Miscellaneous- 



110 



[June 1907. 



8^Sy^S Sa8Peeted dogs and other animals should be firmly tied up and kept under 

 observation, or they may be killed by shooting them in the head, their spinal cord 

 or a portion of it removed, placed in a bottle containing glycerin, and sent to the 

 nearest laboratory to be examined as to the exact diagnosis. All uncared for 

 animals should be shot for an area of about ten miles round the focus of the disease. 



In the unfortunate event of one being bitten by an animal doubtfully mad, 

 the patient should be sent to Saigon or one of the Indian Pasteur Institutes, with a 

 piece of the spinal cord of the animal which bit him, for confirmation of the fact of 

 madness, and, if confirmed, for treatment. The reason for taking the cord is that 

 some animals show very rapidly the effect of the poison, and the disease can be with 

 certainty diagnosed by injecting them, and treatment rapidly started. 



Hospitals.— Under the Labour Code which deals practically exclusively 

 with Chinese, sec. 79 lays down " That the resident may order an hospital to be 

 built, and a dresser engaged provided not less than fifty labourers be employed." 



Under the Indian Immigration Enactment Rules, "Hospital accommodation 

 of eight beds for every one hundred is required, they should be under the charge of 

 a resident and qualified apothecary." The dimensions, floor-space, etc., are all laid 

 down, it will therefore suffice if 1 express my fixed opinion that the appointment of 

 a qualified resident apothecary is most advisable in every hospital in this country 

 if good work is to be done on estates. 



I have seen every slass in charge of the sick I think, and the more I see of the 

 estates which endeavour to economise on their medical department, the more 

 convinced am 1 that it is folly of the most superior brand. I much regret that I 

 have yet to meet the dresser, on $30 to $50 a month, who is dependable for a diag- 

 nosis ; returns one can obtain galore, but they wither under the light of day. The 

 differential diagnosis between, say, malarial cachexia and Bright's disease, and 

 anchylostomiasis (with which you are now I trust familiar) are of the utmost import to 

 the future of an estate ; and again the separation of plague from venereal bubo with 

 fever, small-pox from chicken-pox, typhoid from a simple diarrhoea, and cholera 

 from ptomaine poisoning, and a host of similar cases which may require prompt 

 recognition, must surely prove my point, that the dearer article is the cheaper. 



In my opinion the most important point in dealing with the health of 

 estates and large works is the instant separation of the sick from the healthy. No 

 sick coolie should remain one minute in contact with his sound fellows, certainly 

 not one hour, and to leave him one day is criminal. With the able assistance of 

 Mr. Wilkinson— both of us I may mention working under difficulties— I introduced 

 on the Krian Irrigation Works a system of prompt segregation of the sick, with a 

 view to stamping out the infectious dysentery which played havoc amongst the 

 coolies for a time. The method adopted was : At each lines we established a small 

 isolation shed of from four to ten beds, if any coolie complained of dysentery, or 

 diarrhoea he was immediately sent to the shed, the furniture consisted of beds, 

 chamber-pots, blankets, tinned milk, and cups, an attendant had charge, and all 

 motions were kept for inspection by a dresser or the medical officer. 



The system which was directed against dysentery would work equally well 

 in other cases, and malingerers, diarrhoea, and typhoid cases could be " spotted 

 with some approach to accuracy. If the system be carried a step farther it 

 becomes applicable to all forms of disease, all that is necessary being a shed with 

 partitions for those who complain of different diseases. Please do not mistake me 

 when I speak of these diagnosis sheds, they are not intended to be expensive 

 hospitals, but rather filters for the hospital, and merely resting places as substitutes 



