497
At first sight, the table given for 1902 creates an impression in one's mind that even in the presence of so few cases, the disease is common during childhood, and more common amongst Chinese children than amongst Europeans of the same age. However, if this table is to be interpreted correctly, one must bear in mind the disturbing factors which arise in estimating the incidence of the disease amongst the Chinese.
First of all, the number of children brought for post-mortem examination greatly exceeds that of adults.
Again, older children and adults promptly leave their dwellings in Hongkong and proceed to the country" when premonitory symptoms of any disease appear.
6.
The same argument applies to the cases of typhoid fever examined during 1904. During the past year, quite an appreciable number of cases were brought for post-mortem examination, and proved to be of considerable scientific interest. During 1904, no fewer than 47 cases of the disease were met with in the Public Mortuary. Each case was pathologically examined with care, aud in a few cases the bacillus typhosus was isolated, thus rendering the diagnosis beyond dispute.
The following are the figures for 1904-
0- 1 year,
1- 5 years,
5-10 years,
10-20 years,....
20-40 years,
16
14
1
14
Total,.....
47
As will be seen, my experience of the disease in Hongkong is not a large one, but, owing to the fact that all the cases were diagnosed by post-mortem examina- tion, the results of the past year are of value in regard to the geographical dis- tribution and age incidence of this disease in the Far East. At first sight, the figures given for 1904 would appear to support the dictum that in China typhoid tever is a disease of infants and children. The figures are largest amongst children under 5 years of age.
However, it must be noted that during 1904-and this is the only year from which I can deduce any conclusion-the incidence of the disease reaches double figures between the ages of 20 and 40 years. The difference in the number of years of exposure to the infection during these two periods is considerable, but, from what has already been said earlier in this paper, this large incidence of the disease in children under 5 years of age, by no means proves the frequency of in- fantile typhoid.
In support of this contention, I bring forward the following:-
(1.) That 60 per cent. of the total number of post-mortem examinations held at the Public Mortuary are on children under 5 years of
age.
If this point be taken into consideration, it is evident that more cases of typhoid fever will appear amongst children, and possibly lead to error in estim- ating the age incidence of the disease.
(2.) That during 1904 about 30 per cent, of the total number of cases of typhoid fever occurred in adults. This is important when one remembers that only 40 per cent. of the total number of post-mortem examinations are held on adults.
(3.) That infants and children found sick or dying in Hongkong are taken to one of the Convents, or "dumped". They are rarely taken into the country".
(4.) Adults, finding insiduous disease creeping on them, return post haste to their homes in China.
(5.) The belief in Oriental immunity to typhoid during adult life is not sup- ported by my results.