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Typhoid.-30 cases with 6 deaths. Two of these cases are doubtful. They both resemble the disease clinically but the Widal reaction was negative and the post-mortem signs nil, including a bacteriological examination of the spleen in one case. We held, however, to the clinical side of the cases. Of the cases 12 were imported. The nationalities were Europeans 19, Indians 3, Chinese 3 and Japanese 5. If we exclude the two doubtful cases the death-rate of 14.3 per cent. is a decided improvement on what generally prevails in the tropics. Óuly one case had a relapse-a German. This nationality take the disease very severely in their own country and this peculiarity they bring with them to the tropics as they are generally the worst cases we have. One death was due to perforation and the others to toxæmia. Widal's test was employed in all the cases but one and I am much indebted to Dr. HUNTER for carrying out the test for us.

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Dysentery. -110 cases with 3 deaths as compared with 106 and 6 deaths in 1904. Of this number, 53 were Europeans, 37 Indians, 15 Chinese and 5 Japan- All the fatal cases were of the amoebic variety. Cases occurred all through the year being however more frequent in June, July and August. Though the cause, or causes, of tropical dysentery is still to a certain extent an unsettled question the matter is I think nearing a solution. Personally I am of opinion that there are but two forins, amoebic and bacillary. Since 1903 I have examined micros- copically a large number of stools, over 500, and I have never found amoeba in any but those showing dysenteric symptoms. In a few cases eggs of Ascaris Lumbricoides, Ankylostoma Duodenale, Distoma Sinense, Tricocephalus Dispar and the Cercomonas Intestinale have also been found but they are mere coinci- dences and invariably persist after the dysentery is cured and require, where possible, separate treatment.

As to the prevalence of one form more than the other since July, 1903, 245 cases have been examined of which 166 were bacillary and 79 amoebic so that as found by ROGERS in India the former is more prevalent. This is fortunate as it is far less serious a complaint in the great majority of cases. It is obviously impossible for us here to isolate the bacillus in each case so that I cannot say what special bacillus or group of bacilli produce the bacillary form. In a very few cases the disease is of a virulent type and the patient rapidly succumbs to the toxœmia but as a rule this form is much milder, answers readily to saline or other treatment and does not relapse. Probably like most bacillary diseases one attack confers an iminunity, much the same as typhoid. Of the Police whose history we are able to follow 29 cases were adinitted to hospital of which 18 were of the bacillary type and none of these had a relapse though one came in in January and again in October with amoebic dysentery showing that one forin affords no protection against the other, as one would imagine.

-in some

The amoebic variety is the less prevalent form and fortunately so as it is a much more serious complaint, more difficult and more tedious to treat- cases I doubt whether they are ever cured by anything short of removal out of the tropies and attended by a complication in the shape of liver abscess which may, I think, be looked upon as one of the most serious tropical ailments we have to deal with. The post-mortem appearances explain how unamenable these cases may be to treatment for the ambæ are found to burrow deeply through all the coats of the intestine ending in some cases in perforation, and to attack the cæcum first. Any rectal injections in these cases never get near the seat of the mischief and this accounts for their failure in most cases to do any good. The only chance of a cure lies in some drug through the blood stream poisoning the parasite, and this drug has yet to be found. I tried several cases with a daily rectal injection of quinine and 5 graius in pill form every 4 hours by the mouth in an endeavour to saturate the system with the drug for some time. In most cases this treatment was not of marked benefit though in others a certain amount of success resulted. The best results were obtained with the Indian Police who come in early. It is not always easy to say when a case is cured for we have had patients leave us with norinal stools without any trace of amoeba to return in a very short time with the trouble as bad as ever-in one case 3 times. It is important to differentiate the two kinds of dysentery though it is perhaps diffi- cult to do so, except in hospital, as it will generally be found that a relapse of arabic dysentery should mean an immediate removal from the tropics as far as Europeans are concerned. Sooner or later other attacks occur with the consequat anania if not the more formidable complication of liver abscess. To send a case