ENTERIC FEVER.
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During the ten years 1890-1899 only 51 deaths of Chinese from Enteric Fever were registered as against 65 deaths of Non-Chinese, although the Chinese form 94 per cent. of the total population, and in my Annual Report for 1897, I wrote:
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"It is interesting to note the small number of cases of Enteric Fever which were re- ported as occurring among the Chinese during the year, an experience which accords with the apparent immunity of the native population of India from this cause, while the cir cumstances connected with these cases (at the Berlin Foundling House) appear to suggest
that the same explanation of this apparent immunity may apply to both races, namely, "that they are so fully exposed to the infection throughout the whole period of their "existence that they almost always contract the disease in infancy or early childhood, when, "if they recover, the disease will have been practically un-noticed (at least so far as scienti- "fic observation goes), while if they succumb the death will be attributed to Diarrhea, "Convulsions or some other symptom. Should they then happen to contract a second attack in adult life, it will be so modified by the previous one as to be again scarcely "recognizable, or at least to be insufficient to drive the patient to a Hospital under Euro-
pean control.
Of the seven cases which were reported as occurring among the Chinese last year (1897) one only was an adult, and he had contracted the disease in Saigon, from which port he arrived by steamer, while the other six were children ranging from 6 to 17 years of age, resident in a Home under European management. These children ob- viously contracted the infection from a German Pastor who was brought down to the Home from the Tung Kan Province of China in consequence of illness, and who died of "Enteric Fever a few days after arrival; the children had been carefully protected from any infection of this nature while in the Home, which means practically from infancy, as the Home is a Foundling one, until the arrival of the Europeau case, when they showed that they were equally as liable to contract Enteric Fever as any European children would have been, and it appears to me therefore that we have, in the history of these cases, a very "suggestive corroboration of the theory that the Asiatic is not naturally immune to Enteric
Fever, but that he is almost invariably protected by an attack in infancy."
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These remarks of mine served to draw the attention of Dr. THOMSON, the Officer in charge of the Government Mortuary, to this subject, and in the following year (1898) I was able to report that three deaths from Enteric Fever in Chinese children under the age of ten years had been discovered in the Government Mortuary, while in 1899 seven such deaths were reported.
During 1900, however, the theory has received very strong confirmation, as Dr. THOMSON has fortunately been able to devote more time to this research, and as a result I find that while 15 deaths have been registered as due to this disease among the Non-Chinesc, 39 have been registered among the Chinese, and of these, 6 were infants under one year of age, 5 were between the ages of one and five years, and three between the ages of five and fifteen years.
It is necessary to compare deaths rather than
cases, as while every European case is notified, practically only those Chinese cases which end in death, arc discovered; while moreover these cases have been discovered among the comparatively few bodies that are found in the streets by the Police, and that no post-mortem examination is made of the bodies of the 1,500 or more infants that are taken annually to the French and Italian Convents in a moribund condition, and whose deaths are registered as due either to "Diarrhoea" "Fever (undefined)," "Marasmus" or "Convulsions," and that these Convent returns comprise about 75 per cent. of the total deaths in the Colony, under 5 years of age, and 23.6 per cent. of the total deaths of Chinese at all ages.
Both the English and the American authorities state that true Enteric Fever is rare among infants and young children, and that many of the cases returned at these ages are due to faulty diagnosis, but the cases I have cited have all been detected on post-mortem examination and cannot therefore be questioned, while it is quite possible that the disease may be rare among the infants of the white races, and yet prevail among native infants, whose sanitary surroundings are in every way calculated to encourage the growth of the germs of this disease.
The total number of cases reported during the past year has been 85, as compared with 59 in 1899, but there has been a reduction in the number of European cases, namely, 34 as against 36 in the previous year. The average age of the European cases was 25.5 years, while 16 of the Chinese cases were under ten years age, seven of them being less than one year old.
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Seven cases occurred on board the various British and Foreign Men-of-war in the Harbour, as follows:- II,M.S. Iphigenia 1, U.S.S. Monadnock 1, S.M.S. Gefion 1, French gunboat Argus 2, French cruiser Descartes 1, and U.S.S. Wheeling 1 (a Filipino). Six cases occurred among the British Troops stationed in the Colony.
The case mortality of the Non-Chinese cases was 36.6 per cent., while among the Chinese cases -most of which were not discovered until after death-it was 88.3 per cent.