may be affected, and auscultation may give little lielp.
I hope I am not guilty of pathological heresy when I say I am inclined to believe we have sometimes cases of " pneumonia" infection, when the lungs are not the seat of any special lesion.
In the regions where "sunstroke" is most common, cases of " fulminant pneumonia " are also found. May not some of these cases of "sunstroke" be acute pneulmococcus infections?
Of febrile diseases in which I found no para- sites, three were followed next day by Herpes Zoster Intercostal is. The fever reached 103^ 102 2° and 101*8°, respectively, in these cases, and only lasted part of a day.
Cases in which the blood examination was negative were subsequently diagnosed in 561 cases, of which there were —
Plague (except 16 mentioned) ... ... 102
Pneumonia ... ... ... ... 92
Tuberculosis ... ... ... ... 94
Pleurisy, Influenza, Bronchitis ... ... 77
Enteric Fever ... ... ... 29
Gonorrhoea, Bubo and other forms of Sepsis ... 78 Syphilitic Fever ... ... ... 6
Lepra ... .« ... ... 4
Liver Abscess ... ... ... 9
Sinall-pox, chicken-pox (15) ; measles, mumps, tonsillitis, etc., make up the balance. I met with one case of scarlet fever in a European child. In 210 oases the diagnosis was reduced to unproved malaria (and undoubtedly the majority were such), febricula or simple conti- nued fever.
I know it is the custom among those whose experience is greater in the laboratory than at the bedside, to sneer at the use of such terms, but terms such as " Colon Infection," though high sounding and in some cases correct, do not cover all. Slight fever, for which no specific cause has been detecte<l by me, is not uncommon in young Europeans, who have been but a short time in the country.
I have failed to find any malarial pai*asites in many such cases, and to test the theory that these are malaria with a sparse infection. I have withheld all quinine to see if a relapse would occur. No such recurrence has taken place.
Malta fever or anything suggestive of that disease I have never seen in Bombay. A culture of Micrococcus Melitensis obtained from the Research Laboratory, usually gave with any serum a marked sedimentation in dilutions of one in forty or more. I have reason to believe that many of the statements asserting the exis- tence of Malta fever in India, were based on experiments with this 'strain of coccus. Dr. Gibson informs me that this coccus at first gave negative results with healthy controls, though recently it has undoubtedly become useless. The published cases of Captain Lamb, LH.S., were carefully confirmed by negative control experiments. Since reading this paper, I have attendeil a girl of European parentage who has never been outside India. She has had for about three months fever which was diagnosed else-
where as " Malta fever " on clinical and sedimen- tation evidence. I find her sputum thickly infected with bacillus tuberculosis.
(To be continued.)
ENLARGED PROSTATE.
By W. J. WANLESS, M.D., Miraj.
With special referenoe to the disease in India n siibj&et* and the question of choice of operatUm. With report of six complete Suprapvhic Prostatectomies,
The fact that in India relatively very little seems to have been thus far attempted in the way of radical cure of this most distressing condition is my excuse for offering the follow^ ing remarks and report of cases at this time.
Total extirpation of enlarged prostate is now being performed with increasing frequency in Europe and America. The operative mortality until recent years has been so high as to fre- quently deter even the boldest of operators from undertaking the operation. During the past few years, however, by the aid of improved technique and a bettei- understanding of the surgical pathology, the mortality from opera- tion has been so far reduced as to justify the expectation that the attempt to cure by radical surgery this painfiil and troublesome affection will be undertaken hy general surgeons very much more frequently than it is even at the present time.
That enlarged prostate with complete reten- tion of urine is a condition quite common in India, I feel sure from the large number of moderately enlarged prostates I have met with in disf>ensary practice.
With reference to the exciting causes of the disease as peculiar to India 1 am also led to be- lieve from my knowledge of the people in general and from the peraonal histories I have elicited, that excessive sexual excitement is a causative factor more pronounced in India than in the western countries, for the reason that sexual intercourse is begun earlier and continued later in life than appears to be the; case in western countries. Of course it is not becoming; one to dogmatize with reference to this particular point, since absolutely positive information is not available to prove or disprove the actual truth of one's observations, so one can only state his impressions which have been derived from a somewhat prolonged and intimate contact with the people in matters domestic and private.
Another exciting cause I believe to be the excessive use of hot cuiTy and spices so com- mon to Indians ; the resulting constipation and consequent engorgement of the portal circulation atid the production of chronic congestion of the hemoiThoidal vessels affecting the prostatic plexus of veins with which the hemorrhoidals T are so intimately related. J^ifiLia eyident _ fron^ IC
