1903-05-21 — Page 5

THE

HONGKONG TELEGRAPH, THURSDAY, MAY 21, 1903.

·REPORT ON THE causes anD | emments interested in the Venice Convention,

CONTINUANCE OF PLAGUE

IN HONGKONG.

(Concluded.)

PART 11. PLAGUE AT HONGKONG, AND THE CONDI- TIONS THAT FAVOUR ITS CONTINUANCE,

1. The Colony of Hongkong consists of the island of Hongkong, that part of the mainland of China extending some 20 miles north of the island and separated from it by a strait which at the eastern end or Lyc-mun pass is only about a quarter of a mile wide, together with the adjacent islands, the largest of which is Lan-tao.

On the north side of the island of Hongkong, and situated betwee, it and the mainland, is a magnificent bay forming a fine harbour, which can be entered from the east or the west, and is projected from rough weather by the arrow- ness of the channel on the one side and by the several small islands on the other.

The harbour is capable of accommodating an immense number of ships of every variety, It is a free port, with no customs dues, and there are usually to be seen in it British and foreign warships, large merchant vessels from every quarter of the globe, emigrant ships, large and small crasting steamers, West and Canton river steamers, launches, Chinese junks, and lastly the sampans and boats on which a Chi- nese population of sume 40,000 spend their lives, me", women, and children living-m the boats. On the island of Hongkong there is the City of Victoria, with a population of 200,000 inhabi tants, the small town of Aberdeen, and a num- "ber of villages; while directly opposite, on the mainland, on a portion of the narrow peninsula juning southwird which is some 5 miles in extent, 1situated the town of Kowloon, with a population of nearly 30,0,0,

Until 1899 to Colony of Hongkong was limited to the island, the harbour, and the Kowloon portion of land,. The centre of life and of business is still confined to the City of Victoria and the lown of Kowloon, and does not extend to the new territory, which is but sparsely inha' ited.

The City of Victoria faces the harbour, and is situated on the northern side of the island of Hongkong, which rises almost immediately from the sea, first in a gentle slope, then in steep ascents, to a height of 1,800 feet. It is on the lower slopes that the city is built. Above the city are several very fine roads on the hill- side leading to houses, the foundations of which have with great labour and ingenuity been cut out of the hill-side. They are occupied by Europeans. Still higher above these, on the summit of the Peak, are other European houses. The approach the houses on the hill-side and the Peak is made easy by a funicular tram- way. From the harbour the cky and higher houses present a very picturesque appearance, The City of Victoria is narrow by reason of the conformation of the available land on which houses can be built, and extends along the sea. front for a distance of 4 miles.

The contour of the harbour frontage, more especially the eastern side, is marked by curves and indentures. Formerly that of the western side presented similar features, but they were lessened or obliterated by extensive reclama- tions which have added considerably to the amount of available land for building on. A scheme of reclamation is now proposed for the eastern side which, when carried out, will pro vide a like result.

activity of the busindas of emigration at this whereas cases of plague in Canton, its neigh-time of the year, which brings thousands of bourhood, the Province of Kwangtong, or other: Chinese coolies to Hongkong, sometimes from parts of China, receive no publicity and form infected localities, to await their turn to be no subject of report either to the local or the tallen in emigrant ships to ports which require Imperial authorities of Chita' or to foreign Chinese labour, As no sanitary control is Governments. Silence has been erroneously exercised over the movements of these in- interpreted by those unacquainted with the comers from China, both of them contribute actual state of affairs in China as an indication to a continuance and rise of plague during the or proof that the country is free of plague. season. The influence of these two factors in As a matter of fact the whole of the southern of secondary rather than of primary importance coast of China, including the Provinces of as matters now stand in Hongkong, for, though Kwangtung, Kwangsi, and Fulien, is more or te-infection of the Colony from China plays a less in some parts infected with plague, as well as the eastern coast as far north as Foochow accord the annual recrudescence, more or less, according in the extent of plague prevalence which suffered very heavily from plague in and to the accessibility of the area affected in 1902, losing, it is stated, some 30,000 persons. the Kwangtung Province, yet the main source Further north the country is free unill Man, of plague in Hongkong since 1898 is in the churia is reached, were, at Newchwang and Colony itself, where it is endemic, and where some of the more inland faces, plague has it would appear annually even if it were not 'shown itself.

