommodation for at least thirty more stalls be provided.
STAFF.
On November 7th I returned to the colony from leave and took over my duties from Inspector Fisher, who resumed those of his appointment at Kennedytown, Inspector Watson going back to the Markets as Inspector of Markets.
I am pleased to be in a position to state that both these officers performed the r duties in a very satisfactory manuer during my absence.
Watchman Maher resigned on January 31, and Watchman Dahling was appointed in his
stead.
No other changes of importance took place in the staff and the general routine work ap- pears to have gone on smoothly.
DR. GOMES DA SILVA AND THE HONGKONG SANITARY BOARD.
Dr. Gomes da Silva sends us, with a request for publication, a copy of the following letter,
which he wrote to Dr. Atkinson.
Macao, 2nd April, 1898. Dr. J. M. ATKINSON, Hongkong. Sir, I read the Hongkong Daily Press of yesterday's date, and in it I saw inserted the report of the extraordinary meeting of the Hongkong Sanitary Board, in which it has been discussed the sanitary state of Macao. At first I thought of writing you at once and give vent to the feeling of indignation which the perusal of the document awakened in me. I thought afterwards that the language that I would have to use, would at least he so outrageous, as the language used by some of the members of the Board, when speaking of Macao and the authorities of this colony; and what would be pardonable as a man or a Portuguese, would not perhaps be excused as a physician. I chose, therefore, to allow the first impressions to wear off and address you in polite terms, which, in my opinion, such serious subjects as this ought to be handled. I will not lay any stress on what a Captain Superintendent of Police said at the meeting, who, for some reason it is only the English Government that cau appreciate and justify, has a seat and a vote in a council which apparently ought to be com- posed exclusively of professional men.
First of all, the experience in Hongkong, widely confirmed by that of Bombay in the near past, shows clearly that the severe measure of house to house visitation has but one advantage in comparison to many disadvantages. The advantage is to throw dust in the eyes of the public, making a great fuss and boasting at will by the non-professionals. Among the advan- tages, principally, are that of spreading terror among the people, who are victims of being de prived of freedom; that of hindering the work of the prevention of diseases and of the returns, therefore in place of the police discovering the sick in their houses they only find dead bodies in the streets; that of tiring and exhausting the police agents, rendering them more liable to be victims of the epidemic, as it happened in that "colony in 1894; and lastly that of causing a
It is not, however, Mr. Ede that I shall speak of in this letter, addressed by a physician to one of his colleagues on the subject of public hy. giene; but I cannot help thanking him for his impartiality and mild objections, which reveal a frank and loyal character, a love of truth, superior to all other considerations.
C
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April 16, 1898.
sengers with plague, coming from Hongkong, were prohibited to land and had to return there by the same steamer. But in spite of the care- ful vigilance employed, the preventive measures adopted this year have not. for reasons strange to the wishes of the authorities in Macao, the energy and efficiency of those that were em- ployed here in 1894, in which Macao was abso- lutely free from the action of the deadly_epide. mic, which desolated Hongkong and Canton. The result of the deficiency of the actual mes. sures taken was shown in some suspicions, cases in various parts of the town, especially in the districts whose inhabitants have more direct and frequent intercourse with the inhabitants of Hongkong; and lastly, the sanitary returns of the week ending 27th March registered the first two deaths ascertained from bubonic plague which occurred in the city.
These are the true facts on which you should reflect.
The necrological returns issued by the Board of Health of Macao always represent, in figures, the actual deaths occurred in the city, its suburbs and dependencies, according to the diagnosis, the scientific opinion of the director of the medical-statistical department, and who is one of our colleagues.
As we have been instructed by superior au- thorities to make the smallest number of autop- sies and with the desire to respect the customs and belief of the native population, it is some- times possible that the doctor in Marao, especi ally at the commencement of an unexpected epidemic, is led to a wrong diagnosis post- meet-mortem, based merely on the external appear-- ances of the body and information supplied by relations aud lodgers, who are not always trust- worthy. So, the first cases of the bubonic plague only with fever of typhoid character, without any apparent complication of ganglionic system, might easily be undetected and classi- fied as simple abdominal typhus. But what the
You wrote, and Dr. Clark read it at the ing, that for some months past smallpox and plague have been prevalent in Macao."
