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There is a considerable widespread belief in the theory that the Chinese race, like the natives of India, are immune to typhoid fever. The view tentatively put forward is that these races owe their apparent immunity to their suffering from unrecognised attacks of the disease in childhood. It is said that the blood of native Indians over the age of childhood has been repeatedly found to react to WIDAL'S Test. This evidence has, however, been questioned, and would not appear to obtain so far as Chinese are concerned.
I think there can be no doubt that the virus of typhoid fever is very widely spread throughout China. Europeans are attacked in all parts of the country.
It must be remembered that an enormous number of natives are not attended by skilled observers, and it is therefore possible that large numbers of cases of, and deaths from, enteric fever occur, and are regarded as due to some other cause.
On considering carefully the grounds upon which various observers draw their conclusions as to the frequency of typhoid fever in young, and its rarity in adult Chinese, one finds that the foundation of such conclusions is not so scienti- fically secure, as it would appear at first sight.
At the outset, typhoid fever is, at all times, a difficult disease to diagnose. In the tropics, it becomes even more difficult to diagnose, and in the absence of positive evidence of the presence of the exciting agent, or the agglutination reaction, many cases of fever-typhoid-like in course are almost impossible to understand.
Further, it is difficult to get accurate records of their diseases from the Chinese themselves.
The sick rarely enter a hospital but to die, and, if possible they avoid hospitals administered according to Western principles. Should they enter a Chinese hos-- pital, they are allowed to die peacefully, without much effort being made to estab- lish an accurate diagnosis. If they die, no post-mortem examination is made. Even in Chinese hospitals, superintended by European doctors deference is shown to the feelings of the Chinese, and a diagnosis is concocted by the rough and ready method of corpse inspection."
In Hongkong the estimation of the prevalence of typhoid amongst the Chi- nese population is, under ordinary circumstances, a matter of great difficulty.. This is mainly owing to the old Chinese custom of migrating to their own homes. in China, should they feel themselves gradually falling a prey to some malady.
There is little doubt that this occurs on an extensive scale amongst the sick Chinese, and is responsible for the vitiation of our results regarding the incidence of disease amongst this nation. Of all diseases, enteric fever, par excellence, affords the Chinaman every opportunity of reaching his native land, owing to its insiduous onset and prolonged incubation period.
Taking all these considerations into account and perusing the results of the enormous number of post-mortem examinations held at the Public Mortuary, I think it might be possible to ascertain some facts in regard to this disputed but most important epidemiological question.
During the years 1902 and 1903, few cases of enteric fever were examined at the Public Mortuary. Seven cases were met with during 1902, and oue during 1903.
The following tabular statement is interesting as regards the age incidence:--
In 1902.
0- 1 year, 1- 5 years,
5-10 years,
10-20 years,
No cases.
*
**
-------
??
20-40 years,
In 1903, 1 case in infant under 1 year.
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