366
-
The causal agent at work in the production of these diarrhoeas has not been determined. It is proposed, however, to investigate this question more thoroughly, especially from the point of view of the possible part played by a form of the B. dysenteriæ in giving rise to many cases of this malady.
6. Enteric Fever.-This was returned as the cause of death in 27 cases. The following tabular statement is interesting as regards the age incidence of these cases :—
1 year, 1-2 years,
2-3
years,
3-4 years,
4-5 years,
8 years,
9
8
6
1
1
27
These figures are in accordance with the results obtained during previous years.
·
In my Annual Report for the year 1904, the question of the incidence of typhoid fever amongst the Chinese was fully discussed. Evidence was brought forward in support of the contention that the Chinese-children and adults-frequently contract the disease. The theory, that the Chinese race, like the natives of India, are immune to typhoid fever, owing to their suffering from unrecognised attacks of the disease in childhood would not appear to have any scientific support. Professor OSLER (personal communication), CLEMOW, and other eminent authorities on typhoid fever, have come to the same conclusion as myself, namely, that the Chinese suffer from enteric fever as frequently during adult as during infantile life, and were the conditions of the people, and the conditions of life regulated in a manner similar to that obtained in the Occident, the incidence of the disease would differ but little from that found in Western countries.
7. Beri-beri.-The incidence of this disease would not appear to be diminishing in Hongkong. During the past year 150 cases were examined at the Public Mortuary. Both varieties of the disease, namely, the dropsical and atrophic forms, were present in about equal numbers. The majority of cases occurred in adult males. Examples of the disease were also found in females but the incidence was much rarer. Beri-beri would appear to
be most prevalent during the working or wage-earning period of life.
The question of the etiology of Beri-beri is still involved in obscurity. Of theories as to its causation, there are no en. Deficiency in certain elements of a normal standard diet, bad food, bacteria, protozoa, etc., have been brought forward by different observers at different times as the cause of the disease. The most recent theory of the causation of Beri-beri is that brought forward by Dr. HAMILTON WRIGHT, late Director of the Institute. for Medical Research, in the Federated Malay Settlements. WRIGHT is of the opiniou that the disease is to be classe! as an acute specific and infections disorder, that it is due to a bacterium, the biological characteristics of which probably resemble the B. diphtheria; that there exists a primary lesion or focus of the disease, namely, a gastro- duodenitis, and lastly, that by multiplication of the bacteria in this primary focus, a toxin is secreted which is absorbed into the general circulation of the individual affected, and occasions the various changes which are found in the peripheral nervous system. This theory, published a year or two ago, has been well brought forward by WRIGHT and received considerable attention from those interested in the disease. In Hongkong it was considered desirable, in the presence of a wealth of material, to start a research into this subject from as wide a standpoint as possible, and to put to the test, the various theories, including that of WRIGHT, by the use of all the pathological and bacteriological methods at one's disposal. With the co-operation of the Government the research was commenced towards the end of 1904, and has been prosecuted more or less continuously until the latter end of the past year, when a Special Report on the results of the investigation was submitted to the Government by Dr. Kocu and nyself. It is expected that this Report will be published in a few days. During the course of our investigations, the clinical, pathological, bacteriologi- cal, und experimental sides of the question were studied as thoroughly as possible. Briefly, the conclusions which Dr. Koçu and I have been able to draw are the following:-
(1.) There is no evidence that Beri-beri is an acute specific infectious disease. (2.) No micro-organism, of the hitherto described forms, has been found in any organ or tissue of a Beri-beri patient, or cadaver, which could be brought into causal relationship with the disease.