mainland,

evidence of the want of latrines would be much

The dissemination of plague in Hongkong by rats is even a more influential factor in the spread of plague than its dissemination by man, not because man is not jefective, bat, as a rule, he can be dealt with by the sanitary authorities, but the rat problem is much more difficult to deal with.

total inadequacy of the latrine accommodation

other section of this report, are very susceptible provided is obvious. It is not one seat to 100

to plague if they eat infected food. There were of the male population. Kowloon side of the

many cases of rat plague without any subse Colony the latine and urinal accommodation is

quent human plague. As soon as a case of still more deficiert Large blocks of houses

rat plague came to the notice of the Medical have been built, and not a single lairine or

Officer of Health; and every case was reported urinal provided by the builder of the block. It

to him daily, prompt action was taken by him is impossible under these circumstances that In the plans of the town attached, the cases of to prevent, if possible, the disease extending to the ground should escape being sewage-pollut plague which occurred in 1902 to the end of human beings. The policy was to deal with ed. The offensive smells complained of by the

June are marked with a square in the houses rat plague and prevent human plague, instead public are net from the filthy habits of the and localities in which they were found, and the of waiting for human plague and then taking coolies, but from a want of public conveniences cases of plague-infected rats are similarly mark-action. This policy, combined with other in which they can relieve the necessities of ed on the plan with a circle. In each square measures, appears to have been successful, for in 1902 there were only half the number of nature. Were it not that the daily scavenging and circle is given the week in which the case of the streets and lanes under the Medical

of human plague or rat plague was discovered, cases of plague that have occurred in the best Officer of Health exceptionally good, the and if these plans are examined with a magni- years and less than a third of the cases recorded fying glass it will be seen how very frequently in the worst years. With a thorough and more more perceptible than it is. A tally was made rat plague in the vicinity preceded human systematic bacteriological examination of rats of the number of persons using the to seats of plague, and the great preponderance of rat

in both Victoria and Kowloon, and prompt the Wingick Street Government latrine on the plague over human plague. If sheet No. 2f, action on the intelligence thus acquired in the persons used the seats the twenty-four hours of the town, be examined, it will be seen that expected, notwithstanding the very serious and 2,697 the urinals. If the other latrines in

in Keswick Street a plague rat was found in handicap placed success by the extremely town were used to the same extent, not more the 15th week, another in the 18th week, and a insanitary condition of the interior of the than a little over 90 on persons could have third in the 23rd week; a case of plague occurr Chinese houses in Hongkong. In cleansing gone to the latrines and 70 co to the urinals ined in a boy in the 31st week, in a house adjoin-blocks of buildings in June on account of the twenty-four hours, which is far short of the ing that opposite which one of the plague rats plague-infected premises in the block, no fewer population supposed to go to the latrines. The had been found. In Irving Street plague rats than 17 per cent. of the houses so cleansed existing latrines are far from being models of were found in the 16th and 27th weeks, and a were found to contain plague-infected rats, and what they should be. They are, in fact, in-plague case occurred in the 29th week.

per cent, of the rats caught by the cleansers sanitary fu structure and deficient in light and

were infected. ventilation. By their imperfections they attract rals, and, as the Chinaman contractor is re- luctant to mix disinfectants with what as a firmer he view, ns a valuable commodity, the rats on occasion do not esrapa being attacked with plague, and carry the disease into houses close by.

With no satistical data to go upon, it i. materially assisted by re-infection from the ruth of March, 1952, and it was found that 3,445 which represents one of the most eastern parts infected locality, even better results may be

impossible to state in definite terms the mortalhy from plague in any one of these. In Canton, as elsewhere, the only index to the mortality caused by an epidemic is the num ber of coffins that may be required above the ordinary demand, and which may be counted when carried through the gates. This rough method suffices to give an approximate es- timate until panic seizes the inhabitants and there is a general exodus. Canton has is no year since 1834 been free of plague. There has been an annual recrudescence in spring and summer varying much in intensity in different year. For instance the recrudes- cences of 186, 1898, and 19ar were very severe compared with those of 1895, 1897, 1899, 100, and rooz. Next in the epidemic of 1894, which has already been referred to, those of 1896 and 1898 were the most severe.

