78
additional Chinese disinfecting and rat catching staff.
The PRESIDENT seconded and the motion was agreed to.
This was all the business.
PROFESSOR SIMPSON'S REPORT. The following is the text of Professor Simpson's report :-
As requested by His Excellency I have the honour to furnish him with a brief memorandum on the measures which it is advisable to take in order to combat the annual and seasonal recurrence of plague. Two deaths have been already reported from this disease within the past fortnight, and it is important from a preventive point of view that vigorous action be promptly taken.
2. No success is likely to accrue from any measures which are limited to dealing with plague in human beings and the adoption of which does not take cognisance of the fact that plague in rats and mice also disseminates the infection. It does not serve any very useful purpose to remove the sick and cleanse every thing in
the infected houses and above ground if the infection is being also carried by plague-stricken rats from house to house or district to district by the subterannean movements of rats, whether this be effected by rat-burrows or by sewers and drains. Both rat and human plague possess infective powers, and each can spread the disease not only to its own species but also
to the other.
3. Plague is in fact primarily a disease among rats, the infection of which can be conveyed to human beings, but once estab- lished in human beings the infection is com- municable to others by means of the expectora tion, by the discharges from the bowels and by the urine and by discharges from the buboes or glandular swellings which form in this disease. The clothes, the food and surroundings of a plague patient are likely to be infective and spread the disease to others, while the rats in the house which were previously healthy, by eating the food or coming in contact with the clothes or discharges, catch the infection and also spread the disease. Accordingly, no measures are complete which do not include the prevention of the disease in rats as well as man. It is because of this intimate connection between rat plagce and human plague that the following measures are advised.
The
|
THE HONGKONG WEEKLY PRESS AND
[February 1, 1902.
of which is to destroy the underground agents times when the Colony is free of epidemic which are susceptible to the disease and thus diseases an establishment of this kind with the prevent the infection from being dissemminated Medical Officer of Health and Assistant Medical farther than the already infected areas. If the Officer of Health may possibly be sufficient, but rats and mice are destroyed in a locality before at times of emergency and particularly when an plague is imported plague becomes compara-epidemic disease becomes endemic, recurring tively a manageable disease.
year after year, special officers and special establishments are required to contend with the special conditions that have arisen.
measures.
6. The methods of destruction at the disposal of the public are of a limited nature, consisting mainly of the laying down of poison, such as 11. The town and district should be divided arsenic and phosphorns, the employment of rat inte conveniently sized districts with a medical traps, the pouring of crude carbolio acid down man and sanitary inspector in each, their work the runs of rats, and the killing of them when to consist in the discovery of cases, house to they endeavour to escape, and in the case of house visitation and supervision of preventive large firms with godowns and warehouses the
If they could be assisted, by some employment of rat-catchers. The methods at of the more influential Chinese re iding in the the disposal of the sanitary authority are also district it would be a great advantage. When- somewhat limited. but can be carried out in a ever a case of plague occurs in a house not more systematic manner. They consist in the only should the necessary measures be taken pumping of carbonic acid gas or sulphureons for that houses but a zone of houses and acid gas into small sections of drains and sewers buildings surrounding and adjacent to the previously blocked up for that purpose, and into infected house should be iuspected daily the holds of ships and boats infested with rats, by the medical man of the district to ascer- the employment of rat-catchers on special areas, tain that the inhabitants are healthy and the taking up ground floors in infected houses, not suffering from any suspicions symptoms. demolition of the rat-runs and the setting up of The history also of every case should, as far as another slightly infectious disease among rats possible, be always traced out and recorded as it which is not communicable like plague to other often gives the clue to the discovery of other animals or to human beings This disease can unsuspected infected localities. Particularly be produced by feeding rats with cultures of a the whereabouts of relations and friends who coccobacillus discovered by Danysz.
7. No single method is altogether satisfactory in getting rid of all the ra's, healthy and un- healthy, but each method when employed systematically materially assis's in obtaining that object, and the continuous, regular, and systematic employment of all these methode in 0 district ultimately produces excellent results.
8. For the preparation of Danysz virus to be employed to set up dis ase among rats and mice I would advise that the services of Dr. Hunter, the newly appointed bacteriologist to the Colony, be made use of and be placed at the disposal of the Sanitary Board for the time being. I would further advise that thousands of doses of this virus be systematically dis tributed in different parts of the town not only daring every day of the plague season but throughout the whole year, in order that an impression may be made on the enormous number of rats which exist in Hongkong.
9. This desirable result will not be effected in Hongkong unless special measures are at the same time taken at the wharves and landing stages to prevent healthy or sick rats from be-
into
from
зате
have had communication with the sick or to whom clothes or other articles have been sent from the infected houses should be ascertained. A daily inspection should also be made of the houses within the zone in order to ascertain that all rats have been destroyed and that fresh rats have not take their places, I understand that there is great difficulty in obtaining trained medical men for this work. The same difficulty has arisen in other places and has been overcome by securing the temporary services of medical men from elsewhere.
