271
note.
Typhoid Fever.-Forty-two cases with 9 deaths against 28 with 6 deaths last year.
The death-rate was 21.4 per cent. None of the cases had a relapse. Of the number treated 21 were imported, Europeans accounted for 17, Japanese 12, Chinese 8, and Indians 5 cases. The increase amongst the Chinese is worthy of There is nothing to say about the treatment which is purely one of nursing and treating symptoms. As far as our experience goes no drug is of the least use. Carbolic acid and cyllin were both tried but without reducing the fever in the least and in several cases upsetting the patients' feeding powers-a serious matter. Cyllin especially they would not take as "it repeats so much" and this I found to be the case by practical experience. Possibly if coated in a different manner it might be of some use as theoretically an intestinal antiseptic would be an ideal drug. The difficulty seems to be to find one of any use. B. naphthol and lactic acid were also used. Three cases with rare complications are inserted in the Appendix. Two cases bad "green spinach like" stools shortly before death. This may be a sign of serious import though it is not mentioned by the authorities. "Widal's reaction was sought for in all cases but it was just as often positive as negative and it is no use clinically.
17
Plague.-Only 5 cases came under our notice 3 of which died before they could be transferred to the Infectious Diseases Hospital.
Of
Phthisis.-Fifty-five cases were under treatment as against, 60 last year. these, 14 were fatal. There were 14 cases amongst Europeans, 21 amongst Indians, 14 amongst Chinese and 6 amongst Japanese. There is little to say of this serious disease and nothing in regard to treatment. Cyllin was tried internally without the slightest benefit. We have had two or three cases of apparant cures. One, an Indian Gaol Guard, whilst in hospital lost his fever and cough and the tubercle bacilli disappeared entirely from his sputum but he returned in two months' time as bad as ever and was invalided. Another, an Indian Policeman came in for severe homop- tysis with fever and tubercle bacilli in his sputum. He lost all his symptoms completely but had to be invalided in three months' time for the disease. The third, a European, was admitted as a case of "liver abscess.”. He had fever, cough, hæmoptysis and a swelling over the left lobe of the liver resembling an abscess. His sputum was full of tubercle bacilli. All his symptoms completely disappeared and when he was re-admitted five months' later for venereal disease he was in per- fect health and still continues so. No special treatment was adopted in any of these cases or it might have been credited with the cure.
Febricula.-One hundred and twenty-eight cases against 96. Every endeavour is made to keep down this list, a refuge when all other causes of fever have been excluded. No doubt a few may be malarial where owing to the administration of quinine before arrival in hospital the parasites have disappeared from the blood. There are two causes of mild feverish attacks which I have noticed and which I do not think sufficient stress is laid upon, viz., syphilis and constipation. I have now collected a fair number of irregular fevers, occurring in young adults, without any definite symptoms in which as soon as an anti-syphilitic course of treatment is adopted the fever at once subsides. We have also had several cases in which as a result of chronic constipation a species of auto-intoxication has set in and after free and thorough purging all symptoms have subsided. These cases present in addition to the temperature a furred tongue, general malaise and in some cases complain of general abdominal discomfort or pain in right iliac fossa, in fact one or two have been sent in as cases of appendicitis. A weekly or bi- weekly action of the bowels being a habit with them they are surprised when told they are constipated and still more so when their bowels are opened two or three times daily.
Dysentery.--One hundred and six cases with 6 deaths against 50 cases last year a serious increase which requires consideration. Of this number, 45 were Europeans, 44 Indians, 13 Chinese, and 4 Japanese.
Whatever be the actual cause in each particular case there is no doubt that this disease must be classed in the "tyhoid" group, i.e., a disease almost solely spread by contaminated water or uncooked vegetables especially when the latter are watered as they are in this part of the world. It is alo significant that the number in which no microscopic cause could be ascertained and which are placed in the bacillary group have risen very considerably. Using a continuous "water