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April 21, 1902.]
health of every emigrant in this Colony is also known, and this can only be obtained by regular medical inspection of the emigrants in the emigrant-hönses and immediate compulsory notification of all sickness, whether infections or not, by the emigrant-house keeper.
More serions even than the non-reporting of cases is that a large proportion of the cases are found dead in the street or. floating in the harbour. In 1898, no less than 36 per cent. wre 1bus found, in 1899, 40 per cent., and in 1900, 37 per cent, and this decurred notwith- standing the employment of special constables -soldiers, police, and others for the express purpose of preventing it. Until this is put a stop to, there is no chance of plague being effectually dealt with. The throwing of dead bodies into the street is much worse than leaving the dead body in the house, and all the inmates abandoning the house. His professional duty lay in pointing out the fact that, while this continues, plague will not be got rid of in Hong- kong. It is for the Goverment to devise an efficient method to prevent it, or to check it to a minimum extent and which shall not have any more serious drawback than the Come to the con- plague itself. He had clusion that the Chinese in Hongkong must be treated in this respect more in acco dance with Chinese customs. The responsibility should be thrown on themselves. He would recommend that the City of Victoria and Kow- loon be divided into districts and sub-districts, and each sub-district into street', and if there is a long street sub-divide this again.
householder Then, that each
be served with a notice, pointing out the im- portance to his own welfare of the plague being prevented and the necessity of his com- plying with the law and notifying to the Central Sanitary Office, or office of the medical officer in the district, or the police, any case of sickness or death in his house, and also warning him that, in the event of a dead body being found in his street, that not only he but all the householders in that street will be subjected to a fine which will be placed in a common fund to defray the expenses of providing watchmen, blocking up the street, and of taking other to prevent the spread of plague. It is essential and only fair at the same time that every household in the Colony should be informed by means of hand-bills what are the causes and symptoms of plague and what should be done in the event of plague breaking out in the household. He would recommend that, with some modifications, at least 100,000 copies be printed on coloured and attractive looking paper and that they should not only be distributed so that every householder, shopkeeper, caretaker and godown holder should be given one or more copies but that a copy should be posted on every door of a household, in a conspicuous place in every junk, sampan, native vessel, steamer, craft, workshop, restaurant and factory. In this hand-bill special prominence should be given to the destruction of rats and equal pro- minence to the addresses of the places where sickness can be notified. E.ormous sized posters should also be placed in prominent places in the streets and also in the more public resorts of the Chinese. A conference of Chinese doctors should also be held and the necessity of noti- fication and early reporting should be explained to them; similarly the Chinese contractors of labour and, if possible, the heads of the guilds, should be made fully acquainted with the wishes of the Government.
measures
CHINA OVERLAND TRADE REPORT.
(3)
(4)
}
The tracing out of the history of the human plague and the connection with others, if any, of each case and the following out the course of rat plague.
The removal of patient and disinfection
of clothes, &c.
The examination of contacts and disinfection
of the contacts' effects. (5) The vacating of buildings. ·
(6) The destruction of rats and the cleansing
of infected buildings.
(7)
(8)
because of their impracticability. The abandon- | (2) ment of the block is a mere temporary measure and of little permanent valne unless the rats in the block are destroyed and the houses made rat- preof. The filling up of the rat runs in the footings with glass and cement and a three or four inch layer of cement on and at the sides of the footings and on the floor are necessary to render the ground floors safe. As in the vacat- ing of large blocks, which is quite feasible and useful at the commencement but which is im. practicable later on, so it is with the isolution of contacts. After a certain stage, it is impracti cable to provide for contacts and keep them under observation. The vacating of the house | is the chief measure. When this is done promptly it has been ascertained that the num ber of contacts falling ill afterwards forms but a small percentage. If arrangements are made for the disinfection of the clothing and effects of the contacts and they are thoroughly examined by a medical man, they can be allowed to go to certain districts, provided it is not a case of pneumonic plague which, at the highest com- putation, forms a very small percentage of the plague cases, In such a case the contacts from the floor should be provided for. The system until lately practiced of vacating a floor for six hours only during the fumigation should, there- fore, bo replaced by a complete vacation of the building in all cases.
If a case of plague occurs in a house a medical inspector with an interpreter should immediate- ly visit the house and make as careful an enquiry as possible into its history and the manner in which it was probably caused. If it is a case of pneumonic plague the inmates of the floor should le treated as contacts and isolated for 10 days. If not a case of pneumonic plague the clothes and effects of the inmates of the floor should be disinfected by steam and they should be permitted to leave. If it is possible to get them to report themselves for ten days at the Sanitary Office of the district in which they reside, it is useful; if not possible then the risk run is after all small. The house itself should then be vacated; and by the honse he did not mean the one room which may contain half a dozen families, but the whole building;' and a bye-law should be passed without delay to give effect to this. The building having been vacated, the floors, o ilings and walls should be thoroughly examined for rat rans; rat poison and rat-traps should be laid down for one night and then the building should be cleansed and disinfected. Usually it will be found necessary that the owner should make the honse rat-proof and put it in a sanitary condition before it is re-occupied. If a sufficiency of light and air, cannot by structural alterations be admitted, it should be declared on that account unfit for human habitation and should not be re-occupied. The rats in the adjoining houses should be destroyed and examined bacteriologically and, if found necessary, these houses should also be renders d rat-proof and altered so as to admit a sufficiency of air and light. A similar procedure of vacating the house should be carried out when rats infected with plague are discovered therein, or when several infected rats are found in the adjoining steet.