Dr. Swan, for many years in charge of the American Missionary Hospital in Canon, endeavoured to estimate the mortality of the epidenucs of 1890 and 1898 by obtaining in- formation as to the number of coffins which passed through the gates. His estimate is that in 1890 there were probably 40,000 deaths from plague in Canton. The epidemic began in March and continued till July, creating great alarm and causing large numbers of the popu- lation, rich and poor, to leave hastily for the country. In 1898 it is estimated that another 40,000 of the inhabitants died of plague, and at the height of the epidemic a similar exodus took place. la 1901 the epidemic, though next in order of severity, was nearly so destructive as those of 1899, and 1894. It affected the surrounding villager more than the town.

Nothing is done in China to mitigate the effect of any infectious disease, and plague is no exception to the rule. When the mortality becomes high the well-to-do leave the locality, and the poorer people Bee to another quarter or go back to their native village,

4 The recorded mortality from plague in Hongkong does not at any time approach in proportion the mortality of Canton.

192

6. The accompanying plan with spots marked on is represents infected houses in one part of the town since 1896, and that part not the worst. The different colours which will be seen by a magnifying glass represent different years. Seeing that between 30 and 35 per cent. of the cases of pingue are found in the street and not traced to any house, the plan, notwith- standing this defect, indicates a fairly adher ing infection to certain lanes and houses.

DC-

When a case of plague has once curred in a house, there is a great tendency in subsequent years for the same house, or that on the opposite side, or that close by, to be attacked with plague. When platted out on a map, the distribution of plague appears to be closely cornerte 1 with previous infection of the house or of a defineil locality, the infect ion having been retained in an unrecognised farm in the interval. Inquiry into individual cases very often supports this view. The dis- | nibution of rat plague alay presents similar features. If rats are dying in a house, it is not infrequent to find that the same phenomenon was observed in the same or in a neighbouring house the year previous.

9. The varieties of type of plague in Hong- kong in 1903 may be gathered from the following table, which represents the number examined bactériogically between March 16th and July, 16th----

Type.

Septic

No.

126

+24

Pneumonic... (Axillary

+3

68

...

Tot

1

Bubonic, Femoral

Percentage on the

Total Number Examined.

OF

41

༣I } 35.455%

06)

7. The houses which suffer principally are, speaking generally, the most insanitary and the

Inguinal oldest. It has already been mentioned how

The septic were nearly ten times, and the closely packed the buildings are in the older portions of the town, narrow streets and high bubonic thirteen times, more numerous than This percentage probably hous being the leading features, by which the the pneumonic. aderission of sunlight and fresh air is consider-represents approximately the different in fre ably obstructed. Narrow streets and high quency of the channels by which the vins houses, however, are not pecu iar to Hongkong; enters the human body. they are to be found in other towns, with their injurious effects on health; but in Hongkong tee is, moreover, in the Chinese quarters, a defect in the construction of the houses which inten ifies the obstruction of light. The rooms are long and narrow, with a window at each end, the front window looking into a wide and covered verandah, and the back window into a small open space at the back which forms a sort of well between two houses. The lower floors af many of the houses are remarkable for their darkness, and this in a region not far from the tro, ies, they are also frequently

damp

Sine the epidemic of 1894, many of the lower floors of the worst kind have been changed into store-rooms to contain the goods and merchandise for which Hongkong in an entrepôt. These store-Loonts as a rule are infected with rats, which at times find their way up to the rooms on the higher floors. he basements are generally ra-ridden, both ors and walls, and from the wails being often hollow it is easy for rats to reach the 'upon floors.

onic Gates is fortunate, for the variety of the The comparatively small number of pneum- distant, being highly infectious from the sputum being crowded with plague bacilli, is particularly dangerous to those who come in The lew cases contact with the patient. which were traced showed great infectivity. Fo ty per cent. is a high proportion for the It will be shown in septicemic variety. another chapter that feeding animals with plague-infected food causes se tic plague in the animal, and it may be asked if the alimentary canal is not the most likely channel for the causation of sept a plague in man. Certainly

a number of the post-mortem examinations favour this view, te retro-peritoneal and mesenteric glands, as well as the mucous men?. brane of stomach and intestines, being affected. The manner in which the food robaby be- comes contaminated wil be dealt with later on. No facts were observed to indicate that the bubonic variety of plague was otherwise caused than through the ordinarily accepted channel of the skin, inoculation of the hand or arm being somewhat less frequent than that of the

food or leg The apparent seat of inoculation was in a few instances marked by a vesicle or bleb, which contained plague bacilli

la No. zz sheet plague rats were found in fardine Bazaar Street in the 14th, 21st, and 13. Some instructive facts may be added on 27th weeks, and cases of human plague in the this subject. In 1901 thirty men were employ. 29th and 30th weeks. The case of plague ined in Hongkong to collect rats, and no fewer he earlier period in Jardine's Bazant has al ready been referred to.

