M 16
GENERAL
18. The most important occurrence during the year was the severe small-pox epidemic which, after smouldering throughout the hot weather, flared up in the second week of October and, in spite of an intensive vaccination campaign begun on November 1st, has raged ever since. The total cases notified in 1923 exceeded 1300 and the deaths 1100, the great majority occurring in the last two months of the year—during which period a weekly average of 100 cases was maintained. It is probable that the high mortality is not as pronounced as it appears and that the actual number of cases was considerably higher than is shown; the general practice among the Chinese being to conceal the disease until the necessity of removing the corpse results either in a belated notification or, more commonly, in the surreptitious dumping of the body in the public streets. Several instances of recently recovered cases which were not notified, have actually come to our notice and there are, no doubt, many more of which we hear nothing. A noticeable feature is the high percentage of deaths among children under 5; this is just under 80%.
The campaign to which reference has already been made in paragraph 7 of my report was carried out almost entirely by a staff of Chinese vaccinators hastily collected and trained either immediately before or actually during the campaign. Much assistance was given by the Principal Civil Medical Officer in this respect. Exclusive of unpaid volunteers, this staff reached a total of 40 within 10 days of starting the campaign and was maintained at that figure for some 5 or 6 weeks. The supervision of these men was entrusted to 4 Sanitary Inspectors, who were exempted from ordinary duty during the whole of November and December, acting under the general direction of the Medical Officer of Health and the Chief Inspector. In addition to fixed stations at the main markets and public bath houses, special visits were made to schools and factories: and house-to-house visitation was carried out during which every tenement in the Colony was visited twice and in many cases three times. A vaccination station was also established on the bridge at Sam Chun where the railway enters our territory, and a vaccinator detailed to travel to and fro on each of the main steam-boats plying between Hongkong and Canton.
Two divisions of the St. John's Ambulance Brigade and the Boys Scouts organisation voluntarily