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THE HONG KONG DAILY PRESS, WEDNESDAY, MAY 16th, 1928.

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DR. KOCH ON PREVALENT INFECTIOUS DISEASES.

PREVENTIVE MEASURES WOEFULLY NEGLECTED?

MORE ACTIVE METHODS NEEDED?

At the fortnightly meeting of the Sanitary Board held yester- day, Dr. W. V. M. Koch went into details of the various infectious diseases prevalent in the Colony, and criticised the measures adopted by the Authorities for preventing the spread of such diseases. He described the sanitary measures now in força að inadequate and suggested that the Government should do much more than it does, especially by research, to safeguard the health of the public.

Summing up, Dr. Koch said: "The application of methods of preventing the diffusion of diseases have been woolully neglected in this Colany. The Authorities hava adopted an attitude of apathetic acquiescence when it was their bounden duty to direct caquiry and research into the local conditiors of infectious diseases. Dr. Koch's motion that the Government thould investigate and devise means for the prevention of prevalent infectious diseases was carried by three votes.

Those present at the meeting Justerday Mr. W. J. Carrie (President), Mr. J. Watson (Seare tary), Dr. W. V. M. Koch, Dr. G. W. Pope (M.O.H.), Dr. S. W. Tsa, S. C. Ho, Dr. Fawcett, Mr. Wong Kwong Tin, the Hon. Mr. H. T. Creasy, C.B.E., Mr. R.A O. North

DR. KOCH. Addressing the meeting Dr. Koch said:

|

Many years ago, that brilliant worker, Dr. Hunter, the Bacterio logist, was working on the subject of Infantile Typhoid, and the pre- valence of Typboid generally, but he unfortunately died and the work. was lost. Prior to that I was with him in an investigation into the causation of Bei-Beri by feeding experiments I mention these facts to show that investigations can be made even when men are doing their routine work. "In bringing this Resolution for

Another point I wish to bring ward for the consideration of the forward is, what do the Authorities Board, I would like to emphasize do when they have the results of that it does not mean to dictate in investigation placed before methods of enquiry but merely to them! Lieutenant Olitzky made a suggest theat, and the reason that detailed report on the epidemic of such a anggestion is required in cerebro-spinal meningitis which he that there is a number of problems investigated and also made certain in connection with the prevalence suggestions. Has anything been of what I may call everyday dis done? If not, why not? It is true cases of an infectious nature which

we have not had another epidearic need serious enquiry and that en- we have been lucky-when it comes quiry can only be directed and co-is will find us unprepared and will ordinated by the authorities. We take a heavy tell. know when no epidemic occurs of some of the rarer infectious diseases

died like ice. They could not dig graves quickly enough for the dead. That was in Da Lesseps time. Tho Americano came in, they employed most stringent measures, sanitary measures, to which even the most refractory had to submit. The re- sult was a Zone of health.

When some years ago I suggested measures for extensive dealing with the suppression of Malaria the then D.P.W., Mr. Pekius, acidly remarked that our work would have to be carried into China. And why not if necessary! Our relations

em cordink enough.

Intestinal Complaints.

And now I would like jo touch on another set of diseases of the intestinal tract, akin, I think, to the typhoid group. Quoting from the annual report for 1926 "I End the following causes of death: Diarrhoea (undefined), Enteritis 673, Gastro-enteritis 140, and Dys- pepsia in children under two years including Threpšia and Food Atrophy 366-4 total of 1,477. am convinced this heavy mortality is due to soms infection, at any rate the matter is well worth the investigation. We ebould take a note, in this connection, of what goes on around us daily. The an sanitary and unaesthetic manner in which fresh food is exposed for sale in the markets, the offending man ner in which the carcasses of pigs are pied in open carts or strung

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Tetanus Of The Newly Born, Mr. Tso was of opinion that ex- The oficial report recorda ésperts from England could not deaths of children under one month achieve more

than local Chinese in 1990. This is an eminently pro doctors, because one had to so ventible disease, and I note that quite convereant with the Chiness Professor Wang of the University condition of ving before one could undertook an investigation into do anything to educate them. He this subject and attributes its in- therefore hoped that the Govern shoulder of perspiring cidence to the application of some

ment would take the initiative and coolics wearing unclean vests. The Chinese powder to the navels of way broad is exposed for sale with newly born children. This in ducks and cuttlefish are placed on credit on cut any wrapping, and fish and teresting piece of work reflects the matter. the streets to dry, exposed to the should save many infants liver in MR. W. J. CARRIE'S REPLY.

