Journal of tropical medicine 9.1906

V -

V.

БЕР. mta MOM

THE

Hournal of О хоріса! ӘШішігіле

With which is incorporated "CLIMATE"

A BI-MONTHLY JOURNAL DEVOTED TO MEDICAL, SURGICAL AND

GYNECOLOGICAL WORK IN THE TROPICS

EDITED BY

JAMES CANTLIE, M.B., F.R.C.&, М. J. SIMPSON, M.D., F.R.C.P., AND
G. M. GILES, M.B., F.R.C.S., Lievr.-Cou. І.М.8. (Retd.)

VOLUME IX.

JANUARY 1, 1906, TO DECEMBER 15, 1906

LONDON

JOHN BALE, SONS & DANIELSSON, Lrp.
83-91, GREAT TITCHFIELD STREET, OXFORD STREET, W.

INDEX ТО VOL. IX.

JANUARY 1, 1906, to DECEMBER 15, 1906.

LIST OF

Adie, Col. J. R., I.M.S., 325.
Alexander, Dr. David, 69.
Anderson, J. F., 252.
Austen, E. E., 98, 118.

. Balfour, Andrew, M.D., B.Sc., M.R.C.P., 81, 373.
Branch, C. W., M.B., C.M., 102, 156, 874.
Bremridge, R. H., M.A., M.B., 119.

Brewers, I., M.D., 107.
Сап іе, James, M.B., F.R.C.S., 181, 277, 312.
Castellani, Aldo, M.D., 1, 36. .
Cleland, J. B., M.D., 296.
Dalgetty, A. B., C.M., M.D., D.P.H., 165.
esai, V. G., L.M.S., 215.
udgeon, G. C., Е E.S., 261, 326.
udgeon, L. S., M.R.C.P., 261.

Duncan, Andrew, M.D., B.S., M. R.C.P., 309.

‘Duprey, A. J., M.R.C.S., L.R.C.P., 22.

Eder, M. D., M.R.C.S., L.R.C.P., 159.
Elkington, J. S., 78.

Elliott, J. F., L. RC.E.I, L. .I.
Fink, Major G. H., I.M.S., M.R.C.S., 310.
Gauducheau, Burg ajo , A., 52.

Gerrard, P. N., M.D., D.T.M.H., 4, 347.

Giles, Lieut.-Col. G. M., I.M.S., 99, 180, 153, 169, 182, 198,
217, 285.

Gimlette, T. D., M.D., 149, 153, 173, 186, 198, 235, 262.

Haran, James A., M.A., M.B., B.Ch., 82.

Harford, C. F., M.D., 124.

A

Abscess, subhepatic, 181 f

ABSTRACTS, amoebic dysentery, experimental reproduction of,
52; Carrion's disease, 159 ; Colonel Gorgas’ monthly reports
from the Canal Zone, Panama, 107 ; conditions affecting the
location of missionaries on their return after furlough, 124;
flies and cholera, 41; human trypanosomiasis, 268; mos-
quitoes and yellow fever, 54; paratyphoid fever and typhoid
fever, 378; preventive treatment of disease, 105; tropical
Australia, 73; tropical dysentery, 379.

Acute contagious conjunctivitis in Ceylon, 36

Address delivered at the opening of the winter session of tho
London School of Tropical Medicine, October, 1906. 818 `

Aden Hinterland, culicid fauna of the, 78 :

African poison test, 857

Alimentary canal, the hygiene of the, 189

Allen and Hanbury’s works at Ware. inspection of, 274

Amateurs, meteorology for, 220.

Anemia in Porto Rico, 185

Anatomy of the biting flies of the genera Stomoxys and Glossina,
99, 153, 169, 182, 198, 217, 229

Axaora nos from, 81; tumour and cancer among the natives
ot,

Anthrax edema, malignant, in Central Africa, 250 .

ANTI-MALARIAL campaign in Austria and Hungary, 361; sani-
tation in India, 104

Apology, 351

Appendicitis, 224

Arrangements for 1906, 5 қ )

Arthropods, blood.sucking, on a hemipterous insect which
preys upon, 97

Association, a tropical medical, 103

LION Ввітізи Mepican, meeting at Toronto, 239, 270,

AUTHORS.

Hartigan, W., M.D., D.P.H., 15.

King, Harold, 373.

Koch, Dr. R., 75, 104, 137.

Leitao, A. de S. Maia, M.D., 357.

Гете, C. P., M.D., 199.

Leys, James F., M.D., 47.

Logan, О. T., M.D., 294.

Madden, F. C., M.D., F R.C.S., 293.
Massey, Yale, В.А., M.D., C.M., 250.
Paranhos, U., M.D, 129.

Patton, Lieut. W. S., I.M.8., 78.

Perry, Sir Allen, M.D., D.P.H., 36. :
Phillips, L. P., M.D., M.R.C.S., F.R.C.S., 23, 373. -
Rat, J. Numa, M.D., 135.

Robertson, A., M.B., C.M., 829.

Rosenau, J. M., 252.

Ross, Е.Н. M.R.C S., L. R.C.P., 17.

Ross, Ronald, F.R S., C.B., 841.

Saigh, Selim, M.D., 341.

Scharlieb, Mary, M.B., B.S., 113.

Stanley, Arthur, M.D., 185.

Terni, Dr. Camillo, 229.

Travers, E. А, O., M.R.C.S., L. R.C.P., 197.
Watson, Malcolm, M.D., D.P.H., 197.
Wellman, Е. C., M.D., 31, 97, 215, 928.
Wright, Hamilton, M.D., 245.

Ziemann, Dr. H., 353.

B

Bacillus of Hamilton Wright obtained from two cases of acute
beri-beri, 261

Basutoland (Col. Med. Reports, 5, 7, 71)

BERI-BERI, etiology of, 252; Hamilton Wright’s bacillus
obtained from two cases of acute, 261; mouldy rice:
occurrence of beri-beri in the Sokor district, 262; restate-
ment and reply to some criticisms, 245

Birth-rate in the Punjab, 271

Biskra as a health resort, 41

Biting flies of the genera Stomorys and Glossina. anatomy of
the, 99, 153, 169, 182, 198, 217, 229

Blood-sucking hemipteron, 378

Blood-sucking insects in West Africa, distribution of. 353

Bodies in the sputum and fæces resembling the eggs of para-
sites, 72

Brazil, note on tinea imbricata in, 129

British East Africe, an outline of plague as met with in, 32

British Guiana (Col. Med. Reports), 92

Ввітівн MEDICAL ASSOCIATION, meeting of the, at Toronto, 239,
219, 298

British spas, suitable for tropical residents: Harrogate, 268;
Cheltenham, 274

с

Cambridge, Dr. С. Harford’s lecture at, 27

Cancer and tumour among the natives of Angola, 271
Carrion’s disease, 159

Case of the Indian hospital assistants, 350

Central Africa, malignant anthrax cedema in, 250

Ceylon, an outbreak of acute contagious conjunctivitis in, 36
Cheltenham, 274

Cholera and flies, 41

Climatology, co-operative research in, 27

TIUS

iv. INDEX

Clinical picture of relapsing fever, 215

College of medicine for Chinese, Houg Kong, 53

Colombo, leprosy in, 332

Colonial elimatie data, a plea for uniformity and greater official
support in the collection of, 24

Colonial economic notes, 162

Colonial nursing association, 206

Commission for the investigation of Mediterranean fever,
report of the, 138

Co-operative research in climatology, 27

CORRESPONDENCE, 13, 45, 62, 94, 108, 126, 135, 158, 192, 202.
227, 241, 254, 301, 333, 351, 363

Cuba and Panama, malaria in, 177

Culicid fauna of the Aden Hinterland, 73

Culicidal fumigation, experiments in practical, 360

Cyprus (Col. Med. Reports, 75, 79)

D

Daily range of heat and humidity in tropical countries, 121

Death of Dr. Stewart, 40

Dengue in Egypt, 373

Dengue in Port Sudan, 318

DEPRECIATION OF THE ATTRACTION OF THE INDIAN MEDICAL
SERVICE, 269 ; and its remedies, 38, 70

Destructive uleerous rhino-pharyngitis, 47

Diet, the principles. of. in tropical campaigus, 309

Digestion and food in warm climates, 312

Disease and horse-flies (Tabanidae), 98

DisEAsks met with in South Sylhet, India, 165; seen on the
line of the projected Lobitokatanga railway, 328

Distribution of blood.sucking insects in West Africa, 353

Distribution of Liège exhibition awards, 205

Dr. Charles Harford's lecture at Cambridge, 27

Dysentery, tropical, 379

E

East Africa, results of & voyage of investigation to, 43, 75, 104,
187

Eastern city. some striking facts about an, 119

Echinococcus ооа 18, 924

EDITORIALS, 5. 24, 97, 38, 40, 51, 52, 12, 73, 92, 108, 104,
121, 124, 132, T 176. 189, 190, px 204. 220, 237, 239.
251, 252, 268, 269, 279. 283, 997. 317, 318, 330. 331, 332,
350, 357, 358, 376

Etiology of beri-beri, 252

Experimental reproduction of amwbic dysentery by intravenous
inoculation of pus from а hepatic abscess, 52

Experiments іш practical culicidal fumigations, 360

F

FEVER, paratyphoid and typhoid, 378; relapsing, 215; tick, 65;
yellow, 191

Fit and unfit persons for residence in warm climates, 15

Flies and cholera, 41

Боор and digestion in warm climates, 312; of the natives ot
India, 310; trade and the public, 817

Fronto-nasal cephalocele, two cases of, 329

Further report on measures taken in 1901 to abolish malaria
from Klang and Port Swettenham in Selangor. Malay
States, 107

G

Gambia (Col. Med. Reports, 53)

Geographical distribution of disease, 195, 208, 257, 368

Glossina and Stomorys, auatomy of, 99, 153, 169, 182, 198,
217, 229

Gold Coast (Col. Med. Reports, 16, 19, 23, 27)

Greece, malaria in, 299, 341, 351

H

ILEMOGREGARINE OF MAMMALS, 296; and some notes on try-
panosomiasis in the Anglo- Ену ptian Sudan, 81

Hamilton Wright, the bacillus of, obtained from two ‘cases: of
acute beri-beri, 261

Harrogate, 268

Health department, Shanghai, 193

Heat and Dad thé daily range of. in tropical countries,
121 d

Hemipteron, a blood- sucking, 373

Hemipterous insect, on a, which preys upon blood-sucking
arthropods, and whiclrgoccasionally petagks , mammals
(man), 97

Hong Kong, college of medicine for Chinese, 53

Horse-flies (Табаліде) aud disease, 98

Housing of Europeans on the West Coast of Africa, 376

How to recognise the species of Pulex possibly concerned in the
transmission of plague, 190

Heman biting flies, occurrence and habits of some species of,
320; spirillosis in Loanda (Angola). 357; tick fever, an
insect enemy of the disseminator of, in Angola, 113

HyciENE of the alimentary canal, 189; of travel in tropical
Africa, 40

Hygienic measures against syphilis, 203

Hypnotic influence of the negro race, 102

I

Imperial Institute, 124

Improved method of staining for Schuffner's dots. 206

INDIA, anti-malarial sanitation in, 104; food of the natives of,
810; notes on plague in, 300; sanitary organisation in, 831;
serum therapy of plague in, 204

INDIAN hospital assistants, case of, 350; Government manifesto
on plague prevention, 74; Medical Gazette on ‘* growsing,”
134 ; medical service, depreciation of the attraction of, 269,
and its remedies, 38 ; subordinate medical service, training
of the, 203

Insect enemy of the disseminator of human tick fever in
Angola, 113

Inspection ‘of Allen and Manbury's works at Ware, Hertford-
shire, 274

Intestinal lesions, chronic, and sprue, 277

Is malaria as black as it is painted ? 132

Is yaws syphilis? 1

J

Jamaica, vomiting sickness in, 374
Juvenile smoking, 360

K

Kitasato's suggestion of an international conference to fight
plague, 297
Koch on tuberculosis, 191

L

Leishman or other stains, a simple and cheap rocker for, 4

Leprosy, in Colombo, 332; pathology and treatment of, 330

Lesson on the preservation of health in the Tropics, 157

Leucocytosis, operation, 347

Leucocytozoon found in the Mus rattus in tho Punjaub, 325

LIVERPOOL SCHOOL оғ TROPICAL MEDICINE, 92, 237, 877, 386

Livingstone College, 12, 221

Loanda, human spirillosis i in, 357

LoNDON SCHOOL or Т нос; AL MEDICINE, 205, 253; .address
delivered at the -opening of the winter session of the,
October, 1906,:918

M

Maintenance of health by women in the mission field, 113

MALARIA, a simple preventive against, 283 ; in Cuba and Panama.

` 177 ; im’ Greece, 299, 341, 351 ; is itas black as it is painted ?
132; measures taken in 1901 to abolish, from Klang aud
Port Swettenham, 197. ;

Malay Peninsula, the puru of the, 149, 173, 182

Malignant anthrax oedema in Central Africa, 250

MALTA FEVER in Shanghai, 135; is it peculiar , 16 Malta? 23;
mode of infection in, 17

Mammals, the hwmogregarine of, and some foley on rats, 296:

Medical aid, problem: of, in semi-civilised countries, 51.

MEDICAL ASSOCIATION, BRITISH, the meeting of the; at Toranto,

- 239, 279; tropical, 103. i IN :
Medical notes, 141, 243

INDEX A

Res Se Eu cum RCE EUR: E ---- ee ee 2--- ————————

Mediterranean fever, report of tho commission for the investiga-
tion of, 138

Meetiug of the British Medical Association at Toronto, 239,
210, 298

Meteorology for amateurs, 220

Mode of infection in Malta fever, 17

ue oou notes, 130; worms of Trinidad and their real nature,

N

Natives of India, food of, 310

Negro race, hypnotic influence of, 102

New aspect in the pathology and treatment of leprosy, 330

Nile boils, 203

North Nigeria, notes from, 69

Northern Nigeria (Col. Med. Reports, 8, 11, 15, 62, 63)

Note on a leucocytozoon found in Mus rattus iu tho Punjaub,
325; on the habits of, Ornithodorus moubata, 215; the tinea
imbricata in Brazil, 129

NorES AND News, 14, 55, 79, 95, 108. 127, 141, 161, 178, 195.
907, 927, 942, 255, 272, 288, 301, 335, 355, 364, 387

Notes from Angola, 31; from North Nigeria, 69; on diseases
met with in South Sylhet, India, 165; on plague in India.
300; on rats and the haemogregarine of mammals, 296; on
some of the more obvious disease conditions seen on the
line of the projected Lobitokatanga railway, 328

Nubian woman, rodent ulcer in a, 373

о

Obituary Notices, 111, 254, 324

OccuRRENCE and habits of some species of human biting flies,
896; of beri-beri in the Sokor District, 262

On a hemipterous insect which preys upon blood-sucking arthro-
pods and which occasionally attack mammals (man), 97

Operation leucocytosis, 347

ORIGINAL COMMUNICATIONS :—

Anatomy of the biting flies of the genera Stomoxys and Glos-
sina, by Lieut.-Col. G. M., Giles, I. M.S., 99, 158, 169, 182.
198, 217, 235 : :

Bacillus of Hamilton Wright obtained from two cases of acute
beri-beri, by Leonard Dudgeon, M.R.C.P., 261

Beri-beri; mouldy rice; the occurrence of beri-beri in the
Sokor District, by John D. Gimlette. M.R.C.S.. L. R.C.P..
262

Beri-beri: & re-statement and reply to some criticisms. by
Hamilton Wright, M.D., 245

Blood-sucking hemipteron, by H. H. King, 373 i

EM picture of relapsing fever, by V. G. Desai, L.M.S..
215

Dengue in Egypt, by L. Phillips, M.D., B.C., F.R.C.S.,
MARC. S У“ E !

Dengue іп Port Sudan—Red Sea Province, Sudan, by Selim
Saigh, M.D., 348 ‘

Etiology of beri-beri, 252

Fit and unfit persons for residence in warm climates, by W.
Hartigan, M.D., D.P.H., 15

Food and digestion in warm climates, by James Cantlie, M.B.,
F.R.C.S.. 312 р :

Food of the natives of India, by Major.G. Н. Fink, 1.М.5..
M.R.C.S.. L.8.A.,:810 І MEE

Further report on measures taken in 1901 to abolish malaria
from Klang and Port Swettenham, by E. A. O. Travers.

а Malcolm Watson. M.D., D.P.H..

Hemogregarine of mammals and some notes on rete, by-J: В.
Cleland, M.D., Ch.M., 296

Hemogregarine of mammals and some notes on trypanoso-
miasis in the Anglo-Egyptian Sudan, by Andrew Balfour,
M.D., B.Sc., M.R:C:P., D.P.H 81 - -- - - Aus

Horse. flies (Tabanide) and disease, by E. E: Austen, 98 ~~

Human spirillosis in Loanda (Angola), by A. de S. Maia
Leitao, M.D., 357 P j

Hypnotic susceptibility of the negro race, by С. W. Branch.

Is Malta fever peculiar to Malta? by L. P. Phillips, M.D.,
M.R.C.S., F.R.C.S., 23

Is yaws syphilis? by Aldo Castellani, M.D., 1

Malaria in Greece, by Ronald Ross, F.R.S., C.B., 341

Malignaut anthrax adema in Central Africa, by А. Yale
Massey, B.A., M.D., 250

Mosquito notes, by Lieut.-Col. G. M. Giles, I.M.S., 130

Mosquito worms of Trinidad and their real nature, by А. J.
Duprey, M.R.C.S., L. R.C.P., 22

Nile boils, by F. C. Madden, M.D., F.R.C.S., 293

Note on а leucocytozoon found in Mus rattus in the Punjaub,
by Col. J. R. Adie, I. M.S., 325

Note on the habits of Ornithodorus moubata,
Wellman, M.D., 215

Note on the Tinea imbricata in Brazil, by U. Paranhos, M.D.,
&nd C. P. Leme, M.D., 129

Notes from Angola, by F. C. Wellman, M.D., 31

Notes from North Nigeria, by Dr. D. Alexander, 60

Notes on diseases met with in South Sylhet, India, by A. B.
Dalgetty, C.M., M.D., 165

Notes on some of the more obvious discase conditions seen on
the lino of the projected Lobitokatango railway, by Е. C.
Wellman, M.D., 328

Occurrence and habits of some species of human biting flies
belonging to the families Tabanide and Muscidc (Glossina)
from the West Coast of Africa, by G. C. Dudgeon, F.E.S..
326

On a hemipterous insect which preys upon blood-sucking
arthropods, and which occasionally attacks mammals (man),
by Е.С. Wellman, M.D., 97

Operation leucocytosis, by P. N. Gerrard, B.A., M.D., 347

Outbreak of acute contagious conjunctivitis in Ceylon, by Sir
Allen Perry, M.D., D.P.H.. and Aldo Castellani, M.D., 36

Outline of plague as шей with in British East Africa, by
James А. Haran, M.A., M.B., 32

Principles of diet in tropical campaigns, by Andrew Duncan.
M.D., B.S., M.R.C.P., F.R.C.S., 309

Puru of the Malay Peninsula, by T. D. Gimlette, M.D., 149.
178, 186

Question of the mode of infection in Malta fever, by E. H.
Ross, M.R.C.S., L.R.C.P., 17

Rhino-pharyngitis mutilans, by С. W. Branch, M.B., CM.,
156 i

by F. C.

Rhino-pharyngitis mutilans, by J. F. Leys, M.D., 47

Rodent ulcer in a Nubian woman, by Andrew Balfour, M.D.,
873

Simple and cheap rocker for Leishman and other stains, by
P. N. Gerrard. M. D., 4

Some striking facts about an Eastern city, by R. H. Brem-
ridge, M.A., M.B., 119 . .

Sprue aud chronic intestinal lésions, by James Cantlie, M.B.,
F.R.C.S., 277

Studies in plague, by Prof. Dr. C. Terni, 229

Subhepatic abscess, by James Cantlie, M.B., F.R.C.S., 181

Suggestions for the maintenance of health by women in the
mission field. by Mary Scharlieb, M. B.. B.S., 113

Three cases of infection with Schistosoma japonicum іп
Chinese subjects, by O. T. Logan, M.D., 294

Two cases of fronto-nasal cephalocele, by A. Robertson.
М.В., С.М., 829 :

Verruga peruana, by M. D. Eder, M. R.C.S., L.R.C.P., 218

Vomiting sickness in Jamacia, by C. W. Branch, M.B., C.M.,

' 974

Orgauisatiou of the medieal service of the native army of India,

358
Ornithodorus moubata, note оп the habits of, 215
Outbreak of acute contagious conjunotivitis in Ceylon, 86

‘Outline of plague ás met with in British East Africa, 94

P

"Panama and Cuba, malaria in, 177

Parasites, bodies in the sputum and faces resembling the- eggs
of, 72 :

“Рагабурһоій and typhoid fever, 378
‘Pathology and treatment of leprosy, 330

PegsonaL Nores. 59, 77, 109, 145, 162, 179. 195, 208, 227. 243.
.. 957, 273, 990, 303, 887, 356, 366, 386
Philippine Journal of Science, 191

PLAGUE, 80, 95, 111. 177, 291. 303; ап outline of, as met with in
British East Africa, 32; and flies, 127; how to recognise
the species of puler possibly concerned in the transmission
of. 190; in India, notes on. 300; in India, serum therapy
of, 204 ; Kitasato's suggestion of an international conference
to fight, 297; prevention of, Indian Government manifesto
on, 74

Plea for uniformity and greater official support in the collec-
tion of colonial climatic data. 24

Poison test, the African, 857

Porto Rico. anemia in. 135

Precise definition of diseases, 360

Preliminary statements on the results of & voyage of investiga-
tion to East Africa, 43. 75. 104, 137

Prescriptions, 146, 301, 303

Preservation of health in the Tropics, 157

Principles of diet in tropical campaigus, 809

Prizes, Belilios and Sivewright, 251

Prizes offered for the discovery of the typhus fever germ, 271

Problem of medical aid in semi-civilised countries, 51

Professor Elie Metchnikoff, 176

Public and the food trade, 317

Pulex, how to recognise the species of, possibly concerned in the
transmission of рігете, 190

PUNJAB, birth-rate in, 271; leucocytozoon found in Mus rattus
in the, 325

Puru of the Malay Peninsula, 149, 178, 186

Q

Question of the mode of infection in Malta fever, 17

R

Rats, notes on, and the hwmogregarine of mammals, 296

RECENT AND CUBRENT l.ITERATURE, 14, 30, 46, 57, 79, 95. 112,
128, 146, 163, 179, 195, 209, 224, 928, 249, 258, 275, 292,
804, 338, 856, 369, 388

Report of the commission for the investigation of Medi-
terranean fever, 138

Reports, on beri-beri, 225; health of British Navy, 283;
health of Hong Kong, 240

Residence in warm climates, fit and unfit persons for, 15

REVIEWS : –

A Few Hints on Ше Care of Children аб Sea, by Samuel
“Synge, M.A., M.D., M.A.O., B.Cb.(Dub. Univ.), L.M.

(London: J. Bale, Sons and Danielsson, Ltd., Great
Titchfield Street. W., price 1s. net), 854

Anesthetic Technique, for Operations of the Nose and
Throat, by A. de Prenderville (London: Н. T. Glaisher,
1906, pp. 88, illustrated), 207

Animal Parasites of Man, a Handbook for Students and
Medical Men, by Dr. Max Braun; third enlarged and
improved edition, with 294 illustrations in the text, trans-
.lated from the German by Pauline l'alcke, brought up to
date by Louis W. Sambon, M.D. (Naples), and Fred. V.
Theobald, М.А. (London: John Bale. Sons and Danielsson,
Ltd., Great Titchfield Street, W., 1906, price 218, net), 177

Beri-beri— Observations in the Federated Malay States on
Beri-beri, by C. W. Daniels, M.B.Camb., M.R.C.S., Jate
Director, Institute for Medical Research Kwala Lumpur,
F.M.8. (Londou: E. G. Berryman and Sons, Blackheath
Road, S.E., 1906, pp. 105, price 3s. 64.), 140

Blood-sucking Flies and How to Collect Them, by E. E.
Austen (British Museum), 108 `

Courmont, J., of Lyons, on the Atmo: phere, and C. Lesieur, of
Lyons, on Climatology, in а Treatise on Hygiene, published
by P. Brouardel and E. Mosney, Т. 1, fascic. i., pp. 124
(Paris: J. B. Bailliére, 1906), 126 :

Extra Pharmacopoeia, by Martindale and Westcott, Туе!
Edition (London: К. Lewis, 186, Gower Street,
London, W.C., 1906), 301

Handbook of Climatic Treatment, including Balneology,
by W. R. Huggard, M.A., M.D., FRCP. (London:
Macmillan and Со., 1906), 29 К

Handbook of Climatology, by Dr. Julius Hann, translated
from the Second German Editien by Robert de Courcy
Mr: (New York and London: Macmillan and Co., part
i.), 28

vi. INDEX

Hiustrated Key to the Cestode Parasites of Man, by С. Н.
Wardell Stiles (Washington, 1906, pp. 104), 363

A Japanese Text.book on Plague, by Dr. Tohiu Ishig&mi,
Superintendent Bacteriological Institute. Osaka, Japan,
formerly Assistant Bacteriologist to Professor Kitasato; re-
vised by Professor Shibasaburo Kitasato, Tokyo, Japan;
translated, enlarged and illustrated with Pathogenic Horti-
culture by Donald MacDonald, M.B., C.M.(Glas.), late Con-
sulting Bacteriologist to the South Australian Government ;
152 illustrations, 3 plates. (Adelaide, Vardon and Pritcbard.
Gresham Street, 1905), 385 ;

Lectures on Tropical Diseases, being the Lane Lectures for
1905, delivered at Cooper Medical College, San Francisco,
U.S.A., August, 1905, by Sir Patrick Manson, K.C.M.G.
(London: Archibald Constable and Co., 16, James Street,
Haymarket, S.W., 1905, pp. 230, illustrated, price 7s. 64.),
94

Management of a Plague Epidemic, by Е. F. Gordon Tucker,
(Calcutta: Thacker, Spink and Co., Government Place,

. 28 pp.), illustrated, price 1.8 rupees, 161

Medical Diseases of Egypt, by F. M. Sandwith, M.D.,
F.R.C.P., (London: Henry Kimpton, 13, Furnival Street,
Holborn, E.C., 1905, part i.. pp. 316), 193

Nature and Treatment of Cancer: Some Methods of Hypo-
dermic Medication in the Treatment of Inoperable Cancer,
by John A. Shaw-Mackenzie, M.D.Lond., third edition,
revised and enlarged (London: Baillitre, Tindall and
Cox, Henrietta Street, Covent Garden, 1906, рр. 99, price
28. 6d. net), 177

Notes, by Ernest Edward Austen, Assistant Department of
Zoology, British Museum (N.H.), 1906, pp. 74, with. 84
coloured plates. Printed by order of the Trustees of the
British Museum (London, 1906, price 25s.), 254

Nutrition and Dysentery, by Lieutenant-Colone] U. N.
Mukerji, M.D., I.M.S., (Rtd.) (Calcutta: B. K. Lahiri and

о.), 240

Paten Foods ава Patent Medicines, two lectures, by Robert
Hutchison, M.D., F.R.C.P., second edition (London : J.
Bale, Sous and Danielsson, Ltd., Great Titchfield Street,
W., 1906, price 1s. net), бі

Principles of Treatment and their Application to Practical
Medicine, by J. Mitchell Bruce, M.A., M.D., LL.D.,
F.R.C.P., third edition (Edinburgh and London : Young
J. Pentland, 1906, demy 8vo, pp. 614), 398

Reged of the Expedition to the Congo, 1908-5, by the late

. Everett Dutton, M.B.Vict., and John L. Todd, В.А.,
M.D., C.M.McGill; with Descriptions of Two New Der-
manyssid Acarids, by Robert Newstead, A.L.S., Е.Е.8., &c.,
and Tbe Anatomy of the Proboscis of Biting Flies, by
J. W. W. Stephens, M.D.Cantab., and Robert Newstead,
A.L.S., F.E.8., &c., March, 1906 (London : Published for the
Committee of the Liverpool School of Tropical Medicine
by Williams and Norgate, 14, Henrietta Street, Covent
Garden, piee Ts. 6d. net), 287 :

Scientific Memoirs, by Officers of the Medical aud Sanitary
Departments of the Government of India; On в Parssite
found in the White Corpuscles of the Blood of Palm
Squirrels, by Captain W. S. Patton, M.B., I.M.S. (Calcutta :
icon 2 the-Superintendent of Government Printing, India,

» 241 ;

Simple Guide to the Preservation of Health in South Africe,
by Н. Strachan, C.M.G., М.Е.С.5., L.R.C.P., Р.М.0.
Lagos, West Africa, Second Edition, 72

With the Abyssinians in Somaliland, by Major J. Willes
Jennings, R.A. M.C. (Hodder and Stoughton), 61

Rhbino-pharyngeal lesions іп yaws, 195
Rhino-pharyngitis mutilans (destructive ulcerons rhino-pharyn-
gitis), 47, 156
ulcer in a Nubian woman, 973

8

Saint Lucia (Col. Med. Reports, 66, 67, 71)
Sanitary organisation in India, 331
Sanitation, anti-malarial, in India, 104
Santyl, 139 te

Schaudinn memorial, 882

Schistosoma Стоте in Chinese subjects, three cases of infec-
tion with, 204

Schuffner’s dots, an improved method of staining for, 206

Scorpion poison, 30

Serum therapy of plague in India, 204

Seychelles (Col. Med. Reports, 82, 83, 87, 91)

SHanGuat Health Department, 198 ; "Malta fever in, 135

Simple and cheap rocker for Leishman or other stains, 4

Simple preventive against malaria, 283

Sivewright prize, 251

Sleeping sickness, 291

Somaliland Protectorate (Col. Med. Reports, 50, 51).

Some notes on trypanosomiasis in the Anglo- Egyptian Sudan,
and a hemogregarine of mammals, 81

Some of the regulations concerning plague, cholera, and yellow
fever drawn up during the Second International Sanitary
Convention of American States, October, 1905, 54

Some points of interest in tropical work during 1905, 6

Some striking facts about an Eastern city, 119

Southern Nigeria (Col. Med. Reports, 55, 59)

South Sylhet, diseases met with in, 165

Special food preparations, 316

Sprue and chronic intestinal lesions, 277

Stomoyrs DN glossina, anatomy of, 99, 153, 169, 182, 198,
217, 9%

Straits Settlements (Col. Med. Reports, 31, 95, 39, 43, 47)

Studies in plague, 229

Study of the cause of sudden death following the injection of

^^ horse serum, 252

Subhepatic abscess, 181

Sudan, dengue in, 348

Suggestions for the maintenance of health by women in the
mission field, 118

SYPHILIS, hygienic measures against, 203; is it yaws ? 1

T

Tabanide (horse-flies) and disease, 98

Three cases of infection with Schistosoma japonicum in Chinese
subjects, 294

Tick fever, 65

Tinea imbricata in Brazil, 129

Toronto, meeting of the British Medical Association at, 239,
279, 298

Training of the Indian subordinate medical service, 208

Transmission of plague, how to recognise the species of Puler
possibly concerned in the, 190

INDEX vii

Treatment and pathology of leprosy, 330

Trinidad (Col. Med. Reports, 3)

Trinidad, the mosquito worms of, and their real nature, 22

TROPICAL Africa, the hygiene of travel in, 40; campaigus, prin-
ciples of diet in, 309 ; countries, the daily range of heat and
humidity in, 121 ; Medical Association, 103; medical work
during 1905, some points of interest in, 61 ; residents, British
epas suitable for, 268

Tropical dysentery, 879

TROPICAL MEDICINE, Liverpool School of, 92, 237, 377 ; London
School of, 205

Tropics, & lesson on the preservation of health in the, 157

Trypanosomiasis in the Auglo-Egyptiau Sudan, and a hemogre-
garine of mammals, 81

Tuberculosis, Koch on, 191

Tumour and cancer among the natives of Angola, 271

Two cases of fronto-nasal cephalocele, 329

Typhus fever germ, prizes offered fordiscovery of, 271

U
Ulcer, Zambesi, 64
University of Cambridge, 292

ү

Verruga peruana, 213
Vomiting sickness in Jamacia, 374

Ww

Warm climates, fit and unfit persons for residence in, 15; food
and digestion in, 812

West Africa, distribution of blood-sucking insects of, 358

West Coast of Africa, housing Europeans on the, 376

Y
Yaws, is it syphilis ? 1
Yaws, rhino-pharyngeal lesions in, 135
Yellow fever, 191

Z
Zambesi ulcer, 64

COLONIAL MEDICAL REPORTS.

No, 16, Trinidad (contd.), 3 E
+» 17, Basutoland, 5, 7
, 18, Northern Nigeria, 8, 11
. 19, Northern Nigeria, 15
., 20, The Gold Coast, 16, 19, 23, 27
. 21, The Straits Settlements, 81, 35. 39. 48, 47
F 22, Somaliland Protectorate, 50, 51
. 28, Gambia. 58

No. 24, Southern Nigeria. 55, 59
25. Northern Nigeria, 62, 63

.. 26, Saint Lucia, 66. 67, 71
.. 27, Basutoland, 71
,. 98, Grenada, 74
.. 99, Cyprus, 75, 79
.. 80, Seychelles, 82, 83, 87 91,
ж 91, British Guiana, 92

viii.

LIST OF

JaNuARY 1st, 1906, Plate, Is Yaws Syphilis ?

JANUARY 15th, 1906, Illustration to accompany article ‘+ Mos-
quito Worms ”

FEBRUARY 1st, 1906, Plate illustrating article “ Preliminary
Statement on the Results of a Voyage of Investigation to
East Africa”

FEBRUARY 15th, 1906, Illustration to accompany article “ Rhino-
pharyngitis Mutilans ”

Marca 156, 1906, Temperature charts to illustrate article * Tick
Fever"

Marcu 15th, 1906, Plate and illustrations to article “А Hæmo-
gregarine of Mammals, and some Notes on Trypanosomiasis
in the Anglo-Egyptian Sudan ”

APRIL 2nd, 1906. Plate, Thos. E. Charles, M.D., LL.D.Edin.,
F.R.C.P. Lond.

Illustrations to accompany article ‘On а Hemipterous
Insect which Preys upon Blood-sucking Arthropods and
which occasionally Attacks Mammals (Man) ”

Illustrations to accompany article “Тһе Anatomy of the
Biting Flies of the Genera Stomoxys and Glossina”

APRIL 16th, 1906, Plate. London School of Tropical Medicine,
20th Session, January to April, 1906
Charts to illustrate article “Тһе Daily Range of Heat and
Humidity in Tropical Countries "

May Ist, 1900, Illustration to accompany article “ Mosquito
Notes”

May 15th. 1906, Illustrations to accompany article “Тһе Anatomy
of the Biting Flies of the Genera Stomoxys and Glossina”

JUNE Ist, 1906, Illustrations to accompany article “ The Anatomy
of the Biting Flies of the Genera Stomorys and Glossina."'

ILLUSTRATIONS.

June 15th, Plate, Outline Figures of Fleas possibly concerned
in the Transmission of Plague
Plate to illustrate article © The Puru of the Malay Peninsula”
Illustrations to accompany article * The Anatomy of the
Biting Flies of the Genera Stomorys and Glossina "

JuLY 2nd, 1906, Plate to accompany article © The Anatomy of
the Biting Flies of the Genera Stomorys and Glossina

Jory 16th, 1906, Illustrations to accompany article '* The Ana-
tomy of the Biting Flies of the (tenera Stomorys aud
Glossina”

Plate, London School of Tropical Medicine. 21st Session, May
to July. 1906

AUGUST 1st, 1906, Illustrations to accompany article *' The
Anatomy of the Biting Flies of the Genera Stomorys and
Glossina”

AuGUST 15th, 1906, Illustrations to accompany article ** Malig-
naut Anthrax CEdema in Central Africa "

OCTOBER Ist, 1906, Illustrations to accompany article “ Three
Cases of Infection with Schistosoma japonicum іп Chinese
Subjects " 4

NOVEMBER 186, 1906, Plate to accompany article “Notes on
Disease Conditions seen on the Line of the Projected Lo-
bitokatanga Railway ”

Illustrations to accompany article “Note on а Leucocy-
tozoon found in the Mus Rattus in the Punjaub”

NOVEMBER 15th, 1906, Plate. London School of Tropical Medi-
cine, 22nd Session, October to December, 1906

DECEMBER 15th, 1906, Plate to accompany article “ Rodent
Ulcer in a Nubian Woman,”
Illustration to accompany article “А Blood.sucking Нетір-
teron,”

JOURNAL OF TROPICAL MEDICINE, JANUARY 1, 1906.

General eruption, Yaws. General eruption. General eruption

Spirochiete of the pallida type.

White scar at the seat of the Scar at place of primary growth.
primary growth.

To Illustrate Dr. Агро CasTELLANI's article, “Is Yaws Syphilis?”

January 1, 1906.)

Original Communications.

IS YAWS SYPHILIS?

Ву Агро CasrELLANI M.D.
Colombo, Ceylon.

To everyone interested in tropical. medicine the
theory is well known according to which yaws (fram-
beesia, parangi, pian, &c.) is simply a form of
syphilis. This theory, supported by so high an autho-
rity as J. Hutchinson, has raised much discussion. The
medical men practising in those parts of the Tropics
where yaws is endemic are divided into separate
camps: those who believe іп this theory, and those
who consider yaws to be & distinct disease. Among
the latter some recognise, however, that the anti-
syphilitic treatment is effective also in yaws, while
others affirm that mercury and potassium iodide are
quite worthless.

At the suggestion of Sir Allan Perry—to whom I

am greatly indebted—I have studied several cases of
yaws in Ceylon, and may be permitted, therefore,
to express the conclusions to which I have my-
self arrived in regard to the nature of the disease.
I may say at once that in my opinion yaws is not
syphilis. It seems to me that the study of the
geographical distribution, the clinical symptoms, and
the histo-pathology show clearly the two diseases to
be different.
: Geographical Distribution.—At the present time
syphilis is practically pandemic; yaws, on the other
hand, is localised to some parts of the Tropics (Ceylon,
Assam, Java, West Indies, West Africa, &c.). Yaws
is extremely common in Ceylon, extremely rare in
India. Syphilis is frequent in both countries.

In Samoa, according to Turner, syphilis was un-
known up to at least 1880, while yaws has been
endemic ever since the group was discovered. In
Fiji, too, up till a few years ago syphilis was not
pos while yaws was almost universal. Daniels

as made the interesting observation that in British.

Guiana yaws in late years has disappeared, while
syphilis is still rampant.

Symptoms and Course.—After an incubation period
varying in length, but generally not exceeding three to
four weeks, characterised often by signs of malaise,
rheumatoid pains, headache, irregular rises of tem-
perature, a primary sore, if it may be called во,
appears at the seat of inoculation, which is generally
extra-genital. І have never myself seen the primary
lesion in its very firat stage, as all my cases were in
later periods of the disease. I have very little doubt,
however, about its presence. The natives are very
positive about it. Moreover, in Ceylon at апу rate,
they are in the habit of cauterising it themselves in &
primitive way, во that а white scar remains plainly
visible. This scar, which is usually of rather large
dimensions, in all my cases was extra-genital; in
women it was very often found on one of the mamma,
in men and children on the trunk and arms.

The primary growth at the seat of inoculation is
apparently quite different from the primary sore of
syphilis. From the description given by natives it
would seem to appear as а rather large fungoid

THE JOURNAL OF TROPICAL MEDICINE. 1

growth, covered with a crust, not very dissimilar from
the elements of the general eruption which appears
later on. This large, single, projecting tubercle is
called ** mother yaw” or ' maman pian” in French
patois. Ву the Samoans it is called *''ta'rr" or
“ leader ” (Turner). This primary growth may remain
single for several weeks and even months. It often
heals before the general eruption begins.

Before the typical general eruption of yaws begins
some furfuraceous, whitish, pruriginous patches appear
on the trunk and limbs. These may coalesce and cover
large portions of the body. Some of them may
disappear, leaving the skin without lustre and rough.
Others may remain for the whole course of the disease.
It is on these furfuraceous patches that according to
many writers the elements of the general eruption
appear; in my experience, however, these may
develop also on parts of the skin absolutely normal.

The general typical eruption of yaws makes its
appearance in the form of papules. These are at first
small, often flattened, and with the epidermis intact.
They may disappear, or more often they increase in
size, become moist, and are soon covered with a crust
yellowish or brownish in colour, formed of desiccated
secretion ; if the crust is removed а raw surface will
be observed throwing up coarse red or yellowish fun-
goid granulations secreting a thin, slightly purulent
secretion which soon dries into a crust again. These
papillomatous growths are of various size, and
practically may be found on any part of the body;
they are extremely common on the upper and lower
limbs, and on the face; very rare on the scalp. They
may remain of the ваше appearance and size for
months; often after а few weeks the secretion
diminishes, and a process of hyperkeratosis sets in;
they become of much harder consistency, and some of
them, especially on the feet, may be covered with
numerous hard, verrucose-like small protuberances.

Generally within three to six months in children,
and six to twelve months in adults, the yaws dry up,
shrink and disappear, leaving dark hyper-pigmented
spots in their site. In some cases the eruption is very
persistent and appears in successive crops; in other
cases large irregular ulcers may develop showing often
in their centre reddish papillomatous masses which in
my experience do not usually heal spontaneously.

Constitutional symptoms of severe nature are
generally absent during the whole course of the
disease in ordinary cases; the physical examination
of the internal organs does not reveal anything
abnormal; a few superficial lymphatic glands may be
enlarged, but in my experience this is not & constant
feature. The analysis of urine does not present any-
thing abnormal. The stools may contain ova of various
worms, but this is also a frequent occurrence in
normal natives.

The Blood.—In all my савез in which the blood
was examined a certain degree of anemia, never very
severe, was present. The number of red blood
corpuscles varied from 3,800,000 to 4,400,000; the
hæmoglobin index (Fleish) from 60 to 75. The red
blood corpuscles did not show anything abnormal in
their shape. On several occasions I noticed & com-
paratively large number of polychromatic erythrocytes
staining blue instead of pink with Leishman's method.

t2

THE JOURNAL OF TROPICAL MEDICINE.

[January 1, 1906.

Many of these basophile red cella were micro-
erythrocytes.

The leucocytes varied from 7,000 to 12,000 рег cmn.
In the majority of cases an increase was noticeable іп
the number of the large mononuclear, even when there
was no sign and no history of malaria. In almost all
the cases the eosinophiles were increased, this being
due probably to the presence of intestinal worms as
revealed by the microscopical examination of the stools,
which showed frequently ova of Ascaris lumbricoides,
Tricocephalus dispar, and, in & few instances, of Anky-
lostoma duodenalis.

I attach a table giving the results of the examina-
tion of blood in four typical cases with no history of
malaria, and in which no ova of ankylostomata were
found in the fæces, although eggs of other worms
(Ascaris lumbricoides and Tricocephalus dispar) were
present.

x | DIFFERENTIAL COUNT OF LEUCO-
a 3 | CYTES (7 WITHOUT FRACTIONS)
5 od i E d L——N
j= B PE n ы ы ж
Cae 19 Б аза КЕСЕ E
Н = - Б 5 5 сы =
q i ! 88 32|22|88| =
! o e е б б
! & BI E Ы
| ers ie, к I ашы” ЖЕУ iran ARES
1. Woman .. | 65 | 8,900,000 | 11,000 | 46 ! 84 | 9 | 3 т
2. Воу 2.1170) 4,000,000 9,000 41 26 | 25 6 2
3. Girl. .. .. | 60 | 8,500,000 7,000 64 15 11 2 8
4. Girl 65 | 4,100,000 | 10,000 52 20 15 j 8 10

The interesting point shown by the examination of
the blood is the increase in the number of .the large
mononuclear leucocytes. This is of frequent occur-
rence, though not constant. An increase in the mono-
nuclear has been noticed also in syphilis by several
writers, it is, however, very common in many diseases
of protozoal origin, as shown by Manson, &o.

From the brief clinical sketch given of yaws, it will
be seen that the disease presents the following prin-
cipal features in contrast to syphilis : Primary sore, if
it may be so-called, generally extra-genital ; eruption of
one type only, viz., the papule which proliferates into
a papillomatous growth ; extremely well-marked pruri-
tus. Moreover, in yaws sequele comparable to ter-
tiary syphilis or parasyphilitic conditions are absent
or extremely rare, though it must be admitted that
our knowledge on this point is far from being com-
plete. It is also to be noted that yaws is not heredi-
tary and not congenital.

Pathology.—MaeLeod, in his excellent paper on
the “ Histo-pathology of Yaws,' calls attention to
the following differential points between yaws and
syphilis :—

(1) The proliferative changes in the epidermis are
much more marked in yaws than in syphilis. When
the yaws has reached a certain stage a well-marked
hyperkeratosis is noticeable which is rare іп
syphilis.

(2) The blood-vessels in the yaws granulomata
have no tendency to thickening, nor is there any
endothelial proliferation such as occurs in syphilitio
gummata.

(3) The plasma cells in yaws form a more diffuse
infiltration, and retain their original type better than
in any other of.the granulomata.

MacLeod rightly states that these differential histo-
logical details must be considered collectively, as there
is no individual histological character, which excep-
tionally might not be present both in syphilis and yaws.

Examining films from yaws granulomata stained
by Leishman's method it is interesting to note the
very large number of polychromatic red blood cells of
very different dimensions ; some much larger than the
normal erythrocytes, others very much smaller.
Sometimes these polychromatic cells have a granular
appearance.

The leucocytes frequently contain in their proto-
plasm, and sometimes also in their nuclei, roundish
or oval, more or less deeply blue-stained bodies.
These I believe to be probably basophile microery-
throcytes engulfed by phagocytes.

Inoculation Experiments in Man and the Lower Ant-
mals.—The experiments of Paulet aud Charlouis are
well known. Paulet (1818) inoculated fourteen negroes
with the secretion taken from yaws granulomata. All
of them developed yaws, the incubation period vary-
ing from twelve to twenty days, when at the place of
inoculation in ten cases the first nodule of yaws
appeared, soon followed by a typical general eruption.
In two cases apparently the eruption did not start
from the seat of inoculation.

The more recent investigation of Charlouis (1881) is
most important. He first took four cases of yaws
and inoculated them under the skin at various spots
with the secretion of their own yaws: -in three
cases at the places of inoculation typical yaws
granulomata developed. Charlouis also inoculated
thirty-two Chinese prisoners—who had never suffered
from the disease—with crusts and scrapings of a

aws. In twenty-eight cases the disease developed,
(білет always from the seat of inoculation.

Moreover, Charlouis, to в native suffering from
typical yaws, inoculated syphilis. The inoculation was
quite successful, а primary syphilitic sore developing,
followed by all the usual types of secondary eruptions.

That yaws patients are not immune against syphilis.

