17
i
?
8
Hospital with very favourable results. Therefore for comparison of case mor- tality with the people treated locally it was considered better to take the period embracing the first half of the epidemic. In that time there were 123 cases of Chinese patients of whom 106 died showing a mortality of 86.17 per cent. In the experimental block 35 cases were reported of which 10 were already dead. The number treated was therefore 25, with 21 deaths, showing a mortality of 84%. I am aware that these numbers are too small to afford a sound basis for scientific com- parison yet it is satisfactory to find that so far as it went, the result of the experi- ment was apparently in its favour to the extent of 1.83%. In noting this result the disabilities of the system of local treatment as tried by me must be considered. I have stated that the prescriptions given by the Chinese doctors are good, so far us they go.
But with the administration of medicine the care of the average Chinese practitioner ceases, and the question of nourishment and all the assuagements that come under the head of nursing are neglected. The sufferers in my district would take no medicine save the usual prescription given by the Chinese doctor, which they obtained from the local druggist. The doctor, at my request, prescribed port wine, and beef tea, both of which I had supplied to the druggist, who was one of the most active members of the Kai-fong, and anxious to do anything in his power that might increase the chances of recovery. But the patients refused to take them, and I found them having nothing but rice, or congee, which is water thickened with rice flour. In Kennedy Town I understand that patients take the nourishment ordered for them without difficulty, and I am of opinion that with properly equipped local hospitals under proper supervision and with trained nurses the mortality would be sensibly diminished.
19. We found it difficult to trace the means of infection. The immunity of people living, sometimes for several days, in the same room went far to disprove the theory of contact. With the exception of Chu Kom and Wong Sam fron No. 4 Sheung Fung Lane none of the people of that house who were attacked worked together, or partook of the same food. Fourteen days after Sheung Fung Lane had been cleansed out I directed that as many fleas, bugs, &c., as could be found should be sent to the Government Bacteriologist for examination. A number of bugs and a spider were found, and on the 10th June Dr. HUNTER reported that in both bugs and spider were found plague bacilli. At the same time he reported as the result of examination of a number of bugs, flies and fleas from No. 4 Sheung Fung Lane, where several cases of plague had arisen, that no bacilli were found. Again, after the death of the two boys who lived on the first floor of 109 Second Street, bugs were procured from the first floor and from the ground floor. Dr. HUNTER reported that in the two bugs from the first floor no bacilli were found, but a num- of bugs from the ground floor were found infected with several plague bacilli. During a visit to the Plague Hospital at Kennedy Town, I observed a large number of flies in one ward, numbers of which had settled on the patients. I directed that a number should be sent for examination. On the 9th July, Dr. HUNTER reported that the majority of the flies were plague-infected. He reported at the same time that several cockroaches caught in a stall in the Central Market contained B. pestis, On the 1st June it was reported that fowls from the Western Market were found to have died of plague, and as the poorer classes of Chinese eat the entrails of fowl with their rice in a semi-cooked state, a notice was issued that such food if not thoroughly cooked was dangerous. On examining specimens of varions foods exposed for sale, Dr. HUNTER has since found the B. pestis in inferior rice. I have suggested to Dr. THOMSON to find by experiment if mosquitoes which fed on plague patients contain bacilli, and several have been examined by Dr. HUNTER with negative results. The examination is, however, being continued.
20. We have from Professor SIMesox's report evidence that pigs, calves, sheep, monkeys, geese, ducks, turkeys, hens, pigeons and rats are susceptible to plague, which may be contracted by food or by inoculation direct, or by means of suctorial insects. To this list the examination mentioned above adds bugs, spiders, flies and cockroaches. I may add that quails kept in the market for sale were also found to *be infected. In paragraph 22, page 100, Professor SIMPSON points out that domestic animals suffer from chronic plague and surmises that this is probably one of the bridges by which the interval of the attacks in man is connected. I have for a considerable time been of opinion that man is himself subject to chronic plague, which may either pass away after a considerable time, or continue dormant over the winter months regaining activity with the annual movement of Spring when the
9
sugar
curve of the epidemic is almost constant. This opinion was strengthened by the fact that in August, 1899, the body of a Chinese lift-man at Queen's Buildings who was accidentally killed when attempting to enter the lift while in motion was found to contain plague bacilli. A similar result followed the examination of a man who on the 4th March, 1901, was killed at Tai Koo sugar works by a bag of falling on his head from a height of 20 feet; while on the 2nd April, 1903, in the body of the chief steward of a ship lying in dock, found floating with a large wound on the head, were also found plague bacilli. Early in June several men from H. M. S. Ocean were sent to the Naval Hospital, suffering from pneumonia; on examination of their blood seven were found to be suffering from mild cases of plague. In like manner two Officers of the Sherwood Foresters who developed feverish symptoms were, on having their blood examined, found to be similarly affected. In the Boletim Official" of Macao containing the report on the plague epidemic, 1895, Dr. GOMES DA SILVA, the Medical Officer who published the re- port in 1895, stated that during the height of the epidemic he had discovered plague bacilli in his own excreta.
21. In June I directed Inspector GIDLEY to obtain as many specimens of blood as possible, on slides procured from the Government Bacteriologist. He obtained 110 specimens from men, women and children taken at random. These slides were sent to Dr. HUNTER for examination, who reported that in five slides he found plague bacilli, and in seven slides "bacilli were present in considerable numbers, sonie of which showed bipolar staining. They were not sufficiently distinctive, however, to be regarded as B. pestis." These slides were obtained between the 23rd June and 10th July. Since they were obtained there were but three cases of plague in the district, from none of which was a specimen of blood taken.
22. I am not unmindful of the fact that these reports were the result of microscopic examination only. But the examination was the same as that on which a great many of the cases treated in Kennedy Town Hospital were sent to that institution where their cases ran the usual course of plague invasion.
23. Now, putting aside the five doubtful slides, it will be seen that of those people examined at random 4.54 % were found to be infected with plague though to all appearance perfectly healthy. If we exclude all the well-to-do, and take the working coolie population alone, they probably number 180,000 and, assuming the same average amount of infection, there are among that class alone 8,172 persons at present infected in Hongkong. If even a quarter of that average be accepted for the 105,000 inhabitants of superior class the number of infected will be increased to 9,361. In Appendix G. will be found the number of rats examined in each month of the present year with the proportion of infected rats. I am afraid that the incidents mentioned in para. 5 weakens deduction as regards Hong- kong. But from whatever source the rats were procured the proportion of infection in June was 9% or 4.46 % more than the percentage of the slides examined, or, if the doubtful cases mentioned by Dr. HUNTER be included, 1% less, while in January the proportion falls to .8 %. This being so, with the complete circle of vermin, insects, food, rats, domestic animals and man all infected in possibly simi lar, possibly different proportion, it appears to me unsound to concentrate attention upon the rat as the principal means of bridging over the dormant season.
24. I do not know whether the conduct of a culture of the bacillus pestis bas ever been observed for an annual cycle. I am informed that the usual culture in a culture tube dies in a short period, either by having exhausted the nutriment from the culture medium or by having poisoned it by its own toxin. If the blood of those in whom plague bacilli now exist without producing the usual effects of plague could be periodically examined all through the coming year much light might be thrown upon the dormant period, and the highly important question of the infectivity of these people might he solved. But failing this I have suggested the possibility of preparing a culture in so large a quantity of culture medium as will permit of the spread of the bacillus to the utmost extent during the period shown to be that of annual activity and still leave the medium in sufficient quantity to support any renewal of propagation. In this way I suppose that the annual movement of the bacillus might be observed.
230
No comments yet.
Private notes are available after approval.