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1. The first case was Septicemic in type.
2. The epidemic was mainly established by the prevalence of the bubonic
type of the disease.
3. The epidemic was prolonged chiefly by a continuance of the Septicamic
type of the disease..
4. Pneumonic types of the disease were most frequent at the commence-
ment of the epidemic.
5. The Bubonic type was most frequent during the middle of the epidemic. 6. The Septicæmic type was most frequent towards the end of the epidemic. 7. The Pneumonic tpye was most prevalent amongst young children.
8. The Bubonic and Septicæmic types were mostly found between the ages
of 20 and 40.
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9. After the age of 40 the number of cases of plague diminished rapidly.
So far as the pathological anatomy of plague is concerned, one has nothing to add to the voluminous investigations and writings of Indian Commissions, and the valuable researches of WILMS in Hongkong. The description given by him agrees entirely with my own results.
The question of the bacteriological diagnosis of plague cases is one of the most important if trustworthy results are to be obtained. The methods adopted are too well known to be again recorded.
Beri-Beri.
During the year, 149 post-mortem examinations have been inade upon the bodies of persons dead from this disease. All forms of the disease are met with, but for general purposes we may speak of a dropsical form and an atrophic form. So far as 1902 is concerned, the dropsical form of the disease has formed by far the larger number of cases.
The pathological anatomy of this disease is of great interest, and as no recent references in regard to the post-mortem appearances as met with in Hongkong have been made, the following is of interest :---
The Dropsical Form.-On superficial examination, the dead body of a case of Beri-beri is frequently characteristic a cyanotic, swollen face with protruding eyes, foaining mouth, and swelling of the veins of the neck are all frequently met with.
On Section-a characteristic appearance is the great infiltration of the subcu- taneous tissues with serous and mucoid like fluid.
The pericardium is often distended with fluid, which may reach enormous quantities, when one considers the normal size of the sac. The fluid is of a clear yellow colour.
The heart is enlarged, sometimes enormously, and the condition of the ventri- cles is usually dilatation of the right ventricle with contraction and thickening of the left ventricle. The cardiac muscle is frequently in a condition of fatty de- generation. On opening the heart, enormous quantities of extremely dark red blood escapes, which is perfectly fluid. On allowing it to stand for a few minutes freely exposed to the air, it becomes of a brighter red colour and begins to clot. As is generally now accepted, this peculiarity on the part of Beri-beri blood is accounted for by the fact of the presence of an excess of C 0o.
The aorta, arteries and veins are frequently the seat of extensive atheromatous degeneration.
The lungs are as a rule edematous and emphysematous. The empyhsema inay be so extreme as to completly cover the pericardial sac.
Hydro thorax is frequently present and is often bilateral.
So far as the abdomen is concerned, there is usually a certain amount of Hydroperitoneum. This may be extreme, The fluid as in the other cavities is clear, yellowish and viscid in character.