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we did before, dream of diagnosing blood films taken by all and anyone and sent to hospital for report. As in next epidemic we are sure to be called upon for diagnosis now and again I would submit to you the advisability of bringing the above report, condensed or otherwise, to the notice of the medical men here so that they may be alive to the possibility of error.
We have hitherto been chary of treating cases in a General Ward for fear of infection amongst nurses, attendants or other patients. Judging from our experience here and at Kennedy Town Hospital this is very rare however, though as already mentioned one Sister contracted the disease presumably at Kennedy Town Hospital. ASHBURTON THOMPSON, Chief Medical Officer to the Government of New South Wales, in the last report ridicules the idea of its spreading in this way, save perhaps in cases of the pneumonic form. If his conclusions are verified by others, and it is about time something definite was settled regarding plague, it will remove a great anxiety from our shoulders as no doubt many cases would do all the better if they were spared a second journey to Kennedy Town Hospital. One case of relapse in this disease, being a rare occurrence, has been inserted in the Appendix. Two cases were also met with in which the premonitory symptom was diarrhoea with fever and on the third day both patients developed plague. This looks as if it were possible to contract the disease via the alimentary tract though THOMPSON and others deny this.
Phthisis.-60 cases were under treatment with 15 deaths, Of these, 10 were Europeans, 24 Indians, 17 Chinese, 4 Philipinos, and 5 Japanese. This disease is very prevalent here due no doubt to a variety of causes which would come under the heading of low vitality and bad hygienic conditions. Both Indians and Chinese suffer more severely from malaria than do Europeans, and one is inclined to suggest this latter ailment as a predisposing cause. As with the Police so in the General Hospital returns it is seen that they suffer in the same proportion from phthisis as they do from malaria.
Indians,. Chinese.....
Phthisis.
24 17
Malaria,
159 cases 108 +
If this is so there is not much hope of removing the cause as the various malaria preventive measures do not touch the bulk of the moving coolie class who suffer badly from this disease. The following table gives the percentage of cases each month compared to the number of patients admitted:-
January..... February,
March,
April,
May.
June,
July,
August.
September.
October,
November,
December,
2.44 per cent. 6.00
2.11
21
3.52
11
0.89
0.41
:7
1.20
17
2.12
$1
1.79
:7
1.16
2.56
$7
1.66
2.93
1.34
**
Winter (November to April), Summer (May to October),
As in the Police so in these figures it is noticeable that February and April are the worst months and that the number of cases occurring in the winter are double the number of there occurring in the summer. I attach the meteorological record issued monthly from the Observatory as it may be useful for reference in connection with this disease.
As regards treatment we have nothing new to suggest. The urea treat- ment as suggested by Dr. HARPER of Liverpool has been thoroughly tried here, and in view of its failure (Principal Civil Medical Officer's Report for 1902) it was not continued as a routine treatment though I again tried it in one or two cases, giving 40 grains 4 hourly for days but without any result.
Needless to say my thoughts were turned towards carbolic acid as a possible cure and I am much disappointed in the result. If the disease is due to bacilli one would expect good results from internal antiseptics. I gave up to 40 minims ter die and con-
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