Sessional_Paper_1904 — Page 543

434

One was

Cholera,-Only two cases were admitted, both male Europeans. constable from No. 5 Fire Brigade Station-he was discharged cured after 12 days' treatment; the other was a seaman from the S.S. Sithonia, who was received in a state of collapse and died shortly afterwards.

Plague. There were 301 cases of plague admitted for treatment, of whom 248 were males and 53 females, the former being 82.4 per cent., the later 17.6 per cent., and the proportion of males to females being about 6 to 1.

(a.) Its varieties.--The cases of bubonic plague numbered 182, a percentage of 60.5. Of these the femoral bubo occurred in 110 cases, 60.45 per cent., the inguinal in 25 cases. 13.73 per cent., cervical in 15 cases, 8.24 per cent., and multiple buboes in 11 cases being 6.04 per cent. The septicemic and pneumonic cases together amounted to 119 or 39.5 per cent, of the admissions, and there were two cases of intestinal plague.

(b.) Its mortality.-Of the admissions 139 males and 37 females died, and there were discharged cured 109 males and 16 females. The recoveries among the males amounted to 44 per cent., and among the females to 30 per cent, roughly, three males recovering as compared with two females. Of the deaths 56 per cent., were among the men, and 70 per cent., among the women. This proportion, like that which obtains among the recoveries, tends to shew that the man, generally stronger and more robust, bas a greater power of resistance to the disease than the woman. The total mortality was 58.5 per cent., and the total recoveries 41.5 per cent.

(c.) Its racial incidence.-The Europeans numbered 27, and there were two deaths giving a mortality of 7.4 per cent. Three Portuguese were admitted, of whom two died, equalling 66.6 per cent. Of the 216 Chinese, 156 died making a percentage of 72.2, and of other races 55 cases were admitted of whom 16 died giving a percentage of 28.2. Thus it will be noted that the better fed European, brought up and living amid more healthy surroundings, and who is presumably more stalwart and of a more robust physical development, has the greater chance of recovery than a patient of any of the other races. The mortality among the Chinese is high-they are not as a rule strong and robust, and probably they do not seek treatment until the disease is somewhat advanced. No definite conclu- sions can be drawn regarding the Portuguese from the small number under treat- inent, though they are for the most part not so robust, and are of a more delicate physique than the European. Among "other Races" are included East Indians who though more lusty and strong than the Chinese do not attain that degree of physical vigour that is seen among Europeans.

(d.) Its treatment.-Three methods of treatment were tried serially:

(1.) Thirty cases were treated as follows: Essence of cinamon 15 minims was given every 3 hours, liq. strychnine 5 minim every 3 hours, and 5 grains of quinine in solution three times in the day. Injections of morphine were admin- istered hypodermically as required, and belladonna was applied locally to the buboes. The deaths amounted to 26, making a percentage of 86.6.

(2.) One hundred and twenty cases were treated as above but omitting the cinamon. 101 deaths occurred, a percentage of 84.2.

(3.) In this series 151 cases were treated. Carbolic acid in 12. grain doses flavoured with syrup of orange and chloroform water was given every two hours. The deaths under this method of treatment amounted to 49 giving a percentage of

31.4.

It will be observed that so far the greatest success has been obtained by the free use of carbolic acid. The very purest preparation should be used, and in order to be efficacious it should be given in large doses-12 grains or more every two hours. Contrary to expectation carboluria seldom, if ever, occurs. Should it threaten of course the dose should be reduced or its administration suspended. Its exact mode of action is not known. It is stated however to enter the blood un- changed (BRUCE, Materia Medica). and presumably it acts directly upon the bacillus pestis and its toxins. As an aid to treatment, and to counteract the depression, the free exhibition of stimulants such as strychnine, digitalis and alcohol is called for.