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tinued the treatment for a long time but as with all other drugs only the very early cases were benefitted and as they are not now under observation it is not possible to say if the improvement has been maintained. A European who entered into the experiment with zest has been, and still is, taking the drug since August (60 minims daily). His weight has improved and the fever stopped but other- wise his condition is the same. Guiacol carbonate has also been tried but I can- not say it is of much use either in phthisis or in those curious cases of abdominal tuberculosis which we see amongst the Indians.
One case is reported in the Appendix as the patient suddenly developed meningitis, a rare ending in an adult.
Possibly the collection of cases of this disease in sanitoria may lead to some successful method of treatment being discovered. A short but very interesting report the first I have seen-has lately been issued by Dr. SMITH from the man- chester Sanitorium. So far he does not speak very enthusiastically of any special drug but agrees with us as to the uselessness of urea. 'The best results were obtained with guincol but the cases were all in an early stage.
Febricula.--96 cases come under this heading. One is naturally loth to place patients under this heading but it has to be used for a fair number after all methods of diagnosis have failed to identify the cause of the disease. No doubt a few are malarial, in which, owing to the previous use of quinine, no parasites have been found in the blood and one or two may be cases of phthisis in an early stage. None, I think, are due to trypanosoma as a very careful look out has been kept for this parasite and the constant daily blood examination, more especially by Ross' method, would have detected them if they were present. Three cases were interesting inasmuch as after the fever had kept up for several days a very short The results were so evident- antisyphilitic course of treatment at once reduced it.
ly due to the treatment that one is, I think, justified, even in the absence of all other signs, in looking upon the cases as "yphilitic fever."
Dysentery.-50 cases with 11 deaths as against 74 in 1902. The word dysentery is now practically considered as a symptom of a disease due to many causes, but not much has yet been done towards elucidating the special factor in each case.
With the increase of microscopical work now done here I hope we may be able in due course to add a few facts to those already accumulated regarding this serious ailment. The stools in 31 cases were examined daily and the results are worth recording
1". In 4 cases no cause save malaria could be found. They all had fever parasites in the blood. Malaria per se is not generally considered to produce this In view of the enormous disease though personally I am inclined to think it does.
number of parasites found in a smear from the mucus membrane of the bowel in fatal cases of this disease it is easy enough to understand that small patches might have their blood supply cut off by blocking of the capillaries and this would account for the local condition.
9o. In 3 cases amabie were found in the stool and malaria in the blood. These will be looked upon as cases in which a debilitating cause precipitates an attack of malaria.
3o. In 4 cases the only cause found was the presence of cercomonas intestinale in the stools. I have not hitherto seen these parasites except in cases of dysentery. Little or nothing is said of them in text books though Simons' "Clinical Diagnosis alludes to them as a possible cause of diarrhoea. They all rapidly disappeared as the stools became normal and the cases were mild in type. One case was com- bined with malaria.
4o. In one case in a Chinaman nothing was found but eggs with which we were not familiar but Dr. HUNTER, Government Bacteriologist. kindly saw the specimen and reported "these are eggs of Distoma Cranum, a fluke said to be com- inon in parts of India and South China and also said to produce diarrhoea with blood in the stools.” The case was fairly mild and the eggs disappeared as the case progressed to a favourable termination.
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5o. In 10 cases Amœbæ Coli were found. It still seems to be doubtful whether this is a cause of dysentery or not but in all these cases they diminished in numbers daily and rapidly as the stool became normal and the blood disappeared.