Sessional_Paper_1896 — Page 352

DEATHS.

349

With such a population as we have in this Colony, one would reasonably expect to find an abnormally low death-rate, but unhappily such is the condition of filth, of overcrowding and of squalor generally in which these people have been allowed to live, that instead of this low death-rate, our rate has, during the past year, amounted to 21.65 per 1,000. The average death-rate during the past five years (excluding, for obvious reasons, 1894) has been 22-9 per 1,000, so that this past year shows a slight diminution upon the previous average.

The total number of deaths recorded was 5,400; of these only 191 were non-Chinese, representing a death-rate of 17.6 per 1,000.

One of the most deplorable features of this high death-rate among the Chinese is its partial dependence upon the crass ignorance of the Chinese in regard to the remedial treatment of disease, for not only are they unaware of the use of such a drug say, as Quinine in Malarial Fever, or of the simplest surgical operation for the relief of disease and pain, but such remedies as they do adopt are often, as I will show elsewhere, in reference to the alarining prevalence of tetanus neonatorum among Chinese infants, of a most prejudicial and even dangerous character. So strongly has this aspect of our death-rate impressed me, that I would urge the Board to represent to His Excellency the Governor the desirability of taking, at an early date, some active steps in the matter of the education of the Chinese in Western medicine, such as the endowment of a College of Medicine for the education of the Chinese inhabitants of this Colony. At the present moment no restrictions whatever are placed upon the sale and administration of poisons by native quacks, and it is a notorious fact that many an ignorant coolie practises the divine art of healing, in this Colony, to the great benefit of his own purse, but to the serious danger to the health and even the lives of his credulous victims.

I am aware that it is no easy matter to induce the Chinaman to accept the teachings and practices of Western medicine, but there can be no question that something must be done, and that promptly, to check the waste of human life which unquestionably results from the ignorant practices of these so-called "doctors." The prohibition of the sale or administration of poisons by other than registered persons, the registration of Chinese midwives, and the absolute prohibition of such Chinese methods. of treatment as are admittedly dangerous to the lives of the patients (such, for instance, as the cauterization of the bodies of newly-born infants) are matters which demand the urgent attention of the Government.

Another of the consequences of this ignorance of the Chinese respecting medical matters is that although the statistics of the Registrar General respecting the total deaths may be accurate, yet any analysis of the causes of these deaths teems with inaccuracies, because causes of death are registered merely upon the statements made by the person registering the death, and these statements are, as I have already good reasons to know, often deliberate fabrications containing not an element of truth. Apart altogether from the question of the accuracy of our vital statistics, such a system as this must of necessity tend to encourage crime, by facilitating the disposal of the dead body of any victim to foul play, and I would therefore suggest to the Government the advisability of associating a medical man with the department of the Registrar General preferably the officer appointed to act as Govern- ment pathologist, or failing him, the Medical Officer of Health, so that all uncertified deaths may be properly enquired into and a more accurate diagnosis arrived at than is at present possible. be observed that in no less than 10 per cent. of the deaths no attempt whatever is made to arrive at even a proximate diagnosis, the deaths being merely recorded as "Ill-defined and undiagnosed." Surely, there is a vast opening here for the utilization of well-trained students of the College of Medicine if only the Government can see its way to endow that most deserving but struggling institution, and offer employment to its alumni.

AGE DISTRIBUTION OF DEATHS.

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The most important feature in regard to the age distribution of the registered deaths is the enormous mortality among Chinese infants under one year of age, for in spite of the fact that the total birth- rate is only 9.3 per 1,000, yet no less than 28 per cent. of the total deaths occurred in infants, and nearly two-thirds of these were at ages under one month. The number of infant deaths registered during the year was 1,519 representing a total infant death-rate* of 680 per 1,000, while the infant death-rate among the European civil community was only 116 per 1,000, and among the Portuguese community it was 197 per 1,000. I have made soine enquiries into the causes of this high infant death-rate among the Chinese, and find that it is largely due to diseases of a convulsive type, many of which are doubtless produced by the foul atinosphere which these infants breathe in the ill-ventilated dwellings of the poor, but I am of opinion that not a few are the direct result of the forms of treatment to which these infants are subjected by the native midwives and quack doctors. It appears to be a Chinese medical custom to cauterize the face or body of an infant, as a remedial measure in the treatment of flatulence or other trivial ailment, and I am sure that the sores and scars thus produced are one of the most fruitful causes of these convulsive deaths. The disregard of the value of female. lives by the Chinese has also to be reckoned with, for it is a significant fact that the death-rate among infant girls is double that among infant boys, and under these circumstances I consider that the

* By "infant death-ratc" is meant the number of infant deaths per 1,000 births, registered during the year.