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Malaria. In the early history of Hong Kong Stanley Peninsula was notorious for its malaria which caused a high mortality rate among British troops and their families. Although the nature and source of the disease was then unknown its seasonal inciden was noted and it is recorded that troops were frequently billeted on board ships in Ho Kong harbour so as to avoid the deadly disease which attacked them in the autumn and early winter if they remained on shore. The old cemetery inside Stanley Camp was a grim reminder of the results of uncontrolled malaria. At the time of the Japanese occupation the Stanley Camp area and its immediate surroundings were practically free of malaria but to maintain the position constant anti-malarial measures were necessary, The dangers of neglect were immediately appreciated and requests for permission to carry on this work in the vicinity of the camp were repeatedly made to the Authorities and consistently refused until late in 1942 when the position became serious. All mosquito breeding grounds inside the camp, and there were many as a result of hostilities and neglect, were dealt with early in 1942 and permanently eliminated or under regular control. But the really dangerous anopheline breeding grounds were just outside the camp boundary and near Stanley village and mosquitos, unlike internees, could not be forced to respect barbed wire fences. Once permission was given to deal with several of these areas an anti-malarial gang consisting of health staff was formed. Thus the work was undertaken by skilled men all of whom rapidly became familiar with the localities concerned and the control measures required. When work was particularly heavy the anti-malarial gang was augmented by volunteers and on some occasions it was possible to have as many as 30 men employed at a time. But the regular and systematic performance of this work, which is so essential for success, was never allowed by the Japanese. In one week three outings might be allowed or it might be only one and more frequently none at all. Similarly, the number of workers allowed might be anything from three to 30, the limitation in this respect being usually determined by the number of guards available to accompany the party. A working party of three might be escorted by a Chinese Supervisor and two Japanese and two Indian armed guards!
Friction between the camp authorities and the Gendarmerie post just outside the camp was the greatest obstacle to regular work as the latter repeatedly refused to confirm permits issued by the former and on one occasion went so far as to arrest, and remove to the post a working party operating on the foreshore under the control of a Chinese Supervisor carrying a permit issued by the Japanese Officer in charge of the camp. Fol- lowing this incident, which occurred in February, 1943, there was a complete ban on anti-
malarial working parties until late in July when the rapid increase in Malaria cases was le
attack and that helped. From that time working parties were allowed at irregular intervals to operate outside the boundary until shortly before the end of the war when they were permanently prohibited for military reasons", these being no doubt the preparation of defence positions around the camp.
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Rock pools
Anti-malarial measures consisted of grass-cutting, drainage and filling. on the foreshore, happy breeding grounds for culicines, were drained where possible or filled with sand and stones as circumstances permitted. Equipment was limited and no anti-malarial oil was provided. A few gallons of a cheap disinfectant fluid of Chinese make were provided on a few occasions but this material was useful only in so far as its use saved the official face and led to improved relations between the authorities and the workers. While these activities undoubtedly proved of great benefit to the camp it was impossible to eliminate malaria entirely as prolific breeding grounds at Stanley village, within half a mile of the camp, were not allowed to be included in our operations and distribution of malaria cases and mosquito catches indicated the village area as the main source of infection. However, it was the best that could be done in the circumstances and involved much heavy and trying work performed under conditions which were always difficult, usually unpleasant and not altogether free from danger. Of the camp population 1,400 were without mosquito nets but the authorities refused to supply any.
During 1942 there were 143 cases of malaria, in 1943, which was our worst year, 331 cases, in 1944, 151 cases and to the end of August, 1945, 57 cases, a total of 682. The figures given may not be entirely accurate as lack of stains made microscopic confirmation impossible in the later stages of the camp but, taken as a whole, present a reasonably true picture of the malaria situation. There was a shortage of quinine and relapses were common but there were no deaths. The last quarter of the year showed the highest incidence and A. minimus was the chief vector. While we must consider ourselves fortunate in being granted such facilities as were allowed for anti-malarial work around the camp, and in the results obtained, a large amount of sickness, discomfort and anxiety could have been prevented if the Japanese Authorities had been more responsive to our insistent requests for freedom to carry on regular control measures over the entire area affecting the camp.
