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hospital and then left with crescents after periods varying from 7 to 27 days. Several cases were put on methyl blue (grs. 2 ter die) and the average duration was 14 days, the shortest being 4, and the longest, 19. Methyl blue is therefore useless and this is much to be regretted. A patient with crescents in his blood is a source of infection to others if he proceeds to an "Anopheles infected" neigh- bourhood and yet it is not always possible to keep him in hospital as long as it appears to be necessary in some cases. Further investigations will be carried out in this direction and the results duly recorded in next year's report.
Typhoid Fever.-28 cases were under treatment with 6 deaths as against 34 with 8 in 1902. Typhoid in the tropics is usually considered a more serious ailment than in temperate climates and our records bear this out. Taking the cases for the last two years the death-rate has been 22:57 per cent, and the relapse rate 11.28 per cent. and the average duration of the initial fever 24.85 days. BRAUNAN (20th Century Medicine) states that the rate of mortality varies and is about 10%. Maidstone epidemic (1897), 7.6, United States Army (1900) 6%. The relapse rate also varies. In 11,640 cases from all sources it was 6%, BRAUNAN himself having a rate of 7.8%, and MURCHISON 3%. The duration of the initial fever is from 24 to 28 days. It will thus be seen that except for the initial fever rate our figures show that it is a more serious disease here at any rate than in temper- ate climates. Face to face with a disease which runs its course and becomes al- most purely a question of skilled nursing numerous remedies have been advocated, from time to time, chiefly with a view to reducing the death and relapse rate and not the duration of the initial fever and most of them have fallen into disuse. Until the bacteriologists have settled the vexed question as to whether the typhoid bacillus is a bacillus sui generis or only a variety of the bacillus coli group they will have nothing to offer us in the way of a curative serum and we must endeav- our to work out our own salvation in this as in many other diseases. Being anxious to settle the therapeutic value of carbolic acid I have given it in this disease. The cases treated (11) are too few to justify positive statements, but as the results are more promising it is as well to put them on record so that others may be induced to try the method and settle its usefulness. Out of this small number there have been no deaths and no relapses, but the duration of the initial fever has only fallen to 20 days. The dose employed was 30 minims thrice daily well diluted. The average amount taken was 904 minims. Next year's report will show, I hope, whether this line of treatment is of much use or not.
One case is inserted in the Appendix as the association of jaundice with the disease is are,
Two cases occurred in Chinese, both fatal. 15 cases were imported. In connection with this disease our best thanks are due to Dr. HUNTER for kindly doing the Widal Reaction" test in all cases. To be of any use to a clinician this test must be positions aut nihil and this it certainly is not and I cannot
I am any more impressed with it than I have ever been.
say
Plague.-78 cases were admitted with 5 deaths. The bulk of the cases were, of course, transferred to the Infectious Disease Hospital. As soon as the epidemic started we had a stock mixture of carbolic acid (20 minims for a dose) made up, and all cases were put on this as soon as they came in- if the blood showed no malaria and the symptoms pointed to plague so that no time was lost in starting the treatment. In view of the favourable report issued on this treat- ment by Dr. THOMSON I would like to point out that, though I suggested this treatment to you, the real credit for introducing this drug in such large doses belongs to Dr. A. WIGLESWORTH of Liverpool (Vide Lancet April 8th, 1899).
After working at malaria with Ross' method and trying it with equal success in filaria, we (Dr. LAING and myself) tried the method on plague and reported to you that we considered that all cases, both mild and severe, could be diagnosed by finding the bacillus in the general circulation. Dr. THOMSON, Medical Officer to the lufectious Hospital, spoke highly of the method in his report and is in fact a greater believer in it than I am now myself. After a long run of undoubted cases several mistakes were made in diagnosis; this led me to go into the question of microscopical diagnosis of plague and I duly submitted to you a report on the subject. To be brief, I found that throughout the alimentary canal of man there exists a bacillus identical in shape, size and staining properties as the plague bacillus and also that it is very easy to get blood films contaminated with the Thongh blood diagnosis is possible it is alsolutely necessary to be sure that perfect cleanliness of the part has been secured- which means taking it your- self- and this necessarily limits the scope of the method.
I would not now, as
same.
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