The plague work should be independent of the ordinary sanitary routine work of the day, and therefore requires a special establishment which can work in conjunction with the Sanitary Department and get the benefit of its assistance. But the two should not be amal gamated to that degree that one set of duties are Another and additional method of improv- lost in the other. The director and executive, ing the intelligence branch of the plague head of both should be the Medical Officer department and locating the disease is the of Health for the Colony. His time must bacteriological examination of all rats daily not, however, be occupied with clerical work, secured by the 1at catchers. Having organised which should be relegated to a capable head the machinery for the early discovery of human clerk or if necessary several clerks working in and rat plague together with the machinery for his office. He also recommends that the weekly tracing out its ramifications and conditious of bulletins received by the Government and all extension, the plague department is in a posi-official documents relating to the health of the tion to deal with the disease,
It is important to thoroughly grasp the fact that plague spreads slowly at first whether among rats or human beings. When an epidemic once gets beyond a certain stage none of the measures which were useful at the beginning will influence the duration of its destructiveness,
·M Measures such as the vacating of a whole block, account of rat: or human plague, will prove successful if applied promptly and at an early "stage, but cannot be recommended later on
Colony, or to outbreaks of disease in other countries, should be sent direct to the Medical Officer of Health; while official documents relating purely to administrative work should be addressed to the administrative President of the Sauitary Board.
(6)
(10)
(11)
(12)
The seeing that infected buildings and ad- joining buildings are made rat-proof and that air and lightis admitted into these buildings.
ав careful supervision The
regards cleanliness and freedom from rats of the houses provided by the Government for people removed from any block of buildings. The boarding of vessels when required and
inspection of sick persons.
The establishment of a quarantine station for the observation of any sick persons com ing by boat from an infected district, The inspection of the quays and reporting to the Harbour Master any relaxation or infringement of the regulations relating to the precautions in the harbour to prevent rats from coming on shore,
The general destruction of rats in godowns and elsewhere. For this purpose several of Clayton's machines for pumping gas would be useful. The distribution of rat poison in the storm-water channels, houses, quays, stores, &c.; the superintendence of the work of the rat catchers; the preparation of cultures of Danysz bacillus and its distribution.
(13) The special destruction of rats in infected
areas.
(14) Preventive inoculation with Haffkine's
prophylactic.
(15) The keeping of the necessary registers and
notices, also bulletins received from Southern China and the issuing of the weekly reports.
In order, however, that the President and Sanitary Board shall be able to effectively deal with these questions, it is necessary that the Public Health and Building Ordinances shall give them the necessary powers. He had already mentioned that the interual design of Chinese houses as constructed in this Colony is insanitary. The rooms, as a rule, are far too deep, the object of this depth being to sub-divide each room into a number of cubicles for the accommodation of families or lodgers. Though there may be win. dows at each end of the rooms, the great depth materially obstracts the light. In any future Ordinance and in any future rales of land the Government should have powers to prescribe the type of house to be built in different parts of the Colony. The long deep rooms without any lateral windows to them are very objec tionable. It is obvious also that rules and regulations suitable for European houses at the Peak are not suitable for Chinese houses or for houses of the warehouse and office class. Powers should also be obtained to regulate the maximum proportion of the roofed over hereafter domestic building area of erected in such a manner that every such building shall have an adequate open space attached to it. This open space should in future be at least one-third of the total area, and the streets and so venging lanes should not be in- cluded in calculating this total area. Back yards should bear a minimum proportion to the height of the houses and not as now to the depth. The depth of a house should be regulated by its lateral windows; the objection to deep rooms is removed with lateral windows. No cubicles should be allowed in new hoses unless each cubicle is provided by a window. In old houses the cubicles should be gradually eliminated ex- cept perhaps in top storeys, where skylights and special arrangements for ventilation can be To prevent overcrowding, the introduced. superficial area or floor area should be raised from thirty to fifty feet per head.
Aby
There are other matters which call for atten- tion, but probably the foregoing will suffice to indicate that many important measures require to be enforced aud that the details of them can The duties of the special Plague Depart-only be properly considered and efficiently
carried out by having an administrative-Pres ment summarised, are:- (1) The discovery, location and microscopical dent of the Sanitary Board whose whole
examination of plague cases whether—(a) ' is devoted to this work and whose title migh rat plague: (b) human plague.
be "Sanitary Commissioner" for the Colony,
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