PUBLIC RECORD OFFICE
Reference :-
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23 PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC-
COPYRIGHT PHOTOGRAPH-NOT TO
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2. The notification clauses in my opinion are unusual and incomplete at least to the extent and in the sense indicated in my report dated 20th November, 1913. As the failure to notify exposes him to a penalty, I think every medical practitioner should be entitled to a fee for his notification. If it be intended that the District Medical Officer should examine and report upon every leper who is notified to him or whom he himself notifies (which he certainly ought to do at once), then there is not apparent any sufficient reason why the obligation as well as the power to do so should not be definitely imposed upon him. But Clause 9 (1) now leaves it optional with him to examine or not to examine any leper who may be notified to him, and thus the notification may become of no effect.
3. I strongly advised the Government that Clause 9 (2) should be deleted from the second draft; it did not appear in the first draft which was sent to me for report, and it was introduced, when I was absent from the Colony, at the instance of the Medical Board, who did not assign any reason for their recommendation. Under this clause a heavy penalty rests upon the unfortunate leper who fails or refuses to attend at any place where the District Medical Officer orders him; such a power as this sub-section confers should not be given, and so far as I am aware it is not given anywhere else, to any person in the case of a notifiable contagious disease; there is no reason for giving such a power-it might easily involve a very great hardship to the leper, and, even more important, it might conduce to the further spread of leprosy by multiplying foci of infection.
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4. In Section 22 there is a distinction made between articles purchased and articles received from a leper in an asylum-the former are prohibited but the latter be allowed. The objections that I submitted to the Government against this section as it appeared in the second draft Ordinance are based upon an appreciation of the risk that attaches to traffic in any article that has been in contact-possibly close and prolonged contact--with a leper. The draft clause was altered in the Legislative Council to the form in which it now appears in Ordinance 32, and I am unable to appreciate why the risk is now held to attach to articles purchased from a leper but not to articles received from a leper, if the Medical Superintendent gives his consent in writing to traffic in the latter articles.
5. Under Clause 5, Sub-Section (2), the control and management of every leper asylum is imposed upon the Surgeon-General as they always have been-subject of course, to the Governor's direction. In future, however, the rules for the manage- ment and discipline of asylums are to be made by the Governor in Executive Council, of which the Surgeon-General is not a member, instead of by the Surgeon-General, who makes them now. Some of the "matters with respect to which the Governor in Executive Council may make rules under Clause 28 clearly fall more properly within the purview and the sphere of duty of the Surgeon-General, who is the professional officer charged with the control and management of the asylums rather than within the domain of a purely lay body like the Governor in Executive Council. The Surgeon-General may be severely embarrassed in "the control and manage- ment of a Leper Asylum if the matters included in Clause 28, Sub-Sections (2), (3), and (4) are taken out of his hands and placed in the hands of the Executive Council. The preventive effect of the Ordinance would be strengthened, I think, by the addition to Sub-Section (7) of this Clause of the words that I advised are important, because I do not find anywhere in the Ordinance any power to visit and inspect lepers at the places where they may be permitted to isolate themselves, and without this power it does not seem possible to ensure that measure of effective isolation which is one of the main recommendations of the delegates at the Bergen Conference on Leprosy.
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6. The provisions of Clause 33 practically perpetuate the free intercourse of the public with the leper asylum that exists and is notorious here now, and that, I think, should be prohibited if it is really intended to carry into effect the principal recommendation of the Bergen Conference.
*
H. L. CLARE,
Surgeon-General.
+
SIR,
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Annexure 3 to No. 10.
Medical Board, Trinidad, 19th January, 1911. I HAVE the honour to report that a schedule of questions having reference to the main points in connexion with the prevention of the spread of leprosy in this Colony was addressed to the members of the Medical Board, and from the replies sent in the Council has ascertained that the consensus of local medical opinion upon this important subject is as follows:-
Leprosy should be classed as a communicable disease, and the following measures should be adopted for its control :—
1. All cases of leprosy should be compulsorily notifiable.
2. Lepers, particularly vagrants, beggars, and persons whose domestic surroundings are such that efficient isolation is impossible, should be segregated in settlements or asylums, the latter preferably in early cases, and the former in all advanced or tubercular types of the disease.
3. Leprous parents or guardians should be relieved of the custody of healthy children, and leprous children should be removed from healthy parents. Certain lepers may, however, at the discretion of the Health Officer, and provided that their domestic surroundings are suitable to the purpose, be isolated at their own homes.
4. Lepers should be prohibited from carrying on any trade, industry, or occupation which brings them or the products thereof in contact with the public.
They should also be prohibited from engaging in any form of domestic service.
5. They should not be permitted to appear in public places except after having been certified by the Health Officer, or a medical practitioner, to be free from infection.
7.
6. Lepers should not be allowed to marry, except, perhaps, in settlements. The present position of the Leper Asylum in close proximity to the town of Port of Spain is considered by a majority to favour the spread of leprosy, especially having regard to the possibility of indirect infection by flies, fleas, and other insects, and it is therefore suggested that the asylum should be removed to such an island as Patos, where the conditions for effective isolation are naturally present.
8. In view of the importance of the disease and the still imperfect know- ledge of its causation and mode of spread, the Council is of opinion that the Medical Superintendent should be an officer appointed to devote all his time to the duties of his office and to engage in research work.
I have, &c.,
E. PRADA, Secretary Medical Board.
The Honourable
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The Colonial Secretary.
No. 11.
HONG KONG.
REPORT ON WORK (OTHER THAN ROUTINE WORK) DONE IN THE.
BACTERIOLOGICAL INSTITUTE DURING THE SIX MONTHS- 18T JULY TO 31ST DECEMBER, 1913.
(Received 6th March, 1914.)
[Published as No. 2 in Appendix VIII. to [Cd. 7796], April, 1915.]
31st December, 1913.