GEOGRAPHK ' DISTRIJl CTJOy OF B UBOyiC PLA G VE 107 



excreta of the sick, insects, and especially fleas and house flies, prob- 

 ably play an ini])ortant part in the spread of the disease. 



Dr James A. I^owson, who has written an excellent account of the 

 epidemic in Hongkong, says: "Filth and overcrowding must be re- 

 corded as two of the most important factors. The district of Tor- 

 pingshan supplied these factors in a marked degree at the beginning 

 of the outl)reak. the majority of the bouses being in a most filthy con- 

 dition, as owing to the uncleanly habits of the ])eople the amount of 

 what is generally termed rubliish accumulates in a Chinese house in 

 a crowded city to an extent beyond the imagination of civilized peo])le. 

 \\'hen to a mixture of dust, old rags, ashes. l)roken crockery, moist 

 surface soil, etc., is added fecal matter and the decomposing urine of 

 animals and human beings, a terribly insanitary condition of atlliirs 

 prevails." 



The period of incubation in bubonic plague, i. e., the time which 

 ela})ses between exposure to infection and the development of the 

 disease, is comparatively short, usuall}'^ from three to six days. 



From the report of Dr Lowson of cases treated in the various hos- 

 pitals of Hongkong under the control of English physicians, it ap- 

 pears that the mortality was much greater among natives of Hong- 

 kong than among the foreign residents of that city. The mortalit}' 

 among Europeans (11 cases only) was 18.2 per cent ; among Japanese 

 (10 cases), 60 per cent; among Portuguese ( 18 cases), 66 percent; 

 among Chinese (2,619 cases), 93.4 per cent. To a considerable ex- 

 tent, no doubt, this difference in mortality was due to the unfavorable 

 surroundings of the natives and their lack of proper nursing and 

 medical attendance, many of them being brought to the hospital in a 

 dying condition. 



Dr Lowson pays tlie following tribute to the trained female nurses 

 who assisted in nursing in the plague hosj)itals : 



"If ever this colony had reason to congratulate it?^elf it was wiien we were 

 able to procure well trained British nurses. I think tiic greatest compliment 

 that I can i)ay these ladies is to say that had it not been for their presence there 

 could have been no well run epidemic iiospital during last summer. Amateur 

 nurses at the beginning of an epidemic, or indeed at any stage where tliere 

 is a rush, are worse than useless, and multiply the worries of a medical otHcer 

 ikI infiniliun ; not only this, but all outsiders took care to give our hospihds a 

 wide bertli. When in the hospitals it was often a matter of dilliculty for the 

 meilical olliccrs em)tloyed to keej) their meals on their stomachs. It would have 

 been much harder if they had had to remain in constant attendance all the 

 time, as our sisters had ti) lin. Sniidlimx is iiad.liut there is something s|ircially 



