746
Tuberculosis (Abdominalis).—The bulk of cases were amongst infants and chileren, only two cases being over 12 years of age. At the present stage of the Tuberculosis question these cases are of great interest. The Chinese do not feed on milk, butter or beef and therefore there can, in their case, be no question of direct inoculation of the intestines by the ingestion of tubercle bacilli in their food.
DISEASES OF RESPIRATORY SYSTEM.
These account for 17% of the mortality (exclusive of plague) and are very prevalent both amongst adults and children. Most of the "Empyema" cases might have been saved if they had only applied for assistance early.
DISEASES OF DIGESTIVE SYSTEM.
Peritonitis.-4 of these cases were due to appendicitis, the abscess having ruptured into the peritoneal cavity, and 2 were due to perforation of duodenal ulcers. The cause of this latter disease is very obscure. In each case there was only one large ulcer about the size of a twenty-cent piece and neither of the cases had suffered, as far as one could see, from burns.
Jaundice In only one of these cases were any gall stones to be found so that the bulk of them were as far as one could judge catarrhal nor were there any evidences of recent malaria.
INJURIES.
Wound of Chest.-This was caused by a stab, the intercostal artery being omit severed and the chest full of blood.
Wound of Wrist.-The radial artery was cut and apparently no aid being at hand the woman bled to death.
Ruptured Spleen (12).—It is a pity these cases do not seek advice early as in most of them surgery might have saved a fatal termination. Some of them, from the history of the case, had survived for hours after the injury. One of them was due to a buffalo accident--rare in Hongkong--but I was not able to ascertain whether the animal tossed the man only or whether he was gored. In connexion with the spleen a curiosity may be recorded here as tropical practitioners are more used to large spleens than otherwise. The smallest spleen I have ever seen, at any rate in an adult, I found in an old man of 52. It weighed 3 ounces and was 2 inches long. It was not a supplementary organ and no other glands in the body were in any way enlarged.
Ruptured Heart-One of these, a case of a body aged 12 who, swinging on a gate at the Race Course, brought the structure down on himself. No bones were broken nor was there any external bruising but the auricle was torn and the pericardiun was full of blood. He lived about 10 minutes.
Ruptured Liners -2 cases were in children about 1 month old. There were no bruises or fractured ribs in either case. The abdomen was full of blood. As the children were found in the streets or sent from the Convent no history was obtainable, a regrettable fact as this accident seems to be very rare at this early age.
Forms (reflex action).-This occurred in a boy aged 12, in my predecessor's time, but as there are no notes of the case, it is impossible to explain the exact cause of death. This cause must be very rare, however, though round worms are extremely common amongst the natives here and do the most extraordinary things.
Premature and still birth,—No doubt a good many of these are due to plague in the mother as the bacilli were found in the spleen in several cases late in the epidemic. Unfortunately I did not examine the early ones in this manner. Even with a plague epidemic on, many of these cases must represent difficulties in labour with the mother, perhaps ending fatally, though what becomes of them it is not easy to say as we have only had 8 cases in the mortuary where death was the result of child-birth.
Unknown.-153 seems a large number but the practice of dumping the bodies on to the hillside or into the harbour leads to a delay before they are found and as decomposition sets in so rapidly here it is out of the question in most cases to give any cause of death. All spleens are, however, now examined so as to be sure, if possible, that plague was not the cause of death and in the plague epidemic it has been the practice to bury them as plague so as to be on the safe side. These are cases in which a crematorium would be most useful. I would like to mention one very useful practical hint, for which I am indebted to Dr. KINYOUN, in connection with this work. I refer to the use of the dye-Thionin. It has two advantages over all others owing to its having no time limit and where one has to examine many specimens, especially at the monthly survey of rats, this is very important, and, secondly, owing to its being a differential stain for plague bacilli. These take on a faint blue colour in contrast to the dark blue of the other bacilli. These advantages have been most useful in the work. It, however, does not last, so it is not so good for permanent specimens.
I have the honour to be,
Sir,
Your obedient Servant,
J. BELL
Medical Officer in charge of Post-mortems,
THE PRINCIPAL CIVIL MEDICAL OFFICER.