the investigator and dust and flies and getting an added future. flavour impacted by passing animals

surely all these are potential application of methods of

Summing up I may say that the agencies of the spread of diecace, tion in the diffusion of diseases and are within the province of the have been troefully neglected in Sanitary Department to deal with this Colony The authorities have We may be told we should not adopted ah attitude of apathetic interfero with established customs acquiescence when it was their but customs that may tend to bounded duty to direct enquiry spread diseases could surely be ex- and research into the local condi- plained to the people and their tions of these infectious diseases, co-operation en.isted. Many of There are well equipped laborn- Malaria,

these diseases must be spread by tories, there are able and well Now the subject of Malaria. We dies-yet in reply to my questions trained men on the spot. It is no such as cerebrospinal meningitis, have had some illuminating figures the Head of the Sanitary Board excuse that men are too much en pacumonic plague or typhus fever, how the population becomes alarm regarding the prevalence of the dis states-re matsheds that the re-gaged in their routine work, for ed, the Authorities hastily devissee. The numbers giren do not ceptacles should be typroof to niemorable and far reaching dis

obviously comprise all the cases of

the satisfaction of the Board" (Icoveries have been made by general steps to deal with it, and an expert malama which occurs. We might may state that such has never to practitioners. Koch, a general is summoned or may be summoned generally in the decline of such without exaggeration add one third my knowledge been releared to the practitioner, in the country, dis epidemic, to investigate and advise. one half more. Many cases do Board), and that no bye-laws or covered the tubercle bacillus in the A real case of shutting the stable not come under treatment, specially regulations exist for covering over interval of his daily work. Man- door after the horse has been in the further parts of the Colmy refuse with earth or mould.

in the outer parts of the city and hidden manure heaps and garden son, a general practitioner in discovered the Filaria stolen.,

ary treatment and even lie up for s who are content to apply the ordin

It seems time that alteration was Laveran, an Army surgeon dis inade in the bye-awe of the Board covered the malarial parasite and day or two. One might say that the to affect these improvements. It is Ross, another Army surgeon work epidemic, of contagious or infec investigations into the subject of to me astounding that there mated out its conveyance by the mos

Amoy

In his reply, Mr. W. J. Carrie, Head of the Sanitary Board, said that the Sanitary Department had no power to carry out the sugges tions with regard to market condi- tions and sale of fruits, etc., 5 referred to by Dr. Koch.

The Sanitary Board, he said, was hot an executive body, and it had struck him all through that Dr. Koch's suggestions were not mat- tere which the Board could deal with. He at Arst thought that the motion was a general one and he did not expect such detail as was given by Dr. Koch.

Mr. Carrie added that the Board had the power to make byc-laws in connection with such matters as prevention or mitigation of any

It is fortunate that there is this natural decline in all epidomice for this Colony benefits by it but it forgets that a returrence may take place later and so ia lulled into & \ and that enough is known to guide / tera: primary matters of hygiene, quito and so on. I only want to been given the Board 35 years ago.

izi

malaria are thoroughly worked out

false sense of security. And when

us to initiate and carry out com- the recurrence occurs, the Cology pletely means of prevention. The will be unprepared. When the newly appointed medical officers in epidemic of cerebrospinal man the Government service are men who ingitis a few years ago VAA its decline, an expert was lent by ave passed through the School of the Rockefeller Institute, Lieuten-perience of Tropical work-I would Tropical medicine and have had ex- ant Oliteky. He made certain aug suggest that their services he gestions. His report was duly reutilized in work on this subject ceived and duly pigeonholed!-the In my opinion there seems no need epidemic pursued its usual course for a malaria expert to point out and declined as such epidemics de

to us what should be done. The decline and as far as I know noth ing has been done and Honour is to deal with the situation, provided. nan on the spot are quite competent satished.

"they get the backing of the Authori- ties and are told off for the work. But the question is, will the Authe rities take action if they get "the opinion of a malaria expert, or will the report be pigeonholed and forgotten. Years ago Dr. J. C. Thomson in the course of his daily labours undertook a research into the types of mosquitos in the Colony Later Dr. Macfarlane made more extensive researches when he was Assistant Medical Officer of Health in Kowloon and afterwards Government Bacteriolo-

"When The Mosquito Is Exterminated."

