# M 3
## II.-PUBLIC HEALTH.
### (A) General Remarks.
#### (I) General Diseases.
The year 1938 was marked by the prevalence and persistence of infectious disease in the Colony. At the end of 1937 smallpox had begun to attain epidemic proportions and the number of cases notified increased rapidly in the early part of the year, reaching a maximum in March. The last case of this series was notified in July and by the end of that month the disease had died out.
2. Cholera recurred in Hong Kong in 1938, the first case being notified on the 25th of May. The disease was not as wide-spread as in 1937, thanks in part to the rigorous measures of control which were adopted, in part to the fact that the disease was expected and everything was in readiness to combat an outbreak.
3. These were the two major epidemic diseases occurring in the Colony in 1938, and there is no doubt that they lasted longer than they would have done in normal years owing to the overcrowding in all parts of the City of Victoria.
The prolongation of the Sino-Japanese "Incident" has meant that the advent of poverty-stricken and starving refugees to Hong Kong has continued throughout the year. The extension of hostilities to the South of China in November led to a sudden rise in the number of refugees crossing the frontier and this attained a maximum during the month in question?
4. The measures of control taken were not adequate to ensure inspection of all those who crossed the frontier, and it is regrettable to have to record that smallpox was undoubtedly brought into the Colony during this November migration.
5. A sudden sharp rise in the number of cases of epidemic cerebro-spinal meningitis was also noted shortly after this inflow, and this was probably due to the fact that these people were brought into contact with carriers of the disease in the Colony and, being exhausted and ill-fed, succumbed to it only too readily.
6. The congestion of the urban districts in Hong Kong continues unabated and the sanitary condition of most of the town is calculated to promote rather than to prevent the spread of infectious disease. This congestion has undoubtedly been the most important factor in keeping up the incidence of meningococcal meningitis. Even in the hottest months of the year cases of this disease have been recorded, although it is well-known that this disease has an increased preference for the winter and spring.
7. The numbers of deaths occurring each month during the year were as follows:-
Month Total Deaths January 3,291 February 3,652 March 4,114 April 3,478 May 2,961 June 3,292 July 3,110 August 2,983 September 2,640 October 2,517 November 3,047 December 3,733 TOTAL DEATHS 38,819Table II.