12. Inoculation with Haffkine's prophylactic should be encouraged. If the protectve effect of the prophylatic were carefully explained to the inhabitants in the immediate neighbourhood of a plague house or to those who have come in contact with a person sick of plague many probably could be persuaded to be inoculated, residents in the district showed an example by especially if some of the more enlightened
The prophylatio being inoculated themselves. is very efficacious. In Poona, Bombay, and apetown I found it gave a very great protec- tion to those inoculated, the difference of
attacks between these inoculated and not inocu-
is not an absolute protection, but it diminishes the chances of attack immensely and at the same time if an inoculated person should be attacked it · reduces the chances of death. The inoculation is quickly done and less painful in its doing than that of ordinary vaccination. The inoculation causes in a few hours fever, headache, malaria.
4. To begin with the preventive measuring imported. Every newly arrived ship moolated being nearly 80 per cent. The plague against rat infection, it is absolutely essential to know in what houses, areas and quarters of the town the rats are infected with plague, To obtain this intelligence, I would advise the appointment of two trained medical officers to bacteriologically examine daily the rats which are found dead by the rat-catchers and any that are alive which may appear to be ill. Large numbers of rats do not become infected all at once, but the infection as in human beings gra- dually spreads from one to another until plague among them becomes epidemic, ease acquires a firm hold on the rats, the danger to a locality is very great. I think it might be possible to obtain the loan from the Indian Government of some assistant surgeons specially trained in plague bacteriological work. rat-catchers also should le at least doubled in number. The disease among rats could then be localised, and the information obtained would correspond in usefulness with the notifi- cation and early discovery of plague cases among human beings. It would then be possible to concentrate with precision attention on the infected localitics, and bring special measures to bear on them with the view of destroying the rats and their infection before these localities became dangerous in any high degree to man. In connection with the habits of rats, it may be mentioned here that whenever rats begin to die in numbers, whether from disease or poison, there is a disposition for the others to emigrate from that locality in a more or less distinctly defined direction. This phenomenon of migra- tion should be borne in mind, and watched, so that on its first appearance the rats coming into a healthy locality may be destroyed.
ed at the landing stages without being subjected commission sent to India from England have to precautionary measures adds its quota of fresh rats to the warehouses and godowns. reported very favourably on the protective This is a matter for careful consideration and effect of Haffkine's prophylatic, especially when precautions similar to those taken in other two inoculations have been carried out at inter- vals of one week from another. The prophylatic ports should be introduced at the landing stages and wharves of Hongkong and Kowloon.
10. Once the requisite measures are taken against rat plague which sometimes in addition to the foregoing necessitate the evacuation of a badly infected area in order to
inhabitants Once the dis- the
being extensively then the measures attacked with plague against human plague resolve themselves and discomfort for about thirty-six to forty- those that are ordinarly employed eight hours and a painful swelling at the site against an epidemic disease such as small- of the inoculation which necessitates rest for a day or two, The discomfort and pain experi- These consist in arrangements for an prx. early discovery of cases, the tracing ont enced in the inoculated arm are however seldom greater than those following vaccination against of their connection with previous cases, small-pox, and only last a few days instead of a
the healthy. removal of the sick from cleansing and disinfection of the infected fortnight as in the case of vaccination. The house, and inoculation if possible, of those inoculation against plague with properly pre- which pared material is perfectly harmless. If the persons who reside in localities in the disease prevails. These measures it will inhabitants residing in a zone surrounding an be observed are distinct from the every day infected honse are inoculated, they are routine sanitary duties of an ordinary nuisance dered in a high degree immune to the plague, and conservancy inspectorial staff whose time and the risk of the spread of the disease among in Hongkong is occupied in the morning in the inhabitants in that particular area which is supervising the removal by contractors of the dangerons area is much reduced.
13. In Hongkong with its proximity and nightsoil and refuse, and in the afternoon in
to making house house inspections with daily intercommunications with Canton and reference to house nuisances. The inspectors Macao, which appear not to be free of plague, usefully combine with their duties in the after-it is necessary to prevent as far as possible the noon that of ascertaining whether there is any importation of plague, because every such sickness in the house but as they cannot possibly importation is likely to add to the number of in the few hours at their disposal get over more infected centres. This requires arrangements than a few houses the number of sick persons and medical officers for the inspection of incom- they discover is necessarily very small. As a ing passengers from these] places. Possibly in matter of fact a large number of the eases the Port as in the districts assistant surgeons discovered are dead or dying. There is one from India trained in plague work could be trained disinfecting Inspector. For ordinary employed under supervision.
5. These measures would not interfere with but should go on side by side with the more general destruction of rats throughout the town and district carried out by the public, the object
a
ren.