Regarding smallpox, I do not mind. The weekly returns of deaths, sent with the greatest regularity by the Sanitary Board of Macao to the Sanitary Board of Hongkong, by the Boletim Official da Provincia, had already and the monthly returns published in due course
shown the existence of smallpox in Macao. long before you were aware. According to these re- measles and another of scarlatina, and the re- turns, the eruptive fevers, including a case of
maining cases of smallpox, had from its com- following victims in this city, its suburbs and mencement up to the present date made the dependencies
1897, November.
December 1808, January.
February March
Total
3
.14
21
32
..... 29
94
The percentage of general mortality is 7ļ. You and other physicians will be able to say if this constitutes an epidemic.
As to the existence of the bubonic plague in Macao during the past months, it is a pure fancy ou your part, if there is no other reason to explain the assertion which you made so boldly, unaccompanied by proofs or arguments. I was informed since last January, though un- officially, that the first endemic forms of the plague had made its appearance in Hongkong. did not attach great importance to the fact, and I will tell you why. I can well understand that the bubonic plague had entered Hongkong in 1894: what I cannot understand is how can the plague leave Hongkong once it had entered. It began under an epidemic form and took root in an epidemic form; as long as Hongkong re- mains as it is, the same cause acting in the same medium will always produce the same effect.
Nobody takes extraordinary measures against endemic cholera in India and Siam, nor against endemic beriberi in Java, nor ag inst endemic smallpox in temperate countries. These mes sures are only adopted against the epidemic form of the great infectious diseases. If the in
plague epidemic were to appear this year Hongkong, it could not be concealed for long, as in an endemic form. In due time measures should be taken, if necessary.
Unfortunately it did happen, but only in the month of March last. Singapore and Java had already declared it before Macao. Besides the ordinary measures which are usually employed in this city to prevent the development of the bubonic plague in spring, other extraordinary measures were adopted without fuss and noise, but steadily and constantly.
Thus, during the month of March two pas.
physician in charge cannot help registering are
the number of deaths occurred, from which the sanitary condition, of Macao can be judged, by noticing the increase, the condition, or the de- crease of general mortality.
Perhaps you might doubt the veracity of the registration of deaths in Macao, if you suspect that the same thing happens here as in Hong- kong, which is nothing but a sieve with big hole...om where corpses constantly escape with- out being registered. But, if you reflect a little, you will see that the statistics of Macao are more exact than those of Hongkong: (1st) be- canse Macao is a small territory, having only an area of 3 square kilometres, and a great portion of the shore is of difficult access, where, therefore, the inspection can be made with the greatest precision; (2) because the Chinaman who gives the information to the registrar pays no fee to obtain the permit for burial of the body ontside the city, in ground beyond the Portuguese jurisdiction; while the relatives and lodgers who conceal the dead body, even for one day, or attempt to remove it from Macao, run great risk to be heavily punished; (3rd) because we have not in Macao the system of house to house visitation, as practised in a vexations way in Hongkong; (4th) it is a matter of fact, that the Chiuose inhabitants of Macao are more gentle and submissive than the Chinese of Hongkong.
For this reason and many other cireum- stances, which would be long to relate here, it follows that returns can be obtained in Macao with an exactitude which is not possible in Hongkong. Lastly, the moment that a physi- cian becomes aware of the existence of the plague, the fact is recorded immediately on the returns of the deaths occurred, and, were it possible to conceal in an official and scien- tific document, what use would it be to Macao? Unfortunately, are not the preventive measures adopted regarding persons proceeding from Macao utopical and purely theoretical?
The interest to conceal an epidemic in this colony would be for the benefit of Hongkong and Cantoo, whichjowing to its constant and un- avoidable intercourse with Hongkong, might be considered as suspected ports and their trade and navigation injured. But what could Macao suffer? What advantages would there be to deny the existence of an epidemic in the colony, if it really exists? It is possible that the epidemic of the babonic plague may develop this year in Macao, now that the germ is al-
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