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I 
35 per 1,000 miners respectively. The other two districts are two mining 
districts with few people engaged in agricultural pursuits. The figures for 
the first half year 1903 were quoted by Durham for the first half year of 
1903 the relative mortalities are comparable. The substantial correctness 
of diagnosis in the period was verified in each case. 
Exclusive of Beri-Beri the ratios for Dysentery and Diarrhoea were 
practically the same in the three hospitals, and also for respiratory diseases, 
so that the variation in the proportion of Beri-Beri or in the case mortality 
is not due to differences in the popularity of the different hospitals. 
There has been a steady diminution in the case mortality as well as in 
the number of cases in Selangor for some years. In 1895 3 > 7 Sl cases were 
treated with a mortality of 18.7 per cent., in 1902 2,673 cases were treated 
with a death-rate of 12.15 per cent. The mining population in 1897 was 
47,000, and Mr. Dykes, the Senior Warden of Mines, informs me that 
it was probably about 40,000 in 1895, in : 9° 2 ^ wa . s 7°> 000 > so that the 
proportion attacked is little more than a third of what it was. 
Post-mortem examinations were made in 34 cases. 
Of the gross pathological lesions the most important and most constant 
i was cardiac dilatation. As a rule both sides of the heart were dilated and 
■ rigor mortis of the cardiac muscle either absent or poorly marked. This 
dilatation is associated with a certain degree of hypertrophy, as the average 
cardiac weight was 315.81 grammes (normal 260, the average in Chinese 
suffering from chronic disease such as dysentery which puts no extra work 
on the heart, 161.26k In some cases this dilatation was extreme and in 
almost every case was marked and unmistakeable. More variable was the 
amount of effusion into serous cavities, the Pericardium, Pleura and 
Peritoneum in the order named were those most frequently involved. In 
some cases, especially those in which the subcutaneous oedema was 
excessive, there was effusion into all the serous cavities. 
Cultures made from these fluids in all cases where it was possible soon 
after death were negative, and so were those from the cerebrospinal fluid. 
The oedema is not limited to the subcutaneous tissues, the submucous, 
such as that of the intestine, gall bladder, etc., was frequently involved. 
The lungs in cases of excessive effusion showed of pulmonary collapse 
areas at the bases. In the great majority of the cases the lungs were 
: oedematous. 
The central and peripheral nerve lesions are fully described in the 
second part of Studies No. 2, by Dr. Hamilton \\ right. 
The early lesions according to Dr. Hamilton \\ right and Dr. 
Durham are in the alimentary tract. According to Dr. Durham some 
j congestion of the fauces is common, and organisms with peculiar characters 
were obtained in some cases. The occurrence of these organisms probably 
owing to the scarcity of early cases neither Dr. Tuck nor myself have been 
able to confirm, though the congested condition described was sometimes 
seen. Dr. Hamilton Wright laid great stress on the condition of the 
stomach and duodenum, and on the congestion in some cases of extensive 
areas of the intestines in early cases or in cases with acute exacerbations. 
This congestion is certainly common and was present in 13 of these fatal 
cases, and in two others the duodenum was markedly congested though the 
stomach was not. In two others there was marked congestion of large 
I intestine though none of the stomach or small intestine. In four of the 
cases in which there was marked congestion the examination was made 
