Sessional_Paper_1937 — Page 7

14. On the 13th the Director of Medical Services, the Deputy Director and the Health Officers met in conference to discuss matters and elaborate a scheme of enquiry. Thereafter there were daily conferences where the information gathered by different investigators was compared and discussed. These conferences were frequently attended by the Chairman of the Urban Council who throughout the epidemic was kept informed of the position.

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15. The question of notification was discussed. Owing to the number of diseases covered by the term "dysentery and the necessity for confining attention to the one type causing the outbreak it was decided that no useful purpose would be served by making dysentery" notifiable, a process requiring an amendment to the Quarantine and Prevention of Disease Ordinance which would take time to accomplish. It was resolved that the best procedure under the circumstances would be for the Health Officers to approach the private practitioners in an endeavour to ascertain where cases were occurring and obtain from them such data as was neces- sary to trace the source of infection. The medical officers in charge of Government hospitals and Chinese hospitals were instructed to pay particular attention to the subject and to report early any information of epidemiological importance coming to their notice.

16. The Government Bacteriologist reported that on the evidence before him the outbreak was due to the Bacterium dysenteria of Shiga a much more virulent type of organism than the Bacteria dysenteria of Flexner the common cause of dysentery in Hong Kong.

17. On the 14th the various private hospitals were visited in search of infor- mation and conferences took place between the Health Officers and the private practitioners under whose care dysentery cases were being treated.

18. There being some indication that the infection was milk borne the public were advised to boil all milk. The various dairies were visited by the Health Officers and instructed to take special precautions. One of them the Dairy Farm decided to institute pasteurisation of all milk and cream before issuing thus obviating any risk there might be of infection spreading from this source. The other dairies not having pasteurising plants were unable to adopt this measure of safety.

19. It having been ascertained that all cases so far reported had partaken of milk issued by the Dairy Farm Company attention was directed to this organisation as a possible source of infection. The fact that thousands of individuals had daily consumed milk from this dairy showed that the milk as a whole had not been at fault. It was inferred that one particular batch had in some accidental way become infected.

20. All twenty-four cases taken ill on the 8th and 9th drew their milk from the dairy farm and almost all had consumed a special kind designated "nursery milk" which differed from the ordinary in that cream had been added sufficient to raise the butter fat content from 3.5% to 4%. This brand was much used among Europeans as a food for infants and children. It was prepared and bottled at the Pokfulam depot.

21. The majority of the total cases came from Kowloon the remainder with two exceptions from the Peak. There were almost no cases among the considerable population living at the eastern end of Victoria The milk supplied to the Peak and Kowloon is bottled at the Pokfulam depot, that supplied to the City of Victoria is transported from the Pokfulam depot to the depot in the City where it is bottled.

22. Instructions were issued for a thorough investigation to be made into the conditions prevailing at the Dairy Farm with special reference to circumstances connected with the production, the preparation and the distribution of milk. The investigations were to commence at the cow and end at delivery to the consumer. Reports were called for regarding water supply, flies, and carriers.

23. The Manager of the Dairy Farm on being informed of the situation offered to assist and cooperate in every way in the furtherance of investigations.