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square fect. Third 45 feet in depth, the open area in rear being from 76 to 122 Street is about 35 feet wide, the houses, generally two-storied, averaging 20 feet in height with a depth of 40 to 45 feet and open spaces in rear of from 40 to 68 feet.
9. The return of the dimensions of the floors in which plague occurred shows that the cubic air space per head of the inhabitants fell far short of the requirement of 550 feet under the Public Health and Buildings Ordinance.
10. On the 13th April, I proceeded to the district accompanied by the Prin- cipal Civil Medical Officer. the Medical Officer of Health, the Director of Public Works, the Hon. Ho KAI, M.B., C.M.G., and Mr. FUNG WA CHUN, a Member of the Sanitary Board, and, collecting the people, I told them, through the Chinese gentlemen present, that the Sanitary Board had offered no objection to my trying how far they would be prepared to help themselves and assist the Government in carrying out the necessary measures. I emphasised the necessity of personal cleanliness and the destruction of vermin in their houses, and undertook that, if they would give timely notice of sickness, they could be attended by either European or Chinese doctors, whichever they elected, at their own houses. To enable them to clean their houses and themselves I proposed to erect tanks for boiling water and Jeye's fluid into which their bed boards and most of their simple furniture could be dipped, and to supply wash houses in which both sexes could have a supply of hot water for washing purposes. To carry out these proposals I asked the people to form a Kai- Jong, or committee who would assist by their supervision. The Kai-fong is a Chinese institution in every Chinese town, each street or ward having its Kai-fong formed of men of consideration among the inhabitants. Fifteen people at once came forward, to whom five were added on taking over the further block of houses comprising the North side of Second Street and South side of Third Street, a month later, at the earnest request of the inhabitants. The list of the Kal-jong given in the report of Inspector GIDLEY shows the class of the leading inhabitants of these that I am entirely satisfied with the work done by them. They may say disseminated my views as to cleansing operations, and assisted by their personal efforts in seeing that they were carried out. They reported cases of sickness, and at every visit to the district all who were not away at their work were ready to accompany me and show me what had been done.
streets.
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11. By the 20th April, the six houses selected were prepared as wash houses- four for men and two for women-and three large tanks were erected of the dimen- sions given by Inspector GIDLEY to enable the bed boards and furniture to be immersed in boiling water. To exercise a supervision over all the operations I obtained the services of this fuspector who had in the epidemic of 1894 done excellent service, who speaks Cantonese like a native, and who enjoys the confidence of the Chinese. I cannot speak too highly of the manner in which he has done the work for which he so readily volunteered, and without him there would have been great difficulty in carrying out the experiment. Mr. FuNG Wa CRÜN took a very active interest in the work. He accompanied me several times to the district and inspected the hospital, and he gave directions to a Chinese doctor of the Tung Wa Hospital to visit the district, three times daily in case his services should be required. Doctors ATKINSON and PEARSE also visited the district audi examined the cases then under treatment by Chinese doctors, while, on the 9th May a Chinese gentleman, Mr. Ho Kom TENG, wrote to Inspector GLLY enclosing two hundred dollars with the request that the money should be used to snecour the families renced to straitened circumstances by the death from plague of those ou whom they were dependent. The houses required for bath-houses were evarnated without a murinur. The immediate landlords were among the inhabit- ants of the district, and the letter, of which I attach a copy, shows the spirit in which they met the inquiry of Mr. FUNG WA CHUN for particulars of rent payable. The landlords of the six houses first taken for bath-houses on being asked by me what would be the rent for two months answered "for such a purpose, nothing."
12. The people were left free to choose their own doctors, but were offered the services of either European or Chinese medical men, the services of the Tung Wa Hospital doctor being given gratuitously, while outside practitioners were engaged by the people on the Chinese principle of "no cure, no fee," the honorarium in case of recovery being about twenty-five dollars. obtained the prescriptions of the Chinese practitiouer who successfully treated one case, of which on examination he expressed approval.
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may
add that Dr. ATKINSON
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13. My object was (1) to endeavour to secure the cleanliness of house and person, that must in any case be beneficial; (2) to induce the people to undertake this work themselves; (3) to put a stop to the dumping of dead bodies by re- moving the dread of disinfection by the coolies of the Sanitary Department; (4) to induce the people to give notice of sickness. Inspector GIDLEY'S report (Appendix A.) will show how far these efforts have been successful. It will be observed that in cases where death had occurred the people destroyed or disinfected bed and clothing of deceased, cleaned the house and remained. In cases of illness we at first removed the inmates, who in case of the death of the patient returned to the house as soon as it had been cleansed. In no case was there any plague developed among these "contacts" after the ordinary period of incubation; for instance in five cases occurring among the inmates of 4 Sheung Fung Lane they were all deve- loped within five days of the date of the first scizure reported. The return of cases attached to Inspector GIDLEY's report shows that in 41 cases, apart from those reported dead, & were reported at once,
9 after one day's illness,
7 after two days,
1 after three days,
2 after five days,
3 after six days,
1 after seven days.
Considering the reluctance of the Chinese to speak of illness, the return speaks well for the efficiency of supervision by the Kai-fong and the readiness of the people to co-operate with the efforts to assist them.
14. Having got the tanks in order the whole district was systematically taken house by house, the occupants bringing their bed boards and inats, their settles, and any furniture that could be immersed to be dipped in the boiling water for a few minutes and thoroughly scrubbed. Clothing was either taken to a wash house and washed, or sent to the Disinfecting Station at the option of the people. With 253 houses to clean, this process took some time, but apart from the thorough cleansing as above all the householders in the experimental block turned out their furniture into the streets, scrubbed it and swept the houses within a week of the taking over of the small district. With two exceptions there was no case of plague, the first invasion of which was after the date of thorough cleansing.
15. So many cases occurred in the second week in May that difficulty was found in obtaining accommodation for the occupants of the houses. I therefore took a house in Third Street as a local hospital, where the patients might be attended by their friends. Two hospital attendants were engaged, but unfortunately trained attendants could not be procured. The people showed no disinclination to go to this hospital.
16. On the 14th May directed that the inhabitants of Sheung Fung Lane should be moved as so many cases of plague had occurred, and I wished to have the houses thoroughly explored for rat runs to see if any connection could be traced between the houses in which plague had occurred. The report (Appendix B.) shows that while rat runs were connecting respectively Numbers 1, 3 and 5, 7 and 9, 15 and 13, 6 and 8, 2 and 4, the houses in connection with 8 and 4 the only infected houses in the series namely 6 and 2 were not apparently infected.
18. Having stated the objects of my experiment, the question remains whether, assuming that local hospitals and a minimum of disturbance will en- sure a more timely discovery of cases of plague we may hope for a material diminution in the case mortality. As affording a rough comparison I have obtained from Dr. THOMSON a return of the cases of plague in Kennedy Town Hospital during this year's epidemic. It will be found in Appendix Ě. Dr. THOMSON divides the cases into two divisions, the reasons for which are two- fold. About the middle of May an improved method of examination of blood for bacilli first, I believe, discovered by Dr. Ross, was adopted by Dr. BELL of the Government Civil Hospital and by this method a large number of mild cases of plague were diagnosed, especially among Europeans, which under for- mer methods would have escaped observation, and again at this time the treat- ment of patients by large doses of carbolic acid was adopted in Kennedy Town
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