192
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inside or outside the wall of the house, as a means of disposing of fecal matters. In many houses, at the beginning of the year 1896, I saw the slop-waters from the kitchens of the upper storeys, running down in pipes through the houses to open into the gutter used to carry away slop-water from the ground-floor, and overflowing onto the ground. Men have been specially appointed to empty and clean daily the pots used for excrement, but the Chinese continue in many cases to empty the excreta away through the slop-water pipes. These open into channels running below the level of the street, and these channels debouch at various places into the harbour.
This slop-water system of drains consists of small earthenware pipes, which frequently become stopped up, and, being leaky, allow filthy water to escape into the houses. In addition, there is a system of much larger drains for dealing with storm-waters, which also debouches by many openings into the harbour.
In the town of Victoria and in the district of Kowloon, there are public latrines (Kübel system), which, in consequence of the filthy habits of the Chinese and of insufficient cleansing, are frequently choked with dirt.
The Island and Kowloon are for the most part supplied with water by two large mains, but still in part also by open wells. The water-supply of the Island is no longer sufficient for the needs of the inhabitants, the storage capacity of the two reservoirs in which rain-water is collected not being enough to provide the town with water during a long-continued drought.
Many of the Chinese, notwithstanding that they are supplied from the public service, still prefer to draw their water from open wells. In 1894, these wells existed, not only in the open air, but also, according to Dr. Lowson's report on the epidemic of bubonic plague in 1894,* in houses, kitchens, and even latrines, in an excessively filthy condition. Since 1894, wells exist in the open air only.
It was in the districts inhabited by the poorest class of Chinese, in which the above-described bad hygienic conditions especially prevailed, that both in 1894 and in 1896 plague first broke out, to spread thence over the whole Colony. In 1894, the first cases occurred in the centrally situated district of Taipingshan, and in 1896 in the western part of the town. It is not surprising that in these small, gloomy, filthy houses, with their thoroughly bad hygienic conditions, the contagium of plague, when once introduced, should find a suitable soil.
Microscopical and bacteriological researches and inoculation-experiments have clearly established the fact that plague cannot arise spontaneously and that it did not arise spontaneously in Hongkong, but was engendered by the specific bacillus of plague; and we may assume with confidence that Hongkong, in which the disease had never appeared before, received the contagium from Canton or from Pakhoi (on the border of Tongking), for between both these Chinese towns and Hongkong there is a brisk shipping-trade. Canton and Pakhoi probably themselves received the infection by means of the river traffic from the province of Yunnan, in which, according to the reports of missionaries, plague is endemic.†
Now that we have described the localities in which the epidemics of 1894 and 1896 in Hongkong took place, it is further of great importance to enquire whether, in addition to the bad hygienic conditions in which the houses of the Chinese and their inhabitants were placed, there were any other elements of importance, such as climatic influences, that had a share in bringing about the spread of the disease. It must further be shown by what means the contagium was brought to Hongkong, and by what means it was disseminated from the first infected parts of the town to the other inhabitants of the Colony, and also to the Europeans, who, with the exception of the Portuguese, live in excellent hygienic conditions.
Both in 1894 and in 1896, the epidemic broke out at the end of the cool season, which was damp though free from rain. It began in May in 1894, in April in 1896.
In the latter year, isolated cases came under observation from January to March, and these occurred chiefly in the western part of the town inhabited by Chinese. In both years, the epidemic reached its height in the early months of the hot season, in May and June, and then suddenly subsided. From these facts, the only conclusion to be drawn is that plague in Hongkong thrives better in a damp, moderately cool, tropical climate, than in a hot one. But in this connexion, we must not forget to consider that in the cool season, the houses of the Chinese are much more overcrowded than in the hot season.
(25)
The observation, that the contagium of plague does not as a rule thrive in a long hot season, has already many times been made in Egypt.
