(28)
VII.—PROPHYLAXIS.We shall first describe the prophylactic measures that were enforced during the epidemic of plague at Hongkong in 1896. The Colony of Hongkong has a department of sanitary affairs (Sanitary Board), and is divided into thirteen sanitary districts. Of these, including the harbour, nine belong to the town of Victoria, while the four others are constituted by the districts of Kowloon, Shao-ki-wan, Aberdeen, and Stanley. In each district, a police-inspector was appointed, with English and Chinese policemen to act under him, to search the houses of the Chinese for patients and dead bodies. Those suffering from plague among the Chinese inhabitants of the island of Hongkong, and the bodies of those that had died of the disease in the same area, were sent to the Chinese Hospital (Tung Wa Hospital) in the town of Victoria, which was under Government supervision, and at which the patients and bodies were inspected every morning and evening by Dr. ATKINSON and myself. From this hospital, all the patients and suspicious cases, and all the dead bodies, were transported to the Kennedy Town Hospital. The patients of other nationalities were, as a rule, after preliminary medical inspection, sent direct to the Kennedy Town Hospital. On the mainland, that is to say in the district of Kowloon, all the bodies that were found were taken to a shed. Thence, day by day, after I had inspected them, they were taken in coffins on a steamboat direct to the Kennedy Town Hospital on the island of Hongkong. Patients and suspicious cases from the mainland were always taken by steamboat to the Kennedy Town Hospital.
A daily report was made to the Sanitary Board of the number of patients and bodies brought to the hospital, and of the dwellings or other places in which they had been found.
The Sanitary Board, under the guidance of the physicians attached to that body, then undertook the disinfection of the houses in which cases of plague had occurred. While the houses were undergoing disinfection, the inhabitants were housed in temporary barracks that had been erected in various parts of the town. The disinfection consisted in clearing out the houses, burning all worthless articles, cleansing the walls and floor with milk of lime, washing the furniture with 5% carbolic acid solution, and disinfection of clothing, et cetera, in a steam disinfecting apparatus. Ten days after the complete disinfection and airing of their houses, the inhabitants were allowed to return to them.
The bodies of those that had died of plague were buried in coffins containing quicklime in a church-yard situated on the slope of a hill near the Kennedy Town Hospital.
While by stringent inspection and disinfection of the houses, suitable measures were taken for the suppression of plague on the island, too little attention was paid to the water-borne traffic. In the first place, intercourse with Canton, where in May and June plague was as prevalent as in Hongkong, should have been subject to better inspection. Further, owing to the fact that patients suffering from plague were allowed to leave the Colony, the carrying of the disease to other places was greatly favoured. How widely plague can be distributed by sea-borne traffic was shown many times in June and July, by the fact that ships coming from other ports, especially from Singapore and also from Saigon, had bad cases of plague on board.
Since October 1896, when the above lines were written, plague has broken out at the Indian ports of Bombay and Calcutta, and the widely expressed opinion that these towns received the contagium of plague from Hongkong appears to be not unwarranted.
As a result of the above-described experience of plague at Hongkong during the year 1896, the following measures should in general be taken for preventing and contending with the disease.
A.—Measures of Public Hygiene.The most successful prophylactic measure against plague is to prevent the importation of the contagium. This is to be effected by a stringent supervision of intercourse, as in the case of cholera. Persons arriving from infected districts suffering from plague or from illness of a suspicious nature, must be isolated or kept under observation until fully recovered, and their dejecta must be rendered harmless. By these measures, as has already been shown in the case of cholera, we shall be able with certainty to prevent the diffusion of the plague-poison. As a rule, according to the experience of 1894 and 1896, the observation of suspected persons may be limited to a period of from seven to nine days. Sometimes, however, as will be shown later, plague may have an incubation-period of fifteen days. Especially in need of official supervision are those quarters which, in consequence of overcrowding with persons in unfavourable social circumstances, are extremely dangerous from a hygienic point of view.
Ships coming from infected ports, with their passengers and cargo, must, as the experience of the epidemic of 1896 so frequently showed, be subjected to the same inspection as persons suffering from plague or from illness of a suspicious nature. In the first place, a rule must be made that while a ship from an infected port which has remained free from plague during the voyage should be allowed to land passengers and discharge cargo, any ship on which cases of plague have occurred during the voyage must be subject to inspection and disinfection at the discretion of the sanitary authorities of the port of arrival.
A ship's cargo could tend to introduce plague only in so far as it contained damp infected articles, such as dirty clothing, etc., of those that had suffered from plague. Dry articles would hardly serve to introduce infection.
