An interesting case of infection by the bite of a sick rat occurred during the year. A man em- ployed as a turn-cock and living in No. 2 Health District, was bitten on the left thumb and some two or three days later the arm became swollen and painful; the case was not reported and the man died in his home some nine or ten days after he had been bitten. On post-mortem examination two small wounds were found on the ball of the left thumb, the left hand and forearm were much swollen, and in the left axilla there was a brawny, oedematous swelling, in the midst of which was an enlarged, hæmorrhagic gland; a smear preparation from this gland showed numerous typical plague bacilli."
Another clear case of infection by inoculation was an Indian lad 3 years of age whom I was asked to see by an Army Medical Officer.. I found an abrasion of the left knee which had been caused by a fall in the street while at play some two days previously; the abrasion was covered by a dry scab and surrounded by an inflammatory areola; the femoral glands in the left groin were enlarged and painful, and there were the other characteristic symptoms of the disease.
Several instances have occurred of coolies actually engaged in loading junks, etc., and falling into the water and being drowned, who on post-mortem and bacteriological examination showed marked evidences of Bubonic Fever, and in one case a man working in a sugar refinery was struck by a beam upon the chest and fell down dead, and on post-mortem examination was found to present all the evidences of advanced plague infection. I may add, however, that no subsequent case occurred in the house in which this man slept, or among the fokis with whom he worked. These are no doubt instances of the ambulatory type of the disease, and death probably resulted from Syncope, the effect of the shock upon a heart already weakened by the Fever. It is such cases that render it so difficult to stay the progress of an epidemic, as they must be, more or less, a source of infection to the people with whom they are brought in contact.
The chart of "Bubonic Fever and mean atmospheric temperature" shows that, as in former years, the epidemic abates in this Colony as soon as the mean atmospheric temperature rises above 80°F. During this year the temperature after rising to 82.6°, fell for four weeks to below 80°, and in consequence there was a slight recrudescence of the epidemic, the number of cases rising from 63 in the twenty-fifth week to 99 in the twenty-sixth week, but the number fell again to 65 in the following week, and from that time, with a mean temperature varying from 80° to 84°, the epidemic rapidly declined.
It is difficult, however, to explain why the disease does not recrudesce when the temperature again falls below 80° in the early autumin, but there are no doubt many other factors at work in the causa- tion of an epidemic, than mere atmospheric temperature.
The chart "Bubonic Fever and Rainfall" shows that the rainfall has some influence upon the pro- gress of the disease-thus in the twentieth week a heavy fall of rain is followed by a slight reduction in the number of cases, in the twenty-fourth week a very heavy rainfall is followed by another slight reduction, and in the twenty-sixth week a further big rainfall is followed by the final decline of the epidemic.
Early in the year the Government procured a considerable quantity of Haffkine's prophylactic serum,
but unfortunately it has not been found possible to persuade many of the Chinese to accept protection in this form.
In the Appendix will be found a detailed account of 493 cases occurring in the City of Victoria, with known addresses, and it will be seen that, as in former years, Health Districts 2 and 9 have suffered the most severely.
HEALTH DISTRICT.
1
N
No. of Cases
44
131
3
4
5
6
7
9
10
67
63
30
24
19
98
17
During the progress of the epidemic a memorandum was issued by the Sanitary Board, for general information, detailing the method adopted for dealing with the outbreak; the following is a copy of this memorandum
METHOD OF DEALING WITH OUTBREAKS OF BUBONIC FEVER (PLAGUE).
1. Notification.-All cases of infectious disease should be reported at once to the nearest Police Station or to the Sanitary Board (Telephone No. 257), or to the Medical Officer of Health (Telephone No. 120). This is compulsory on "all persons knowing or having reason to believe that any person has been attacked by or is suffering from" Bubonic Plague, Cholera or Small-pox (Bye-law 17, Ordinance 15 of 1894); but it is universally evaded by the Chinese and even by the Chinese "Doctors." The penalty for its evasion is $25.
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