[ 4 1 J 
in none had the patients been less than 2 years in this country In 9 they 
had been from 3 to 5 years, in 11 from 6 to 10, and in 10 o\er 10 \e • 
The increase of Tuberculosis in other tropical countries is important 
m th ^ h C e °" n i e s Ct e °; dence t i lat Tuberculosis was very rare in Pemerara 111 the 
early part of last century. In 1842 Blair states that cases were more 
numerous than usual, but that of the 17 cases 111 the Georgetown Hospita 
n0t °From aS i842^0 1848 there were 86 deaths from Phthisis out of 2,268, or 
3 ' 7 ^Now between 25 and 30 per cent, of the deaths, and a larger proportion 
if infantile deaths are excluded, are from Tuberculosis, and the proportion 
amongst the natives is as high as in imported races. 
* 
Distribution .—Evidence of tubercle was present in 70 . J--ome it 
was either cured or in an early stage and not sufficiently extensile to be the 
cause of death. In 5 there were calcareous nodules at one 01 both apices 
much puckering of the apical portion of the lobe and some increased 
fibrosis^ In two more there were similar calcareous or cretaceous no u s 
with surrounding recent miliary tubercle, and in one of these theie were also 
tubercular ulcers in the small intestine. This tendency to cure in cases of 
Tuberculosis in the Chinese is promising. It is m marked contrast to 
absence of any such tendency in Negroes and in most primitive races, 
four a small portion of the superior lobe on one side only was involved and 
in one of these there was a small recent cavity. In the remaining 60 cases 
Tuberculosis was advanced. Both lungs were involved in 4 ?i J” ^ 
in 21 ; so that in all the lungs were involved. In addition in 3 the lary 
was extensively involved; in one the tonsils; the stomach "V ’^e 
small intestines in 40; and the large intestine also in 2r. W hen the1 lar 
intestine was involved, superficial or deep non-tubercular ulceratio r a 
often present as well. In some cases where there were no tubercular ulcers, 
ulcers of other nature were present. . . f K rr1 _ • 
This extensive implication of the large intestines m cases of tubercle is 
one of the features of tropical tuberculosis. It is to be note ^ ‘ ’ ° 
case it was associated with almost healed pulmonary u rercu , 
in extent it is not related to the amount of pulmonary tuberculosis, that it.is 
not usually associated with tuberculosis of the mesenteric g ;in ' a " | 
a general tuberculosis though they may be present together ^he Probable 
source of the intestinal tuberculosis is auto-.nfection by swal owing sputum^ 
The absence of tuberculosis from cattle renders it improbable that here it is 
derived from external sources. . , r • i 
General tuberculosis involving several organs of the bodywasfairly 
common. In 16 the spleen was involved, in 7 the iver, and in 6 theGu > • 
In some of the instances no visible tubercles could be seen, but scrapings 
showed the presence of tubercle bacilli. In 5 t ere w There 
peritonitis, and in one other case extensive old peritoneal adhesions. The e 
were two cases of Tubercular Meningitis, and one of a tubercular mass in 
the brain. 
