8
CANCER IN HONGKONG.
We have procured a copy of the further correspondence relating to the Cancer Research (Colonies) Scheme, presented to both Houses of Parliament. Therein we notice that Hongkong claims a considerable space. H.E., in a letter to Mr. Lyttleton, states that the wishes of the. Imperial Cancer Research Fund have been expressed to all the medical practitioners in Hongkong and South China. This letter accompanied a report by the Acting Principal Civil Medical Officer with regard to the relative incidence of the disease upon different races, Dr. Clark's interesting report showed that during the decade beginning 1895, the total deaths from cancer and sarcoma was 119, equal to a death-rate of 4.45 per 100,000 of the population, which compared very favourably with the rate in England, which for the period 1891-95 was 71.0 per 100,000. He added:-I quite recognise, however, that the facilities for a cor. rect diagnosis of the cause of death are far greater in England than among the Chinese in Hongkong, and that our figures may possibly understate the case, but it is not probable that the disease is as prevalent here as it is in Eng- land, and this is borne out by the mortuary returns, which I will presently quote.
After giving the statistics relative to the disease, he continues-The most striking figures, however, are those obtainable from the records of the Public Mortuary. During the past 10 years no less than 15,365 post-mortem examina- tions have been made on the bodies of Chinese dying in the Colony, and out of this total namber only ten are returned as having died of malignant disease. These bodies cannot be said to be specially selected, though a small propor. tion of them are bodies removed to the mortuary during an epidemic of plague, under suspicion that they have succumbed to this disease. The bulk of them represent merely those Chinese persons whose deaths have occurred outside the public hospitals, and bave not been certified by a registered medical practitioner. The figures, as they stand, represent a proportion of only 0.65 per 1,000 deaths, whereas, I believe, in England about 38 per 1,000 of all deaths are due to malignant disease.
Our hospital statistics show that during the past five years 42 Chinese cases of malignant new growth were admitted to the (native) Tung Wah Hospital, and 31 Chinese cases were admitted to the Government Civil Hospital, making a total of 78 cases. It must be remembered, however, that some of these cases have been admitted to hospital more than may once, or may have transferred themselves from one of these hospitals to the other.
Moreover, in considering both cases and deaths, it is necessary to bear in mind that, in addition to the population given in Table I., the following number of Chinese persons who are classed as immigrants, i.e., persons arriving in Hongkong by ocean-going steamers on their way back to China-may furnish
101
1900
1901
***
1902
1903
1904
121,322 129,080
་་་
129,812
+
140,551 149,195
These persons all land in Hongkong and remain here pending trans-shipment, staying meanwhile in registered emigration houses, and such of them 88 are suffering from disease dubtless find their way to one or other of the
hospitals, while some no doubt die here.
With regard to the question of the age incidence of the disease, it will be seen from Table I. that 70 of the deaths occurred in
persons over the age of 45 years, and 46 between the ages of 15 and 45 years.
From these figures and also from the census return, which I quote below, it will be seen that the hypothesis suggested in paragraph 12 of the circular of November 18th, 1904, that malignant disease is rare in these races, because such a very small percentage of them attain ages: exceding 45 years, does not apply to the Chinese in Hongkong, for at the last census, taken in 1901, the age distribution of the Chinese population was as follows :-
24 0.16 years ... ...... 17 per cent.
years and upwards
1...
*
14
THE HONGKON 3 WEEKLY PRESS AND
The corresponding figures for England (1891 cansus) in the urban districts were as follows :-
0-15 years
35 per cent.. 47
15-45 years
??
**
45 years and upwards... 18 The difference between 14 per cent. and 18 per cent. in the proportion of persons over 45 years of age would not be sufficient to account for the very great difference in the incidence of malignant disease.
It may be intesting to add that out of 882 deaths of Chinese recorded in Hongkong last year, no less than 712 were of persons over 61 years of age.
To anyone unacquainted with the Colony the age distribution of the population may appear remarkable, and I would explain, there- fore, that Hongkong is peculiar in two respects, namely (1), in having a high infant mortality, and (2) in the fact that the population is main- tained and increases almost wholly as the result of the immigration of adults from the mainland of China. Thus it is that our percentage of children is low while our percentage of young adults (15-45 years) is very high.
The only fallacy attaching to the death returns, which I have quoted, lies in the possibility that Chinese suffering from malignant disease may return to their own country before they die, but experience with regard to other lingering
illnesses is that the Chinsman whose home is
here will remain ere as long as possible, and will continue to do sach odd jobs as the nature of his ailment will permit, or will be maintained by his relatives: d friends, until he ultimately dies of the disease. This is borne out by the fact that there are nearly 6,000 death of Chiness yearly in Hongkong, and that nearly 28 per
cent. of these deaths are attributable either
[April 18, 1906.