(ің proved also by Powell, who describes two very

interesting cases of syphilis supervening on уау.

The lower animals, as far as we know, are refractory
to yaws. In Ceylon, I tried to inoculate an anthro-
poid monkey, following the technique used by Metsch-
nikoff and Roux for syphilis. The inoculation did not
succeed. It would be premature, however, to come to
the conclusion that the disease cannot be inoculated
into monkeys. Numerous experiments on various
species of monkeys are necessary.

Etiology.—Various bacteria have been described in
yaws: Eijkmann found some peculiar bacilli; Pariez
observed numerous micrococci; Breda described вњ
bacillus which he called ‘ Boubas, or Framboesia:
bacillus ” ; Powell, in 1896, cultivated in two cases a
yeast which was present in the granuloma and also

_between the epithelial cells.

Nicholls and Watts, in 1899, found in the granu-
lomata a cocous which they cultivated in pure

cultures. The same coccus was found once in the
lymphatic glands. Inoculation into animals did not
succeed.

Personal liesearches.—KFourteen cases of yaws were
examined by me in Ceylon. In the open sores aud

January 1, 1906.)

fully developed yaws all sorts of bacteria were present,
cocci, sarcinæ, bacilli. When the eruption. elements
are, however, in the. very first stage, not moist, and
with the epidermis intact, по baeteria, according to
my experience, are found either microscopically or by
culture methods; instead of that, rare spirochetes
may be observed.

A preliminary note on the presence of spirochaete
in cases of frambosia was published on June 17th,
1905, in the Journal of the Ceylon Branch of the
British Medical Association. Other cases of yaws
showing spirochetes have been communicated by me
at the meeting of the British Medical Association,
Leicester, July, 1905, and several more cases described
in the British Medical Journal, November 18th,
1905.

Technique.—Films are made in the usual way from
scrapings of the eruptions. It is advisable to select
lesions in which а secondary pyogenic infection has
not yet taken place. Giemsa stain, which I have
used only lately, gives good results, but Leishman’s
method gives also very good results, if the staining is
done according to the following instructions :—

(1) Let the alcoholic solution of Leishman act for
five minutes without fixing the films previously.

(2) Mix the stain with equal or double amount of
ШЕНІ water, and let it act for half an hour to several

ours.

(3) Wash with distilled water and leave afew drops
of it on the films as usual for half to one minute.

(4) Blot and examine with very high power.

Morphology of the Spirochete.—In non-ulcerated
lesions, and sometimes also in open sores of yaws,
there may be found an extremely delicate organism
which morphologically, in the present state of our
knowledge, I do not think can be distinguished from
the S. pallida of Schaudinn. The organism takes up
generally a pale reddish tint when stained by Leish-
man’s or Giemsa’s method. It is extremely thin,
some individuals are, however, thicker and better
stained than others, though always much thinner than
any spirochete of the refringens type. The extremities
are often pointed, but possibly due to the manipulation
of the film, forms may be met with presenting blunt ex-
tremities, or one extremity blunt and the other pointed.
In a few individuals опе of the extremities may present
a rather largo roundish or pear-shaped expansion.

The length varies from a few microns to 18 and
20 microns, and even more. The number of waves
varies also, but they are generally rather numerous,
uniform, and of smal] dimensions. Sometimes a por-
tion of the spirochæte shows numerous narrow, uni-
form waves, while the rest of it has no waves at all.
Sometimes, also, two spirochætæ may be attached
together, or apparently twisted one on the other.
Two organisms close together and nearly parallel, but
united at one end as described in Spirochate pallida,
by Schaudinn, have been seen. On the minute struo-
ture of the parasite I have not any observation of
importance, but in a few individuals I have observed
а few chromatoid points here and there.

In rare cases, several preparations presented, be-
sides the spirochætæ, some peculiar bodies, extremely
rare. These bodies are generally oval or roundish,
5 to 8 microns in length and 4 to 6 in breadth.

THE JOURNAL OF TROPICAL MEDICINE. 3

Sometimes they may have smaller or much larger
dimensions.

In preparations stained by Leishman’s method
these bodies are stained slightly purplish or bluish,
and contain chromatin. The chromatin may be eol-
lected at one point near one of the extremities, or
scattered at several points. Whether these bodies have
anything to do with a developmental stage of the
spirochaete I cannot yet say.

Spirochete Found in Open Sores of Frambesia.—The
fungoid ulcerations are invaded very quickly by all sorts
of germs. Besides innumerable bacteria, often spiro-
chætæ of various kinds are present. One form is rather
thick, and takes up easily the stain; it is morpholo-
gically identical with the S. refringens of Schaudinn.

Another form is thin, delicate, with waves varying in
size and number, and with blunt extremities; I pro-
posed for this variety the name of S. tzmuis obtusa.
À third form is also thin and delicate, but is tapering
at both ends: I named it S. tenuis acuminata. The
spirochætæ of the pallida type, as found in non-
ulcerated lesions, may also be present.

Recapitulating, I have examined for spirochætæ
altogether fourteen cases of yaws, the search being
positive in eleven. Іп one case the spirochmtm of the
pallida type were present also in films from an excised
gland. The spirochætæ found in the non-open lesions
and some of those found in open sores of yaws are, in
my opinion, morphologically identical with the 5.
pallida. of Schaudinn. This is also the opinion of
Schaudinn himself who very kindly has examined
several of my specimens. Му observations have been
recently confirmed by Wellman in one case and by
Powell in another.

Even supposing that future investigations should
confirm these observations, it will be by no means
proved that syphilis and yaws are the same disease.
The leprosy bacillus, the tubercle bacillus, and many
other acid-fast bacteria, are morphologically identical ;
however, leprosy is not- tuberculosis. It is also
practically impossible to distinguish morphologically
the surra from the nagana trypanosome, but the two
diseases are different.

I believe, that if future investigation will prove that
p ів a spirocheste disease, the yaws spirochste will

ave to be considered to be biologically different from
the spirochæte of syphilis.’

Treatment.—According to my experience there is
no doubt that the anti-syphilitic treatment is effective
also іп yaws, although I do not deny at all that some
eases may recover spontaneously. Іп any stage of
yaws potassium iodide in large doses is much more
effective than mercury. Ав there are authors who
state that this treatment is useless, I kept four typical
cases of yaws without any treatment for a certain
time. One remained stationary, three got worse and
worse. Іп one of theso—a woman—for humanity's
sake I had to give up the experiment after four weeks,
numerous large fungoid ulcerations having developed.
The symptom of which she complained the most and
for which she was continuously begging for some
remedy, was the unbearable pruritus. Ав soon as

‘In such а case the name I suggested of S. pertenuis (June,
1905) seu Pallidula (November, 1905) might be a proper one.

4 THE JOURNAL ОЕ TROPICAL MEDICINE.

[January 1, 1906.

potassium iodide in anti-syphilitic doses was ad-
ministered this symptom decreased remarkably in
intensity and finally disappeared, the eruption also
soon getting better.

The potassium iodide cure doing good in yaws is
considered as an argument in favour of the disease being
a form of syphilis. The fallacy of this argument is
shown by the fact that potassium iodide has a very
beneficial effect on another disease quite different from
syphilis, viz., actinomycosis.

Conclusions.—The clinical symptoms, the geo-
graphical distribution, the histo-pathology .of fram-
beesia tropica show many points of difference from
syphilis The presence of a spirochete of the
pallida type in some cases is not sufficient, for the
reasons already stated, to come to the conclusion
that the two maladies are the same entity. I
agree, therefore, with such authorities on yaws as
Manson, Powell, Daniels, Jeanselme, Sambon, &c., that
syphilis and yaws, though closely allied, are two
different diseases.

REFERENCES.

BARRETT. Pathological Society, November, 1905.

CASTELLANI. Journal of the Ceylon Branch of the British
Medical Association, June, 1905; Meeting of the British
Medical Association, Leicester, July, 1905 (proceedings of which
appeared in the Lancet and JOURNAL оғ Творісаг, MEDICINE,
August, 1905); British Medical Journal, November, 1905.

DamrELs. British Journal of Dermatology, November, 1896.

JEANSELME, “Cours de Dermatologie exotique."

Macteop. British Medical Journal, 1902.

Manson. “ Tropical Diseases,”

PowELL. British Journal of Dermatology, 1898 ; Pathological
Society of London, November, 1905, &c.

WELLMAN. JOURNAL OF TROPICAL Mepicine, December 1,
1905.

-----т----

A SIMPLE AND CHEAP ROCKER FOR
LEISHMAN OR OTHER STAINS.

By Р. N. Gerrarp, M.D.(Dublin), D.T.M.H.(Camb.).
Krian Perak, Federated Malay States.

Havine suffered many times and oft from the
* tricks" of Lieut.-Col. Leishman’s excellent stain,
necessity at length drove me to make the rocker of
which I enclose rough diagrams, and since the adoption
of which I have had the greatest comfort and infinitely
better results than before І made it. The materials
used by me were as follows :—

One small piece of a deal box, say 6 in. by 5 in. by

in.

Four lengths of thin bamboo.

One piece of ordinary string.

Two trouser buttons.

The shot from two cartridges, or two bullets.

Two fingers of an old white glove.

About two dozen ordinary pins and two surgical
needles.

. The time taken to make the machine, about an hour
and a half.

The diagrams explain the construction.

I find it works best if the stain is poured on the
slide and the string then pulled, the rocking continues
for about ninety minutes, depending, of course, upon
the length of the supports and the weight of the shot-

bags, the length in mine being 12 in., exclusive of the
small square block which steadies the machine.

I use iton my pathology table, with two or three
sheets of blotting paper under it to catch the dropping
water when the stain is flushed off.

A.—Trouser button.
B.—Solid squared piece of deal.

C.— Bamboo. — Wood. .
D.— Bamboo spreader. I.— One No. 7 split.
E.— Pins. J.— Shot-bags.

C.—Bamboo. J.—Shot-bag.

E.— Pin.
J.— Shot-bag.

K.— Slide

with stain (N.B.,
lengthwise).

L.—Surgical needle.

J.—Shot-bag.

After the stain has been on about ninety minutes
the rocker is almost at a standstill, and the dilution
is carried out from a syphon tube (into a whisky bottle
containing rain-water, filtered).

January 1, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE. 5

The rocking is again started and when it has slowed
after the usual ninety minutes or so, another tug at
the string will give another ninety minutes, and
flushing can then be performed, the waste trickling
down the pendulum to be absorbed by the blotting
paper below. This dries in about three hours in the
Tropics, and I find I have no difficulty from flooding
in using the rocker three times a day, namely, for
about two hours before breakfast, two hours after
tiffin (one o'clock), and sometimes between 5.30 and
6.30.

I trust this may be of assistance to all who recognise
the impossibility of “running” hospitals in the
Tropics nowadays without a careful study of hæmic
conditions.

I shall be happy to supply any further details
required.

——__

Victoria. Mepicau LEaisLATION.—À Bill about to
be presented to the Government of Victoria, Australia,

is to the efféct that no degrees will be recognised from.

universities other than. the United Kingdom or a
British possession, unless it appears to the Medical
Board that such universities recognise the medical
graduates of the University of Melbourne, and that
Melbourne graduates are permitted to register in the
country of the university, A clause is introduced pro-
bibiting any persons but registered medical practitioners
(and chemists) from dispensing medicine or rendering
to any person medical or surgical aid for fee. The
penalty for evading these provisions is fixed at £50.

Yellow Fever.

CoroNEL WirLiAM C. Goraas, Chief Sanitary Officer
for the Canal Commission in his report for the month
of August, 1905, publishes some interesting yellow
fever statistics for the period from July 1st, 1904, to
September lst, 1905, а résumé of which is given
below. .

CasES OF YELLOW FEVER IN PANAMA, COLON, AND THE
А CANAL ZONE.
a r

No. of | Mortality
Deaths Pertentage

Employees of the Canal Commission :
appointed from the U.S... ..| 69 14

20:3
Employees of the Canal Commission А
appointed from the Isthmus . . 43 | 10; 23-2
Employees of the Panama Railroad f
Company 9 2 . 222
Persons not employees of the Com: |
mission or Railroad . 4 ... 88, 38 "e

Transients to and from foreign ports ..| 26 : 10

During this period 116 cases occurred in Panama,
57 cases in Colon, and 33 cases in the Canal Zone
proper.

During August, 1905, there were 27 cases of yellow

fever on the Isthmus.
[We are obliged to Dr. Isaac Brewer, U.S.A., , for

this information.—E»p.!

Business Motices.

1.—The address of the JOURNAL oF TROPICAL MEDICINE is
Messrs. BALE, Sons & DANIELSSON, Ltd., 83.91, Great Titchfield

Street, London, W
9, —All literary communications should be addressed. to the

Editors.

8.—All business communications and payments, either for
subscriptions or advertisements, should be sent to the Publishers
of the Loren or TRoPICAL MEDICINE. Cheques to be crossed
The Union Bank of London, Ltd.

4.— The Subscription, which is Eighteen Shillings perannum,
may commence at any time, and is payable in advanca,

— Change of address should be promptly notified. `

& — Non-receipt of copies of the Journal should be notifled to
the Publishers.

T.—The Journal will be issued on the first and fifteenth day
of every month.

| Reprints.

Contributors of Original Articles will be supplied FREE with
six copies of the Journal if a request accompany the MS. If
reprints are required they will be supplied by the publishers, if
_the order is given with remittance when sending the MS. The
‘price will be as below :— 5

; 50 Copies of four pages, 5/-;
100 ” ” 6/- i
” ” T/ 6 ;
50 Copies beyond four up to eight pages, 8/6;

” ” ” ;
200 14/6.
One page of the Journal equals 9 рр. of the reprint.
If а printed cover is desired the extra cost will be for 50
Copies, 5/6;

100 uae 6/6; 200 Copies, 7/6.

Journal of Tropical Medicine

JANUARY 1, 1906.

ARRANGEMENTS FOR
1906..

. To-DAx we commence the ninth volume of the
Journal.. The Journal of 1905 increased in
bulk considerably beyond any of its predecessors,
.& feature which some proprietors of journals
consider a subject to be congratulated upon, but
which it has been our endeavour, in view.of the
enormous amount of literature produced at the
present day, and in the desire that the JouRNAL
oF TROPICAL MEDICINE shall be read from start
to finish, we have attempted to avoid. Хо de-
partment of medical literature has increased in
amount in the same proportion as that to which
the JOURNAL OF TROPICAL MEDICINE is devoted,
so that it is impossible to carry out the promise
with which we started, that this Journal should
be one as concise as possible in order to ensure its

being read.

6 THE JOURNAL ОЕ TROPICAL MEDICINE.

[January 1, 1906.

We think it may be of interest to readers to
know what arrangements have been made for the
future.

The Editors have had the good fortune to secure
the able services of the following medical col-
leagues as coadjutors in the foreign literary work
of the Journal :—

T. P. Bepposs, M.B., (Cambridge), F.R.C.S.
(England), for French, Spanish and Portuguese
literature.

J. CAMPBELL GRAHAM, M.A., M.D., for German
and Dutch literature.

J. E. NicHorsoN, Lieut.-Col. R.A.M.C. (Rtd.),
for Italian, French and Spanish literature.

We have been indebted to Lieut.-Col. Nichol-
son and Dr. Beddoes for the past year or two for
their help and co-operation in the department
of foreign literature, and it is satisfactory to know
that we are to continue to be benefited by their
‘help.

Contributors sending Articles representing really
Good Original Work to be Paid.

We have long felt that original articles repre-
senting really good original work sent to the
JOURNAL OF TROPICAL MEDICINE should be paid
for, and we have induced the proprietors to
apportion a certain sum to that end. The amount
at the disposal of the Editors will not allow of
anything but small payments, yet we are satisfied
it is а move in the right direction, and we hope
our contributors will approve of the step.

The proprietors desire we should draw atten-
tion to the conditions which have always obtained
іп this Journal concerning reprints. A contributor
of an original article is entitled to six copies of
the Journal free. Should, however, reprints be
desired, notice must be sent to that effect before
the article is published; a small charge is made
for reprints under these conditions.

"The inclusion of the Colonial Medical Reports
was the most important feature of the Journal
during 1905. Through the kindness of the
authorities of the Colonial Office we have been
permitted to publish these valuable contributions,
and we hope, by our doing so, the highly important
and systematic records of disease from every part
of the Empire lying in tropical latitudes have
proved practically useful to medical practitioners

in the Tropics, and will be found reliable for
reference to future statistical and epidemiological
writers.

SOME POINTS OF INTEREST IN TROPI-
CAL MEDICAL WORK DURING
1905.

SLEEPING SICKNESS.

THE members of the Sleeping Sickness Com-
mission of the Royal Society in a summary of
their work state, in the No. 4 Report by E. D. W.
Greig, Captain I.M.S., their conclusions :—

“(1) That the disease is at first a specific poly-
adenitis caused by the Trypanosoma gambiense.

“ (2) That, in addition to enlargement of lym-

phatic glands, the blood shows a constant lym-

phocytosis at all stages of the disease.

“ (8) That sleeping sickness is the last stage of
this disease, and is invariably fatal. It consists,
essentially, in а polyadenitis, plus signs and symp-
toms due to changes in the nervous system; the
onset of these signs and symptoms synchronises
with the entrance of the T. gambiense into the
lymph spaces of the nervous system; this is
accompanied by a rise of the mononuclear ele-
ments in the cerebro-spinal fluid.

“ (4) That the resistance of both men and
monkeys to ће Т. gambiense, as judged by the
duration of tbe early stage, veries greatly, and
probably a certain proportion, not yet exactly
determined, acquire sufficient immunity to. arrest
the development of the disease at that stage.

“ (5) That the action of arsenic in vita on the
T. gambiense is partial. It destroys a number of
the trypanosomes, and probably these act as im-
munising agents. Its administration in the stage
of polyadenitis tends to help the natural resistance
to combat the disease.

“(6) That bacterial invasion, chiefly coccal,
occurs in some cases, but only in the very last days
of the sleeping sickness stage, and therefore cannot
determine the onset of this phase of the malady.

“(7) That, in addition to the T. gambiense,
other varieties of trypanosoma occur in Uganda,
which are pathogenic to animals.

“(8) That these trypanosomes differ entirely
from T. gambiense in morphology and animal
reactions.

Januar y 1, 1906.)

THE JOURN AL OF TROPICAL MEDICINE. 9

ment by Statf-Surgeon Shaw, from the ordinary
sweat (bacteria-bearing) of a Malta fever patient an
agglutinative reaction was obtained. Experiments made
to ascertain the presence of M. melitensis in the ex-
pired air of Malta fever patients, all proved negative ;
nor could monkeys be infected by the injection of
broth infected by the expired air of Malta fever
patients.

It has often been stated that Malta fever was caught
from the polluted sea-water in the harbour of Malta,
but experiment proved that the M. melitensis could
not be detected in the sea-water of the harbour.

In the Fourth Report of the Mediterranean Com-
mission, Major Horrocks gives details of “ Experi-
ments of the Mode of Conveyance of the Micrococcus
melitensis to Healthy Animals." By experiments on
monkeys it was shown that the inhalation or ingestion
of infected dust will give rise to Malta fever in
monkeys; and the ingestion of infected food (milk)
proved positive, but whether the organism was ab-
sorbed by the stomach or by the mouth or throat was
not determined.

The infection of healthy monkeys by contact with
infected monkeys is probably through the urine excreted
,and not by bodily contact. The experiments made with
the mosquito—Stegomyia fasciata—to test the pos-
sibility of the mosquito transmitting the disease
proved negative in Major Horrocks's hands, although

_Dr. Zammit reported several cases that seemed to
point to the possibility of the ca being the
agent of transmission.

In Report Five, by Staff-Surgeon R. T. Gilmour, is
given a “ Description of a Method of Cultivating the
Micrococcus melitensis from Small Quantities of Peri-
_pheral Blood and Inoculation Experiments with the
Miero-organisms Isolated.”

In quantities of so small amount as 1:0 cc. with-
drawn from a vein of a Malta fever patient, and of

_this quantity 0:1 cc. in broth medium of which but
10 cc. was injected, a positive result was obtained.

Report Six, by Dr. Т. Zammit, on “ Isolation of the
Micrococcus melitensis from the Blood,” contains the
technique to be observed in drawing blood from pa-
tients suffering from Malta fever, and the laboratory
methods followed for cultivation.

Report Seven, by Staff-Surgeon E. A. Shaw, con-
tains an “ Interim Report of Experimental Work in
the Investigation of Mediterranean Fever dealing with
Blood, Skin, Sweat, Inoculations, Agglutinating Serum,
and various Inoculations in Different Animals.”

Shaw’s conclusions are: (1) M. melitensis exists in the
blood of patients in relatively very small amount, the
smallest quantity of blood in which it has been found,
gig CC., is practically the equivalent of 4 c.mm. This
small amount of bacilli in the blood is interesting when
the question of transmission of infection by mos-
quitoes is considered. (2) No definite relation can be
established between any given stage of the disease and
the presence of М. melitensis in the blood. (3) There
is some indication of a diurnal variation in its presence
in the blood. (4) No relation can be established
between the agglutinating power of a patient's blood
for M. melitensis and the amount of the latter present
in the blood. (5) M. melitensis does not pass through
Chamberland, F., nor Berkefeld filters, IV., V., or VI.

The most important practical point determined by
the Commission was the discovery by Dr. Zammit, in
June, 1905, that the goats in Malta are infected by
the M. melitensis, that the coccus can be isolated from

_the milk of infected goats, and that the urine of these
animals contains the specific organism. Аз the milk

supply in Malta is chiefly derived from the goat, it is
readily understood how important this discovery is.
The udders of the goats are usually very large, actually

‘touching the ground, and it is plain that the udder

may become contaminated by the urine-polluted soil,
so that both by mechanical means and by the secretion
of milk itself the milk supply may be contaminated.
The whole constitutes a fine piece of scientific work,
and the members of the Commission are to be con-
gratulated on their work, which promises to be
eminently successful in staying the ravages of this
scourge in Malta. The reports received from time to
time that Malta fever has been met with in places
other than Malta, and perhaps Gibraltar, have to be

‘received with some hesitation, for except perhaps the

reports from Orange River Colony, in but few cases
have we any ,authority for pronouncing the disease
to be Malta fever, except from clinical evidence alone.

BERI-BERI.

Next in importance to the work accomplished
in Malta fever during 1905 is perhaps that of

` Dr. Hamilton Wright in connection with beri-beri.

Dr. Wright may not have completely proved his point,
but his conclusions have been arrived at after pro-
longed and careful study and investigation, and if he
has done no more than to direct our attention into
other channels of study in elucidating this mysterious
disease he has contributed towards widening the field

10 THE JOURNAL ОЕ TROPICAL MEDICINE.

of investigation. But Dr. Wright would seem to have
done more than that, for be has by clinical and
pathological demonstrations succeeded in presenting
to us beri-beri in a new aspect and on a convincingly
clear scientific basis. Dr. Wright’s observations and
conclusions are summarised as follows :—

so That beri-beri is an acute or subacute infectious
That it is due toa
specific micro-organisin not yet isolated. That this
specific organisin is not one whose special habitat is a
particular food, such as rice or fish, but one that may,
nevertheless, be ingested with any food or drink
accidentally contaminated. That this organism,
having gained entrance to the alimentary canal,
multiplies in the contents and mucosa of the stomach
and small gut, but chiefly in the contents and mucosa
of the pylorus and duodenum. That it there elaborates
ап extracellular toxin, which, being immediately

disease of short incubation period.

absorbed, poisons the peripheral terminations of, first,
the vagi to the stomach and heart, and then other
efferent, afferent, and autonomic neurones to different
extents and degrees, thus giving rise to groups of
symptoms which may be broadly classified as acute
pernicious beri-beri, acute, and subacute beri-beri.
That these cases run a definite course of about five
or six weeks, and on the elimination of the causal
organism and its toxin the poisoned neurones recover
and the patient becomes whole again, or that the
poisoned neurones only partially recover, and there
develops in those of them which do not a true de-
generation which migrates centralwards. For this
persistent atrophy, and the various paralyses, atrophic
disturbances, and oedema which result, Wright has
proposed the term “ beri-beric residual paralysis.”

This view of the clinical history of beri-beri points
to в gastro-duodenitis as the primary local lesion in
the complaint, and is supported by actual clinical
observations of patients. The paralysis is a late
development or even a sequela of the disease: as in
diphtheria paralysis supervenes after the acute signs
and symptoms have subsided, as in plague the bubo
is subsequent to gastro-intestinal lesions, so in beri-
beri we find an alimentary preceding the neural and
other evidences of the disease.

The etiology of the gastro-duodenitis has not yet
been worked out, but Dr. Wright suggests a bacillary
origin, and that it is by way of the feces that the
infecting organism or material escapes from the body.
Acting on this grounded belief he applied it to the
treatment of the disease in a gaol at Kuala Lumpor,

[January 1, 1906.

and was successful in practically eradicating the
disease from amongst the prisoners in the gaol, which
for many had been subjected to virulent
and persistent outbreaks of beri-beri.

years

PLAGUE.

There is little to record concerning plague, except
that it continues to prevail in the several haunts we
have associated with the disease for several years.
The persistency of plague when once it has established
itself ina town or district is characteristic of the dis-
ease, as it has been known from early times. This
fact alone, in addition to the actual mortality it entails,
is sufficient to explain the dread of its appearance and
the extraordinary precautions taken to prevent its
inroads.

India remains the chief centre of the disease in the
world at present, and except in China, no other
country could have withstood the mortality which
prevails there and continued to play its part in the
economy of nations.

During the first six months of 1905 no fewer than
878,602 persons died of plague in India. This is the
largest mortality for any period of six months yet re-
corded, for it is 151,971 in excess of the corresponding
period of 1904, which up to 1905 presented the highest
death-rate since plague appeared in India.

During the months August to November, 1905, the
mortality from plague has been much reduced in India,
so that possibly the death-rate for the year may be
under one million, and if that proves to be true the
total for 1905 will be under that of 1904, when the
deaths from the disease numbered 1,084,787.

The diminution may actually prove that the
virulence of the disease is abating, or it may only be a
wave of subsidence with which we are familiar in (he
history of the disease.

Inoculation is making considerable, if not wholly
satisfactory, headway in India, but more is being done
in this direetion than is generally known. Certain
it is that inoculation affords marked protection
against plague, and also considerably diminishes the
case mortality of those attacked.

Haffkine’s method of inoculation is the one at present
followed, and there seems every reason to consider it
The report of Major E. Wilkinson, I.M.S.,
founded on work done during 1902 03 is satisfactory
In & community of 827,497
persons 630,030 were not inoculated, 187,797 were

the best.
evidence of protection.

inoculated ; of the foriner 29,723 died of plague, whilst

`

January 1, 1906.]

among the latter there were only 814 deaths from the
disease. Had the 187,797 not been inoculated the
presumed number of deaths would have been 8,680,
in place of the 814 which actually did occur. But by
the inoculation it would appear that some 7,866 lives,
or stated in percentages 90:62 per cent., were saved
by the inoculation.

A report from Aden by Mr. E. S. Winter also con-
firms the efficacy of inoculation, and from several
-parts of India we have similar accounts. Stated
broadly, it appears that inoculation affords well-nigh
an eightfold degree of immunity ; and when plague
has developed amongst an inoculated community, less
than half the number of deaths occur than amongst
those not inoculated.

We are indebted to W. J. Simpson, Hunter and
Bell, in Hong Kong, for а more clear clinical history
of plague than any yet advanced. These observers
showed that plague was in most instances 8 disease
set up by infection by way of the alimentary canal,
and that the bubo is a rather late development in the
illness. Gastric and intestinal lesions precede the
lymphatic gland enlargements. They at the same
time admit the possibility of а direct pneumonic
infection. This view of plague was a great stimulus
to further investigation and afforded a key to pro-
phylaxis.

The vexed question of the relation of plague in rats to
plague in man is not yet settled. There can be no doubt
that men and rats suffer in common from the disease,
but whether they are both infected by some common
agent or whether they stand to each other as cause
and effect is not determined. The suggestion that
the black and brown rats play different parts in the
disease was first mentioned by Cantlie in 1897, and
the idea has been elaborated since then. The black rat
—the Mus rattus—is more a household pest than is the
Mus decumanus, or brown (Norwegian) rat, which lives
chiefly in drains and outhouses ; and it is considered
possible that the geographical distribution of these rats
aids in determining the geographical distribution of
plague in man.

YELLOW Fever.

Around the Gulf of Mexico yellow fever prevailed
during July, August, and September of 1905, and
even in October and during November cases of the
disease were reported. New Orleans seemed to be the
chief centre of the outbreak. Cases were first notified
in New Orleans in July and up to the end of the

THE JOURNAL OF TROPICAL MEDICINE. п

second week іп November, when the disease seemed
to have well-nigh wholly subsided, some 3,400 per-
sons were attacked by yellow fever. The deaths
from the disease numbered 451, а mortality rate of
13-20 per cent. only. The only other town on the
northern littoral of the Gulf of Mexico where yellow
fever seemed rife was at Pensacola, a town situated
in Florida, close to the Alabama frontier, and only a
short distance by sea from New Orleans. In Pen-
sacola 560 cases and 80 deaths were reported, again
furnishing a remarkably low death-rate, some 14:28
per cent. only. It is a curious turning of the tables
that Havana, the home of yellow fever in Cuba for
some 150 years, and the centre from which the disease
formerly spread to the Gulf of Mexico ports, should
during the recent outbreak have been taking rigid
quarantine steps against infection from New Orleans
and other ports. Since the determined suppression of
yellow fever in Havana some two or three years ago
the city has been practically free from the disease, and
the few cases that occurred during 1905 were de-
scribed as imported cases merely.

Yellow fever was stamped out in Havana by the
practical application of the belief that the Stegomyia
fasciata mosquito is the means by which the disease is
transmitted. This plan of yellow fever prophylaxis
was practised also in New Orleans and elsewhere, but
not until the disease had got a fairly firm hold upon
the communities.

The treatment of the disease has not advanced
beyond treatment by “general principles.” Ап initial
purge, а vapour bath, а mustard bath to the feet,
stimulants, alcohol, strychnine and caffeine when
indicated, diuretics and hot wet packs for suppression
of urine, constitute the sum and substance of yellow
fever treatment at present.

Tick Fever.

Excellent work in the elucidation of tick fever has
been done by J. L. Todd, by the late T. Everett
Dutton, and by Drs. Ross and Milne in the Congo
Free State. А spirochete has been demonstrated to
be the specific agent in the causation of human tick
fever. The Ornithodorus moubata (Murray) is the
tick by which the spirochete is transmitted from
animal to animal, and monkeys also have been infected
experimentally by allowing ticks to bite them.

Human tick disease was described by Livingstone.
He first noticed the disease in Portuguese South Africa,
and he also mentions being annoyed hy the tick whilst

staying at Nyangwé in 1871. Тһе natives in the tick-
infected districts have always declared that the bite of
the animal caused illness, but it was not until 1904
that their contention was absolutely proved by
scientific investigation.

THE COURSE OF THE DISEASE.

Incubation Period.—One week.

Invasion, Signs, and Symptoms.—The onset is
sudden, but a distinct rigor has not been noted. The
patient is suddenly prostrated and complains of head-
ache, bone-ache, and back-ache. Vomiting generally
obtains at the commencement of illness. Diarrhaa is
fairly constant, but constipation may occur. There аге
usually three or four attacks of fever, each attack lasts
from three to four days, with marked relapses extending
from a period of five to as many as nineteen days.
The temperature during the feverish attacks may rise
towards the evening to as high as 104? F. or to over
105° F. The attacks usually end in а marked perspira-
tion. The most notable feature of the disease is the
extreme prostration which prevails during the febrile
attack and the sudden recovery of spirits and the
feeling of fitness as soon as the temperature falls to
normal. The spleen is sometimes enlarged. Herpes,
epistaxis and hiccough have been recorded during the
attacks.

The spirochete, when numerous, can be readily
seen in fresh preparations of blood as rapidly moving
spiral threads. When the parasites are scanty in
number the best method of demonstrating their pre-
sence is by dehæmoglobinising a thick blood film and
staining by some modification of Romanowsky’s
method, or a weak solution of carbol-fuchsin.

The distribution of the human tick in the Congo
Free State is interesting. Livingstone says before
the Arabs came to the country bugs were unknown,
and that wherever the Arab traders went the bugs
were met with. This holds good at the present day,
for tick fever is confined to the commercial highways ;
these are the old caravan routes and the rivers. It
is probable, however, that ticks reached the Congo
Free State from the east, carried by the Arabs, and
from the Portuguese territory to the south.

The conclusions arrived at by Drs. Dutton and
Todd are :— Р

(1) Tick fever is clinically identical with relapsing
fever, and has for pathogenic agent а spirochmte.

(2) The spirochete is probably Spirochete ober-

12 THE JOURNAL OF TROPICAL MEDICINE.

[January 1, 1906.

(3) The tick Ornithodoros moubata can transmit the
spirochate from animal to animal.

(4) The transmission is not merely mechanical,
but some developmental process is carried on in the
tick.

(5) A considerable degree of immunity or tolerance
to the spirochaete can probably be acquired.

J.C.

аф
LIVINGSTONE COLLEGE.

THE annual report of Livingstone College for the
year 1905 is one which must serve to encourage all
those engaged in furthering the admirable work which
is being so ably conducted there. By the acquisition
of a neighbouring plot of land, through the generosity
of Mr. Robert Barclay, the College has been freed of
the possibility of being overlooked by cheap dwellings,
which were contemplated being built close by. The
medical education given by the Principal, Dr. C. F.
Harford, and other members of the staff has proved of
pronounced benefit to missionaries proceeding to up-
country districts in tropical countries. The marvel is
that the number of students at the College have been
so few; for one cannot conceive missionary societies
sending men or women to outlying parts of the world,
where no medical men are available for advice, without
their having previously availed themselves of the
opportunities afforded by the Livingstone College,
whereby not only the health of the missionaries
themselves may be better maintained, but also the
physical welfare of the natives who come to them for
spiritual instruction. l

That the College is fulfilling its functions in a cir-
cumspect manner cannot be better gathered than from
the statement made by Dr. Donald MacAlister, Presi-
dent of the General Medical Council, at the lecture on
“ Risks to Health in the Tropics, their Relation to
Imperial Expansion and Missionary Enterprise,” given
at Cambridge on November 22nd, 1905, by Dr. C. F.
Harford. Dr. MacAlister said :—

“ТІ you like to quote me you may do во as saying
that I have watched with interest, and perhaps some
solicitude, the development of Livingstone College. I
had doubts lest its initial purpose of giving to mia-
sionaries about to settle in tropical countries such
lessons in the elements of hygiene and of medical and
surgical first aid should be diverted to that of enabling
imperfectly trained or unqualified men to pose as
doctors in foreign parts. If that doubt had been con-
firmed, I, as official guardian of the Medical Register,
would not be there that night; but I-had satisfied
myself that this was neither the purpose nor the effect
of the training afforded at Livingstone College. I
was sure that so long as a medical man so excellently
qualified by experience, knowledge and prudence as
Dr. Harford was responsible for the instruction given
and the policy pursued, nothing but good could result
to missionaries and their flocks from the fact that they
had passed through the College.” l

We propose to deal more fully with the report in
our next issue.

January 1, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE. 13

To тне EDITORS OF THB ‘JOURNAL OF TROPICAL
MEDICINE.”

Si1rs,—I enclose an illustration of an instrument
invented by myself, though not patented, for the
examination of the throat by day or by night.

A gives the front view of the instrument, showing
at (а) an opening of a circular form, fitted with a piece
of plain glass, through which the fauces and palate,
the mouth, pharynx, and upper part of the cesophagus,

D the face-piece also detached.

At B the detached parts, C and D, are to be secn
connected and ready for use. At this point (a) is
attached the wires of the battery which pass through
an opening at the bottom of the stem when required
for use; at (b) you press the button on to the stem and
in contact with the latter a powerful little electric
light is emitted at (c) ; while through the glass opening
at (d) you view the parts of tho patient's mouth,
throat, and windpipe. The face-piece can be cither

Invented by Major G. Н. Fink, I.M.S., M.R.C.S. (Eng.), L.S.A.(Lond.), and the instrument made for him by

Messrs. Down

as well as the epiglottis and larynx with vocal cords,
may be clearly seen by day or by night. In the latter
case an electric lamp at (c) illuminates these parts,
while (5) depresses the tongue and so gives the surgeon
a good view of the parts behind and below the root of
the tongue. It protects the surgeon or physician
while examining cases of infectious throats.

B gives a side view of the instrument.

C the tongue depressor detached, and can be
lengthened or shortened.

гов., London.

fixed firmly at the point (e) by the revolving disc, or it
can be moved freely to any direction you desire to fix
your examination upon. If you desire to obtain a
clear view of the larynx and vocal cords you depress
the stem, which also causes the tongue to be depressed
by the tongue depressor, C. To obtain a magnified
view of the parts you can attach either a magnifying
glass at (d), or the binocular glasses properly focussed.
Yours, «c.,
G. Н. Fink.

14 THE JOURNAL OF TROPICAL MEDICINE.

{January 1, 1906.

Hotes and 905.

Tue Director of the Wellcome Physiological Re-
search Laboratories desires to notify the medical pro-
fession that in consequence of the increasing demands
upon the space available at these Laboratories in con-
nection with physiological and bacteriological research
and the production of therapeutic serums, clinical
diagnosis work in this Institution will be discontinued
on and after December 11th, 1905.

The clinical diagnosis work will be transferred to—
Dr. E. C. Bousfield, The Camberwell Research La-
boratory, 363, Old Kent Road, London, 8.Е.

MEDICAL CONGRESS AT LISBON, 1906.
Thursday, April 19, to Thursday, April 26.

Tne Orient-Pacific Line beg to notify that they pro-
pose sending their fine twin-screw 8.8. Ophir, 6,814
tons register, 10,000 horse-power, to Lisbon, for this
Congress.

The fare for the seventeen days’ cruise (exclusive of
shore excursions) will be from £15 15s. upwards,
according to the position of cabin occupied.

Plan of the steamer and further particulars will be
sent on application.

Managers: F. Green and Co., Anderson, Anderson
and Co. Head Office: Fenchurch Avenue, London.
For passage apply to the latter firm at 5, Fenchurch
Avenue, E.C., or to West End branch office, 28, Cock-
spur Street, S.W.

PROGRAMME OF CRUISE BY THE 'OPHIR."

Thursday, April 12th, 2 p.m., leave Tilbury.

Friday morning, call at Cherbourg to embark Con-
tinental passengers.

Sunday, 15th, at Vigo.

Tuesday, 17th, at Tangier and Gibraltar.

The principal places of interest ashore will be visited.

Wednesday, 18th, 6 p.m., arrive Lisbon. During
the stay of six days at Lisbon various excursions will
be made, including visits to Madrid, Toledo, and the
Escurial.

Tuesday, 24th, 6 p.m., leave Lisbon. Passengers
who wish can leave at 4 p.m. next day, Wednesday,
and rejoin the Ophir by train at Loixoes.

Wednesday, 25th, at Leixoes (for Oporto). The day
will be spent ashore visiting the principal sights.

Saturday, 28th, call at Cherbourg to land Continental
passengers.

Sunday, April 29th, 8 a.m., arrive back at Tilbury.

———.9————

Plague. :

India.—During the weeks ended November 25th,
and December 2nd, the deaths from plague numbered
2,836 and 2,890.

South Africa.—No case of plague during the weeks
ended November 25th and December 2nd and 9th in
Cape Colony.

Mauritius.—During weeks ended December 14th,
21st, and 28th, fresh cases of plague numbered
8, 5, and 2; deaths from the disease, 7, 3, and 2.

Hong Kong.—During the week ended December
23rd, fresh cases, 3; deaths from the disease, 3.

Hew Brugs.

Tue pharmaceutical preparations of Messrs. P.
Beiersdorf & Co., of Hamburg, have long been re-
nowned for their purity and excellence. The readers
of the JounNAL оғ Творіса, Mepicrxe will be in-
terested to learn that this firm achieved great dis-
tinction at the ''Exposition Universelle," held at
Liége in 1905, they having gained the highest possible
award, the Grand Prix, for their pharmaceutical
specialities.

We congratulate Messrs. P. Beiersdorf & Co. on this
signal triumph, which is the more significant, inasmuch
as their products were the only ones of German manu-
facture to gain the highest award, the Grand Prix, at
the Liége Exhibition.

“ ERNUTIN.” А new product presenting the active
therapeutic principle of Ergot.

* Ernutin ” is issued in hermetically sealed phials,
and being sterile is eminently suitable for h rmic
or intramuscular injection. | When it is desired to
obtain an immediate effect, as in post-partum hæmor-
rhage, intramuscular injection is to be preferred.

As “ Ernutin” is a very potent preparation, its
administration must be carefully guarded, and the
dosage regulated accordingly. It is suggested that
the initial dose be five minims, and that any subse-
quent dose required should depend upon the ascer-
tained reaction of the patient.

BunRovoHs WELLCOME AND Co.

— ——»9—————

Becent and Current Riterature.

A tabulated list of recent publications and articles bearing on
tropical diseases is given below. To readers interested in
any branch of tropical literature mentioned in these lists
the Editors of the JouRNAL OF TROPICAL MEDICINE will be
pleased, when possible, to send, on application, the medical
journals in which the articles appear.

“New York Med. Journ.,” September 23, 1908.

MALARIA. LECTURES ON THE DISEASES OF THE
Вгоор. By Joun M. Swan, M.D.

“Riforma Medica,” August 5, 1905.
SIGNORELLI, А. DisTURBANCES OF CUTANEOUS SENSI-
BILITY OF TUMOURS OF THE SPLEEN AND ІМ
SPLENOPATHIES IN GENERAL. THE SPLENIC ÁREA.
Signorelli states that (a) “the splenic area ” for
clinical purposes is in the fifth intercostal space along
the mammary line; (b) the ‘ posterior splenic area”
corresponds to the fifth, sixth, seventh, and eighth
spinous process of the dorsal region ; (c) ‘ the lateral
splenic area ” exists in the intercostal spaces in the
left mid-axillary line. These regions become sensitive
in splenic derangements due to tumours or enlarge-
ment of the spleen. Corresponding areas of sensi-
tiveness may occur on the right side by diffusion in
exactly corresponding points to those described on the
left side.

January 15, 1906.)

THE JOURNAL OF TROPICAL MEDICINE. 15

Original Communications.

ГІТ AND UNFIT PERSONS FOR RESIDENCI
IN WARM CLIMATES.

By W. Hartigan, M.D., D.P.H.

Ir has occurred to me that a few notes, embodying
the results of experience gained during many years’
residence in the Far East, might be interesting and
useful to those who, by necessity or inclination. are
induced to make their homes and seek employment in
tropical and sub tropical regions. This must be my
excuse for the following article, which makes no
pretence to be a learned disquisition on climatology,
but is simply a series of practical hints from a
practising physician.

Whilst living in China I had often noticed how
many more or less delicate men had heen advised “to
go out East, as they would be sure to improve,” and
now, when examining in London for various Far
Eastern firms, I have frequently to reject applicants
as ‘unfit’’ who had likewise been told that ‘ they
ought not to remain in England, but would get on
capitally in China, or Burmah, or Peru, as the case
might be.” Such advice has usually not been given by
those who have bad tropical experience, or made a
a special study of epidemiology, but by the generally
well-informed, thoroughly practical family doctor, in
whose ken any distant clime, with a bright sun and
tropical foliage, where an open-air life can be enjoyed,
is just the place for the boy whose ‘lungs are slightly
touched," or whose delicate physique unfits him for
the rough-aud-tumble of the football field, ог who
cannot bear the hardships of school life. This fallacy
frequently gives rise to disappointment, and осса-
sionally leads to disaster. It is true that excep-
tionally fine physique, great muscular development,
or exuberant energy, are not necessary for healthy life
in the Tropics. In my experience, wiry men, of medium
height and slight build, even though a little under
weight, of an active disposition, but not nervous
temperament, do quite as well when transplanted to
the East as the herculean gladiator of the playing
fields or the madly enthusiastic gymnast. These
latter (certainly when engaged in office work) seem to
give way more to tropical ennui, become lazy, go in
for verandah-life in a long chair, plus а whisky-and-
soda, lose their energy, give up games апа exercise,
and soon “гап to blubber." Тһе nerve tone of the
big man seems to be pitched in a lower key than that
of his weaker brother, as if Nature would not pour out
&ll her gifts on one subject, and balances the want of
showy, physical attributes, by the gift of greater
physiological resisting power against enervating
climatic influences.

The great tropical explorers—Livingstone, Stanley,
Emin, Johnston—men of superabundant grit and
energy, were none of them giants, whilst it is an open
secret that Lords Wolseley and Roberts, who have
faced death and disease in every clime, would not
“come up" to the present physical standard of an
Army medical board. Careful discrimination must,
however, he exercised. The weedy, narrow-chested,
undersized, anaemic applicant, with thin, sandy or fair

hair, pale pinched features, too clear or high-coloured
complexion; and likewise the gawky, undeveloped,
lanky skeleton, with straight, lustreless, dark hair,
probably bright eyes, but sallow, jaundiced features ;
or again the physically well-built, middle-sized man,
uncertain and slow of speech, with a dull heavy
expression, and face of unhealthy colourless hue, phleg-
matic, except when he enlarges on the state of his own
health ; are all equally unsuited for the Tropics. The
former become early victims of tropical anaemia, with
its consequences, loss of energy and inability to work,
and readily succumb to prevalent intestinal diseases :
whilst the latter develop into chronic dyspeptics,
with a morbid tendency to introspection and dislike of
companionship, which too frequently leads to secret
tippling.

Another type to be avoided is the over-strung, exu-
berantly active, good-all-round, “ admirable Crichton,”
who burns the candle at both ends, dragging through
his long office hours with good grace enough, doing
his work fairly well—for he has brains—but perhaps not
very thoroughly, spending his evenings in theatricals
or dancing, enjoying his little dinners and suppers,
taking or giving “а peg” or liqueur at every oppor-
tunity; he has exhausted his reserves, and whilst he
may get along happily enough in a temperate climate,
will, should he go to the Tropics, almost inevitably
become “jumpy” and hysterical, subsequently
physically weaker, with progressive loss of weight,
followed by loss of interest (if it ever existed) in work,
incapability of concentrated application, degenerating
into a childish state of “ don't саге”; in short, he has
generally “ ропе to pieces” without any very definite
reasons therefor. This condition is usually combated
by frequent “ nips,” forenoon “ cock-tails,” and early
morning *'' night-caps," eventually culminating in that
well-known euphemism, ‘ tropical neurasthemia,” or
“climatic dyspeptic gastritis,” more correctly known
ав ‘chronic alcoholism," vulgarly “drink”; finally
eventuating in ‘‘a passage home,” with a polite
intimation of “ services being no longer required." |

A tropical climate does undoubtedly “ get on the
nerves," but it is usually ably assisted by “ Scotch,"
* Irish," or “Cognac,” good, bad, aud indifferent ;
nevertheless, the man of nervous temperament is not
a good subject for the Tropics, whilst the victim of
any of the neuroses is generally unfit for work or
residence in hot climates. Asthma may probably be
excluded from this generalisation, as supposing the
asthmatic to have the power of selection, he may find
a suitable place wherein he will enjoy almost com-
plete immunity, but in the absence of such choice the
Tropics and Sub-Tropies should be avoided. This pro-
hibition applies also to the epileptie, even if only
suffering from ‘‘ petit mal."

