By the end of April, the government in Hong Kong requested Dr. Alexander Rennie, the consular surgeon for Canton, to report on the disease.

[2][3] The outbreak also coincided with the replacement of junks with steamships, which made travel between infected ports faster and more convenient,[5] and the return of Chinese celebrating Qingming Festival from Guangzhou to Hong Kong.

[6] On March 2, 1894, a large Chinese procession was held in Hong Kong, which involved the arrival of 40,000 laborers from Canton.

[7] The Chinese-majority Tai Ping Shan district, where the first cases appeared,[8] was characterized by having poor ventilation, drainage and sanitary services, and was overcrowded.

[9] In 1880, Colonial Surgeon Dr. Philip Burnard Chenery Ayres reported that, while he was investigating the sanitary conditions of the Chinese, "many and many a time have I come out of the houses to vomit in the street, in spite of using strong scents and essences to prevent it," and he warned that "while this state of things continues we stand in danger of being visited at any moment by some fearful epidemic, and I do not think the most advanced sanitary authority at home would combat this opinion.

[11] The summer of 1894 saw Hong Kong suffering from a dry spell, which did not wash away the usual house refuse accumulating on the streets.

[12] The first case was discovered by Scottish doctor James Alfred Lowson, acting superintendent of the Government Civil Hospital, on May 8, 1894.

[19] On May 11, legislation was passed to make the reporting of cases compulsory, and to allow authorities to enter houses to search for and remove infected persons for isolation.

[24] During an inspection, the occupants were given new clothes, and sent to temporary lodgings on Chinese boats anchored off Stonecutters Island[25] or to government-hired buildings, including the Alice Memorial and Nethersole Hospitals.

The house was then sprayed with a solution of perchloride of mercury or fumigated by chlorine gas, the floor and furniture cleaned with Jeyes Fluid and the walls lime-washed ("whitewashing").

[24] At the time, Chinese residents of Hong Kong had a deep mistrust for Western medical science, making the containment of the plague difficult.

[26] The Chinese would hide their sick from the authorities,[21] and infected bodies would be thrown out at night to avoid detection.

[25] The western practice of using ice to cool down a fever was rejected by the Chinese, who viewed extreme cold as damaging to the body.

[31] Members of the Chinese community continued to petition Governor William Robinson to halt the cleansing operations completely, and to allow patients to travel to China to seek treatment.

Robinson responded by moving the gunboat HMS Tweed to Taipingshan and offering a reward for information leading to the arrest of the poster distributors.

[21] Whitewashing could only continue after a great deal of persuasion and explanation by both the government and some esteemed members of the Chinese community.

[20][21] When patients were removed according to the policy from Tung Wah Hospital to Hygeia, violent protest erupted in the city.

[22] The plague saw a mass exodus of panic-stricken Chinese workers back to China, causing a significant economic downturn in the city.

[44] In June, Robinson reported to Secretary of State for the Colonies Lord Ripon that "without exaggeration I may assert that so far as trade and commerce are concerned the plague has assumed the importance of an unexampled calamity.

"[45] On May 31, a bylaw drawn up by the Sanitary Board allowed for the eviction and closure of houses deemed unfit for habitation.

[50] This drastic measure called for, as described by Robinson, "the destruction and rebuilding of one tenth part of Hong Kong.

Areas such as Bowrington (now between today's Wan Chai and Causeway Bay), Sai Ying Pun, Shek Tong Tsui and Kennedy Town saw more deaths than Taipingshan.

[53] Internationally, steamships from Hong Kong carried the bacillus to every major seaport in the world,[1] including to India.

[17] For example, the decision by the colonial government to place patients on ships and to demolish houses were, in part, influenced by the miasma theory.

[27][34] Lowson speculated on the origins of the disease as "poison is probably developed from atmospheric conditions underneath houses in certain districts, and that it is caused simply by poverty and dirt.

[65] At almost the same time, on June 15, French-Swiss bacteriologist Alexandre Yersin, a member of the Pasteur Institute working in Saigon, arrived in Hong Kong.

[67] Some historians consider the plague as the starting point of the colonial government's direct involvement and interference of the Chinese community of Hong Kong.

[47] Tung Wah Hospital, where Chinese medicine was originally practiced, was at first considered to be a menace to public safety by the colonial government.

The ordinance, regulating the designs and sanitary conditions of tenement blocks, was drawn up according to recommendations by Scottish physician William John Simpson, who observed the plague in 1902.

Headed by Scottish bacteriologist William Hunter, the institute was used for post-mortem and bacteriological examinations, along with the development of vaccines.