What
| bias to flow down the cons more in ode directions, than another--the slope of all straight Hines from the apex of the cone being the same. It is known, too, that alluvial plains, or portions of them, occasionally partake of the nature of flattened cones. If we examine Plate III. showing the various recorded courses which the Yellow River has taken, it is obvious that here at all events a coniform plain exists, for at `different times the river has flowed in all ponnible directions where not prevented by the mountains. A realisation of this faot enables one to understand the instability of any one course of the river, and how it is that at one time or the other it has traversed every part of the plain. This is one of nature's methods of plain formation. Another method used when the plain is more confined, auch as a valley plain, and where the gradient is less steep, is by means of the gradual migration of the river bed from limit to limit of the plain. In: the latter case results a smooth plain, with a gentle declivity in the general "direction of the river and free from any minor irre- gularity of level caused by the main river (whatever may be the result of other stresms). In the former case results a series of elevations marking the sites of former beds of the river and standing up above the general level of the cone-shaped surface. our general
is the condition of the Great Plain in this respect? Certainly the river at the present moment is running on an elevated ridge; certainly an elevated ridge lies in the course which it followed from 1924 to 1852, possibly in the course which it followed from 1209 to 1324. But what about the ancient courses to the northward of the present one? Kingsmill writes of an ancient elevated bed near Po-haing, and I have myself crossed the apparently elevated bed of the old Tu-hsieh-ho, which was in 600 B.C. occupied by the Yellow River. It is not to be expected, however, that these ancient elevations should be visible to the eye, especially such as were due to a river anartificially restricted. Weathering and agricultural processes will have merged such sharp outlines as they originally bad with the plain; but they probably still exist, to serve as a factor in limiting floods and in determining the course of the river if it deserts its present bed. Since writing the above I have orossed two old river beds between Ping-yüan and Te-chou, one 45 l from Te-obou and the other 3. The former, which was well defined with a massive dike, which must originally have been at least 30 feet high above the plain, is still called the Lao Hwangho, or Old Yellow River; the latter, which was less defined, bad, apparsat- ly, no name, but the village on its north bank The plain between the river beds [surveyed] was called Huang-ho-yen (or Yellow RiverEdge), dipped, apparently, to the northward. small channel in the centre of the north bed, is an overflow channel from the Grand Canal, stili mill's paper it would appear that the Yellow in use. From the map compiled from Kings
and, apparently, one of these-probably the River left a bed in this neighbourhood in 1194, southern one-must be it. It is astonishing, however, to find the dike so well defined after some 700 years. Another important factor with regard to the development of the levels of the plain is the northern part of the Grand Canal. The elevated bed of this waterway has probably in the course of years entirely altered the original drainage system. The rivers which from the mountains in the south-east of Shansi formerly flowed direct to the sea have been deflected to the north and concentrate their water in the neighbourhood of Tientsin. From Lin-ch'ing-ohon to Tientsin the Grand Caual is now merely a continuation of the Wei-ho. (It is to be noted that the defluents to the eastward of the Grand Canal which are shown on the mape do not exist in reality, except in one or two cases, as flood drains, and that from Lin-ching- chou to Tientsin the “ Canal” has nd affluents.) The portion of the Canal lying between the Yellow River and Lin-ch'ing" is now silted up. At high river, however, waters would run north if they were not dammed off. Our knowledge of the condition of the levels of the plain is very limited; but do we know enough to form any opinion as to the probable course of the river if it permanently left its present bed. ? Perhaps it is best to consider what the Chinees my about it, and soo if our own little knowledge
to phthisis, to beri-beri, or to old age--the latter being persons well over 60 and not a few approximately to 80 years of age. All of these diseases, with the exception of a few of the more acute types of beri-beri, are such as would enable the patients to get back to their own country, for which there are so many facilities, at a cost of a few cents only, had they any overwhelming desire to do so. As a matter of fact, the sick persons who are hurried back to their own country are, I should say, those who are suspected by their friends to be developing an attack of plague or of smallpox; the reason in such case being the rooted objec. tion of the friends to the disturbance and dis- comfort attending disinfection of the premises, or perhaps the objection of the patient himself to removal to hospital.
With regard to predisposing causes I am inclined to think that in the case of a disease, in which the mean annual death-rate is only 4 45 per 100,000, personal idiosyncrasies are of more moment than the habits of the community, but of these former I have no information. As, however, the habits of the community may throw some light on the fact that the Chinese in Hong kong enjoy a marked immunity from malignant disease, I may say that they smoke but little. in comparison with the European, they practically do not chew at all, and their diet consists in the main of rice with small quantities of fish or of pork, and that spices, per pers and hot chillies are not used by them to any appreciable extent. The Chinese "soy" or sauce, of which very little is used at a time, is a very mild aromatic liquid, having a slightly vinegary taste.
NOTES ON THE YELLOW RIVER.
A NEW BED: ITS POSSIBLE DIRECTION.
We take the following notes from a recent I. M. C. publication:-The general impression gained is that the Yellow River cannot main tain its present bed for another 20 years if nothing better than existing methods of control are used, It becomes therefore a matter of anxions interest where, under these conditions, the river will go when it takes up a new bed. It is well known that where a mountain torrens suddenly reaches a plain where its volume it reduced, it tends to deposit its load of detritus in the form of a cone, the apex of which is situated in the ravine from which the water rushes. Except in so far as the water is temporarily confined by natural dikes or by a temporarily scoured channal, the water had no
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