If No. 4. sheet, which represents a locality in the western part of the town, be now examined, it will be seen that the first infected rat was found in Yat Foo Lane, in the 16th week; that the first case of plague occurred in the 17th week, at No. 5, Belcher Street, which is a house in which plague occurred the previous year, in 1301. On cleansing the block of houses on the same side there were caught in a house, three doors away, nine rats, and of these no fewer than five were infected with plague, and in another house, a few doors further away, two

The next plague-infected rats were found. cases in the neighbourhood were in the 18th and roth weeks, at No. 468, 478, and 5oz,

first had been living in a house in the block Queen's Road West, all in one block. The which had had cases of plague in it in 1901, the second had no distinctive history, while the third occurred in a house the lower floor of which was used as a slaughter-house, and in which forty-six rats were caught, three of which were affected with plague. This house was next door to one in which plague occurred in 1900. In the 18th and 19th weeks, plague rats were also found at the end of Queen's Road Weat, not far from Belcher Street, and it will be observed that plague cases accurred in the block in the 23rd and 24th weeks. On the opposite side of Queen's Road West, a plague case occurred at sea in the 23rd week, a plague rat having been found opposite 578, two doors away, in the 18th week, A plague rat was found in No. 5, Third Lane, in the 20th week, and plague corpse was found in the lane in the 21st week.

Coming to a more populous locality, it is seen in sheet No. 6, that a group of plague cases centre round Pokfulum Road and Second Street. Infected rats were found in the 18th, 19th, and 20th weeks, and plague cases discovered in the Toth, 2131, 22nd, 23rd, and 24th weeks.

An opposite policy to that of prompt clean. sing and evacuation was tried in this locality, with a very obvious spread of the disease trace able to this centre. Similar relationships of rat pl gue and human plague, were repeatedly observed in different parts of the town, as seen)

in a careful examination of the several plans. In cleansing houses on account of plague, having occurred in them, plague-infected rats were found in a few instances.

than nine, or 30 per cent., died of plague, three others leaving the Colony sick. In 1983, 172 men employed on the same business, but they were previously inoculated with Haffkine's prophylactic, made to wear shoes and take a bath after their duties before meals. Not a single one of them was attacked with plague.

In a private firm, of thirty coolies employed in sorting, and one of whose duties was to col lect dead rats from the godown when required, five, or 16,6 per cent, contracted plague and died.

In another firm rats were dying in the store. room, and two men engaged in removing them were attacked with and died of plague. In the case of a firm where in 1901 thres Europe.ins and two Chinese were attacked, the evidence points to a preceding invasion of infected rats. mien, which is the European settlement, the inhabitants and their Chinese servants re mained free of plague though only separated from the infected quarters of Cantor by a canal. It was also observed that the rats on the Sha- mein enjoyed the same immunity, though they, were dying by thousands in the native part of Canton. In other towns also exposed to infec- tion it was observed that when the inhabitants remained free of the disease the rats also shared that freedom. A similar immunity among rats and human beings was observed among the boat population in Canton and has also been observed in other parts of China. It was observed this year in Hongkong that the rat plague would pass along a number of houses on one side of the street and then suddenly

In Canton it was observed that at the Sha-

pass over the other side. A similar phenome non has been observed in different épidemics of plague in human beings, and in the first phenomenon is to be found the explanation of the second:

The following is an instance of rat plague and human plague on board ship -

The P. & 0.5 S. Ballarat arrived in Hong-. kong from Bombay on the evening of February toth, 1933, and started for Shanghai on the following afternoon, it arrived at Wessung, the port for Shanghai, on February 201b, and by the 2nd had had two deaths from plague on board. These were at first attributed to

