PUBLIC RECORD OFFICE
Reference :-
TLCO. 885
ALLY WITHOUT PERMISSION OF THE COPYRIGHT PHOTOGRAPH-NOT TO BE REPRODUCED PHOTOGRAPHIC- [
22 PUBLIC RECORD OFFICE,
LONDON
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Dr. Johnson has written, and I may remark that his proposals are based on the fact that Hong Kong is the first British outpost on the possible route of infection from the endemic areas, and that it is now, and will probably continue to be, the terminal point of the main lines of steamships coming from those areas. If, therefore, effectual measures can be taken in Hong Kong to prevent the spread of yellow fever further west, the authorities at Singapore would be relieved from the necessity of taking special measures of protection as is pointed out in the last paragraph of the report of Major James on page 26 of the print.
5. Major James recommends that an intelligence officer should be appointed in an area of which Hong Kong would be the centre, who would occasionally visit Manila and possibly Shanghai. It will, I think, be found desirable to have a somewhat stronger staff than that suggested, but this can be considered later on. I concur, however, with Dr. Johnson that any officers appointed for this duty should be attached to the Medical Department of the Colony, and be available for general duty if required.
The establishment of a completely isolated quarantine station at Hong Kong would not present any great difficulty, but, as I have already suggested, the cost of erection and maintenance should not fall on this Government, except to a limited extent. I agree with Dr. Johnson that the station at Lai Chi Kok, which is at present occupied by an Indian regiment, would not be suitable. The best place for such a station, in my opinion, would be the island of Lamma, which lies to the south of Hong Kong. There are several good sites on the island protected from the north- east and south-west monsoons within easy distance of Victoria. An ample water supply could be provided at no great expense, and there is a safe anchorage for the largest vessels. There are very few.inhabitants on the island, and it would probably be unnecessary to disturb them except in the vicinity of the station. It would, of course, be necessary to ascertain by careful investigation that the island is free from mosquitoes of a harmful nature and malaria. Dr. Johnson is inclined to think that Lamma is too large an island for a quarantine station, and that it is too close to Hong Kong, but I do not think that these objections outweigh the advantages which it possesses. It is broken up by comparatively high hills, which would act as natural barriers, and I quoted to him the case of Pulau Jerejak, at Penang, where a quaran- tine station of great size and a leper settlement are within a mile of each other.
7. The investigations to be undertaken with a view to ascertaining whether Stegomyia fasciata is present in this Colony, and whether Stegomyia scutellaris carries the disease of yellow fever or not, are now proceeding, and a report will be furnished as soon as possible.
I have, &c.,
CLAUD SEVERN, Officer Administering the Government.
Enclosure in No. 121.
SIR,
Medical Department, Hong Kong, 20th October, 1913. I HAVE the honour to submit, for His Excellency's information, the following zemarks and recommendations arising out of Major James's Report upon the possible introduction of yellow fever into Hong Kong, and as to the measures which should be taken in order to prevent this possibility.
2. The first of the recommendations made by Major James is that a Medical Officer should be appointed as an Intelligence Officer at Hong Kong for the purpose of securing continuous and trustworthy information regarding any outbreak of yellow fever in areas whence infection is likely to be conveyed, and the measures which may be taken to prevent ships from carrying infection from such areas. In the event of yellow fever occurring either as a considerable outbreak or even as a few cases, it is assumed that this port would be immediately informed, and the position then would turn upon our preparedness or otherwise for dealing with ships coming from the infected port.
3. If we cannot be sure that we shall receive early information from any port or country in which yellow fever may arise, then an additional safeguard would be supplied by the "Intelligence Officer " in question. It is said that the American Government has found that the practice of attaching Medical Officers to their Consulates abroad has resulted in the obtaining of trustworthy and complete infor- mation, and of exercising control over ships bound for the United States from those ports. But such an * Intelligence Officer "stationed in one place would be in a more
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favourable position than one who had to move about from his headquarters in search of information, and who might not be at the right place at the right moment for acquiring early information."
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4. However, while it does not appear to me that the appointment of an Intelligence Officer " in Hong Kong would be a powerful factor in excluding yellow fever, it would prove of some service. This recommendation is not in such need of an early settlement as the other recommendations, for it can be carried out in a very short period of time as compared with the others, and further criticism and examina- tion of it would be useful. But should it be found necessary to have an "Intelli- gence Officer" in Hong Kong it would be necessary to make a new appointment, as there is no officer on the medical staff who could be spared for the work. It would thus be necessary to supplement the staff and to appoint to the post an officer who should be attached to the Medical Department; this Department, together with the Health Officer of the port, being a separate one from the Sanitary Department.
Recommendation II." The prosecution of organised enquiries into the etiology and prevention of yellow fever, which should be under the auspices and control of the Royal Society in England." A separate report will be made on the work which has been done so far by the Bacteriologist in determining the presence or absence of Stegomyia fasciata in Hong Kong.
1. Although the survey is not a complete or adequate one, many thousands of mosquitoes have been examined. But it is necessary that the whole question, as stated in the second of Major James's recommendations, should be pursued by definite and organised enquiry, and it is advisable that such an enquiry should be under the supervision either of the Royal Society or of the Imperial Bureau of Entomology; whichever of these institutions may undertake the duty, the efficiency of the super- vision will be guaranteed.
2. The work requiring to be done locally in conformity with this recommenda- tion could be best carried out in the Bacteriological Laboratory, but the staff would need to be increased for the purpose not only by skilled assistance, but by the employment of two or three Europeans for collecting specimens of mosquitoes.
Recommendation III-" The establishment of a Central Intelligence Bureau for the receipt, compilation, and distribution of all information collected under (1) and (2)."
The existing Bureau of Tropical Medicine would seem to meet this requirement, and it could equally well provide for the case whether the enquiry be subject to the guidance of the Royal Society or to that of the Bureau of Entomology. If necessary, it could be expanded to meet the demands of India, while the arrange- ment of having one bureau for tropical medicine in its various departments would be a more symmetrical one, apart from the fact that it is already in being, and has heen long enough in existence to have acquired much experience in affairs of this character. All information would, of course, be forwarded from Hong Kong to the Central Bureau.
Recommendation IV:-
1. The Quarantine Regulations have been brought up to date within the last six months.
2. The Government do not possess a Clayton apparatus of their own for the destruction of mosquitoes, but this should be included in the equipment of a quarantine station.
3. Regarding the present arrangements for the inspection and control of ships in this port :-In the opinion of the Health Officer of the Port improvement would result from the appointment of two inspectors whose duty it would be to accompany the Health Officer of the Port-when that officer is inspecting a ship-in order to see that the passenger and crew accommodation are in a satisfactory condition, and that all hands on board are mustered for inspection by the Health Officer of the Port. understand that this is done in most ports, and it would save much time and improve the conditions for inspection.
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4. The strengthening of the line of sanitary defence in Hong Kong, &c.":- The present quarantine station at Lai Chi Kok is not well situated, nor is it adequately equipped for dealing with the passengers of a ship infected with yellow fever. It is on the mainland, and within a mile of a considerable population, and it would be difficult, if not impossible, to isolate patients who were suffering from an infectious disease which is conveyed by insects. Even for the general purposes
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