As with cholera, so with plague, water from an infected port must be regarded as dangerous, whether drinking-water or ballast-water. That water may be contaminated with the plague bacilli by dejecta or by dirty clothing, was clearly proved by the numerous cases of plague on the junks in Hongkong harbour and by the detection of the bacillus in well-water, even though the bacillus was not detected in running water.
The sanitary regulations have further to take into account that the contagium of plague may be distributed by developed cases of the disease. Patients suffering from plague must be isolated in a hospital specially appointed for this purpose; and the pus from the buboes, the faeces, the urine, and the expectoration, of the patients, must be destroyed. Also, articles that have come into contact with the patients, such as utensils, beds, and clothing, must be disinfected before further use.
Utensils are best disinfected by boiling. Experiments with pure cultures of plague bacilli have shown that water at a temperature of 58° C. (136° F.) kills the bacilli in an hour; at a temperature of 80° C. (176° F.) in twenty minutes; and at a temperature of 100° C. (212° F.), within ten minutes.
Disinfection of the pus from buboes, of the faeces, the urine, and the expectoration, is best accomplished by an hour's immersion in a 5% solution of creolin (Beackhead), carbolic acid, or milk of lime. It was shown experimentally that pure cultures of plague bacilli, suspended by means of silk threads in a 5% solution of creolin (Beackhead) were killed in five minutes, and in a 5% solution of milk of lime in 10 minutes.
Linen clothing should be soaked for two or three hours in a 5% solution of carbolic acid or creolin.
Other articles of clothing, and bedding, should be exposed for half an hour to a current of steam at a temperature of 100° C. (212° F.).
Rooms or houses used by patients are best disinfected as follows:
All the movables are taken out of the houses, and, according to their nature, are disinfected with 1% carbolic or creolin solution or with hot soap-solution, or are placed in a steam-disinfector. The walls and floor of the empty room or house are, wherever accessible, scrubbed with milk of lime (one part of powdered slaked lime mixed with four parts of water). This scrubbing must be repeated in three hours.
When dry, the walls and floor may be scoured again. The walls may also be rubbed down with dry bread, and the floor washed with a 5% carbolic or creolin solution. After the disinfection, the room should be left unused for three days, being well heated during this time.
Worthless articles that have come into contact with the patient should be burned. In this connexion, care should be taken not to carry the articles to be burned to any considerable distance, for to do so may lead to a dissemination of the contagium of plague.
(29)
194
( 28 )
VIIL-PROPHYLAXIS.
We shall first describe the prophylactic measures that were enforced during the epidemic of plague at Hongkong in 1896. The Colony of Hongkong has a department of sanitary affai (Sanitary Board), and is divided into thirteen sanitary districts. Of these, including the harbour, nine belong to the town of Victoria, while the four others are constituted by the districts of Kowloon, Shao-ki-wan, Aberdeen, and Stanley, In each district a police-inspector was appointed, with English and Chinese policemen to act under him, to search the houses of the Chinese for patients and dead bodies. Those suffering from plague among the Chinese inhabitants of the island of Hongkong, and the bodies of those that had died of the disease in the same area, were sent to the Chinese Hospital (Tung Wa Hospital) in the town of Victoria, which was under Government supervision, and at which the patients and bodies were inspected every morning and evening by Dr. ATKINSON and myself. From this hospital all the patients and suspicions cases, and all the dead bodies, were transported to the Kennedy Town Hospital. The patients of other nationalities were as a rule, after preliminary medical inspection, sent direct to the Kennedy Town Hospital. On the mainland, that is to say in the district of Kowloon, all the bodies that were found were taken to a sherl. Thence, day by day, after I had inspected them, they were taken in coffins on a steamboat direct to the Kennedy Town Hospital on the island of Hongkong. Patients and suspicious cases from the mainland were always taken by steamboat to the Kennedy Town Hospital.
A daily report was made to the Sanitary Board of the number of patients and bodies brought to the hospital, and of the dwellings or other places in which they had been found.
The Sanitary Board, under the guidance of the physicians attached to that body, then undertook the disinfection of the houses in which cases of plague had occurred. While the houses were under- going disinfection, the inhabitants were housed in temporary barracks that had been erected in various parts of the town. The disinfection consisted in clearing out the houses, burning all worthless articles, cleansing the walls and floor with milk of lime, washing the furniture with 5% carbolic acid solution, and disinfection of clothing, et cetera, in a steam disinfecting apparatus. Ten days after the complete disinfection and airing of their houses, the inhabitants were allowed to return to them.
The bodies of those that had died of plague were buried in coffins coutaining quicklime in a church-yard situated on the slope of a hill near the Kennedy Town Hospital.