Hongkong, but history of the ship points to The Ballarat had lain for another cause. thirty-seven days in Bombay, over a fonnighit being in the dock and the rest of the time alongside the quay. Between Singapore and Hongkong the storekeeper discovered some dead rats in the store-room, and one night the doctor woke up and found a rat in his bed. which he attributed to a mosquito bite. On the 17th day of February, the day the ship was in Hongkong, he went on shore, but returned and went to bed feeling ill, and at the same time with his leg painful and swollen in the popliteal region. The swelling went on to suppuration and was opened at Shanghai. He was treated

row lanes, and the rooms are arranged to pro. ity of at least 3 per ceni., and an incidence of so dark that it is impossible for anyone side abutted on another house, which had al-Oject was to ascertain the relative frequency that Shortly after he complained of pain in his leg,

plague of 41 per cent, while the recorded mortality for the Colony was a little over 5 per cent, during the same period. In another firm in which ten, or 3 per cent, of the men died of plague in 1901, only three died in Hongkong, the other seven died in China.

The deaths since 1894 are follows.-- 1894 1893 1896 1897 ¿B48 1899 1900 195 2,485

1,504 19 1375 47 2,000 11637 540 These numbers are not to be taken as repre- senting the actual mortality from plague con- tracted in Hongkong, because immediately a Chinaman 'eels sick he will, if possible, go home to his native village. He sometimes dies on the way, even before he reaches Canton. For instance, in 190s, from May 24th to the end of lune, in a period of five weeks and two days, the custom house cfficers at Canton detected 160 cases of illness from plague, and The building of a large city on se small a also found 35 persons dead of plague among strip of land ha: necessarily been attended with the passengers on steamers from Hongkong. great difficulties and with results which are far The voyage takes from eight to ten hours. In from being satisfactory from a health point of the same year, in one firm which endeavoured to trace the cause of nearly 25 per cent. of its view. The streets are narrow, with the excep tion of those on the recla med land and skirting workmen having left on account of sickness, no the harbour; the bouses are high, closely built fewer than zo per cent, were discovered to be together, often constructed back to back or cases of plague, giving on the total establish close to the hill side, or only separated by narment, as far as could be ascertained, a mortal vide accommodation for an exceptionally large number of persons,

The drainage of a city such as this presents many difficulties, but these in the main have been overcome. There are surface drains for the storm water, which at times is very torren tial, and there is a system of drainage from a number of the houses which discharges itself into sewers. Both underground sewers and surface drains discharge into the barbour, in which the tidal currents are strong. Some of the storm water drains have been covered over and probably lost sight of, and there is a likeli bood that in a number of instances drainage from houses discharges into them. On the whole, however, as far as system and construc, tion are concerned, the drainage of Hongkong is good. It, however, requires arrangements for regular inspection, cleansing, flushing, &c. The water supply is good so far as it goes, but limitation of gathering ground, together with the necessity of storage for long periods during the dry season, combined with the great demand on the supply owing to all the floors of the houses being connected with the mains, leads to an annual scarcity which, in a particularly dry season such as 1937, amounted to a water famine. The quality is excellent, but as point- ed out in my preliminary report of 20th March, 1902, the reception of the filtered water into an open reservoir instead of into a covered one at Albany Road renders it liable to pollution.

It is lowest or

It

5. Plague in Hongkong possesses distinct seisons for its prevalence, even absent in the autumnal and winter months, and reaches its maximum in the sum mer months, especially in May and June. Dr. Clark, the Medical Officer of Health for the Colony, at my request has kindly drawn up the appended chart, showing the weekly prevalence of the epidemics since 1896. will be observed that the figures for four of them, e, for the years 1896, 1848, 1901, and 1902, reach their maximum before the 24th week, and that the other two, viz., the year 1899 and 1990, after reaching a maximum about the same time as the others, differ in their later behaviour in that, after a decline, they again rise even to a greater height than before. This second rise reaches its height by the 26th week at the latest.

There were from Januar, tothe end of June: In 1895 no fewer than 1,116 out of 1,70; for the year, Le, sa per cent of the cases.

In 1898, 1.312, out of 1,325, for the year, 1.2. 99 per cent. of the cases.

In 1899, 1,072 out of 1,462 for the year, 72 per cent of the cases.

In 1900, 764 out of 1086 for the year, L, 70 per cent of the cases

In 1951, 1,487 out of 1,651 for the year, 90 per cent. of the cases.""

