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The disease is comparatively easy to diagnose as other forms of peripheral neuritis are not common here, but it is probable that many cases vaguely named rheumatism," and paralyses of different kinds, are instances of beri-beri, so also are many of the cases which are said to be locomotor ataxia. For some reason the
wet" variety is uncommon.
From time to time circulars have been issued by the Sanitary department to all large employers of coolie labour in which the danger of using polished rice as a food is explained and the appropriate advice given as to the proper selection of their food. It is so difficult to alter the customs of the ages that it is not easy for any one to buy unpolished rice in the open market; it has to be sought for specially. A few years ago we got out a new preparation derived from yeast, known as "marmite which is supposed to
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of the vitamines and to be useful in the treatment of beri-beri. Dr. McKenny reports that "it is liked by the majority of patients and is rapidly effective" in removing sensory symptoms". He thinks it is useful also for improving the condition of the muscles in the earlier stages of the disease.
Plague.--From 1915-1921 inclusively the number of cases of plague in each of these years may be considered a moderate one for an area in which it exists in an endemic form. But the disease was more prevalent this year, and 1,181 cases were certified. Plague is to be regarded as a disease of rats primarily and as one of nature's methods for restricting their indefinite multiplication. The three species of the rat family which are found in the colony are Rattus norvegicus,Rattus rattus and Mus musculus, and the comparative percentages of these are 41, 32 and 27 but the com- parative figures for the It. norvegicus and R. rattus are 557 and 143, respectively, in Kowloon, and 60 and 40 in Victoria. In the last nine years the brown rat was found to be infected with the plague organism for just about twice the number of months that the black rat was found infected; and on the average, the brown rat has been recorded as infected for seven months of this period, Of the entire number of rats which were reported as infected during this period, 15 per cent were black rats and 85 were brown rats. The fleas known to be present are the Xenopsylla cheopis and the Ctenocephalus felis and canis but a systematic search has not been made so far.
Preventive measures. To prevent rats from gaining access to dwellings the Sanitary Department requires the ground surfaces of all dwellings to be covered by concrete, and every drain or opening for ventilation is protected by iron gratings. Ceilings and hollow walls are not allowed in new buildings, and in some instances in which they existed they were removed by order; in the uative parts of the town all dead rats are collected and examined to ascertain whether they are infected or not. There are hundreds of bins containing a disinfectant, which are dis- tributed throughout the city and suburbs for containing every rat either found dead or trapped. The information required as to the particular house or tenement from which the rats have been collected is obtained and a special inspection of the premises is
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made when evidence of infection is found in the specimen. The next stop taken is to fill up the rat holes with broken glass and cement, whatever may be found amiss with the drains and gratings is remedied, rat poison is provided for the occupiers to use; in the event of several infected rats being found in one locality a special survey is made from house to house and special attention is given to the cleaning up of the district; poison, traps, and birdlime are resorted to, the value of cats as destroyers of rats inculcated, and there is no dearth of dogs of every variety. Direct action is taken against fleas by the use of a kerosine emulsion for cleansing all native dwellings once every three months; the streets and lanes are cleaned up and all refuse removed from the houses daily; each house is provided with a covered metal dust bin to contain the rubbish and to prevent rats from feeding on it; any house or building in which infection has been found to exist is thoroughly washed with kerosine emulsion and all articles of clothing &c., are disinfected by steam.
Rats probably enter the colony by means of the shipping, especially in junks. At present it seems that to disinfect all junks periodically and kill the rats and fleas would require a large organisation for the purpose as some four or five thousand junks would have to be dealt with.
A point of interest in the diagnosis of the disease has been noted by Dr. C. W. MeKenny who states that he has seen about twelve cases which were proved to be infected with plague in which there was a small area of skin, dark in colour and necrosed, situated generally on the buttocks or the back, although not necessarily restricted to these parts. The material obtained from such areas by means of an incision was found to contain the organisins of plague in large numbers. This necrosed patch may be the only sign of plague but buboes may be present as well. The condition is said to be a rare one and all of the patients who were affected in this manner, died,
Dysentery. For the nost part cases of this disease belong to the amoebic variety; practically in every case in which the clinical signs of dysentery occur the entamoeba histolytica is found, and treatment by ipecacuanha or emetin is generally successful. Although dysentery is not as common in this colony as it is in parts of India and Africa it is still a disease which is often encountered. Amongst Europeans it is more common in children than in adults, and all of the cases which I have seen in children have been due to the amoeba and all were cured by emetin. Emetin seems to be more efficient even in the treatment of amoebie dysentery in children than it is in adults. As compared with this variety of dysentery the number of cases in which the bacillary form was the cause has been small, but this refers more particularly to the European population.
The number of patients treated for dysentery in the Tung Wah Hospital during the last five years (1918-1922 inclusively) was 1,376; and the number treated in two of the government hospitals during the same period was 301, The percentage of patients who
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