In all 122 camps, including approximately 58,000 refugees have been supervised during the month. "At the commencement of hostilities the sanitary condition of some of the camps was definitely bad, but, as the number of camps increased, overcrowding became less neue and sanitation could be carried out with some degree of Permanence. In one of the largest camps a temporary hospital was established, which proved very useful.
Shallow wells were abolished, any suspicious water supply was bacleriologically examined, fly extermination measures were set afoot, and particular attention was pald to commode coverings.
Halt kerosene tins were obtained, filled with a solution of eyllin, placed of latrines, and the reinstructed to' rinse their hands after using commodes, ete.
Perhaps the most striking feature of the refugee problem is the uncomplaining fortitude with which the refugees bear their burden, Medical Laboratory.
A total of 5,208 specimens includ ing 138 sera for Wassermann and Kahn Tests were examined which involved 6,807 separate exanimations, This number of specimens exceeds any previous total by more than 1,500. Cholera and dysentery with 2444 and 2,087 examinations resspectively account for the major proportion of the work done.
Intestinal Infections all showed a markedly increased incidence.
Typhold—20 positive diagnoses were made; 18 by blood and two by stool culture. This is approximately three times the August figure in spite of the number of specimens being reduced by 60 per cent.
Dysentery—Bacillary dysentery shows a sharply rising Incidence curve, 215 cases being diagnosed this month as against of in August Pact. flexneri accounted for over 95 por cent. of all eases, Cholera—From 2444 specimens examined, Vib. cholera. was isolated 142 cases. 'A proportion of the specimens were from contacts and onvaleseents; from the remainder bolero: vibrios were isolated bout 60 per cent. of cases: Both the humber of specimens received and the proportion confirmed. as true bolero declined towards the end {he month From. numerous cages throughout the epidemic, only agglutinable "vibrios "were isolated, 'A few. cases of mixed" cholera and iacitiary dysentery were detected.
Diphiherla~50 cases were da-mosed. from 196 specimens The Increased incidence normally Derlenced during. the Autumn and Winter months has already come Malaria—No increase noted, only ten infections due to Plas. vivax and two due to Plas. falciparum were found.
Deep Well Waters—Seven samples were examined of which one was found to be below standard, Milk Products—Five ice cream specimens were examined for sence of cholera vibrios. All were. negative, Anti-Rabie Instityte—48 persons, including 44 from the Settlement, two from the Shanghai City Govern: ment area and two from Outports called for advice, cauterisation and/or treatment, and in 47 eases treatment, was advised. 12 received a full course of treatment, 28 a precautionary course, whilst six falled to complete the treatment advised and one Fefused to be treated.
The 44 cases from the Settlement were in contact with and/or bitten by 39 dogs, a cat, a rat and one human case involving three contacts, 20 dogs were privately owned, the remainder being stray animals, Vaccine-—The following vaccines were issued free:—smallpox 16275 doses and cholera 92,909 es, Vital Statistics, Foreign Deaths,—33 deaths were recorded and the death rate was 0.96 per mille, Chinese Deaths—The Chinese death rate of 6212 per mille 4s the highest {in the annals of the Department. Of 6.103 deaths recorded, 4483 (73 per cent) were exposed corpses, of which a large proportion were refugees and no less than 8,007 were children. The bodies had been dumped on vacant plots of land for collection and burial by the Shanghai Public Benevolent Cemetery, whose assistance has been invaluable, Of the 1,670 other deaths recorded, the major causes were cholera, dysentery, and typhoid fever.
The death rate for communicable lscases was 5.63 per mille as com pared with 1.30 in August.
Communteable Diseases General—Diseases of the alimentary group such as cholera, dysenteries, and typhoid fevers chowed an Increase over August, as did also diphtheria and measles, Rables—Two deaths were reported during the month, a British male aged 41 and a Chinese male aged 17. Neither had received any treatment.
Cholera which broke out in Shang-hal on August 30° was declared epidemic within the "International Settlement on September 8 The Incidence increased rapidly and Teached its peak during the week. ending September 18,
Text read from the printed page and cleaned; old type leaves the occasional error.