The admission of sunlight into the dwelling room of Chinese tenement houses is still further ob trected by the subdivisions into several cabins or compartments, sometimes numbering up to six, which every room is sub jected to Each cabin is let out to a separate lenam and not infrequently accommodates a separate family. These compartments or cubicles are windowless rooms, and are often coming directly from the light outside and drawing the curtain or opening the door of the cubicle, to see at once whether it is occupied I have stood at the entrance of one of these cubicles and peered in, trying to discern what was in the dark room, and suddenly been startled by discovering that not more than a foot from me was some occupant, whom at first sight it was impossible to see on account Some attempts have been made to improve this state of thing by limiting the height of the subdividing walls to 6 feet, The car ditiun which obtained before this im- provement was made it is somewhat difficult in realise, for what I am describing is that which now exists. Fresh air and sunlight never get into the cubicles except perhaps the compartment at each end of the room opposite the window. The aub fivision of a single room into a number of rooms called cubicles in an ingenious device for crowding together large number of people into a small space and securing a correspondingly large rental, but it is an arrangement which en- genders disease and favours its spread There is no doubt whatever that, every such windowless cabicle is unfit for human habita- tion, and should not be permitted.

of the dark ess.

Further details concerning the insanitary housing in Hongkong are given in the con- joint report submitted by Mr. Osbert Chadwick, CM.G, and me, to the Hongkong Government in May of 1902, and, as it is important and bears largely on the continuance of plague in Hongkong, it is included in the Appendices of the present report Appended also are some notes on the condition of a few rooms which Dr. Pearce, the Assistant Medical Officer of Health, kindly collected for me.

11. A number of rats bacteriologically ex amined in May and June was subjected to a more minute examiration for bacilli than was necessitated for diagnostic purposes. The ob- the spleen, blood, lungs, intestinal contents, urine, and mucus of mouth contained plague bacilli in plague-infected rats.

The result was as follows :~~-

Mucus

Moult

Intestinal

HONGKONG, 1901

Urine

Lnag-

Contents.

Bladder,

17:2%

%% 5.91

28-4%

22:2%

%t.91

au

8 Zazó %

Za55 8.6 Xaooz

Intestinal

Macus

Lung.

Confents.

Mouth.

| 453%

33*3%

33.9%

X 4.65

70*3%

Month.

May....*****

Number

of Infacted

LID

KOWLOON, 1902.

Blood. Spleen.

100%

91%

1000% 949%

as a case of plague, Yersin's serum being given to him; and though he was a strong and athle- tic man, he was much reduced, and it was over three weeks before he could return to his duties. On the 19th a Goanese scullion complained of illness and slightly swollen groin glands. He was isolated, but the next day he was found dead in bed. On the zrat a Goanese Topaz complained of feeling , but there was 'no fev. and no enlargement of glands, but the next day died suddenly The Health Officer ordered the disinfection of the fore part of the ship, but previous to carrying out the order, on the 23rd, it was thought advisable to remove

the stores, especially those liable to spoil, from the store-room, and as the stewards lived on the same floor, with only a grating between it and their cabin, disinfection of their cabin would affect the store-room. In carrying out

this work, a large number of dead rats collected together were come across, many of them in an advanced state of decomposition. A few of the rats were placed in sealed receptacles and sent to Dr. Stanley, the Medical Officer of Health for hanghai, by Dr. Jackson, the acting Medical Officer of Health for the port. Most of them were in too advanced a state of decomposition for Dr. Stanley to give any de-

In 1992 the first repor ed ease of plague in Hongkong occurred on the 16th of January na Chinawoman who was suffering from a buba in the armpit; she was removed to hos pital, but died the next day. Her residence at the back joined on to a house which had two cases of plague in a previous year. Its cast. in a former year been affected with plague while its west side was next to a house in which them had been five persons attacked with symptoms corresponding to plague early in January, and who had fed to China. It was reported that three of the five had died. A plague-infected rat had been found a fortnight!! earlier a few yards away from the house. If the woman had not been the wife of a respect- able Indian, it is very probable that the sanitary authorities would not have learnt of her illness at first hand, any more than they did of the five other cases. The block in which the house is situated contains twenty houses, and in four of them during the process of cleaning twenty-two dead ats were found between the ceiling and floor of the lower and upper rooms. The walls of the houses were hollow and riddled with rat holes, the space between the hollow walls being evidently used as rat run in fact there was bo obstacle to prevent rats entering at one and of the block and passing from bouse to house to the other end. The batement floors of the houses were mostly of concrete, which formed a protection against the entrance of rats into the rooms from under the floor, but the gain in this respect was lost by the hollew walls and covered-in ceilings, which served as excellent shelters for rats, infected and healthy. As the block and the locality possess an evil reputa tion fr plague the twenty houses were vacated 2. The proximity of Hongkong to China, and

until they were ropired, accommodaties for to the estuary of the Pearl or Canton River,

the inhabitants being provided by the Govern- gives it a very intimate connection with Canton.