Likewise the man of bibulous habits is most un-
suitable ; his thirst is certain to be aggravated, whilst
the amount of liquor consumed with comparative
impunity in Britain becomes a potent nerve-poison in
the Tropies. He who has once been tbe victim of
alcoholism, even if apparently cured, should never
return to the East, the old temptation will grow with
opportunity, an increased inclination will overcome an
enfeebled resistance, “апа the dog is returned to his
own vomit again.”

16 THE JOURNAL ОЕ TROPICAL MEDICINE.

[January 15, 1906.

The slave of the pipe too, with blackened, carious
teeth, irregular heart’s action, short of wind: and the
cigarette fiend, whose congested throat, dried, furred
tongue and watery eye proclaim the chronic dyspeptic,
will not improve in a land where cigars can be had for
a few cents, and smoking is permitted and encouraged
everywhere and anywhere. In moderation the fragrant
weed is soothing and harmless, but when а pocketful
of cigars can be smoked between early breakfast and
tiffin, and the chimney is then kept going till bedtime,
the result is a shaky, nervous individual, frightened
at his own shadow, seeing fatal illness in every trifling
ailment, imagining those he has not got, incapable
of exertion, or breaking into profuse perspiration on
making the most ordinary etfort, unable to make up
his mind on any subject, droning into unsympathetic
ears his personal or business worries, who finally
** goes smash," financially and morally, or goes home.
This is not a fancy picture. I have seen it; ergo
“eave canem: For such, “ better fifty years of Europe
than a eycle of Cathay."

To return to the point whence I started, in my ex-
perience the man whose lungs—to use the popular
expression— are merely weak, has generally on his
first arrival in the more healthy Tropics improved,
particularly if he has previously enjoved fairly good
health ; but should he unfortunately be attacked by
malaria, dysentery, sprue, or other debilitating disease,
which, however, he is not especially liable, the weak
spot is sure to һө found out and pulmonary disease
follow.

If, however, there exists latent pulmonary disease,
by which I mean a previous lesion at the moment
quiescent, the damp tropical heat and super-saturated
air, even in the absence of other illness, will almost
inevitably eause a recrudescence of active disease in
the impaired lung, whieh will rapidly break down
under continued exposure to its unhealthy and
debilitating surroundings; whilst, if foci of active
disease are already present, evidenced by a general
infection or enlarging cavities, the subsequent course
is most rapid, either the cavities pour forth pints of
stinking pus swarming with bacteria, or, the lungs
rapidly solidifying, breathing becomes most laboured,
expectoration, which may not be at all profuse, is full of
tubercle Eacilli, then high temperatures and exhausting
perspirations, frequently followed by severe and re-
peated hemorrhages, ensue ; these rapidly wear out the
patieut, and death ends the scene in a few weeks.

We have all seen the girl, previously in apparently
good health, with perhaps too high a colour, who,
you are, told ‘has caught cold." You take a grave
view of the case, but are not believed. Ina few dava
her downward progress puts a melancholy end to the
scepticism and incredulity of family and friends.

Or perhaps the athletic young man, often a
Scandinavian or Dane, who knows he has had some
slight lung trouble, tells you he has spat up a little
blood which he thinks has come from the throat, and
brings some blood-tinged, scarcely viscid sputum, in
which tubercle bacilli abound. You recommend
prompt departure for healthier climes ; he does not or
cannot take your advice; rapidly recurring hamorrhages
follow. He at last gets away, the hamoptysis ін
checked, but irreparable mischief has been done, and

he, too, succumbs, a victim of the too exuberant growth
of the tropical forcing-house and of the mistaken
advice which preferred ‘е nice warm climate" to
his native northern snows. Sensible precaution can
minimise the ill-effects of cold, which in many ways is
most beneficial, but the deleterious qualities of damp
heat are impossible to eliminate.

Although in my opinion continued residence in most
parts of the Europeanised Far East is very detri-
mental to those phthisically inclined, the conditions
obtaining in Hong Kong, Amoy, &e., during winter,
and in Shanghai and Northern ports in spring and
early autunin, may be actually favourable to them,
whilst Chefoo and Wei-hai-wei are, even in summer,
fairly good. Pekin, Tientsin, &c., being drier, are less
objectionable (as all-the-year-round residences) than
the South China stations, but the dust is a great
disadvantage.

Japan, likewise, though better than South China or
the Straits, cannot be recommended. Its climate is
variable and damp: even the hill resorts, though ideal
at certain seasons, are injurious for other and longer
periods.

Manila, called in some geography books “a sani-
tarium," is also unsuitable. Damp and great dry
heat alternate, the climate is most relaxing, intestinal
complaints are prevalent, cholera epidemics far too
frequent. Singapore, Penang, the Malay States,
Burmah, Java, Seychelles, Mauritius, &c., are all
objectionable, though some have hill resorts where the
conditions are decidedly more favourable, but one
must always remember that the man who is earniug
his living can very rarely take advantage of them,
whilst the man of means will go to Egypt, or Davos,
or California, where good air, comfort, and life-giving
amusements all contribute to renewed health and
vitality. I have purposely excluded the Riviera,
having found its climate lowering, treacherous, and
changeable, many of its popular resorts insanitary (in
flies and smells they could favourably compete with
** Eastern bazaars,” or “ China towns "), whilst, when
the mistral blows, the dust is most irritating to
delicate throats and bronchi: the sun and sky give
them their only advantage over our cloudy land.

The man whose first object is “ to get a living," and
who сап only afterwards indulge in the endeavour to
keep alive, should seek an open-air life in Colorado,
Arizona, or parts of South Africa, Australia, or New
Zealand, &c. If he must dwell in cities, Sydney,
San Francisco, Cape Town, &c., will afford him fair
opportunities with comparative safety, but let him
keep away from Eastern towns. With care, he would
have as good chances of prolonged life at home.

In conclusion, I would say that the healthy, steady
man, of slight physique, active habits and cheerful
disposition, not necessarily a tectotaller, but tem-
perate in all things, who recognises his duty to work
as well as the necessity of play, need have no hesita-
tion, should the glamour of the East allure him, in
seeking ‘fortunes, buffets, and rewards,” “at the
quiet limit of the world,” or in following a vocation
which called him to labour in tropical vineyards. Of
such it may not be said that ‘the eyes of a fool arein
the ends of the earth,” always remembering im medio
tutissimus ibis.

January 15, 1906.)

THE JOURNAL OF TROPICAL MEDICINE.

17

THE QUESTION OF THE MODE OF INFEC-
TION IN MALTA FEVER.

Ву Epwanp Н. Ross, M.R.C.S., L.R.C.P.
Medical Officer, Sanitary Department, Port Said, Egypt.

Maura fever has been the subject of some con-
siderable attention during the past few years on
account of its ravages amongst the personnel of the
British Army and Navy stationed in the island of
Malta. Malta is the headquarters of the Mediter-
ranean Fleet ала possesses а large military and naval
garrison with a total numerical strength of nearly
30,000 men. Amongst these Malta fever has had a
fairly constant annual incidence of nearly 700. Owing
to the prolonged nature ‘of the disease a majority of
the cases have had to be invalided home to England,
and thus their services have been temporarily lost to
the Empire. This disease, therefore, has been the
cause of the expenditure of much of the publie money
and a notable reduction in the efficiency of our avail-
able fighting forces in the Mediterranean. In addition
to this the people of Malta suffer greatly from Malta
fever, which gives the island а bad name, keeping
away visitors, and interfering with its commerce.

Malta, however, is not the only place where the
disease is prevalent, for its existence has now been
demonstrated in several of the seaports of the Medi-
terranean, the Philippine Islands, Hong Kong, «с.
The name Malta fever, therefore, is hardly fair to
Malta, nor that of Mediterranean fever to the Medi-
terranean ; but the disease is now so well known by
these names that a new one would be inconvenient
and confusing.

Malta fever, then, may be defined as a prolonged
fever which may be cither continuous, remittent or
even intermittent in type, usually exhibiting waves,
undulations, or cycles of severity, and accompanied
almost invariably by enlargement of the spleen, pro-
fuse sweating, and certain complications. It is caused
by the Micrococcus melitensis of Bruce, which is found
in the blood and blood-forming organs of men and
animals suffering from the disease.

The waves of fever continue in the majority of
cases for two or three months, but the disease occa-
sionally aborts in two or three weeks, or it may
continue for more than a year with apyrexial inter-
vals. The mortality is low; in most years it is less
than 3 per cent. Тһе diagnosis of Malta fever does
not, as а rule, present much difficulty ; the prolonged
nature of the fever, the accompanying sweating, the
complications of synovitis, neuritis, and the persistent
anemia, in addition to the fact that the disease is
only endemic in certain sub-tropical towns, renders
the clinical diagnosis an easy matter. In a person
living in Malta, or who has recently resided in Malta,
who has fever which continues for two or three
months, who complains of little but malaise, headache,
pains in the limbs and joints, and who exhibits no
physical signs save those of fever and enlargement of
the spleen, and who has never shown the ordinary
signs of typhoid, the disease is almost certain to be
Malta fever. But in addition to the clinical aspect of
the case the knowledge that the Wicrococcus melitensis
will agglutinate in the presence of immune serum is

of great service. "This serum reaction is fairly con-
stant in its results aud is of the greatest value asa
confirmatory test in diagnosis. But it is not without
its fallacies, for one occasionally finds variations in
the agglutinating capabilities of apparently identical
strains of the mierococcus, and thus confusing results
are sometimes obtained.

The most conclusive means of diagnosis lies in the
separation of the micrococcus from the blood of the
patient; but this is not always practicable, and the
fact that it could not always be carried out has
diminished the value of much of the experimental work
done. When obtained from the blood or elsewhere
the identity of the micrococcus may be tested by its
agglutination with immune blood serum, innoculation
into susceptible animals and its subsequent recovery
from them, its reaction to litmus, and negative Gram
staining. Unfortunately it has not been in the power
of many of us who have been investigating this disease
to carry out all these confirmatory tests, so that the
results of our experiments cannot be regarded as
conclusive as might have been wished. Butas a rule,
save in exceptional cases, the diagnosis is easy and
the work done must be valued accordingly.

There is no known specific cure for Malta fever, and
up to the present time, according to the literature, not
very much work has been done to obtain an antitoxin
or a prophylactic serum for it; therefore it is neces-
sary to find out how the disease is conveyed from one
person to another in order to be able to take measures
for its prevention. Having this object in view, Sur-
geon G. M. Levick, R.N., and myself undertook to
investigate the disease by observation and experiment.
After observing тапу cases of the disease from an
epidemiological standpoint, we noted the following
factors, and on these factors or postulates we based
our experiments.

Postulute 1.—Malta fever is only prevalent in the
towns near the coast of sub-tropical seas.

The only exception to this rule that we have, up to
the present time, any reason to consider is the oocur-
rence of Malta fever in Cairo. In this place the
disease is said to exist, but beyond the statement to
that effect we have but little proof of it at present.
Judging by the only obtainable statistical returns,
namely, those of the Army Medical Service, one finds
that in the report for 1898, 191 cases of Malta fever
occurred in the British garrison in Cairo; while in the
reports for 1901 and 1902, when better methods of
diagnosis had been instituted, and the disease better
differentiated, the number of cases which occurred in
in the garrison fell to 7 and 4 for the two years respec-
tively; so that in the space of four years, and with
the same numerical strength of troops—namely, 5,000,
the incidence of the disease had diminished from 191
to 4; while in the contiguous ports of Port Said and
Alexandria the disease had increased. The inference
is that the existence of eudemic Malta fever in Cairo
is at present non-proven.

With this exception, then, so far as we have been
able to find out, Malta fever is confined to sea-
port towns in the Mediterranean, in the Philippine
Islands, Hong Kong, Cuba, and Bermuda, its existence
in the last two places, as in India, being still
doubtful.

18 THE JOURNAL ОЕ TROPICAL MEDICINE.

So far as the Mediterranean is concerned the distri-
bution is peculiar, for it is confined to the southern and
eastern shores. Having visited many of its ports
during the past eighteen months, we have enquired
into the prevalence of the disease in each, with the
following results: In some places cases of prolonged
fever were examined by us clinically, and tested with
the serum reaction, and were found to be cases of
true Mediterranean fever—Corfu, Beyrut, Port Said,
Malta. At the following places the disease has been
identified by the local medical men, and tested by
them with the serum reaction, and found to be: preva-
lent: Tunis, Algiers, Athens, Alexandria. At the
following places prolonged fevers are endemic, but we
have been unable to find out if they have been defi-
nitely proved to be Malta fever or not: Smyrna,
Constantinople, the Island of Lemnos, Oran. At
Gibraltar, Malta fever was very prevalent two years
ago, but from all accounts the disease has now almost
disappeared, although at Algeciras it is still believed
to exist.

On the northern shore of the Mediterranean the
discase, if it exists at all, is very slightly prevalent;
but we have not been able to obtain much information.
At Toulon, and on the Riviera, it is absent (Shaw) ; at
Barcelona it is probably malaria; at Genoa it is
absent ; but we have been informed that Neapolitan
and Sicilian fever is true Mediterranean. With the
exception of the case of Cairo above mentioned, our
enquiries have led us to believe that the disease
does not spread inland. It does not exist at Ismailia
(Pressat), nor at Suez (Creswell), whilst at Port Said
and Alexandria it is very prevalent; also three years
ago the disease was present in Gibraltar, and is now
at Algeciras, but not in the neighbouring Rhondda
Valley, and while prevalent in Naples it is absent
from Rome; so that we concluded that the disease
is in some way connected with the sea, and this has
consequently influenced our work.

Postulate 2.—Malta fever exists in endemic places
all the year round, but its incidence is enormously
increased in the hot weather, namely, from April until
November, during the Mediterranean dry season.

Postulate 3.—In Malta the disease is especially
prevalent in the hospitals in which cases of the disease
have been treated, but it is not specially confined to
the fever wards. Doctors and nurses in these hospitals
frequently contract the disease.

It is very common for patients admitted to the
Naval Hospital at Malta with surgical, venereal, or
other affections to contract Malta fever after a stay
there of a few days; and so commonly does this occur
that it is sometimes necessary to question the advisa-
bility of sending patients to this hospital during the
summer months.

The disease is also very prevalent in the Civil and
Military Hospitals in Malta and in one of the hospitals
in Port Said. In addition to this, it had been
remarked by many observers, and by no less an
&uthority than Hughes, that attacks of the disease
may be localised to certain houses and barracks, and
even to individual rooms, and to certain beds in a
room. This, and knowing the fact that the disease
cannot be conveyed by direct contact or by clothing
worn by a patient, is of the utmost importance. Then,

(January 15,

1906.

again, newly built houses and those near which build-
ing operations are going one, are specially prone to
the disease.

Postulate 4.—Malta fever frequently occurs in epi-
demie form, the cases then invariably appearing one
after another, not simultaneously, as if they were
caused by a common means acting at the same
moment. Examination of the recorded epidemics is
very interesting in this respect, for those which
occurred during the summer months show an interval
of only one day between the cases, whilst in those
which occurred during the cold weather this interval
is often prolonged to three or four days.

Postulate 5.—Amongst the officers and men of the
warships stationed in Malta the disease is, as men-
tioned before, very rife, but the manner in which these
contract it is interesting. As а rule, when in Malta,
these ships are moored in the harbours a short dis-
tance from the shore, which is steep-to; and amongst
the erews of such ships the disease never occurs
except in the case of men or officers who have recently
spent the day or night on shore, or have a few days
before returned from hospital. This fact we have
verified by the most careful enquiries and observa-
tions. If, however, one of these ships goes into dry
dock, or is moored alougside a wharf in Malta harbour
during the summer, an epidemic of Malta fever almost
invariably breaks out on board. The case has occurred
when such a ship, having been in dock for some days,
has then left Malta for a prolonged cruise, and a few
days after leaving port an epidemic of Malta fever has
occurred on board, one case appearing regularly after
another with a one or two days’ interval; and this has
continued for two months, several of the cases then
occurring amongst men who had not been out of the
ships for weeks.

On these five epidemiological postulates we based
our experiments, realising that infection іп Malta
fever is due in all probability to ‘one definite and
specific cause, which we determined, if possible, to
find out, in order that prophylactic measures might
at once be instituted.

This вресібе method of the transmission of the
disease must therefore coincide with and account for
all the above five postulales before it can be stated
that the correct mode of infection has been dis-
covered.

On my arrival in Malta in June, 1904, I associated
myself with Surgeon Levick, R.N., and we agreed to
start work at once.

The question then arose: Which would be the bost
method of working? We were then both surgeons in
the Navy attached to ditferent ships in the Medi-
terranean Fleet, and we knew that we should often
be separated from one another, the ships rarely
remaining in one port for any length of time, so that
we could not experiment with monkeys or other
animals; nor could we hope to make elaborate bac-
teriological analyses, for we were rarely at Malta,
where, however, Dr. Zammit did his utinost for us ;
and we had no laboratories beyond the cabins in our
respective ships. So we determined to repeat, so
far as our circumstances would allow, the methods
employed by Reed, Carrol, Lazear, and Agramonte
for the discovery of the mode of transmission of

January 15, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE. 19

yellow fever, by endeavouring to obtain volunteers
who with ourselves would be willing to undertake the

experiments, to expose themselves to the probability

of contracting the disease, and at the same time to
live under such conditions as would reduce the
possibility of error. Five others without hesitation at
once volunteered to join us, so we determined to try
upon ourselves every possible method of the trans-
mission of the disease, and then by a process of
exclusion eventually to hit upon the right mode of
infection.

Up to the present time the Micrococcus melitensis
has been found constantly in the blood of patients
suffering from Malta fever, even in such a smal
quantity as 5 milligrammes of the peripheral blood,
and it has been found to be excreted intermittently
in the urine; so that the possible modes of infection
in Malta fever as in other analagous diseases are as
follows :—

(а) By direct contact with Malta fever patients.

(b) By the clothing whieh has been worn by Malta
fever patients.

(c) By urine-infected dust.

(d) By urine-infected water or food.

(r) By biting insects.

(f) Transmission in some way from some inter-
mediate host.

Our first care was to assure ourselves that we were
not immune to the disease; but as none of us had
had Malta fever, and none of us had spent many
months in the Mediterranean, and none of us had
ever had any serious illness, we concluded that we
were, some of us at all events, capable of contracting
it. In addition we have all from time to time been
tested with the serui reaction and this has always
given negative results.

At first we proposed to experiment with artificial
cultures of the micrococcus, but after much delibera-
tion we realised that the results so obtained could
only be inconclusive, for Nature does not work with
agar cultures ; aud it is difficult to believe that under
any natural conditions could the micrococcus occur
in such numbers, such a degree of concentration and
freedom from contamination as it is found when
planted out on agar in the laboratory. As we could
not afford to try experiments when their results would
be inconclusive, we postponed the use of cultures
until every other method of the transmission of the
disease had been tried and failed.

We therefore decided to imitate natural methods as
far as possible and to avoid artificially prepared
materials for our experiments. From the outset we
encountered some difficulties, as might have been
expected. Chief of these was that we were constantly
being separated, so that instead of being able to carry
out the experiment with all the non-immunes simul-
taneously, we, as a rule, had to be content with three or
four, and therefore each experiment had to be repeated
and its result confirmed. Then we experienced great
diffieulty in obtaining materials to experiment with.
Thus we frequently wanted to examine several
patients in the hope of discovering some fact which
would throw some light on the problem before us, or
we wished to obtain urine from a patient, especially
When it was known to contain the micrococeus, or we

desired to allow recently hatched mosquitoes to bite a
patient, who was willing that 16 should do so, in order
that it might subsequently bite us, but we often en-
countered every conceivable opposition from those who
had charge of such patients, and by those who are kept
constantly acquainted with the ravages of the disease
and apparently regard it in a state of lethargy from
which it is impossible to wake them. Our work, there-
fore, is not as complete as it should have been had we
been enabled to take advantage of every opportunity.

(а) We first considered the possibility of the trans-
mission of Malta fever by direct contact. The possi-
bility of this is remote, for although Malta fever is
very prevalent in hospitals іп Malta and other places
where the disease is endemic, yet every year hundreds
of men suffering from Malta fever are invalided to
England and ave treated in the naval and military
hospitals at home, but the disease has never been
known to spread in these latter hospitals; nor have
nurses or orderlies ever been known to contract Malta
fever at Haslar, Netlev, Chatham, or Devonport.
Nevertheless, as the opinion has been expressed that
“ One is driven to accept tentatively the unwelcome
conclusion that Mediterranean fever is probably of a
directly contagious nature ” (Shaw), we attempted to
reproduce the disease in the following way: A man
suffering from Malta fever contracted in a Malta
hospital was nursed in the ordinary sick-birth of a war-
ship for a month by some non-immunes, who were in
daily contact with the ship's company, but none of
them contracted Malta fever.

This was repeated in another ship with another
patient with the same result. Then on two separate
occasions two non-immunes slept in the bedclothes
which had been used by Multa fever patients, and still
none of them contracted the disease.

This mode of infection does not agree with any of
our postulates except possibly No. 3.

The conclusion is that the disease cannot be con-
tracted in this way.

(6) Infection by clothing

Nightshirts which had been worn. by Malta fever
patients were conveyed on board four different ships
and there slept in by four different non-immunes.
They all remained well.

This mode of infection can only possibly agree with
postulate 3; but it will not account for the increase
of the disease during the hot weather nor its preva-
lence in ships which have recently been in dock.
Then if the disease was transmitted by clothing or
fomites it ought to spread in England ; but it does
not.

(c) Transmission by urine-infected dust.

In Malta, during the summer months, there is an
almost complete absence of rainfall, and in conse-
quence dust is blown about everywhere; in Malta,
also, some of the people have an unpleasant habit
of urinating in the streets, and therefore it seemed
possible that the dust might become infected with
the micrococcus excreted in the urine, and so passed
from one man to another. It has been held that this
is the chief means of the propagation of the disease.

We therefore mixed urine obtained from a Malta
fever patient with some dust, and this was sniffed up
the nostrils by two non-immunes, but they did not

20 THE JOURNAL OF TROPICAL MEDICINE.

(January 15, 1906.

contract the disease. This experiment was then re-
peated by four non-immunes, with the same result.

Unfortunately we were not in a position to demon-
strate the presence of the coccus in the specimens of
urine employed in these two tests; but as one of us
had, previous to our determination, mixed a living
culture with some dust and inhaled it without dele-
terious consequences, we did not repeat or continue
dust experiments.

Infection by dust will not explain the prevalence of
the disease in hospitals, nor epidemics on board ships
when at sea. It is impossible to believe that a particle
of infected dust should strike the nostrils of John
Smith lying in Z Ward of the Naval Hospital at
Malta, the remainder of the patients in that ward
escaping, and another particle of urine-infected dust
should strike the nostris of William Jones lying iu
the same ward of the hospital three days later, and
so on. Also ships at sea do not contain dust. This
dust theory will not agree with postulates 3, 4 and 5.

(d) Infection by urine-infected water.

“ The water-borne theory ів оп all sides considered
improbable" (B. Smith) Epidemics do not follow
the course of the water supplies in Malta. The
incidence of the disease does not follow the course of
that of typhoid. Hospitals are usually the last places
to consume polluted water, and on board the ships of
the Navy the water is distilled when at sea.

Infection by drinking water will not agree with
postulates 8, 2, 4, and 5; but to make sure we mixed
urine from & Malta fever patient with some water,
and this was drunk by six non-immunes and none of
them contracted Malta fever.

We made no experiments with food apart from
water, except that four non-immunes drank some goat's
milk which contained diluted urine in which the
micrococcus was present, and they all remained well.

(e) Infection by biting insects.

l have stated elsewhere the opinion that this is the
common and specific mode of infection in Malta fever,
and up to the present time have met with no reason
to alter that opinion.

Of all the methods of infection this seems to be the
most probable one. It is the only one which will
agree with all our postulates. .

(1) The disease is endemic only in certain places;
then it is probably conveyed by some insect which
only inhabits these certain places.

(2) Malta fever occurs in the endemic areas all the
year round, but its incidence is enormously inereased
during the summer months; some mosquitoes and
biting flies live and bite in these endemic areas all
the year round, but all biting insects increase enor-
mously during the hot weather.

(3) Malta fever is specially prevalent in the hospitals
where cases of the. disease are being treated. When
we know that it is not directly contagious and cannot
be conveyed by infected clothing the insect-borne
theory will alone explain the marked prevalence the
disease has in hospitals and among nurses and order-
lies in them. In hospitals, of all places, water and milk
should be carefully sterilised and food carefully
prepared.

Then the predilection Malta fever has for certain
houses, rooms, and cven beds, can only, iu the absence

of the conveyance of the disease by direct contact, or
by clothing, be explained by the insect-borne theory.
These last factors favour the transmission being by
mosquitoes rather than by flies, for a mosquito will
remain in the same room of a house or ship for
months, so long as it can obtain а sufliciency of food
in it.

(4) Then, again, during epidemics persons commonly
contract the disease one after another in the hot
weather, the interval between the cases being then
short, for the mosquitoes feed regularly; but this
interval is increased to two, three, or more days when
the weather is cold, and when the digestive periods of
inseets is prolonged during partial hibernation. Mos-
quitos rarely fly off to the men-of-war in Malta har-
bours, but if a ship goes into dock then she is at once ·
invaded by these pests and an epidemic occurs.
Sometimes when such a ship goes to sea the epidemic
continues because the insect remains on board con-
veying the disease from one person to another with
a regular interval corresponding with its digestive
period.

(5) Then amongst the crews of the men-of-war
which have not recently been in dock the disease does
not occur except in the case of men or officers who
have been on shore a few days before. Every one on
board necessarily consumes the same food und water,
and fresh milk is never obtained by the men, so that
this means of transmission by food and water seems
improbable, and men must become infected by insects
when on shore. The British sailor does not, as a
rule, when he goes on shore at night on the spree,
drink MILK.

We have experimented with many kinds of biting
insects by making them imbibe the blood of patients
suffering from Malta fever, and then allowing them to
bite as many non-immunes as it was possible to
arrange; but owing to the fact that we were living on
board ship we had often the greatest difficulty in
keeping the insects alive and making them bite regu-
larly. Іп the case of Асағіотуіа zammitii, а mos-
quito which passes its larval stages in concentrated
sea-water, which we have found in every place in
the Mediterranean where Malta fever is known to be
endemic, and which we in confidence thought to be
instrumental in conveying the disease, we have been
quite unable to make it bite regularly or to live long
enough, with the means at our disposal, to give
conclusive results. Had we been able to let loose
in & mosquito-proof room a few infected mosquitoes of
various species, and then been able to sleep in that room
one by one, I am sure that we should have all of us
contracted the disease, and its means of transmission
been proved. Nevertheless, we did succeed in experi-
menting with some of the common species—namely,
Culex pipiens, Culex fatiyans, Stegomyia fasciata, and
with fleas and bugs, but we did not apparently hit upon
the right insect, for none of us contracted the disease.

Apart from this, very little work has been done upon
this mode of infection in Malta fever. The Mediter-
ranean Fever Commission has, it is true, made some
experiments with Stegomyia fasciata, but so far as I
am aware no other species of mosquito or kind of
insect has yet been tried. Zammit claims to have
succeeded in transmitting the disease from one monkey

January 15, 1906.)

to another by Steyomyia fasciata, but he has been
unable to confirm this result, and our experiments
with this species have failed.

Apart frorn these experiments this mode of infection
has been ignored, so that there still remains a great
deal of work to be done before it can be said that this
mode of infection can be excluded. Some arguments
have been adduced against it, but they may be readily
dismissed. The argument that because typhoid is not
insect-borne Malta fever cannot be is not reasonable.
It has been stated that the Micrococcus melitensis has
not been ‘discovered in sufticient quantities in the
peripheral blood to render it possible for insects to
infect themselves by biting Malta fever patients.
This argument was made much of three years ago
before the mieroeoceus had been discovered in the
peripheral blood. It was repeated after it had been
discovered in the peripheral blood. It was again
repeated after it had been demonstrated in 1 ce. of
blood. It was again repeated after it had been separ-
ated from 0:0005 cc. of blood. Perhaps it will be
again repeated when it has been found in 1 milli-
gramme of blood. It seems probable that the zenith
of bacteriological method has not yet been arrived at.

Then it bas been stated, “ Мо known disease of
bacterial origin (as contrasted with those of protozoal
origin) has yet been proved to beiusect-.borne." Have
we, then, so fathomed the depths of Nature’s methods
that we can afford to dismiss a possibility like this on
the strength of a negative analogy ?

The Mediterranean Fever Commission has produced
the disease in monkeys in а variety of ways. These
monkeys were kept chained to cages placed close
together on an‘open stone causeway at the Public
Health Laboratory at Malta.

Dust which had been mixed with the whole con-

tents of three, four, or more agar cultures was blown
into a monkey's cage periodically from July 10th until
August 26th, and it was not until the latter date that
the monkey showed signs of Malta fever. This was
repeated in another monkey, only the dust in this case
was blown up its nostrils. This was continued almost
daily for a month before the monkey contracted the
disease. Some monkeys were fed daily on whole agar
cultures for more than a month before their blood re-
acted. These monkeys required, on the average, to
be given the growths on twenty-seven agar slopes before
they contracted Malta fever. These animals are
always gnawing at their chains or the bars of their
cages, and during the dust experiment had to be
gagged, so that it is diflicult to exclude the possibility
of infection through the sores and abrasions thus
caused, and the saine applies to experiments with
goats.
, Tt is impossible to believe that under any conditions
In Nature could a man partake of the number of
Micrococci found on twenty-seven agar slopes. If
the minutest quantity of a culture of the micrococcus
18 placed under the skin, the disease is invariably
Produced after an incubation period of about six days;
Whereas these monkeys had to be fed for weeks before
they contracted the disease.

While these experiments were going on, two other
. Monkeys which had not been the subjects of any
eXperiment at all contracted Malta fever. Some

THE JOURNAL OF TROPICAL MEDICINE. 21

monkeys which, had been the subjects of contact
experiments also contracted it. Subsequently some
other monkeys which had received injections of
epidermal scrapings gave temporary reactions to
Malta fever after varying intervals, but these were
ascribed to the action of toxins, paddling about in
infected urine, or to Stegomyia.

But is it not possible that these monkeys which
contracted the disease “ naturally," as Major Horrocks
calls it, in reality contracted it in the only way in
which it is commonly contracted, and the only way
which has not been the subject of thorough experi-
ment? One cannot help thinking that perhaps some
of the monkeys which were the subjects of experiment
also contracted the disease '' naturally." :

None of these monkeys were kept under mosquito-
proof conditions, and consequently these experiments
lose much of their value. We know that the disease
does not spread by contact, or by clothing, or by the
sweat, or by the breath, for if it did we should have
Malta fever every summer in England; so that the
inference is that some of these monkeys which were
supposed to have contracted the disease by artificial
means in reality contracted it naturally. Perhaps an
infected insect was hovering in the neighbourhood of
these monkeys, and it spread the disease from one
to another, their infection not being the result of
experiment at all.

We ourselves have swallowed reasonable quantities
of the micrococci under conditions which precluded
the possibility of insect infection and we all remain
well to this day. :

(f) Infection in some way from some intermediate
host.

During the winter of 1904-1905 we were informed
by Zammit that he had found goats to be susceptible
to Malta fever, and he subsequently discovered that
а large percentage of these animals in Malta were
actually suffering from the disease which had been
contracted naturally. Ав a result of this the Micro-
coccus melitensis was looked for in the milk of these
animals and found in it. It was therefore at once
concluded that the disease was transmitted from goats
to man through the medium of the milk. This dis-
covery was published broadcast and the matter was,
by some, considered finished, for it was supposed that
the goats contracted the disease by eating offal in
the streets. Butit was then discovered by Zammit
and Shaw that cows also were susceptible to Malta
fever, and that some of the cows in Malta had also
contracted the disease naturally. It was then sug-
gested that cows also sometimes eat offal.

We were all very much struck by these discoveries,
and in consequence I at once wrote to the Medical
Superintendent of a hospital in which several cases
of Malta fever had been contracted and in which the
disease was actually prevalent at the time, asking him
to put these discoveries to the test by carefully sterilis-
ing all the milk supplied to his hospital and to watch
results.

This he did on receipt of my letter (August). Milk

. had always been carefully sterilised in his hospital, but

he made doubly sure of it by superintending the
sterilisation of it himself. The result was that not
only did the disease continue to occur, but he himself,

alone of his household, having always disdained the use
of mosquito netting, first contracted benign tertian
malaria and then a severe attack of Malta fever, from
which he is still suffering.

In the meantime, on our return to Malta we deter-
mined to try the effect of drinking vaturally infected
goat's milk on as many поп-іпипипеѕ as it was
possible to collect together in the short time we had
at our disposal (seven days), but we were very dis-
appointed to find that we could not obtain the milk
in which the presence of the micrococcus had been
demonstrated, so we had to be satisfied with the
following test. We mixed a large loopful of a living
culture of the micrococcus with some goat's milk,
which, after keeping а few hours, was drunk by four
non-immunes. One of these kept the milk too long,
for after drinking it he had an attack of vomiting. but
the others retained it well. То our astonishment
nothing ocenrred, all the non-immunes remaining
well; but we realised that at the best this experiment
was artificial as we had used an artificial culture, but
we were quite unable to obtain naturally infected milk.
When we considered, however, the results of this
and our former experiments and that all epidemio-
logieal factors point most strongly to the discase
being insect-borne and against infection by the ali-
mentary canal, we sought an explanation of the
disease occurring alike amongst men, goats and cows
under the insect-borne theory. We therefore debated
the possibility of Malta fever not being conveyed by
milk or the eating of offal, but by insects which trans-
mitted the disease to all these animals. If this was
the case, then one would expect that some other
animal which did not under any conditions eat offal
or drink milk, and which lived in Malta, would also
commonly suffer from the disease.

I, therefore, being away from Malta at the time,
wrote to Dr. P. Micallef, of the Public Health
Department in that Island, asking him to examine
the bloods of as many horses as possible to see if any
of them reacted to Malta fever.

Thig he did at once. He has examined up to the
present the bloods of thirty-eight horses of which four
reacted to Malta fever. As one cannot accuse horses
of eating offal in the streets or of drinking goat's milk,
and taking into consideration our experiments and the
epidemiological factors herein set down, one must
conclude that although the microcoecus is present in
goat’s milk and is excreted in the urine of men and
animals suffering from the disease, yet it is in all
probability nct conveyed by the drinking of milk or
the eating of offal, but by an insect, as yet undis-
covered, which transmits it from person to person, goat
to goat, cow to cow, and horse to horse, and possibly
from one of these animals to the others.

Lastly, from the epidemiological factors and the
experimental work done, the possibility of the disease
heing conveyed by dust, water, food, or direct contact
seems highly improbable.

It behoves us all, therefore, who are in daily con-
tact with the disease, or who are interested in it
and are able to do so, to search diligently for the
mosquito, biting fly, or other inseet which conveys
it, and when found to institute means for its exter-
mination.

THE JOURNAL OF TROPICAL MEDICINE.

1906.

‘January 15,

THE MOSQUITO WORMs OF TRINIDAD AND
THEIR REAL NATURE.

Ву А. J. B. Duprey, М.Һ.С.8.) LARC.
Mayaro, Trinidad, West. Indies.

Іх Trinidad, more than any of the other West
Indian Islands, cases of external myiasis are not of
infrequent oecurrence. This is especially the case in
this district, where the presence of various parasitic
diseases is mostly due to the extensive tracts of purely
virgin forests in an, as yet, uncultivated part of the
country, and in which abound all kinds of biting and
venomous animals. The traveller in these forests will
experience very great annoyance through a myriad of
flies and other insects of all sorts and sizes, some even
beautiful and glittering in their varied colourings of
blue and green, keeping up a continuous buzzing for
miles of forests through which the wayfarer travels.
Fortunately for inan, who is well able to defend him-
self, these flies, with the exception perhaps of the
undaunted mosquitoes, do not often attack him; but
the poor animal which lie bestrides is not infrequently
blooded to a considerable extent. Often the hunter or
the planter, after his bush excursions, finds that he
has been bitten, as he thinks, by mosquitoes, which
fact in itself is not at all surprising, but he dis-
covers later that there are four or more very irritable
and bumpy spots about his body, usually on the
hands aud face, sometimes on his legs, for which
he cannot account. The experienced bushman knows
these to be mosquito worms, and awaits patiently for
a day or two, when the worms shall have matured,
and forthwith takes the necessary steps to rid himself
of them. The uninitiated, however, continues to rub
the irritable spot until he finds that, instead of sub-
siding, a not inconsiderable blush of inflammation has
spread around the original bump, where he may notice
а small aperture about the size of a pin's head, from
which exudes a sero-purulent discharge. А knowing
one now sees this inflamed spot, and at once recog-
nises the nature of the condition: he proceeds either
to squeeze out.the worm, or, if the part is very painful,
he applies a little plaister over the aperture usually,
among the labourers, made of brown paper coated over
with a soft tallow. The worm being an air-breather
soon dies, after which it can һе readily squeezed out.
On account of the knowledge and experience which
the labourer has of quickly ridding himself of this
worm a ease is seldom allowed to go far enough to
require the services of a medical man, so it comes
about that the doctor rarely sees a case. I had the
opportunity of seeing a very severe case of so-called
mosquito worm infection а short time back, and as І
had no idea of what a mosquito worm was I was
naturally much interested in the case.

The patient had been out on an excursion in the
woods for the greater part of the day, and, as a con-
sequence, was infected in the lower third and outer
aspect of his left thigh, where there was to be seen a
round hole about the size of a No. 9 shot, from which
pus exuded on slight pressure. The surrounding in-
flammation was fairly extensive and indurated, of a
bright red colour, and acutely sensitive. The consti-
tutional symptoms were severe: һе had a thickly
coated tongue, a febrile pulse, and really looked very

January 15, 1905.)

THE JOURNAL OF TROPICAL MEDICINE. 93

pale and ill. On the front of his leg on the same side
there was au angry and weeping eczematous eruption,
probably also of a parasitic nature of some kind, which
easily subsided on treatment. А little 1 in 40 сағһоПе
lotion syringed in the aperture quickly killed the worm,
and on the following day, after the subsidence of the in-
flamimation, the worm was extracted. This latter was
not kept for my inspection, but the gentleman gave
some description of its appearance which caused me
to think it was the larva of the Dermatobia nonialis.
An abscess developed in his thigh, which was opened
a few days after by a doctor in Port of Spain.

Some weeks after another gentleman came to show
me several little swellings on his face and hand, which
he said were mosquito worms. There were no less
than four on his ehin, over one of which һе had placed
the proverbial plaister, and one on the back of his left
haud. The swelling over which the plaister was
placed was the size of a pea, and two small holes
could be seen where entranees were effected. The
bump was very painful on pressure, and the man said
that the worms were not ready to be squeezed out,
` but that he would return on the morrow. The little
swelling on his hand was a mere papule, in the centre
of which was the minute aperture of entrance, very
much like a mosquito bite (hence the name of mosquito
worms). It wasextremely irritable, and I noticed the
mau rubbed it continually. Оп the morning of the
next day he came again, when I squeezed out two
little worms from his chin quite close to one another,
from the examination of which I made the ыы.
drawing.

t Ue с
ie " A
MAGNIFIED J

we
e To NAT. SIZE

2
РДЕ

Se

Dermatobia nonialis ** Mosquito Worms.”

The larvæ belong to the genus Dermatobia, which
are variously described by authors: the length. aud size
vary considerably according to the stage of development.

he larva are whitish in colour and club-shaped, the

handle-part of the club or posterior extremity being
furnished with the respiratory apparatus. There
is, [ think, some mistake made with regard to the
mode of infection. The larvæ are described as though
the fly actually deposits her eggs directly in the skin
of man, dogs, or wild animals. Scheube says “it
mostly lays its egzs in tlie skin of cattle, sheep, and
dogs, and sometimes in the skin of тап”; and
Manson, in his * Tropical Diseases " (1898 ed.), says
the same. Daniels thinks “ man as well as animals
тау be attacked." 16 may be said here that the Ну
never attacks man or animals directly, but that the
eggs are deposited on leaves and branches in wooded
lands and forests, and thus man, hunting dogs and
other wild animals in passing through get the larva;
deposited on them accidentally. 1 believe this is
evident from the fact that, though the affection is
common in Trinidad, no one has as yet seen the fly
or can tell in what way the worms get deposited on
the skin. The presence of the Dermatobia nonialis is
not even suspected, seeing that the worm is attributed
to the bite of the mosquito. I am inclined to think,
therefore, that the nature ой the mosquito worms has
never been recognised in Trinidad. І have never
heard of the existence of the Dermatobia in the other
British Islands of the West Indies.

IS MALTA FEVER PECULIAR TO MALTA?

By LükwErnLyN P. Pms, M.D., M.R.C.5., F.R.C.S.

Cairo, Egypt.

Іх а leading article on this subject in the Journal
of December 15th, you state that Malta fever is

infrequent and rare elsewhere than in Malta. Now
the following facts will show that it is far from

its occurrence not
the

rave in Egypt, the evidence for
resting on clinical facts alone, but also оп
agglutination test.

Catro.—In Cairo this year five cases of Malta fever
have been under my саге, а short résumé of them
being as follows :—

(17 A Coptic lady who lived in Cairo and who had
not left it this vear, called me in to see her in October
she had been ill for about three months with a fever
which was constantly relapsing, and had been treated
for malaria with no sucecss. I suspected Malta fever,
and had her blood examined by Dr. Dryer, the
medical officer of health for Cairo; it was found to
agglutinate the Micrococcus melitensis. She had a
subsequent relapse, and still remains ill.

(2) Another Egyptian called me in a few days later,
and told me that he had Malta fever. He lived some
six houses away from the preceding case in the same
street. Пе had been ill for about eight months. The
original attack occurred in Cairo, but was not sus-
pected. Не then went down to Alexandria, where a
relapse occurred. Ап agglutination test was then
applied, and gave a positive result of Lin 500. He
then went after that to Vienna for the summer, and
promptly had another relapse. Professor Nothnagel
saw him there, and had a further blood examination
made. This was positive in a dilution of 1 in 1,000.
When I saw him he was in his sixth relapse, which

24 THE JOURNAL ОЕ TROPICAL MEDICINE.

[January 15, 1905.

was of the undulant type, and proved to be the last.
Іп December his blood was again examined and
agglutinated the Micrococcus meltensis in a dilution of
1 in 300.

(3) A Berherin servant living in Cairo was admitted
to Kasr el Ainy Hospital under me with what I at
first diagnosed as rheumatie fever, there being pains
and sweats ; a systolic mitral murmur developed. He
Was put under salicylates and kept on them for ten
days, but with no effect, so I stopped them ; the tem-
perature then ran up to 102, but came down with cold
sponging. l now had his blood examined, with the
result that it agglutinated the micrococcus of Malta
fever. Meanwlile I put him on liquor hydrargyri
perchloridii in drachm doses, his temperature came
down and remained down, and he slowly got well.

(4) А Cairo policemen was attending my out-patient
department for some weeks with what was apparently
chronic rheumatism. Two weeks running his tem-
perature was 100 , so I had а blood examination made
by Dr. Ferguson, with а positive result for Malta
fever. He, however, refused to be admitted into
hospital.

(5) This was the case of an Englishman who was
employed in the Cairo police stores. It is particularly
interesting, as he had а double infection with typhoid
fever and Malta fever. І intend publishing the case
in detail shortly.

He was taken ill in September with diarrha:a and
fever, and in fact went through a severe attack of
typhoid fever, with a positive Widal reaction. He was
very delirious and nearly died. This was followed by
a relapse of the same nature. After an interval of
some twenty-five days again he had a relapse, with
signs of bladder irritation. The fever did not, how-
ever, subside, but became remittent in type; he having
served in Malta some years ago he said he thought he
had “slow continued fever,’ which һе said was
cominon in Malta, but which he escaped there. I had
a specimen of his blood tested by Dr. Dryer, with the
result that it agglutinated the micrococcus of Malta

fever. A second specimen a week later still agglu-
tinated the Micrococus melitensis, but no longer

agglutinated the typhoid bacillus. I treated bim with
sodium thiosulphate, as suggested by Dr. Betts, and
found useful by him at Port Said, but with no ctfeet.
I then gave him perchloride of шегешу as in the
former case, with excellent results. In fact, I believe
that perchloride of mercury given whilst the fever is
coming down at the end of a paroxysm and continued
for some time, is very eflicient in cutting short the
disease.

Besides these cases which were under me, there
were several others admitted to the Cairo Fever Нов-
pital, in whom the nature of the disease was proved
by the agglutination test.

In Port Said there has been quite an epidemic of
the disease, the doctor of the Government Hospital
himself contracting the disease. Whilst under my
care for it at Cairo, he told me that he had treated
about a hundred cases there during the last few years,
many of them being confirmed by the agglutination
test.

I therefore consider that the fact is undoubted that
Malta fever cecurs endemically in Egypt.

Business Hotices.

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Street, London, W.

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may commence at any time, and is payable in advance.

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Beprints,

Contributors of Original Articles will be supplied FREE with
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THE

Journal of Tropical Medicine

Januaky 15, 1906.

A PLEA FOR UNIFORMITY AND GREATER
OFFICIAL SUPPORT IN ТНЕ COL-
LECTION OF COLONIAL CLIMATIC
DATA.

METEOROLOGY is a science that, perhaps more
than any other, is dependent on amateur effort ;
for the professional meteorologist is one of the
а dozen or so
sufficing for the needs of even a good-sized

rarest of the scientific fauna ;
kingdom. Many of our colonies are absolutely
unprovided with specialists in this branch of
knowledge, the work being handed over to the
astronomer, where such a scientific luxury is in-
dulged in, or elsewhere to the medical authorities

,

“in addition to their other duties”; and every-
where the rank and file of the official observers
are furnished by the medical services.

Doubtless, by virtue of his scientific training,

the medical officer is usually the best man avail-

January 15, 1905.)

able for the purpose; but against this may be put
the fact that, like a woman’s, a doctor’s work ig
never done, so that he is liable to be called away
at any time and so perforce neglect this less im-
portant item of his duties.

Now, to be of any real value with the customary
equipment, meteorological observations must be
taken punctually at stated times, and it would
therefore be probably better if more usually en-
gineering officials, who are less liable to irregular
calls, were chosen for these duties.

As matters stand, the actual taking of the ob-
servations must necessarily be often deputed to
native assistants ; and the result is that personal
observation becomes irregular, and the medical
officer necessarily loses the personal and con-
tinuous interest in this branch of his duties,
which alone can secure valid results.

