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Section 84 of the Public Health and Buildings Ordinance gives to the reader the idea that Hong Kong is more concerned with guarding the liberty of action of the cow-keeper than with the health of the people he supplies with milk. The sen- tence which allows the Medical Officer of Health to examine an employee suspected to be suffering from infectious disease (unless such person should produce a certificate in writing from a private practitioner that he is not suffering from infectious disease) is simply astounding. And more astounding is the delay which the law allows when there is suspicion of milk being the medium for the spread of disease. A batch of Cholera infected milk could kill an enormous number of people yet the law actually allows the dairyman at least 24 hours in which to dispose of that batch and the mat- ter has to go before the Governor-in-Council before the supply can be stopped.
Eating Houses. As mentioned before many of those which supply the needs of the poorer classes are dirty and badly kept.
Veterinary Matters.
The measures for the prevention of the importation and spread of animal diseases and those for the prevention of the spread of disease from animals to man are controlled by the Colonial Veterinary Surgeon and his staff who are attached to the Sanitary Department.
These Officers perform their duties under the Public Health and Buildings Ordinance which does not yet extend to the New Territories.
Veterinary science is of value to this Colony almost entirely through its bear- ing on the Public Health. The Government Veterinary Officers' chief duties are (a) to prevent disease passing from animals to man, (b) to prevent disease passing from animal to animal
con-
The duties which come under category (u) are so closely connected with human preventive medicine that in most Municipalities the Officers performing them stitute one of the several divisions which together make up the Public Health Depart- ment under the Medical Officer of Health.
The duties which fall under category (b) might well be called those of public health economics for they are chiefly concerned with the cattle, swine, sheep and goats which form such an important source of the food supply of this Colony.
There are a number of diseases which are common to man and to animals and which can spread from one to the other. Animals. therefore, are factors in the spread of disease among humans.
The principal diseases which are inter-communicable are tuberculosis, actino- mycosis, anthrax, glanders, trichina tapeworms, hydatids. flukes, plague, psittacosis, rabies and brucella infections.
In all matters connected with the transferrences of disease from animals to humans the veterinary staff should work in close communication with the medical staff especially with the Laboratories where the bacteriological and chemical investi- gations are carried out.
Much of the anti-mortem and post-mortem work on this subject takes place at the abattoirs but up to date there has not been that close co-operation between the Veterinary Officers and the Laboratory workers which is a feature of the public health work in other cities.
In the matter of rabies prevention the Veterinary Surgeons work hand in hand with the Ciovernment Bacteriologist who is responsible for the diagnosis of the dis- ease through microscopical examination, who prepares the anti-rabies vaccine and who treats the human cases, The most important source of rabies lies in the New Territories and the Veterinary Surgeons have at present no standing there,
From the above it will be seen that the duties of the Government Veterinary Surgeons are closely connected with those of the Public Health Officers, both in- vestigative and preventive, and that the two should closely cooperate for the advance- ment of the Public Health.
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Measures for the Prevention or Mitigation of epidemic, endemic, contagious or in-
fectious disease including notification, removal, disinfection, and disposal of the dead.
Responsibility for reporting cases of notifiable disease lies with the legally qualified medical practitioner in attendance on the case, or in the absence of such on the occupier or keeper of the premises, or on the nearest male relative living on the premises, or in default of such relative on any person in charge of or in attendance on the sick person.
In actual fact practically the only reports received by the M.0.H.
are (4) those from qualified medical practitioners (b) those from Medical Officers in charge of Mortuaries where bodies dumped in the street by friends or relatives of the de- ceased have been taken by the authorities for inspection and disposal. Sometimes cases are notified before death but in the majority of cases the first news received by the M.O.H. is that from the Mortuary and this only gives the disease, the sex and the approximate age, the names and the addresses being unknown.
With regard to the removal of a patient suffering from infectious diseases neither the M.O.H. nor the Head of the Sanitary Department has any power to re- move him or her without his or her consent. The only thing the MO.H. can do is to get a magistrate's order for removal. The English law as far back as 1875 allowed the compulsory removal of a case. During the time occupied in obtaining a Magis- trate's order the case is often spirited away and when the M.O.H. arrives with the order it has disappeared .
This extraordinary regard for the personal liberty of an infectious case and the disregard of the interests of the populace is difficult to understand. In Malaya and Macao the law is different.
There is no quarantine station and no proper infectious disease hospital. The Government has converted an old Police Station at Kennedy Town into an infectious disease hospital for Europeans and better class Asiaties but has provided nothing for the indigent Chinese who are supposed to go to the so-called isolation hospital next door which Institution was erected and is maintained by the Tung Wah Authorities. This hospital is one in name only for it has no proper accommodation and no proper equipment. A case when admitted is not isolated and friends and relations visit at will becoming themselves foci for further spread of infection
There are only 26 beds in the Government Hospital and there is room for 60 patients at the outside, in the Tung Wah Hospital. În England the number of beds provided per population is one per thousand. On this basis Hong Kong should have 1.000 beds: she has less than 100 and the chances of epidemics are far greater than is the case in England.
The Government Hospital consists of one building only which means that when there are smallpox cases in residence, cases of other infectious disease cannot be ad- mitted.
It should be noted that the only legislation dealing with infectious disease is the Public Health and Buildings Ordinance and that the Infectious Diseases Hospitals are not under the authority of either the Sanitary Board or the Sanitary Department.
Prevention of Disease by Mosquitoes.
Practically no work is being done by the Sanitary Department in the matter of prevention of disease by mosquitoes. A small gang under one overseer is employed but he knows little about mosquitoes and less about disease. With regard to malaria there is no one in the Sanitary Department who has the knowledge necessary for dealing with the problem on a scientific basis. There are 52 European Inspectors and not one of them can distinguish one anopheline from another either in the adult stage or in the larval stage. In the Federated Malay States there are at least 100 Asiatic Inspectors who can do a complete anopheline survey and take the measures necessary to destroy the breeding places of the dangerous carriers.
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