While by stringent inspection and disinfection of the houses, suitable measures were taken for the suppression of plague on the island, too little attention was paid to the water-borne traffic. la the first place, intercourse with Canton, where in May and June plague was as prevalent as in Hongkong should have been subject to better inspection. Further, owing to the fact that patients suffering from plague were allowed to leave the Colony, the carrying of the disease to other places was greatly favoured. How widely plague can be distributed by sea-borne traffic was shown many times in Juce and July, by the fact that ships coming from other ports, especially from Singapore and also from Saigon, bad cases of plague on board.
Since October 1896, when the above lines were written, plague has broken out at the Indian ports of Bombay and Calcutta, and the widely expressed opinion that these towns received the contagium of plague from Hongkong appears to be not unwarranted.
As a result of the above-described experience of plague at Hongkong during the year 1896, the following measures should in general be taken for preventing and contending with the disease.
A.-Measures of Public Hygiene.
The most successful prophylactic measure against plague is to prevent the importation of the contagium. This is to be effected by a stringent supervision of intercourse, as in the case of cholera. Persons arriving from infected districts suffering from plague or from illness of a suspicious nature, must be isolated or kept under observation until fully recovered, and their dejecta must be rendered harmless. By these measures, as has already been shown in the case of cholera, we shall be able with
( 29 )
194
certainty to prevent the diffusion of the plague-poison. As a rule, according to the experience of 1894 and 1896, the observation of suspected persons may be limited to a period of from seven to nine days. Sometimes, however, as will be shown later, plague may have an incubation-period of fifteen days. Especially in need of official supervision are those quarters which, in consequence of over- crowding with
persons in unfavourable social circumstances, are extremely dangerous from a hygienic int of view.
Ships coming from infected ports, with their passengers and cargo, must, as the experience of the epidemic of 1896 so frequently showed, be subjected to the same inspection as persons suffering from plague or from illness of a suspicious nature. In the first place, a rule must be made that while a ship from an infected port which has remained free from plague during the voyage should be allowed to and passengers and discharge cargo, any ship on which cases of plague have occurred during the voyage must be subject to inspection and disinfection at the discretion of the sanitary authorities of the port of arrival.
A ship's cargo could tend to introduce plague only in so far as it contained damp infected articles, such as dirty clothing, etc., of those that had suffered from plague. Dry articles would hardly serve to introduce infection.
As with cholera, so with plague, water from an infected port must be regarded as dangerous, whether drinking-water or ballast-water. That water may be contaminated with the plague bacilli by dejecta or by dirty clothing, was clearly proved by the numerous cases of plague on the junks in Hongkong harbour and by the detection of the bacillus in well-water, even though the bacillus was not detected in running water.
The sanitary regulations have further te take into account that the contagium of plague may be distributed by developed cases of the disease. Patients suffering from plague must be isolated in a hospital specially appointed for this purpose; and the pus from the buboes, the faces, the urine, and the expectoration, of the patients, must be destroyed. Also articles that have come into contact with the patients, such as utensils, beds, and clothing, must be disinfected before further use.
Utensils are best disinfected by boiling. Experiments with pure cultures of plague bacilli have shown that water at a temperature of 58° C. (136° F.) kills the bacilli in an hour; at a tempera- ture of 80° C. (176° F.) in twenty minutes; and at a temperature of 100° C. (212° F.), within ten
miuntes.
Disinfection of the pus from buboes, of the faces, the urine, and the expectoration, is best ac- complished by an hour's immersion in a 5% solution of creolin (Bleakhead), carbolic acid, or milk of lime. It was shown experimentally that pure cultures of plague bacilli, suspended by means of silk threads in a 5% solution of creolin (Bleakhead) were killed in five minutes, and in a 5 solution of milk of lime in 10 minutes.
Linen clothing should be soaked for two or three hours in a 5 / solution of carbolic acid or creolin.
Other articles of clothing, and bedding, should be exposed for half an hour to a current of steam at a temperature of 100° C, (212° F.).
Rooms or houses used by patients are best disinfected as follows
All the movables are taken out of the houses, and, according to their nature, are disinfected with 15% carbolic or creoliu solution or with hot soap-solution, or are placed in a steam-disinfector. The walls and floor of the empty room or house are, wherever accessible, scrubbed with milk of lime (one part of powdered slaked lime mixed with four parts of water). This scrubbing must be repeated in three hours.
When dry, the walls and floor may be scoured again. The walls may also be rubbed down with dry bread, and the floor washed with a 5% carbolic or creolin solution. After the disinfection, the room should be left unused for three days, being well heated during this time.
Worthless articles that have come into contact with the patient should be burned. In this connexion, care should be taken not to carry the articles to be burned to any considerable distance, for to do so may lead to a dissemination of the contagium of plague.
الات الاستخر
No comments yet.
Private notes are available after approval.