22,2 Mendelson: Resistance of Siamese to Disease 121 



sheet and put into an earthen jar and the same thrown into a canal some 

 4 to 5 feet deep. Patient managed to escape from sheet and jar and 

 reach the bank of the canal where she was found and brought to hospital. 

 Half of omentum amputated. Several large intestinal wounds repaired. 

 Protruding abdominal contents washed with normal saline and replaced. 

 Abdominal cavity not irrigated. Abdomen closed with one small drain. 

 Result, uneventful recovery. 



The reader no doubt feels that this is a very exceptional 

 case; but, as a matter of fact, cases of extensive injury and 

 complete uncomplicated recovery are so numerous as to justify 

 taking surgical risks that would not be legitimate in a white 

 person. 



Another interesting observation is the comparative lack of 

 syphilis of the nervous system. Primary and secondary syphilis 

 are rampant; but tertiary, and especially nervous, manifesta- 

 tions are so rare as to be absolutely exceptional. We have notes 

 of only two cases of tabes, and in a local asylum for the insane 

 where we have just completed a series of 544 specific serum 

 reactions we find 17.2 per cent positive; yet the medical officer 

 in charge reports that there is not, as far as he is able to 

 recognize, a single case of insanity that can be traced directly 

 to syphilis. This is certainly not due to any difference between 

 the eastern and the western strains of spirochete, as some 

 authors seem to think. Unfortunately, syphilis of the nervous 

 system is not at all uncommon in Europeans who have contracted 

 their primary infection in Siam. 



Of the respiratory group of diseases tuberculosis is, of course, 

 the most important. Of the total deaths reported last year 12.5 

 per cent were reported as due to pulmonary tuberculosis. This 

 percentage stands to be corrected, as we have been able to 

 demonstrate that from 20 to 25 per cent of cases showing signs 

 and symptoms of clinical tuberculosis are, in fact, either mycotic 

 or spirochete pulmonary infections. It is surprising that one 

 does not find a greater number of pulmonary infections, con- 

 sidering the crowded quarters that thousands of people occupy. 

 It seems that, given even a small chance, the body is to a very 

 great extent able to overcome the tendency to lung infections. 

 A corrected pulmonary death rate (tuberculosis) of 9.5 per cent 

 is not considered alarming under existing conditions, and we feel 

 quite sure that this rate will gradually reduce itself as sanitary 

 conditions gradually improve. In other words, we feel that it 

 is not necessary to carry on a special tuberculosis campaign if 

 we can educate the masses to a point where they will appreciate 

 and apply a few sanitary and hygienic principles. 



