315
M
cases were Indian adults. It is safe to infer that the disease does not occur here in Europeans as we should undoubtedly meet with or hear of them. As to whether it occurs in Chinese I cannot say but none have come under our notice. Every case was typical of the disease as described by ADDISON as far back as 1851 and more recently by HUNTER of the London Fever Hospital. In none of them was there any previous illness to account for the disease. The ages varied between 20 and 30 and they were all males. The blood in each case was carefully examined and the results correspond with those found at home. The hæmoglobin varied from 40 to 15 per cent. and the color index from 1.8 to 0.9, being above 1 in all cases but one. The red cells varied between 2,000,000 and 500,000, and the leucocytes from 2,000 to 1,000 with a large increase in the lymphocytes (68 to 45 per cent.). In all there were poikilocytosis, granular and polychromatophilic degeneration, with numerons megalocytes and megaloblasts. The post-mortem signs were practically nil either macroscopically or microscopically but in several cases the liver gave the iron reaction. In three of them there was marked stomatitis and ulceration of the mucous membrane of the mouth but unlike HUNTER's cases these were secondary and only occurred after the disease was well marked.
Heart Disease' (Valvular).—-25 cases were under treatinent of which 10 were Chinese, 6 Indians and 9 Europeans. The ordinary causes which obtain at home, rheumatic fever and the exanthemata, being out of the question here one falls back on one of other causes, viz., Syphilis, which I suppose must be credited with giving rise to the bulk of valvular mischief in Chinese, We had one case of ma- lignant endocarditis in a European in which the patient died suddenly of cerebral embolism. Post-mortem the mitral valve was found extensively affected and a, smear taken from this resembled a pure culture of pneumococcus.
Aneurism.-Three cases were under treatment. The aortic case died suddenly from rupture into the pleural cavity, the femoral recovered after ligature of the external iliac and the brachial was cured, under Dr. Kocn, by dissecting out the complete sac.
Phihisis-47 cases of this serious malady have come under treatment-II Europeans, 15 Indians, 15 Chinese and 6 Japanese.
Appendicitis. 4 cases of which a European and a Chinese died from perito- nitis and the other two recovered without operation.
year.
Liver Abscess. cases with three deaths compared with one case last The cansation of this disease is still sub judice in some minds, but I think enough evidence has now been adduced both here and elsewhere to show that it is entirely and solely due to the amoeba dysenteria and forms one of the worst and most serious complications of intestinal amoebiasis. I have under dysentery alluded to this already and given our figures. There is little doubt that most medical men treating these cases would be of the same opinion but for the fact that some of them probably are not familiar with the appearance of the parasite and are possibly also unaware that the amoebae may not be found in the pus when the abscess is first incised but are easily detected in a day or two especially if a scraping from the wall is taken. In all of our cases they were present and in 2 of the cases were also found in the stool the patients being the subject of dysentery at the time. Liver abscess is with us a very fatal disease but many cases are brought here in the last stage of the disease. Since 1900 we have had 27 cases with 12 deaths, i.e., 444 per cent.- a high rate. Two of the cases were interesting inasmuch as the
pus showed large numbers of amœbe but there were no traces of old or recent dysentery in the large or small intestine. CouNCILMAN and LAFLEUR proved the power of the amœbe to work its way through the bowel wall into the peritoneal cavity and be carried along towards the lymphatics of the under surface of the diaphragm and so to the upper surface of the liver suggesting indirect infection from the bowel across peritoneal cavity with or without adhesions previously forming and this no doubt happened in the two cases above mentioned. All the abscesses were in the substance of the liver. In one, a Chinaman, the main abscess consisted practically of solid pus, a very rare occurrence, so that aspiration failed to detect the condition and it would have been an impossible one to treat. Most of these cases are fairly easily diagnosed but in a certain number the question is a difficult one to decide."
One naturally turns to a blood count as a help and in most cases it is of great assistance taking the relative count of white to red and taking the normal as being between 1 to 1,000 and 1 to 715, ie., 5,000 to 7,000 white corpuscles. In 3 cases in which the count was made the relation was 1 to 269, 1 to 520 and 1