PUBLIC RECORD OFFICE
Reference
C.O. 882
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO
PUBLIC RECORD OFFICE, LONDON
Violation of laws of health
certainly pro- duces disease.
Immunity of Hong Kong from epideanies
possibly due to the newness of
the city.
The recorded
death-rate per
thousand can-
not absolutely
be relied on.
Average age
at death a more
certain test. Average at Hong Kong compared with
other places.
Table of
average ages
at death.
Observations
at death of Chinese com pared with those of Europeana
22
115. Even assuming the absence of certain forms of disease, and a comparative inimunity from epidemics, there is no ground for the assertion that the violation of the laws of health is not punished, in China as elsewhere, with a general lowering of vital condition, and not only by intermittent scourges of epidemic disease.
116. It is stated that hitherto Hong Kong has escaped the epidemics which have afflicted other places in the neighbourhood. The settlement is but 40 years old, and the subsoil beneath the city may not yet be sufficiently saturated with filth to make it a hot- hed for disease and a breeding ground of filth poison. It is somewhat premature to assume that this happy immunity will always continue, for the process of saturation is slowly but surely going on, and if unchecked cannot fail to bring forth abundant fruit, in the form of misery and disease.
117. Death-rates in such places as Hong Kong are at best but uncertain guides as to the state of health of a community, for it is almost impossible accurately to estimate the population to which the number of deaths apply. This is more particularly the case where, as in Hong Kong, there is so large a shifting population. The officially published death-rates of Chinese vary from 26 to 30 per 1,000, rates far too high to permit the assumption of a good state of public health.
118. To check the death-rate, which might be too high on account of an under- estimate of the population, I ascertained the mean age at death of all Chinese who died at Hong Kong during 1881. This test has the advantage of being independent of the correct estimate of the population, or even of the total numbers of deaths, provided that the average of a sufficient number of instances be taken.
119. The following table gives the mean age at death in Hong Kong, compared with that found in certain other places :-
Mean Age at Death
Mean Age at Death of those
Name of Place.
of ALL who died, Men, Women, and Children.
who died over 20 years of age.
g| | |
Men. Women.
Victoria, IIong Kong, in 1881
18.33
42.0
46.0
All England, 1840
29.00
All. 43.0 55.0
Croydon, 1878
31.0
56.6
58.4
Exeter, in 1878
Oxford, in 1878
29.5
56.7 62.2 55.7
57.9
Christian Hakkar Community
in Hong Kong, from 85
deaths recorded by the Pastor
Dr. Lechler
30.48
Christian Community at Lelong,
Basel Missiont
45.64
• Most of the converts are adults, so total average age is bigh.
51.81
55-6
†The pastor observes that the mean age from his returns exceeds that of the remainder of the people, for most converts are elderly people. Moreover, the infant mortality is not represented, as many die unbaptised and therefore unrecorded by him, owing to the great extent of his district.
120. The first comparison, that of the mean age at death of the whole population, is On mean age possibly of no great value. The infant mortality of Hong Kong abnormal on account of the practice, which obtains amongst certain religious bodies, of collecting moribund infants from all quarters, for the purpose of giving them the advantage of baptism. The comparison in the second column of the ages of those who die over 20 years of age is sufficiently striking and is especially applicable to Hong Kong, where so large a pro- portion of the people are adults. It may be objected that the exodus of aged Chinese reduces the mean age at death. This is possibly the case to some extent, but if so, the death-rate per 1,000 will be correspondingly diminished by the same cause. In the case of the resident European population we have a striking illustration of the effect of the deportation of the aged and sick, their death-rate being but 13 per 1,000.
Conclusion.
Recommenda- tion as to returns of mean ages at death.
121. I think that the foregoing facts clearly show that the health of the population is not so good as to make it presumptuous to attempt to reform time-honoured abuses; on the contrary to my mind they prove that reform is urgently required.
122. It is most desirable that accurate vital statistics should be obtained. I would most strongly recommend that the Registrar General be directed to prepare returns of the mean ages at death for the whole Colony of the city of Victoria, both as a whole, and subdivided into its various districts: for the larger villages such as Yan-ma-tee, Sankiwan, and Aberdeen separately, and for the smaller villages collectively. If practicable also, the mortality of the boat population should be dealt with separately.