It was shown experimentally that the plague bacillus, when pure cultures were exposed on cover-glasses for four hours to the sun at a temperature of 42° C. (108°F.), no longer grew on bouillon. Pure cultures exposed on cover-glasses to the temperature of the room at 29° to 31° C. (84° to 88° F.), ceased after four and a half days to have any further power of growth on bouillon. It appears from these experiments that the plague bacillus is very sensitive to desiccation and to heat. In the exsiccator, under similar circumstances, the bacillus succumbed after three hours.
The question of by what means the contagium of plague was brought to Hongkong is difficult to answer.
There can be no doubt that it was brought from Canton or Pakhoi on board ship during the ordinary intercourse of commerce, for it would not be possible for the contagium to be carried so great a distance through the air. As carriers of the contagium, we must in the first place mention men themselves suffering from plague; next, pieces of clothing contaminated by the feces, urine, or expectoration of patients suffering from plague; and, finally, such animals as mice, rats, pigs, etc., coming from plague-infected districts. The two first-named methods by which the contagium of plague is conveyed from place to place are no doubt the commonest, and are easy to understand, since the presence of the plague bacillus can be demonstrated in the feces, the urine, and the expectoration of infected persons, and on pieces of clothing soiled with their feces and urine. It was often possible to start a culture of the plague bacillus from portions of the body-clothing or bed-clothing that had been soiled by the urine and feces of plague patients. When sterilised pieces of linen were soaked in a bouillon culture of the plague bacillus and then preserved in porcelain capsules, cultures on agar plates could still be made from them after the lapse of four weeks.
That animals, such as mice, rats, and pigs, can also carry the contagium of plague from place to place is less easy to prove. In the reports of physicians or missionaries on greater or lesser epidemics of plague in the interior of China, for example, in the province of Yunnan, or on the coast, as at Pakhoi, we read always that either simultaneously with the outbreak of the epidemic or shortly before it, there was great mortality among mice, rats, pigs, and horned cattle. Dogs and chickens also often died of the disease. In Hongkong, both in 1894 and in 1896, rats perished in great numbers, especially in houses in which human beings were affected with plague. Mice, rats, and pigs, animals susceptible to plague, are found everywhere.
In the beginning of August 1896, on board two steamships carrying pigs to Hongkong from the island of Hainan and from Pakhoi respectively, a large number of pigs died. A great many died also after they had been landed at Hongkong. Post-mortem examination of the bodies of these animals showed the same morbid appearances as in those killed by giving them plague-infected organs to eat, the appearances being most marked in the intestinal tract. A bacillus was cultivated from the blood and the intestinal glands, which was not to be distinguished from the plague bacillus found in man; it killed mice, rats, guinea-pigs, and rabbits when subcutaneously injected, and produced in these animals similar pathological changes to those produced by the plague bacillus. This observation is of importance for this reason, that the Chinese are extremely fond of pork, and breed pigs in very large numbers. Flies are also to be regarded as carriers of the disease.
The contagium of plague can, then, be carried by men suffering from the disease, by articles that have come into contact with the patients (fomites), and by animals, especially mice and rats.
On dry articles, the contagium of plague will not for long be able to retain its virulence, as it has no power of resisting desiccation.
An especially favourable soil for the growth and dissemination of the contagium of plague, as of the contagia of all other infectious diseases, is found in damp, warm, dark, and dirty places, and such places exist in sufficient numbers in the above-described parts of the town of Hongkong.
The question has now to be considered, in what manner the contagium of plague makes its way into the body.
The first point to note is that it has been observed in many epidemics of plague, as well as at Hongkong in 1894 and 1896, that the doctors and the attendants who had charge of the patients and the persons who removed and buried the bodies were very rarely attacked by the disease.
* "The Epidemic of Bubonic Plague in 1894." By J. A. Lowson, M.B., Medical Officer in charge of Epidemic Hospital, p. 5.
† Les Missions Catholiques. Tome dix-huitième, 1886, pp. 585 and 673, et seq.
