Sessional_Paper_1902 — Page 844

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not easy to suggest a remedy. Cremation is now carried out for this disease all over the world and it is perhaps more needed here as our space, for disposing of bodies dying from epidemic diseases, is extremely limited. I would much like to see a crematorium attached to the Mortuary as it would save much unnecessary handling and carrying about of bodies which, especially in the summer months, is anything but pleasant and an attempt to popularise this method might be made by thus disposing of all unclaimed bodies.

The largest number of cases occurred in May (428). There were 12.18% of non-bubonic cases. At the beginning and during the height of the epidemic by far the largest number of cases were of the bubonic type whilst from July onwards the septicaemic variety prevailed. The percentage of septicemic cases were month by month :-

January,

February,

March,

April, May, June,. July,

August,.

September,

October, November,

December,...

...Nil.

.Nil.

.Nil.

..11.1 per cent.

5.3

17

8.6

17

..35.8 .72.7 100

27

No cases.

100 per cent. .Nil.

The routine examination of the spleen blood of every case sent in has been extremely useful in detecting cases sent in as one of drowning, accident, &c. and especially amongst the bodies so decomposed as to prevent the cause of death being ascertained.

In the latter cases it is thus possible to exclude plague as a cause of death.

Two cases may be cited as showing the necessity of being careful in this matter. A girl was sent in, found by the Police floating in the harbour, and her mother stated she last saw her alive asleep on the sampan where it was presumed she fell off and was drowned. A spleen smear, however, showed it to have been a case of plague. A boy was sent in who had fallen downstairs and dislocated his neck. His neck was dislocated but his spleen was full of plague bacilli and his house was accordingly disinfected. Another interesting case was that of a Chinaman who had been bitten by a rat a few days previous to his death. The bite on the thumb, the lymphangitis up the arm, and the axillary bubo full of plague bacilli were all well marked.

Enteric Fever-From these figures (3) it does not seem as if this disease was very prevalent amongst the Chinese though it must be borne in mind that in a long illness of this kind no doubt many cases are removed to their own homes on the mainland.

+

Malarial Fever.--Exclusive of plague about 5% of the deaths come under this heading. Next year, I am inclined to think, the figures will be higher as the "unknown" cases from the convents will no doubt come in fair numbers under this heading as well as some of the "unknown" cases found in the streets. In connection with this disease I may mention that the parasites, spores and crescents in the spleen rapidly disappear after death being apparently disintegrated by the post montem bacilli and I found this to occur in one case inside of 40 hours. Probably therefore many of the cases under the heading "unknown" may be malarial. I have also found signs of recent malaria (spores, &c.) in smears taken from brain, liver and kidney as well as spleen and this may have a practical use inasmuch as the liver and kidney disintegrate much slower than the spleen so that in some of the "unknown" bodies one may be able in future to ascertain whether or not death was due to malaria for, as I have already stated, 30 or 40 hours after death all traces of recent malaria have disappeared from the spleen.

Septicam-2 cases out of the 9 were puerperal. The cases where death was due to some com- plication of labour only amount to 8, a small number, though they were all preventable in the sense that proper supervision or skilled aid might have saved the mother's life.

The

Titmus-Four of these cases were reported by my predecessor, two of them being tetanus neanotorum but no note was made as to the presence of the tetanus bacillus in the wounds. curious and interesting fact about this disease is that the bacilli very like tetanus bacilli may be found in numbers in the spleen in certain decomposed bodies-both rat and human-in which death has not been due to tetanus but the disease itself is extremely difficult if not impossible to diagnose post mortem. “The "bacillus in the disease itself does not appear in the internal organs or blood-and lesions in internal organs both of human beings and animals which have succumbed to tetanus are very trifling." (Flexner.) Why the bacilli are found after death in other diseases is difficult to explain nor do I think any one has so far noted its occurrence so that possibly it may be a peculiarity of the tropics. So far I have found them chiefly in acute septic diseases (plague, endocarditis, &c.) and in one case of apoplexy in a chronic alcoholic subject. In the only two cases of tetanus reported by myself I found the bacillus easily and in numbers in the unhealed end of the umbilical cord in both cases.