di in a new block of buildings close by, For the purposes of trade, the Chinese resort

hired for the purpose. There was no casa in in large numbers to Hongkong, which is an No epidemic lasts longer than from twelve to

this neighbourhood after this until the end of

finite opinion on them, but the more recently entrepot for the transit of Chinese commerce. sixteen weeks, three months, being about the

dead yielded the plague bacillus. The process May.

The next case reported, was that of a, Por-

of removing the stores was accordingly stop- Its warehouses are full of the produce of nearly average. If any epidemic begins carly it ends every country waiting to be taken into the early; and if It begins late it ends late.

The cubicle system leads to overcrowding inggesa boy at school, who was attacked with

ped, and the store-room fumigation with sul- phur, and whole of the crew's quarters as well. Provinces of Kwangtung, Kwangsi, Yunnan. Though the rise and height of the epidemic its worst form and under the worst conditions, plague in the last week of February, and which

The fumigation lasted for twelve hours. In and Fukien, and, in exchange, the produce of correspond as a rule with the beginning of the for wherever more than two cubicles are in a proved fatal. He suffered from a bubz in the

cleansing the vessel, 177 dead rats were these provinces is stored in Hongkong ready rains and that period of the rains when the room the compartments become so dark as to groin. The source of infection was not traced.

counted. Most of those had not been, killed for export. The Colony is one vast depot of temperature is below So F, and the decline render it impossible for them to be kept clean. The relatives removed to the grandmother's Apart from the detrimental effect which the house, and in two months' time there was a cotton, flour, rice, sugar, ail, spices, teas, dried begins generally in the middle of the rainy

by the sulphur, as they were found in an ad- absence of fresh air and sunlight has on the second case of plague among them.. There is

vanced state of decomposition. On tha, 17th fish, and other merchandise. It produces little season when the temperature is above 8o F, in itself; there are only a faw factories, and it yet it is to be noted that in the two worst general health of the occupants, the darkness reason, to believe that a number of article of

of February, the cook for the nativo, crow was found dead in the galley. This was also is dependent on Canton for its food supply epidemic yeats, 1898 1901, the declins had no by favouring uncleanliness and other insanitary clothing were taken from the house before

supposed to be plague, but no post-mortem The population of Hongkong itself is mainly apparent relationship to any continuous tem- conditions, is an important factor in the spread disinfection. The next case was found in the

As a factor in the dissemination of the in was made. Cantonese, consisting of traders and a large parature over Bo F. having begun before that of an infectious disease the causal agent of street, and no trace of the hense from which the proportion of the labouring class; it is floating temperature was reached,

· Dr. Stanley found plague bacilli in the glands which is not infrequently discharged in the ox body has been laken, and deposited. The fection while the rat is alive, probably, the There appears to be no special connection cretions and sputum of the patient, Were it fourth was a Portuguese boy who was attached presence of plague bacilli in the intestinal of the Goanese. Hongkong, was placed in made up of males whose wives and families between the behaviour of plague and the rain not that it is the custom in many instances for with pneumonie plague... The case gave rise to contents, urine, and mucus of the mouth is the quarantine, in this instance, for something abe in its character, non-residential, and largely remain at home in the villages of Chins. There fall. If the rain has noy influence, it is perhaps the people in the room to take to fight immedia ether, obylourly due to infection. The most important. It will be observed that, even

was quite innocent of At the time there was are nearly 1,000 registered lodging houses in on the executive and the carrying out of meas ately one of their number is ill or dies of plague house was one in which a large pumber of rats in the highest percentage, plague, bacilli were no plague in Hongkong, and the plague o

died under the floor in 1901.

