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Enclosure E.
# METHOD OF DEALING WITH OUTBREAKS OF BUBONIC FEVER (PLAGUE)
1. Notification.-All cases of infectious disease should be reported at once to the nearest Police Station or to the Sanitary Board (Telephone No. 257), or to the Medical Officer of Health (Telephone No. 120). This is compulsory on "all persons knowing or having reason to believe that any person has been attacked by or is suffering from" Bubonic Plague, Cholera or Small-pox (Bye-law 17, Ordinance 15 of 1894); but it is universally evaded by the Chinese and even by the Chinese "Doctors." The penalty for its evasion is $25.
2. Detection of the Sick.-In the absence of notification, this can only be effected by means of house-to-house visits. The Sanitary Board has power to institute such house-to-house visits in any district in which the disease may prevail and must define the limits of such district (Bye-law 25, Ordinance 15 of 1894).
3. Removal of the Sick.-Ambulances for the removal of the sick are kept at the various Police Stations, at the Canton Wharf, and at the Board's matsheds at Praya East, Taipingshan, Yaumati, and Hunghom, and sick persons are removed in these ambulances to the Tung Wah Hospital on application to the Sanitary Board, the Medical Officer of Health, or the Police, and are there examined by a Chinese Doctor trained in Western medicine and are either drafted at once by him to the Plague Hospital or detained under observation in case of doubt. In making any such application, care should be taken to state distinctly whether the patient is alive or dead, for in the case of dead bodies, a dead-box is forwarded for the removal. The ambulance is attended by a Chinese constable who conveys the details concerning the case to the Hospital Authorities.
Heavy wooden boxes, with rubber washers fitted to the lids, are used for the removal of dead bodies to the Government Mortuary; these are kept at the various Police Stations and at the Board's matsheds, and information concerning the death is forwarded on a card attached to the body.
4. Treatment of the Sick.-This is entirely in the hands of the Medical Department. The Government Hospital at Kennedy Town is supplemented by a series of Matshed Hospitals, also at Kennedy Town, which are managed by the authorities of the Tung Wah Hospital but are under the supervision of the Medical Department.
5. Disinfection of infected Premises.-This is carried out by a European officer assisted by eight coloured foremen, a Chinese foreman, and a varying number of coolies. As soon as it is known that a case of the disease has occurred at any house, a Chinese constable is sent from the nearest Police Station to detain all persons found therein (Bye-law 22, Ordinance 15 of 1894), and the officer in charge of the disinfection proceeds to the house to ascertain how many persons are detained there. He then procures, either from the matshed at Praya East or from the Disinfecting Station, as many suits of Government clothing as are needed for the persons so detained, and having thus provided these persons with clothing, he removes their own clothing, bedding, curtains, and carpets, to the Steam Disinfecting Station, the clothing being tied up in sheets dipped in a solution of Jeyes' fluid and conveyed through the streets in baskets; persons who are able to obtain new or clean clothing from some uninfected premises are, however, not detained after they have discarded their infected clothing and handed it to the Inspector for disinfection. New goods, silk clothing which has not been recently worn, furs, and leather goods are not removed to the Steam Disinfector, but must, as a general rule, remain on the premises until they have been fumigated. When the clothing, etc., is returned (in the course of some two hours) from the Disinfecting Station, the persons who have been detained are required to put on their own clothing and must then leave the premises for some 5 or 6 hours while it is disinfected and cleansed. The Government clothing is returned to the Disinfecting Station to be steamed before it is again used. The people so displaced from their homes are at liberty to make use of the Board's matshed shelters until the processes of disinfection of the premises are complete.
The disinfection of the premises consists in the spraying of the walls with a solution of perchloride of mercury (1 in 1,000) or fumigation with free chlorine obtained by the addition of diluted sulphuric acid to chlorinated lime (1 quart of a 1 in 8 solution of the acid to each lb. of the chlorinated lime). Floors and furniture are then scrubbed with a solution of Jeyes' fluid, and the walls are then lime-washed, chlorinated lime being added to the lime-wash in the proportion of 1 lb. to the gallon.
6. Burial of the Dead.-This is carried out under the superintendence of one of the Board's Officers; all bodies being buried at the Kennedy Town Plague Cemetery, unless a special permit has been granted for burial elsewhere.
7. General Sanitary Precautions.-Chlorinated lime is supplied to all the public latrines for use in the buckets, and the officers of the Board are instructed to see that it is freely used.
A reward of 2 cents per head has been offered since January 16th for every rat brought to an officer of the Board, and some 25,000 rats have, by this means, been collected and destroyed.
FRANCIS W. CLARK,
Medical Officer of Health,
HONGKONG, June, 1900.
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Enclosure F.
SANITARY BOARD OFFICES,
HONGKONG, 21st July, 1899.
