272
supply as an intermittent one is no doubt responsible for some of the spread of these water-borne diseases as the vacuum in the pipes at times must be greater than any valve will stand and so dirt and germs must get drawn into the pipes. The storage of water in all sorts of receptacles and places is probably even more res- ponsible, and lastly the system of manuring vegetables as employed in this country is not only disgusting but extremely dangerous to health not only giving rise to serious illnesses but to a good many minor ailments which are at least unpleasant.
Several of the cases have been very serious ones necessitating the patients leaving the tropics for good or for a considerable time. Two cases were interest- ing as from them the incubation period of the disease may be inferred, a some- what difficult matter in tropical diseases. Both were on their way out from home and were on shore for the first time at Singapore. Forty-eight hours after, at sea, they were attacked with typical dysentery. One I regret to say died shortly after admission. The cases were presumably of the bacillary type. The Japanese referred to in last year's report (p. 16) as having Amoebae aud Ankylostoma eggs in his stool again came in with dysentery and was extremely ill but nothing was found in his stools. I found that occasionally when magnesium sulphate failed to cure the substitution of the soda salt proved of immediate benefit.
Divded into apparent causes the cases are as follows :-
1°
23 cases with Amobo Coli.
20
2
"
3o
2
11
""
Cercomonas Intestinale. Distoma Crassum eggs.
4°
8
*
}}
Malarial parasites in the blood,
5o
71
""
nothing to be found in stool or blood
(?bacillary).
Diphtheria. Only one case, a Chinese child was under treatment. The antidiphtheritic serum was used but the child died from heart failure rather suddenly.
Pernicious Anomia.-Two cases of this somewhat rare disease here were under treatment. One recovered sufficiently to leave for his home in India but the other-a Policeman-succumbed rapidly.
Hepatic Abscess.-Only one case was under treatment with a successful result and the case is published in the Appendix. With the large increase in the number of dysentery cases one would expect more of the theory had anything in it that one was the cause of the other.
Appendicitis.-Three cases were under treatment. Two recovered without surgical interference and the other after the usual operation was discharged well.
Poisons.--Only one case was under treatinent and that due to lead. The patient, a Chinese storekeeper, recovered after a somewhat prolonged stay in hos- pital.
Fractures.-The following were treated during the year :-
Femur, Arm,
Forearm,
Leg, Skull.. Patella,
5 cases.
3
-6
11
.14
: 1
59
19
27
"1
with 13 deaths.
Scapula,.
Clavicle,.
Ribs, Fingers,
1
1
1
17
Dislocations. The following were under treatment :-
Thigh,
Shoulder,
Elbow,
Clavicle,
1 case.
I
1
1
""
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