found in the intestinal contents in only a little board the Ballarat was evidently derived the other houses are tenement houses, Under It tends to prevent the continuance of those mentioned, even more sendus results. these conditions, the epidemic diseases of active, measures against the spread of plague 8. Probably another cause for the continuance the bacteriologist, for the Colony, rendered less than one-fifth of the infected rats, and in bad either been braught on the ship with the thongtons synchronize, tu, & very great extent which are carried out in fine sveather. It is of plague, besides the insanitary condition of possible the daily examination of a small pro- the mucus of the mouth in about one-third of stores, or had passed on to the ship when it more dificult to get the coolies to work, they the houses referred to, is the very inadequate portion of the rats found dead in the street in the cases. This may account for the absence was lying alongside the dock or quay. This with those prevailing in the chief centres and

need more supervision, while cleansing and number of latrines and urinals with hich different parts of the city, and this examination of plague at times in a house, though there case emphasizes the importance of the destruc» and villages of Southern China.

3. From the facts related it is clear that disinfection operations are carried on under Hongkong is provided. The urine and feces disclosed, the fact that a small percentage of the may be infected rats, for the chances of con- tion of all rats on board ship before leaving an of many plague patients contain plague bacilli rats in certain quarter of the city were fofected, tamination of food and other things likely to infected post if the ship has been lying along- plugue in Hongkong was derived from Canton many difficulties of the seas or its environs. This is an important fact which

seasonal prevalence before they take to bed, and, with the want of Later, a daily examination of the rats caught infect man are not as great as they probably side of the quay or dock. Another interesting The explanation has generally been overlooked in Europe. It of plague must at the present stage of our

urinals and latrines, infectious material gets in cages or found dead was made on a much would be if the intestinal contents, arine, and case, but perhaps not quite so clear, is the ca30 is not uncommon even amongst those who knowledge be purely theoretical, and as such distributed on the ground, and in places where more extended scale by three of the Japanese mucus of the mouth of every plague, rat con of the Coremanded. The following letter, writ

the bacillus finds favourable conditions for medical men who were engaged by the Governmined plague bacill

ten by the Captain, gives the details par bave paid special attention to plague to meet will not be dealt with in this report. There can

* P. & O. COROMANDEL" with some who are under the impression that be little doubt, however, that the seasonal pre permanent growth and often none for its des dent of Hongkong to 20ist in the medicalIt was also observed ibat the rat plague

"China Sea plague started as it were da nove in Hongkong, valence in Hongkong is favoured by one or truction and removal. The number of publile management of the plague. The method was appeared often where plague had been the and remains there as the only focus of danger, two circumstances which occor about, this latrines appear to be ap belonging to the Govs, most valuabis, in locating infected centres and previous year, for example, in: one locality

“rst January, 1993. An impression of this kind has been produced time. First of all, in the early part of the crament and 17 to private owners. The total infected houses, and as time went on it was which bad fifty-five houses attacked with plague "TO PROFESSOR SIMPSON MAN in consequence of plague having been first spring there is the tombs festival, which number of icats is 1,302 most of them have evident that what had been observed in the intro01, in eleven instances plague rat were "Dear Sir The Coromandel left Bombay heard of in Europe as an epidemic in Hong- attracts to China large numbers of Chinese urinals attached and in addition there are thres lowes and villages of China, with reference to found in rooa either next door or opposite the on April 11th, 19co, and arrived at Hong

from Hongkong to perform ceremonial rites at small public urinals insha to ma Sesiog that their mortality preceding plague, was also butas previously affected,

kong April 27th, with everybody on board is kong, and subsequent attention having bean- directed to its annual recurrence, owing to the the tombs of their ancestors. If plague is all the men and boys go to the public latrines Trke in Hongkong, and that plague infected rate A large numbers of persons became affected good health. We remained in port twentys

re case in Hongkong It prevalent in the part visited there is fisk of and there are no sanitary appliances la held a house or locality means, sooner or later, if the precedence of the rat plague became les four hours alougalda Kowloon Warr cind the daily papers, and a weekly infection, which brought hack on their houses except sarthern, pots, which used immediate massures of evention were not sharked; for the human crass of plague in their April 28th, we proceeded to Shanghal, arrivar mucin is issued and sent to the different Gov- return to the Colony. Next there is the extra exclusively by the women and children; the taken, cases of plague in that locally or house turn infected the rate, which, as shown in an- there on May 285, all wallet fubertetlarizici

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Rats.

151

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Number

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Rats.

69

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