I have the honour to submit the following report for the information of the Select Committee of the Sanitary Board, appointed to consider the question of the adequacy of the present Staff.
The City of Victoria is divided into ten Health Districts, the smallest of which has a built-over area of 23 acres and the largest of 581 acres; Kowloon Peninsula is similarly divided into two Health Districts.
The average population of each of the City Health Districts is 16,425, and the average number of domestic buildings is 768, or about 2,000 floors to each district, each floor being a separate dwelling for one or more families.
Each Health District is in charge of an Inspector of Nuisances, whose duties comprise the supervision of the scavenging and conservancy of that district; the scavenging work is performed by coolies, who are supplied with Dust Carts and baskets, and who work under the supervision of a Portuguese or Indian Foreman in each of the City Health Districts. Each District Inspector is required to be about his District between the hours 5:30 a.m. to 8:00 a.m. in the summer and 6:00 a.m. to 9:00 a.m. in the winter, to see that the scavenging work is properly carried out.
During the forenoon, the District Inspectors are required to visit the Bakeries, Lodging Houses, Opium Divans, Offensive business premises, Laundries, Cattlesheds, Latrines, and Urinals in their District, and during the afternoon, a systematic inspection has to be made of the District, in such a manner that every floor of every house in the District is visited at least once in every two months. It is as much as the District Inspectors can manage to get this house-to-house visitation work into the two months' limit, and they are required to send in a daily report showing the houses so visited by them and a record of all the nuisances and illegal structures observed in those buildings.
There are five first-class Inspectors of Nuisances in the City of Victoria, each of whom has the supervision of two Health Districts, and the daily reports of the District Inspectors, which contain mention of nuisances or of illegal structures, are referred to them to deal with the nuisances and see that they are at once abated. The First Class Inspectors also have to supervise the six-monthly cleansing and lime-washing of all tenement houses, the investigation of all uncertified deaths, the supervision of the Chinese and non-Chinese cemeteries, the supervision of the Rubbish Depôt at Tsun Wan Bay, the supervision of the Peak Sanitary District, and the institution of all prosecutions.
The duties of the Chief Inspector of Nuisances will be mainly supervisory, and I have already arranged that he should accompany the various District Inspectors on their rounds of house-to-house visitation.
I beg now to direct the attention of the Committee to the following matters which, in my opinion, cannot be adequately dealt with by the present Staff, and which, it may well be argued, are entitled to receive more attention in the future than it has been possible to give them in the past.
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Į
20-
Enclosure E.
METHOD OF DEALING WITH OUTBREAKS OF BUBONIC
FEVER (PLAGUE),
1. Notification.-All cases of infectious disease should be reported at once to the nearest Police Station or to the Sanitary Board (Telephone No. 257), or to the Medical Officer of Health (Telepone No. 120). This is compulsory on "all persons kuowing or having reason to believe that any person has been attacked by or is suffering from" Bubonic Plague, Cholera or Small-pox (Bye-law 17, Ordinance 15 of 1894); but it is universally evaded by the Chinese and even by the Chinese "Doctors." The penalty for its evasion is $25,
2. Detection of the Sick.-In the absence of notification this eau only be effected by means of house to house visits. The Sanitary Board has power to institute such house to house visits in any district in which the disease may prevail and must define the limits of such district (Bye-law 25, Ordinance 15 of 1894).
3. Removal of the Sick.--Ambulances for the removal of the sick are kept at the various Police Stations, at the Canton Wharf, and at the Board's matshols at Praya East, Taipingshan, Yaumati and Hunghom, and sick persons are removed in these ambulances to the Tung Wah Hospital on application to the Sanitary Board, the Melical Officer of Health, or the Police, and are there examined by a Chinese Doctor trained in Western medicine and are either drafted at once by him to the Plague Hospital or detained under observation in case of doubt. In making any such application care should be taken to state distinctly whether the patient is alive or dead, for in the case of dead bodies, a dead-box is forwarded for the removal. The ambulance is attended by a Chinese constable who conveys the details concerning the case to the Hospital Authorities.
Heavy wooden boxes, with rubber washers fitted to the lids are used for the removal of dead bodies to the Government Mortuary; these are kept at the various Police Stations and at the Board's matsheds, and information concerning the death is forwarded on a card attached to the body.
4. Treatment of the Sick.-This is entirely in the hands of the Medical Department. The Government Hospital at Kennedy Town is supplemented by a series of Matshed Hospitals, also at Kennedy Town, which are managed by the authorities of the Tung Wah Hospital but are under the supervision of the Medical Department.
