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epidemics, 647, or 70 per cent., took place during the summer months. If we omit those in regions where the mean temperature for the year does not exceed 15 C., we have 668 epidemics, or 74 per cent., which occur during the same period of time.
The post-mortem examination of the 379 cases of Asiatic Cholera has supplied some interesting details as to the pathological changes which may be met with.
At the commencement of the epidemic, it was noticed that a larger number than usual of deaths from intestinal diseases were reported, these cases being classified as diarrhhoa, infectious diarrhoea, choleraic diarrhea, or cholera, In regard to this point it is important to remember that the diagnosis may be specially difficult in the first cases where no epidemic yet exists. The first cases of an epidemic are frequently violent and run a rapidly fatal course. Appearances similar to cholera are also met with in severe cholera nostras, and acute poisoning with arsenic, tartar emetic, or mercury, and frequently discussions have arisen at the beginning of an epidemic as to whether the disease in point was true Asiatic Cholera or Cholera Nostras. Fortunately we possess to-day a means of decisively recognising almost all cases. With the help of the method which KоCH gave us in 1893, there can be no doubt about the disease being Cholera, if the result of the examination is positive. During the past year, this method has been applied in every case at the commencement of the epidemic, although after the disease had fully established itself as an epidemic, cases were received at the Mortuary which were so striking and characteristic that the microscopic test was alone employed, and owing to the prejudices of the Chinese, as partial a post-mortem made as possible.
So far as the anatomical changes are concerned, it has been observed that the more rapid the death, the slighter the post-mortem changes. It was the routine custom at the Mortuary during 1902 to examine the intestinal contents for the vibrio cholera in almost every case, and certainly some cases-which to the naked eye did not warrant a diagnosis of cholera-proved themselves, after bacteriological examination, to be undoubted cases of the disease. This was more particularly the case in individuals who had previously been enfeebled by other diseases, c.g., Berit beri, Tuberculosis, Dysentery, &c. Further the first cases of the epidemic, which are usually of a severe and rapidly fatal character, were markedly devoid of any severe or typical choleraic post-mortem change.
In general, the post-mortem appearances met with during the epidemic were the following:-The external appearances, including the Boxer Pose, were in the majority of cases well defined. The cyanosis present during life and the injection of the superficial veins were in most cases absent. Post-mortem rigidity was a marked feature, and further those peculiar and long-standing post-mortem muscular contractions which may be called forth by light tapping were sometimes found well marked. This phenomenon was found to be most frequent in the extremities.
In addition, these bodies were scarcely ever found in a state of decomposition even during the height of summer. This, which is a feature of subjects dead from Cholera, is probably due to the anhydræmic condition of the tissues in general.
The rose
The examination of the abdomen is in all cases of peculiar interest. colour of the small intestine and the sticky, slimy, and dry appearance of the peritoneum are striking contrasts to the normal colour of the stomach and large intestine. In a large number of cases so intense was the acute hyperamic reaction that instead of the rose red colour being met with, the whole small intestine was converted into a dark purple mass of congestion with hemorrhages into the in- testinal mucous membrane and with the presence of a large amount of broken down blood detritus in the intestinal contents. In these cases, the intestinal contents are of a deeply blood stained colour, and the microscopic examinations in all instances demonstrated the presence of enormous numbers of vibrio cholera, practically a pure culture.
The contents of the intestine are so well known as not to require special reference.
The other abdominal organs present little pathologically. In women hæmor- rhagic extravasations were commonly met with about the internal genital organs. Frequently the women examined were pregnant. In such cases the foetus was always examined, but apart from such pathological changes as would be produced by intoxication, nothing was found. No cholera-producing micro-organisms were ever found present in the fœtus.