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(2.) In addition to this there were 5,264 out-patients attended to during the year, this includes the minor surgery cases treated in the Receiving Ward; these were principally scalp wounds, lacerated and contused wounds, dog bites, &c.
(3.) Out of the total number of in-patients 89 were females an increase of 21 as compared with last
year, 5 of these were difficult obstetric cases all requiring instrumental assistance.
It is to be re- gretted that the Chinese women do not seek assistance earlier, when they do come it is simply as a last resource. Now that we have a competent Chinese amah in charge of the native female ward-a nurse who was well trained at Dr. KERR's hospital in Canton-I should not be surprised if more Chinese women avail themselves of the advantages of skilled hospital treatment.
(4.) There were 67 less Police admitted than during the previous year further on examining the different nationalities it will be seen there was an increase of 19 European, a diminution of 49 Indian and of 37 Chinese Police.
I regret to have to record the deaths of 5 European Police from remittent fever of a par- ticularly malignant type.
During the past year there has been a greater prevalence of malarial cases no doubt a result of the severe rain-storms of last May.
The enormous down-pour of rain washed down great quantities of alluvial soil from the many landslips which occurred on the hillsides, this being deposited on the lower levels with the high tem- perature and the excessive humidity gives all the conditions necessary for the evolution of malaria.
(5.) There has been a remarkable immunity from cholera, and epidemic diarrhoea.
(6.) Dysentery contributed 124 cases, more than twice as many as in the previous year, with 9 deaths giving a mortality of 7-25 per cent. as against 9-26 last year. There is no doubt that dysentery and malarial fever are intimately connecte as to their causation, the increase during the past year being coincident with the increase in malarial fever cases bears this out.
(7.) Malarial fever contributed 423 cases as against 371 last year with 10 deaths giving a mortality of 2.36 per cent. This disease was much more fatal this year, the remittent cases being of a parti- cularly malignant type.
By far the greater majority of these cases were of the intermittent type viz.: 384 out of 423. I classify all those as intermittent in which with an initial high temperature often as high as 105° F. or 106° F. the temperature falls on the next morning to 99° F. or just above normal. In our treatment of these cases we have found the best result from the administration during the stage of fever of antipyrin in 10-grain doses repeated every hour until the temperature falls to within a degree of normal; this result is generally obtained after four or five doses, if the bowels have not been open in the previous twenty-four hours before giving the antipyrin one of Livingstone's powders containing 4 grains of calomel, 5 grains of quinine and 20 grains of compound Jalap powder is administered. As soon as the temperature has fallen quinine is administered in 5-grain doses every hour the result generally being that the temperature does not rise so high by 2 or 3 degrees as in the initial paroxysm of fever.
If we find the temperature is not kept down to this extent by these doses of quinine, after again giving the antipyrin as before, on the following morning after the fall has occurred quinine is given in 10-grain doses every hour and there are very few cases in which the fever does not succumb to this treatment and in from five to six days the patient is practically convalescent.
We have not lost one case of intermittent fever during the year.
Antipyrin certainly seems very efficacious in these cases, it promotes free perspiration and under its administration the temperature falls much quicker than when diaphoretics or other antipyretics are given.
In many mild cases in which the temperature only rises to say 102° or 103° F. in the initial stage a combination of antipyrin and quinine in the proportion of 8 grains of the former to 5 grains of the latter given every 4 hours is all that is necessary, the fever often succumbing to this treatment in three or four days.
Notwithstanding the large doses of quinine, in many cases as much as 2 drachms being given in the twenty-four hours, very few bad effects are produced and then only in a few cases tinnitus or slight deafness.
In the remittent type the patient is always much more prostrate, there is generally bilious vomiting present and the temperature does not fall more than a couple of degrees notwithstanding the hourly administration of antipyrin.
These cases during the past year have been of a peculiarly malignant type the nervous symptoms were much more marked and the temperature rapidly rose to as high as 107° F. or even 108° F., and in some cases 108 6° F. was registered, urgent measures are then required. As a rule when this occurs the stomach will reject everything.