5. Disinfection of infected Premises. This is carried out by a European officer assisted by eight coloured foremen, a Chinese foreinan and a varying number of coolies. As soon as it is known that a case of the disease has occurred at any house, a Chinese constable is seut from the nearest Police Station to detain all persons found therein (Bye-law 22, Ordinance 15 of 1894), and the officer in charge of the disinfection proceeds to the house to ascertain bow many persons are detained there. He then procures, either from the matsbed at Praya East or from the Disinfect- ing Station, as many suits of Government clothing as are needed for the persons so detained, and baving thas provided these persons with clothing be removes their own clothing, bedding, curtains, and carpets, to the Steam Disinfecting Station, the clothing being tied up in sheets dipped in a solution of Jeyes' fluid and conveyed through the streets in baskets; persons who are able to obtain new or clean clothing from some uninfected premises are however not detained after they have discarded their infected clothing and handed it to the Inspector for disinfection. New goods, silk clothing whichhas not been recently worn, furs and leather goods are not removed to the Steam Disinfector, but must as a general rule remain on the premises until they have been fumigated. When the clothing, etc. is returned (in the course of some two hours) from the Disinfecting Station, the persons who have been detained are required to pat on their own clothing and must then leave the premises for some 5 or 6 hours while it is disinfected and cleaused. The Government clothing is returned to the Disinfecting Station to be steamed before it is again used. The people so displaced from their homes are at liberty to make use of the Board's matshed shelters until the processes of disinfection of the premises are complete.
The disinfection of the premises consists in the spraying of the walls with a solution of perchloride of mercury (1 in 1,000) or fumigation with free chlorine obtained by the addition of diluted sulphuric acid to eblorinated lime (1 quart of a 1 in 8 solution of the acid to cach Ib, of
21
the chlorinated line). Floors and furniture are then scrubbed with solution of Jeyes' fluid and the walls are then lime-washed, chlorinated lime being added to the lime-wash in the proportion of lb. to the gallon.
6. Burial of the Dead.-This is carried out under the superintendence of one of the Board's Officers, all bodies being buried at the Kennedytown Plague Cemetery, unless a special permit has been granted for burial elsewhere.
7. General Sanitary Precautions.--Chlorinated lime is supplied to all the public latrines for use in the buckets, and the officers of the Board are instructed to see that it is freely used.
A reward of 2 cents per head has been offered since January 16th for every rat brought to an officer of the Board, and some 25,000 rats have by this means been collected and destroyed.
FRANCIS W. CLARK,
SIR,
HONGKONG, June, 1900.
Medical Officer of Health,
Enclosure F.
SANITARY BOARD OFFICES,
HONGKONG, 21st July, 1899.
I have the honour to submit the following report for the information of the Select Committee of of the Sanitary Board, appointed to consider the question of the adequacy of the present Staff.
The City of Victoria is divided into tea Health Districts, the smallest of which has a built-over area of 23 acres and the largest of 581 acres; Kowloon Peninsula is similarly divided into two Health Districts.
The average population of each of the City Health Districts is 16,425 and the average number of domestic buildings is 768 or about 2,000 floors to each district, each floor being a separate dwell- ing for one or more families.
Each Health District is in charge of an Inspector of Nuisances whose duties comprise the su- pervision of the scavenging and conservancy of that district; the scavenging work is performed by coolies, who are supplied with Dust Carts and baskets, and who work under the supervision of a Portuguese or Indian Foreman in each of the City Health Districts. Each District Tuspector is re- quired to be about his District between the hours 5,30 a.m. to 8.00 a.m. in the surumer and 6.00 a.m. to 9.00 a.m. in the winter, to see that the scavenging work is proporly carried out.
During the forenoou the District Inspectors are required to visit the Bakeries, Lodging Houses, Opium Divaus, Offensive business premises, Laundries, Cattlesheds, Latrines and Urinals in their District and during the afternoou a systematic inspection has to be made of the District, in such a manner that evey floor of every house in the District is visited at least once in every two months. It is as much as the District Inspectors can manage to get this house-to-house visitation work into the two months' limit and they are required to send in a daily report showing the houses so visited by them and a record of all the nuisances and illegal structures observed in those buildings.
There are five first class Inspectors of Nuisances in the City of Victoris each of whom has the supervision of two Health Districts, and the daily reports of the District Inspectors which contain mention of nuisances or of illegal structures, are referred to them to deal with the nuisances and see that they are at once abated. The First Class Juspectors also have to supervise the six-monthly cleansing and limewashing of all tenement houses, the investigation of all uncertified deaths, the supervision of the Chinese and non-Chinese cemeteries, the supervision of the Rubbish Depôt at Tsun Wan Bay, the supervision of the Peak Sanitary District, and the institution of all prosecutious.
The duties of the Chief Inspector of Nuisances will be mainly supervisory and I have already arranged that be should accompany the various District Inspectors on their rounds of house-to-house-
visitation.
I beg now to direst the attention of the Committee to the following matters which in my opinion cannot be adjuttely dealt with by the present Staff and which, it may well be argued, are entitled to receive more attention in the future than it has been possible to give them in the past.
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