HONG KONG.

841 the entrance to the staircase. They are worked from the the cases. In 1885 the number of patients treated in it was subway, so that any one, or all, may be used as required; 1967, and the deaths amounted to 1006. But 283 were and the arrangements are such that they can not only be moribund on admission; if these be deducted, there still worked, but even started, without any of the noise hitherto remain 723 deaths in 1684 cases, or 42 9 per cent. " The always associated with this means of heating. This was chief reason for the great mortality in this hospital is that done during the visit of the Prince, steam being introduced most of the patients when admitted are hopeless cases, the cold pipe while he was in the ward with- Chinese having a great antipathy to going into hospital at into the out any noise whatever. As the whole of the outside wall all except in the last extremity, or in case of utter destitucan thus be uniformly heated without any disturbance to tion." Mr. Ayres, the colonial surgeon, calls attention to the patients, it is considered that in this point also a very the lamentably defective state of sanitation in Victoria, the great advance has been made. In the matter of ventilation, subsoil of which " is steadily being poisoned by sewage," and besides the advantages offered by the form of the ward, to the difficulty of getting even European house-owners ta. and the eighteen large windows, each with deep-bottom undertake the necessary sanitary measures of improvement. frame, so as to admit air between the sashes at the middle With regard to quarantine, he believes it to be perfectly of the window, Ellison’s conical ventilators have been intro- useless in excluding cholera, even if it could be properly duced below the windows between the beds; while over enforced. " What we have got to do," he says, "is to look each bed, eight feet from the floor, a Sheringham valve at home, and not prepare a hotbed for the reception of has been placed. Around the central block at the ceil- disease, as a gardener does for mushrooms." Malarial diseases, ing level exit openings for the air have been inserted, fevers and bowel complaints, are the most prevalent, and the flues from which ascend in the inner wall of the are followed in many instances by severe anaemia and day-room, or sun-room, above, and thence proceed to serious deterioration of health. It is evident there is much the upper part of the central ventilating flues. By these required to be done to put the town in a decent sanitary the warm air in winter will readily make its way out. condition. Till that is accomplished, "it is reasonable to The arrangements for ventilation in summer are very per- expect that the colony will become every year more and more fect. At the floor level eight horizontal flues are provided, liable to an epidemic of cholera....... A more plentiful which run inwards below the stair to the bottom of the supply of water may do something to retard the evil day, but ventilating chamber, which surrounds the central smoke nothing short of a general conflagration in China town is flue. This is annular in form and over thirty feet in height, likely to avert it." The colonial medical staff is still kept and contains a series of four coils of steam pipe, each of down at starvation point, and is obviously insufficient for different size, all worked separately from the subway. By the duties required of it, especially in the event (by no these means fourteen different amounts of heating surface means improbable) of even one of its members falling sick. can be obtained in the flue, and it is hoped that even on the We trust that the question of an increase to its numbers warmest summer day the column of air in the ventilating may receive the favourable consideration of the Colonial chamber, thirty feet in height, may be warmed to such an Office. extent that it will ascend and draw the air through the ward at a rate sufficient to keep the air pure and the ward well ventilated. In Dr. John S. Billings’ work on the Principles of Ventilation and Heating (New York S‘anitar,y Engineer), attention is drawn to Professor Troubridge’s investigations on the determination of heating surfaces LOCAL GOVERNMENT DEPARTMENT. required in ventilating flues, and descriptions are given of the arrangements in the Columbia College and the Johns OF THE MEDICAL DEPARTMENT Hopkins hospital, but in neither of these does there seem REPORTS OFOFINSPECTORS THE LOCAL GOVERNMENT BOARD. to be the necessary power of varying the amount of heating surface according to the external temperature, which is Scarlet Fever at Atherton, by Dr. PARSONS.-The average provided in the ventilating flues of the wards of the annual death-rate from scarlet fever between 1876 and Victoria Hospital. 1885 at Atherton, in Lancashire, amounted to 1’40 per 1000 of the population, whereas it was only 0.55 for England and Wales. The total mortality and the infantile mortality HONG KONG. are also excessive; and measles as well as scarlet fever tend THE report of the Colonial Surgeon at Hong Kong for to recur in an epidemic form every five years. The scarlatina 1885 shows it to have been a very unfavourable year for the spread immediately under consideration was largely due to foreign residents, 3040 in number. The death-rate among the free intercourse between households infected and those them was higher than in any of the nine preceding years, as yet uninfected, the parents looking upon scarlet fever as and amounted to 32’56 per 1000 living; among the white a thing that everyone ought to have, and therefore the The wearing of infected sooner it was over the better. troops it was 15’27, and for the rest of the European and clothing at the mills and participation in large funerals also American residents, 42’57. We are, however, without any had a share in producing spread of the disease. The arrangeinformation as to the composition of the latter in regard to ment of the houses, opening as numbers of them do on to age. The high rate of mortality among the troops, greatly common back spaces, and the use of common privies, also above the average of the preceding five years, was due to an tended to the extension of the infection; and badly kept, outbreak of cholera, which caused half of the deaths. The ill-paved yards, together with inadequate ventilation of source of the disease could not be traced. No cases occurred houses, were found amongst the insanitary conditions which among the police or in the gaol, and only nine were received doubtless tended to increase the severity of the disease. The into the Government Civil Hospital, of which six proved attempt, during a previous epidemic, to secure isolation in fatal, three being destitute European seamen, and three a cottage hired for the purpose failed, although admission Chinese. The admissions into hospital of the white troops was free ; but this failure was, perhaps, in part due to the fact that the mothers of sick children were not admitted. It were 886 per 1000 of the strength, considerably under the average of the preceding five years; those of the black troops has very generally been found that, the admission of mothers were 1173, and the deaths 20’46 per 1000 in an average is not a serious inconvenience, since they are, as a rule, ready strength of 173 men. In the police force the death-rate of to go out and leave their children directly they find that the Europeans was 26 0, of Indians 5’5, and of Chinese 13’2 per isolation arrangements are comfortable. In the absence of 1000; but the numbers employed are too small to justify isolation, disinfection, though assiduously carried out, proved any positive deductions from these results. The daily of little value, and, as Dr. Parsons observes, the reduction average number of prisoners in the Victoria gaol was 530, of scarlet fever in districts like Atherton must be sought the admissions into hospital were 255, and 42 were treated in mainly in the instruction and enlightenment of the people their cells, making a total of 297 cases, of which two died ; themselves. Although there has been some sanitary these numbers give a ratio of 560 cases, and 3’77 deaths per progress in Atherton during the past ten years, yet nume1000, a result which compares very favourably with the gaol rous defects still remain, and faults of house-drains, statistics of India. The Tung Wa Hospital, " which is together with the mischievous form of midden-privy which entirely managed by Chinese directors and doctors," con- has long been such a common source of nuisance in Lancatinues to furnish an enormous death-rate in proportion to shire, are among the most prominent that call for immediate

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