314
of amoebic dysentery from one part of the tropics to another for a change is bad treat- ment as most of the cases sent to us in this way, when it was just as easy to send them home, have certainly had their change but it has been to a country where "nothing matters". The question as to what percentage relapses form is not easy to say as so many of the hospital cases disappear from notice. The Police figures are small but they give 10 per cent. Liver abscess due to amabæ is a much more frequent complication than is generally supposed judging from the records of this hospital. We have had 11 cases against 73 of amoebic dysentery since June, 1903, ie, 15 per cent., and the number is probably greater as it is diffi- cult to get statistics relating to Chinese in this Colony. I was in hopes that a differential blood count might be of use in distinguishing the two forms theorising that there might be an increase of Eosinophiles due to the ambæ as a parasite but practically this was not borne out. The latent form mentioned by ROGERS rarely occurs here but we had one case which was interesting. An Indian was admitted with fever and vague pains in the abdomen. The blood was negative for malaria and there were no physical signs. For several days (4) the fever con- tinued and noticing there was a slight increase in the number of stools (3 daily) though the patient made no complaint of diarrhoea the stools were examined mi- croscopically when blood and inncus cells were found together with numerous amabæ both mobile and encysted forms. The patient went through an attack of dysentery and recovered. But for an examination of the stools the case would have been overlooked.
We are still in the dark as to how dysentery spreads and I have not even a theory to put forward. Neither variety assumes an epidemic form here and the cases occur all over the Colony throughout the year though there are more cases in June, July and August. These facts exclude the water as a carrier of the infection so that as with typhoid in this Colony one is inclined to fall back on the "raw vegetable" theory. The Chinese suffer much less from both forms, according to our figures, than the Europeans and Indians. The mobile formn of the amœbæ die rapidly in the stool but the encysted form are much hardlier and must be the means of spreading the disease. The question for the future to solve is whether they do not undergo some change in a suctorial insect and so get passed on to man, in a similar manner to malaria. In these days of theories I put forward this one for what it is worth as it seems to me to fit in with the etiology of amœbic dysentery better than any other one.
Malignant New Growths.-14 cases have been under treatment. As so much interest is now being taken in this subject and the question of native races suffer- ing from the disease being in dispute I append a list of all our cases with parti- culars, the diagnosis in all but two having been settled microscopically by Dr. HUNTER:
European male, aged 42-Dis. of omentum, etc.
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36-Chorion epithelioma.
female,
""
91
Portuguese female,
male,
41-Sarcoma of neck.
**
Chinese male,
3-Sarcoina duodenum and liver. 33-Epithelioma of penis.
32-Colloid cancer of mesentery.
39-Carcinoma of liver.
53-Epithelioma of tongue.
40 Carcinoma of liver.
28-Sarcoma of leg.
17
**
31
31
"
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""
17
71
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female,
35
39-Sarcoma hard palate, etc.
17
95
22-Sarcoma of arm.
50-Epithelioma of penis.
35-Schirrus of breast.
The last case was one of recurrence after an operation done here in 1904. This Table shows that Chinese at any rate do not enjoy any immunity over other
races.
Pernicious Anæmia.-9 cases with 5 deaths. Though we have cases diagnosed under this heading before not much attention has been paid to them.
This year, however, they have all been carefully studied in view of the possibility that they might be due to Leishman-Donovani bodies or human piroplasmosis as suggested by Dr. HUNTER. Nothing of the kind, however, was found either by ordinary blood examination or by spleen puncture before death or at the post-mortem. All
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