I must add that the number of double tertian cases is understated, as I did not always, when onl}' the benign parasite was found, record the various ages of the parasites. It is also probable tliat a larger number of the malignant cases than the table shows had also benign infection.
Valuable information was obtained in many cases where the blood showed no paiasites by the leucocyte count, which often gave rise to suspicion of pneumonia, internal abscesses, fila- ria and other worms.
Enteric, — ;0f 29 Civses of enteric 24 were natives. Of these two were complicated with malarial infection. Widal's test gave positive results in 21, including those complicated by malaria.
Tubercle, — The list includes 94 cases of tuber- cle. In all diagnosis was confirmed by finding the bacillus in the sputum. Several cases had malarial fever when admitted ; the persistence of the fever after the exhibition of quinine and the absence of hseuiamoebse should always rouse suspicion of typhoid or tubercle. The oft- repeated statement that malaria and tubercle are antagonistic has not the shadow of a found- ation in fact.
May I ask those present if they can confirm my experience that in pulmonary tubercle the first symptom the native nearly always com- plains of is fever?
Certainly in my cases the patients almost all have first come in on account of fever, and only on subsequent enquiry or observation is a history of cough or emaciation obtained. Spitting of blood is very rare among natives in the earlier stages, and in the majority of cases is never seen at any stage. To me this seems a very remark- able fact, especially as in Europeans, either at Home or in India, hsemo|)tysi8 is verj* ofien the first sign to arouse suspicion.
Of my 94 cases in Bombay two were Euro- peans ; both had early and repeated haemoptysis. Of 92 natives only four gave any history of blood-spitting.
I think it a very safe estimate to say that nine-tenths of the cases of fever in Bombay, which last ten days or more, are due to either tubercle, enteric or abscess. I do not think the mortality returns of our city by any means afiford a good index to the real number of deaths from tubercle, nor do the public, nor perhaps the profession, appreciate what a scourge this disease is in Bombay.
We have had 66 deaths or invalidings from advanced tubercle during the past twoyenrs in a police force of 2,400 men, being at the rate of 14 per thousand. The policeman's life is pro- verbially not a happy one, and doubtless they have more than their share of exposure and hardship. Still when we consider that they are a selected body of men who undergo a careful physical examination when recruited, these facts point to an appalling prevalence of tubercle in this city.
In comparison with leprosy tuberculosis is a much more infective disease and of vastly greater importance from a politico-economic point of view. Leprosy is, however, more oflfen^ sive from the aesthetic point of view, and by Europeans is seen through the halo of romance in which the Hebrew scriptures have shrouded it.
The census of 1901 shows the absurd figure of 27 as representing the number of free lepers in the city in that year. Tet we have an asylum for the imprisonment of 370 lepers suppttrted by our Corpoi-ation, largely assisted by voluntary subscriptions, while for the infinitely more im- portant and contagious disease, consumption, there is nothing.
So does sentiment triumph over practical utilitarian views.
Of the leucocyte count I can quite confirm Christophers and Stephens' observations that the large mononuclear cells are always increased in malaria. To this fact may be attributed the large percentage of cases in which I have found the parasite. If after a search of about ten minutes no malarial parasite be seen, if the mononuclear cells seem increased, I continue my search, but if their proportion be low, I cease to look further.
Lev.cocyte Count in Chicken-pox. — In nine cases of chicken-pox among the Bombay Police, the proportion of large mononuclear cells has been ascertained, and in all nine found increased, though in none was there any evidence of recent malaria. Seven had been in the force for a year or upwards and never had fever or been admit- ted to hospital. Two had had benign tertian, six and eight months respectively before admis- sion for chicken-pox.
This is a matter of interest, but whether a series of fortuitous coincidences, or the result of recent latent malarial infection, I am not in a position to state. It would be well if some pathologist in England or other malaria-free country would make leucocyte counts in a few cases of chicken-pox.
Liver Abscess. — I have examined the blood in nine cases, and must confess I got but little help thereby. In most the diagnosis w as complicated by a little basal pneumonia, and as this disease also gives rise to an increase of the polymorpho- nuclear leucocytes, all I could do was to exclude malaria as a cause of the fever.
Filaidal Fever, — In one case of prolonged fever of a hectic type, in which there was a slight swelling of the groin glands, I can only attribute the fever to the filaria. The fever lasted four weeks. Widal's test was negative.
Eosinophile iricrease in cases of Guinea^ worm. — Some of the members of this Society may remember that in 1901 I drew attention to the increase of the eosinophile leucocytes in patients harbouring the filaria nocturna. I will iiow add that, a Kimilar, thouQfh not so great an incrtjase, takes place in tne_ca8e of |juinea-woii