During the writer's work in unearthing clima-
tological data from official sources he met with
the most ludicrous instances of this sort.

Observations at stated hours recorded as above
the maximum or below the minimum of the same
days; wildly impossible readings of the differences
between the wet and dry bulb thermometers
and deliberate fudging. In one case an entire
year's observations were cooly copied, figure for
figure, from a previous year. Of course such a
case as this implies not only neglect of personal
observation but an entire absence of any attempt
at supervision. Such lapses are, however, far
more excusable than at first sight appears.

The most exact and careful series of personal
observations may be utterly spoiled by the advent
of & baby or a surgical emergency, and practically
the actual observation must often be left to a
ward coolie or even a private servant, who at
most can barely read.

Under such circumstances 16 is impossible for
the work to be well done, however keen the
medical officer may be ; and no man can be fairly
expected to take a genuine interest in any work
unless he is so circumstanced as to be able to do
it thoroughly.

Under these circumstances it is by no means
surprising that one has to exercise considerable
care in selecting observations, and must needs

THE JOURNAL OF TROPICAL MEDICINE.

to
Zt

often reject a large proportion of those recorded
or purporting to be so.

In one case, indeed, a discriminating super-
intending medical officer refused to record an
entire year’s observations, as he had convinced
himself that they were entirely valueless.

This condemnation was probably too sweeping,
as the records were probably neither better nor
worse than the average, and doubtless included
many that could be picked out by an expert as
sufficiently reliable for inclusion as components of
averages ; but it is obvious that the administra-
tive officer could not take this course without
exposing to reprimand overworked officers, excel-
lent and energetic in their proper duties; and whom
he knew under.existing circumstances could not
fairly be expected to take any genuine interest in
this by-path of their work. То expect observa-
tions at stated hours from medical men of any
class is to demand an impossibility, and the farce
When по
other observer is available the observatories should

of attempting to do so should cease.

be supplied only with self-recording instruments,
which can be recorded and set at almost any time
of the day.

Instead of this, however, the equipment of
colonial observatories 18 of the most variable and
often of a needlessly complicated sort. More-
over, even where observations taken at stated
hours bear the impress of care and exactitude
their value is greatly discounted by the fact that
they are not uniformly taken at the same hour,
even within the limits of a single colony ; and are,
therefore, useless for purposes of comparison, and
after all the main value of all such observations
is comparative.

The reason for this deplorable want of system
and wasted labour and opportunity are not far to
seek, and lie in the fact that, in spite of the enor-
mous extent and value of our Colonial Einpire,
this rich country does not afford itself even a
single specialist to collate and systematise the
reports coming in from all parts of the world, on
& subject which may, without exaggeration, be
affirmed to afford some of the most indispensable
data for all rational sanitary and economic pro-

gress. Without this knowledge the sanitarian

JOURNA

26

THE

L OF TROPICAL

1966.

MEDICINE.

[Juuuary 15,

is unable to pronounce what measures promise
best for the vuinerability of the parasites which
cause most tropical maladies of man and beast, as
these depend more than anything on the intelli-
gent application of an accurate knowledge of the
climatie peculiarities of a region — while on the
economie side, who can say what sites ave likely
to be suitable for the growth of cotton and other
crops, without accurate and systematic informa-
tion on this vitally important subject.

Enormous sums have been and are being
wasted on bootless experiments of this sort;
while a tithe of the cost would sutlice to equip and
maintain an adequate colonial and central statt for
the collection and publication of this most in-
dispensable class of information; but just as our
armies have had to blunder through uninapped
areas of our own territory, so must those who
would exploit the latest resources of our colonies
blunder into unknown climates.

Let us hope that our new Liberal Government
will show itself liberal 1n more than name іп this
matter, for if is humiliating to turn from the
climatological returns of our own colonies to
those of other governments, which usually show
а much better claim to the title in the best inter-
pretations of the word.

Science, however, in any form can expect little
encouragement from any English government,
but pending the unfortunately very unlikely con-
sumination of money being spent on this most
important and certainly remunerative
something at least might be done in the di-

object,

rection of uniformity and in the simplification
With
the exception of observatories at the seats of

of the equipment of observing stations.

Government where a specially trained subordinate
should be detailed for the work, in addition, per-
haps, to clerical duties, all observatories working
at stated hours should be done away with, at any
rate, if they are to be conducted through the
agency of the medical services. Barometric ob-
servations have but little interest to the climato-
logist, and are only useful for weather forecasts
when combined with simultaneous telegraphie re-
porting over large areas; and such observations
might very well be omitted from the ordinary sta-

tions, which should be equipped with only a rain
gauge and maximum and minimum dry and wet
bulb thermometers. Under this system five instru-
ments only would have to be attended to once а
day, and it would be a matter of no moment what
hour of the day was selected. for the purpose;
nor, within very wide limits would it matter if
the hours of observation were the same; though
probably some time in the evening would be most
which case the
at any time be-

convenient for the purpose, in
observations might be recorded
tween 4 p.n. and midnight, at the observers’
convenience.

A sixth. column should be added to the form
for a statement of the average amount of cloud,
and in certain cases, perhaps, a sixth instrument
might be added, in the shape of a wind vane.

The data suggested. afford the maximum and
minimum and range of temperature of the day
definitely, while in the case of temperature the
average of the maximum and minimum ap-
proaches so closely to the true mean temperature
of the day that it 1s adopted as such in many
countries. It also furnishes definitely the maxi-
mum and minimum relative humidity of the day,
and the average of these, though constantly less
than the true mean, 1s exactly comparable with
the means of other stations where the same system
is adopted.

It gives also the amount of rainfall and the
number of rainy days, while the complement of
the amount of cloud gives the proportion of inso-
lation received at the station. Тһе monthly and
annual means derivable from these figures should
be calculated at the station of observation, but it
is better that the caleulation of the relative hu-
nidity, from the wet and dry bulb data, should be
left to those who make use of the information,
as it introduces а second source of error, and
so renders the value of the records less easily
appraised by the expert.

The “screens ” for the exposure of the ther-
monieters should be of uniform pattern, and
should, in all cases, be placed beneath a thatched
shed about twelve feet in diameter, open at the
sides, and well clear of neighbouring buildings,
and the site chosen should be one which the

January 15, 1906.)

THE JOURNAL OF TROPICAL MEDICINE. 27

observer must visit in the course of his other
duties in the evening, or be placed near his private
quarters. Тһе form of record would then ran as
in the example below.

Station, Jaipur. Lar. 960222, Lona. 72220.
HEIGHT ABOVE SRA, 1,430 feet. Мохтн, May, 1907.

Гав [ев ав [аз 2.5.
35.25 BE) 22, 22128
Е FER:
Dte; AE аЗ AME Sei es Remarks
ЕН 23 PE / tS) ef) sc
сой 5: ы Ex] = | 25
Іі? SBR FAL BA i a 9
I doya хә? о 1 Пса су dust-storm

| 292 1 661
|

&e., &e., «е.

Means °

Heaviest rainfall of a day, Number of rainy days,

Signature.

* Note. —In the case of rainfall, the total and not the mean
of the month should be given.

It may be fairly claimed that all really im-
portant climatological data are included in the
scheme outlined ; that the facts required can be
collected with the least possible trouble to the
observers, and, the most important of all, that
they are easily comparable.

Lastly, it may be pleaded that the reform is
one that would cost nothing more than the few
shillings required for the purchase of the two
wet bulb thermometers, and that it can be effected
literally by a stroke of the pen of the Colonial
Secretary.

CO-OPERATIVE RESEARCH IN
CLIMATOLOGY.

IN presenting to our readers the first “ Climate "
issue of the JOURNAL OF TROPICAL MEDICINE,
the Editors desire to impress upon the alumni of
the Livingstone College who have done so much
to give interest to the pages of CLIMATE, now in-
corporated with this publication, that they look to
them to continue the literary and material support
afforded to its predecessor.

No class of men are better placed than the ex-
students of that College for prosecuting and ad-
vancing the study of climatology, for they penetrate
to the uttermost corners of the world, and are
often stationed for long periods, where other

white men at most pay only flying visits, and
they can thus render immense service to science
by undertaking systematic observations at the
scene of their labours.

The Jesuit missionaries have in a variety of
localities dane work of this sort of the greatest
value, and surely Protestantism, which prides
itself on its more liberal attitude towards science,
should not allow itself to be put to shame by
these self-sacrificing pioneers of civilisation.

The trouble and expense involved in systematic
observations of this sort 1s singularly small, for
the instruments can be bought for a sovereign,
and five minutes daily is all the attention required.
The Journal will be glad to furnish any gentle-
men desirous of taking part in these investigations
with a set of forms for each year's observations,
and it is needless to say will gratefully publish the
results when transmitted to them, besides which
it is proposed to afford some little recognition of
the service rendered to science by a compli-
mentary gift of appropriate literature.

The Editors’ idea is in fact to make the
Journal the organising centre for the systematic
extension of our knowledge of tropical clima-
tology by the medical profession and the alumni of
the Livingstone College. English meteorology
would be in a most backward state but for the
efforts of the Royal Meteorological Society, and it
is our ambition to do something to emulate its
invaluable work by organising the systematic
study of the climatology of the back of behind.
We indulge in the hope that a considerable number
of gentlemen may be induced to participate in this
scheine of co-operative research.

In the next (April) climatological number it is
also proposed to include a short series of articles
on the methods and aims of observations of this
sort and the physical facts on which they are
based.

DR. CHARLES Ғ. HARFORD'S LECTURE
CAMBRIDGE.

Dr. Hanronpn has devoted considerable attention to
the best methods of interesting that sectiou of the
publie who are concerned in various enterprises con-
nected with the Tropics and especially those who
go abroad as missionaries. His work has chiefly
centred round Livingstoue College, where а special
course of training on well-defined lines is given to
missionaries. Besides this he has organised several
exhibitions of outfits for the Tropics and has sought
to influence a larger circle by means of Ciimate. On
Wednesday, November 22ud, 1905, Dr. Harford
addressed a University audience in the anatomical
theatre by the invitation of Professor MacAlister who,
by a strange coincidence, was attacked by malaria on
the very afternoon of the day, as the result of his

AT

98 THE JOURNAL ОЕ TROPICAL MEDICINE.

[January 15, 1906.

recent visit to Palestine, and so was unable to be
present.

The lecture had the support of all the professors
апа teachers of the Cambridge Medical School, and
Dr. Nuttall most heartily co-operated to make the
occasion a useful one by arranging a demonstration of
drawings of parasites and many interesting diagrams,
and he, as well as Sir Patrick Manson and Major Ross,
had lent many of the lantern slides which were shown
at the lecture, which proved to be a valuable oppor-
tunity of setting forth the urgent necessity of spreading
a knowledge of tropical health problems, and showing
what is being done in this direction.

The chair was taken by the Master of Trinity who,
in the course of a most interesting speech, strongly
urged the importance of preventive medicine and illus-
trated his remarks by reminiscences of Jenner in the
early days of vaccination. He also drew attention to
the recent sanitary measures at Panama.

The lecture, which was entitled “ Risks to Health
in the Tropics: their Relation to Imperial Expansion
and Missionary Enterprise,” was a type of how a
subject of the kind ought to be presented to the
public. The necessity for educating the public in this
country, in the meaning and nature of the chief scourges
which attack our fellow-subjects in many parts of the
Empire, may appear to many “stay-at-homes” of acade-
mic interest merely; but even to those who have never
personally known what the dangers of a tropical
climate are. but who take wider views of our imperial
duties, let alone their humanitarian aspects, the
subject of the health of both the white and coloured
populations of the tropical parts of the Empire is one
closely bound up with our daily life. If education in
these matters is of direct interest to dwellers in these
islands, how much more personal and immediate is it
to the hundreds of millions of men and women who
are exposed to the deadly diseases which prevail

"around them. Instruction how to protect themselves
and to ward off disease from their children is a factor
in their life which has hitherto been neglected; but,
thanks to recent scientific discovery, it is now possible
and ought to be the duty and pleasure of every man
and woman who is capable of giving it. Dr. Harford
brought out this point most clearly in his lecture and
it is hoped his audience took the lesson to heart. Dr.
Harford, in advocating the means whereby disease in
the Тгорісв is to be fought, did not commit the mis-
take of advocating this or that nostrum, but strikes
at the root of the matter by stating that the chief
prophylactic measure we possess consists in the educa-
tion afforded to medical men practising in the Tropics
by the Schools of Tropical Medicine in London,
Liverpool and Cambridge. Не also pointed out what
is being done at Livingstone College in educating
missionaries in the rudiments of tropical hygiene.
This most beneficent development is one of great
national importance, for in many parts missionaries
are the teachers of the children; and the education
the missionaries receive at Livingstone College
eminently fits them to give reliable instruction based
on scientitic methods in the schools under their
charge.

At the London School of Tropical Medicine по
fewer than 550 medical men practising, or destined to

practise, in the Tropics, had already taken out the
course of instruction provided by the School. The
Liverpool School of Tropical Medicine had gained a
world-wide reputation by the numerous expeditions it
had sent to gather information and to teach how
disease is to be prevented. Тһе Cambridge School
had placed its laboratories at the disposal of men in-
terested in Tropical Medicine, aud had raised the
status of this branch of medicine by granting a diploma
іп Tropical Medicine and Hygiene. At the Living-
stone College 248 missionaries have availed themselves
of the privileges there granted them, and have gone
forth equipped in a measure unknown to their prede-
cessors in the missionary field.

The lecture at Cambridge was amply illustrated by
lantern slides, and, like all “ teaching" lectures, the
bald text is apt to appear meagre in comparison to
the actual instruction conveyed. Dr. Harford, іп his
lecture, stated the principal diseases met with in the
Tropics, and showed how many of these diseases were
conveyed, and how they were to be avoided. Не
showed by simple tables the meaning of heat and
moisture in а tropical, compared with a temperate,
climate. A short account of the malarial parasite, its
development in the blood of human beings and in the
mosquito, and its mode of transmission by a particular
species of mosquito, was illustrated by lautern demon-
strations. Yellow fever, filarial ailments, and tick
fever were dealt with in the same manner ; nor was
ankylostomiasis neglected. The methods of stamping
out malaria advocated by Major Ross, and successfully
employed by him at Ismailia, and by Dr. Malcolm
Watson at Port Swettenham, were cited as instances
of how malaria may be prevented by the destruction
of mosquito breeding grounds. Dr. Harford, in his
summing up of the subject-matter of his lecture, again
advocated the necessity of educating not only the
medical men, but also the natives, and especially the
children in the schools, in the manner which had been
so successfully carried out in the colony of Lagos on
the West Coast of Africa.

eo

2101006.

A Hanprook оғ Cuimatonocy. Ву Dr. Julius
Hann. Translated from the Second German Edi-
tion by Robert De Courcy Ward. New York and
London: Macmillan and Co. Part I.

We have nothing but praise for this much-needed
translation of Professor Hann's well-known work, as
it forms the only available book on the general prin-
ciples of climatology available to the English reader,
in which the subject is at all exhaustively treated.

The original German work consists of three volumes,
the second and third of which are devoted to regional
climatology ; and we think Professor Ward is well
advised in confining his translation to the first volume,
which deals with the general principles of the sub-
ject. Regional climatology is obviously better dealt
with by local experts than by a writer whose experi-

January 15, 1906.)

THE JOURNAL OF TROPICAL MEDICINE. 29

ence is necessarily mainly confined to Europe. The
book, however, is something more than a translation,
for in addition to the examples cited by the original
author, parallel cases, drawn mainly from American
experience, have been added by the translator, which,
even if they do not appeal specially to the English
reader, at any rate make the illustrations fuller. Much
new matter has also been added to bring the book up to
date, together with plentiful references to English
papers on the subject.

All this adds greatly to the value of the book,
but best of all, the translation has been done into
excellent English, so that involved confusion that
appears inseparable from German prose composition is
converted into & clearness of expression almost French
in its style. The number of full stops has been, we
should think, at least doubled, and the commas propor-
tionately reduced in number, characteristics which
make the reading а pleasant contrast to the general
run of translations from German authors.

May we express a hope that Professor Ward may
see his way to giving us a work on North American
climatology ; as encyolopcedic as are the publications of
the American Weather Bureau, the very completeness
of the work of that model national institution making
it extremely difficult for Englishmen (we refuse to say
foreigners) to gain any clear idea of the climatic
characteristics of the vast area with which it deals.

A HANDBOOK ок CLIMATIC TREATMENT, INCLUDING
Вагмкогову. By №. В. Huggard, M.A., M.D.,
F.R.C.P. London: Macmillan and Co., 1906.

There are probably no specialists who more fre-
quently require to Prescribe “change of air" than
those who deal with tropical diseases, whether while
acquiring а hard-bought experience abroad, or when
in after years the returned Tropical physician is sought
out by the returned layman. | Those still practising
in the Tropics are continually meeting with cases in
which change is not merely “indicated,” but is an
absolute matter of life or death; and the puzzle
always is, where to send them. Аз a rule, the prac-
titioner is content simply to get a patient out of the
Tropics by the shortest route, with the result that he
makes straight for his native place—perhaps Edinburgh
in March—and is rewarded by & severer and more
prolonged bout of malarial fever than he has. had
to endure in his entire tropical experience. The
tropical practitioner's library must needs be select,
if not absolutely scanty, and if it contain no work on
health resorts he is hardly to be blamed ; as it must
be confessed that a large proportion of so-called bal-
neological literature savours too strongly of the patent
medicine vendor, the reader findiug that the vaunted
locality із ‘‘ contraindicated’ only in ingrown toenail
and the acute stage of bubonic plague.

The work under review, however, concerns itself
mainly with general principles, and is entirely free
from pretentious matter of the sort alluded to, so that
we feel sure it will be most useful to those who require
a convenient epitome of climatic treatment, and to
none less than the tropical practitioner.

We say this, albeit tropical maladies are scarce men-
tioned in its pages, and the word malaria does not occur

in the index, although there is a casual mention that
malarial convalescents do well at Davos, a fact well
known to most tropical specialists, with the reservation,
of course, that they must be re-acclimatised in some
moderately warm, dry climate before they can be con-
sidered fit for so tonic and bracing an environment.

It speaks highly, too, of the book, that even in the
case of the author’s own station of Davos, the contra-
indications are numerous and evidently the outcome
of thoughtful experience.

Of the 520 pages to which the work runs, the
first 60 are devoted to meteorology from the general
point of view, and we are least pleased with this portion
of the work, as it occasionally lacks the clearness of
the rest of the hook; some of the explanations being
rather hard to follow, even to one fairly conversant
with the subject. To our thinking, the space devoted
to the subject, while far too short for exhaustive treat-
ment, is too long for an outline, and there are occa-
sional errors, as, for example, the explanation of the
comparative coldness of the upper layers of the atmo-
sphere, which is said to be “ mainly due to the physical
law of the expausion of gases." Now this law ex-
plains only the rather exceptional ease of the coldness
of up-hill winds, but the absorption of heat from
expansion under these cireumstances would rapidly be
replaced by the sun's rays; were it not for the true
reason, which is the universal operation of the law of

. selective absorption. Air, whether dry or wet, is very

transparent to short-wave rays, but absorbs the long
dark heat waves, such as are radiated by the ground,
and therefore acts in the same way as the glass of &
greenhouse, forming a sort of heattrap. The more
dense the atmosphere, the more efficient it is in this
respect, and hence naturally the rarer upper regions,
being less eflicient heat-traps, do not trap as much
heat.

Moist air is a much better trap than dry air, but
this does not affect the explanation, as under any
circumstances the upper layers would be to a greater
or less extent cooler. In а book devoted mainly to the
sanitary aspects of meteorology we should have ex-
pected better information as to the composition and
effects of town fogs, but the subject is disinissed with
а mere casual mention, and F. А. Russell's researches
on London smoke deposits are not even noticed.
Speaking generally, indeed, the bibliography of the
subject is most scantily treated, so that the book
affords but a poor guide to those whose interest
having been aroused, would wish to follow up some
point further. Тһе construction in these chapters,
too, is often loose; on page 47, e.g., we are told that
“the black bulb registered 55 5° C., while at the same
time the temperature of the snow in the shade was
5-57 C." We presume the air over the snow is meant,
for at 5:59 C. the snow, of course, would become water.
Again, we are told at page 211 not to put faith in
meteorological tables, when the author merely intends
to caution us against comparing tables that, owing to
varying hours of observation, &c., are in no way com-
parable ; for he evidently very properly regards meteo-
rological data as the only sound source of information.
Still, such tables are rather wanting, and he cannot
help wishing that the greater portion of the first 60
pages had been devoted to terse tabular statements of

30 THE JOURNAL OF TROPICAL MEDICINE.

‘January 15, 1906.

monthly climatic data in connection with the various
health resorts discussed. Other instances might be
given, but we аге not concerned in picking holes in a
really meritorious piece of work, which сап be
thoroughly recommended to those who require a
handy reference book of the subject.

----ть:---
PROFESSOR DAVIS ON THE EFFECTS OF
ARIDITY

THE current number of the Geographical Journal
includes a paper on “ The Geographical Cyele in an
Arid Climate," by Professor W. M. Davis, which will
be read with especial interest by all whose work
has led them to such ill-favoured regions. The
* geographical eyele is the period in which an up-
lifted land area will, if no disturbance occur, be worn
down to base line by the processes of erosion.” The
absolute duration of such а eycle, therefore, varies
enormously in proportion to the activity of the erosive
forces, and tends to be indefinitely prolonged under
conditions of aridity, where denudation by rain is
insignificant, and the effects of wind only tend to pre-
dominate. The characteristics of the resulting desert
landscape are broadly indicated, and will atford inter-
esting food for retlection to those who have opportu-
nities of visiting such scenes.

аф

PROFESSOR KOCH'S WORK IN EAST
AFRICA.

Tar current number of the British Medical Journal
contains a good abstract of. Professor Koch’s prelimi-
nary statement of his work in East Africa. The sub-
ject is, however, far too important to the special class
of students of Tropical Medicine to be dealt with in
this way in our pages. Its translation in erfenso, and
the reproduction of the numerous illustrations, are in
progress, but necessarily take some little time to carry
out. We hope, however, to be able to provide our readers
with the paper in English dress in the first issue of
the month of February.

-------о--
SCORPION POISON,

So little is known about scorpion poison that it is
satisfactory to find that the subject is being taken up
by MM. C. Nicolle and Catouillard, who have been
experimenting on the poison of the common North
African species, Heterometrus maurus (С. 1. Soc. de
Biologi, 1905, pp. 100-102). Бо far their experiments
do not seem to promise well for the discovery of either
an antidote or a protective serum, as small doses con-
ferred no immunity on rabbits. Antivenomous (snake)
serum also has no protective action, though this could
hardly be expected, as scorpion poison does not appear
to resemble any form of snake poison.

At the same time, there must be some method of
producing immunity, as all who have been in the East
know that certain individuals, usually fakirs, obtain
a curious power of handling these animals, and will
allow themselves to be stung without suffering any
apparent inconvenience, G.M. G

LONDON SCHOOL OF TROPICAL
MEDICINE,

THIS

19тн SrssioN— DECEMBER, 1905.
I[camiuation tor the Certuicute in Tropical Medicine.
Result.

With distinction.

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Original Communications.

NOTES FROM ANGOLA.
By F. C. WeLLMaN, M.D.
С'оғғезр. Memb, Ат. Soe. Trop. Med.
(Concluded from p. 345.)

Nore ХІХ.--Тнв Occurrence or ам Емвкуо Іх-
TESTINAL WorM IN THE BLooD STREAM AND
ітв CONCEIVABLE Імровт.

THE worm seen by me in the blood of an Angolan
negress, and described in the Journal for February
15th, 1904, has been pronounced the larva of an intes-
tinal parasite. Looss’ discovery that larve of Unci-
naria duodenalis, after piercing the skin, leave the sub-
cutaneous tissue in the blood stream, and, passing
through the right heart to the lungs, travel up the
trachea and down the esophagus to the stomach and
intestines, has suggested to me that my worm may
possibly be the larval form of some other intestinal
parasite which, when observed, was in the process of
reaching, by a similar route, its normal habitat in the
alimentary canal. It may turn out that several forms
e helminthiasis can be prevented by cleanliness of the

in.

Nore XX.—On тне POSSIBLE HETEROGENESIS
оғ AUCHMEROMYIA LUTEOLA, FABR.

While engaged in working out the complete life-
cycle of A. luteola, I was recently told by the blacks
that its larve were capable of both sucking blood like
a tick and also of embedding themselves in the skin.
Further enquiry was rewarded by the appearance of a
native with a small swelling in his side, from which I
extracted a maggot identical (in size, shape and,
so far as I could see, every detail, including the
mouth parts) with the usual hemophagous larva of
А. luteola, во common in this region. І have since
looked for, but hitherto failed to find, more than this
single instance. It would be interesting should these
anomalous blood-sucking maggots prove to be capable
under certain circumstances (possibly when the skin
is slightly broken from any cause) of causing, like
their allies the Іагув of A. depressa, ordinary cutaneous
myiasis in addition to their equally disgusting role as
vermin.

Nore XXI.—Quartan MALARIA IN TROPICAL
ÁFBICA.

The writer for some time thought that probably the
malignant parasite was the only form of malaria to be
found in this region. During 1904, however, one case
showing the quartan. parasite was seen in Biké
district, and during the past year (1905) several unmis-
takable cases of the latter infection were studied in
Bailundo district. The type differs in no respect that
I can deteot from that seen in quartan cases in other
countries. The infection cannot be recognised clinic-
ally, however, for in only one case was there slight
irregular fever, while three other cases in which the
parasite was plentiful and regularly going on with its
cycle showed no symptoms whatever. Probably native

Africans who have become practically immune to the
effects of Hemomenas precor are as a rule undisturbed
by this feebler variety which at home sets up a very
respectable fever. Out of a series of 531 natives
recently examined by Mr. W. E. Fay and myself, 14
individuals showed the quartan parasite in their blood.
Benign tertian has not yet been seen.

Note ХХП.-Іктохісатіка Drinks, Drug Навіт,
&c., IN West AFRICA, AND THEIR RELATION TO
MENTAL DISEASE.

The following remarks refer only to the Angola
Bantus’ :—-

Alcohol.—They constantly use and occasionally get
very drunk on their native beverages, principally maize
beer (‘‘ochimbombo’’), and a mead made of honey
and water (“ ochasa "). Palm toddy ('*alufu") is
also drunk in some districts. Of late years the Portu-
guese, having ignored their agreement not to introduce
rum among new tribes, that beverage has become
common right into the interior.

Tobacco.—Universally used, generally in the form
of snuff, but not seldom smoked ; it is never chewed.

Hashish (Cannabis sativa) is smoked by a certain
per centage of the natives; more common in some
districts than in others.

Kola (Sterculia acuminata) is extensively used in
some localities north of the Coanza River, so much so
that there is a superstition among the blacks and
Creoles that one cannot endure the climate without it,
which is expressed in a rhyming proverb which may
be roughly “ Englished ” in this fashion—

** Who doesn’t eat Kola
Can't live in Angola."

“ Okapilangau" (Burkea africana).—The bark is
chewed, and also occasionally inserted into the vagina
by women as an aphrodisiac.

Mental disease is very rare among these people.
Rum and hashish are the most deleterious stimulants
used by them. I have heard the statement made that
hashish smoking is a frequent cause of insanity among
them. Such statements lack proof. Of the few cases
of mental derangement I have examined none were
hashish smokers.

Note XXIII.—A SUGGESTION AS TO THE PROBABLE
RELATION OF CHIGGERS TO AINHUM.

I have recently pointed out on two occasions the
possibility of chiggers bearing an etiological relation
to ainhum. I have long noticed that the chigger has,
even in healthy feet, a predilection for the under-
surface of the little toe. When the skin of this region
is, as is so often the case, cut or torn, the liability to
invasion is increased, for one of the first things that
one notices in regard to the chigger’s habits is that it
enters abraded or irritated surfaces oftener than sound
skin. The inevitable inflammation and cicatrisation
following such invasion accounts for at least part of
the symptoms belonging to ainhum. I have stated
this hypothesis more in detail elsewhere in a paper
from which I here quote: “Тһе fold of skin under
the proximal joint of the little toe corresponding to the
edge of the web between the toes is the point where
wounds are oftenest made by the sharp grasses, &c,
through which the barefooted native.walks and runs.

The principal reason for this in the African is that the
little toe of barefooted negroes lies separate from the
others at an angle due to anatomical reasons connected
with flat-footedness. As I have suid, chiggers are
oftenest found on the under-surface of this toe, even
when all the toes are intact. When wounds are once
made here, however, the chiggers persistently invade
them, and must be removed constantly. While I do
not wish to be read as advocating 5. penetrans as the
sole cause of ainhum, it seems to me that this insect
must play a part (in some instances at least) in the
continued irritation which, especially іп blacks (who
have a fibrogenetic tendency), may lead to the con-
tracting fibroses occasionally resulting in the sponta-
neous amputation known as ainhum. It may be
further stated that such a theory goes far to account
for the geographical distribution of the disease, which
is particularly common in the two great homes of the
chigger,viz., tropical America and Africa.”

Note XXIV.—Tue INFLUENCE OF Various Prants
ON THE Hapits оғ Mosquitoks.

On referring to my diary I find, scattered over two
or three years, the following notes of experiments as
to the effects of different plants on the actions of mos-
quitoes. In each case the test was not whether the
mosquitoes would come to the plant in question, but
whether the plant tested would drive the mosquitoes
away when placed in one end of the cage containing
them. Asmany substances such as wormwood, tobacco,
chrysanthemum, pyrethrum, &c., when burned (and
also various volatile bodies, viz., essential oils aud
various gases) will do this, it would not seem an
unreasonable test. Тһе mosquitoes experimented upon
were principally of four species common here— Culex
hirsutipalpis, Heptaphlebomyia simpler, Myzomyia
funesta, and Pyretophorus austeni.

Castor-oil plants (Бісіпіб communis). No effect
whatever. Both Anophelines and Culicines alight on
the leaves quite as often as on banana leaves used for
comparison.

Gum trees (Eucalyptus globulus). No effect unless
the leaves are crushed, when the gnats seem to avoid
them.

Pawpaw (Papaya vulyaris). No effect.

Suntlowers (Helianthus sps.). No effect.

On the other hand, large plants, when cultivated
near quarters, afford shade (and even breeding places),
and so actually increase the number of mosquitoes.
The principal plants here which afford collections of
water suitable for breeding mosquitoes are: a bamboo
(ombungu), bananas (aAond/o) metroxylon (etome)
and especially two Bromeliacee, Amomum sp. and
Costus sp. (ovomoma and ochiteke). Some of these are
cultivated as useful or ornamental plants. I per-
sonally know nothing of the “ neem,” or margosa tree
of India (meliacec), or of the vaunted effects of
Chenopodium vulvaria, Solanum nigrum, and other
similar plants, but, in view of my experience with
African plants, doubt on general principles their re-
puted eflicacy. Іп view of our knowledge of the
mosquito's hatred of light and sunshine, the most
obvious protection to a bungalow is a large sur-
rounding open space kept free from depressions and
clear of high grass.

THE JOURNAL OF TROPICAL MEDICINE.

‘February 1, 1906.

CoxcLubpIiNG NOTE.

In looking over these notes there occur to the writer
other observations of interest which might have been
added were the series not already so long. Soie of
these are: The effects of the venom of the puff adder
(Clotho arietans), Additional Notes on the Mosquitoes
of Bihé, Dental Caries among the Angola Blacks,
Cutaneous Diseases, Venereal Affections and Eye
Troubles in Angola, Tumours and Cancer in South-
west Africa, the Climate of the Interior of Benguella,
Reports on Various Collections of Entozoa, Noxious
Arthropods, &c., ќе. Several of these have, however,
already been published in more elaborate papers and
reports. The foregoing notes have served as a sort of
clearing-house for some of the many scattering memo-
randa which collect in one’s medical diary during the
course of study and practice, and remain after the
notes bearing on special investigations in hand have
been transferred. If, therefore, I add to the obser-
vations contained in the preceding notes a list of the
diseases not therein mentioned which I have reported
from South Angola, the reader interested in the geo-
graphical distribution of tropical disease will be able
to compare the district with other regions. These
diseases are: Subtertian Malaria, Filariasis (Ғ. per-
stans), Ankylostomiasis, Cestode Infection, Ozyuris
vermicularis, Trichocephalus dispar, Bilbarziasis,
“ Vonulo ” (Sternodynia neuralis endemica), Leprosy,
Ringworms, Prickly Heat, Leucodermia, “ Craw-
Craw ” (severe scabies), Beri-beri, Low Fever, Heat
Stroke, “ Akatama " (Neuritis peripheralis endemica),
Manioc Poisoning, Poisoning by Witch Doctors,
“ Onyalai ” (hemorrhagic bulla), Marginal Ulceration
of the Gums, Keloids, Bites of Venomous Creatures,
Milk-pox, Chicken-pox, Mumps, Epilepsy, Pneu-
monia, Spermatozemia, Gonorrhoea, Syphilis, Hernie,
Cancer and Tumours, Yaws, Blackwater Fever, Spiril-
losis (‘tick fever”), Abscess of Spleen, Gundu,
Ainhum, Climatic Buboes, Tropical Phagedena,
Myiasis, Multiple Nodules, &c., &c. New diseases and
additional observations from this region which шау
be recorded from time to time will be published on
some future occasion.

AN OUTLINE OF PLAGUE AS MET WITH IN
BRITISH EAST AFRICA.

By James А. Haran, М.А., М.В., B.Ch.(Dublin).
Medical Officer, Mombasa, British East Africa.

PLAGUE is a specific infectious disease characterised
by either—

(a) Local or general lymphatic tenderness and glan-
dular enlargement.

(b) Septicemia, associated or not with (a).

(c) Pulmonary or intestinal manifestations of a
rapidly fatal character.

Previous to the establishment of European govern-
ment, native tradition records two outbreaks, one
among the Wateita, whose territory is about 100 miles
from the coast, and the other among the section of
Wakanionda dwelling on that part of the shores of
the Victoria Nyanza now occupied by the terminus
of the Uganda Railway. The latter people preserve a

February 1, 1906.)

very lively remembrance of the outbreak, inasmuch as
the disease dislodged them from place to place for a
period of years, and was accompanied by a fatal
disease affecting their cattle. The neighbouring
kingdom of Uganda has been frequently visited by
localised outbreaks, and is known to the natives as
“ Kaumpuli."

Since the establishment of the Protectorate five
outbreaks have been noted, two of which were preceded
and accompanied by the wholesale death of rats.
Three of these took place at stations on the Nyanza,
and two at Nairobi, a headquarters station 326 miles
from the coast, and 5,800 feet above sea-level.

The Bacillus pestis, the exciting cause of the
disease, is a non-motile, non-sporing, aerobic or-
ganism with rounded ends, 1:5 » in length, stained
by ordinary dyes, and decolourised by Gram. The
colouration is best marked at the poles, the central
area being left unstained. It is of low vitality, and
easily destroyed by sunlight. 'The usual procedure
for its demonstration is the introduction, with the
usual precautions, of an exploring needle into the
enlarged gland or bubo of the patient. Тһе piston is
then slightly withdrawn and the needle removed, the
unstained fluid being ejected aud spread on a slide.
The puncture is covered with antiseptic dressing.

Leishman’s is a useful and ready stain with which
to treat the film. A pure culture is usually demon-
strated. The sputum in the pneumonic form affords
material for excellent smear preparations. In rats
and cats the bacillus can be detected by means of
smear preparations made from sections of the sub-
maxillary glands and the spleen. In dead bodies smear
preparations can be made from the particular organs
found to be affected.

I am inclined to think that puncture by an explora-
tory needle of a plague bubo in a living patient is not
altogether а harmless proceeding, inasmuch аз it allows
additional infective material to enter the blood stream,
as well as injuring a gland or mass of glands engaged

. in opposing the entrance of infection. In doubtful
and mild cases it is very useful for purposes of
diagnosis.

The bacillus has been demonstrated twelve times
after death. In some cases the staining reaction was
not well marked, while in others a bulbous enlarge-
menl was observed at опе or both poles.

The disease is usually conveyed by—

(a) Infected rats.

(b) The discharges of patients.

(c) Infected food.

When a community of rats is invaded by the disease
those which are unaffected emigrate in а body from
the area, to return аба later period. At the commence-
ment of the outbreak in Kisumer during the present
year a European who was camped some distance out-
side the settlement was surprised one night to find his
tent invaded by swarms of rats passing through,
apparently in & hurry and from the direction of the
town. He had no further visits, and a few days later
the first cases were discovered.

The diseased rats emerge from their burrows and
stagger about in the open, passing large quantities of
infective dung. It is easy to understand that indi-
viduals walking on this’ material with bare, abraded,

ж 2 2 = le

THE JOURNAL OF TROPICAL MEDICINE. 33

and cut feet, collecting the sweepings of the floor with
injured hands, or not washing their hands subse-
quently, and using them (as natives will) instead of a
suspensory bandage, are liable to contract the disease.
I happened on а case in which a Beluchi slept on the
floor of an infected house with an abraded ear, and was
subsequently brought into hospital with a cervical
bubo. In another instance а boy was secretly ordered to
sweep the floor of an infected house, with the result
that he was dead the next afternoon of pneumonic
plague, presumably caused by inhalation of the dust. As
а native eats with the hand direct there is also danger
of food contamination.

The discharges of patients are especially dangerous
in the pulmonary form of the disease. os

The bubonic variety does not apparently possess
such grave terrors. We had one case of an Indian
child with an axillary bubo, who was attended by a
servant of his own caste. This latter was supposed
to sleep close at hand on a rug, but I frequently
caught him sleeping in the same bed. He never
developed the disease. Тһе discharge from suppurat-
ing buboes has been frequently examined, but most
usually no bacilli have been demonstrated.

Clothes soiled by discharges, after exposure for
some time to the sun, would seem to be harmless, if
one is to credit the records of the Egyptian outbreaks
of the commencement of the last century. Among
them one finds it stated that the wearing apparel of
the dead were hawked through the streets, and that
they were subsequently worn by their buyers with
impunity.

Food is liable to be contaminated by the discharges
of infected rats, which are found dead or dying among
bags of grain, &c., or by the dust of infected areas.
Consumption of such may give rise to the bubonic
form, involving the submaxillary glands, or to the in-
testinal form. Predisposing causes may be summed
up ав insanitary habits and defective houses. The’
barefooted and poorly fed Asiatic, who insists on ex-
cluding all possible light and air, whose ablutions are
nominal, and who prefers to dig a latrine in the floor
of his bedroom rather than go outside, can hardly be
accused of possessing powers of resistance to disease.
Tne structure, moreover, of his house leaves much to
be desired. It usually consists of an earthen plinth,
faced with mud and stone, on which is built a gal-
vanised iron shop and dwelling place combined.
Windows and ventilation are avoided, if possible.
Within, as much merchandise is placed as can well be
stored, his bed being almost surrounded by bales.
Unless for sale purposes these are never shifted, so
that a practically permanent home is afforded to the
rats. Thus, on an outbreak taking place among these
rodents, evidence is concealed for some time.

CLINICAL COURSE.

The incubation period varies between twelve hours
and seven days. I have been unable to ascertain
the presence of any signs or symptoms during that
period, such being, perhaps, due to a desire for con-
cealment on the part of the patient when brought to
hospital, or to mental torpor resulting from the infec-
tion and consequent inability to answer questions
coherently. The invasion is sudden and characterised

--- ---- -2

34 THE JOURNAL OF TROPICAL MEDICINE.

hy intense headache, vomiting, sometimes diarrhea,
epistaxis, furred tongue, and a rise of temperature to
between 102? and 104? F. Тһе respirations vary be-
tween 30 to 40, the pulse between 130 to 145,
being small and compressible. The gait is staggering
and the voice thickened. The face is pale and
characterised by an expression of fear. Тһе con-
junctive are injected. Іп the bubonie form the
appearance of a bubo may be simultaneous with these
signs or may follow within forty-eight hours. Тһе
commonest situation is in the femoral region. They
may also be found in the axillary, post-cervical, trans-
verse inguinal, or lumbar groups, or involving one or
more of the submaxillary glands. General gland
enlargement is occasionally met with. Tenderness
along the'course of the lymphatics is always present,
as well as in the regions of apparently unenlarged
glands. The bubo consists of a conglomeration of in-
flamed glands. It may not be larger than the terminal
phalanx of the little finger and may remain so during
the course of the disease. On the other hand, it may
gradually enlarge and, before death, present a tumour
as large as the closed fist. It is granular, hard,
intensely tender on palpation, and is surrounded by
a large area of infiltrated cellular tissue. Movement
is avoided, as it causes exquisite pain. Incision at
this stage liberates a small quantity of bloody serum
which, under the microscope, shows a pure culture of
the B. pestis. As the disease progresses the bubo
usually enlarges and the general symptoms become
more severe, temperature varying between 103° to
104°, respirations 40 to 60, pulse 145 to 160. The
voice becomes incoherent and the patient unable to
stand. The tongue is dry, brown in the centre, and
red at the tip and edges. Secondary buboes appear,
e.g.,in femoral manifestations, the iliac group, axillary,
the infra-cervical. The area of periglandular infiltra-
tion increases. In the femoral region it forms a large
triangle with the base resting on Poupart’s ligament.
In the axilla the swelling extends from the inner wall
up to and above the clavicle, and may cause cedema of
the arm. In involvement of the submaxillary glands
the lower part of the face, on the affected side parti-
cularly, is so swollen as to render the patient almost
unrecognisable. All the above changes may take
place within forty-eight hours. Secondary pneumonia
of fatal import sometimes appears, causing hemoptysis,
and pain and tenderness over the affected area, with
fine crepitation on auscultation, the expectorated
blood being full of bacilli. Between the third and
sixth days in the bubonic form cases usually die.
Should the patient survive and the bubo go on to
suppuration, bogginess and redness appear over the
infiltrated mass about the sixth day, followed by fluc-
tuation on the eighth and twelfth day. On opening
the abscess the general symptoms at once disappear,
the temperature falling to between 96° and 97° F.
morning and evening, the pulse below 70, and respira-
tions 14. The tongue clears and the abscess cavity
rapidly fills up. At this period a pseudo-dysentery,
with tenderness over the colon, is very frequently
observed, and is probably due to elimination of the
toxin. During the heuling of the wound the infiltra-
tion gradually lessens and the glands slowly reappear
from the mass. А certain amount of thickening and

[February 1, 1906.

gland enlargement persist up to at least three months
and probably for some years.

In favourable cases not ending in suppuration, the
termination of the disease is reached more slowly,
subsiding masses of glands remaining tender for a
long period, and liable, on slight ог non-appreciable
causes, to become enlarged again. Rises of tempera-
ture, associated with delirium, may accompany these
manifestations. —Pseudo-dysentery has been also
noticed at the conclusion of these cases.

In fatal cases of the bubonic variety the general
symptoms and signs become aggravated, the tempera-
ture falling to 100° or 101°, respirations exceeding
60, pulse uncountable. Riles are found on auscul-
tation over the pulmonary area. Restlessness and
subsultus appear. Involuntary evacution of bladder
and rectum may take place. Bubonic tenderness
persists to the end. With all this the patient may
preserve some degree of consciousness to the end,
which is caused by failure of the cardiac centre,
resulting from toxiemia. One case, that of an Indian
babu, was in my charge, who insisted on lighting а
cheroot. I went outside for а moment, leaving him
puffing with evident enjoyment. On my return within
two minutes I found the man dead.

In the septicemic variety, gland enlargement,
usually general, with lymphatic tenderness, may or
may not be present. The onset of the disease is
sudden, the patient soon becoming delirious, with
heightened colour, subeonjunctival ecchymoses, and
dry, brown tongue. Epistaxis appears early and
sometimes continues, at intervals, during the course
of the disease. Jaundice, with involuntary action of
the bladder and rectum, quickly ensues. Тһе spleen
is enlarged and tender. Coma follows, and a fatal
termination may be expected within three days of the
onset of the disease. Іп this form of plague the pulse
and respiration are even more rapid than in the
preceding. The temperature runs the same course.

I have seen but one case of the intestinal variety
It was that of à man resident in а quarantine camp
with others for purposes of observation. They had
been removed from some houses in which plague had.
broken out. Тһе patient in question was suddenly
taken ill about midnight with abdominal pain, vomit-
ing, diarrhoea with hemorrhage, and collapse. Con-
stant evacuation continued during the night, but
ceased with the advent of morning. Patient's tempera-
ture was 101° in the mouth, pulse 150, and respira-
tions shallow and rapid, cutis anserina, and the
tongue dry, furred and shrunken. A patch of bron-
chial breathing, with associated dulness and tender-
ness, appeared in the right apex and was accompanied
by hemoptysis. Patient died at one in the afternoon,
the entire manifestation having lasted about thirteen
hours.

The pueumonic form is the most fatal to the
patient and dangerous to the attendants. In a case
which came under observation the boy, an African,
had been secretly engaged on the previous day to
sweep out a house in the infected bazaar, which had
been temporarily evacuated. The next morning the
boy was awakened at four o'clock by a severe pain
over the sternum and hypochondria, associated with
dyspnoea. On being brought to hospital he could not

February 1, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE. 35

stand. He was lethargic, the voice was thickened and
verging on incoherence, conjunctive suffused, tempera-
ture 103°, pulse 140, and respirations 60. Оп
examination dry crepitations were found on ausculta-
tion over the bases of both lungs, with diminished
resonance. Cough and expectoration were absent, as
well as gland enlargement and tenderness. Two
hours later the patient had passed into a state of
torpor, the tongue being dry, black and shrunken, and
lying in the bottom of the mouth. Bladder and
rectum were acting involuntarily. Respiration was
extremely rapid and shallow, and the pulse scarcely
perceptible. He died at 1 p.m., the disease having
run its course within nine hours. Infection in this
case was due to inhalation of the dust.

Post-mortem appearances are: marked rigor mortis in
association with well-marked putrefactive signs, sub-
mucous, subserous, or cavity hemorrhages. Effusion
into the various cavities, congestion or consolidation of
pulmonary areas, pial congestion, enlarged spleen,
tissue staining in the neighbourhood of vessels,
enlarged masses of agglomerate glands, purple on
section, the surrounding tissues heing engorged with
hemorrhagic fluid. Intestinal congestion, the lumen
being occupied by blood.stained fluid or actual blood
casts. Heart chambers may be occupied by un-
formed clot.

