26th February.
Ir the Municipal Council rises to a full conception of its duties in regard to the maintenance of the public health, it will open an Isolation Hospital for fever enses at once, even if the Town Hall has to be used temporarily for the purpose. We shall perhaps best preface our remarks by reprinting the following extract from the Municipal Health Officer's report for January Eleven cases of scarlet fever were notified and four deaths occurred from this disease, Until the present winter, 1893 has been the only year in which deaths from scarlet fever have been registered among the foreign population. Scarlet fever is, therefore, practically a new disease to Shanghai, and the exceptional incidence during this winter is probably due to introduction of the discase by foreign immigrants. As would be expected with a comparatively new disease against which evolution has afforded no natural immunity, scarlet fever has been of a virulent type among the native population. In England the disease has a comparatively trivial case-fatality of some 5 per cent, but in Shanghai 16 per cent of cases have terminated fatally among the foreign population. It is probable that the passage of the disease through the susceptible Chinese has led to an increase of intensity of virus. Although a large amount of disinfection has been done in houses, both native and foreign, where cases have arisen, this, as would be expected, has not limited the outbreak to any great extent, which shows the necessity for a pro-Both foreigners and Chinese, and for erly equipped Isolation Hospital for 1
means of compulsory isolation of cases among vagrants, and where means of isolation in private houses are insufficient.
"Among the Chinese population the number of deaths during the month was 631; being at the rate of 18 per thousand per annum, There were but seven deaths from smallpox. 120 deaths were attributable to scarlet fever."
Dr. Stanley, it will be seen, dwells upon the necessity for "a properly equipped Isolation Hospital for both foreigners and Chinese, and for means of compulsory isolation of cases among vagrants, and where means of isola~ tion in private houses are insufficient." There are a large number of foreigners in Shanghai living in houses spacious and commodious enough to allow of isolation being properly carried out if an inmate of the house is attacked with scarlet fever; but) there are a very large number of foreigners whose means do not permit them to carry out the necessary isolation, and the constant increase in rents here makes this condition every year more prevalent. The people who live in small houses, people not poor but in moderately comfortable circumstances, with limited sleeping accommodation, cannot possibly properly isolate a member of their family who is attacked by an infectious disease. The only resource is the General Hospital, which is not designed to receive infectious cases, and which is constantly crowded. The lowest charge at the General Hospital is $1.75 a day; a scarlet fever patient Tequires isolation for six weeks; which involves an expense that people of moderate means find it impossible to meet. The consequence is that the patient has to be treated at home and becomes inevitably a source of danger to the whole community.
This is the main point; isolation is of no benefit to the patient: it does not accelerate his cure or add to his comfort; in fact, most sufferers would much rather b left in rheic own homes than taken off to a_hospital, however well appointed. Isolation is prescribed as a safeguard to the community; and it is therefore the community, whose representative is the municipality, that must make the necessary provision for isolation. The ratepayers must face the duty in their own interest, and recognising as they must that it is in their interest to do it, they may confidently be called on, as in the past, whenever danger menaces them. Steps should be taken at once to op: n and equip a temporary hospital; no doubt to use the Town Hall for this purpose would be an extreme measure, but it isa measure that must be taken ifuo other place can be found. What is imperative is thatan Isolation Hospital shall be provided as promptly as possible, unless the Health Officer can assure the Council that the epidemic of scarlet fever is disappearing.
So far we have only dealt with foreign fever patients; what is to be done with the large number of native cases is a more difficult matter. At any rata, it cannot be right to do nothing. There are, we know, g difficulties in the way of isolating natives attacked with an infectious disease in such a densely populated city as the Foreign Settlements now are; but it is this density of the population that emphasises the necessity for isolation, Wede not doubt, however, that the able Secretary of the Council and the Health Officer, in consultation with the Mixed Court magistrate and the heads of the principal Chinese guilds, can soon elaborate a working plan. Recent events at Woosung have warned us again that we cannot be certain of successfully warding off the plague for an indefinite period, and it will be a good thing to get into working order a system that will be forced on us if the plague should get a footing here in Shanghai.
@utports, Ete.
Text read from the printed page and cleaned; old type leaves the occasional error.