This could have been done at no cost and but little inconvenience to them but their attitude, and I refer particularly to responsible senior officials, in this as in other matters, showed little regard for the welfare of those temporarily in their charge.
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Other Diseases.-One case each of cerebro-spinal meningitis and mumps were recorded. A mild epidemic of chickenpox with 57 cases occurred late in 1944 and early 1945. For- tunately there were no cases of smallpox or cholera. Internees were vaccinated against
allpox in 1942 and inoculated against cholera annually in early summer,
(16) RECREATION AND ENTERTAINMENTS
During the first two years football and softball were played in camp but were discon- tinued owing to physical unfitness. Lawn bowls were played each summer. Sea bathing
at Tweed Bay beach, which was open to internees for a few hours daily during the summer months, was popular at first but its popularity declined as the rations deteriorated during the last two years,
Concerts and plays were frequently given and lectures on topical subjects were a feature of camp life. There was a good supply of books in camp libraries and many in private, and secret, circulation.
The Hong Kong News, a newspaper published in English provided both entertainment and recreation by its clumsy propaganda and its methods of presenting world news.
(17) HEALTH ORGANISATION
This consisted of Hong Kong Government health staff which functioned on A departmental basis under my control throughout internment. Both Health Officers and Health Inspectors performed valuable work, not only in their normal capacity but as manual labourers in activities connected with anti-malarial measures, maintenance of drains and septic tanks and scavenging and refuse disposal. I am grateful to them and to those who came forward to help them, especially in the early days, in work which was of such vital importance to the interned community.
(18) EDUCATIONAL
X
A branch of the Royal Sanitary Institute was formed in camp and a course in Tropical Hygiene was conducted for Health Inspectors and others interested. The course lasted six months and with a total of 68 lectures covered a wide field. by 27 men. The lecturers were Health Officers and certain engineers from the Public Works
It was attended Department. After completion of the course an examination was held and results and papers have been submitted to the Royal Sanitary Institute with a view to its granting its Certificate in Tropical Hygiene to the successful candidates.
(19) ACKNOWLEDGEMENTS
No report on the health of Stanley Camp would be complete without special acknowledge- ment of the services rendered to it by Dr. Selwyn-Clarke, Director of Medical Services, Hong Kong, who was able to remain in town until May, 1943- In addition to hospital equipment and supplies he, either directly or through the Hong Kong Informal Welfare Committee which he created, supplied milk, food, soap, disinfectant, scavenging gear, footwear, clothing and bedding. On one occasion when it was forbidden by Japanese Military Law, with the usual penalties, to sell or move cement he delivered to me in camp 20 bags which met urgent requirements connected with kitchens, bakeries and other works. Mothers of babies and small children have particular reason to be grateful to Dr. Selwyn-Clarke for it is largely due to supplies of milk and other foods provided by him for their use that these infants are now in good health and, in many cases, probably saved from permanent disability resulting from infantile malnutrition.
(20) CONCLUSION
one of
The period of internment, which lasted three years and eight months was difficulty, hardship and anxiety for the population of the camp, but, considering everything, the health of internees was generally more satisfactory than the most optimistic could have expected in the circumstances. Internees never lacked confidence and morale was high. There were occasional waves of depression and the worst of these occurred shortly after the collapse of Germany, possibly due to an increased sense of frustation and isolation and impatience for an ending to the war which seemed so near and yet so far."
The presence of women and children, however, unfortunate it may have been, gave the camp population the semblance of a normal community and may well have been responsible for its mental stability, as only one case of serious mental disorder occurred.
From a health point of view Stanley Camp must be regarded as extremely fortunate. There was always the possibility of the introduction of major infectious disease for which we were totally unprepared and even serious epidemics of dysentery or malaria