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Hong Kong as a Colony is more or less unique in that almost all that matters is contained in the City and Port of Greater Hong Kong which includes the port and town of Kowloon. Greater Hong Kong corresponds closely to those fine imperial cities of old Germany which were run so successfully on Bureaucratic lines.
The Governor as head of the Colony is head of the City and the Port.
If the Singapore Municipality were given control of Port matters, of Police. of Education and of Medical Relief, its governmental machinery would closely cor- respond to that of Hong Kong, and the Colonial Heads of Departments (Director of Public Works, Director of Medical and Sanitary Services, Colonial Treasurer, Direc- tor of Education, Captain Superintendent of Police. Harbour Master,) would cor- respond to Municipal Heads of Departments.
It is important that the above facts should be recognised for it would seem that in the past failure to do so has been responsible for much of the confusion of thought which has attended discussions on the subject of control of the l'ublic Health machi- nery of the Colony, and for false comparisons with cities like Singapore and Colombo.
If it he realised that Colonial Government and Municipal Government are one and the same thing so far as Hong Kong is concerned and that the Colonial Heads of Departments are really Municipal Heads under another nomenclature and that the Sanitary Board never has been and never can be anything but an advisory body-the issue will be cleared considerably.
Interpretation of the terms "Medicine” and “Sanitation”.
A perusal of past history makes it clear that one very important reason for failure to come to agreement as to what is the best organisation for the health of the Colony has been differences of opinion as to what exactly is the meaning of the terms "medicine" and "sanitary' Lay opinion has been based on the assumption that sanitary science though allied to medicine is a thing apart and that a medical qualification is not necessary for its proper administration and (judging from the re- port of the Lay Commission of 1906) is in fact a disqualification for an administra-
tor.
Fifty years ago medicine was described as the science of the cure of disease through therapeutics and surgery; and sanitation was interpreted to mean cleanliness and freedom from environmental nuisances through action taken by the individual and by the state.
The scope of modern medicine is expounded by Sir George Newman, the chief medical officer of the Ministry of Health in his "Outline of the Practice of Preventive Medicine which was presented to Parliament by command of His Majesty in 1919 and which was reprinted by the Government in 1926--The following are extracts from that work—
"The science and art of medicine is not restricted to the diagnosis and cure of disease in its gross forms, it includes a knowledge of how disease comes to be of its earliest beginnings, and of its prevention. It is in fact, the science and art of health, of how man may learn to live a healthy life at the top of this capacity of body and mind. avoiding or removing external or internal conditions unfavourable to such a standard, able to work to the highest power, able to resist to the fullest, growing in strength and efficiency".
tion.
"Preventive medicine must not be understood to consist only of external sanita- It is something wider than Public Health one of a dozen subjects in the me- dical curriculum. In regard to disease, it is something more than the closing of its channels of communication, something more than an avoidance of the ways and means of its infection and invasion, certainly much more than a registration of its effects, a record of morbidity and mortality which follow in its train“.
"Its object is to prevent not only the spread of disease but its occurrence, to remove its occasion. Its spirit must not be confined to sanitation or the "Public Health" alone but must pervade and inspire all branches of medicine. For it is con-
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cerned with the causes and conditions of disease, which must be sought and known, then brought under control; in achieving this, or attempting to achieve it Preventive Medicine must define and secure the maximum of those conditions of life for the in- dividual and the community which are the frontier defence against disease, and establish the foundation of sound living. For the health and physique of the people is the principal asset of the nation".
Medical opinion is emphatic that modern sanitary science in its fullest sense is based on physiology, bacteriology, parasitology, entomology, epidemiology, chemis- try and physics, all of which form part of the medical curriculum; and that no one who has not undergone a medical training can obtain a proper grasp of the whole subject or can judge the relative value of its different parts.
Chapters on town cleansing, scavenging, conservancy and the disposal of re- fuse and excrement are to be found in all hooks which deal with the theory and prac- tice of hygiene and these subjects are all included in the syllabus of examinations for the Diploma of Public Health and the Diploma of Tropical Medicine and Hygiene. The Sanitary Engineer is the adviser to the Health Authority on all matters of mech- anies and his is the executive branch which deals with the mechanical side of water supplies, drainage and sewerage, conservancy and night-soil disposal, town cleansing, scavenging and the disposal of refuse The Medical Officer of Health reports on the health aspects of these matters and tests waters and sewage effluents-It is his duty to bring to the notice of the Council any matter which is likely to endanger the pub- lic health.
Hong Kong has never given to medicine the rank it has accorded to finance, chinese affairs, police or engineering and the reason is perhaps confusion as to what is covered by the term "medicine”
It is most important that the great difference between the "medicine" of the "eighties" and that of to-day should be realised in Hong Kong and a decision made as to whether the term "Sanitary" shall have its modern interpretation or that of the early Victorian era. Without this decision argument will be interminable and the chances of getting an up-to-date organisation in this Colony very remote,
Factors hearing on the Public Health.
In order to give a clear impression of the Public Health conditions obtaining in Hong Kong it is necessary first to describe the situation of the Colony, its geographi- cal features, its climate, the nature of the population. the housing conditions and the hearing old Chinese customs, traditions and beliefs have on the question of co-opera- tion with the authorities in the promotion and preservation of the Public Health.
The territory under British jurisdiction includes the Colony proper, namely the Island of Hong Kong with the Peninsula of Kowloon and the New Territories. The area of the Island is 32 square miles, that of Kowloon is 2 2/3rd square miles while the New Territories cover approximately 300 square miles.
Situated between 22°-9′ and 22°-37′ North Latitude the area under discussion
is just within the northern limits of the tropics. It is in fact practically on the same level as Calcutta. It may be said to form the lower extremity of the left bank of the estuary of the Canton River, at the head of which is the city of Canton and on an island in which stands the Portuguese city of Macao
Topographically the Tsland and the Peninsula may be described as a series of granite ridges separated by narrow valleys and having here and there flat areas fac- ing the sea. The New Territories are of similar formation with some fairly wide val- leys towards the north and west. The features are such that flats suitable for town sites are few in number and limited in extent. In the Island the only level of any
size is that on which the City of Victoria stands and this does not cover more than one square mile. With regard to Kowloon not more than one half is flat and con- venient for street formation.
The Climate-Situated just within the northern limits of the tropics and oc- cupying an insular position inimediately south of the great mass of China, Hong
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