192
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inside or outside the wall of the house, as a means of disposing of facal matters. In many houses. at the beginning of the year 1896. I saw the slop-waters from the kitchens of the upper storeys, run- ning down in pipes through the houses to open into the gutter used to carry away slop-water from the ground-floor, and overflowing on to the ground. Men have been specially appointed to empty and clean daily the pots used for excrement, but the Chinese continue in many cases to empty the excreta away through the slop-water pipes. These open into channels running below the level of the street, and these channels debonch at various places into the harbour.
This slop-water system of drains consists of small earthenware pipes, which frequently become stopped up, and, being leaky, allow filthy water to escape into the houses. In addition there is a system of much larger drains for dealing with storm-waters, which also debouches by many openings into the harbour.
In the town of Victoria and in the district of Kowloon there are public latrines (Kübel system), which, in consequence of the filthy habits of the Chinese and of insufficient cleansing, are frequently
choked with dirt.
The Island and Kowloon are for the most part supplied with water by two large mains, but still in part also by open wells. The water-supply of the Island is no longer sufficient for the needs of the inhabitants, the storage capacity of the two reservoirs in which rain-water is collected not being enough to provide the town with water during a long-continued drought.
Many of the Chinese, notwithstanding that they are supplied from the public service, still prefer to draw their water from open wells. In 1894, these wells existed, not only in the open air, but also, according to Dr. Lowson's report on the epidemic of bubonic plague in 1894,* in houses, kitchens, and even latrines, in an excessively filthy condition. Since 1894 wells exist in the open air only.
In was in the districts inhabited by the poorest class of Chinese, in which the above-described bad hygienic conditions especially prevailed, that both in 1894 and in 1896 plague first broke out, to spread thence over the whole Colony. In 1894, the first cases occurred in the centrally situated district of Taipingshan, and in 1896 in the western part of the town. It is not surprising that in these small, gloomy, filthy houses, with their thoroughly bad hygienic conditions, the contagium of plague, when once introduced, should find a suitable soil.
Microscopical and bacteriological researches and inoculation-experiments bave clearly established the fact that plague cannot arise spontaneously and that it did not arise spontaneously in Hongkong, but was engendered by the specific bacillus of plague; and we may assume with confidence that Hongkong, in which the disease had never appeared before, received the contagium from Canton or from Pakhoi (on the border of Tongking), for between both these Chinese towns and Hongkong there is a brisk shipping-trade. Canton and Pakhoi probably themselves received the infection by means of the river traffic from the province of Yunnan, in which, according to the reports of mission. aries plague is endemic.†
Now that we have described the localities in which the epidemics of 1894 and 1896 in Hongkong took place, it is further of great importance to enquire whether in addition to the bad hygienic condi- tious in which the houses of the Chinese and their inhabitants were placed, there were any other elements of importance, such as climatic influences, that had a share in bringing about the spread of the disease. It must further be shown by what means the contagium was brought to Hongkong, and by what means it was disseminated from the first infected parts of the town to the other inhabitants of the Colony, and also to the Europeans, who, with the exception of the Portuguese, live in excellent hygienic conditions.
Both in 1894 and in 1896, the epidemic broke out at the end of the cool season, which was damp though free from rain. It began in May in 1894, in April in 1896.
In the latter year, isolated cases came under observation from January to March, and these occurred chiefly in the western part of the town inhabited by Chinese. In both years the epidemic reached its height in the early months of the hot season, in May and June, and then suddenly subsided. From these facts the only conclusion to be drawn is that plague in Hongkong thrives better in a damp, moderately cool, tropical climate, than in a hot one. But in this connexion we must not forget to consider that in the cool season the houses of the Chinese are much more overcrowded than in the hot season,
The Epidemic of Bubonic Plague in 1894." By J. A. Lowsos, M.B., Medical Officer in charge of Epidemic Hospital, p. 5. Les Mission Catholiques. Tome dix-unitieno, 1886, pp. 585 and 673, et seq.
