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Note the difference between these two cases. I have no doubt in my own mind that these so ably described by Dr. GORDON were cases of what I term Malignant Remittent Fever.' Similar in almost the minutest detail with cases which have come under treatment in the Government Civil Hospital during the three years 1889, 1890 and 1891.
The symptoms of the Batavian case are, I think you will agree with me, plainly those of Yellow Fever.
1849.
In the Colonial Surgeon's report for 1849, the following extract from the work done at the Government Civil Hospital appears :--
In
"Amongst the diseases, fevers of various types, and of these the remittent is the chief, are
the most numerous.'
++
every instance the malignant fever which has appeared in the Colony has been described to be of the remittent form, and certainly it is the prevailing disorder.
In the 95th Regiment, the large number of 94 deaths is stated to have arisen from "Intermittent Fever," it may be reasonably suspected that some of these, if not the greater number, were from the Remittent type, as it appears very rarely that a death occurs from the Intermittent variety.
The following table shows the fixed European population in Hongkong during the year 1849, and the proportion of deaths :----
No. of Europeans. Deaths.
987
64
Proportion of Deaths.
6.48 p.c. or 64.80 per 1,000. (Military and Naval forces not included). I think I have gone sufficiently into the early records of the medical history of this Colony to show that undoubtedly Remittent Fever was one of the main causes of the enormous fatality which then prevailed.
I cannot but express my obligation to those who have, with great care, handed down the history of these cases and the valuable records made nearly half a century ago together with the details of their clinical history, which we even now, with our increased facilities for closer and more detailed observation, have not been able to scientifically formulate.
CAUSATION (Etiology.)
Remittent Fever is undoubtedly a non-contagious disease; it is strictly an endemic affection, and is found whenever its specific cause is generated in sufficient concentration.
Whatever that specific cause may be there is no doubt that in the experience of Hongkong when soil which has long been untouched is upturned, either by the process of excavation for building purposes, or by natural agencies, then does the fever become more rife and fatal.
There can be no doubt that freshly upturned earth is here a point of considerable importance in relation to the causation of this disease.
I might here introduce evidence in favour of this:-See the Report of the Fever Commission of 1888, the memo by Dr. YOUNG in my report for 1889 concerning an outbreak of Malarial Fever at Kowloon Point caused by the extensive earth cutting required in the preparation of the site for the New Water Police Station at Tsim Tsa Tsui in the summer of 1878, or again Dr. PIKE's cases at North Point Battery as narrated by him in his paper on "Malarial Fevers" read before the Hongkong Medical Society in 1885, and appearing in the Transactions of that Society.
On this point I think there is no difference of opinion.
According to TOMMASI CRUDELI (Lancet, November 1st, 1884), three conditions are necessary for the production of the Malarial poison :-
1st. A temperature of not less than 68° F.
2nd. A certain humidity of the soil.
3rd. The free action of the air on the soil which contains the ferment
In the summer months from May-September these conditions exist in this Colony.
As to the intimate cause of malaria Professor A. LAVERAN gave an account before the International Health Congress last year of the hæmatozoa described by him in 1880:-
The Etiology of Malaria.
Professor A. LAVERAN, gave an account, illustrated by lantern demonstrations, of the hematozoon described by him in 1880. It had, he said, since that date been recognised by many other observers. Its morphology was now well known. The chief forms which it assumed were described, namely: 1. The spherical bodies. 2. The flagella. 3. The cruciform bodies. 4. The rosette-like bodies. The flagella could only be demonstrated in fresh blood; the other forms, however, were well seen in preserved blood. The blood in paludism was easily studied by rapid drying and fixation of the specimen by heat, followed by staining with a concentrated solution of methyl blue or gentian violet; a double staining could be effected by successively immersing the specimen of dried blood in concentrated aqueous solutions of eosin and of methyl blue, whereby the red cells assumed a rosy hue, and the leucocytes, together with the parasitic bodies, were coloured blue. Nuclei had been observed in both