There is a degree of modesty about the Public Health Department's report for July, which while eminently proper, may tend to} Jdiminish in the public eye the really excellent work which that department has been carrying on, especially with regard to the extraordinary conditions brought about by] the prolongation of hostilities. The state of]
fairs created last August, with the enormous influx of refugees into the foreign areas, had a very definite effect upon the health conditions prevailing in the French Concession land the International Settlement. These remarks are more particularly confined to the latter. Many thousands found asylum in the! different refugee camps, others with funds, Jor relatives and friends, found homes in various families or hotels, a number succeeded in squatting in premises which they should rot have been allowed to occupy, while an leven greater number found what shelter they could in the various alleyways, or even on the pavements of some of the principal thoroughfares. It is impossible to give exact figures showing what this influx amounted to, but it is fairly safe to suggest that during the past year the International Settlement has been harbouring about twice the number lof people it would cater for in normal times. [This should be remembered when endeavour ing to estimate the seriousness of the cholera continue to be faced with problems inherent in the situation which the hostilities in China have created. It may reasonably be expected that there will be no great diminution of the Settlement's surplus population during the next few months, for many of the refugees will not be anxious to return to the places which were their homes, until a greater degree of security prevails in the environs of Shanghai, while olfiers, even if they wished, are probably without the means to return and resume their former occupations. Many of them have already spent their small savings, and, when the time comes, one of the problems will be to provide them with means of going back and earning their lyings. It is consequently not to be expected that there will be any decrease in the demands made upon the department in the immediate future, and, should the cold weather bring with it its own particular problems, it may be fully expected that present large demands upon it will be continued. There has been so much criticism of the municipal service, chiefly for political reasons, that these facts deserve to be emphasized. The record of the Public Health Department is a particularly striking one, but the manner in which the various other departments have met the singular difficulties arising from the hostilities, is, something of which the ratepayers may well be proud. to be an important factor in the matter, for! if she were to take action automatically, with full clan the dangerous long war" could arise. But there are strong ob-Jections. France's mobilization requires much time that in the interim the fate of Prague might be decided. Whether after an accomplished fact, after the lightning occupa tion of Czechoslovakia and with a completely mobile army, with victories already behind it, the French people without being, threatened, could be had for such a fearful war, merely for the restoration of a destroyed Czechoslovakia, must be a matter of doubt."
Russia the colonel regards as of no particular account, and his general theory is that if within the space of fourteen days or so Czechoslovakia could be destroyed, France [would take no action, The assumption may or may not be correct, but whichever way! France might decide, it is clear that the author is inclined to take a gamble on short successful war, against a prolonged one the result of which might be entirely differ~ ent. On the face of it the element of surprise would be an enormous advantage to the attack, but in all such elaborate schemes such as this a breakdown in the timetable is a breakdown in the whole scheme. The! Invaders of Czechoslovakia would have to eliminate immediately all resistance groups tu which he refers: they would have to bring about the complete subjugation of the country within the space of two weeks, and 1 [the forces at the disposal of the Czechoslovaks suggest that Col. Conrad takes somewhat of an optimistic view of the possibilities. The operation against Czechoslovakia [would have to be substantially over and the German march to the West complete in principle by the end of the French mobilization. In other words the whole scheme would have to be completely successful before France got under way.
