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and he quotes other doctors as being of the same opinion. The second, Dr. Adams, says (answer 1,455), that this disease differs strikingly as a whole both as to frequency and in type from what he remembers 15 years ago; and (answer 1,492-3) all "the cases of "the most virulent type came from Japan formerly. Now I hardly get a case of any consequence. I think the virulence of the disease has itself abated, but I think the "introduction of compulsory medication of women in Japan has contributed in a marked "degree to the result."
The written reports of Dr. Grant, (Appendix,p. 317,) on behalf of the Army, and Dr. Wills, (Appendix, p. 319,) on behalf of the Navy, contain similar decided opinions as to the modification of the type of disease in Hong Kong, and as to its diminution in frequency, though on this latter point Dr. Grant speaks with less decision. I regret that the Commissioners did not think it advisable to examine these gentlemen vivâ voce, and to test by further examination the grounds of their opinion.
As it is, upon the evidence before me, I can come to no other conclusion than that the condition of the Colony in respect to the character of the disease has greatly improved since the introduction of these Ordinances. Of the medical authorities, civil, military, and naval, just cited, three of the four consider that the operation of the Ordinances has diminished the prevalence of the disease, as well as its violence; the fourth, Dr. Avres, gives no opinion on the subject in his verbal evidence, but his private memorandum, printed at page 268, entirely corroborates the other medical opinions. The contrary view seems to depend much on the medical evidence of the Chinese doctors, Mr. Lum Chan Fan (answer 493) and Mr. Pang-Ui-Shang (answers 684-6), which, it can scarcely be contended, outweighs the opinions of the experienced European practitioners referred to above.
The Report, however, page 52, states that there is no sufficient evidence to show that the spread of the disease has been checked or prevented or its type modified by the operation of the Brothel Laws.
I find it impossible to accept these statements without reserve, for, besides the agree ment to the contrary of the European medical testimony already referred to, I find much other evidence pointing to the same conclusion to which no allusion is made in the body of the Report. The experience of Macao, p. 205 of Appendix, Malta, pages 200 and 278, Gibraltar, in the despatches not printed, and of Japan, Dr. Hefferman's letter of January 28, 1868, Appendix, page 252, all indicate that elsewhere similar laws have been followed by a reduction of disease, while the arrival of the "Kearsage" (answer 348) from a port where, as I understand, there were no regulations, seems to have been marked by a serious increase of disease, traceable to the ship's company.
There is a marked diminution in the percentage of discase among the troops from the time that the returns are confined to the garrison of Hong Kong, instead of comprising also the forces in China. It will be seen that from 1859 to 1864 (Appendix, page 221), including China, the percentage of disease among the white troops ranged between 22.96 in 1863 and 51'09 in 1861; while from 1867 to 1877 Hong Kong only it ranged between 6-23 in 1874 and 19-23 in 1872 (Report, page 36). I have omitted the year 1866, which records a percentage of 29-92 on the white troops in Hong Kong, for apparently the garrison consisted of troops passing through from other places. Of three battalions of infantry none were in the Colony for more than part of the year (No. 1 Appendix, page 220), and whether the high rate is due to men coming sick to the Colony or to other causes, the diminished rate in the succeeding 10 years indicates that the causes, whatever they were, were probably exceptional.
The navy returns are not equally available for comparison, but Dr. Pottinger's letter of December 1870 (Appendix, page 282) from that officer's own experience affords independent testimony to the contrast between the state of things at Hong Kong in 1850 and in 1870,
The document which follows in page 282 is the letter from Dr. Ramsay of the 75th Regiment dated December 1870, in which that officer also speaking from his own experience, contrasts the greatly improved state of the Colony in 1870 with "the prevalence and terrible severity of the disease in 1857."
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In his report as Colonial surgeon for 1869 (Appendix, page 279), Dr. Murray gives the result of his experience during "about 12 years daily supervision of the system of inspection and control, as carried out in this Colony as being "the great improve- "ment that has resulted from legislative interference, not only in reducing the extent,
but also the malignity of the disease."
