The area under the control of the Board comprises the Island of Hongkong containing 32 square miles, with a sea frontage of 13 miles in length. Included also is the old city of Kowloon which is situated one mile and a third across the harbor and contains two and three-fourths square miles. The city of Victoria on the northern shore of the Island of Hongkong has a sea frontage of 5 miles, contains about ten thousand domestic buildings, of which about one thousand are non-Chinese.

The population of Hongkong is difficult to estimate, as the floating population is so great. In the 1912 census there were 446,614 Chinese and 21,163 non-Chinese.

The city of Victoria is divided into 10 Urban Health Districts and old Kowloon into 2. There is an inspector in charge of each. These districts are built over an area averaging from 31 to 140 acres. The houses in these districts average one thousand and the population from 8000 to 33,000. There are four inspectors in charge of the scavenging work, one for the disinfection stations in Victoria and old Kowloon, one for the cemeteries and two for general duty.

The measures employed by the Sanitary Board are summarized as follows:

  1. The exclusion of rats from all dwellings by means of concreted ground surfaces, the protection of all drain openings and ventilating openings by iron gratings, and the prohibition of ceilings and of hollow walls in new buildings and in those existing buildings from which they have been removed by order.
  2. The collection and bacteriological examination of all dead rats. Facilities for the collection of rats in the quarters are provided in the shape of small covered bins attached to lamp posts, telephone posts, electric light poles, etc. These bins contain a carbolic acid disinfectant, and the inhabitants are invited to at once put into them all rats found or killed by them. There are 650 of these bins distributed throughout the city and its suburbs, and each of them is visited twice daily by rat collectors who take all rats found by them to the City Bacteriologist. Each rat is at once labelled with the number of the bin from which it is taken, and if subsequently found to be plague infected, a special survey is immediately made of the block of houses in that vicinity. All rat-holes and rat runs are filled up with broken glass and cement, defective gratings and drains dealt with, and rat poison distributed free to the occupants. If several plague-infected rats are found in one locality, a special house-to-house survey and cleansing of that district is made.
  3. The destruction of rats by poison, traps and birdlime boards; special efforts in this direction being made just before the onset of the regular plague season which is in the months of from March to July.
  4. The encouraging of the community to keep cats.
  5. The systematic cleaning and washing out of all native dwellings at least once in three months with a flea killing mixture made by emulsifying kerosene in water.
  6. An efficient daily scavenging of all streets and lanes and the daily removal of refuse from the houses, coupled with the provision of covered metal dust-bins, to reduce as far as possible the amount of food available for rats.
  7. The disinfection of plague-infected premises by stripping them and washing them out thoroughly with a kerosene emulsion. The bedding, clothing, carpets, rugs, etc., are conveyed in a huge covered basket to the disinfecting plant and sterilized with superheated steam. No objection is made to the treatment of plague cases in native hospitals, and no restrictions are imposed in regard to the burial of those dead with plague except the provision of a substantial coffin.
  8. Every effort is made by means of lectures, addresses and explanations to induce the native population to participate in the above preventive measures.

Upon my last visit to Hong Kong, in July last, plague was abating. The South China Morning Post of July 15, 1914, contained the following statement:

Plague is gradually disappearing from Hongkong. Last week's return shows that there were 26 cases, of which 19 were fatal. All were Chinese. The total number of cases for the current year to date is 2093, with 1939 deaths resulting.

I regret that circumstances do not permit me to relate in detail the work done and the observations made during the closing six months of the Manila epidemic.

Up to the day of my departure from the Philippines, in July, 1914, I remained in charge of plague suppression, but the added duties of administration at San Lazaro Hospital and the coincident occurrence of a cholera epidemic prevented me from keeping a detailed record in such form as to permit reproduction here. It will therefore suffice to say that the first six months of 1914 witnessed the passing of the most threatening situation that has confronted the city of Manila in years. The record of plague rats found does not convey an accurate idea of the prevalence of rat plague by any means, for the simple reason that, when found, the rat cadavers were in such condition as to forbid bacteriologic examination; and inasmuch as the bacteriologic test of plague had been used exclusively in determining rat plague up to this time, it seemed desirable to adhere to the original method.

In February we found in one of the districts, in which we undertook systematic work in consequence of a few cases of human plague, a very large number of dead rats, in and adjacent to houses which furnished human plague cases. In one building alone more than 150 rat cadavers were found during our cleaning and rat-proofing operations. It is this district concerning which the letter to the public (already quoted) was written.