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In 1883 the Order and Cleanliness Ordinance was passed which provided for a permanent "Sanitary Board to have supervision over all sanitary matters in the Colony". The Surveyor General was appointed Chairman of the Board. A Sanitary Inspector was appointed by the Secretary of State and three Inspectors of nuisances were appointed locally. Chadwick's advice to have a full-time officer in charge of the Sanitary Department who would receive instructions from the Colonial Surgeon and Surveyor General was not followed for all four Inspectors were attached to the Sur- vey Department or Department of Public Works.
In 1887 was passed the Public Health Ordinance which gave the Governor power to appoint to the Sanitary Board a Chairman, a Vice-Chairman, a Secretary and four members leaving two members to be elected by rate payers on the Jury list. The Colonial Surgeon who was a clinician and actively engaged in the practice of medicine, surgery, and midwifery, was appointed President of the Sanitary Board and Head of the Sanitary Department. At that time sanitary science was in its infancy and had not yet won for itself the status of a special branch of medicine. From this period up to 1894 when Plague made its appearance public opinion was content to have a clinician as a chief sanitary officer. In this year the Plague which killed 2,485 per- sons thoroughly frightened the populace and caused an exodus of 100,000 souls. Enquiries made showed that the sanitary conditions were far from satisfactory and a request was made for the services of a health expert.
In 1895-the first Medical Officer of Health was appointed. A Committee formed for the purpose of enquiring into the working of the Medical Department re- commended that the M.O.H. should be adviser to the Governor on all sanitary mat- ters through the Sanitary Board to which he would be attached but on which he would have no seat and no vote. The Government decided to place the M.O.H. on the Board as a full member. In this year the sanitary system of the Colony was seve- rely criticised and an effort was made to persuade Government to create * Munici- pality similar to that of Shanghai or Singapore.
In 1901, there being no abatement in the yearly Plague epidemics, public opinion was strong for improvement of the sanitary conditions of the Colony. Arti- cles appeared in the Press severely criticising the standard of sanitation maintained and the general system of sanitary control. The movement for improvement cul- minated in a petition signed by many prominent citizens being sent to the Secretary of State asking for a Commission of enquiry by experts wholly unconnected with the Colony. The petitioners stated there had been no improvement in the sanitation for over 19 years and that the conditions were as bad as Chadwick reported on them in 1883.
In August 1901 the Secretary of State for the Colonies. Mr. Joseph Chamber- lain, expressed the opinion that a necessity existed for a plan of re-organisation of the Medical and Sanitary Departments. In September the Governor was of opinion that the P.C.M O. should be in administrative control of the entire Medical Depart- ment including Health Officers and Port Health Officers and be relieved of duty at the Government Civil Hospital. A local Committee appointed to enquire into the nume- rical strength of the Medical Department and also the duties of the P.C.M.O. advised against this step and recommended that the Medical and Sanitary Departments be wholly separated, that the M.O.H. should be independent of the P.C.M.O. and that the Sanitary Department be under the administration of the Medical Officer of Health subject to the control of the Sanitary Board.
In January 1902 arrived a Sanitary Commission appointed by the Secretary of State. This Commission consisted of two members viz. Mr. Chadwick, who had acted in a similar position in 1882, and Professor Simpson, Professor of Public Health at King's College, London, Lecturer on Tropical Sanitation at the London School of Tropical Medicine and an expert on Plague and Plague prevention.
Mr. Chadwick's preliminary report was as follows:-
1. He had no hesitation in saying that "the housing is rather worse than better than it was in 1882. As regards area per person they are the same but as regards ground area they are worse owing to the large number of lofty houses which have been built in the last twenty years.
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In this matter the advice and recommendations made from time to time dur- ing the last twenty years have been practically set aside. The reason is the interests of the landed proprietors and the influence they have been able to bring before the Legislative Council. The Government has been loath to use its official majority.
Since the advent of Plague the mercantile section of the Community has come to realise that their interests are not quite independent of the health of the Chinese population. Commerce is disturbed by the quarantine in other ports and otherwise and hence the petition which was sent to the Secretary of State for the Colonies.
The Commercial and land owning interests are opposed, the former desire free- dom from epidemic disease, the latter, the majority of which are Chinese, and not British subjects, desire to get the greatest possible rents which connotes overcrowd- ed and insanitary buildings.
One thing is certain so long as buildings are overcrowded and insanitary, no amount-of external sanitation will give immunity from disease. The Government should face the problem which is still awaiting solution elsewhere, viz: the housing of the working classes".
Mr. Chadwick recommended among other things : —
(1) That the scavenging and removal of excreta be under the M.O H (2) That the maintenance of all sewers, drains, storm water channels, and nullahs covered and open, be handed over to the Department of the Sanitary Board which is charged with the scavenging and street cleansing and that this department be under the Medical Officer of Health.
Professor Simpson in his preliminary report made the following observations—
"The houses in Hong Kong are too close together and too over-crowded and they are defective both in design and construction". Mr. Chadwick referred to this in 1882. His report led to the passing of the Public Health Ordinance of 1887 which originally contained clauses providing for improvement in buildings by insist- ing on adequate open space in the rear of each. Owing to the strong opposition raised by the Chinese members of the Sanitary Board and others these clauses were deleted. It was represented that landed property to the extent of millions of dollars would be sacrificed, vested interests greatly interfered with and public confidence shaken to the ground.
The proximity of Hong Kong to the China Coast and the very intimate inter- course between the districts of Canton. the West River and Hong Kong together with the fact that in the towns and villages of South China infections disease is not noti- fied, renders the problems of the prevention of disease very difficult. Medical in- spection of the steamers is of little use as the journey is too short. Quarantine ang surveillance is impracticable because of the numbers passing in and out daily. Medi- cal men might be carried on the steamers to detect actual cases of infectious disease.
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In June 1920 Chadwick and Simpson put up a draft Public Health and Build- ings Ordinance containing the following clause :--
"The Sanitary Board shall consist of the Sanitary Commissioner who shall be ex-officio Chairman of the Board, the Director of Public Works, the Registrar General, the Captain Supt. of Police, the Principal Civil Medical Officer and six additional members four of whom shall be appointed by the Governor and two elected by the rate payers who are on the Jury list or who have been exempted. The Sanitary Commissioner shall be Head of the Sanitary Department. He shall give such orders as may be necessary to carry out the decisions of the Sanitary Board".
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