TREATMENT should be оға stimulating character
from the commencement. Тһе early administration
of brandy in frequent doses is often attended with
good results. Digitalis and strychnine аге also
useful. The hypodermie infection of Yersin's serum
is of the highest value. In the bubonic forms, bella-
donna and glycerine fomentations, or linseed meal
applied locally, relieve the pain. I һауе seen improve-
ment following on the hypodermic administration of
morphia and strychnine. When fluctuation is palpable
the pus should be liberated by free opening. Incision
prior to the advent of suppuration is harmful. After
evacuation daily dressing with pieces of cotton-wool
saturated in 1-1,000 hydrarg. perchlor., may be applied
and fixed by a bandage soaked in the same solution.
I have never found drainage necessary. Тһе cavity
fills up quickly. Fluid diet is given in the earlier
stages ; solid diet may be resumed as soon as the bubo
has been opened, should it suppurate, otherwise the
special circumstances of each case have to be studied.
I have seen patients given solid diet through the entire
course of the disease. In the intestinal form stimu-
lants and astringents should be administered vigorously,
very little time, however, is available. It is possible
that Yersin's serum in large doses would-be of advan-
tage, but the great exhaustion which quickly follows
the onset of the disease should not be forgotten.

The pneumonicform is practically hopeless as regards
treatment. Stimulants and Yersin's serum may be
administered freely. The веріісетіс variety may be
treated on similar lines. Isolation is essential in the
septicemic, intestinal and pneumonic forms, more
especially in the last. The medical attendant should
make his examination in the open air, if possible.
Should the patient be expectorating aimlessly in every
direction, the wearing of some form of face protection
is to be recommended. In its absence I should he
disposed to cover the patient's face with a towel, which

might subsequently be boiled. А drawback to such
procedure may be the possible irritation on the
patient's part. In such eventuality a lot may be taken
for granted. When it is considered that the subjects
of suppurating bubces (which result from a mixed
infection) frequently recover, should they survive the
earlier days of the disease, it might be useful were
experiments made in the administration of measured
doses of toxin, derived from pyogenic cocci, to animals
inoculated with plague. There would seem to be an
antagonism between the former and the B. pestis.

PROPHYLAXIS.

Cleanliness, light and air, rat-proof houses, and the
destruction of these rodents, are essential. An out-
break of plague rarely reaches large proportions,
unless the rats are involved. Experiments are in
progress with a view to obtaining a germ capable of
causing their wholesale destruction. The Danysz
bacillus has been successful with mice, and itis to be
hoped will prove equally so with rats. When a case
occurs in a house the patient should be removed to
hospital and the other residents placed in an isolated
building or camp under observation. Persons wearing
boots should then enter the house and first lay the
dust by freely sprinkling the floor with a solution of
Jeyes’ crude carbolic or other antiseptic. The goods
and furniture are then taken out and placed in the
sun, all rubbish or uncleanly material being destroyed
or disinfected. Additional windows may be made, if
thought necessary, and they, together with all doors,
should be left open. The walls are then covered with
limewash, and the floors sprinkled freely with lime, or
saturated with strong carbolic or corrosive sublimate
solution. Haffkine’s prophylactic may be adminis-
tered to those isolated for observation. This is usually
injected in varying doses апа with antiseptic precau-
tions into the outer side of the arm. Within twelve
hours reaction occurs, accompanied by rise of tempera-
ture, and pain, tenderness and enlargement of the
corresponding axillary glands. The temperature
quickly subsides, but the gland phenomena persist for
about a fortnight.

Inoculation gives riee at first to an increased
susceptibility to infection, followed in a week or so
by an immunity, which persists for a fortnight or
three weeks. The advantage of the measure is that
it replaces to & certain extent the more cumbrous
practice of quarantine. Despite the above, plague
may persist, the rats continuing to die. When these
are involved the length and extent of an outbreak
probably depend on the time the disease takes to
work through the affected rat community and the
extent of country over which that community ramifies.
When cleanliness and general precautions have failed
we have caused the evacuation of the infected area,
placing the inhabitants in tents. This is a costly
proceeding and only possible in small settlements.
Were one certain of the guard and the weather, it
might suffice to sleep in the streets, leaving all doors
and windows of the houses open. This remark, of
course, applies to tropical countries,

In endemic areas it is possible that the disease
constantly exists among the rats in a very mild form,
and that increase in their numbers or aggregation in

86 ТНЕ

JOURNAL ОҒ TROPICAL MEDICINE.

1, 1906.

a
f February

human habitations causes an aggravation of the type
and consequent communicability. It might be of
interest to hold enquiry into all lymphatic manifesta-
tions occurring among the inhabitants of an endemic
area, as it may not be impossible that the disease is
constantly present in a mild form and passes
unobserved.

AN OUTBREAK OF ACUTE CONTAGIOUS
CONJUNCTIVITIS IN CEYLON.

By Sir Arres Perry, M.D., D.P.H.,
Principal Civil Medical Officer ; and
ALDO CasTELLANI, M.D.

In March of last year our attention was drawn to
several cases of the above disease which occurred in
the city of Colombo, and our thanks are due to Dr.
W. H. de Silva, the Ophthalmic Surgeon of the General
Hospital, for his courtesy in placing at our disposal the
clinical material for the preparation of this paper.

In our experience such an outbreak had not been
seen previously, and we have the authority of Ceylon
practitioners of longer experience of eye diseases in the
island than ourselves, who state they do not re-
member a similar occurrence.

The first cases were thought to be examples of
gonorrhceal conjunctivitis until a bacteriological ex-
amination of the secretion demonstrated the error.
As a noticeable characteristic the outbreak was limited
practically to the well-to-do classes, there were more
Europeans attacked than those of any other race, and
it was almost unknown among the poor. The onset
of the disease was sudden, with early symptoms of an
alarming nature, and its course was rapid. It yielded
readily to treatment, and serious complications were
rare.

Daring the prevalence of the north-east monsoon
in the early months of the year the meteorological
conditions over the western part of Ceylon are high
temperature, low humidity, a long spell of drought,
and unintérrupted brilliant sunshine. These conditions
seem to favour the development of a small fly, one of
the family Muscide, popularly known as the “eye
fly," from its habit of always trying to settle on that
organ.

А4 this season of the year the surface of the roads
is pulverised by the traffic into an irritating red dust,
which is blown about by the wind in clouds, and it is
usual to come across many cases of simple catarrhal

conjunctivitis in all classes, particularly among the.

prisoners in the gaols. The cause of this affection is
commonlv attributed to the dissemination of infective
particles by one or other, or by both, of the above-
mentioned effects of the meteorological state. Хо
history of the iutroduction of acute contagious con-
junctivitis could be traced, but the probability of this
is great, considering the large number of ships that
arrive аб the port daily, bringing foreigners from
all parts of the world. The symptoms of this out-
break were an acute onset with great swelling and
discolouration of the eyelids, an early watery dis-
charge becoming muco-purulent and in some cases

purulent, swelling of the conjunctiva, especially of its
ocular portion, with subconjunctival hemorrhages (the
hemorrhagic catarrhal conjunctivitis of Nettleship),
and photophobia with pain of a burning character.

The cases were extremely infectious, more than one
member of the same family being attacked.

In many instances both eyes were affected. We
consider the incubation period was from twenty-four
to forty-eight hours.

The ages of the patients ranged from two years to
forty years, the greater number were in children and
young adults. Ап attack lasted about three weeks,
and as a rule there were no complications. Haziness
of the cornea occurred іп a few cases, and in only
one of them was there any permanent corneal damage.
This case is so interesting that we give it some
detail.

The patient, а planter's daughter, 2% P reis of age,
living in а remote part of the country, had been suffer-
ing from the affection in both eyes for about a week
before she came to Colombo. When seen by us she had
great swelling of the lids, blepharospasm, & purulent
discharge, and an ulcer on the lower segment of each
cornea, with a bound-down pupil on the left side. In
the experience of one of us the destruction of corneal
tissue in cases of gonorrhcoal conjunctivitis generally
occurs in the lower segment of the cornea ; the reason
for this determination of site is the extra pressure
there, produced by the overlapping of the upper lid;
these conditions were present in this particular
instance.

The ulcer on the right side and the general condition
of that eye yielded rapidly to treatment, but the
corneal complieation of the left eye increased in depth
and area, notwithstanding the application of pure
carbolic acid and subsequently the actual cautery.
After some days the destructive process stopped and
the ulcer was seen to be filled by a yellowish-grey
membrane, the surface of which was glistening and
level with the rest of the cornea. This membrane
was easily peeled off, leaving a clean, ragged bed; a
fresh layer formed within twenty-four hours after
each time it was removed. The membrane was
examined by one of us for the Klebs-Loetller bacillus
with a negative result. This pseudo-membrane may
have been the result of the caustics, or more likely it
was an instance of the development of an exudation
which is said by Weeks to happen in 4 per cent. of
cases of acute contagious conjunctivitis. The forma-
tion of the pseudo-membrane continued for about a

, month and the child made a fair recovery, but with a
; scar which is likely to be permanent.

Bacteriological Examination of the Cases.—We have
Т examined microscopically and bacteriologically the
2, secretion from six patients.

Fresh aud stained preparations were made. The
discharge consisted of nuinerous leucocytes, most
of which were polymorphonuclear; some fibrinous
threads and a few squamous epithelial cells ; occasion-
ally some erythrocytes could be seen. In fresh pre-
parations, using a high power and a very small
diaphragm, some short, slender non-motile rods could
be detected.

Films stained with the usual aniline dyes showed
fairly numerous bacilli. The stain which brought them

February 1, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE. 37

out best was diluted carbol-fuchsin (1 in 20),
which was allowed to act for ten minutes. These
bacilli appeared as short, thin, straight rods, evenly
stained throughout their length, which varied from
one to two microns; no capsule was present.

The organisms were often grouped together irregu-
larly ; in rare instances some were arranged in short
chains. Many were contained in the protoplasm of
the leucocytes.

The bacilli were decolourised by Gram’s method.
These morphological characters suggested to us at once
the probability of our being in the presence of the
Koch-Weeks bacillus, which proved to be the case by

Preparation” stained{with diluted {carbol-fuchsin.

the results of the cultural investigation. We employed
the ordinary laboratory media, as well as blood agar
prepared by smearing on the surface of the agar
tubes some drops of blood. taken aseptically from the
finger; the media were inoculated with the purulent
discharge under aseptic precautions. In the first case
examined all media, including those containing blood,
remained sterile, with the exception of one agar tube,
which showed three or four colonies of the Micro-
coccus pyogenes albus.

In the remaining five cases the blood agar medium,
kept at a temperature of 35? C., showed after thirty
to forty-eight hours some growth; and of the other
media some remained sterile, while others showed a
few colonies of staphylococci. The blood agar tubes
presented small, roundish, translucent, dew-like
colonies, with very little tendency to become larger or
confluent. Preparations from these showed small
non-motile bacilli well stained by diluted carbol-fuch-
sin and not stained by Gram’s method. We succeeded
in obtaining subcultures from these colonies on blood
agar, while we always failed with the ordinary media.
The organism showed a great, tendency to die out
rapidly.

The morphological and cultural characters described
clearly show that the germ isolated by us was the typical

Koch- Weeks bacillus (Bacterium egyptiacum, Lehmann
and Newman). We must add that in one case (Case
No. VI) we found associated with it a bacillus of the
xerosis group. On the blood agar tubes іп this-case,
besides the typical colonies of the Koch- Weeks bacillus,
there were larger, opaque, granular colonies easily.
distinguishable. Preparations from these colonies
showed bacilli which were well stained by Gram's
method. То this association of the xerosis bacillus
with the Koch-Weeks, we are not inclined to place
much importance, as it is well known that the xerosis
bacillus can be found very frequently in any inflamma-
tion of the conjunctiva.

Pathogenicity of the Koch-Weeks bacillus isolated in
Ceylon.—We have made several attempts to infect
animals. We give here a few examples of our experi-
ments.

Experiment 1. Monkey.—Into the conjunctival sac
of the left eye were instilled three drops of the puru-
lent discharge containing many Koch-Weeks bacilli
collected from Case No. IV. Result: Nil; not even
the slightest hyperemia was noted.

Experiment 9. Monkey.—In the conjunctival sac
of the right eye an emulsion of two loopfuls of a blood
agar culture of the Koch- Weeks bacillus was instilled
drop by drop. Result: Nil.

Experiment 3. Monkey.—The conjunctiva of each
eye was scarified by means of a sterilised pin. In the
left conjunctival sac an emulsion in broth of one
loopful of & blood agar culture was instilled. Result:
Marked hyperemia; the same degree of hyperemia,
however, was present in the other eye, where the
scarification was not followed by the inoculation of
the organism. In the inoculated eye the germ could be
recovered during the first five hours, afterwards it
disappeared completely.

Experiment 4.—The discharge taken directly from
the patients’ eyes, and in other cases emulsions of
cultures, were injected into the conjunctive of several
rabbits, guinea-pigs, and white mice. Result: Nil.

Experiment 5.—To study the virulence of the strains
of the Koch-Weeks bacillus isolated by us, several
guinea-pigs and rabbits were injected subcutaneously
aud into the peritoneum. All the animals survived
without showing any signs of malaise. These researches
on the pathogenicity of the Koch- Weeks bacillus found
in Ceylon, gave the same results as have been arrived
at in other countries, viz., that the germ is practically
non-pathogenic for the lower animals.

ae ee NINOS
“ Clinical Studies," November 1, 1905.

SPLENIC ANEMIA.

Bramwell, B., treated a case of splenomegaly with
ferri carb., grs. v. thrice daily, and exposure of the
splenic area once daily to X-rays. The spleen slightly
diminished in size and the red blood count improved.
In another case, boric acid in 20 grain doses in con-
junction with quinine hydrobromate, grs. v., and tinct.
ferri perchlor., min. x., allayed the febrile symptoms,
and improved the general condition, but did not
diminish the spleen. The temperature seems to have
fallen in consequence of the exhibition of boric acid.

38 THE JOURNAL OF TROPICAL MEDICINE.

{February 1, 1906.

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i THE
Journal of Tropical Medicine

FEBRUARY 1, 1906.

THE DEPRECIATION OF THE ATTRAC-
TION OF THE INDIAN MEDICAL
SERVICE AND ITS REMEDIES.

T.

No body of medical men have done more to
advance our knowledge of tropical maladies than
the officers of this ancient aud honourable service,
and its welfare is therefore of great public import-
ance. In the early days contributions by practi-
tioners in the Tropics to medical literature were
evidently regarded by their brethren at home
almost in the light of travellers’ tales, or at any
rate of no more than a curious interest to the
general body of the profession. The establish-
ment of tropical medicine as a distinct branch of
the healing art may, indeed, be said to date from
the establishment of a chair on the subject
at Netley, to which a retired Indian medical
officer, the late Professor Maclean, was appointed.

Maclean was a man of exceptional ability, as well
as à born lecture-room orator, and his lectures and
valuable systematic work on the subject soon
elevated tropical medicine to a recognised position
in the medical commonwealth. Не taught,
amongst other forecastings of modern opinion,
the value of the mosquito net in the prevention of
malaria and the communicability of cholera through
the agency of water ; though it must be confessed
that it never seems to have occurred to him that
the efficacy of the mosquito net might be due to
its efficiency in excluding mosquitoes.

From the therapeutic side, however, his book
may to this day be consulted with the greatest
advantage, and 1t 1s a pity that no new edition has
been prepared, as this side of the question has
been a good deal neglected in the more modern
works on the subject. About the early eighties
the service seemed to be neglecting to maintain
its reputation, though the work of Carter, of
Bombay, on spirillum belongs to this period.

The burning question of the day was, however,
the etiology of cholera, and the conflicting interests
of the time led to unbiassed research being placed
beneath the cold shadow of official disapproval.
The Indian Government quite rightly regarded
quarantine as useless, but unfortunately fell into
the error of believing that its adoption de-
pended, not on the question of its efficiency
and expediency, but on that of the communica-
bility or otherwise of the disease. When keen
and scientific officers recorded facts tending to
prove communicability they were accused of
“ theorising,” and deliberately ordered to delete
the facts from their official reports, so that a repu-
tation for a weakness for research was about the
worst а man could earn who desired to succeed in
the service. The visit of Koch to India, however,
tumbled the whole flimsy edifice based on the
supressio veri about the ears of its authors, and
what is more, demonstrated the inapplicability of
quarantine; but the men who would have worked
had packed away their microscopes in disgust,
and it was some years before this blow to efficiency
could be recovered from. The Indian Govern-
ment had not, however, learned its lesson. It
formally punished King, of Madras, for invaluable
original work on the vaccine virus, and when
Ross made his great discovery it first obstructed
his work, and then, after according some tardy
and grudging support, made no efforts whatever to
retain the services of the brilliant investigator it
found to its hand within the ranks of its own
servants. Was there ever a better case for selec-
tive promotion ?

There are signs, indeed, that matters are im-
proving in regard to the promotion of research,
but the man who should have been the honoured .
and rewarded head of that department has been
lost to India to Liverpool's gain. То this day,

February 1, 1906.)

however, the best advice that can be given to the
would-be recruit for the I.M.S. is as follows:
Qualify at as early an age as possible. Do not
waste time by taking up a resident medical ap-
pointment in your hospital, or in acquiring such
useless lumber as an honour, degree, or a qualifi-
cation in public health, but go up for the first
examination that occurs.

As the keenness of the competition has a good
deal diminished you will probably get in somehow ;
and your position on the list will have so little
influence оп your future career that six months
seniority on the list will avail you far more than
the kudos of being highly placed in the compe-
tition. The truth of this will be especially ap-
parent towards the end of your period of service.
Only the other day thirteen excellent officers were
“ passed over" for promotion simply because they
were too old. "There was no other reason ; for the
thirteen included men holding most distinguished
records, and who, moreover, were known to be
persone grate with the authorities, who really
had no choice in the matter.

Once in the service stick to routine work, pre-
ferably on the military side, as the civil branch no
longer presents any particular pecuniary advan-
tages, and you will have light, pleasant work, and
serve in the pleasantest stations.

Above all, avoid all suspicion of originality or
special ability in any particular direction, as it
may lead to your being placed on “ special duty,"
and when you return to the ordinary line of work
you will find yourself penalised, as if employment
of the sort, were an indictable offence.

No one who knows the service will deny the
soundness of the above advice, and it further can-
not be denied that the fact of the expediency
of such counsel reveals a state of things that
urgently calls for reform.

For the routine work of the service, good, aver-
age men whose professional experience outside the
lecture-room is strictly limited to India will always
be available in sufficient numbers; but ihe Indian
service includes so many appointments for which
such humdrum credentials are entirely inadequate
that every effort should be made to attract men of
matured study and exceptional qualifications.

With this object the following reforms are
respectfully suggested to the “ powers that be " :—

(1) The present age limits are absurd under
modern conditions of medical education. Prac-
tically speaking, it is impossible for the ordinary
student to qualify under two or three and twenty,
and a man who completes his education by taking
а resident medical оћсегѕһір and ап honours
degree cannot possibly enter till he is twenty-five
Or twenty-six, under which circumstances it is
quite impossible for him to reach the highest ranks
of the service.

Тһе age limit should be absolutely done away
with, and in its place a term of service substituted,

THE JOURNAL OF TROPICAL MEDICINE. 39

say thirty-five years in the case of promotion to
colonel, and thirty-seven in the case of surgeons-
general.

To judge mankind by its years is a rule-of-
thumb absurdity.

There are plenty of veterans of sixty who can
hold their own even in practical field sports ; and
if men far in advance of this limit be physically
and mentally fit to act as Cabinet Ministers they
may surely be trusted to cope with the far lighter
strain of the efficient conduct of the duties of
director-general of a medical service. A man
prematurely senile would presumably not be se-
lected for promotion to so Important a post; and
if physically unfit, the ordinary mechanism of
invaliding, which is applied to officers of all
grades, may be trusted to deal with the difficulty.

(2) Every effort should be made to attract men
of the highest qualifications.

It will not be enough to allow time spent as
resident medical officer of & teaching hospital to
count for service and pension. In addition, a
monetary bonus should be given to successful
candidates who have sacrificed immediate pecu-
niary returns to the desire for professional effi-
ciency. The same arguments apply to the holders
of honours degrees; that is to say, those that
require more prolonged study than is exacted for
bare qualification; the F.R.C.S. and the holder
of a qualification in public health for example.
To those who have gained such degrees a small
extra allowance should be made.

Engineering firms find that they cannot obtain
a fitter for the same wages as a rivetter, and to
offer the same rate of pay that is given to bare
qualification to the finest flower of the medical
schools is to put into practice the ideals of the
worst school of trades unionists who would reduce
all workmen, bad, good, and indifferent, to the
same dead level of remuneration.

In the sister service of the R.A.M.C. the expe-
diency and justice of rewarding men for the labour
involved in acquiring additional professional know-
ledge has been recognised by the grant of what is
known as specialist pay. We consider, however,
that while the principle of rewarding exceptional
zeal and ability is entirely sound, this particular
application is a mistake.

It is an abuse of the ordinary application of the
word to dub as a specialist a young fellow who
has merely passed a few months in the clinic of
some special hospital; for men cannot be con-
verted into specialists in the same way as the
pork butcher turns out an Oxford or a Bologna
sausage by stuffing a skin with varying kinds of
meat.

True specialism can only be attained by those
who have laboured to give themselves an excep-
tional general training, and have then devoted
special study and observation to a particular class
of cases; and the best evidence of fitness to be-

come a specialist is the possession of an honours
degree.

At any rate, the plan is entirely inapplicable to
а service in which a large percentage of officers
have, for example, far better claims to call them-
selves eye specialists than the majority of London
ophthalmic surgeons, numbering their successful
operations by hundreds when the latter сап boast
only of tens. Just fancy the position of the young
officer who presented himself before the university
professor in charge of the Eden Hospital, Cal-
cutta, as an obstetric specialist.

The system would be killed by ridicule; but no
such objection could be raised to а special allow-
ance to the holders of honours degrees, as all are
well aware of the time and labour involved in
their acquirement, and there can be no doubt that
it would enormously stimulate post-graduate study
within the ranks of the service.

HYGIENE OF TRAVEL
TROPICAL AFRICA.

Proressor Kocu’s valuable communication,
a ful translation of which appears іп our
columns, is naturally mainly occupied with etio-
logical questions, but contains one very obvious
prophylactic recommendation with respect to tick
fever. This is to the effect that officers travelling
should seek out fresh ground at halting places on
which to pitch their tents. The proposal is a
very proper and natural one, though it indicates
a certain amount of unfamiliarity with the difficul-
ties of tropical travel; for there are undoubtedly
an enormous number of situations where, owing to
the closeness of the jungle or the difficulty of
obtaining supplies, it would be absolutely im-
possible to carry it into effect.

When a possession has passed beyond the stage
of exploration, and has entered that of occupation
and administration, officers must needs be con-
tinually passing to and fro, and it is clear that any
such procedure is absolutely out of the question ;
and that to avoid interference with private
rights, special camping grounds must necessarily

THE IN

be adopted even in fairly open country. Under
such circumstances, Koch's recommendation
becomes a mere counsel of perfection. What

should be done is that at all habitual halting places,
a sufficient space for the tents of one or two
European officers should be fenced in, and if
possible macadamised. Moreover, as quite apart
from humanitarian considerations, it is most incon-
venient and fatal to service efficiency that native
subordinates апа followers should become in-
fected ; a considerably larger space should be
similarly hardened for their accommodation when
bivouacking for the night.

The ticks harbour in dust, and are not so

10 THE JOURNAL OF TROPICAL MEDICINE.

[February 1, 1906.

constituted as to be able to burrow into & hard
surface, so that by insisting on such а ready
prepared surface being swept, a very fairly
efficient degree of protection would be afforded.
What, however, would Koch have said had he
been dealing with the ordinary travelling customs
in vogue in most parts of Dritish Tropical Africa
where our officers are unable to carry tents at all,
owing to the insufficlency of the amount of
transport allowed to them; and where our Colonial
Governments actually countenance the unfortu-
nate natives being turned out of their huts to
afford their undesired visitors the necessary
shelter for the night? ‘Talk of Chinese slavery !

"here, indeed, is a splendid opportunity for an

election cry utterly wasted.

The procedure is, of course, justified on grounds
of economy, but is surely indefensible and im-
politic from an administrative point of view ; and
the risks to which it exposes our officers are so
great and obvious from our present standpoint of
knowledge that it is marvellous that such a
system should continue to be tolerated for à single
day. To be bitten by infected ticks is, of course,
only one of the dangers to which those who are
forced to adopt such a repulsive shelter are ex-
posed, as native huts necessarily swarm with
malarial mosquitoes, and half a dozen other sorts
of parasites of а more or less objectionable
character. An order should be promptly issued
that officers should under no circumstances sleep
in native huts when marching, and proper tents
and transport should be provided for them so as
to obviate all necessity of resort to so terribly
risky a procedure.

----------

THE DEATH OF DR. STEWART.

THe murder, under circumstances of peculiar
atrocity, of Dr. Stewart, of the Nigerian Medical
Service, is an event that cannot fail to impress the
stay-at-home Englishman of the smallness of his know-
ledge of the conditions of life in an African colony.

To a scientific man, the contingency of being eaten
afterwards, is one that adds little or nothing to the
horrors of a violent death, beyond perhaps inspiring а
grim hope that one may “ disagree" with the diges-
tive economy of one’s murderers; but that an officer
should be actually killed and eaten, not only well
within the boundaries of a British colony, but no
more than thirty or forty miles from its capital,
gives rise to reflections that should give pause to
those authorities at home who, though absclutely
without local knowledge, have yet the last word as
to the administration of these distant colonies. It
is true that Nigeria has only come under British
rule quite recentlv, but as & matter of fact, this
debased appetite is a common characteristic of most
of the tribes of Western and Central Africa; and
though fear of consequences would, in the case of a

February 1, 1906.)

white man, render such an event extremely unlikely
in the neighbourhood of Cape Coast Castle or Sierra
Leone, few who know the country would care to
deny that cannibalistic tastes are still prevalent, or that,
amongst themselves, when safe from the eye of the
ruling race, such occurrences are either impossible
or even uncommon.

Evidences of cannibalism have been found even in
Europe, though it is doubtful if these ancient cannibals
were really Caucasians, and with this doubtful exception
the Caucasian and Mongolian races have always re-
garded cannibalism with the horror that should be natural
to any race that aspires to survive in the struggle
of fitness. At any rate, if ever given to such prac-
tices, the white and yellow races abandoned them in
the very earliest stages of the evolution of their
civilisation, whereas the negro retains them long
after emerging from the stone age, and even when
he bas made considerable advances in agriculture
and in the arts of weaving and working in metals.

So inbred, indeed is this savagery, that even after gen-
erations of nominal Christianity in the West Indies, the
rising in Jamaica, which wrecked the reputation of
the much maligned Governor Eyre, was marked by
such incidents as the scooping out of the brains of
their European victims and the conversion of skulls
into drinking cups. The irony of the situation,
however, lies in the fact that under our system of
administration it is quite possible that the very men
who ‘chopped ” poor Dr. Stewart may give trouble
to his immediate successors, in the less congenial
but more humorous guise of an obstructive village
sanitary committee, or some such exotic organisation,
based on the latest European models. Surely such
an incident shows, inter alia, that at any rate in a
matter as foreign to his philosophy as sanitation, it
is essential that the negro should be ruled benevo-
lently but despotically by the European.

——— 9 —————

BISKRA AS A HEALTH RESORT.

Вівкна, the desert city, is an agglomeration of oases
to the south of the Aurés Mountains which has be-
come a very popular resort during the last few years.
It is only 360 feet above sea-level and the climate is
delightful for six months in the year. The tempera-
ture in the shade averages 60° F. during the winter
season (November to May), and rain is practically
unknown, the total annual fall not exceeding an inch
and a half.

Within the sphere of influence of the carefully hus-
banded water supply the soil is remarkably fertile and
vegetation is exuberant. The oasis of Biskra alone
contains a hundred thousand date palms, besides
other fruit-bearing trees, and this luxuriance of
growth is in startling contrast with the surrounding
aridity. There are plenty of objects of interest in
Biskra and its immediate neighbourhood. The town,
with its 8,000 inhabitants, is а typical example of
“life in an oasis." -

THE JOURNAL OF TROPICAL MEDICINE. 41
Abstract.
FriEs AND CHOLERA (Mouches et Cholera). By Dr.
A. Chantémesse and Dr. F. Borel. 1 vol. in 16.

Price 1s. 64. Ј. В. Bailliére et Fils, Paris, 1906.

Cholera which started from India in 1900, had
arrived gradually in the vicinity of Berlin in October,
1905. Has it reached the final limit of its on ward
march? It would be rash to state so. During the
four preceding years cholera has apparently dis-
appeared at the onset of the cold season, but has
always resumed its progress in the early days of the
following summer. We must therefore be prepared
for a fresh extension of this epidemic which hitherto
has been uncontrolled, in the first fine days of 1906.

Truly we may face this alternative without much
fear, the progress of hygiene having provided us with
arms of ever increasing efficiency for combating this
scourge. Nevertheless, we have not as yet reached
the time when it can no longer be feared. Ав yet we
can only restrict the number of cases; it is difficult,
on the other hand, бо entirely prevent а manifestation
of contagion, and the brutal fact of a contamination
may at any time occur.

Drs. Chantemesse and Borel have therefore deemed
it of interest to draw up in this small volume a
schedule of the latest ideas on cholera collected by
science since the last epidemic. Amongst these, there
are аб least two which appear to us to be specially
worthy of notice, as a kuowledge of them is of a
nature to invite some important modifications in the
prophylaxis of cholera. "These are latent microbism
and the dissemination of the diseases of microbic origin
by the intermediate agency of insects. i

A historical review of the several incursions of
Indian cholera into Europe between 1817 and 1892
leads the author to the following conclusions. India
is the original home of cholera, from which it spreads
and reaches Europe by three different routes. The
first is through Afghanistan and.Persia ; the second is
by way of the Persian Gulf, Chat-el-Arab, and Persia ;
the third is that by Mecca and Egypt to the Medi-
terranean Sea. The progress of the various epidemics
has been notably influenced by the amplification of
the means of transport and by their ever-increasing
ratio of speed. Thus in 1823 cholera did not go
beyond the South of Russia. In 1830 and 1848 it
took two years to invade the whole of Europe; whilst
in 1892 this continent was completely affected in a
few months.

Towards the end of 1899 and early in 1900 cholera
in India again broke out with great severity both at
Bombay and Calcutta ; it then proceeded to the south
of the peninsula, and thence gradually extended east-
ward to China and westward to Europe.

On the eastern route it attacked the Dutch Indies
in June, 1901, and then in succession appeared in
Singapore, Burmah, the Philippine Islands, China,
Formosa, Japan, and Cochin China, and with deadly
force afterwards in Manchuria and Corea, finally only
ceasing its advance to the north on arrival at the end
of the inhabited world.

To the west of India three routes lay open, all of

42 l THE JOURNAL OF

them equally familiar with this scourge. The land
route through Afghanistan, the sea route gia the
Persian Gulf, and that through the Red Sea.
Which of these three roads would it follow? Briefly
stated, cholera, leaving India in December, 1901,
reached Hedjaz in March, 1902, contaminated Egypt
in July of the same year, and following the Medi-
terranean coast appeared in Damascus in January,
1903. After reaching Bagdad early in 1904 it passed
on and ravaged Persia, and by July had attacked
Bakoum on the borders of the Caspian Sea; from here
it invaded on one side the Caucasus and on the other
the Volga, which it ascended as far as Saratow, from
whence it spread through Russia, finally appearing in
August, 1905, in Eastern Prussia and in Austria.

In order to arrest the onward march of cholera, and
especially if logical barriers are to be opposed to it,
this march must һе considered under the three fol-
lowing different aspects : its transportation, propaga-
tion, and dissemination.

Transportation is its extension from a contaminated
country to a distant healthy region; propagation is
its extension from town to town, or village to village,
іп а recently infected territory ; and lastly, dissemina-
tion consists of the various methods of which the
epidemic avails itself to spread in the same town
from house to house, or from one individual to
another.

Cholera can be transported to a distance only by
healthy individuals, in whose intestines specific
cholera vibrios may be found, although they them-
selves show no clinical symptoms of the discase.

Cholera may be propayated by the agency of
individuals in a state of latent microbism, but also by
clothing, &c., infected with choleraic dejecta, within
five days, and by individuals in whom cholera is
incubating.

Cholera may be disseminated іп five different
ways :—

(1) and (2) By linen and personal effects, if recently
soiled by cholera dejecta.

(3) By drinking water, if the contamination can
reach the wells, cisterns, or ground water.

(4) The actual patients will infect their surround-
ings by their dejecta, which represent pure cultures
of the dangerous microbe.

(5) Healthy individuals may become a source of
contagion for others, as their fæces in many instances
will contain the cholera vibrio, which, although not
active in their case, may yet become pathogenic for
others.

Modern science now entitles us to say :—

In times of cholera, the dejecta of many people
are receptacles of cholera vibrios; everything con-
taminated by these dejecta becomes in its turn a
source of danger, so long as desiccation, disinfection,
or spontaneous alteration have not destroyed its
activity. The multiplication of the cholera, microbe
takes place in the digestive canal to the exclusion of
other parts of the body, but not necessarily manifest-
ing its presence there by any pathological trouble.

The prophylaxis applicable to cholera is, therefore,
at once both restricted and yet amplifled; it is
restricted, since we know that all that is required is
to destroy only the fresh dejecta wherever they may

TROPICAL MEDICINE.

(February 1, 1906.

be found ; it is extended, since we now know that all
dejecta must be attacked, not only in the case of
patients, but also those of men apparently in good
health.

Now how does the cholera vibrio usually pass from
these dejecta into the digestive tracts of individuals
living in an infected arca? Is it by drinking water?
Not necessarily. By inhaling dust? No. Judging
by the analogous cases of plague and yellow fever
(which are also lessened in number, but not іп inten-
sity, during winter), may we not conclude that a
similar effect, whilst not affecting the cholera vibrio
itself, may, nevertheless, act on the intermediate
agent which carries the germ and permits it to pene-
trate-—if not indeed directly, at least indirectly—into
the human stomach? Without mentioning the
numerous insects which—especially in hot countries
—might act this part, can we not find one, in Europe
as elsewhere, answering in all points to the descrip-
tion of the intermediary required? We allude to the
ubiquitous fly.

Natural history shows that a fly can transport
cholera germs in two ways, either as an inert carrier
(owing to the vibrios adhering to its feet or any other
part of its body, and then heing deposited on food),
or by means of its proboscis, which retains and pre-
serves the germs and redistributes them successively
over different media, which, if favourable for their
development. ensures their multiplication, especially if
the temperature is also sufficiently high for this pur-
pose. Several series of experiments prove that flies can
disseniinate cholera, but that this contamination dis-
appears in about twenty-four hours after contact with
the source of choleraic infection. We do not assign
to flies an exclusive role of disseminating agents of
cholera, for other modes have also a certain value.
For instance, recently soiled linen may be touched by
the hand, which may then touch one’s mouth or food,
and cholera thus be contracted. Water may become
infected by infiltration with fecal matter, and thus
become the cause of part of the epidemic. We only
here insist on a new method of dissemination which,
conjointly with others, permits us to explain more
completely the progress of cholera. -

The prophylaxis against cholera is divided into
several headings: International, National, Urban, and
Individual.

International prophylaxis against cholera will prob-
ably remain an open question for very many years
to come.

National prophylaxis can only play a restricted part
in the defence against cholera; it can forbid entry on
its territory of patients or of freshly soiled linen, but
it is practically powerless against individuals in а
state of incubation or of latent microbism, and it
must delegate the ulterior and rigorous duty of keep-
ing them under observation to the respective muni-
cipalities. Jt is, therefore, to urban and individual
prophylaxis that we must look to for successful protec-
tion against cholera invasion,

Urban prophylaxis. Тһе cholera microbe resides
in the fæces of the sick and in those of many healthy
individuals ; therefore the urban struggle against the
epidemic must consist exclusively in successfully
dealing with the excreta, but this task is not one that

JOURNAL OF TROPICAL MEDICINE, FEBRUARY 1, 1906.

Vo illustrate ** Preliminary Statement on the Results of a Vovage of Investigation to East Africa," By R. Koch.

February 1, 1906.)

ТНЕ JOURNAL ОЕ TROPICAL MEDICINE. 43

can be undertaken on the spur of the moment. The
pail system and privies must be things of the past,
and no town can cease to fear infection until its
system of sewers is in a perfect condition, from its
water-closets to its final and distant discharge outlets.
Urban prophylaxis against cholera may, therefore, be
summed up in a few words: an incessant, determined
and methodical fight against fecal matter, before,
during and after the epidemic.

Individual prophylaxis against cholera depends on
two main principles: the prevention of the cholera
microbe from entering one's body, and if in spite of
all precautions the microbe has found its way into
one's digestive tract to prevent it from manifesting its
presence there. То accomplish the first aim, the
individual should attend not only to his drinking
water, but also to his food in general. Water and
milk should be boiled, food should be well cooked and
served hot, and kept from flies; no food should be
eaten which is not cooked at home ; flies must be kept
down—say, by formol—especially if the water-closets
are defective, or if stables and manure heaps are in
the neighbourhood. If, in spite of all precautions,
the microbe has somehow managed to enter one's
body, this latter should be protected from all causes
which might bring about any intestinal trouble, such
as chills, over-eating, unripe fruit, &c.; in other words,
one should keep one's intestinal balance.

As regards the patient, since his dejecta— vomit
and excreta—contain the dangerous microbe, every-
thing that has been contaminated by these, or in
contact with his mouth or anus, must be at once
disinfected. Тһе vessels containing the dejecta must
be protected from flies whilst being carried about,
their contents must be disinfected—or, better still,
burnt, when this is possible—and the recipients then
sterilised. The bed and the patient must be placed
under a mosquito net, and the vessels which contain
his food, drink, or medicines should be enclosed in a
wired safe, so as to prevent all access thereto of flies.
No meal should be taken in the sick-room, and hands
should always be disinfected after touching the
patient. Ina word, prophylaxis consists in destroy-
ing the microbe at the very moment of quitting the
patient’s body, and before it has had an opportunity
of becoming disseminated. .

As regards the future, the land route from the East
to Europe—the one already preferred by cholera—is
about to be largely developed, and the plans have
already been drawn up. There will be no protecting
deserts, no lengthy sea voyages, during which cholera
сап be stamped out on board ship. Тһе rapid propa-
gation along the railroads will suffice to bring cholera
into Europe every time that it undergoes the slightest
recrudescence in the Indian peninsula. Urban prophy-
laxis alone will be able then to contend agaiust the
ceaseless threatening danger; the problem resolves
itself into this: Will the networks of the sewers be
everywhere ready before those of the railroads ?

J. E. NICHOLSON.

Translation.

PRELIMINARY STATEMENT ON THE RE-
SULTS OF A VOYAGE OF INVESTIGA-
TION TO EAST AFRICA.

Ву R. Kocu.
(Translated from the German by P. Falcke.)

Іх December, 1904, I travelled to German East
Africa by commission of the Imperial (German) Govern-
ment, to institute enquiries as to combating the
Coast fever of cattle in the colony, which was said
to be widely disseminated. For this purpose it
was first of all necessary to confirm the actual
spread of this disease in a reliable manner. Itis a
well-known fact that cattle from healthy regions
become affected when they are taken to the infected
coast, whereas those animals that are bred there
remain healthy. It was accordingly resolved to im-
port cattle from the principal stations of the colony to
Daressalem, and to put them out to graze on severely
infected pasturages, in order to test their liability or
immunity to the disease.

In consequence of the great distances from which
the animals had to be driven, it was two to three
months before all arrived at their destinations, and I
employed the time in the study of relapsing fever.
The disease is undoubtedly endemic, but such cases
as had been met with had always been mistaken for
malaria, und it is only а year ago that the disease has
been correctly diagnosed, by microscopical examina-
tion of the blood. Once attention had been directed
io the disease its frequency was recognised, and in-
vestigations as to the cause of its origin were begun,
leading to the conjecture that a species of tick might
be implicated. I procured a number of these ticks, and
succeeded in demonstrating spirochsetw, which
appeared to be identical with the spirochetw of
relapsing fever, in some of them. This discovery
naturally suggested the necessity of following up the
question on the spot, that is to say, on the caravan
track. І therefore undertook an expedition іп com-
pany with Staff-Surgeon Dr. Meixner by the caravan
route to Morogoro, a ten days’ march.

Soon after our arrival there, we received the an-
nouncement by telegraph that cases of а disease,
suspected to be plague, had occurred in the Rubeho
Mountains, south of Mpapua, and that the outbreak
had been preceded by a remarkable mortality amongst
rats. This alarming news caused us to travel thither
to see if there was an outbreak of actual plague.
Fortunately we were able to establish that there had
not been a single undoubted case of plague, and that
the mortality amongst the rats had nothing to do with
plague, but was caused by the larvee of a gad-fly.

I then visited the Uhehe country, where two years
ago a few undoubted cases of plague had occurred, and
where recently a suspicious mortality bad been ob-
served amongst the rats. In this place also the rat
mortality was found to be referable to the same larvae.

During the march into the interior of the Pro-
tectorate I passed through many tsetse-fly localities.
This was particularly the case on the homeward march,
when I made a detour into the Uluguru Mountains in

44 THE JOURNAL ОЕ TROPICAL MEDICINE.

[February 1, 1906.

order to investigate a rather important centre of
leprosy. It had not originally been my intention to
undertake any work on “ tsetse,” but the opportunity
was so favourable that I was involuntarily drawn into
investigations on the tsetse-flies. This took upa con-
siderable time, but led to interesting results.

On my return to the coast I found that a number of
oxen had arrived, and that some of them had already
fallen ill with Coast fever aud Texas fever. This
afforded me an excellent opportunity to continue the
investigations I had formerly begun in Rhodesia on
the history of development of the piroplasma. In
Rhodesia, in consequence of the unfavourable climatic
conditions, I had not been able to make much pro-
gress, and had only discovered the first indications of
a further development of this interesting parasite in
the tick. I had now at my service a wealth of
material in а climate suitable for the development of
the ticks and the parasites they harbour. Here again,
was a proof of how greatly the success of such research
depends on the correct choice of time and place. This
time 1 succeeded without difficulty in tracing the
history of development of the piroplusma to the forms
assumed in the ova of the tick.

In addition, I continued my study of the tsetse-flies,
and as Daressalem was not very favourable for this
purpose, I removed my headquarters to the biological
experimental station of Amani, where there is a well-
arranged laboratory, and around which the Usambara
Mountains furnish extensive tsetse centres for study.

As I gained further rather important results in the
course of these observations, I considered it expedient
to visit Uganda before my return to Europe to gain
personal information on sleeping sickness, and to
ascertain in what measure my observations on the
glossina of tsetse disease coincided with those on
Glossina palpalis, the carrier of sleeping sickness,

give here briefly an outline of the most im-
portant observations and discoveries I made in these
expeditions, and hope later on to publish a detailed
communication on the subject.

ReLAPsING FEVER.

The relapsing fever which is prevalent in German
East Africa differs in but few particulars from the
European form of this disease. The brevity of the
individual attacks is particularly remarkable, as also
is the small number of spirochætæ discoverable in
the peripheral circulation. The African spirochætæ
appear to me to be, on an average, longer than the
European variety. I have never seen chromatin
bodies in the spirilli, which would have presumed
their relationship to some ёгурапоѕота ; neither did
I observe any indications of either an undulating
border or of longitudinal division. On the other
haud, gaps were frequently seen, which gave one
the idea that the parasite increased by transverse
division' (fig. 1).

Monkeys could always be infected with certainty by
means of subcutaneous injections of *' relapsing blood."

“Тһе plate has been prepared from drawings made by
Dr. Kudicke, with Zeiss’ drawing apparatus, from the original
preparations, and with an enlargement of 2,500, апа redrawn
in our office, as the blocks illustrating the German original were
hardly sharp enough for advantageous photographic repro-
duction.—Ed. J. Т. M.

The disease thus artificially induced ran a severe
course, sometimes even terminating fatally. The
spirochete are more numerous in the blood than is
the case in man.?

African relapsing fever is transmitted by the bite
of a Иск." This tick, Ornithodorus moubata (Murray),
lives in the floors of the huts of the natives. At
night it comes out, sucks the blood of the iumates,
and again conceals itself in the floor during the day.
They are also regularly found in the floors of the
so-called bandas, or shelters under which caravan
travellers pass the night, but only in those parts not
exposed to rain. The ticks are probably distributed
over the entire Protectorate, and are also found in
localities far removed from caravan traffic.

When a tick has sucked the blood of a man or
monkey suffering from relapsing fever the spirochætæ
do not multiply, but in the course of a few days dis-
appear from the stomach of the tick. If, however,
such ticks be examined more minutely it will be dis-
covered that in a certain number of them spirochaete
сап be demonstrated on the surface of the ovary. This
examination is effected in the following manner: The
ovary is squeezed out of the tick, teased out on а
cover-glass, spreading it out as much as possible,
allowed to dry, and then stained with a solution of
&zur-eosin. The spirochwte are then mostly found
in such numbers and arrangement that a considerable
increase must undoubtedly have taken place. This
demonstration is most successful in cases where the
ova are in an eurly stage of development.

After the ticks have deposited their eggs the spiro-
chætæ will also be found in their contents. There are,
however, only a few groups of eggs, and in these again
only a few eggs which are infected. — At first only
single specimens or groups consisting of a few, are
found in the eggs, later on they are more numerous
and often form conglomerations (fig. 2). It therefore
appears as if they continue to multiply within the
egg. 1 have not observed any alterations which
would lead one to construct а hypothetical cycle 'of
development.

The young ticks from infected localities are capable
of infecting monkeys on which they have been
applied.*

Of the ticks examined for spirochietie, 5:15 per cent.
were usually found to be infected, and in a few cases
this number rose to 50 per cent.

Infeeted ticks were found in all locations on the
caravan route from Daressalem to beyond Kilossa, in
the direction of Mpapua, and on the track from
Kilossa to Tringa. They were also found in the
villages of the Rubeho Mountains, and in locations
away from the caravan routes.

Neither of the three Europeans who were with the
caravan suffered from relapsing fever, because they

? As far back аз the end of 1903 Dr. Kudicke succeeded in
transmitting African relapsing fever to monkeys.

“During the expedition I was unable to obtain the current
literature of the subject, so that it was only later that I heard
that that cute investigator, the late Dr. Dutton, had simul-
tancously infected monkeys with relapsing fever by the agency
of ticks. Compare British Medical Journal, February 4th and
May 6th, 1905.

‘Hitherto I have succeeded eleven times in this experiment.

February 1, 1906.)

never passed the night in native huts, nor did they
sleep in the bandas. Of the five native servants who
observed no such precautions, four were attacked with
the disease. Of tho sixty carriers, none had relapsing
fever, although they slept in huts or under the shelters.
This was probably because they had been infected on
former expeditions, and so acquired immunity.

Certain observations demonstrate that fever, has
always been widely distributed and endemic in German
East Africa. The natives, as a rule, contract the
disease during youth, and consequently acquire more
or less immunity, so that they either escape or get
only single slight attacks. The European can best
protect himself from infection by pitching his tent
only on spots which have not been used by others for
camping.

Amongst the cattle examined by me in Daressalem
I incidentally found that two oxen were suffering from
the cattle spirillosis discovered by Theiler. In these
animals also, I succeeded in tracing the spirochete
to within the ova of the ticks.