-

have

been omitted. Proper Refuse Destructors Nesdad.

tious diseases, and that power had emphasize the fact that costly The Board, after all, was a body laboratories, well equipped with of workets The Head of the Sani- modern apparatus and instruments tary Department had no of precision are not all that is except a member of the Board. Then there in a further poten required. The Research worker is He worked for the Board and car tial danger in the dissemination of like the poet, born not made, and tied out the instructions, of that diseases in the present manner of we have bere in this Colony ample body. refuse disposal. in my opinion the material for research, by which Mr. Carrie pointed out that the refuse should be burnt in properly men will gain undying fame, even Board had defate powers and one constructed destructors and notif na money

of these was to devise means of accumulated for carriage in oarges Let us hope now that the Govern combating diseases. He also said "" to be later dumped in the seament have got a Director of Medi- that the Medical Officer of Health Here again when I ventured to cal and Sanitary services that they was under-staffed at the moment tion of destructors the suggestion subjects and means of investiga by the arrival of another two fully ruggest the advisability of the erec-will be guided by him as to the and when the staff was augmented was stated not only to be costly tion that it will not be as the qualified doctors, they would then. but impracticable. The Authorities French saying is the more you be able to go into the matter thor- said that our refuse contained too change, the more it remains the oughly.

Alas, poor P.CM.O.T large a percentage of moisture and same.

In reply to Dr. Koch's remarka so could not be burnt. But I have As it is the fashion in these parts regarding to maláris and mosqui- seen the latest type of destructor to quote from Chinese classics may tocs, Mr. Carria maid that accord in the Borough of Marylebourne I also quote from Confucius: Toing to the laws laid down he could and was told they could deal with see the right thing and not to do act do more than to serve a notice

on any person found encouraging. refuse containing 95 per cent. of it, is want of courage."

"With these words I wish to put the breeding of mosquitoes. If the moisture, and 1 was struck with the thorough manner in which its before the board for its approval person rectified his fault within incineration gas effected. But we are told that in seaside places, the ethcient method of refuse deposal probably effective in England when is to dump it into the sea. This

Tuberculosis

the motion:

OTHER MEMBERS'

OPINIONS.

EDUCATION NEEDED,

As to hawking of food, Mr. Car- rie said that he had certain pro- posals in hand, and he nexured Dr. Koch that he would do his best to.. improve the present methods. In any case, these evils were at pre- sent all covered by 'bye-laws, and if werb hot zkkinfactory, the only thing to do was to introduce y amendment to the

he existing bye- laws.

Typhoid In The Colony. Now there are many diseases in the Colony the prevalence of which might be diminished, if not sup: pressed Take typhoid fever, for instance. According to the report of the Sanitary Department for 1926, there were 204 cases including 7 cases of Paratyphoid I quote the annual prevalence-In 1917, 185

Three days of the notice, the mat cases; in 1918, 249 cases; in 1919,

That this Board respectfully ter ended there. Even if a per- 130 cases; in 1990, 132 cases; in 1921, 104 cases; in 1929, 183 enses; in 1923

ggests to the Authorities, the pro- son continued to encourage breed.. priety of setting in action in- ing of mosquitoes after the receipt 302 cases; in 1924, 883 cases; in 1923, gist. I emphasise that all this

devising means for the preventiois do was to take out a summone and.. vestigations into the possibility of of the notice, all the Board could 163 cases; in 1996, 204 cases.

Thus we see this disease occurs work was done in the midst of

a strong tide disposes everything of the prevalent infectious diseases, the offender would probably pay & regularly throughout every year the Authorities to make use of it. their daily routine. It remains for

cast into the sea, but in this such as Typhoid, Malaria, Tuber small fine. There was no prov and in every year cases ocour every "No mosquito, no Malaria” should

Colony. I think everything cast meath. In the absence of the dir be our slogan

It further suggests vision, he said, to prevent a per- culosis, etc. into the

returns to rest

that such investigations might be son from repeating his ottence. case in epidemic form we must

on our shores, and our bathing undertaken by local medical men The speaker added that that by acknowledge that this steady occur-

beaches are rendered offensivo and rence is disconcerting, and as we

unhealthy. The experiments with under the direction of the Govern- law needed amendment and if the know the cause of the disease why When the mosquito is exterminat floats carried out two years ago in ment, and that their reports, be members of the Board desired it. cannot some effort be made to ined, malaria will disappear. We the month of November are not published for the guidance of the they could bring the matter up. At

community,"

a meeting. vestigate its mode of sprend. When know how the mesquito can be got convincing. If the Roats do not there is a threatening of its assum- rid of-part of the campaign island in our shores the refuse does ing an epidemic form, or when some being carried out. We are inform- Now this matter of dealing with prominent permage has been ated that so many thousand feet of refuse should be taken up. tacked, the languishing interest is nullahs have been trained in three stirred, and wild guesses are made years, that swamps have been re as to how the illness was contracted, claimed in Hong Kong and in Kow- The water is blamed, the milk is con, but that paddy fields must re- blamed, oysters are blated, salads main potential breeding places for and fruits are blamed, but no in- mosquitos, and that building sites vestigation is made.

