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the year, and on the 28th January I received his suggestions, anticipating that. No. 9 district would probably be the worst; he recommended that:-
(a.) European Constables should make a thorough house-to-house visitation once a week, each to speak Chinese or have an Interpreter.
(b.) That to prevent the depositing of dead bodies on the street, the police patrol of that district should be augmented by swearing in fifty Indian soldiers as Special Constables to be controlled by a European Officer, the same system to be extended to other districts, should the Plague spread.
(c.) That the Light Regulations (Sec. 131 of Ordinance No. 13 of 1888) should be re-enacted in plague districts, and that they should be at once applied to the Western part of the City.
(d) That in case of dead plague bodies being found in back-lanes, which could not be controlled by the Special Police, every house in the lane should be cleansed and disinfected.
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(August 3, 1901.
10. On the 20th May, I authorised the employment of a launch and of two junks, in which patients could be taken to the plague hospital from the eastern district, or dead bodies sent for burial, that they might not be carried through the streets. At the same time additional accommodation in the shape of a good and airy matshed was provided at Kennedy Town and two additional nurses were engaged.
THE HONGKONG WEEKLY PRESS AND
myself if the very full facts submitted afforded 9. On the 10th May, I authorised the erection ground for a workable theory as to the cause of of a matshed plague hospital' at Yaumati on the disease. How does it originate? How is the Kowloon peninsula and obtained from it propagated ? Is it a dirt disease, a drain | Major-General "Gascoigne the services of Dr. disease, or is it caused by want of light and Stewart of the Indian Medical Service to air? or by some atmospheric condition not yet relieve Dr. Thomson from his duties as Medical grasped by scientific research ? Is it infections Officer of the Gaol, so that his entire time or contagious? Is it air borne or propagated should be devoted to plague work, by vermin ? The last theory holds water to a certain extent, for undoubtedly the advent of plague-stricken rate has been very fre- quently followed by cases of plague, and patients have been received in hospital with insect bites about the ankles, the serum from which was found to be swarming with plague bacilli. On the other hand a large number of the rats collected, against which vermin we have been waging war for the past eighteen months, have been found by the coolies engaged in collecting the city rubbish for removal, to whom the reward is a matter of great concern. These men, I am informed, carry the rats sometimes about them until counted out to the Inspector, lest their prize should be appropriated by their fellows, yet none of these men have contracted the disease. Again the plague charts show an invariably rapid fall from the maximum plague rate to normal. The epidemic always ceasing in from three to four weeks.
(e.) That a reward of five dollars should be offered for such information as would lead to the conviction of persons depositing dead bodies in the street or public thoroughfare.
(f) That a reward of one collar should be offered for every living case of Plague reported to the Tang Wa Hospital (an excellent Charitable Institution supported entirely by the Chinese) or nearest Police Station, and that in all such cases Govern- ment should pay two dollars for each floor disinfected as compensation for small articles that might be destroyed or damaged in the process of disinfection.
(g) Should disease spread in spite of these precautions, a further European Staff would be required to assist in disinfection. 4. With the exception of the regulation made under Ordinance No. 13 of 1888 that all Chinese should carry a lantern, a suggestion of which the Colonial Secretary and the Captain Saper. intendent of Police disapproved, I approved at once of all these proposals, and, in addition to the Police, the requisite number of men was lent by the Military Authorities, isolated matshed accommodation being prepared for them at the expense of this Government and extra pay given to them, as during the epidemic of 1894.
5. Further suggestions were made by the Sanitary Board for the improvement of the Sanitary staff and were adopted. Unfortunately the health of Mr. Dandy, the Chief Sanitary Inspector, broke down, and on his departure I have recommended the appointment of an As- sistant Medical Officer of Health.
6. From the middle of February the cases began to increase. In the week ending 23rd February there were five cases reported, which increased to fourteen in the second week of March, and to twenty-four in the third week of April, the next week's returns showing sixty- five cases, the first week in May ninety-three, and the following week one hundred and twenty-eight. In the first week of June it reached two hundred and twelve, with two hundred and six deaths. The second, third, and fourth weeks in June the returns were one hundred and fifty-nine, one hundred and forty five, and one hundred and fifty-three, while the last week it sank to sixty.
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6. By this time the people became seriously alarmed. Since the 11th May twenty-five Europeans had been attacked and nine had died. The public Press published letters and articles that increased the alarm, which was intensified among the Chinese by the refusal, under your instructions, to permit the removal to Canton, as in 1894, of any person suffering from plague, even under conditions of regulated precaution. An exodus of the Chinese community ensued, which has had the result of paralysing certain works in the Colony and has caused the gravest inconvenience and loss. I addressed you on this subject by despatch No. 239 of the 29th ultimo. On the 7th ultimo the Chamber of Commerce addressed to the Government the letter of which, with my reply, I enclose a copy, and also of a further letter of 24th June, of which a copy is also enclosed and which I pro- pose to answer, giving them full information as to sanitary matters, which is now being collated. 7. From the first I have watched the returns day by day with an anxious endeavour to satisfy
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11. Feeling that if the disease is propagated by vermin, the Chinese coolies ought to have an opportunity of washing, I directed the Public Works Department to erect a number of mat- sheds with arrangements for hot water. It was generally assumed that the Chinese coolis would not avail himself of this means of cleanliness, but the thousands who have since flocked to these bath-houses have shown that they are ready to avail themselves of any opportunity for securing personal cleanliness, and the Sanitary Board has requested that more mat- sheds may be erected, and provision made for permanent baths. I have suggested that the working women shall have like facilities, but the Board reports that they would not use them. I propose, however, that one or two shall be provided as an experiment.