(To be continued.)

————.»9—————

Correspondence.

WyTMAN's GENERA Іхзкстовсм. 26th Fasciculus. — Culicidw.
By F. V. Theobald.

The above publication may be prestmmed to mark the
termination of the tentative stage of Mr. Theobald's work on
the classification of the Culicidie, and the presentation of his
results in а more or less definite and final form. so that it
шау be opportuue to consider how far the proposed classi-
fication can be said to fulfil its purpose.

Putting aside the Corethrine in which the structure of the
mouth presents such radical anatomical differences, that,
apart from the accidental similarity of their wing venation,
no one would have thought of grouping them in the same
family with} the Culicidis, it must be premised that the
family is characterised by such uniformity of structure that
there is no real need for multiplying the number of its con-
stituent genera, apart from considerations of convenience.
The difference in the proportional length of the palpi in the
two sexes furnished the earlier collectors with the four
genera that were alone firmly established when the writer,
in 1900, published his compilation of published descriptions
of species, but such a number was even then obviously
insuflicient, as the genus Anopheles included thirty, and that
of Culex no less than 159 names.

Added to this, the hygienic importance of the family
led to such great activity in collecting that an enormous
mass of material, including some hundreds of new species,
flowed into the British Museum, and the most difficult
problem presented to Mr. Theobald, to whom the work of
classification and examination was entrusted, was to find
some plan of reducing the family into genera of more
manageable dimensions.

This he believes he has has accomplished by the adoption
of scale-structurcas a basis of generic distinction, but it must
be confessed that the result is somewhat disappointing, as
the genus Culez is already more crowded than ever. and now
includes no less than 175 species, and is still growing ; or, in
other words, more than 44 per cent. of the four hundred and
odd species enumerated remain crowded together as one of
67 genera enumerated.

. Of these 67 genera no less than 52 do not contain more
than four species, and 82 of these include but a single
species,

THE JOURNAL OF TROPICAL MEDICINE.

In the Anopheling, where, not scale-structure but scale-
distribution has been mainly relied on, the result is fairly
satisfactory, in other words, in four or five of the thirteen or
fourteen new genera; but whereas in the Culicine, scale-
distribution is painfully uniform, the number of genera
including but a single species is so large that it is obvious
that the characteristics relied on, viz., that of scale-structure,
is in no sense of generic, but merely of specific, value ; and,
even in the Anopheline the sane result has followed where-
ever seale-structure alone has been adopted for the distinc-
tion of venera.

The net result is that the identification of species would
be far easier by a merely artificial system of tabulation,
until some characters of better generic value than scale-
structure can be hit upon, and this we appear to be as far as
ever from discovering.

The fact is that any system which relies on one class of
character alone is sure to break down in practice, because
classification on such a basis, necessarily results in a grouping
as littie natural as & frankly artificial tabulation, with none
of the advantages of the latter in the matter of ready
recognition of species.

Some of Mr. Theobald's genera will no doubt stand, евре-
cially his earlier ones; the genus Stegomia forming un-
doubtedly, a fairly defined and natural group of species ; and
the saine шау be said of Mansonia, through the. weakness
of scale-structure as а generic criterion must be evident to
any one who is at the pains to examine closely the wings
of the various species, for why some of these should not
be placed in T«entorhynchus, if judged by their wing-scales
alone. is & mutter that is difficult to understand.

Coming to Teeniorhynchus, it сап easily be seen? that
while the original definition of Arribalzaga brought together
a distinctly natural group, the modified diagnosis of
Theobald excludes many obvious congeners and includes a
number of undesirable aliens.

Space forbids any further criticism of individual genera.
but the above examples should suttice to indicate the
grounds that have gradually led the writer to regretfully
abandon the use of Mr. Theobald's classification. Nor is
һе alone, for recent criticism shows that these opinions are
shared by those whose position as professed entomologists
entitles them to be constituted as judges on such a question.

Six months ago Captain James and Captain Liston, I. M.S.,
produced their monograph of the Indian anopheling,
rejecting Mr. "Theobald's classification for much the
sume reasons as those advanced above, though that work
and the critiques on it had not been seen by the writer at
the time the earlier portion of this article was penned, the
dates being about contemporaneous.

The process of genus making, however, goes on as merrily
as ever, for the worst of work of this sort is that it is
infectious, and a busy group, including Blanchard in France
and Miss Ludlow in America, seem to be conspiring to
make the recognition of a mosquito an impossible task,
even for naturalists, let alone for medical men. It may be
well, therefore, to quote textually the opinions on this
subject of two of our best known British dipterologists as
expressed in the critiques above alluded to on James and
Liston’s work.

Mr. Verrall, in the J2ntomologist's Monthly Magazine for
Мау. 1905, p. 121, says: “ The writers do not profess to be
ultra-scientific entomologists, and thereby show their com-
mon-sense, and probably better true science than the genus
and species makers who have preceded them. At any rate
there remains the fact that their species will be easily and
aceurately recognised, while the works of Theobald will
prove stumbling-blocks for generations. They have wisely
ignored the insufficiently distinguished genera of Theobald,
which have commonly been founded on minute and prac-
tically indistinguishable characters, and which аге соп-
sequently valueless to the ‘field’ naturalist.”

In another review of the same work, which appeared in
the British Medical Journal, June 10th, 1905. Mr. E. E.

46 THE JOURNAL OF TROPICAL MEDICINE.

{February 1, 1906.

Austen, if less emphatic, is obviously of the same opinion,
as he records his opinion that ‘* For the reasons stated,
therfore, we are disposed to agree with the authors in their
conclusion that while differences of seale-structure are
undoubtedly of great value in the distinction of species,
such differences as are present, at any rate among Ano-
pheles are not sufficiently important to be considered of
generie value."

Once this is aduiitted, the whole basis of Mr. Theobald's
classification falls to the ground, but meanwhile the
game of genus making goes merrily on, aud each new
species that comes to light is made a pretext for the estab-
lishment of a new genus. For the genus makers this
amusement is doubtless highly satisfactory as n labour-
saving expedient; because it is far casier to describe your
species and call it a genus than to go to the pains and
labour involved in fitting it in to some existing group; but
it is quite the reverse for those who are frequently called
upon to identify mosquitoes.

At the time of the issue of the second edition of the
writer's ** Handbook of the Gnats or Mosquitoes " the pro-
cess had not gone far; and while somewhat distrustful of
several of the new genera, the results were in many cases
satisfactory and useful, so that. having nothing better to
propose, and recognising the urgency of the subdivision of
the unwieldy recognised genera, it was felt desirable to fall
into line with so authoritative a publication as a British
Museum monograph.

The growing complexity of the classification, as further
evolved in the third or suppleinentary volume of the mono-
graph, however, made him feel that any further adoption of
the classification of the monograph would be a distinct mis-
take in a work primarily intended for the use of medical
men, но that, in issuing his “ Revision of the Anophelime,”
while employing Mr. Theobald’s new names, the writer
declined to employ his genera as a key to the recognition of
species, feeling that neither he nor his readers could be
trusted to sort out mosquitoes by the plan proposed. Тһе
memory of prolonged helpful correspondence and pleasant
days of work together made him loth to bring this dis-
approval more prominently to notice, but the rapidly
inereasing rain of new genera is bringing such utter con-
fusion to the subject that he feels it incumbent as one who,
if not a professional naturalist, was yet the first to take up
the subject systematically, to add his voice to the protests of
those far better qualified than he to judge on such points.

G. M. Gres.

— aera ea

Recent and Current Literature,

A tabulated list of recent publications and articles bearing on
tropical diseases is given below. То readers interested in
any branch of tropical literature mentioned in these lists
the Editors of the JounNAL oF Trovicat MEDICINE will be
pleased, when possible, to send, on application, the medical
Journals in which the articles appear.

** The Australian Medical Gazette," December 20, 1905.

An EPIDEMIC OF ÁcuTE DysENTERY OCCURRING AT
RurHERGLEN. J. В. HARRISON.

In Rutherglen, a town on the Murray River,
Victoria, Australia, an outbreak of dysentery began
on January 22nd, and lasted until June 6th, 1905.
During this period 53 cases of typical dysentery
were seen and treated by Dr. Harris, who reports
the epidemic.

Of the 53 cases 7 were observed in children from
6 months to 2 years old, with four deaths; 11 cases
occurred in children from 2 to 8 years old, with

no deaths: the remainder occurred at ages varying
from 15 to 79 years, and of these three were females,
aged respectively 20, 22, and 27 years, and one male,
aged 79, died.

Dr. Has found treatment by bismuth, opium and
mist. creta, ipecacuanha and pulv. ipecac. Co. and
calomel, useless in the severest cases. He gave up
these drugs in favour of Epsom salts, which he pre-
scribed as follows :—

R Mag. вир. ...

Acid sulp. dil.
Tinct. belladonnw
Liq. opii sedat.
Liq. strychniæ mv.
Aq. piperitæ ... ee si ad. 3i.
One ounce every three bours.

grs. XXX.

аа mx.

Sete

This mixture acted immediately, and the results
obtained were ‘all that any one could desire.”

The cause of the outbreak was attributed to the
water supply, which is laid on unfiltered from the
Murray River, but analysis has thrown no light on the
water being the source of infection.

The bacteriological results of the stools and of tbe
blood showed :—

(1) No Shiga bacillus in the stools.

(2) A para-typhoid bacillus was present in excess of
the common fæcal colons.

(3) The patient’s blood yielded a positive agglutina-
tion reaction to the above bacillus, suggesting a causal
relation between the bacillus and the dysentery.

* L'Europe Coloniale," December, 1905.
Un Mission А Lanc-Bian. Dr. VASSAL.

The author gives a vivid picture of the difficulties
with which a doctor has to cope when working among
semi-civilised people. The Annamese hiding them-
selves, or only consenting to have their children
vaccinated when bribed with beads and tobacco ; and
it was only by availing himself of ostensibly chance
scratches when vaccinating that he could get sufficient
specimens of blood to establish the malarial index of
the population. Two types of parasites were found—
malignant tertian and the benign tertian—and 64 per
cent. of the natives were affected. Dr. Vassal appears
surprised to find malaria at Celoa in Reunion at a
height of about 3,800 feet, but as a matter of fact,
such an elevation is quite insufficient to affect the
question in ordinary tropical or sub-tropical climates.

Hotices to Correspondents.

1.— Manuscripts sent in cannot be returned.

2. — Аѕ our contributors are for the most part resident abroad,
proofs will not be submitted to those dwelling outside the United
Kiugdom, unless specially desired and arranged for.

3.—To ensure accuracy in printing it is specially requested
that all communications should be written clearly.

4. — Authors desiring reprints of their communications to the
JOURNAL оғ TRopicaL MEpicINE should communicate with the
Publishers.

5.— Correspondents should look for replies under the heading
“ Answers to Correspondents.”

February 15, 1906.) THE JOURNAL OF

TROPICAL MEDICINE. 47

Original Communications.

———

RHINO-PHARYNGITIS MUTILANS (DESTRUC-
TIVE ULCEROUS RHINO-PHARYNGITIS) :
A PROBLEM IN TROPICAL PATHOLOGY.

By James FAnqUHARSON Leys, M.D.
Surgeon, United States Navy.

IT is the purpose of this paper to call the attention
of the profession to a pathological condition which
prevails in only a few limited areas in the world, so far
as known. This condition may, perhaps, be a late
stage of frambcesia or yaws, or a sequel of that
disease; or it may be a peculiar manifestation or a
sequel of some other known or unknown constitutional
disease. On the other hand, it may be a localised
special affection, independent of any other disease, a
disease peculiar to itself and caused possibly by a
fungoid or bacterial invasion.

To introduce this subject to the reader's attention
I cannot perhaps do better than quote at length from
my annual report, as senior medical officer in the
Island of Guam, to the Surgeon General of the Navy,
for the calendar year 1904. The quotation follows :—

“ Rhino-pharyngitis mutilans. (Destructive ulcerous
rhino-pharyngitis). We have a disease to deal with
which no one of us or of our predecessors has under-
stood. We have no name for it except the descriptive
one which I here propose. Many cases of it in the
remoter pueblos and in the country have not been
seen. The disease, early in its progress, affects the
quality of the voice and in an advanced stage renders
the face repulsive, so that many of its victims avoid
public notice. Between forty and fifty cases have been
seen, treated, and studied as long as they could be
kept under observation. Many others are known to
exist that will not present themselves for treatment.
It is estimated that there are from 100 to 150 cases
in the island. Among those seen regularly one case
aged 3 and one aged 4 died, and another aged 9
was carefully observed and treated for several
months, and was improving steadily, when she left
Aqaia for Merizo. These three have been the
youngest cases seen. The rest are of all ages up to
eighty years.

* 16 is not unusual for a casual visitor here, even a
medical опе, to remark: “ You have leprosy here,
don't you? I meta leper as I was coming up the
road." We can assure such an one that we have
segregated all the known cases of leprosy in the
island, and believe we have them all. He has met
one of our noseless victims of rhino-pharyngitis.

CLINICAL SIGNS AND SYMPTOMS.

* The usual history of & case of this disease is as
follows:—The patient, if seen early, as few are,
complains of sore throat. On examination an ulcer
is seen on the back of the pharynx, on a posterior
faucial pillar, or on the free edge of the palate. It
18 superficial, movable, covered with a thin, dirty,
brownish-grey pellicle of slough. This appears to be
the initial lesion. The pellicle breaks down and
leaves an ulcer which steadily increases, advancing
up the throat into the posterior nares. The disease

begins in the soft parts, but after reaching the soft
palate and eating its way through its entire thickness,
attacks the bone of the palate and nasal septum, finally
destroying these entirely. Тһе disease usually
arrests itself at this stage, the ulcers healing, and
leaves the victim with no septum, the nasal cartilage
and skin fallen in, and the nose and mouth one large
cavity. The disease rarely, if ever, advances down-
ward from its starting point. The larynx is un-
atfected and phonation remains perfect, though
articulation and the quality of the voice are sadly
deranged, as in a bad case of cleft palate. Ina few
of the cases, fewer than 10 per cent. of them, the
process is not arrested at this stage, and the ulcera-
tion destroys the cartilage and skin of the nose and
&dvances upon the face. The upper lip always re-
mains as a bridge across the large opening in the
face; but above it, through the anterior nares, one
looks into the mouth and down the throat. The
tongue is unaffected.

GEOGRAPHICAL DISTRIBUTION AND ETIOLOGY.

“Тһе disease certainly appears to be of an infectious
nature. The process is somewhat amenable to local
surgical and antiseptic treatment, with tonics and
iodides. But the infection is very difficult to eradicate,
and though the process be apparently arrested for a
time it tends to recur till it runs its course. Through-
out the active stage of the disease, which sometimes
lasts months or years, the patients, if so in the first
place, remain muscular, well fleshed, and well
blooded ; their condition being thus in marked con-
trast to the anemia and debility which accompany
tuberculosis and secondary syphilis. It thus seems to
be local, not constitutional, and this suggests that its
cause may be of a fungoid nature.

“This disease appears to be known only in some of
these islands of Polynesia. It is reported to be com-
mon in the Carolines. The local practicante here, an
educated Filipino, practised five years in the Carolines
before coming to this island. He holds a Hutchin-
sonian theory of his own that the etiology of the
disease may be connected with the eating of rotten
sun-dried fish, of which the Caroline Islanders are
fond. The Chamorros of Guam have the same
weakness. Dr. Daniels, of Fiji, quoted by Manson!
definitely excludes syphilis from its etiology, and
thinks it may be a sequel of yaws. Dr. Alvarez,’ of
Honolulu, bas expressed the opinion that it is
syphilitic and has no connection with leprosy. In an
allusion made to the disease in a report to the
Governor of Guam in March, 1902, Surgeon Arnold, of
the Navy, says he is not at all inclined from what he
has seen of the disease to ascribe it to syphilis.

“Тһе disease has been assumed by medical new-
comers and casuals here to be a form (1) of leprosy,
(2) of hereditary syphilis, (3) of tertiary syphilis, or
(4) of tuberculosis, or (5) a sequel of yaws. There
are good reasons for believing that it is none of these,
but a peculiar, independent disease. I shall attempt
to summarise these reasons.

! ** Tropical Discases,” London, 1903.
2 Personal letter to Surgeon W. F. Arnold, United States
Navy.

48 THE JOURNAL OF TROPICAL MEDICINE.

{February 15, 1906.

(1) “ Argument against. Leprosy.—Only visitors not
familiar with leprosy itself have ever thought that it
was leprosy. Lepers are not known to suffer from
this peculiar form of destructive ulceration and from
its effects throughout life, and from no other sign or
symptom of leprosy. Leprosy is sufficiently common
all over the tropical world where this disease is not
encountered.

(2) “Argument against Hereditary Syphilis, — It
appears in healthy and well-developed persons of all
ages, with no signs of hereditary syphilis in their own
persons or in their brothers and sisters, and with no
signs of syphilis in their parents.

(3) Aryument against Tertiary (Acquired) Syphilis.
— Acquired syphilis is a common disease in most races
over nearly the whole world. It is an extremely rare
disease here, and neither primary or secondary syphilis
has been seen in a native during the past year, among
thousands of persons treated for other diseases,
including several prostitutes. This disease is common
here, and rare or unknown where syphilis is common.
Dr. Daniels, who was in Fiji for years, states that
there was no syphilis in Fiji at a time when the lesions
observed in this disease were common. The appear-
ance of the primary lesion of this disease in otherwise
healthy children of healthy parents, at 3, 4, and 9
years of age, excludes acquired syphilis.

(4) “ Argument against Tuberculosis.—The victims of
this disease have no signs of tuberculosis in other
organs or parts. Тһе disease does not extend down-
ward and become laryngeal. Instances are observed
of several members of the same family all afHicted
with only the peculiar lesions of this disease. Tuber-
culosis is common here as everywhere, and presents
the same lesions here as clsewhere in the world. This
disease is confined to a very small part of the world,
so far as known.

(9) “ Argument against its being a Sequel of Yaws.-—
Yaws is & very common disease in the tropical world.
It is common here. About thirty eases have been
seen during 1904, seventeen of them in school children
(ав noted above in this report). While a few of the
cases of rhino-pharyngitis give a history of yaws,
fewer still show any yaws marks or scars, and the
large majority deny a yaws history. None of the
three cases of children of 3, 4, and 9 years showed any
evidence of having had yaws, and I think none of
them had had it. The girl of 9 was a particularly
handsome child, with & beautiful unmarked skin.
Yaws is a very common disease among the negroes іп
the West Indies, but no sequel of yaws which resembles
this disease is reported there. I have heard that yaws
is common and this disease unknown in the Philip-
pines. While it may or may not be true that in every
place in Polynesia where this disease exists yaws also
exists, yet there are many places where yaws exists
and this disease does not. We are ignorant of the
etiology of yaws, as we are of the etiology of this
disease, and we have no reason, that I can see, to
assume that they have the same etiology. I can see
no evidence to warrant the assumption that this disease
is a sequel of yaws.

“ The study of this disease offers a fine field for the
labours of any school of tropical medicine which might
be disposed to send an investigator with a good equip-
ment to this island."

This long quotation has been made as the best means
of bringing this subject to the attention of readers to
whom the condition may be as new and strange as it
was to me when the above was written. My annual
report on Guam, from which the quotation is taken,
and of which it forms but a small part, was written
under pressure for speed within the ten days following
an unexpected detachment from that station by
telegram. The part referring to this disease, which I
have quoted here, was a hurried attempt to portray
this condition, which was to me and my colleagues
in Guam а pathological novelty, to the clinical and
statistical aspects of which I had intended to devote
special attention during the following year had I
remained on duty there. During my Guam service
no literature on this subject was available for refer-
ence except the very brief allusion to it in the article
on yaws in Manson's Tropical, Diseases. Some com-
ment ou it, with explanation and modification of
some of the statements contained in it, is now іп
order.

The reference made by Manson to the opinion of
Dr. Daniels is not by direct quotation. Manson's
statement! is: ''Daniels says that in Fiji, where
syphilis is unknown among the natives, these destruc-
tive ulcerations of palate and nose, together with
& skin affection like lupus vulgaris—all of which he
says are amenable to potassium iodide—are not
uncommon ; he is inclined, therefore, to regard them
as true sequele of yaws." I have since had access
to some of Dr. Daniel's reports on this subject and
will give his views in his own words. First, from an
essay on this subject written jointly by J. S. Wall-
bridge and C. W. Daniels? I take the following
statements referring to Fiji: ''There are а series of
pseudo-syphilitie phenomena met with in the natives,
thought by some to have a connection with yaws. Syphilis
is unknown among the natives. First among these
there is a destructive ulceration of the soft palate
aud fauces and sometimes of the nose. I
have twice seen this ulceration under 10 and it is
common abouttwenty. In rarer cases it occurs late in
life, and in one woman about 60, on whom I made а
post mortem, the larynx was involved ; there were no
tubercles in any of the organs and neither gummata
nor other signs of syphilis were present." ‘That
syphilis is unknown amongst the Fijian natives is the
experience of every medical man in that group."

Daniels; writing later of yaws as he saw it in
Georgetown, British Guiana, makes the following
statements: “ My experience of yaws has been gained
mainly in Fiji. There it is called by the natives
' Coko,' and there сап be no doubt that it is identical
with the yaws I have seen in British Guiana."
** Various ulcerations of the pharynx are met with later
in life, and are by some thought to be the sequele of
yaws.” “Тһе chronic pharyngeal ulceration attributed
to yaws appears much later than the eruption, and I
think is doubtfully caused by that disease." The
clauses which I have italicised in these quotations give
quite a different impression as to Dr. Daniels’ views

! Op. cit.

? « Selected Essays and Monographs,” New Sydenham Society,
London, 1897. .

з Brit, Jour. Dermat., London, 1896, viii., 426,

February 15, 1906.)

THE JOURNAL OF TROPICAL MEDICINE. 49

Шат... ГГ... а

from that which I had derived (rightly or wrongly)
from the reference to them in Manson’s book, quoted
just before. Dr. Daniels evidently considered that
there was little ground for the assumption that this
pharyngeo-palato-nasal condition is a sequel of yaws,
or at least he appears to have considered it only an
assumption unsustained by any proof. His view
would appear to be very much the same as my own.

My reference to Dr. Alvarez, of Honolulu, as holding
а belief that these lesions are syphilitic is misleading,
and I must correct the wrong impression it might give.
I do not know that Dr. Alvarez has ever seen this
condition in Fiji, Guam, or any other place in Polynesia.
Surgeon W. F. Arnold, one of my predecessors in
Guam, impressed by the prevalence of these lesions
there, wrote to Dr. Alvarez, аб Honolulu, asking him if
these lesions were seen there, and if he believed them to
have any connection with leprosy. Dr. Alvarez's letter
in reply was left on the medical file at Guam, where I
read it. His reply to this point was, in substance,
that a few people were to be seen among the
Hawaiians whose palates and noses had been destroyed
by disease, that the lesions were not leprous, and that
he regarded such cases as were seen in Hawaii as
probably tertiary syphilitics. .
` In the “ Argument against Tuberculosis" I have
stated that the disease ''does not extend downward
and become laryngeal.” This is a rule which, like
most other medical rules, must #016 an occasional
exception, as in the one case referred to in the essay
of Drs. Wallbridge and Daniels, and quoted above.

In the argument against its being a sequel of yaws,
I said: “ Yaws is a very common disease among the
negroes in the West Indies, but no sequel of yaws
which resembles this disease is reported there.” This
statement was made in ignorance of the literature.
As already stated, at the time when this report of mine
was written I had not seen any reference to such a
pathological condition as the one under discussion
except the allusions to it in Manson's chapter on yaws,
which I have already mentioned and partly quoted
here. I had travelled extensively in the West Indies,
had a personal acquaintance with several medical men
in the islands, had often discussed professional subjects
with them, and I had never heard such a condition
mentioned. I had supposed that Dr. Daniels was the
first to call attention to it.

Similar lesions, however, similarly assumed to have
& connection with yaws, were briefly mentioned by Dr.
James Maxwell, іп 1839, as having been observed by
him in Jamaica.

Certain indolent nose and throat lesions were de-

scribed by Professor Breda? as having been observed.

by him in Italy in the persons of three Italians who
had emigrated to and returned from Brazil, which
lesions Professor Breda assumed to be due to a fram-
boesial infection. From his description of these lesions,
however, and from the coloured plates accompanying
his article, i& would appear that the conditions seen and
reported by him were entirely different from that de-
scribed by Dr. Rat in Dominica, by Dr. Daniels in

«Observations on Yaws.” Prize Essay. Edinburgh, 1839.
***On Brazilian Framboesia ог ‘ Boubas." Archiv f. Dermat.
u. Syph., 1895. .

Fiji, and by myself in Guam. In the personal and
clinical histories of these three cases, moreover, Pro-
fessor Breda gives no facts sufficient to connect them
with yaws, a disease of which he had only heard and
never, himself, had any professional experience.

Lately I have access to Dr. J. Numa Rat’s admirable
treatise on Yaws, published іп 1891, in which the
author describes these naso-pharyngeal lesions, which
he regards as belonging to a tertiary stage of yaws.

After the report of the Surgeon-General of the
Navy, containing a part of my Guam report, had gone
to press, I requested the proof-reader to strike out the
statement I had made that no such condition as this
had been reported in the West Indies. In Dr. Rat's
treatise (1891) the author says :—

* Destructive ulceration ef the nares, pharynx and
soft palate is one of the later manifestations of yaws.
The affection generally begins as a tubercle at one of
the parts above mentioned. When it originates in the
nose, the early symptoms are those of ozæna ; and the
ulceration spreads from this organ to the palate and
pharynx. It often, however, avoids the nares апа com-
menees in the soft palate. The ulceration of the
tubercle extends thence, destroying the uvula and
velum palati, and the septum nasi, and deeply scoring
the pharynx. :

“ This ulceration may occur twenty years after the
last traces of the secondary symptoms, even though
the disease had lasted a short time only, and had been
apparently effectually expelled from the system, and
though the patient may be robust and in apparently
good health. It generally begins about the age of
puberty in those cases in which the earlier symptoms
occurred during childhood ; but it may also commence
in childhood, and soon after the secondary period.

* ж

* After a week the patient either develops the sym-
toms.of ozena, or complains of sore throat. On ex-
amination, the tubercle may be readily detected in the
anterior nares, or a mirror will reveal the tubercle be-
hind the uvula. After about a month ulceration

„begins ; and, іп а month or six weeks more, the-uvula,

velum palati and septum nasi have disappeared, and
the pharynx is deeply grooved and covered with a
greenish-white tenacious secretion. . . .

** The ulceration usually ceases about the palate after
destroying the uvula and velum palati; but it usually
lingers chronically about the posterior nares and
pharynx.

‘Adhesions may occur between the velum palati
and the pharynx, and the posterior nares may be
blocked by an excessive growth of granulation tissue,
which may also project downwards as far as the
cesophagus, leaving a very narrow. passage by which
respiration and deglutition are performed with great
difficulty. ;

“Тһе percentage of those attacked with the milder
form of this ulceration is considerable in some localities
in which yaws is endemic. In a district with a popula-
tion of about 2,000, sixty persons thus afflicted have
come under my notice, and possibly many more in the
same place were similarly afflicted. It appears to

! " Yaws; Its Nature and Treatment." London: Waterlow
and Sons, 1891. vi

50 THE JOURNAL ОЕ TROPICAL MEDICINE.

be specially prevalent in certain parts and rare in
others.

“Тһе above figures refer to a certain quarter of the
windward district of Dominiea, in which it is exceed-
ingly common, and to which it seems to be entirely
limited in that island. It is, on the other hand, very
rare in South America and the West Coast of -Africa,
where comparatively few cases came under my observa-
tion."

I have not observed any lesion in the nose or throat,
either in an early or late stage of this disease, which
could be described as а tubercle, nor have I seen the
excessive growth of granulation tissue interiorly
which is described by Dr. Rat.

In far-advanced and aggravated cases І have seen
such granulation tissue externally on the face, on the
conjunctive, in the eyelids, and in the uleerating ale
of the nose. It is shown in the eyelids in the ac-
companying photograph of one of the Guam cases.
The only inflammatory process I have seen inside is the

serpiginous uleeration of both soft parts and bone, and
the narrowing of the pharynx in some of my cases was
brought about entirely by the adhesions and scar-con-
tractions described by both Dr. Ratand myself. With
these exceptions noted, his description of the local
pathological process and mine are quite similar in all
essentials, and I cannot doubt that the condition he
describes as so prevalent within a limited area in the
island of Dominica is the same that I have seen in
Guam.

Manson! says: “ Corney, in his annual statistical
return of the Colonial Hospital, Fiji, 1896, classifies
eleven cases under the heading ‘ Lupoid Ulceration of
Posterior Nares and adjoining Pharyngeal Parts
(tertiary frambeesia)’” Surgeon J.C. Pryor, United
States Navy, informs me that when he visited Fiji in
December, 1899, Dr. Lynch showed him several such
cases as ‘tertiary yaws," From these statements I
infer that the assumed connection between this serpi-
ginous ulceration of the naso-pharynx and yaws has

! Ор. cit.

[February 15, 1906.

come to be quite generally accepted by medical men in
Fiji.

In December, 1905, I had the pleasure of becoming
personally acquainted with Dr. Rat, in the course
of a visit to the island of Nevis, where, as an officer
of the Colonial Medical Service, he is at present
stationed. I submitted my own observations and
views on this subject, as contained in my Guam report,
to him, and we discussed the subject at some length.
Dr. Rat is one of two medical officers in Nevis, and has
his residence in the district known as Gingerland.

In Dr. Alfred Nicholls’ “ Report on Yaws in the
West Indies,"' С. R. Edwards is quoted as having
reported the existence of between 300 and 400 cases
of yaws in Nevis in 1886; and it was stated for
January, 1889, that “іп that part of the island known
as Gingerland there are probably several hundred
cases.” Ав Gingerland is one of several medical dis-
tricts in the island, and as the total population of the
island at that time was given as 13,087, it will be seen
that when that statement was written sixteen years
ago yaws was excessively prevalent in the Gingerland
district, and it is evident, too, that the disease has
been generally prevalent in the island for at least
twenty years past. Dr. Rat states that it is still ex-
cessively prevalent in the island. Dr. Rat was in
charge of the limited area in Dominica which has
been already referred to, and in which he observed
this destructive rhéno-pharyngitis to be so common
for a period of only eighteen months, and in that short
time sixty cases of such lesions eame under his obser-
vation. At the time I visited him he had been one
year in the neighbouring island of Nevis, yaws being
excessively prevalent there and having been so for
many years. Іп that one year he had not seen а
single ease of these naso-pharyngeal lesions in the
island of Nevis; and this notwithstanding that the
population under his observation іп Nevis is much
larger than that of the limited district in Dominica in
which the rhino-pharyngitis was so common ; and that
yaws is about as prevalent in the larger Nevis popu-
lation as it is possible for it to be in any population,

" and it has been so prevalent, excessively prevalent,

there for at least twenty years. Dr. Rat told me that
he based his belief that the destructive rhino-pharyn-
gitis of the Dominica district was connected with yaws,
was a late or tertiary development, or & sequel of
y&ws, entirely upon the coincident prevalence of this
rhino-pharyngitis in а place where yaws was an ex-
cessively prevalent disease. Тһе assumption had, or
has, no other basis, and, if I understand his present
attitude on the question aright, he feels that such an
assumption can be only a tentative one.

RuINO-PHARYNGITIS AND YAWS NOT COINCIDENT.

If, in the absence of any exact knowledge of its
etiology, the prevalence of this peculiar destructive
rhino-pharyngitis were coincident with the prevalence
of yaws, the assumption of a connection between the
two would have a fair basis of probability. But from
the facts here set forth it does not appear that there
is any such coincident prevalence. The very few spots

'« Report on Yaws," by H. A. Alford Nicholls. London,
1894,

February 15, 1906.)

in the world, only three or four іп number, from
which we have reports of the striking prevalence of
this rhino-pharyngitis are all in the tropics, and all
happen to be in regions where yaws is common. But
in all of these regions tuberculosis is common ; in all
but one, Fiji, syphilis at least exists, and the preva-
lenee of this disease is no more coincident with the
prevalence of yaws elsewhere than it is coincident
with the prevalence of tuberculosis and syphilis else-
where.

It may help the European reader to realise the
extensive and striking prevalence of this rhino-
pharyngitis in the few limited regions from which it
ің reported if he will apply the figures representing its
prevalence in Guam (1 to 1:5 per cent.) or in the
Dominica district referred to by Dr. Rat (3 per cent.)
in some populations with which he is familiar. Any
single case presenting similar lesions in Europe would
probably be put down to tuberculosis or tertiary
syphilis. But only a very trifling percentage of the
syphilitic or of the tuberculous present such destruc-
tive lesions of the palate and nose, and the percentage.
of the total population so affected is insignificant.
Suppose, however, the general prevalence of tubercu-
losis and syphilis and the occasional occurrence of
lupoid and tertiary syphilitic nose destruction to be
just as they actually are in London and other large:
cities and towns throughout England. And suppose
that in Liverpool alone 3 per cent. of the total popu-
lation were afllicted with a destructive and mutilating
serpiginous ulceration of the naso-pharynx, usually
self-limited and having little or no effect upon the
general health. In the population of Liverpool some
25,000 persons so afflicted would be at large. Апа if
these lesions were attributed by anyone to tertiary
syphilis, we would ask why syphilis should bring
about such a state of things in Liverpool and not in
any of the neighbouring towns where it is equally
prevalent. The percentage of the Dominica district
applied to the population of London would give us
180,000 persons with peculiarly mutilated throats and
noses at large in the metropolis, a condition of things
which would attract some attention, and lead to efforts
to ascertain its cause.

At the time I write, January, 1906, after a year's
reflection on this subject, I am. not inclined to modify
materially the opinions expressed a year ago іп my.
Guam report. I think this condition presents a pro-
blem in tropical pathology which deserves investiga-
tion, that no evidence has yet been adduced to warrant
our regarding it as a late manifestation of yaws or of
any other constitutional disease, but that it is more
probably a peculiar and independent local disease. I
think that it may not improbably be caused, like blasto-
mycetie dermatitis, or like madura foot, by the local
invasion of some infecting organism, though I am far
from wishing to advocate this or any other mere
hypothesis as to its etiology.

—— ————————

H.R.H. the Prince of Wales opened a new medical
School at Lucknow during his visit to that town.

THE JOURNAL OF TROPICAL MEDICINE. 51

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THE

Journal of Tropical Medicine

FEBRUARY 15, 1906.

THE PROBLEM OF MEDICAL AID IN SEMI-
CIVILISED COUNTRIES.

Poverty, nationally speaking, if not of the indi-
vidually biting sort, is a common characteristic of
incomplete civilisation, and it naturally follows that
countries in tbis stage of development cannot afford
to pay for the services of the fully-trained medical
product of advanced civilisation in numbers at all
adequate to meet the total demand of their population
for medical services.

Half a loaf is, however, proverbially better than no
bread, and to at least partially meet the necessities of
the case there arises the need for the organisation of a
lower and cheaper grade of professors of the healing
art. It is only lately that the plan has been abolished
in France, and traces of it still remain in our English
medical titles, if not in actual practice; while in Russia
i& is a present fact, but for which the medical exami-
pation of that Empire would be even more incomplete
than it is.

or
114

But if, throughout the enormous temperate regions
occupied by the Anglo-Saxon race, there is fortunately
no longer any need for an inexpensive makeshift of
this sort, it is by no means the case in the even vaster
portions of the British Empire, where the white man
rules and directs, but cannot colonise in the true sense
of the word. “ Exeter Hall" may rave in its fanatical
ignorance, but is powerless to check the instinct of
exploration ; and once the white man has gained a
footing within savagedom he can no more help ruling
than oil can avoid floating in water.

Amongst the first in the field, medical men are always
to be found, and their services are always so thoroughly
appreciated by the indigenous races that their work
forms one of the surest and most effective agencies in
reconciling the native to the yoke of civilisation.

The demand for skilled medical aid soon, however,
_becomes far beyond the scanty financial resources of
races which are but taking their first lessons in the
arts of modern civilisation, and it becomes an urgent
necessity to supplement the supply by training locally
an inferior grade of practitioner, which, if not educated
up to the standard demanded in older and richer
civilisations, is yet capable of doing excellent work
under more skilled supervision, and of forming an
invaluable agency for the promotion of health and
civilisation.

In India this need has long been recognised and
catered for by the formation of a distinct branch of
the medical service, known as Hospital Assistants.
The members of this service are usually drawn from
families of good caste, and in small but increasing
proportion are sons of soldiers in the native army,
a status which counts for a good deal in India.

They go through a three years’ course, conducted
in their own language, by professors who have gradu-
ated in our Indian Universities, working under the
superintendence of an European superintendent belong-
ing to the Indian Medical Service, but who, unfortu-
nately, has usually so many other duties that it is
impossible for him to take any real personal share in
the work of teaching.

` The course is quite gratuitous, the students even
receiving a subsistence allowance ; and on its successful
completion they are drafted into the civil or military
branches of the medical organisation according to
requirements.

The training is an extremely practical one, and if
not exactly scientific practitioners, the men who have
undergone it have learnt enough to deal with all ordi-
nary emergencies in quite effective fashion, and, in
point of fact, form the very backbone of the great and
somewhat complicated mechanism for popularising
modern science in India; for it is the Hospital Assist-
ants in charge of the little “ branch dispensaries”
which are dotted everywhere over the country, who
represents medical enlightenment for the great bulk of
the people. He may know nothing of the communi-
cations of the cranial nerves, or of the significance of
the tendon reflexes, but he has a good working know-
ledge of the whereabouts of the great arteries, and
may be trusted to treat you for fever or dysentery
intelligently and efficiently.

Many, of course, become a great deal more than
this by qualifying themselves to read and understand

THE JOURNAL OF TROPICAL MEDICINE.

[February 15, 1906.

English books, and by observing the practice of their
European superintending officers, so that some of them
are excellent operators and very sound practical
physicians.

In the military branch they now very properly rank
as native officers, and very often the grey-bearded old
senior assistant is the father of the regiment, and
one of the most respected members of the corps.

The success of the Hong Kong Medical School,
which we comment on elsewhere, though, of course,
it aims at a fuller training, is a good example of what
can be done in this direction, and will, we hope, draw
attention to the desirability of instituting a similar
organisation for the purposes of our African colonies.
British Tropical Africa rivals India in area, and now
that we are beginning to effectively open up the
resources of the back-country the need of a body of
medical officials of the type indicated will become
increasingly apparent.

Fortunately, our old-established settlements on the
West Coast can supply us with an ample number of
educated and intelligent Africans to form the personnel
of such an establishment, so that all that is needed is
the mechanism for their education.

For this no elaborate arrangements are necessary,
as no costly laboratories and apparatus are either
needful or desirable.

The first year should be devoted to teaching visceral
and regional anatomy, rudimentary physiology, and
enough of the elements of chemistry to make the
instruction in dispensing intelligible ; while the remain-
ing two years should be given up to the practical work
of the profession.

Nor would any large teaching staff be required, as
a couple of whole-time professors—one а young officer
fresh from home, and the other an experienced Colonial
surgeon—would amply suffice, though doubtless, as
the school progressed, it would be desirable to
strengthen the staff by utilising some of the best of
the trained men as demonstrators and assistants.

We are not so sanguine as to hope that such an idea
is likely to be acted upon at present, but put it forth
in the hope that it may be considered and elaborated
in due time by those who are entrusted with the
medical organisation of our African Colonies.

AN EXPERIMENTAL REPRODUCTION OF
АМ«ЕВІС DYSENTERY BY INTRAVENOUS
INOCULATION OF PUS FROM A HEPATIC
ABSCESS.

By Surgeon-Major A. GAUDUCHEAU.
Director of the Vaccine Laboratory of Tonkin.

IT is well-known that abscess of the liver is often
& complication of dysentery in warm climates, and
although our knowledge of the pathology of these
infections is still very incomplete, it appears that
these diseases are due to amcebe. In a recent work
L. Rogers was able to trace the parasite from the
intestine to the liver. Nevertheless, the amoeboid
nature of hepatic abscess has not yet been entirely
elucidated, as the experimental reproduction of this
lesion has not heen realised.

February 15, 1906.)

THE JOURNAL OF TROPICAL MEDICINE. 58

Eo Же аке A we rs gE Sn A EE ELS Se et Di) he Pi a Es
SS SS eee ee Та ----е-- е-е...

Dr. Gauducheau therefore tried an experiment on
new lines.

-He obtained some fresh hepatic pus from an
European patient. The pus was not sterile, as is
often the case, for he was able to isolate three forms
of bacilli from it, (1) the pyocyanic one, (2) a bacillus
3 4, in length, which he would’ have identified as
Shiga's had it not been for its marked motility, and
(3) а liquefying bacillus. He made ап emulsion of
equal parts of pus and salt water, and injected 4 со.
of the mixture into а mesenteric vein of an adult native
dog. Afteran incubation period of 44 days the animal
(which had shown no sign of intestinal trouble up
till now) was seized with characteristic dysentery.
During the three first days after the onset of the ill-
: ness the fæces contained numerous amcebe, 20 ,
long, moving with rapidity ; they then became more
rare, and during the last few days that the animal lived
could not be found at all; the motions remained
numerous throughout, but towards the end consisted
almost entirely of pure blood. 'The animal died on
the eighth day.

The post mortem showed the whole of the mucous
membrane of the large intestine scattered over with
bright red spots, in confluent patches or isolated,
surrounded by a small inflammatory zone, but with-
out any ulceration whatever; the line of demarcation
was very noticeable, the diffuse inflammation suddenly
ceased at the cecum. The rest of the intestines
were quite normal,-as were also the other viscera.

In a word, whilst trying to reproduce abscess of
the liver by a portal injection, Dr. Gauducheau ob-
tained amoeboid dysentery.: Although the only one
up to date, this experiment demonstrates the converti-
bility of the infection of suppurating hepatitis and
dysentery.

Hanoi, December Ist, 1905.

Тне post of Residency Surgeon in Kashmir is almost
the only appointment in the hills open to medical
officers attached to the Indian Political department.

In place of the “ malarial focus," where he usually
has to put in his time, the holder finds himself in one
of the most delightful of climates; and as a change to
the usual hard work of practically administering all
the. medical institutions of a native state, his duties
are purely advisatory and. correspondingly light;
though far from a sinecure, in view of the number of
health-seekers who now annually invade Kashmir,
Under these circumstances the post bas been very
properly regarded as an exceptional one, which should
be reserved for men whose health had suffered from the
arduousness of service in the ordinary political posts,
as it affords an opportunity, advantageous alike to the
individual and the state, for an officer to recover his
health without the expense of taking or giving furlough.

Recognising these facts, it was officially laid down in
the time of that admirable administrator, the late
Surgeon-General Harvey, that the appointment should
not be tenable for more than five years, and there can
be no-possible doubt as to the wisdom and fairness of

the order, though the period might perhaps have been
curtailed to two or three years with advantage to the
Service.

We hear, however, that this wholesome rule is to
be abrogated in favour of the present holder of the
appointment, who is to be allowed to hold it inde-
finitely.

It may be admitted that the officer in question has
an exceptionally brilliant record, but there are other
ways of rewarding and of utilising his talents than that
of consigning him permanently to this Indian Capua,
and we trust that should this meet the eye of the
Secretary of State for India he may enquire into the
matter, and should there be any foundation for the
rumour, place his veto on what might be described by
ill-natured people as something very like an instance
of ‘ influence."

THE COLLEGE OF MEDICINE FOR

CHINESE, HONG KONG.

We are pleased to gather from the Calendar for 1906
that this College thrives. > Хо fewer than thirty-five
students are in attendance, and since 1892, when the
first students took their diplomas, twenty-four men
have attained that honour. The examinations to which
the students are subjected are maintained at the
standard of examinations for degrees and qualifications
in Britain. The Chinese, as any опе who has had to do
with young Сһіпатеп either at home or abroad knows,
are excellent students, earnest, hard-working, easily
taught and intelligent toa degree. The list of teachers
shows that the various subjects are taught by men not
only well qualified, but many of them experts in their
subjects. Of the original teachers in the College in 1887,
when the College was first founded, one is rejoiced to
see that the Honourable Dr. Ho Kai, C.M.G., Dr.
Gregory P. Jordan, and Dr. J. C. Thomson, still give
their valuable services to, and preserve their interest
in, the College. Dr. Thomson has, by his tact and
organising ability, done more than апу other metnber
of the staff to maintain and forward the interests of
the College. The medical men resident in Hong Kong,
past and present, ably aesisted by local scientific men
and medical officers of the Army and Navy on the
Chinese Station, bave, for many years, without pay or
reward, given their time, experience, and in many
cases their money, to further the interests of the insti-
tution. Тһе work these medical men are engaged іп
is imperial in the widest and. best sense of the term ;
they are presenting modern medicine, and particularly
British medicine, at the gates of China, and offering
the best they have to give to the people of China. It
is easy to wax eloquent over such a theme, but even the
most facile pen or fluent speaker cannot do justice to
the possibilities of the work the staff of this College are
engaged in. Could, however, the possibilities be
brought home to the people of the Empire the students
of the College would be as many thousands as now
they аге tens. Much good work has been and is being
done, but the lack of encouragement from those in
power, or possessed of means, leaves the College de-

54 THE JOURNAL OF TROPICAL MEDICINE.

[February 15, 1906.

pendent upon the self-sacrificing efforts of a few busy
doctors, who have to give the few hours they can
snatch from their daily toil in a tropical climate to
instruct the students without pay, reward, or recogni-
tion. Could the meaning and importance of this
College be brought home to British folk we would have
in Hong Kong a teaching University of the first rank ;
and instead of turning to Japan, where German is the
scientific language of the class-room, the Chinese
would turn to an institution where the foreign language
they are best acquainted with— namely, English, is the
medium of instruction. The prestige accruing to
Britain and British medicine, were this fulfilled, must
surely be apparent to all, however narrow their im-
perialism; and it only wants one Governor of the
Colony of Hong Kong to take the matter in hand and
appeal to the patriotism of the nation to develop a
scheme of superlative importance to the welfare of
China and to the pre-eminence of Britain in the China
Seas.

———— $9 — ———

Abstracts.

Mosquitors AND YELLOW Fever (Moutiques et
Fiévre jaune). By Dr. Chantémesse and Dr.
Borel. 1 Vol. іп 16. Price 1s. 64. Bailliére et
Fils, Paris.

The subject is introduced by the following quotation
from Article 182 of Chapter V. of the “ Sanitary Con-
vention of Paris, 1903," on the subject of yellow
fever :—

“The countries specially interested are recom-
mended to modify their sanitary regulations in such a
manner as to bring them into relation with the actual
data of science on the method of transmission of
yellow fever, and especially on the part played by
mosquitoes as carriers of the germs of this disease.”

The following points have been established :—

(1) Тһаф the virus of yellow fever circulates in the
blood.

