493
Opium Poisoning.
This was the cause of death in 4 cases. In every instance, the diagnosis was confirmed by chemical examination of the internal organs by the Government Analyst. In suspecting such a cause of death, one has to rely greatly upon the history of the case. The post-mortem appearances are not characteristic. There is great congestion of the abdominal viscera with ecchymosis in the mucous mein- brane of the stomach. The blood is fluid and very dark in colour. The meninges are engorged with blood. In general, the venous system is intensely congested and the subjects die from asphyxiation. Too much weight must not be attached to the condition of the pupils in a case of opium poisoning. The pupils may be contracted, but they are sometimes dilated. The presence of opium about the mouth, nose and throat of a Chinese body must not lead one to immediately suspect opium poisoning. Such may be done by the friends of the dead person in order to con- ceal some other important disease.
The Age Incidence of Pneumonia, with special reference
to its relative frequency in Infants.
The occurrence of acute fibrinous pneumonia in infancy has been a recognised fact for many years. The relative frequency of the disease in infants has, how- ever, been variably estimated by different authorities. The majority of text books dealing with the subject, up to the present time, discuss the incidence of croupous pneumonia in infants in a brief manner. Usually the question is dismissed with the conclusion, that it is a rare disease. Thus HOLT (Disease of Infancy and Child- hoot) concludes that cronpous pneumonia is exceedingly rare in infants, but its incidence gradually increases after the first year of life, and reaches its maximum between the ages of three to five years. MORRILL, in his text-book, puts the max- imum incidence of acute fibrinous pneumonia in children between the ages of four and seven years. HENOCK (Trans. Syd, Soc. 1889) regards its frequency at a max- imum between the ages of six and twelve years; and HAWKINS (Pract. 1893) and ASHBY (Diseases of Children) regard the maximal incidence of cronp us pneu- monia as occurring much later in life, probably between the age of fifteen and thirty years.
Thus we see that authorities on diseases of infants and children agree in one point, namely, the rarity of the occurrence of pneumonia in infants. As regards the period of maximal incidence of the disease, these experts have a considerable variance of opinion.
Other investigators have made more definite statements in regard to the age incidence of pneumonia. For instance, PFAUNDLER (Manch: Med: Woch. 1903) says: That this form of pneumonia is exceedingly rare in infancy". RIVIERE (St. Barth. Hosp. Jour. 1902) concludes as follows: "This disease is uncommon during the first two years of life."
The obvious deduction to be drawn from the investigations of so many emi- nent physicians, would be, that acute fibrinous pneumonia, unlike its sister disease of the lungs, namely, acute catarrhal pneumonia, is a disease only occasionally to be found in infants and not a disorder likely to cause much anxiety to the practi- tioner, his young patients, and their parents.
Within the past year or two, however, a certain amount of doubt has been thrown upon the results of the pure clinician as regards his views on the age inci- dence of croupous pneumonia. Evidence has been adduced as to the difficulty of diagnosis of cases of acute fibrinous pneumonia in infants. Again, statis ical proofs of the incidence of the disease cannot be drawn from clinical observation alone, They must, in all cases, be supplemented by careful post-mortem examination.
It would appear, therefore, that in order to settle the question, once and for all, resort must be made to actual examination of the lung issues themselves. One must distrust more and more the evidence brought forward by complicated statistical compilations, founded upon clinical evidence only.
It is thoroughly well known that statistics may be made to prove anything. They only become of value when coupled with the truths ascertained by direct observation. Recently COUTTS (Edin: Med: Journal, 1902) and PEARSON (Lancet, 1903) have come forward with statements that croupous pneumonia is most frequent in the first two years of life.