HEALTH AND HOSPITALS.
By the Hon. Dr. J. M. Atkinson, Principal Civil Medical Officer.
HEALTH.
|N the early years of the Colony Hongkong had an unenviable reputation for unhealthiness. Frequent outbreaks of malignant malarial fever occurred ; indeed, there is a record of such an outbreak in June of 1841, the first year of British occupation. In 1843, between May and October, 24 per cent, of the troops and ID per cent, of the European civilian population died of fever. In 1850, 136 men of the 59th Regiment died out oi^ a strength of 568. mostly from fever. Dysentery, also, has been extremely severe, especially in 1854. The death-rate in 1861 amongst the European and American residents was as high as 648 per 1.000. Hospitals were established, and, along with gradual improvement in sanitary matters, health conditions slowly improved, but. still, in 1871 the death-rate amongst the European and American residents was 303 per 1. 000. Prior to 1883 the sanitation of the Colony was under the control of the Surveyor- General and the Colonial Surgeon, and, owing to frequent changes in the incumbents of these posts, there was no continuity of action, and confusion reigned. In 1882, Mr. Osbert Chad wick was sent to inquire into, and report on, the sanitary condition of the Colony. One result of this was the establish- ment in 1883 of a Sanitary Board, and the passing of an ordinance to enable the Board to carry out the many sanitary improvements which were required. This Board was re- constituted by Ordinance 24 of 1887. It is an adisor>' and consultative body, and is composed of four ofiicial members, two members elected by the ratepayers, and four members (two of them Chinese) appointed by the Governor. It has an adequate staff, and such progress has been made that Victoria is now the cleanest town east of Suez. Owing to the conformation of the site on which the city of Victoria stands, with the hills rising rapidly from near the sea-shore up to a height of 1,860 feet, there was very little land near the harbour available for building purposes. At first, when the popu- lation was small and the houses were only one or two storeys in height, the available space was adequate. Hut when, with ad- vancing prosperity, the population increased, too many houses were allowed to be built ; the original one or two-storeyed ones were heightened without reference to the admis- sion of fresh air and sunlight into the rooms ; each room was sub-divided by partitions into cubicles, generally without windows, a family very often living in one of these cubicles ; and due provision for open spaces was not made. The result was that in the quarter where the Chinese lived great overcrowding occurred, and the areas and houses became extremely insanitary. Thus, in the native quarter all the conditions favouring the out- break and spread of epidemic disease were present. Small-pox has been endemic every winter, and occasionally epidemics have occurred. There was a serious outbreak in 1888, over 98 cases being admitted to the hospital during the winter of that year. Cholera has also occasionally occurred, but the worst epidemic disease which has attacked the Colony is plague. This first broke out in 1894, undoubtedly being intro- duced from Canton. Once introduced, it rapidly spread, and was responsible for 2,552 deaths in that year, Trade was greatly interfered with, and the outbreak is estimated to have produced a temporary exodus of 100,000 Chinese. It was in this epidemic of 1894 that the ftlngue bacillus was discovered by Professor Kitasato, of Japan, who had come to Hong- kong to investigate it. Later, Dr. Yersin made, quite independently, a similar discovery. Measures were immediately taken to com- bat the disease. In 1895 the resumption of one of the most overcrowded and plague- stricken portions at Taipingshan was com- pleted, illegal basements were done away with or were so altered as to be rendered legally inhabitable, back-to-back houses were prohibited, narrow lanes and passages were opened out, and other insanitary areas were resumed. The provision of an adequate amount of light and ventilation in Chinese houses was insisted upon, and a general concreting of the ground surfaces of all the Chinese houses was carried out with a view to the exclusion of rats. Although we have had the disease with us more or less every year since, the outbreaks in the last few years have been much less severe, e.g., the average yearly number of cases for the last three years has been 479 as against an average of 1,290 for the three years 1898 1900. It is an almost hopeless task to expect to stamp out plague entirely in Hongkong, seeing how liable the Colony is, from its geographical position, to re-infection from the neighbouring countries. The disease is now practically endemic in Canton, Southern China, Swatow, Amoy, Formosa, and the Philippines. Since 1899, as a result of the Anopheles theory of malaria, active anti-malarial measures were instituted. Nullahs have been drained, the breeding-pools of mos- quitoes have been done away with, swampy land has been sub-soil drained, and rice- tields have been resumed, particuliu'ly in the neighbourhood of the police stations, and lately, in connection with the Kovvloon- Canton Railway operations. By these means and by the prophylactic administration of quinine, the number of admissions for malaria to our two largest hospitals has fallen from an average of 1,036 for the five years 1897-1901 to 531 in the quinquennium 1902 6. There can be no question that the health of the Colony has improved very much of late years, and for Europeans living in European houses, especially at the Peak, this is now one of the healthiest of the British Colonies. The death-rate has fallen steadily since 1901, as will be seen from the following figures : — Total Non-Chinese. Chinese. Population. I90I ... 20-50 2377 2305
... 1546 2252 2212
One of the greatest difficulties in dealing with the Chinese is that they will not notify cases of infectious disease. They prefer to hide the case, and, when the patient has died, to watch their opportunity and "dump" the body in the street. This is no doubt due in large measure to the dread they have of the necessary disinfecting operations. The percentage of "dumped" bodies in 1903 was as high as 327. It is to be hoped that as the Chinese become imbued with Western methods they will become more enlightened in this respect, but this leavening process is sure to be a very slow one.