(2) That the mosquito Steyomyia fasciata, after
being itself infected for at least twelve days, is capable
of propagating the disease.

(3) That Stegomyia fasciata is the only mosquito
capable of playing this part.

The whole world is therefore divisable into two
vast regions; in the one Sleyomyia can live, it is con-
sequently liable to infection by yellow fever; in the
other Stegomyia cannot exist, and it is therefore not
liable to become infected.

The Stegomyia mosquito is widely distributed round
the earth, but its habitat is strictly defined by the two
parallels of 43° of latitude, both north and south; it
has never been found outside these limits, and any
country situated beyond these parallels ought to be
free from yellow fever.

А temperature of about 82? Е. is necessary to
enable the Stegomyia to exist in а normal condition,
and more especially to carry on its functions of re-
production, so that eveu under the most favourable
conditions if a few specimens of this insect were
brought to France or England by a ship, although

they might live for some days, their reproduction
could not take place.

A country liable to infection шау become соп-
taminated in one of iwo ways :—

(1) If a patient in the dangerous stage of yellow
fever is admitted thereto, aud if Stegomyia is found to
exist there permanently.

(2) By the importation of Stegomyia mosquitoes
previously infected, which after contaminating healthy
human beings, then find the conditions necessary for
their existence, and especially for their multiplication.

An interesting historical and critical study of the
several local outbreaks of yellow fever in Europe is
now given at some length, and from which the fol-
lowing conclusions are arrived at :—

Yellow fever has almost entirely disappeared from
Europe since 1870; the improvements iu shipbuilding
since this date have rendered diflicult the preserva-
tion, and especially the multiplication, of mosquitoes
on board modern vessels; there is no insurmountable
difficulty in eliminating from our ships the chance
specimens of Stegomyia which might occasionally
stray there (especially in the engine-rooms), and in
thus suppressing the last chances of propagating
yellow fever in our own country.

The prophylaxis of yellow fever may be summed up
as follows :—

In countries where Stegomyia exists, the patient
should be protected from mosquito bites, and the
insects should be destroyed wherever possible, as also
their breeding grounds.

In other countries, yellow fever may be considered
ав а non-contagious and non-transmissible disease,
caling for no special measures. The bodies of
persons dying of yellow fever in the Colonies may
therefore be brought home.

J. E. NicHoLsoN.

SOME OF TIIE REGULATIONS CONCERNING
PLAGUE, CHOLERA, AND YELLOW
FEVER DRAWN UP DURING THE
SECOND INTERNATIONAL SANITARY
CONVENTION OF AMERICAN STATES,
OCTOBER, 1905.

G.) ІммеЕрІАТЕ notification of the disease, stating
place, date, number of: cases, and, in the case of
yellow fever, whether the mosquito Stegomyia fasciata
is in the locality ; and in the case of plague, whether
rats or mice are infected.

(i.) Foreign countries to be notified through their
Consuls, aud weekly notifications to be issued until
the outbreak ends.

(ii. The exact limits of the area imputed to be
infected to be declared.

(iv.) Neither plague, cholera, nor yellow fever can
be transmitted by merchandise. It only becomes
dangerous in case it is soiled by pestous or choleraie
products, or, in the case of yellow fever, when the
merchandise may harbour mosquitoes.

(к) All rags and clothing from districts infected by

February 15, 1906.)

cholera or plague suspected of being soiled are to be
disinfected or destroyed.

(vi.) Ships infected with plague are to be subjected
to the following regulations :—

(1) Medieal visit (inspection).

(2) The sick are to be immediately disembarked
and isolated.

(3) Other persons should also be disembarked, if
. possible, and subjected to ап observation which
should not exceed five days, dating from the day of
arrival.

(4) Soiled linen, personal effects in use, the belong-
ings of crew and passengers which, in the opinion of
sanitary authorities, are considered as infected, should
be disinfected.

(5) The parts of the ship which have been inhabited
by those stricken with plague and such others as, in
the opinion of the sanitary authorities, are considered
as infected, should be disinfected.

(6) The destruction of rats on shipboard should be
effected before or after the discharge of cargo as
rapidly as possible, and in all cases with a maximum
delay of forty-eight hours, care being taken to avoid
damage of merchandise, the vessel, and its machinery.

For ships in ballast this operation should be per-
formed immediately before taking on cargo.

(7) On ships suspected of plague the crew and
passengers шау be subjected to observation, which
should not exceed five days, dating from the arrival of
the ship. During the same time the disembarkment of
the crew may be forbidden except for reasons of duty.

The destruction of rats on shipboard is recom-
mended. This destruction is to be effected before or
after the discharge of cargo as quickly as possible, and
in all cases with a maximum delay of forty-eight hours,
taking care to avoid damage to merchandise, ships,
and their machinery.

(vii.) If an area should no longer he considered as
infected, official proof must be furnished :—

First: That there has been neither а death nora
new case of plague or cholera for five days after
isolation, death, or cure of the last plague or cholera
case. Іп the case of yellow fever the period shall be
eighteen days, but each Government may reserve the
right to extend this period.

. Second: That all the measures of disinfection have
been applied ; in the case of plague that the precautions
against rats have been observed, and in the case of
yellow fever that the measures agains& mosquitoes
have been executed.

———9—— ———

Hotes and Hews.

NURSING ім INDIA.

The hospitals administered under the Dufferin
Fund and the Victoria Memorial Scholarship Fund
have increased their surgical and nursing staffs since
1898 by no fewer than ten lady doctors, seven assis-
tant surgeons, and 337 hospital assistants and women.

. The number. of women trained at the hospitals amounts
to 447. The Victoria Fund, founded by Lady Curzon
in 1901, has trained 160 native midwives, of whom
many are doing excellent work.

THB JOURNAL OF TROPICAL MEDICINE. 22-56

Tue PHILIPPINE “ JOURNAL OF SCIENCE."

The Government of the Philippines are publishing
a “ Journal of Science," commencing January 156, 1906.
The Journal is replacing the Bulletins of the Bureau
of Government Laboratories, and will include the
reports of the work done in all departments of the
Bureau. The editor is Paul C. Freer, M.D., Ph.D.,
the director of the Bureau of Science, with R. P. Strong,
M.D., and H. D. McCaskey, B.S., as co-editors. The
subscription price is five dollars, U.S. currency,
and the Journal can be obtained from the Director
of Printing, Manila, Philippine Islands, to whom
remittances are to be sent.

THERAPEUTICS.

Chase, Walter B., finds codein, іп 1 gr. to 4 gr.
or more given hypodermically, is more satisíactory
than morphia after abdominal section.

For the relief of intestinal paresis, salicylate of
physostigmina in rj; gr. to ұу gr. dose is recommended
by the same authority.

PUNJAB VETERINARY COLLEGE.

When the Ajmere Veterinary School was closed a
short time ago, the students and staff were transferred
to the Punjab Veterinary College, and about twenty
students joined. In view of the great demand which
exists for the services of veterinary assistants trained
at the Lahore College, which far exceeds the supply, it
was decided to increase the number of students con-
siderably and to improve the standard of education.
The extra staff from Ajmere made this practicable and
the Local Government has provided the extra accom-
modation necessary, and a new laboratory and class-
room have been built in connection with the segrega-
tion ward sanctioned by Sir Charles Rivaz, while a
spacious lecture-room and offices for a hospital have
also been erected.— Pioneer Mail, January 26th, 1906.

Poison ін Juan Еоррен.

Sra, —In the Pioneer of the 13th instant you mention
the poisonous effect of juari stalks as a curious thing,
but at least in the Northern Punjab апа Bar tract this
fact is known even to every zemindar child. This
phenomenon is limited to droughty seasons in Barani
tracts only, and to such fields of well-irrigated areas
also which have not been watered from wells. The
poison may be prussic acid, but the zemindars think
that a kind of very fatal and poisonous worm generates
in the stalk, and any animal (cow, bull, buffalo) which
eats the stalk certainly dies within ап hour or two, but
goats do not suffer a bit. То remove the poison,
zemindars, after cutting such stalks, sprinkle water
over them and then bury them for some hours under
blankets. Even a little quantity of rain removes the
poison from the standing stalks.— W. Pioneer Mail,
January 19th, 1906.

THE Medical College of Calcutta has received £6,000
out of the lac of rupees presented to the Prince of
Wales by the Maharaja of Darbhanga for distributi"
amongst Indian charities.

56 THE JOURNAL ОЕ TROPICAL MEDICINE.

[February 15, 1906.

A Силік оғ COLONIAL MEDICINE IN Paris.

M. Emile Flourens, the ex-Minister and present
Deputy for the Department of La Seine, advocates
the endowment of a Chair of Tropical Medicine in
Paris on the lines of those existing in the Schools of
Liverpool and London, and furthermore, that only
those medical gentlemen who have obtained the
diploma .in tropical medicine should be allowed to
practise in the Colonies; this much is due to the
troops, for whom little has been done; to the officials,
for whom still less has been done; and to the natives,
who, as a rule, have received nothing in return for
their loss of іпдерепдепсе.-// Europe Coloniale et
Diplomatique, January 24th, 1906.

ANKYLOSTOMIASIS PROPHYLAXIS.

In Belgium, by the establishment of dispensaries for
the miners afflicted with ankylostomiasis, and the pay-
ment of 1 france 50 cents. continued daily until the
cure was complete, the disease has been stamped out
in five of the largest mines.

Desert Самгв: A PRoroskD METHOD оғ TREATMENT.

Felkin, R.. W., holds (Treatment, January, 1906)
that camp-life in the real desert at a distance from
towns gives a genuine mental and bodily rest unob-
tainable elsewhere. The expenses should not be
much more than in а large hotel in a city.

On the evening of December 15 last the first official
banquet of the ** International Medical Association for
the Suppression of War" was held in Paris at the
Hotel Continental. .

There were about fifty members present, all of them
belonging to the medieal profession. Тһе chair was
taken by Dr. J. A. Riviére (of Paris), the founder aud
President of the Association.

The after-dinner speeches were all against war, and
great stress was laid on the preponderating part which
the medical profession throughout the world, by
reason of its influence on Society, is called upon to
fill in this work of realising univeraal peace.

The following gentlemen spoke: Professors Langlois
апа Richet, Doctors J. А. Біуіеге, Maréchal, Grellety,
Suarez de Mendoza, Mazery, Cogrel, and Bérillon.

Although this Association is only a year old, it
already numbers 600 members, all of them medical
men, and iucludes more than 200 professors of all
nationalities.

А NEW GERMAN SLEEPING SICKNESS COMMISSION.

The Medical Weekly of Berlin announces that
Professor Robert Koch has been commissioned by the
Imperial Government to proceed to East Africa in
order to resume his investigation into the causes of
the sleeping sickness. Professor Koch proposes to
sail at the beginning of April, and it is understood
that he will make Entebbe, in British Uganda, the
headquarters for his first series of expeditions. lt is
anticipated the expedition will last about eighteen
months, and £6,000 has been allotted for the expenses
of the first year. ;

As our readers are aware, Professor Koch has
already passed some time in East Africa in the study
of this and kindred diseases, but in view of the suc-
cessful work of the English commissions engaged in
the investigation of sleeping sickness, there is little
beyond matters of detail left for Professor Koch’s
investigation from the etiological standpoint. On this
account the Germans would perhaps have been wiser
to have sent some of their admirable, economic
entomologists to study the question of checking the
multiplication of the flies concerned in the trans-
mission of the disease, as this department of the

army of science is one in which England is, unfortu-

nately, very short handed; and this most practical
question appears at present to be almost untouched.

THE more than usually mild winter in Britain con-
trasts peculiarly with the weather experience in
Algiers, where deep snow has fallen, breaking down
telegraph lines, blocking the railways and causing
great damage to property.

The establishment of a medical school for Burmese
is contemplated in Rangoon.

-----о--

Drugs,

TRYPSIN IN CARCINOMA.

Tryrsin is being given by many practitioners іп
Britain at the present moment in cases of carcinoma.
Perhaps the best method of exhibition is hypoder-
mieally, ав all possibility of total destruction of the
ferment in the stomach is avoided.

Messrs. Allen and Hanbury, 7, Vere Street, London,
W., supply Liquor Trypsin Co. for internal use;
Injectio Trypsin Co. for hypodermic use, and Pigment
Trypsin Со. for local use.

MALARIAL Fever axp Dnvas.

WE publish a portion of a letter from Mr. J. Н. Nie-
mann, Daly River, Northern Australia, which ap-
peared іп the Chemist and Druggist of February 3rd,
1906: “ Is anything known or published regarding the
manner in which malarial fevers modify the normal
effects of drugs and of other germ diseases? . . . .
I have ascertained from painful experience that bella-
donna cannot be safely given to any person whose
system is impregnated with malaria, except in infini-
tesimal doses; that the effects of many other drugs
are diminished or inereased ; and have strong reasons
for asserting that the benign malaria of North Aus-
tralia greatly modifies all other germ diseases, if it

does not entirely prevent them. Тһе first point, re- .

garding the effect of drugs, is of great importance to
the prescriber; the second, regarding the prevention
of other diseases, is important to everyone, especially
as tuberculosis is included in the list of ‘other
diseases.’ "

We must confess we are unable to make any definite .
answer to Mr. Niemann on this subject. The sugges--

tion is & novel one, but it is possible, now that the
attention of our readers has been directed to the action

February. 15, 1906.)

THE JOURNAL OF TROPICAL MEDICINE. 57

of drugs in persons suffering from malarial infection,
that some information may be forthcoming from
medical men engaged in practice in the tropics.

-------о-
Books and Papers Siecciocb.

PROSTATISM WITHOUT ENLARGEMENT OF THE PRos-
TATE. By О.Н. Chetwood.,

Chetwood attributes the signs and symptoms of
so-called prostatic irritation when the prostate is not
enlarged to contracture of the neck of the bladder, in
other words, a fibrous stenosis of the vesical orifice.
He does not recommend cutting the stricture, but
galvano-prostatotomy through a perineal opening by
means of an instrument he hasdevised. His pamphlet
is a reprint from the Annals of Surgery, April, 1905.

---------
Becent and Current Miterature.

A tabulated list of recent publications and articles bearing on
tropical diseases is given below.
any branch of tropical literature mentioned in these lists
the Editors of the JouRNAL OF TROPICAL MEDICINE will be
pleased, when possible, to send, on application, the medical
journals in which the articles appear.

“ American Medicine,” January 6, 1906.

MALARIA INFECTION IN KURDESTAN.
Underwood, H. L., considers that in Kurdestan malaria
is not only carried by mosquitoes, but also by bed bugs,

lice and fleas. І

Several species of mosquito, including some
Anopheletes, however, occur in Central Asia, and from
the point of view of comparative helminthology, any

such means of transport of malaria as that suggested .

is in the last degree improbable.

“Le Nevis Scientifique,” November, 1905.
CHOLERA PROPHYLAXIS.

Chantemesse, A., and Borel, F. contend that no person
suffering from cholera should be allowed to enter an unin-
fected country. He should be quarantined, the -clothes
disinfected, food and drink carefully examined, protection
against fly contamination, especially where latrines are

defective, and every precaution taken to prevent gastric and.

intestinal upset.

Such recommendations are, however, of а most
reactionary type, and if adopted, would carry us back
to the bad old days of quarantine. Modern sanitary
practice has shown that, under proper precautions,
there is no danger whatever in landing cholera
patients, and the adoption of these modern measures
have rendered the importation of cholera practically
impossible in every country where they have been
employed. . Quarantine has been abolished by all the
more civilized nations because it had proved itself un-
practical and inefficient. 0

“ American Medicine," January 13, 1906.
AMERICAN Hookworm. А

Stiles, С. W., and Goldberger, Ј., find that the eggs of
Necator americanus may hatch the rhabditiform embryo in
less than twenty-four hours. When the young intestinal
stage of the worm is placed on the skin of the back of
dogs and rabbits the worm penetrates the skin, and reaches
the small intestine in from eight to twelve days.

To readers interested іп.

“Journal of Cutaneous Diseases,” January, 1906.
TROPICAL ULCERATION oF Nose, PHABYNX, AND LARYNX.
Fordyce, J. A., describes a case of ulceration of the upper

air passages, which began with an offensive muco-purulent
discharge from the nose. The nose enlarged and ulcerated,
the septum necrosed, the uvula disappeared, and the soft
palate presented a worm-eaten appearance; the tongue
became atrophied at the base, and the pharynx and larynx
showed ulcerations and old cicatrices.

A condition similar and probably identical with the case
described was met with by Dr. W. F. Arnold at Guam іп
1902. Dr. Arnold found 5 per cent of the population of
Guam suffering from this ailment. Тһе disease is neither
tubercular nor syphilitic. Breda has described analogous
ulcerations amongst Italians returned from Brazil, and
named by him Ғғатбовіа Brasiliana, or Boubas.

The above is of interest in connection with the
paper on “ Rhino-pharyngitis Mutilans," by Surgeon
J. E. Leys, M.D., U.S. Navy, published in another
column, as it seems probable that both papers refer to
the same condition.

* Boston Med. and Surg. Journal," January 11, 1906.
MALARIA IN THE PHILIPPINEs.

Chamberlain, W. P., from the study of 120 cases of
malaria in Camp Gregg, Philippines, concludes that (1) large
numbers of anopheles increase the malarial index; (2) Quar-
tan infections were infrequent ; (3) (Estivo-autumnal infec-
tions were remittent 85 per cent., quotidian intermittent 25
per cent., tertian intermittent 30 per cent. ; (4) no distinctive
parasites were recognised in the wstivo-autumnal infections.

“Nature,” January 4, 1906, p. 235.
INSECTS AS CARRIERS OF DISEASE.

Shipley, A. E., F.R.S., publishes an address to the
British Association at Pretoria under the above title.
From the nature of the occasion it can hardly be expected to
contain any information that has not appeared in these
columns, but it forms, nevertheless, a most convenient and
up-to-date resumé of our knowledge on the subject, which
may be consulted with advantage by any one requiring a
handy reference paper on this question.

* Indian Med. Gazette," January, 1906, p. 7.
THREE Days’ FEVER оғ CHITRAL.

McCarrison, Captain R., I.M.S. Тһе author describes his
paper ав a contribution to the unclassed fevers of India. As
may be gathered from the title the attacks are short, but
they are also sharp, the principal subjective symptoms being
bone-aches and frontal headache.

Though hitherto returned as such, the disease is
not malarial, as the blood contains no parasites, either
protozoal or bacterial. It can hardly be influenza, as,
though seasonal, it is confined to the hotter times of
the year, coinciding with the mulberry harvest. It is
not contagious, though houses and places become
infective, so that the disease can only be acquired by
visiting them. Those who have suffered are immune
to subsequent attacks. Quinine is useless, either re-
medially or as a prophylactic, and treatment resolves
itself into measures to diminish the patient's discom-
fort, such as sponging and douching.

Many years ago the writer met with exactly similar
cases in Natal, and indeed suffered in his own person.
At that time the cases were locally known to the
profession as “ dengue," and were, he believes, usually
returned as such.

The uniformly rapid and complete recovery, how-
ever, made any such a diagnosis quite untenable, so
that personally he returned them as '*febricula," for
want of any better term.

58 THE JOURNAL OF

TROPICAL MEDICINE.

[February 15, 1906.

He feels, however, little doubt as to the identity
of the clinical pictures, and it is to be noted that
Captain MeCarrison, while rejecting the diagnosis,
remarks on its similarity to dengue.

We should like to hear from our readers in Natal
and Zululand whether such cases are still met with
there, and would in such case draw their attention to
the circumstance that Captain McCarrison evidently
suspects sandtlies of being the transmitting agents of
the disease, and so suggests the prophylactic use of
mosquito nets.

* Revista de Med. y Criug," Vol. ix., No. 22, 1905.

ANAKHRE OR GOUNDOU.

Ayala, A., Havana, reports a case of goundou occurring in
Caracas, Venezuela, in à white man, aged 39. The growth
on either side of the nose was symmetrical, The man was
otherwise quite healthy.

* Reforma Medica," August 12, 1905.

SUBFEBRILE TEMPERATURE OF ANKYLOSTOMIASIS.

Gabbi, W., states that slight elevations of temperature are
present in ankyvlostomiasis, This state, which he terms
** subfebrile," is present in severe cases only. The elevation
in temperature is irregular, there is either an evening rise,
an intermittent, or an irregular subcontinuous type. Caliri
finds albumose present in the blood of persons with anky-
lostomiasis, and believes that it is the presence of albumose
in the blood which determines the rise in temperature.

* Quarterly Journal Microscopical Science," November, 1905.
OBSERVATIONS ON Н жматолол IN CEYLON.

Castellani, Aldo, and Willey, A., state they discovered in
human blood fine ** vermicules? of crescentic form, rather
longer than the diameter of a red corpuscle, eharacterised
by the absence of pigment and presence of vacuoles. The
specimens were taken from a case of * fever," which showed
no malarial parasites and a negative Widal reaction, and are
not at all unlike certain known trypanosomes in certain
stages of development. Similar bodies were found in the
finger blood of fever patients, and the authors do not appear
to consider them as freed and altered “crescents,” or as
necessarily connected with malarial parasites at all. Similar
bodies were found in & babbling thrush and in the Indian
crow.

“С. R. Soc. Biologie,” Т. lix., pp. 240-245.
SERUM DIAGNOSIS OF MEDITERRANEAN FEVER, «с.

Nicolle, C. employs for serum diagnosis cultures of
Ше B. melitensis, three to six days old, оп ordinary
gelose, emulsified without preliminary grating in physio-
logical water or bouillon. The suspected serum is added
to this in the proportion of 3. 1, үр pe Ap and (215, in small
test tubes, and the examination is made after sixteen to
twenty hours. When distinct agglutination, to the naked
eve and under the microscope. is obtained in ту dilutions, he
considers that the diagnosis of Malta fever may be taken as
proved,

In the second paper he records the results of the appli-
cation of Wright's serum reaction to the cases of thirty-live
paticnts affected with various other infections, and shows
that serum drawn from them had little or no agglutinating
action on the B. melitensis,

In collaboration with M. Hyat. in the same publication,
he gives results showing the value of the procedure in actual
practice.

In five cases, which were ultimately proved not to be
instances of. Milta fever, the action was negative, while in
thirteen others, which presented throughout the clinical
picture of Malta fever, it was positive.

The leucoeyte formula of Malta fever is an intense
mononucleocytosis amounting to НО per cent. of mono-
nuclear cells.

“С. R. Soc. Biologie," T. xix., pp. 302-30.
DIAGNOSTIC VALUE OF POLYNUCLEAR HYPERLEUCOCYTOSIS ОР
Віоор ік TrovicaL ABSCESS OF LIVER.

Khouri, J., out of ten cases exiunined, found the number
of leucocytes was normal in one, subnormal in four, while
three showed moderate, and three pronounced leucocytosis.
From this it is evident that the syinptom or its absence
is of little or no diagnostic value.

* Amer. Naturalist,” xxxix., pp. 601-724.
THE INTERRELATIONSHIPS OF THE SPOROZOA.

Crawley. H.. regards the relationships between the sub-
classes Telosporidia апа neosporidia ав vague, so that
the class, taken as а whole, may not even belong to a
single phylum. Amongst the Telosporidia he regards
the gregurines as the most primitive form, and, amongst
the latter, the polveystids. M. F. Mesnil, the well-known
protozoologist, commenting on this paper in the current
Bulletin de l'Institut. Pasteur, notes that Crawley ignores
the now well-recognised intestinal monocystids, and states
his opinion that it is amongst these that the ancestral form
should be sought. Both, however. are agreed in consider-
ing the Shigogregarines as derived from the Engregarines.
He looks upon the Coccidia and the Hiemocytozoa as closely
allied, and во approves of Dotlein combining them under
the title of Coccidiomorpha.

* C. В. Soc. Biologie,” lix., p. 308.

ABSORPTION OF TUBERCLE BACILLI BY FRESHLY SHAVEN

SKIN.

Nouri, Osman (Inst. Bacter., Constantinople), shaved
the inguinal region of guinea-pigs, und then rubbed them
with absorbent cotton, fouled with tuberculous sputum, with
the result that the corresponding lymphatic glands became
swollen in eight to fifteen days, and the animals died in
from thirty to fifty davs.

This is hardly pleasant reading for those who do
not shave themselves, and, in view of the rudeness of
of the tonsorial art in Mahommedan and other coun-
tries where the victim is scraped with a blunt razor,
moistened with water, which the operator not unfre-
quently supplements, in awkward corners, with saliva,
may account for the puzzling location of certain
tubercular lesions occasionally met with in such
countries, where the portions of the body habitually
shaven are much more extensive than is anywhere
the case in Europe.

“Centralb. fiir Bakt. Parasiten. u. Infektionskrank,”

xxxix., рр. 610-613.
A New. CERTAIN, AND HARMLESS METHOD OF ІММСМІЗА-
TION AGAINST PLAGUE.

Huetope, F., and Kiruchi, J. by experiments based
on those of Bail, show that an "'agressine" effective
against plague can also easily be obtained. А single
injection prolonged the life of animals subsequently inocu-
lated with plague, and a second infection enabled them to
resist the action of an infection surely fatal to controls,
always provided that the inoculation be not practised too
soon after the second, in whieh ease the morbidity of an
infection is not diminished but enhanced.

They accordingly claim to be the first to devise a sure and
harmless plan of immunisation.

* Ann. Soc. Entom.," Paris, Ixxiv., pp. 20-28.

EGG DEPOSITION AND THE LARVAL LIFE ОҒ THE TABANID Ж.

Leguilon, А. Ав the Таһапійе are implicated in the
transmission of trypanosomes, the author's observations
on T. quatuornotatus, Meig., possess a special interest for
our readers,

Тһе eggs are laid in bunches in places that may be either
dry or moist, for instance, on the leaves of plants, and are
at first white. but soon darken. As is already known, some

` months’

February 15, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE. 59

larve may be aquatic and others terrestrial, and that their
habits are carnivorous. The eggs of the species under
consideration hatched out in fourteen days (in June), and
are white and transparent.

They feed on dead prey and on organic detritus, and per-
haps even on sluggish living animals.

They can live under varied conditions of moisture, and
even in water. Further observations are promised.

———— ——— — —

Personal Hotes.

R.A.M.C.

Embarkations. — For India: Lieut.-Cols. В. J.
MoCreery and J. М. Е. Shine; Majors Т. W. Gibbard
and H. A. Hinge; Lieuts. J. Campbell, W. H. Hills,
J. P. Lynch, W. G. Maydon, and L. V. Thurston.
For Mauritius: Lieut.-Col. A. Peterkin; Capt. C. 8.
Smith ; and Lieuts. P. Power and C. S. Wallace. For
Malta: Major C. C. Fleming, D.S.O., and Capt.
Н. S. Anderson. For West Africa: Major G. T.
Rawnsley and Capt. J. MeD. McCarthy.

Ceylon (November 1, 1905).—Lieut.-Col. В. D.
Hodson, Capt. L. M. Purser, and Capt. T. B. Unwin,
R.A.M.C., are under orders for England, tour expired,
and will probably leave Ceylon on January 3rd, 1906,
in His Majesty's transport Dunera. Lieut.-Col. G. Н.
Sylvester, Capt. Е. C. Hayes, and Lieut. C. В. Miller,
В.А.М.С., are expected by the same boat on November
30th, 1905.

Lieut.-Col. G. H. Sylvester, R.A.M.C., takes over
the command of the Royal Army Medical Corps and
Senior Medical Officer of the Troops іп the Ceylon
Command. Capt. E. C. Hayes and Lieut. C. R.
Miller, R. A.M.C., will be stationed in Colombo, the
former performing the duties of Sanitary Officer in
addition to ordinary duty.

Sierra Leone.—Capt. Н. W. Grattan, R.A.M.C.,
writes (November 24th, 1905): Capt. W. H. S. Nicker-
son, V.C., arrived on November 23rd, for a tour of
service.

Simla (India).—Capt. E. Blake Knox, R.A.M.C.
Secretary to the Principal Medical Officer, His
190p rs Forces in India, writes (November 23rd,

“ Appointments.— Lieut.-Col. A. W. P. Inman, M.B.,
R.A.M.C., to officiate as Principal Medical Officer, 8th
(Lucknow) Division, vice Col. G. D. N. Leake,
R.A.M.C., granted leave out of India. Lieut.-Col.
J. R. Dodd, R.A.M.C., to officiate as Principal Medical
Officer, Bareilly and Gharwal Brigades, vice Col. G.
J. Kelly, І.М.б., appointed to officiate as Principal
Medical Officer, 7th (Meerut) Division. Col. H. R.
Whitehead, R.A.M.C., to officiate as Principal Medi-
cal Officer, 2nd (Rawal Pindi) Division, vice Col.
B. M. Blennerhassett, C.M.G., R.A.M.C., granted six
sick leave out of India. Lieut..Col. D.
O'Sullivan, R.A.M.C., to officiate as Principal Medical
Officer, Abbotabad and Sialkot Brigades, vice Col.
Whitehead, R.A.M.C., transferred to Rawal Pindi
temporarily. Lieut.-Col. D. O'Sullivan bas also been
confirmed to the Command of the Station Hospital,
Rawal Pindi, with effect from November 4th, 1905.

Capt. W. R. P. Goodwin, R.A.M.C., to be Personal
Assistant to Principal Medical Officer, Northern Com-
mand, vice Capt, E. T. F. Birrell, R.A.M.C., vacated.
Lieut. S. C. Bowle, В А.М.С., to be Dental Specialist
in Western Command."

Singapore (Straits Settlements). — Lieut.-Col. W.
Dick, R.A.M.C., writes (November 2nd, 1905): “Тһе
following officers are tour expired. Lieut.-Col. W.
Dick, Major J. H. E. Austin, and Capt. б. F. Sheehan.
Notifieation has been received that these officers are
to be relieved in December by Lieut.-Col. H. H.
Johnson, C.B., Major C. B. Martin, and Lieut. G. A.
D. Harvey. Major J. Ritchie, who was also tour
expired, has been permitted to extend his service in
Singapore for another year.”

The services of Capt. J. Tobin, R.A.M.C., on the
Aden Boundary Commission, have been brought to the
special notice of the Commander-in-Chief.

INDIAN MEDICAL SERVICE.

Major Molesworth, I.M.S., Captain Vane and
Captain Popham, now on Lord Ampthill’s Staff, have
been appointed to serve on the Staff of Sir Arthur
Lawley, the Governor-designate of Madras.

Major E. R. Parry, M.B., L.M.S., is appointed
temporarily to be Superintendent of the Dacca
Central Gaol, vice Mr. W. А. С. Beadon, retired, with
effect from the date of receiving charge of the office.

The services of Captain A. C. MacGilchrist, M.B.,
І.М.8., are placed at the disposal of the Government
of India in the Home Department.

Captain W. D. Ritchie, M.B., I.M.S., Civil Surgeon,
is posted to Jalpaiguri. i

Major J. S. S. Lumsden, I.M.S. Civil Surgeon,
Bahraich, furlough on medical certificate for one year,
from December 23rd.

Consequent on the death of Honorary Captain G.
McCall, I.S.M.D., Civil Surgeon, Babu Kedar Nath
Bose, Officiating Civil Surgeon, Jaunpur, to be con-
firmed as a Civil Surgeon.

To be Major: Captain Hugh Bennett, M.B.,
F.R.C.S.E.

SANITARY—PLAGvuE.

Lieutenant-Colonel W. B. Bannerman, M.D., I.M.S.
(Madras), Director, Plague Research Паһогафогу,
Parel, is granted privilege leave for three months,
with effect from November 18th.

Captain G. Lamb, M.D., I.M.S. (Bengal), is ap-
pointed to officiate as Director of the Plague Re-
search Laboratory, Bombay, during the absence on
leave of Lieutenant-Colonel W. B. Bannerman, M.D.,
І.М.8., in addition to his special duty under the
orders of the Sanitary Commissioner with the Govern-
ment of India.

DEPARTMENT OF REVENUE AND ÁGRICULTURE.

Mr. R. E. Montgomery, M.R.C.V.S., Civil Veter-
inary Department, is appointed with effect from
December 8th, 1905, to make, under the orders of the
Inspector-General, Civil Veterinary Department, a
special investigation into the diseases of camels.

60 THE JOURNAL OF TROPICAL MEDICINE.

CoLONIAL MEDICAL SERVICE.

Dr. W. T. Kergin, of Port Simpson, British
Columbia, has taken over the duties of a Medical
Health Officer in that Province of the Dominion.

Fry.—The selection of Dr. W. H. Fry, Colonial
Surgeon of Province Wellesley, North, Straits Settle-
ments, for the office of State Surgeon of Pahang,
Federated Malay States, has been approved by the
Secretary of State.

Purcuas.—Dr. Е. А. G. Purchas, District Medical
Officer for Newport, Manchester, Jamaica, has been
transferred to Swanswich Trelawny, in place of Dr. C.
T. Dewar, who has retired from the service.

The offices of Dr. E. H. Bannister and Dr. J. W.
Hawkins as Health Officers for the Port of Bridge-
town, Barbados, have been abolished on the coming
into operation of the new Quarantine Ordinance.
Both officers receive gratuities.

Dr. J. White Hopkins, Assistant Medical Officer,
Sarawak, acts as Principal Medical Officer and Super-
intendent of Indian Immigrants during the absence on
leave of Dr. A. J. G. Barker.

Dr. F. O. Stedman has been made а Member of the
Medical Board of Hong Kong, and will serve as
Secretary of the Board in place of Dr. Alexander
Rennie, who has resigned.

Dr. Alexander Rennie has permanently retired
from practice in Hong Kong.

Dr. Smartt has arrived in England from British
Guiana.

Dr. Ireland has arrived in England from Trinidad.

COMMERCIAL CORPORATIONS.

Baeas.—Dr. J. б. Baggs has been appointed
Medical Officer to the Para Electric Railway and
Lighting Co., of Brazil, and leaves England about
February Ist.

DoMEsTICc.

Macnicon.--At the Medical Mission House, Kalna,
Bengal, on January 20th, 1906, the wife of the Rev. Malcolm
Maenicol, M.B., C.M., of a son.

Inuius—Forp.—At St. John’s Church, Calcutta. on
December 80th, 1905, by the Rev. С. R. T. Winckley, Henry
Warwick Illius. Capt. I.M.S., to Frances Elsie, younger
daughter of the late Matthew апа Mrs. Ford.

PLAGUE.
PREVALENCE OF THE DISEASE.

Cases. Deaths.

India.—Week ended Dec. 9th... — 8,075
? » 16th... — 3,947
n » 28rd... 4,182 3,170
3 » 30th... 5,184 4,278

South Africa.--No plague up to January 20th, 1906,
in any part of South Africa since November 18th,
1905, when one case was reported in Port Elizabeth.

Rats and mice were still found plague-infected in
Port Elizabeth on January 20th.

Cases. Deaths.

Mauritius.—Week ended Jan. 5th... 4 4
ні » 19th... 4 3
А » 19th. 1 1
Ai „ 26th.. 1 1
Я Feb. 2nd. 2 1
E » 9th. 1 0

Cases, Deaths.

Hong Kony.—Week ended Jan. 8rd... 2 2

» » 6th... 2 2
a » 10... 6 6
i » 27th... 1 1

Persia.— Plague prevailed in the Maisar district of
Seisan on January 22nd.

Cases. Deaths.

Zanzibar.-—Week ended Oct. 14th... 15 8
m Nov. 4th... 12 —

Egypt.—Case of plague reported in Alexandria on
November 7th.

- Australia.—No fresh cases of plague in Queensland
since September 14th. As late as December 20th, 1905,
plague-infected rats were found in the neighbourhood
of Darling harbour.

Sydney. —Nine cases of plague occurred on а French
mail steamer which called at Sydney, and infected rats
were found on board the vessel.

Brazil.—From January lst to October 22nd, 1905,
there were 91 deaths from plague in Rio de Janiero.

Madeira. — The report that plague existed at
Madeira is contradicted.

Tue CAMPAIGN AGAINST THE Rats IN RANGOON.

Tux total number of plague cases for December was
98, with 91 deaths, against 113 cases and 110 deaths
during November. The incidence of the disease was
heaviest among the low-class Hindu population. One
hundred and thirty-two rats were examined, of which
27 were found infected with plague. Fourteen thou-
sand six hundred and sixty-six rats were destroyed
during December. Although the total number of
cases was less in December than in any previous
month since the outbreak of the epidemic in February
last, yet no quarter of the Municipality was free from
the disease during the whole month. No case is re-
ported from Cantonments. The centres of the infection
appear to be widely scattered throughout the muni-
cipal area, and there is no indication that the disease
has been stamped out in any locality.—Pioneer Mail,
January 12th, 1906.

Рглвов RESEARCHES.

(1) M. Herzog, from experience of plague gained in
the Philippines, finds a hyaline fibrin thrombosis in the
glomeruli of the kidney; in post-mortem examination
of seven out of twenty cases of plague, Dr. Herzog
believes that plague is not a true septicemia, but a
local lymphatic infection, and that the universal dis-
semination of the infecting bacilli through the blood
current generally only occurs during the agonal stage.

{February 15, 1906.

—————

February 15, 1906.)

THE JOURNAL OF TROPICAL MEDICINE. 61

(2) R. P. Strong has succeeded in preparing a
vaccine against plague. He uses the living plague
organisms in his protective inoculations. So far, the
experiment has proved successful in rats.— Manila
Medical Society, November 22nd, 1905.

——9— ——

Reviews.

Patent loops AND Patent Мерісіхея. Two lectures.
By Robert Hutchison, M.D., F.R.C.P. Second
edition. John Bale, Sons апа Danielsson,
Ltd., Oxford House, 83-91, Great Titchfield
Street, Oxford Street, London, W., 1906. Price
1s. net.

It is time some one spoke out freely about patent
foods and patent medicines, and Dr. Robert Hutchison
has done so in fearless terms. Some of his remarks
are most telling and express what every medical man,
who thinks at all, must have frequently wished to
express. He says, “ most patent foods exist because
certain persons have found that it pays to produce
them’; and, we might add, the benefits they bestow
upon the public are confined to those few who profit
by the production of the articles. The further state-
ment that of the patent foods “ поб one of them is
worth the money asked for it,” is an expression of
opinion with which every medical man will coincide ;
and that it is merely the fact that patients will more
readily listen to their doctor when he advises patent
foods, in place of simple foods prepared at home, that
any medical man would ever think of recommending
them. The honesty of the doctor is thereby strained,
but as he has to live he, calling it tact, agrees with
the patient's desires. In regard to patent medicines,
Dr. Hutchison shows that they are compounded for
the most part of the usual pharmacopoeial drugs in
ordinary use, and attributes their reputation to “ per-
sistent and audacious advertisement." Belief in
quackery and patent medicines is “ав rife, nay, I
venture to say is more rife, in Belgravia than in
Bethnal Green,” so that so-called education has
nothing to do with their belief in the efficacy. These
lectures should be read by every practitioner at home
and abroad, as he will be thereby better able to
guard his patients against the patent food vendor,
who is destroying the health and emptying the pockets
of a credulous publie, and to stem the iufluenee of
quackery, which tends to react deleteriously upon the
character of the people of any nation. One means of
obtaining “ certificates of cure" Dr. Hutchison has
not told us, it is this: An agent for a patent medicine
finds out from a tradesman those of his customers who
owe bim money. He buys the bad debts for a small
sum, proceeds to the houses of these customers and
informs them that if they will take his medicine for a
week, and at the end of the week state that the
medicine has done them good or cured them, he will
pay the bill they owe to the tradesmen. This method
of obtaining evidence of cure needs no comment, but it
is one which was told in the public press lately.

EXAMEN DE 43 CAS DE PALUDISME PROVENANT DE

RéaroNs Tropicatrs (An Examination of 43 Cases
of Malaria from Tropical Regions). By Surgeon-
Major A. Billet, Chief of the- Bacteriological
Laboratory at the Military Hospital at Marseilles.
Extract from the Minutes of the Societe de
Biologie. (Meeting held on November 25th,
1905.) |

During the year 1904-1905, Dr. Billet was able to
make notes on 43 cases of malaria which came from
the Tropics, viz., Madagascar, Tonkin, Senegal,
Ivory Coast, and the Soudan. They were divided as
follows :—

(1) Primary tertian ague, simple or double,
characterised in all cases by small schizonts, annular,
slightly or not at all pigmented, with crescents.
Endogenous forms of multiplications rare or even
absent in the circulation. Schiiffner’s dots scanty. (20
cases.)

(2) Secondary tertiam ague (chronic), simple or
double, characterised by large schizonts, &mooboid,
black pigment abundant, rounded gametes. Endo-
genous forms of multiplication, with from 16 to 20
merozoites. Schiiffner’s dots plentiful. (18 cases.)

(3) Quarian ague, characterised by pigmented
schizonts, smaller than those of secondary tertian
type, and by gametes, also rounded, but smaller.
Segmentation forms show eight merozoites at most.
No Schiiffner’s dots in the infected blood cells
(5 cases).

According to Laveran both the small and the large
forms belong to the same pathogenic agent. Dr.
Billet verities this assertion, inasmuch as it applies to
the tertian type of ague, which is more commonly
found in the French colonies generally; in fact, he
quotes four cases where he was able to study the
transformation of the small tertian parasitic rings
into large pigmented parasites of the same type of
malaria, which he designates as secondary ague.

He considers the parasite of quartan ague as be-
longing to a distinet species from that of tertian ague.
He was only able to observe crescents in two authentic
cases of quartan ague.

WITH THE ABYSSINIANS IN SOMALILAND. By Major
J. Willes Jennings, R.A.M.C. (Hodder and
Stoughton.) i 4 e

Although in no sense a medical work, but a well-

“written and breezy book of travel, this book will be

interesting to all our readers as a lively illustration of
the evidences of the field of adventure and interest
open to those who follow up the profession of medicine
in tropical lands. Major Jennings was in medical

‘charge of the little knot of British officers who were
-attached to the Abyssinian Army which co-operated

with us against the much misnamed ** Mad Mullah ” ;
and his adventures make pleasant reading, and con-
vey to the reader in excellent colloquial English a

. vivid idea of the country and its primitive inhabitants.

Those who have shared in similar expeditions will
not be surprised to find Major Jennings devoting more
of his time to veterinary surgery than to human

62 THE JOUBNAL OF TROPICAL MEDICINE.

[February 15, 1906.

medicine, for the Abyssinian soldiers proved so
healthy as to seldom require any other treatment
than an occasional dose of male-fern, while the
efficiency of the transport animals depended greatly
on his scientific and devoted attention.

As might be expected, however, the book is by no
means devoid of interesting medical observation. He
notes, for example, how ill the fish-eating theory of the
causation of leprosy fits in with the facts of the case
in Abyssinia, where there are some 8,000 lepers who
can rarely, if ever, have eaten fish, owing to the
scarcity of the article in a country where '' during the
greater part of the year many of the wells do not
contain water, much less fish." His remarks on the
enormous practical sanitary value of tropical sunlight
are also interesting, as he doubts if the inhabitants of
the terribly insanitary Abyssinian towns could survive
at all but for the “ merciful dealings of a tropical sun,
which can well-nigh convert the smell of a pole-cat
into the aroma of a nosegay." His instance of the
disappearance of cholera effected by removing troops
from & warm, damp, shady site, to a bare, breezy,
tropical plain, is most instructive. He notes, too,
that the greater part of Abyssinia is practically free
from malaria.

It is mainly, however, as a book of travel and
adventure that the book is to be commended, and
from this point of view it is one of the best that has
appeared for some time.

<
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Bell, W. D. Beri-beri in the Philippine Islands. An. Therapist,
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Borel, Е. Le béri-béri nautiquo d'aprés les travaux les plus
récents. Normandie mid., Rouen, 1905, хх.

Crozier, G. С. An outbreak of true beri-beri among the students
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Gesellsch. zu Tokyo, 1905, xix.

Turner, б. А. Ship beri-beri. Erit. M. J., London, 1905, i.

Uchermann, Y. Ош beri-beri. Norsk Mag. f. Lagevidensk.,
Kristiania, 1905, 5, R., iii.

Vintras, L. Beri-beri. Hospital, London, 1904, xxxvii.

Wall, J. 8. Case of beri-beri. Wash. M. Ann., 1904.5, iii.

Winter, Н.Е. Observations on beri-beri. J. Roy. Army Med.
Corps, London, 1905, iv.

Wright, H. The successful application of preventive measures
against beri-beri. J. Hyg., Cambridge, 1905, v. i

An outline of acute beri-beri and its residual paralysis,
Rev. Neurol. and Psychiat., Edinburgh, 1905, iii.

Yamagiva and Yamanal. (The nature of beri-beri.)
Tji-Shinshi, 1904.

Yamagiwa, K., and Yamanouchi.
(beri-beri). Beitr. 2. wissensch.
Ernst Salkowski, Berlin, 1904.

Tokyo,

Ueber das Wesen дег Kakké
Med. u. Chem. Festschr.

———— di9———————

Correspondence.

THE REVIEW OF HUGGARD'S HANDBOOK OF
CLIMATIC TREATMENT.

То the Editors of the JOURNAL оғ TRoPICAL MEDICINE.

Sins, —While thanking you for the favourable notice of my
Handbook of Climatic Treatment іп your issue of January
15th, may I be allowed a word of comment ?

The reviewer says ‘‘there are occasional errors, as, for
example, the explanation of the comparative coldness of the
upper layers of the atmosphere, which is said to be mainly
due to the physical law of the expansion of gases." Now
this law explains only the rather exceptional case of up-hill
winds, but the absorption of heat from expansion under
these cireumstances would rapidly be replaced by the sun's
rays, were it not for the true reason, which is the universal
operation of the law of selective absorption. Air, whether
dry or wet, is very transparent to short-wave rays, but
absorbs the long. dark heat waves, such as are radiated by
the ground, and therefore acts in the same way as the glass
of a green-house, forming a sort of heat-trap. Тһе more
dense the atmosphere, the more eflicient it is in this respect,
and hence naturally the rarer upper regions, being less
efficient heat-traps, do not trap as much heat.

“ Moist air is a much better trap than dry air, but this
does not affect the explanation, as under any circumstances

February 15, 1906.)

Ше. upper layers would be to à greater or less extent
cooler.” . з
` On going again through the literature touching the point,
I find that the account given on pp. 17 and 18 of my book
" states and explains the facts with perfect accuracy, though
іп а very condensed form. The supposed “error” is the
teaching to be found in every treatise on the subject. Loomis
(Treatise on Meteorology, New York, 1892, p. 41), says:
' "This decrease of temperature as we rise above the earth’s
surface is mainly due to the expansion of the air.” A. Buchan,
in his Introductory Tezrt-Book of Meteorology (1871, p. 76,
p ph 208); К. Н. Scott in his Elementary Meteorology
(4th ed., 1887, p. 218); F. Waldo in his Modern Meteorology
71898, рр. 908-216); Julius Hann in his Lehrbuch der
< Meteorologie (Leipzig, 1901, pp. 161 and 748-759) ; Wilhelm
“Trabert in his Meteorologie und Klimatologie (Leipzig und
Wien, 1905, pp. 47-48), all give the same explanation.

