M 88
14. The hospital accommodation of the Colony was severely taxed by this advent of refugees, and three new wards were opened at the Infectious Diseases Hospital as well as an auxiliary hospital of 500 beds at Lai Chi Kok on the outskirts of Kowloon.
15. The extent of the refugee problem may be gauged by the fact that the number of persons coming into the Colony during 1938 by steamship and train exceeded those leaving by 305,957. This figure does not include an unknown number probably in the neighbourhood of 200,000 who entered the Colony during the year over land frontiers and in junks and sampans and in other ways. This represents an addition of nearly one half to the normal estimated population of the Colony. As was to be expected, a proportion of the cases of cholera, smallpox and cerebro-spinal meningitis which were seen in the Colony were imported from infected parts of China.
Appendix III.
SMALLPOX IN HONG KONG IN 1938.
1. The disease was already well established in Hong Kong at the beginning of 1938, and the incidence of it increased week by week to reach its maximum in March. It declined gradually from then on and finally died out in July to reappear in a minor form at the end of the year when refugees from Kwantung poured across the frontier to escape "mopping up" operations by Japanese troops.
2. Five Europeans were stricken with the disease. One died of a severe attack of unmodified confluent smallpox in January, 1938, although he said he had been "vaccinated" in England in October, 1937. No scars were found to corroborate his statement. Two others recovered from moderately severe semi-confluent attacks, and two had mild discrete and modified attacks. The mortality among Europeans was therefore 20 per centum. All said they had been vaccinated before contracting the disease, and all save the one who died were clearly speaking the truth.
3. Taking the series as a whole, it was found that seventy-three of the patients lived twelve hours or less after admission to hospital, fifty lived more than twelve hours but less than twenty-four. These figures make it easy to realise how difficult it was to obtain accurate histories in many of the cases; and, in fact, in 177 cases it was impossible to obtain a clear account of the course of the disease from the patient. The majority of such cases were young children. Four cases were dead on arrival at hospital.
4. The number of toxic cases in the series was surprisingly high. Eighty-three of the total of 834 were classified as toxic. Forty of these cases were men and most of these men were in the twenty-thirty decennium and were well-developed. Of the forty-three women in this group, seventeen were either pregnant or puerperal. It is well known that pregnancy and the puerperium conduce to the manifestation of toxic signs and symptoms in smallpox. Two men only, in this group of eighty-three cases, recovered. All the women died. The mortality was, therefore, 98 per centum in the toxic cases. Twenty-seven puerperal women and seventeen pregnant women were admitted suffering from the disease. Of the twenty-seven puerperal women, eight developed toxic smallpox and died, seven died of other forms of the disease, and twelve recovered. Of the seventeen pregnant women, six died of toxic smallpox, one of another form and ten recovered.