China Medical Journal - Yale University Library Digital Collections

i6 The China M edical Jo u rn a l.
of all patients is made, we find that over 95% of all cases are infected.
The whipworm leads all parasites in frequency, but whether or not
this is pathogenic is an unsettled question. I have not been able to
make out a case against it, but ascaris, ankylostoma, tsenia, clonorchus
sinensis and other parasites, when present, are largely responsible for
many digestive disturbances. Too much emphasis cannot be laid on
the importance of animal parasites in the etiology of indigestion.
Some observers have stated that the round-worms and tape-worms are
not pathogenic, but the burden of proof is 011 them. Marked improvement
after the canal has been rid of these worms has been too
-commonly observed in my work for me to entertain any other idea
than that they are important causes of trouble in the alimentary canal.
Every case of indigestion should be examined for worms, and I feel
sure that such a procedure would soon prove its value.
In the discussion of the varieties of indigestion we have a difficult
matter to deal with. The lack of autopsy work and of careful chemical
-examinations of gastric contents render it difficult to treat the matter in
a scientific way. We have to depend largely upon clinical observations.
One of the most noteworthy things it seems to me, after nearly
eleven years’ work in Korea, is the absence of two conditions so
frequently met with in western lands, viz., hj^perchlorhydria with peptic
ulcer, and appendicitis. I have yet to see the first case out here which
I could diagnose as ulcer of the stomach. No doubt such cases exist,
and some of you have probably seen them, but they are certainly not
so common as in western lands. Dr. Mills, of Severance Hospital,
Seoul, tells me that all the examinations of gastric contents made
by him have shown much less acid than is met with in the average
American or European. No doubt the lack of meat diet explains this
partly, but it is also very likely that the lack of strenuosity and nervous
tension in the daily life has something to do with it. If those who live
the simple, unhurried and unworried life are comparatively free from
hyperchlorhydria, then certainly the Korean should be almost immune !
The second condition, the infrequency of which is noteworthy, is
appendicitis. I was so struck with this the first few years of my
practice out here that I really questioned whether the Korean possessed
such an organ as an appendix ; and I recall that at the first autopsy
I performed, which was done, by the way, behind locked doors and
screened windows, the first thing I did w?as to ascertain the presence
of this organ. In later years I have had some cases, and there are
undoubtedly many cases of appendicitis that we never see, but
•certainly the trouble is far less frequent than in our homeland. The