23
tion as to
to Chinese
123. For the reasons given in paragraph 114, it seems to be impracticable to obtain Recommenda accurate returns of the causes of death. The Colonial Surgeon has, however, to some classification extent classified the diseases returned in causes of death by the Chinese medical men. of diseases
causing death. It seems probable that a conference with them, and the circulation of some instructions, Instructions to translated into Chinese, would enable them broadly to distinguish the more characteristic be circulated zymotic diseases, from other complaints. This information, with the returns of the ages medical men. at death, would afford much valuable and reliable information as to the health condition of the people, and would enable the effects of sanitary improvement to be traced. Even if it prove impossible to discriminate the causes of death in every case, the imperfect return would not be without value, for the relative number of deaths from zymotic diseases to those from other recorded causes could be obtained.
PART II.
SECTION 1.
124. The sanitary requirements, the fulfilment of which comes principally within the Statement province of the engineer, are→
of general
sanitary re-
1st. The provision of a sufficient supply of pure air and water to every inhabitant, alsɔ quirements. light.
2nd. As a consequence of the first, it is necessary that all organic refuse, solid and fluid, capable of putrefaction be removed from the dwellings, and from the city, before putrefaction commences. If these substances be allowed to collect within the dwelling, the products of their decomposition taint the air, and thus the first requirement remains unfulfilled.
3rd. As a consequence of the first and second proposition, after removal from the city, the said organic refuse must be disposed of in such a manner as to render it harmless, and prevent contamination to wells, or to the air near dwellings.
4th. It is necessary to prevent the moisture in the subsoil from rising to within a certain depth below the surface of the ground; or in other words, the level of the subsoil water must be kept below a certain depth. Experience shows that this depth should be never less than 3 feet. In tropical climates an even greater depth is desirable.
quirements
125. There are other sanitary requirements of equal importance, such as the regulation Sanitary re- of food supply, prevention of contagion, and the disposal of the dead, but they belong, which do not indirectly only to the province of the engineer.
appertain to the engineer.
hours, daily
fore Decoemry.
filling sanitary
cost only.
126. It is found that the decomposition of human excreta commences in warm Decomposition English weather in about 12 hours after evacuation. At first the products are harmless, of fith com- but they become dangerous in from 24 to 36 hours. In hot climates this action takes menees in 12 place sooner, and therefore we obtain, as a corollary to the second proposition, the removal there- principle that all such substances should be removed at least once in 24 hours.
127. Provided that problems stated in paragraph 124 be solved completely and Means of ful- sufficiently, the choice of the methods for their solution becomes a question of expediency requirements and expense only. For example, it is within the bounds of possibility to remove all refuse⚫ question of of all kinds, foul water as well as excreta, by hand in buckets, but what would be the amount of labour involved in this undertaking? At the lowest estimate, the liquid refuse and excreta may be taken as equal to the water supply, 6 gallons or 60 lbs. per head per day, say, in round figures, half a hundredweight. The population of Victoria is 130,000, so that 3,250 tons must be carried daily. In other words, the load of an able- bodied coolie being about 1 cwt., this would be about equivalent to every adult Chinaman making one trip daily with a pair of buckets to a distance of at least a mile, going and returning.
Equally antis-
to be obtained by drains.
Methods of
differ according to local con-
128. I trust that I shall be able to show that the same result can be attained equally factory real effectively by the use of drains, and that no danger to health need result from their use.
129. The means best adapted to satisfy the requirements laid down in paragraph 124 will vary in detail even in principle in different lands, and indeed in different cities. The itation must recommendations that will be made are based not on English practice only, but on experince gained in India and other tropical countries, and from the study of continental ditions. practice. I do not propose blindly to copy English models, but to adapt known and tried expedients to local circumstances, and to Chinese custom, avoiding the mistakes which have led to partial or complete failure, in Europe and elsewhere.
draíus.
130. The chief objections urged against use of underground drains, by the opponents Objections to of that system, is that they conduct foul and pernicious gases into dwellings, and that underground they disseminate and diffuse, from house to house, the poisons which produce certain diseases. Where underground draine and sewers are badly designed, and imperfectly constructed, where the system is not complete, both as to the arrangements within the C 4