It is indeed remarkable how the theory of the lightning military blow still finds so much favour in some quarters, and that despite the experience of recent years. General Franco's failure to capture Madrid is largely responsible for the present long drawn out] campaign. The suddenness of his original stroke very speedily lost all its value, and fa long drawn out misery has resulted. There is nothing to suggest that the Czechoslovak farmies could not put up a very stubborn resistance, and well-equipped and well-commanded as they undoubtedly are, the idea that they would be overwhelmed and crushed in so short a time seems to be the height of optimism. The chances are that, even if the author's scheme proved successful, only the commencement of a great European war} would have been ushered in. The world is] becoming somewhat fired of these fairs accomplish, and there are certain schools of political thought which do not pay so much attention to immediate results as to final settlement. The preparations undertaken by at least some of the countries in Europe suggest that they have in view prolonged hostilities. That at least is apparent from the recent developments in Britain, and the danger of the short. sharp victory is that it] may be the prelude to a long drawn out struggle which may very well end in defeat. But that is not the only consideration. Herr] Hitler's doctrine must be taken as one of the [causes for much of the insecurity which pre-yalis throughout the world; the sun of {friendship might be smiling in Berlin, while the gloom of warfare might simultaneously darken countries who up to that fell moment might conceive themselves to be at peace. It would not be prudent to believe that the lightning thrust cannot succeed, but it has failed in the past, is becoming more difficult] to administer, because of the intricate points it involves, and is consequently in all the jereater danger of failing. Germany is not] prepared, on the authors own admission, to meet all' the consequences which might follow the collapse of his scheme in the country against which it is aimed.
Jepidemic, for while the number of cases looks undoubtedly large when compared with the normal population of the Inter-ational Settlement, the figures only appear jin their proper perspective when considered in relation to the temporary and permanent populations which are at present to be found hhere. For this reason the department is probably quite correct in saying, as it does in the report, that "the suggestion that the epidemic has become uncontrollable is hardly warranted if a careful study be made of similar towns in the Far East which have been affected by cholera, where if due allowance is made for population factor, epidemics of practically equal severity have occurred—even during times when services were not dislocated."
With the outbreak of summer diseases the Settlement was faced with a lack of hospital accommodation. A considerable expansion lof hospital units was necessitated, a circumstance which was not rendered easy owing to the fact that hospitals were not available land temporary accommodation had to be! availed of.' Some of this was in unsuitable buildings, and the expansion of structures into suitable hospitals rendered the task of dealing with the epidemic by no means easy. [Nevertheless it was possible to arrange that! 1,000 eds would be available, and, at any rate for the time being, these appear to be sufficient to deal with the cases which occur.
It is not easy for the average layman to appreciate the enormous amount of organiza~ tion which such a feat necessitates, for it is not only @ question of preparing the accom modation, but of maintaining it at such a pitch of efficiency as to enable it to cope satisfactorily with the demands made upon it. Figures do in some instances give an idea of what the demands upon the Department! during July must have amounted (0, Thus for the month of May, the pathological laboratory examined 6,600 specimens. The following month the total had zisen to 7,431, and in July no fewer than 8,880 specimens had to be dealt with which amounted to a daily average of somewhere in the neighbourhood of 280 specimens a day. In the Chinese Isolation hospitals bed accommodation had been increased from 600 to 1,000, 2,291 clini~ cal cases of cholera were admitted, and no fewer than 179,678 inoculations against cho-Tera administered, or something around 6,000 day. These are imposing figures. The work of dealing with 290 specimens a day, and making sure that identity between specimen and patient was completely pre~ served by adequate check is in itself no small task, and it speaks well for the department} thatthe work of such importance has been'
efficiently handled. Despite the handicaps under which the work has been carried out} the cholera situation appears to have been' kept well in hand, and there is nothing to suggest that the epidemic has at any time! become uncontrollable, or that it is likely to do in the future. Indeed with the improvement of climatic conditions some improvement may be expected.
It is as well that this great work which the Public Health Department is doing should be recognized at its full worth. Had it not been faced with all the limitations arising {from the plight in which Shanghai at present finds itself, the work would have been excellent and worthy of the highest praise, but when all the circumstances are taken' into consideration it is difficult to find words with which to commend properly the achievements of the past month. The Department has been the butt of considerable criticism during the past few months. This journal is not prepared to admit that all of it was unjustified, but when the major preoceupations of the department are taken into consideration, there is ample ground for suggesting that it has been doing all that it possibly can, and, what is more, doing it with an' efficiency so amply demonstrated by the results. It will still
Text read from the printed page and cleaned; old type leaves the occasional error.