are inspected and that an perienced foreman and two coolies More Thorough Methods Hooded.

are constantly employed on anti- The Sanitary Department steps malarial work on this side of the in, makes a few inquiries through harbour, and another foreman and its Inspectors, and on termination four coolies are similarly employed of the case, disinfecte the premises. in Kowloon newer of the Head Now this does not seem enough "tó This is the answer. me. The Colmy, supports a Banj- of the Sanitary Department to my tary Department and a well equip questions. What a naive way of ped Bacteriological Department, dealing with so eminently preven- Why should not them, in collabora tible a disease as malaria. I ven. tion, undertake an investigation ture to say that the few dollars into the method of spread which expended or this work, carried out can be checked so easily if only it in this manner; might be saved to

la conclusion, Mr. can be found how it spread! Why ward the gigantic expenditure of

that he agreed with Us, Ho that should the Medical Officer of the projected Government Civil

more lectures, should be given, and Health be diverted from what I call Hospital, for all the good it does

ad for the matter of tuberculosis, his legitimate duties, such as ine The work should be undertaken they sliguld adopt towards the pre- Dr. B. W. Tso said that investi H.E. The Governor bad practically vestigation into the mode of spread with greater zeal with more per of infectious disease and be com- tinacity and not in this dilly dolly-vention and amelioration of this gation into the prevalence of in covered the ground in his speech at disease. Pouring gallons of Cod. fectious diseases would be of con- the Chinese Medical Association pelled to undertako the beartbreaking slipsbod way, wit Ing daties of a sanitary inspector, a It conta monsy, it is true, but Liver oil and cough mixture down siderable help in preventing theat dinner

With regard to other medical clerk and a legal adviser! His money is frittered away every day, their throats is not all that is re- He was glad that Dr. Koch had time and and energy should be use and if a determined effort werequired. A campaign of instruc suggested that local medical practiquestions raised by Dr. Koch, Mr. tioners should be called in to help. Carrie said that he was, Dot in "a fully applied to research and the minds to deal with the aubject there tian should be instituted well-equipped Bacteriological In is no reason why we should not have Diphtheria, Infueurs, and Puer and in this, he felt sure that there position to anewer them off hand, stituts might also be assigned some the same success as in Australia and peral Fever are other diseases which could not be anyone more can. Dr. Koch's motion was then pat of this work of investigation in- in Malaya. Look how Yellow lever might be investigated with a view tersant with the conditions of to the meeting There were three stead of rambling contentedly along was stamped us in the Panama to their prevention and kuppres living among the Chinese than local in favour and none against, and it

Chinese medical, practitioner., was declared to be carried.⠀ the rut of routine work,

Zone. I was acquainted with the slon

The methods for the prevention of tuberculosis are well-known, and can easily be combined with the treatment. The causes flourish in In seconding the motion Ur. S. darkness in the absence of sun- C. Ho said that it appeared to him light and in darkness. The pro- that the last speaker had struck

With regard to intestinal diseases, visions of the Building Ordinance the keynote in his speech when he

regards fresh air and sunlight advocated public education in mai Mr. Carrie agreed that they coud should be strictly enforced and in ters of health and hygiene, have done more than what had been

In England a child was well look so far attempteda o special attention should be paid to ed after from the day of its birth new buildings and tenement hauser

Refuso dumped into the ses, Mr. this. If fresh air and sunshine until it went to school, when the Carrie said, did not return to cannot be brought into the house, teachers would take up the mat pollute the harbour, a suggested the patient should be taken out ter of health education where the by Dr. Koch That might be the into the fresh air and sunshine parents had left off. He was of case as regards refusé dumped over- This could be done with some gentle the opinion that public lectures and board by steamels leaving the port, compulsion. In my opinion are demonstration would be most bene and nothing could be done to stop gufar plan of campaign should be ficial, and although this was done them once they were outside the undertaken by this unfortunately to some extent in the Colony, it harbour inita, Carlo and named Sanitary Board" which should be further encouraged. should be renamed the General Help Of Chinese Doctors people and sufferers as to the manne Board of Health," to instruct the

Desirable

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