SJ
(c) CAUSES OF DEATH
6
(1) Malnutrition
57
Abundant evidence was available both in the public mortuaries and in the patients admitted to hospitals that malnutrition (indeed, actual starvation) was the principal cause of death. So bitterly did the population suffer that repeated instances of cannibalism came to light during the Japanese occupation. In at least one third of the bodies examined, beri beri and other deficiency diseases were given as the cause of death. As might be expected, the incidence of tuberculosis terminating fatally rose steeply during this period.
(2) Acute infectious diseases
Acute infectious diseases were, on the whole, relatively unimportant in the list of causes of death. Records of the actual incidence of these diseases are incomplete, but it is of interest to note that no cases of death from smallpox or plague were reported.
As regards cholera, the table given below shows the cases dealt with in the two main infectious diseases hospitals in 1942 and 1943. Apart from the three suspected, but not proved, cases of cholera admitted to Lai Chi Kok Infectious Diseases Hospital in 1944, no patients were diagnosed as suffering from this disease in 1944 or during the first eight months of 1945.
Kennedy Town Hospital
Lai Chi Kok Hospital
Combined Hospitals
1942
1943
275
Admissions Deaths
167
Admissions
Deaths
87
62
439*
247*
100
61
714
414
187
123
In 1942, the cholera outbreak was at its worst during February and March, although it continued on until October in spite of a very intensive anti-cholera inoculation campaign. It is important to note however, that the majority of the cases of cholera admitted to Lai Chi Kok Hospital in February, 1943, did not emanate from the town but were derived from a ship carrying coolies from Hong Kong for work in connection with the quarries for harbour works on Hainan Island. In the following June, sixteen cases of cholera were admitted to the same hospital from a ship bound from Canton to Shanghai on which many deaths from the disease had taken place before the arrival of the ship in Hong Kong.
In the following year, no cases were recognised until June, the peak being reached in July and the outbreak ending in September.
The case mortality of cholera patients treated in hospitals amounted to 58 per cent. in 1942 and 66 per cent. in 1943. This compares with a rate of rather under 22 per cent. in 1941.
Of the other acute dangerous infectious diseases, typhoid, dysentery, diphtheria and meningitis were represented in that order of importance in the two infectious diseases hospitals. There is little to comment upon these disease except that the case mortality was very high, for example, some 36 deaths took place in 73 typhoid admissions to the Kennedy Town Hospital and 61 deaths in 101 dysentery admissions; the reason, however, is not far to seek for the patients were suffering from a very advanced stage of malnutrition on admission and the Japanese failed to supply either adequate food or medicines.
* Figures are exclusive of the period 1st January, 1942 to 4th February, 1943 when Lai Chi Kok Hospital remained closed.
7
It would be unwise to try and draw any definite conclusions from the statistics in relation to the incidence of dangerous infectious diseases during the Japanese occupation because reliable epidemiological studies were extremely difficult throughout this period and the population was undergoing rapid reduction. All that could be fairly claimed would be that, despite the prevailing malnutrition (with its concomitant loss of powers of resistance to infection) and the progressive lowering in the standard of cleanliness, Hong Kong enjoyed relative freedom from epidemics during 1943, 1944 and the portion of 1945 covered by this report.
E. Deficiency Diseases
(a) Beri beri, malnutritional oedema, loss of visual acuity (amounting to actual central nerve blindness in some cases), and other manifestations of dietetic imbalance or deficiency, became increasingly common in Hong Kong during the Japanese occupation. Thousands died of starvation, although many went to the extreme of cannibalism in their vain endeavour to hang on to life. It is of interest to note, in this connection, that the Japanese publicly denied the existence of cannibalism in the Japanese-controlled Press. They appeared to be extremely sensitive to such suggestions which came at a time when they were making strenuous attempts to persuade the Chinese community that the occupation had resulted in a better and brighter Hong Kong. The postmortem evidence, however, was incontestable and instances came under notice in which the victim had been cut up before life was actually extinct. Investigations made at the public mortuaries at the time of the Japanese collapse indicated that over one third of the deaths were due to starvation and deficiency disease.
When it is recalled that some 600 cases of beri beri were discovered amongst the rather less than 3,000 interned in Stanley Civilian Internment Camp by the end of June, 1942, it is understandable that the incidences in the general population of Hong Kong was very high.
(b) TUBERCULOSIS
Associated with the considerable increase in the incidence of deficiency diseases, the tuberculosis death rate rose steeply during the occupation period. The disease appeared in many who had previously shown no outward sign of infection and, in the absence of adequate diet, the progress of the disease in individual cases was very rapid. Although the Hong Kong Anti-Tuberculosis Association could no longer function openly in Hong Kong, it was found possible to rent two wards from the authorities of St. Paul's Hospital for cases of tuberculosis occurring amongst the wives or dependents of the interned in the various camps in Hong Kong. A considerable number of such cases were treated during 1942, 1943 and a portion of 1944, after which this activity had to cease owing to lack of funds. The project to open a sanatorium for hopeful cases of tuberculosis which had been one of the principal aims of the Association unfortunately had to be postponed until the Colony had been freed from the invading forces.
(c) LEPROSY
While many Japanese as individuals have a marked horror of leprosy, the authorities soon allowed the Leper Settlement at Kennedy Town to disintegrate. When an inspection of the building was made by the writer in August, 1945, all roofs, floors, doors, windows, and sanitary structures had been removed for firewood. Steps were taken, as soon as the Medical Department had been taken over from the Japanese to contact missions in South China with a view to sending lepers arriving in Hong Kong to such settlements to be maintained by the Hong Kong Government as was done before the commencement of hostilities with Japan.
52077
A 3