494
This is a statement somewhat startling when compared with the results of other observers. It is founded, they state, upon combined clinical and pathologi- cal observation, which admits of but few fallacies.
Should this be true, our idea as to the age incidence of acute fibrinoñs pneu- monia must change. It will become important for the clinician to endeavour to recognise the disease and to clearly differentiate it from broncho-pneumonia. Such a distinction of these two diseases is also of importance as regards the prognosis of the case. Generally, acute fibrinous pneumonia in infancy has a good prognosis; acute catarrhal pneumonia has generally a bad prognosis.
In a recent paper by CLIVE RIVIERE (Lancet, 1903) the following conclusion is drawn: "Croupous pneumonia occurs in infants probably more frequently than in older children and that the mortality from this disease is greatest in the first years of life."
In consideration of the fact that this view, regarding the age incidence of acute fibrinous pneumonia, is new, requiring further investigation, I have thought it of importance to refer to the results of my own post-mortem examinations, so many of which are held upon infants and children.
That the experience to be gained of the frequency and occurrence of diseases of infants and children, is large, goes without saying, when one considers the average number of autopsies held at the Public Mortuary annually. During 1904, out of a total of 1,551 post-mortem examinatious, no fewer than 498 au- topsies were held on infants under 1 year. Further, over 50 per cent. of the total number of examinations are conducted on children under 5 years of age. This high percentage of children examined has been maintained since I assumed charge of the Public Mortuary about 3 years ago. During the past 3 years, no fewer than 6,693 post-mortem examinations have been made, and about 60 per cent. of these have been performed on children under the age of five years.
It would appear that the real reason for the variable estimation of the relative frequency and mortality from croupous pueumonia during the early years of life, is that the majority of statisticiaus have taken their figures from cases diagnosed clinically.
Now, the diagnosis of croupous pneumonia during infancy is a task of consider- able magnitude-notoriously difficult in fact-in view of the frequency of that closely allied disorder, namely, acute catarrhal pneumonia. Again, in the distinction of those two diseases clinically, RIVIERE very properly points out that, a further element of fallacy must be introduced, owing to the frequency of broncho-pneu. monia with consolidation of lobar distribution—a pathological condition which vitiates the efforts of even expert stethoscopists to differentiate between acute fibrinous and acute catarrhal pneumonia.
As already mentioned, there are great opportunities of examining the dead bodies of infants and children in Hongkong. Indeed I believe them to be unique. During the past three years. no fewer than 2,000 children under five years of age have been brought for examination.
Again, out of 6,693 autopsies, 218 cases of acute fibrinous pneumonia were found.
The following is a resumé of my results as regards the age incidence of the disease:
Number of Cases.
Age.
In 1902.
In 1903.
In 1904.
0- 1
30
26
12
1- 5
19
20
7
5-10
7
4
10-20
8
7
20-30
9
6
7
30-40
9
5
7
40-50
7
9
6
Over 50
1
3
2
Total,.......
90
78
50