Sessional_Paper_1905 — Page 581

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Relapsing Fever.

During the past year, a number of microscopic slides were forwarded to me by Dr. HILL of Pakhoi for diagnosis. On examining these with the ordinary tinctorial methods, I found them teeming with the Spirillum Obermeieri, ie., the exciting agent of relapsing fever. Dr. HILL bad also found them but wished his diagnosis confirmed.

This disease is known to exist in North China. I do not know of any cases having been found in Hongkong unless those imported from India or North China.

There is good reason to believe that the disease does not so far exist in Hong- kong.

The disease is mentioned as being the most common form of fever at Teng- chow-fu. In 1877 it was epidemic at Tientsin, and in former years has raged in North China, Pekin, Swatow, and the surrounding country. It is also common amongst the Chinese in Sumatra, and experts there say that the disease was originally introduced from Swatow (GRAHAM, Jour. Trop. Med., 1901).

The factors determining the spread of this disease are as yet imperfectly un- derstood.

Recent work on protozoology, however, is interesting in this respect, that it throws a considerable possibility of the spirillum of relapsing fever being con- veyed from inan to man by some form of mosquito.

As a matter of fact there has always been a considerable amount of doubt as to the real nature of this spirillum. For want of something better, it has been classed with the bacterial spirilla. It differs, however, from all of these, in being pointed at both ends, and in its flexibility, and it cannot be cultivated.

The recent researches of ScHAUDIUN, however, leave little doubt that the spirillum obermeieri is a protozoan parasite. It is probably a phase in the life of a Trypanosoma and is spread broadcast by some suctorial insect-most likely a form of culex mosquito.

Should cases of relapsing fever present themselves in Hongkong, it is propo- sed to carry on a research along the lines indicated by SCHAUDIUN. With a certain degree of care in such a research there ought not to be any great obstacle in the way of satisfactorily proving the insectiverous spread of the exciting agent of this disease, in a manner similar to that of inalaria, filiariasis, etc.

Malta Fever.

There is every reason to believe that Malta or Undulant fever has a much wider geographical distribution than is generally supposed. Beyond Europe the disease is certainly known in different parts of Asia. There has been frequent note made of the existence of the disease in Bombay, the Punjab, and in Simula.

In China the evidence for the presence of the disease is of the same nature. MANSON states that he has probably seen cases in Hongkong, and WRIGHT, DURAND, and others, have described cases of continued fever in persons from Hongkong, in which the blood gave a serum reaction with the bacteriam melitensis.

Again, the fever would appear to be endemic in the Philippine Islands. Quite a number of authentic cases have occurred in Manila. With all this evi- dence before us, it is only just to admit, that in all probability, we have the disease with us in Hongkong, but, that in the absence of definite symptoms and the omission to apply the serum reaction, such cases of continued and indefinite fever, remain undiagnosed or classified as typhoid fever, septicemia, acute tuberculo- sis, or other vague febrile disorder.