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Dr. Ayres in his report for 1877 (Appendix, page 291) says, "the main intention of "this Ordinance, No. 10 of 1867, is the prevention of constitutional disease in particular, " and so far it has worked with remarkable success," and he appends (page 242) a
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return showing for 20 years, 1858-77, the average number of days in which patients remained under treatment in the Lock Hospital, namely, 1858, 43'8; 1859, 308; from 1860 to 1870 the days varied from 22·0, in 1862 to 28.6 in 1866. Since 1870, the highest was 2019 days in 1872; the lowest, 14-3 in 1876. It would seem that this progressive diminution of the length of treatment is in itself evidence of a corres- ponding mitigation in the severity of the disease in the Colony.
None of this evidence is referred to in the report, as it should have been if the report is to be accepted as giving an impartial summary of the evidence, and I notice that of the documents which are referred to, some have not been quoted with perfect accuracy. For instance, at page 34, the report referring to the navy, says, "In no returns can "we find evidence of that almost total disappearance of syphilis which the writer "alluded to," and proceeds, "it is certain those from the army tell a different tale."
As regards the navy, I observe (Appendix 257), that of 58 syphilitic cases treated by the naval staff surgeon between October 1868 and February 1869, "in not one instance could he trace the disease to infection at Hong Kong," and from Table B (Appendix 269), that in the four years 1873-6, each showing a decrease of disease, no less than 238 venereal cases out of 488, or nearly one-half, are said to have been contracted out of Hong Kong. And looking to this, it seems to me that some evidence might and ought to have been obtained from the naval officers to test the correctness of the assumption (Report, page 36), that "many cases of disease contracted here (Hong Kong) are treated elsewhere." Dr. Wells could doubtless have given valuable evidence upon this important question.
As regards the army, I am unable to find in the Appendix any returns from the military authorites recording any statistics of the cases of syphilis among the troops, with the exception of an enclosure to the assistant military Secretary's letter of 15th April 1867 (Appendix, page 220), giving the number of cases in 1866.
The numbers in that year appear, as I have already observed, to be exceptional as possibly not being fairly attributable to the Colony alone. I find no statistics of syphilis among the troops previous to that year, but since that date figures are given in the appendices to the Colonial surgeon's annual report, and these hardly bear out the above statement in the report. Dr. Murray (Appendix 279), shows that primary syphilis steadily decreased in 1867-8-9, the percentage being only 1 50 in 1869.
In 1870 (Appendix 280), the percentage of venereal cases to strength of the garrison fell to 5.51 against 6 83 in the preceeding year; and the medical officers of hotn services (Appendix 282), bear testimony to the immunity of the Colony from syphilis ; the percentage is not given, but the proportion of syphilitic to other diseases appears to be about one-half (Appendix 282).
In 1871 (Appendix 284) and in 1872 (Appendix 236), there was an increase of disease generally, but without apparently any increase of syphilitic over other disease. It would have been well to enquire whether the administration of the Ordinances in these years may not have been relaxed whilst in the hands of a gentleman who was only acting Colonial Surgeon. For it will be seen from Table C (Appendix, page 269), that the number of syphilitic cases decreased in a remarkable ratio from the time when Dr. Ayres
1873 1874 1875 1876 assumed office, the numbers being
while the garrison (Report, 104 * 12' 32' "26"' page 36), remained at nearly the same strength, viz., for the four years, 1056, 1019, 988, 983. In 1877 (Appendix, page 293), it will be seen that the proportion of syphilitic to other disease is reduced to about one-fourth of the whole.
*At page 35 of the report, after quoting Dr. Murray's annual Reports for 1862, 1865, 1867, as to the benefit resulting from the Ordinances, a sentence is cited as follows: "In an official report, however, dated the 19th April 1867 not intended for publication, "Dr. Murray staled, That venereal disease has been on the increase, &c.' It would have been fairer to Dr. Murray to refer also to his subsequent report for 1869 (Appendix, page 278), which expresses a different opinion,
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Of the two complaints by Dr. Crocker (Report, p. 37) the first occurs in 1872, the year of the greatest amount of disease during eleven years (Report, p. 36), and he recommends greater vigour in administering the Ordinance (Appendix, p. 242). The second in 1873 (Appendix, p. 245) is shown by the next document (Appendix, 246), a report by the Colonial Surgeon, to be explained by the addition of 500 men to the strength of the garrison, and the relative number of cases to strength appears to have been actually less than in the preceding months.
The report states (p. 7), but without quoting any proofs, and I have not been able to find any in the Appendix, that "each inmate of these brothels (for foreigners) appears to have been more or less frequently a resident in the Lock Hospital." Again, p. 38-41, it deals
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