216
The number cases of Dysentery is small. In the two cases returned as the cause of death, the pathological changes were marked to an extreme degree. Dur- ing the year one frequently came across cases showing limited Dysenteric ulcera- tion, altogether insufficient however to occasion death.
Septicemia, apart from cases of plague, was the cause of death in 4 cases, 3 of them being due to infection with Streptococeus pyogenes, the other to Pneumococcus.
The case of Leprosy was of the tubercular variety.
Tuberculosis accounted for the death of a large number, namely 151. The majority of cases occurred in children or young adults. In the general miliary forms, the lesions were of the most pronounced character, pathological changes being present in all the internal organs to such a degree as is scarcely ever seen in Europe.
Two cases of Tubercular Pericarditis were found, typical minute miliary nodules being scattered over the serous surfaces of the Pericardium. Numerous tubercle bacilli were found in those nodules in each case. In one of the cases, the infection could be traced to caseating mediastinal glands, the other organs in the body being apparently healthy.
Eleven cases of Tubercular Enteritis and 3 of Tubercular Peritonitis occurred a rather large number. All of the cases presented very pronounced lesions, and the tubercle bacillus was abundant in all the cases.
A large number of cases of death of infants have been registered under the name Marasmus. This term, which really means a gradual dying off, has been employed to designate certain conditions which one meets with frequently in infants, and which are the result of obscure causes, namely, congenital syphilis, defective nourishment, intestinal atrophy, diarrhoea, &c. The cases, as already mentioned, are all infants from a few days to a few weeks old. A post-mortem examination held on such a body reveals practically nothing excepting acute hyperemia of the internal organs, no definite pathological lesion being discoverable.
Five cases of Aneurism were met with during the year, all of them being of the saccular form. At this point it is interesting to note the great prevalence of atheroma amongst the Chinese. In almost every adult, say after the age of 20 or 25, one will, if carefully looked for, find patches of atheroma in the aorta and other more peripherally situtated vessels.
The cases of Appendicitis are numerous. In several instances the verii- form appendix had been rounded off in a ball-like fashion containing its interior pus
from which pure cultures of B. coli commune were obtained.
The usual large numbers of cases of Fracture of the spleen occurred. In all cases the spleen was previous pathological and more brittle than normally. In hardly a single instance were there any signs of external violence.
Total number of cases 379.
Cholera.
A very severe outbreak of this disease occurred during 1902 in Hongkong, The first case which was received at the Public Mortuary was during the 10th week. From that time onwards the number of cases examined increased rapidly, till the 19th week of the year was reached. After the 21st week, the number of cases diminished rapidly, with the exception of a slight recrudescence during the 33rd, 34th, and 35th weeks of the year. From the accompanying Chart, a good idea is given of the course of the disease, and such a chart is quite typical of an epidemic of cholera in sub-tropical countries. It will be noted that there is a sudden advent of the disease and then a more or less sudden disappearance. Again one will be able to note another important point, namely, the appearance of the disease as soon as the temperature begins to rise, and its disappearance co-incident with a fall in temperature. The epidemic under discussion began approximately about the beginning of April and was present more or less continuously until the month of October. Thus this outbreak of Cholera is quite in harmony with the investigations made by those working in other sub-tropical parts of the world. Although epidemics of cholera have been known to occur during the colder seasons of the year, yet the majority occur in summer. Thus the 1902 epidemic of cholera in Hongkong corresponds favourably with the results of HIRSCH, which are based on the investigation of 920 epidemics and are quite indisputable. Of these 920
Page 300Page 301