( 25 )
The observation, that the contagium of plague docs not as a rule thrive in a long hot already many times been made in Egypt.
season,
has
It was shown experimentally that the plague bacillus, when pure cultures were exposed on cover- glasses for four hours to the sun at a temperature of 42° C. (108 F.2), no longer grew on bouillon. Pare cultures exposed on cover-glasses to the temperature of the room at 29° to 31° C. (84° to 88° F.), Lased after four and a half days to have any further power of growth on bouillon. It appears from these experiments that the plague bacillus is very sensitive to dessication and to heat. In the exsiccator under similar circumstances the bacillus succumbed after three hours.
to answer.
very
The question by what means the contagium of plague was brought to Hongkong is difficult There can at any rate be no doubt that it was brought from Canton or Pakhoi on board ship daring the ordinary intercourse of commerce, for it would not be possible for the contagium to be carried so great a distance through the air. As carriers of the contagium we must in the first place mention men themselves suffering from plague; next, pieces of clothing contaminated by the faces, urine, or expectoration of patients suffering from plague ; and, finally, such animals as mice, rats, pigs, etc., coming from plague-infected districts. The two first named methods by which the contagium of plague is conveyed from place to place are no doubt the commonest, and are easy to understand, since the presence of the plague bacillus can be demonstrated in the faces, the urine, and the ex- pectoration of infected persons, and ou pieces of clothing soiled with their feces and urine. It was ofteo possible to start a culture of the plague bacillus from portions of the body-clothing or bed- clothing that had been soiled by the urine and fæces of plague patients. When sterilised pieces of linen were soaked in a bouillon culture of the plague bacillus and then preserved in porcelain capsules, cultures on agar plates could still be made from them after the lapse of four weeks.
That animals, such as mice, rats, and pigs, can also carry the contagium of plague from place to place, is less easy to prove. In the reports of physicians or missionaries on greater or lesser epi- demics of plague in the interior of China, for example in the province of Yunnan, or on the coast, as at Pakhoi, we read always that either simultaneously with the outbreak of the epidemic or shortly before it, there was great mortality among mice, rats, pigs, and horned cattle. Dogs and chickens, also, often died of the disease. In Hongkong, both in 1894 and in 1896, rats perished in great numbers, especially in houses in which human beings were affected with plague. Mice, rats, and pigs, animals susceptible to plague, are found everywhere.
In the beginning of August 1896, on board of two steamships carrying pigs to Hongkong from the island of Hainan and from Pakhoi respectively, a large number of pigs died. A great many died also after they had been landed at Hongkong. Post-mortem examination of the bodies of these animals showed the same morbid appearances as in those killed by giving them plague-infected organs to eat, the appearances being most marked in the intestinal tract. A bacillus was cultivated from the blood and the intestinal glands which was not to be distinguished from the plague bacillus found in it killed mice, rats, guinea-pigs, and rabbits, when subcutaneously injected, and produced in these animals similar pathological changes to those produced by the plague bacillus. This observa- tion is of importance for this reason, that the Chinese are extremely fond of pork, and breed pigs in very large numbers. Flies are also to be regarded as carriers of the disease.
man;
The contagium of plague can, then, be carried by men suffering from the disease, by articles that have come into contact with the patients (fomites), and by animals, especially nice and rats.
Ou dry articles, the contagium of plague will not for long be able to retain its virulence, as it has no power of resisting dessication.
An especially favourable soil for the growth and dissemination of the contagium of plague, as of the contagia of all other infectious diseases, is found in danp, warm, dark, and dirty places, and such places exist in sufficient numbers in the above-described parts of the town of Hongkong,
The question has now to be considered, in what manner the contagium of plague makes its way into the body.
The first point to note is that it has been observed in many epidemics of plague as well as at Hongkong in 1894 and 1896 that the doctors and the attendants that had charge of the patients and the
that removed and buried the bodies were very rarely attacked by the disease.
persons
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