495
Conclusions
1. 30% of the total number of post-mortem examinations held, were
upon children under 5 years of age.
2. Croupous pneumonia was found to be the cause of death in 3% of the
total number of autopsies held.
3. Out of 218 cases of croupous pneumonia 50% were found in children under five years of age. Of these, 30% occurred in infants under the age of 1 year.
From these results, it becomes evident that acute fibrinous pneumonia is more frequently found in children than at any other succeeding equal period of life.
Again, the large percentage of cases of the disease found post-mortem in in- fants, is probably accounted for by the fact that the mortality from croupous pnen- monia is largest during the first year of life.
Enteric Fever amongst the Chinese with particular reference to its incidence in infancy and childhood.
Since the commencement of my pathological experience at the Public Mor- tuary, I have been on the outlook for cases of typhoid fever amongst the Chinese. My reason for doing so is, that, after a careful perusal of many Government Re- ports, the Chinese Maritime Customs Journals, the various Tropical Medical Journals, and Western periodicals, I am convinced that there exists great confu- sion of opinion in regard to the incidence of this disease in China. This condition of affairs would appear to be due mainly to the absence of carefully prepared records of the various diseases prevalent amongst the Chinese. It is proverbial, that in Chinese Hospitals, Europeanised or otherwise, records of the incidence of disease are conspicuous by their absence, or, if kept, are so imperfect, as to be of no real scientific value.
AS CANTLIE (Practit., 1901) points out, reliable statistics are rarely kept in Chinese, Hospitals and there is more or less complete absence of accurate clinical observation.
In regard to the incidence of enteric fever amongst the Chinese, CANTLIE sums up as follows: "Typhoid is rare amongst the Chinese. Chinese children are liable to typhoid, even more so than European children.”
This conclusion is based upon clinical observation of cases in Hongkong, and in particular of patients treated in the Government Civil Hospital of Hongkong. I ain in perfect agreement with Dr. CANTLIE when he states that this Hospital is the only one from which accurate information can be obtained, but I doubt, if much knowledge in regard to the incidence of typhoid fever amongst the Chinese, -can be got from a Government Hospital, absolutely Occidental in its administration, and not likely, therefore, to entice the lay Chinese population to trust themselves to the efforts of Western medical science.
Hence I am of the opinion, that little weight must be attached to returns issued by this Institution, and conclusions deduced as to the prevalence of typhoid fever amongst the Chinese,, from the annual reports of the Hongkong Medical Department, are bound to be misleading.
MAXWELL (Journal Tropical Med., 1903) is also of the opinion that the disease is uncommon amongst the Chinese. He states plainly--without quoting reliable authority-that the disease is unknown in epidemic form.
CLEMOW, in his recent book on the geographical distribution of disease, notes the incidence of enteric fever very clearly. He states: "that enteric fever exists in China there can now be little doubt. Some doubt. as to the possibility of the natives contracting the disease seems to have existed until recently, because it is practically never possible to obtain a post-mortem examination of a Chinese patient, and observers have hesitated to diagnose the disease upon the clinical appearances only."