I attached a chart of plague cases in the years 1899, 1900 and 1901 that will show how constant is this condition of rapid recovery. This rather favours the theory that the epidemic is due to atmospheric condition. I have no reason to believe that the Sanitary Staff are not doing 12. I have now given you every information their duty faithfully, and if they are, then with
as to the efforts made to combat the disease the large powers given to the Medical Officer during the present year, efforts that I regret of Health there should not be in Hongkong a to say seem to have been unavailing. From house unfit for habitation, nor should any house one experiment just completed it is possible be permitted to continue in an insanitary state. that good results may be obtained. Seeing in At present there seems to be a preponderance the Bombay reports that where a house was of opinion among the community that the thoroughly disinfected plague did not recur plague is attributable to overcrowding, insani- that year, and observing. from the full particu- tary dwellings, and a bad system of drainage.lars given in our returns of the past three years But while all or any of these conditions may that more than one case in any house was com- contribute to the perpetuation of the disease, the paratively rare, I directed the Medical Officer fact remains that one of the worst districts in the of Health to select the worst centre of the Colony this year is at Hunghom, a newly built disease and to thoroughly disinfect a given area quarter on Kowloon peninsula of two-storied (hitherto only the floor on which a case occurred houses, fronting streets 50 feet wide and in- was disinfected). This was carried out on the habited by the best paid working men of the 21st and 22nd June, and if within that area no Chinese community-the workmen of the more cases occur this year, I think it will afford Whampoa Dook Company. I was so struck by grounds for taking legal power to disinfect all this fact in apparent opposition to the various houses within the City when next year it will theories, that I requested Major-General be advisable to employ a very large number of Gascoigne to permit an officer of the Royal men in February and disinfect the entire city Army Medical Corps to make an independent quarter by quarter. If that does not succeed, report upon it, placing the services of a Sanitary the question will remain what structural officer and an officer of the Public Works changes shall be carried out and what property - Department at his disposal. I attach his resumed, destroyed, or rebuilt. report.
8. The very high percentage of mortality here has also engaged my attention. In the epidemic of 1896 it was 91.12 per cent. In 1898, 89.45 per cent. In 1901, 94.56 per cent. This percentage is higher than that reported from other places, and is generally supposed to be much higher than at Macao or Cauton, though there are no figures available for the latter, and at Macao local conditions render statistics on this subject unreliable, as plague patients go across the harbour to the Chinese hospital in great numbers. I have visited the plague hospital on two occasions and thoroughly inspected it. Nothing could be more entirely satisfactory than its arrangements, and so far 88 I could see nothing was want ing in the treatment or the surround ings. Yet there must be some cause for the exceptional mortality. On reading the report of the action taken last year in Bombay, I found that patients were allowed to remain in their houses to be nursed by their friends under proper restrictions, and early in May I suggested that the experiment might be tentatively tried here, but the suggestion was not accepted by the Sanitary Board. Personally I have little doubt that with such a regulation the mortality would not be so high. The plague hospital is at the extreme western extremity of the town, and the carriage of a plague-stricken patient in an ambulance, which, until I ordered wheeled ambulances with pneumatio tyres, consisted of a cot slung upon a pole, and carried for two or three miles by two coolies, could not be conducive to the recovery of the patient.
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13. In approaching this question it must be remembered that we should be dealing with property worth from £100,000 to £150,000 per acre, and I do not feel competent to deal with so large a question without first obtaining the advice of an eminent Sanitarian.
The letter of the Chamber of Commerce shows that a considerable section of the community consider the drainage to be in a dangerous condition. The Sanitary Board point out that houses are too high and call for an Ordinance restricting houses to once and a half the height of the width of the streeta measured from kerbstone to kerbstone, and have on general principle that I cannot gainssy recommended that six private streets at the ends of which are houses erected over archways shall be entirely opened by the removal of the latter, which will, the Acting Director of Public Works estimates, cost one hundred and seven- teen thousand dollars.
If one or the other assumption of the cause of insanitary conditions be correct it will cont a very large sum indeed. I question if the com- munity quite realise how much, but whatever the sum if the result be to banish plagus it will be well spent. The letter of the Chamber of Commerce shows that the people of Hongkong will not object to any expenditure within their means, and I am quite certain that in asking you to send out a Sanitary Engineer of such eminence in his profession as will public o·nfidence, to report upon the state of Hongkong, its drainage system,” water system, and the general question of tation, I have the support of all classes of the community. May I suggest that you telegraph
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