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The ravages of tuberculosis in its various manifestations, still accounts for the lives of a very large number of Chinese of all ages. The Chinese appear to be extremely susceptible to tuberculosis. The following dictum, quoted by CLEMOW, is very true-In China, tubercle may be regarded as the principal scourge of the rich class of nobles, while syphilis is the commonest disease among the middle classes, and leprosy among the outcasts.
Koch's theory of distinct species of tubercle still holds sway and is becom- ing supported by a considerable amount of favourable evidence.
In continuation of my researches into the subject, my observations lead to the conclusion, that pathologically there is little evidence of tubercular infection through the alimentary tract. If tubercle bacilli enter the system through this channel, they never leave evidence of having done so, in the intestine. My results bear this out thoroughly.
Quite recently, BEHRING has come forward with a most important announce- ment. It is almost as startling as that made by Koca in 1901.
He concludes that tuberculosis is acquired in infancy when the intestinal mucous meinbrane is in a state of considerable permeability. The disease remains potential, until the environment or circumstances of the individual, enable the tubercle bacillus to grow and set up the active disease in its typical form. He quotes in support of his contention, the now well known post-mortem results of ÑAEGELI, who showed that evidence of active or latent tubercle could be demons- trated in the bodies of all persons over 30 years of age. Again 68% of the men of an Austrian regiment reacted to tuberculin. Again, it is known that acute generalised tuberculosis, tubercular meningitis, etc., are most frequently found in infants and children. Phthisis occurs most frequently during the working period of life. Intestinal tuberculosis is rare at any age.
Further, acute tuberculosis is usually a widespread blool infection. Phthisis is a direct infection through the respiratory passages, and is a more or less local disease of the lungs.
With the theories of KocH and BEHRING before us, therefore, we have :-
1. Bovine tuberculosis communicated by food to infants and children. It may remain latent, or cause widespread tubercular infection of their bodies.
2. Human tuberculosis communicated from one adult to another by
contact. It sets up localised tuberculosis, e.g., phthisis.
Several interesting cases of poisoning came before my notice during the year. One or two deaths froin opium poisoning occur regularly every year. The number of these cases would appear to be gradually diminishing.
A case of sulphuric acid poisoning in a Frenchman is specially dealt with in the Report.
Three cases of poisoning, by what appeared to be datura, were found. In one only, could an alkaloid-similar to hyoscine-be isolated by the Government Analyst. Mercuric sulphide to the extent of 1.22 grains was also present. The vermilion, however, is a very insoluble substance, and being present in so small a quantity could not have caused death. I have no knowledge of the existence in the Colony of preparations containing vermilion and a mydriatic alkaloid.
Two cases of what I have termed intra hepatic obstructive jaundice, were found. In each case the substance of the liver was beset with soft cholesterin bile pigment calculi. These varied much in size. The largest stones were as big as a plum. They were situated in the biliary canals or in diverticula of the same.
A special report has been given upon a rare tumour of the supra-renal capsule.
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