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Prevention of the dissemination of Plague.
In the matter of the prevention of the dissemination of Plague by rats some- thing is being done for rats are being caught and rats are being examined. Experi- ence in other countries shows that this if of value in finding out the endemic centres of the rat plague, but it has no appreciable effect on the rat population. There are 27 rat catchers employed by the Sanitary Department.
The examination of the rats and the indentification of the rat fleas is done by the Medical Department.
Little or no attempt is being made to control the importation or exportation of rats, and the steamers tied up along the Praya have no rat guards.
The responsibility for action necessary regarding the removal of ceilings and stair linings to prevent the same becoming refuges for rats, lies with the Public Works Department.
The periodical cleansing of houses and the washing of the floors and walls with kerosene emulsion was originally started as an anti-plague measure.
As men- tioned previously this valuable work is being carried out in a very satisfactory man-
ner.
Measures taken with regard to Smallpox.
Every year during the winter months this disease manifests in outbreaks which are sometimes sporadic sometimes epidemic Whatever be the prevalence there is always a tendency for the morbidity rate to decline or disappear with the advent of
summer.
Considering its high infectivity its terrible disfigurement, and the frequency of fatalities, the indifference shown by the Chinese to the presence of cases in their midst is puzzling. All Chinese know the disease and the presence of a case in a tene- ment house cannot escape the notice of the occupiers, yet for some obscure psycho- logical reason they refrain from reporting its presence to the authorities, and more often than not the first notification received by the M.O.H. is that from the Mor- tuary of a body, name and address unknown.
After the 1916-1917 epidemic in an endeavour to stop the practice of dump- ing and to encourage notification of cases, the Sanitary Board passed a resolution- "that patients suffering from smallpox be allowed to be treated in their own homes provided that---
a. All cases in the district be notified to the M.O.H.
b. All inmates of the house be vaccinated.
e. A notice be posted on the door of the house where the patient is
being treated”.
The results did not come up to expectations for the populace ignored the concession and continued their practice of concealing cases and dumping corpses,
The resolution was never rescinded and today in the very overcrowded tene- ment houses of the overpopulated city of Victoria cases of this very infectious disease remain undisturbed spreading infection through all who come
near them. Assuming that all deaths are reported and assuming that 50 per cent of those at- tacked die-then out of 1,708 cases in 1929 -forty-two per cent never came to the notice of the health authorities, 42 per cent were dumped dead and reported through the mortuary and 12 per cent were notified through the hospitals some when the disease was well advanced and some with false addresses. Probably 90 per cent of the infected premises are never disinfected.
Isolation of the sick, disinfection of premises and vaccination and surveillance of contacts, such as carried out in other civilized cities, being impossible, the only means left for combatting an epidemic is general vaccination, and vaccination voluntary not compulsory.
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Disinfection.
There are two
All disinfection is performed by the Sanitary Department. disinfecting stations, one in Victoria and one in Kowloon-both furnished with steam disinfectors of the Washington Lyon or Equifex type, with sack disinfectors for steam, and with sprays and apparatus for fumigation.
As the majority of infectious cases either escape the notice of the Sanitary Authority altogether or only become known through the Mortuaries as dumped bodies, name and address unknown, it follows that there is little disinfection of infected pre- mises or of infectious clothing and bedding.
Dead Bor Service.
The Dead Boxes or vehicles for conveying the dead are in charge of the Sani- tary Department. One of their chief duties is to convey to the mortuary the dead dumped in the streets.
Ambulance Service.
The motor ambulances are in charge of the Police and Fire Department; the hand ambulances in charge of the Sanitary Department. That is to say there are two independent departments engaged in this necessarily emergency service.
WORK UNDER THE REGISTRATION OF BIRTHS AND DEATHS ORDINANCE.
The Registrar is the Head of the Sanitary Department, and the General Re- gistration Office is situated at the Sanitary Department Head Office.
At this Office all non-Chinese births and deaths must be registered. Chinese are required to register in the district within which the birth or death occurred.
The Police Officers in charge of Stations, the Sanitary Inspector in charge of Kowloon Disinfecting Station, and the Principal Clerks in charge of the Chinese Public Dispensaries have been appointed Assistant Registrars.
Death registration being a necessary preliminary to burial is almost universal but many of the notifications come from the mortuaries as those of dumped bodies, name and address unknown, With regard to births a considerable number especially those of females are never registered. Though the vaccinators are under the Medical Department the Registrar of Births and Deaths is responsible for ensuring the vac- cination of all children whose births are registered. According to the 1928 figures about one third of those born were vaccinated. If one takes into account the num- her of births which are never registered the conclusion is that less than 25 per cent of those born are vaccinated.
With regard to vital statistics an accurate basis of facts derived from a suffi- cient amount of experience and tabulated with proper precision lies at the founda- tion of hygiene as of all exact sciences. Year by year a mass of figures supposed to represent the vital statistics of Hong Kong are published in the Annual Report and one who does not know the facts would take them as correct. The following shows what a great probable error there is.
There was no accurate census in 1921 and even if there had been it would have very little value in the estimate of population as the numbers vary far more through immigration and emigration than through natural increase of births over deaths. With trouble in China there is an influx of refugees; with the return of peace there is a reverse movement.
The true death rate is one index of sanitation but no one who knows the overcrowded condition of the houses in Hong Kong can agree that the published death rate is the true one. The Chinese have a longing to die in their native towns and to be buried there, and those who are sick especially those who feel that they are about to die leave Ilong Kong and thus the death rate is not a true one.
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