: The reviewers “trie reason, which is the universal
operation of the law of selective absorption,” explains, con-
trary to what the reviewer supposes, not the comparative
coldness of the upper layers of the atmosphere, but only why

‘the rate of cooling in the lower layers of the atmosphere is
not determined wholly by the law of expansion of gases
(Hann, Handbuch der Klimatologie, 2nd ed., 1897, vol. i.,

. pp. 121 and 261; W. Trabert, op. cit., pp. 21-22.)

In regard to very elementary facts I must confess I had
not.thought bibliographical references needful:

` Through a printer's error a minus sign is omitted on page
47 of the book. The half sentence quoted should run : “ the
black-bulb thermometer registered 55°5°C:; whilst at the
same time the temperature of the snow in the shade was
- 5°6°C.” The absence of the minus sign doubtless warrants
the reviewer's supposition that the observer referred to the
air over the snow instead of to the snow itself.

Trusting that you will be able to find space for this rather

long comment,
ze Ihave the honour to be, sir,

Your obedient servant,

WirLiAM В. Huaearp.

Davos Platz, January 4th, 1906..

[The criticism in question was based, as a matter of fact,
on Hann’s standard work, quoted by Dr. Huggerd, and the
following extract from Dr. Ward's excellent translation of
Hann (р. 265), will be seen affords ample justification of the
criticism :- із %

“ Causes of the vertical decrease оў temperature.— The facts of
the vertical decrease of temperature have now been considered.
It remains to give an explanation of them. It was noted at the
close of the chapter on Solar Climate (Chapter VI.), that the
storage of heat at the bottom of the atmosphere results from the
peculiar behaviour of this atmosphere toward solar radiation.
This process has been called selective absorption. The radiations
of shorter wave-length, including the luminous rays, are less
absorbed, but more scattered, while the radiations of greater wave-
length—the invisible infra-red rays—suffer a greater selective

absorption, and are to some extent altogether prevented from
reaching the earth’s surface. Ав solar radiation is very rich in
rays of such wave-length as are readily transmitted by the
atmosphere, a large proportion of this radiation is available for
warming the earth’s surface. On the other hand, the ‘ heat
rays’ which are emitted from the earth’s surface are to a very
considerable extent absorbed by the atmosphere, because this is
non-luminous radiation, of long wave-length, in the extreme
infra-red portion of the spectrum. Thus it is seen that the
radiation from the sun passes to the earth’s surface through the
atmosphere more freely than the non-luminous radiation from
the earth passes out again through the atmosphere. In this
жау, the atmosphere helps to store up heat at the earth’s surface,
and this process of storage is naturally most effective in the
lower strata, which are the densest and contain the most impu-
tities, and is least effective in the rare, dry, and clean air of
greater altitudes, ;

: «є Therefore the thinner the atmospheric envelope, the less the
effect of the atmosphere, aud the lower the temperature of bodies
within it, which are then exposed to а freer receipt and loss of

.THE JOURNAL OF TROPICAL MEDICINE. 63

ID PCI тт ла:

—

radiant energy. The mean temperature of the air must be dis-
tinguished from that of the surface which the atmosphere pro-
tects. The air temperature decreases with increase of altitude,

_in spite of the increase in the intensity of solar radiation with

the corresponding decrease in the vertical thickness of the
absorbing envelope. Exception must be made, however, in the
case of an elevated zone of incipient absorption, for which the
vertical temperature gradient is nearly zero." .

The remark as to the scantiness of bibliographical refer-
ences referred to the book generally, and. certainly not to its

treatment of “ elementary facts;"]

THE REVIEWER.

——

: DR. HARTINGTON'S ARTICLE ON FIT AND UNFIT
P

ERSONS. - : .
To the Editors of the JougNAL or TRoPtcAL MEDICINE.

Srrs,—It was with much surprise that I read in page 16 of
your Journal, dated the 15th inst., in Dr. Hartigan’s article
* On Fit and Unfit Persons for Residence in Warm Climates,"
the following words, **I have purposely excluded the Reviera,

.having found its climate lowering, treacherous, and change-

able, many of its popular resorts insanitary (in flies and
smells they en. favourably compete with ‘Eastern
Bazaars’ or ‘China towns’), whilst, when the mistral
blows, the dust is most irritating to delicate throats and
bronchi; the sua and sky give them their only advantage
over our cloudy land.” : zs

This wholesale libel on a number of popular health resorts,
both in France and Italy, ought not to pass unrefuted in the
forthcoming numbers of your Journal. ра

I fear that your eminently useful and able periodical ів поё .
much read in the Reviera winter resorts, otherwise I am
sure you would receive many а емее from the dozens of
British doctors, who, like myself, come to this delightful
climate year after year on account of its salubrity and other
advantages.

As I have visited most of the coast towns between
Marseilles and Genoa, and have resided also some years in
Western India, I can safely assert that nowhere is there a
Reviera town, frequented by invalids, that could, “ in flies
and smells, favourably compete with ‘ Eastern Bazaars,’ or
* China towns’.” Furthermore, I would say that as regards
sanitation most of the Reviera health resorts would com-
pare quite favourably with our British watering places. I
do not pretend that every town on this coast is as sanitary
asit might be. I have yet to meet the Medical Officer of
Health in our own land who is fully satisfied with the sanita-
tion of his district.

The thousands of eldeily persons and invalids that come

'out every season to the brightness and beauty of this coast,

thereby loudly attest to the advantages they derive from
being free from fogs, frosts, and other failings of our less
favoured land. Is it likely that these visitors to the sunny
south would banish themselves from their homes and
friends, incurring thereby no small expense, if, as Dr.
Hartigan says, the climate was lowering, treacherous, and
changeable ? .

No one is likely to find a perfect winter climate, but for
accessibility from Great Britain, for salubrity, warmth, and
many other advantages, I know of none equal to that of the
Riviera, and I often flatter myself that I have chosen one of
the best of the North Mediterranean resorts.

I know something of most of the chief resorts of палан
Sicily, but have found no climate equal to that of San Remo

I could add much more, but forbear to burden your
columns any further.

I am, 4с., x
Ж W. Soxray EccLrs,

Hotel Bel Sito, San Remo, Italy.

January 318, 1906. l

ттт

64 THE JOURNAL ОЕ TROPICAL MEDICINE.

ZAMBESI ULCER.

TO THE EDITORS OF THE "JOURNAL OF TROPICAL MEDICINE.”

Sigs,—Having just started to read an accumulation of
your Journals, I now notice under *'Zmmbesi Ulcer,” by
Z. E. Ashley-Emile, in the number of September 15th, 1905,
a description of common ulcers of the leg, met with in
Southern Tropical Africa, of which the writer claims to have
discovered the cause in the following words among others,
viz., “І may, then, lay claim to the unique distinction of
being first in the field in bringing to notice the cause of
these ulcers, which has hitherto remained in obscurity, and
evaded elucidation by many eminent observers in tropical
medicine who have resided in Zambesia." So far as I can
recall, the only eminent observers who have resided in that
part of the world were the members of the Royal Society's
Commission on Blackwater Fever, and it is not likely that
they paid апу particular attention to this question. Тһе
writer шау have been the first to describe these ulcers, I
don't know, but as to а larva not being known to be a cause
of some of these ulcers, and that the point had hitherto
remained in obscurity, I must say that I think he has not
a wide experience of that part of Central Afriea, and of the
medical men there. Тһе attacks of this larva аге well-
known to all and Europeans frequently get their boys to
extractthem. I have been asked to extract one from the
glans penis. I have & specimen I mounted on a slide, north
of Lake Nyassa, over five years ago, and among those who
have seen it are Professor (now Sir John) MacFadyean. At
the same time I got a native to catch some of the parent fly,
and kept a dozen of them in paper for two years, but when
I reached England they were too much damaged to be of
any use for identification. Тһе coinmon sites for Europeans
to be attacked are the various parts of the trunk, and I have
taken them from the back of the hand. They are believed
to adhere to clothes that have been dried on the grass. I
thought it more than likely that specimens of these larvæ
had been taken home to the Tropical School by such men as
Dr. Daniels. Тһе larva appears to resemble the one the
writer quotes as described by Blanchard, and as he has
not proved that it is not identical, how can he claim to have
discovered it? - :

The advice with reference to boots, leggings, long grass
and houses ін unpractical and would not be followed; men
desire comfort and convenience in these matters at home,
and а sportsman cannot avoid long grass; besides, the larva
is not such & pest as to require disinfection of the floors.

Finally, I do not think that the majority of ulcers in the
situation he describes are started by this larva; natives
will generally say they were caused by a knock from a tree-
rn d Common ulcers of the legs in Europeans have also
been known as “fever sores"; some microscopical work is
required on the subject.

I аш, Sirs,
* Your obedient servant,
J. E. S. OLD. M.R.C.S.Eng.

Aden, February 1st, 1906.

BERI-BERI IN SvnLHET, Assam.—During the last
week of October, 1905, cases of beri-beri occurred in
the Sylhet Gaol, and by November 8th 100 cases had
occurred with 8 deaths. The deaths are stated to
have occurred amongst those of the convicts engaged
at the oil mills, which are said to be insanitary. A
more liberal diet and improved hygienic environment
lessened the number of cases.

‘February 15, 1906.

` EXCHANGES.

Annali di Medicina Navale. Annali Ф Igiene rimentale
Archiv für Schiffs u. Tropen Hygiene. Archives de Medicine
Navale. Archives Russes de Pathologie, de Médec. Clinique
et de Bacteriolopie. Australasian Medical Gazette. Boletin
de Medicina Naval. Boston Medical and Surgical Journal.
Bristol Medico-Chirurgical Journal. British and Colonial
Druggist. British Journal of Dermatology. British Med.
ical Journal. Brooklyn Medical Journal ^ Caducée.
Clinical Journal, Clinical Review. Giornale Medico del
R. Esercito. Hong Kong Telegraph. Il Policlinico. Indian
Medical Gazette. Indian Medical Record. Indian Public
Health. Interstate Medical Journal. Jahresbericht. Janus.
Journal of the Royal Army ‘ledical Corps. Journal of
Balneology and Climatology. Ј шта] of Laryngology and

Otol Journal of the American Medical Association.
Journal of Experimental Medicine. La Grece Medicale.
Lancet. Liverpool Medico-Chirurgical Journal. London

and China Express. Medical Brief. Medical Missionary
Journal Medical Record. Medical Review. Merck's

.Archives. New York Medical Journal. New York Post
Graduate. Pacific Medical Journal. Philippine Journal of
Science. Polyclinic. ^ Revista de Medicina Tropical.

Revista Medica de S. Paulo. Sei-i-Kwei Medical Journal.
The Hospital. The Northumberland and Durham Medical
Journal. Transactions of the American Microscopical
Society. Treatment. West India Committee Circular.
West Africa.

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proofs will not be submitted to those dwelling outside the United
‘Kingdom, unless specially desired and arranged for.
' 8.—To ensure accuracy in printin: it is specially request--d
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4.—Authors desiring reprints of tneit communications to the
JournaL оғ TROPICAL MEDICINE should ¢-im:nunicate with the
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5.—Correspondents should loo. for replies under the braiding
“ Answers to Correspondents.” n ES

March 1, 1906.)

THE JOURNAL OF TROPICAL MEDICINE.

65

Original Communications.

TICK FEVER.
By PurniP. Ross, M.D.

Definition.—Tick fever of Uganda is a specific fever
due to the presence of a spirochete in the general
circulation. This врігосһаче is conveyed by the bite
of a tick (Ornithodorus), but is also communicable by
inoculation with infected blood.

History.—Fever due to the bite of a tick, drgas
moubata, probably an ornithodorus, was first described
by Dr. Livingstone. Since this description there
seems to have been very little written on the subject.
Manson, in his “ Tropical Diseases " (1), quotes from
Sir John Kirk, and from letters from Dowson and
Daniels. More recently Christie suggested that thé
disease might be due to F'ilaria perstans, inoculated by
the bite of an ornithodorus, but the general opinion,
as shown by the discussion following a paper by

IUNE

22425126|27|28129130131|1 2131415161

MAY
DATE.[I7 || 819 [20

71819 пог ian s re 7 18]

(Argas). On reading this paper it occurred to me that
perhaps the spirillosis we had found to be so common
in Entebbe was nothing else but tick fever. Àn oppor-
tunity of testing this theory soon occurred, when Milne
arrived from Hoima, bringing with him blood slides
from eight cases of fever, ascribed by the patients to
the bites of ticks. These ticks Milne had already
had classified by Theobald as Ornithodorus Savignyi,
Audouin, var. саса, Neumann (2 Ағдав moubata,
Murray) On hearing of the possible connection
between this disease and spirillosis, Milne most gene-
rously handed over all his slides to me for examination,
and in every one spirochætæ were found. Some two
months after the publication of the paver by Milne
and myself (4), Dutton and Todd (5) telegraphed from
the Congo that they had succeeded in infecting
monkeys with spirillosis by the bite of naturally
infected ticks (Ornithodorus), and the postscript to
Dutton’s last letter announced that he had infected
monkeys by feeding newly hatched ticks on them, thus

Снавт I.

AUF T JUL
jea[z 11221232425 |26/27128/2930| 1 |2 [3 | ^.]

+

—

|_|

I
1

7 |

+ IN T =

pause | +1 ааыа | a + E
ЕЖ 6! 167 |45164 |55145 |47 3555256 55555575135 pe 83550 |32 |90473 22552 |17 |27 5523 (938 | 265/2542540554-520 |53 435
u 125/10 |12 |10 | 16 /4-5125|9517:5 75|6 | 7 (е511515:5| 5 | 9 1675225 10 6 |9 ы 5/5 19-910 [n | a |7|16] |5513-55517 |5:51-5/9 |3-5
L. 26| 7Sj45/20 285/325455/40 |40] 35 412] 351325225435] 39 A78 35 |82345 15 35 |%5%542572572425575145|42| [ers] 6 |55505 36]55 3634-5
т. 2| 1341 а 1016513 |1015 |5 |534/41751105514161 31312 jéS| 10155]. 16 [3 14:5 5]65/55/14/5:555| 4) 5и (1:512 | 413551155
Nore.—The sign - = No parasites found in blood. P.M.N. = Polymorphonuclear leucocytes.
+ = Many ,, y эз L.M.N. = Large mononuclear РА
+. = Few M 27 с L. - Lymphocytes.
+.. = Very few ,, 5 a Tq. — "Transitional.

One parasite ,,

(0

”

+
Monkey, No. 34. — Inoculated
6 days. Intervals (1) 8 days; (2) 5 days; (3)
tion: P.M.N. 20:5; L.M.N. 19; L. 56; T. 5

Nuttall at the Epidemiological Society towards the
end of 1904, seems to have been that the disease was
probably a piroplasmosis. Towards the end of 1903 I
found spirochetz in а case of fever under the care of
Dr. Hodges at Entebbe (2), and succeeded in infecting
a monkey from this case. Within а few weeks Cook,
of the C.M.S. Hospital, Mengo, also found spirochætæ
in a fever patient. This latter writer had probably
seen but not recognised the organism some two years
before.

Nuttall had previously suggested that the spiro-
сһо е of relapsing fever might be conveyed by
such insects as bed-bugs, and in September, 1903,
Marchoux and Salimbeni (3) described the spirillosis
of fowls common in Rio de Janeiro, and, further,
showed that the disease was conveyed by а tick

1 сс. finger-blood from patient during first relapse, May 17th, 11 a.m.

Incubation period,

7 days; (4) 11 days; (5) 1 day. Differential count May 7th, i.e., before inocula-
5.

proving the hereditary transmission from parent tick
to offspring through the egg.

The most recent work on the subject of spirillosis
is contained in the paper by Borrel and Marchoux
6), who show that at 35° C. the spirochætæ of fowls
evelop in the body of the tick, which latter suffers
from a true spirillosis. At 18 to 20° C. the parasite does
not develop, but even after months of starvation,
exposure to the higher temperature will cause the
increase of the parasite and consequent infectivity оѓ
the tick.

THE DISEASE. -

Incubation Period.—The incubation period seems to
be from two or three to eight days. The periods of
one day given by some natives are probably wrong,
and are only the interval since the patient observed

66 THE JOURNAL OF TROPICAL MEDICINE.

IMarch 1, 1906.

that he was last bitten. As will be seen later, the
incubation period in the inoculated disease varies
between two and six days.

Onset.—The onset is usually rather abrupt. The
patient may complain of not feeling quite well, his
temperature is found to be rising, and in a few hours
he is prostrate with all the symptoms of the disease.

Symptoms.—In the European the symptoms are
fever, headache and vomiting. The temperature rises
to 103° to 105°, there is intense headache, sometimes
pains in the back or limbs, and most obstinate vomit-
ing. These symptoms last for a varying time; as a
rule from twenty-four to forty-eight hours, although
they may continue for several days. The temperature
then falls suddenly to normal, and all the symptoms
are relieved. After an interval of varying length,
usually about four or five days, there is a recrudes-
cence of all the symptoms. These relapses may occur
four or five times, but have a tendency to become of
shorter duration. When at last the relapses cease
the patient passes into а fairly rapid convalescence,

CHART Ia.
DE

i

213145

іп the blood, and it may take many hours’ search to
find one organism.

The most difficult disease from which to distinguish
tick fever is malaria. It is hardly possible to do so by
the symptoms alone. If the patient has had malaria
recently, his blood may show pigmented’ leucocytes,
and the observer will be apt to content himself with
finding these and to put down the case as malarial,
but it may be said that a marked rise of temperature
in malaria is always accompanied by the presence of
parasites in the peripheral blood. There may be very
rare exceptions, but personally I have never seen а”
case of malarial pyrexia where half to one hour's
search did not reveal the presence of parasites, unless,
of course, the patient had taken large doses of quinine.
The reaction to quinine may be a useful point in help-
ing to separate the two diseases. Quiniue has abso-
lutely no effect on the temperature or course of the
disease in tick fever, but where the reaction is relied
on a mistake may easily occur, especially in the initial
attack. I bave seen a case where the patient was
given a large dose
of quinine one even-
ing, and next morn-
ing the temperature
was found to be
normal, but it was

& case of post hoc

"MEC nan

but during the course of the disease his general
health gets very poor and he loses a good deal of
weight.

In the native, relapses do not always occur, and as
a rule there is not more than one relapse. In one
of Dr. Hodges’ native cases, at the time when a
relapse might have been expected, I found the para-
site in the blood, although the temperature remained
normal and the patient's only complaint was of severe
headache. Headache and pains are marked symptoms,
and vomiting is more common than in malaria.

Slight hepatic and splenic enlargement may be
observed. !

Course of the Disease.—In the European there are
usually four to six relapses, followed by recovery. In
the native there may be no relapse. Death is very
rare, and seems only to occur in those whose resist-
ance has been lowered by lack of food, exposure or
over-exertion. When it occurs there is a fall of
temperature to or below normal, and the patient dies
comatose.

Diagnosis.—The diagnosis can only be made with
certainty by the discovery of the spirochete in the
blood. The parasites are usually exceedingly sparse

T AY VA
ЕНІН

Inoculated November 12th with 1 cc. finger-blood of patient.

not propter hoc, for
in the next attack
quinine was again
given, but with no
effect whatever ; but
the apparent re-
action to quinine in
such a case might
easily tempt the
observer to say that
it was malaria, till
. Subsequent events
disproved the state-
ment. Reaction to quinine, especially when given
by intramuscular injection, would prove the case
to be malarial, if this fallacy could be excluded.
A European who reacted to quinine and who
continued free from fever afterwards while taking
quinine would naturally be set down as having
suffered from malaria, but a similar course of events
in a native would prove nothing. Later in the disease
in Europeans, the temperature chart is very charac-
teristic, but it is of some considerable importance to
make the diagnosis during the initial attack, as if this
be not done, the patient will probably ply himself or
be plied with quinine, which is quite useless, and only
adds further discomforts to his already miserable state.

Hodges lays stress on the facts that in the native
vomiting is more common, and the pains more
marked and more complained of in tick fever than in
malaria.

Where the blood examination has failed the dia-
gnosis can be made with ease and certainty by inject-
ing а drop or two of the patient's finger blood into a
monkey. When the animal sickens the spirochate
can be found with the greatest ease in its blood.
But this method takes a few days.

March 1, 1906.)

The blood examination will show a relative increase
of polymorphonuclear leucocytes. There may also be
an increase of large mononuclears, but this latter is
of little value in malarial countries.

To sum up, the diagnosis can only be made with
certainty by the examination of the blood. The
leucocyte count may perhaps give the right clue,
and the lack of reaction to quinine may exclude
malaria.

Staining.—Leishman's stain is perhaps as con-
venient as any, and has the advantage over some
other stains in that it permits a leucocyte count to be
made. Actually the best stain for the parasite is
dilute (1 in 3) aniline-gentian-violet for three or five
minutes in alcohol or alcohol and ether.

Inoculation.—If a monkey is to be infected the
finger-blood may be drawn up into а hypodermic

Снавт П.
JUNE. JULY ENDS
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734525 67 5071 48341 [6
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Monkry No. 43.—June 30th, inoculated 1 cc. finger-blood
from monkey No. 39. Incubation 44 to 5 days. Duration of
first attack, 3 davs; interval, 3 days. Duration second attack,
4days. On fourth morning found prostrate, temperature sub-
normal, blood swarming with parasites. Death.

Fowl aud dog inoculated with 5 сс. heart-blood, but showed
no reaction, and no parasites could be found.

Розі Mortem.—Lungs, а few very small infarcts.
а few very small infarcts. Spleen rather large, firm, infarcts
on surface. Liver rather large, congested, infarcts on surface.
Kidneys congested. Lymph glands uniformly enlarged, some
of them hemorrhagic. Brain a little surface congestion, no
infarcts.

Heart,

syringe in which there has been placed a drop or
two of & l per cent. solution of potassium citrate.
The mixrtue is injected subcutaneously.
Treatment.—No drug seems to have any effect
either in shortening the disease or relieving the
symptoms. All that can be done is to feed the patient
in the intervals between the relapse. If a febrile
period is prolonged it may be necessary to have
recourse to rectal feeding. When convalescence sets
in the patient may be given some ordinary tonic,
and should be ordered rest and good food.
Prevention.— Prevention is easy for Europeans, but
becomes difficult when dealing with natives. Тһе
ornithodorus lives by day in the thatch or in cracks
of mud floors and walls of old native huts. At night

THE JOURNAL OF TROPICAL MEDICINE. 67

it comes out in search of food, retiring again when it
has fed.

In a country where tick fever is known to exist old
camping grounds should be avoided, and native porters
and boys should be warned not to use old huts to
sleep in. Huts known to be infected should be burned.
Europeans will be practically protected by their mos-
quito nets, provided these be arranged so that they
càn be tucked in beneath the bed-clothes. Nets with
shot-weighted edges to drop to the floor are more
likely to be a help to than a protection against the
ticks.

It is possible that the reason why natives do not
suffer from relapses as do Europeans is connected with
their house arrangements. A native living in an
infected hut will be constantly subject to reinfection.
If, as in other spirilloses, the immunity conferred be
only temporary, the native when recovered from one
attack will be immune for some time. As the immunity
becomes less he will be liable to fresh infection, but it
seems likely that the previous attack will have in-
creased his resistance to the disease, and may thus be
the cause of the absence of relapses.

THE EXPERIMENTAL DISEASE.

Тһе subcutaneous inoculation of а drop or two of
blood from the finger of a patient during fever into a
monkey (black-faced or Sykes’ Cercopithecus, or Cyno-
cephalus) is sufticient to produce a disease exactly
resembling the disease as seen in Europeans. After
an incubation period of from two to six days the
monkey's temperature rises to 104° to 106°, the
animal is found sitting about resting its head

Снавт III.

A. Disease in native.

Recovery.
B. Disease in native.

Death.

on its hands or against the wall of the cage,
aud evidently feels very ill In a typical case,
after a variable time, usually two to four days, the
temperature, which during this time has remained
high, falls abruptly to normal, and the animal appears
quite well. In five or six days there is again a rise to
104? to 106°, lastivg, as а rule, a couple of days, then
falling as before. As in the European, there cannot
be said to be any regularity either in the duration of
the febrile period or in the length of the interval. The
fever may persist for nearly a week or last but a day,
and the intervals vary between one and eighteen days,
but in the later relapses there is a tendency for the

68 THE JOURNAL OF TROPICAL MEDICINE.

‘March 1, 1906.

febrile period to be shorter and for the temperature
not to rise so high. The animal also is not so
evidently ill as during the earlier attacks.

Blood FEramination.—l1f the blood of a monkey be
examined when the temperature is first found to be
rising it will be found to be swarming with spiro-
chætw. These are rarely found single, but when so
found they are twisted and contorted to a degree not
seen in the regular wavy organism seen in man.
Usually they are in tangled masses of from four or six
to many hundred individuals. Division forms are
fairly common. In the fresh blood specimen the para-
sites are as a rule hard to find in man, but in the
monkey they are present in such quantities as to be
easily made out. If a single organism can be seen
when temporarily arrested in its course its movement
resembles nothing so much as that of an archimedean
drill. When free it moves much too rapidly for the
observer to gather any very clear idea as to its move-
ment. The disturbance of red cells is slight, much
less than that caused by a trypanosoma or filaria.

The organisms can easily be found till the crisis,
when they disappear even more suddenly than they
appeared. In the later relapses the parasites are
present in less number than in the earlier attacks, but
their behaviour is similar in all respects.

After the first day or two of fever nucleated red cells
are found in fair numbers. They persist in the blood
till the termination of the illness, and a few may still
be found some weeks after the last relapse.

Leucocyte Count.— After inoculation there appears
a gradual rise of the polymorphonuclear leucocytes.
When the attack sets in there is rather а marked
leucocytosis, with a large relative inerease of the
polymorphonuclear cells at the expense of the lympho-
cytes. This leucocytosis persists till the crisis, and
may become extreme just before the crisis, every
microscopic field showing large numbers of leucocytes,
especially of the polymorphonuclears. Immediately
after the crisis there is а sudden reversion to the
original leucocyte count, and this persists till the
relapse. А point of interest is that in the later stages
of the disease it is sometimes found that the polymor-
phonuclear increase occurs, although there is no rise
of temperature. In two of such cases I have found
that long search through a slide has shown the presence
of а very small number of spirochætæ. І am inclined
to think that in such cases there has really been a
relapse, but that it has been so slight that the resist-
ance of the patient being increased by previous attacks,
so far as the temperature is concerned, it has proved
abortive. Such an attack would probably be compar-
able to Hodges’ case, referred to above, where the
parasite appeared in the blood without any rise of
temperature, the only sign of relapse being the severe
headache.

Tbe mechanism of the crisis in spirillosis has been
much discussed, especially by the French working
with the parasites of relapsing fever, and of fowls and
of geese. Metchnikoff (7) and Cantacuzéne (8) are
of the opinion that the phagocytes are the agents of
the crisis—in relapsing fever the polymorphonuclears,
in spirillosis of geese, the macrophages of the spleen.
Gabritschewsky (9), on the other hand, ascribes the
crisis to the formation of bacteriolysins in the blood

serum. Working with the Brazilian disease, Levaditi
(10) concludes that in refractory animals the formation
of antibodies takes place in the leucopoietic organs,
especially in the spleen, bone-marrow, and lymph
glands, and the leucocytes should be considered as the
principal if not the exclusive source of the antibodies.
But in animals suffering from the disease he concludes
that “la disparition les spirilles pendant la crise, ne
saurait reconnaitre l'intervention d'une sensibilisatrice
spécifique, considerée comme agent bactériolytique ” ;
and further, “les observations faites sur la septicémie
de Marchoux et Salimbeni sont ainsi d'accord avec les
constatations de Metchnikoff et de Cantacuzéne con-
cernant la fiévre récurrente et la spirillose des oies,
pour accorder aux leucocytes une influence de premier
ordre dans la guérison spontanée des animaux." Тһе
phenomena seen in the Uganda disease would appear
to bear out the importance of the part played by the
leucocytes. The polymorphonuclear leucocytosis co-
incides with the appearance of the parasites in the
blood, and ends at the crisis which coincides with
their disappearance. In both polymorphonuclear and
large mononuclear leucocytes clear spaces can be seen,
and sometimes, though rarely in the peripheral blood,
this space is seen to contain & parasite. In smears of
organs after death, especially in smears from the liver
and lung, this appearance of parasites, engulphed by
the leucocytes, is exceedingly common. After the
crisis the vacuoles can still be seen in the large mono-
nuclears, but not in the polymorphonuclears. Where
the crisis is due to the formation of bacteriolysins one
would expect that the parasites would show loss of
motility, signs of degeneration, as shown by change of
staining reaction and diminution of numbers. Noone
of these phenomena is, however, observed.

A marked feature in blood taken during the febrile
period is the appearance of the polymorphonuclear
leucocytes. Many of these appear to have been so
damaged that the mere act of spreading the film соп-
verts them into an indefinite mass of nuclear material
and granules. In others whose outline is still distinct,
there is a marked rearrangement of the nucleus; in-
stead of being rather compact in the centre of the cell,
it tends to arrange itself peripherally, leaving a granular
space in the middle of the leucocyte. The outline of
such cell is much less definite than that of the normal
cell.

Death.—Death usually takes place during an early
relapse. The temperature of the monkey falls below
normal, but the animal does not show the expected
improvement. A blood slide taken now will show
swarms of spirochwte, and an enormous leucocytosis.
The animal becomes comatose and dies in the course
of a few hours.

Post mortem.—The changes found after death are
slight.

The lungs show small infarction areas.

The liver is rather large and congested.

The splenic enlargement is slight, and the splenic
substance is firm and not at all friable.

The lymph glands are enlarged and some of them are
hemorrhagic.

The brain shows no change.

The heart shows petechiw in its wall.

Smears of the organs show most parasites in liver,

March 1, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE. -69

lung and kidney, and fewest in spleen, brain and lymph
glands.

There cannot be said to be anything characteristic
in the post-mortem appearances in the monkey, any
more than there isin man. .

It is only recently that I was able to attempt experi-
ments with the ticks. After Dutton and Todd's results
in the Congo, I was surprised that the experiments
failed, but Borel and Marchoux offer & ready explana-
tion of this in their paper. If the spirochæte does not
develop in the tick at 18° to 20? C., it is probable that
the tick brought from the moist warmth of Uganda to
the cool days and cold nights of Nairobi ceases to be
infective, and I expect to have to use the incubator to
get any results.

REFERENCES.

(1) Manson, “ Tropical Diseases,” 1903, р. 713.

(2) Hodges und P. H. Ross, B. M.J. Apiil 1st, 1905.

(8) Marchoux and Salimbeni, dn. de Г Inst. Pasteur, Sep-
tember, 1903.

(4) Ross and Milne, B. M.J., November 26th, 1904.

(5) Dutton and Todd, 77. M.J., February 4th, 1905.

(6) Morrel and Marchoux, С. R. бос. Biologie, February 25th,
1905.

(7) Metchnikoff, Virchow’s Arch., vol. cix.

(8) Cantacuzene, An. de UInst. Pasteur, 1899.

(9) Gabritschewsky, Centralb. für Balt., vols. xxiii., xxvi.,
xxvii.

(10) Levaditi, An. de l'Inst. Pasteur, March and August, 1905.

NOTES FROM NORTH NIGERIA.

Liver Авзсевв, FILARIA, CEREBRO-SPINAL FEVER,
BILHARZIA, SPIRILLAR FEVER.

By Dr. Davip ALEXANDER.

{THE following is abstracted from a letter dated
December 9th, 1905, sent by Dr. Alexander to Dr.
Andrew Davidson, Lecturer in Tropical Diseases,
University of Edinburgh, to whom we are indebted
for forwarding the communication.—Eb., J.T. M.]

It may interest you to know, although it has not
been published yet, that a friend of mine who has
been doing special work in connection with amoeba,
their cultivation and relation to liver abscess, has
been able to cultivate them, and has produced liver
abscess; this, no doubt, will appear in print soon, unless
he discovers some fallacy.

None of the subjects in whom I found F. perstans
had any illness that could be traced to it, but then
consider the number of those who have F. nocturna that
have no illness either. АП the cases I found F.
perstans in had been in Ashantee: so far I have not
got it in any local native yet.

Iam surprised that there has been no appearance in
print yet of the Principal Medical Officer's report on
the cerebro-spinal epidemic. It is endemic and
epidemic apparently all over West Nigeria, although I
am told that there are no cases up here. At Kano
there were a great many cases; deaths include one
white man. Капо is 100 miles from here on the one
side, and at Sokoto on the other side there were also
cases. They also had the epidemic at Yola, so it was
present at both extremities of the Protectorate. The
natives connect it, somehow, with small.pox, and say
that when small-pox is not bad, it is bad. It appears

towards the end of the dry season—T'ebruary, March,
апа April—and ends with the first rains. None of
the attendants that we employed got it, and cases
in a town were very irregular in their occurrence ;
one case here, and the next in & house perhaps
600 to 800 yards away. I never saw 8 case at
home, but it exactly tallies with the description in the
text-books. Some of the cases I was incliued to look
on as epidemic pneumonia, but probably I was wrong;
anyway, we had no differential stains. ;

Bilharzia I have not come across yet, but that it exists
in West Nigeria is certain, Dr. Watson, who made
one or two tours in Bornu, tells me he saw it there.
(That is Watson of the new Amphistomum Watsonii.)
Mosquitoes there are many ; I have not done much
in the way of identification of them.

Spirillar fever I am on the look out for; the
ornithodorus is here, and possibly I may have a case.
I make a habit of staining a slide from nearly every
fever case with carbol-fuchsin, on the off chance of
spirilla.

In a note of later date, Dr. Alexander adds : —

І ought not to have said the ornithodorus is here.
I described what I wanted to a rather intelligent
native, and he said that he knew what I meant, but
to-day he brings me in the ordinary bed-bug. How-
ever, I may get it yet.

—— ,9—————

“Indian Med. Gazette," February, 1906.
PREVALENCE OF Yaws IN THE CHINDUIN DISTRICT OF
Upper Burman.

Military Assistant Surgeon, P. A. MeCarthy recalls that
the presence of yaws in this district was first noted by
Mr. A. A. Nolan in the British Medical Journal, February
2nd, 1895. The disease is known by different names in
different townships, some speaking of it as leprosy, and
others by descriptive names, such as “crippling disease,”
“molehill disease," and so оп. This variety of names cer-
tainly appears to indieate a recent origin, and there is a
tradition that it was introduced from Siam ria the Mergui
coast and Chindwin River, and the fact that it is rarely
found in inland villages would appear to support the tra-
dition. He considers that the mode of communication is
usually by direct inoculation of some breach of surface, and
met with it at all aves, from three months to three-score
years.

The period of inoculation, though uncertain, he considers
to be about three to eight weeks. The author then describes
the lesions and course of the disease, which certainly appear
to support his opinion as to the identity of the disease with
that known as ** yaws " in other parts of the world.

He gives some interesting information as to the method
of treatment adopted by the native practitioners, or sayahs,
who employ crude mercury, and occasionally red arsenic.
Mr. McCarthy himself used a mixture of hyd. perchlor. and
pot. iod. in the secondary stage, and soda lotion, and осса-
sionally sulphate of copper, to the granulomata locally.

In a letter to the editor of the same journal, Lieut.-Col.
W. A. Lee, LM.S.. referring to Major Childe's paper on the
oecurrence of Leishman-Donovan infection in Europeans,
states that, unlike Childe, he finds the disease by no means
uncommon in Europeans in certam parts of the town of
Madras, and draws attention “фо the value of carbolic acid,
which should be given for a prolonged period, and in gradu-
ally increasing doses, to the utmost limits of tolerance.”
Some of his cases received “as much as 8 drachms daily,
with ultimately beneficial results, and without any drawback,
such as carboluria, occurring."

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THE

Journal of Tropical Wedicine

Marca 1, 1906.

THE DEPRECIATION OF THE ATTRACTIONS

OF THE INDIAN MEDICAL SERVICE
AND ITS REMEDIES.

II.

Is our first article on this subject we drew attention
to two causes of dissatisfaction, viz., to the want of
encouragement to professional zeal and research, and
to the hardships of the superannuation rules, which
render it practically impossible for any man who has
devoted an adequate time to his student career to
reach administrative rank. In the present, we propose
to touch on a matter which, though of mainly senti-
mental interest to the individual members of the
Service, is of vast practical importance to the State,
as it lies at the very root of the inefliciency of [ndian
sanitary reform, and in many other directions impairs
the efficiency of our medical institutions. We allude
to the lack of proper status and influence in the
councils of the Indian Empire. Politically speaking,
the Surgeon-General with the Government of India is

i THE JOURNAL OF TROPICAL MEDICINE.

(March 1, 1906.

a sort of expert adviser to the Secretary to Government
in the Home Department, and when matters of sanitary
and medical import have to be dealt with, the latter
oflicial may or may not ask medical advice, and, in
either case, is perfectly at liberty to ignore it, and
probably as often does so as not. Owing to this the
position of the Surgeon-General is most unenviable ;
for the general publie, knowing nothing of the gearing
of the bureaucratic motor, naturally imputes any
blunders that may be committed to him, though they
may in reality have been made in defiance of his
strongest protests, while official etiquette renders it
impossible to utter a word to clear his professional
reputation. Nothing can better illustrate the power-
lessness of the medical service in the direction of
sanitary affairs than the history of the methods of the
Indian Government in dealing with plague, of which
the following is a short sketch. It may be admitted
that the most recent pronouncement of the Simla
secretariat on the subject, which we reproduce in
another column, is by far the most satisfactory that
has been hitherto issued by that august body. One
might, in reading it, almost imagine that Simla had
taken medical advice on the subject, instead of treat-
ing their medical experts as persons most of all likely
to take an ignorant and prejudiced view of the ques-
tion; for hitherto the ways of the Indian Government
in the campaign against plague have generally
appeared to be based rather on shortsighted notions
of expediency than on what might be expected to be
the views of their sanitary advisers.

The history of plague prevention in India, however,
has been one long series of blunders and mistakes
of a sort that could hardly have been committed
had the sanitary authorities been trusted to make
their own arrangements.

No doubt, at the time of the importation of the
disease, the medical profession in India knew practi-
cally nothing of plague, but it had had ample experi-
ence in dealing with other epidemic diseases, and its
intimate personal relations with the native population
made it better qualified than perhaps any other branch
of the public service to judge what measures would
command the loyal co-operation of the people and
what would irretrievably offend its prejudices.

As the fact was well known to all epidemiologists
that all forms of inland quarantine had hitherto proved
powerless to arrest disease of any kind, and as no one
understood the ultra-sacredness of the Indian home
better than the members of the medical service, it is
hardly likely that it сап be held responsible for such
costly absurdities as sanitary cordons, and train in-
spections; or for the tactless folly of house-to-house
inspection carried out by Isuropean soldiers, literally
at the point of the bayonet.

The first step in this melancholy tale of misdirection

.was the ostrich-like one of trying to ignore the pre-

sence of the disease in Boinbay; and in this way the
critical days were wasted, during which stringent
measures of isolation and disinfection might possibly
have arrested the further spread of the disease. It
required no special knowledge of plague to suggest
such measures as are required at this stage of an
epidemic, as thev are self-evident, and have since
averted invasion in many parts of the world.

March 1, 1906.)

The disease now spread rapidly, and the Govern-
ment, becoming frightened, attempted to “ stamp
ош” the disease. To this end a Commission, vested
with extraordinary powers, was appointed; directed,
not as might be expected, by a sanitary officer of
proved experience, but by a combatant military officer,
who, it may be incidentally remarked, has since proved
none too competent, even in his own profession.

Of this Commission the medical officers were simply
ihe agents and subordinates, and its proceedings were
of so outrageous & character that, looking back on the
time, it is surprising that murder and riot were not
even worse aroused than was actually the case; for as
if to accentuate its folly the Indian Government ap-
pointed, not an officer of the Indian Staff Corps, but
one of the British Service who could not by any ровві-
bility be acquainted with native prejudices and ideas.

Ап officer who had grown grey in the sanitary
department, who passed through Bombay at this
period, remarked at the time to the writer, that he
would have lost all respect for the natives of India had
they not broken out into riot under the provocation
they were receiving.

The mischief wrought by this outburst of mad mili-
tarism has been irreparable, as all subsequent measures
of the Government, good, bad and indifferent, have been
viewed with such suspicion by the native population
that it has been impossible to obtain their co-operation,
even where they have not resorted to active or passive
opposition.

Terrified by the storm it had raised, Government
rushed to the oppcsite extreme, and instead of trusting
to the individual tact of its officers to do the little that
it had left possible, tied their hands by minute and
stringent regulations. Tosaveits face the portentious
farce of train inspections was now paraded as the
principal line of defence. The medical officera em-
ployed on this duty were supposed to examine several
hundred people during а halt of fifteen or twenty
minutes, and in order to avoid arousing further ebuli-
tions of violence, were, moreover, forbidden to make
any sufficient physical examination.

Assuming the patient to be still able to stand, it was
in the last degree unlikely that а case could be
detected.

Anything more hopelessly futile and harassing than
the duties thus thrown on the medical officers em-
ployed on the work it would be hard to conceive, and
it is probable they were the only people who were
more disgusted with the folly of the system than the
unfortunate passengers (native and European) who
were worried every hundred miles or so by their ob-
viously useless inspections.

Another vagary of this period, born of the desire to
appear to be doing something, was tlie order of a provin-
cial government, that in the chief town of each district
every house should be inspected by the Civil Surgeon.
The cubic space of each room was to be ineasured and
Sanitary recommendations made to each householder.
Several of these towns possessed over 25,000 houses,
and probably none had less than 3,000 or 4,000, so
that the impossibility of a single man, already busy
With а multiplicity of duties, carrying out such a task
In any reasonable time, even in the smallest places, is
Suffüciently obvious. As а matter of fact, nothing but

THE JOURNAL OF TROPICAL MEDICINE. 71

rebuilding could convert these oriental houses into sani-
tary dwellings, and the Government, even if unable to
understand this, must have been perfectly aware that
nothing whatever would come of the Civil Surgeon's
recommendations. What the secretariat evidently
did not understand, however, was that the circular, if
taken literally by the medical executive, could scarcely
fail to cause opposition and rioting. Fortunately,
there was hardly an officer in the provincial medical
service who had not the tact to practically ignore the
order, for every one knew that a broken head and an
official reprimand for want of tact was all they were
likely to earn by taking seriously such a piece of
buffoonery. In one great town, however, it was so
obvious, even to the wiseacres at the helm, that the
job was more than one man’s work, that he was given
a couple of youngsters fresh from home to help him in
the task. Presumably these energetic recruits must
have been so inexperienced as to believe that Govern-
ment orders should always be taken au grand sérieur,
for the result was serious opposition, and it was even
whispered, disaffection in a native cavalry regiment,
though the rumour may be doubted. '

Then urgent telegrams went flying over the coun-
try, “ Cease house-to-house visitation at once." There
was probably not a district medical officer in the
province who, if asked his opinion, would not have
told the authorities that, apart from its futility, such
an order was in the last degree impolitic, and it is
most unlikely that the very able man who was
nominally the administrative medical officer differed
from his colleagues on the point. What he may have `
thought, however, matters nothing, for in any case
his powers, whether of action or protest, were prac-
tically ni.

It would occupy too much space to give a complete
history of the later developments of the campaign,
beyond saying that of late years the policy has simply
been to ‘let things slide," but enough has been
written to show that the course of action has not
been what would be expected of men accustomed to
deal with epidemic disease in азу form, or of
officers who in any way understood what sanitary
measures are, and are not practicable in dealing with
a population whose prejudices are as peculiar as that
of India. To thoroughly understand the caste system
would probably occupy the lifetime of several German
professors, but in the course of fifteen or twenty
years’ work a sanitary officer attains a fair working
knowledge of how to get the maximum possible, under
the circumstances, of sanitary effort, and it is the
systematic ignoring of this invaluable source of
strength that is responsible for the hopeless fiasco
tbat we have attempted to describe.

The old caution of ne sutor ultra crepidam is as
applicable to attempts on the part of the civil and
military executive to deal with sanitary matters as to
the cobbler's criticism of the artist. It is not fora
moment pretended that the Indian sanitary officials,
even if placed in authority, could have succeeded in
arresting the advance of the pestilence, but it is cer-
tain that no one accustomed to dealing with the
native population when attacked by epidemic
diseases would have been guilty of the follies that
have been described. At least the lacs of rupees

19 THE JOURNAL OF TROPICAL MEDICINE.

wasted, or hopeless attempts at inland quarantine
train inspections, and similar expedients, would have
been saved, and we may be sure that coercion would
have figured but little in the programme, and if em-
ployed at all would have been confined to enforcing
the evacuation of infected sites in cases where local
circumstances rendered such a measure practicable.

In this way the road would have been smoothed
for more effectual measures, when advancing know-
ledge indicates more promising lines of defence. The
remedy lies in giving the Surgeon-General with the
Government of India a seat on the Vice-regal Council,
and the Inspectors-General of Civil Hospitals one on
the Provincial Governments.

It is to be feared, however, that the Indian Govern-
ment hardly desires to place its sanitary advisers in a
position of proper trust and authority, as it is haunted
by the fear that this would lead to what they would
regard as undue expenditure on sanitary projects.

In reality it would be more likely to result іп con-
siderable saving, as no men know better how little
сап really be done in the present state of civilisation
of the indigenous population.

Formerly the Director-General was entitled the
«Sanitary Commissioner and Surgeon-General with the
Government of India" ; but a few months back a
great flourish of trumpets was indulged in over the
separation of the officers and the appointment of a
separate Sanitary Commissioner. In reality, however,
the step was a retrograde one, for by a subtle turn of
policy the appointment was laid open by “ selection ”
to any grade of the service, and the Government
selected a quite junior officer, who, moreover, had had
no practical experience whatever in the work of the
Sanitary Department, but һай been employed for the
most of his service in а secretarial post. It is absurd to
suppose that so junior an official, however able, could
possibly carry sufficient weight to enforce his opinions
on a body of veteran “ big-wigs” such as constitutes
the hierarachy of Simla, and the selection is really an
evidence that the latter had no desire to find a medical
Kitehener amongst them. А seat on the Council
would, however, enable the holder to show that
medical oflicials сап be as practical and moderate as
other branches of the Service, and would enormously
facilitate the progress of such sauitary reform as is
practicable under the peculiar conditions of the
country and its people.

BODIES IN THE SPUTUM AND FECES
RESEMBLING THE EGGS OF PARASITES.

Dr. ХУпалам HARTIGAN forwarded for inspection
peculiar bodies coughed up by a patient in the pres-
ence of a medical man practising in the north of Ire-
land. Ofthe bodies in question, some to the naked
eye resembled ova, and were fairly uniform іп
size; some resembled freshwater evclops in their
outiine and appearance; the remainder, seemingly,
couststed of frazments of the above. The bodies in
question were submitted for examination to Dr. C. W.
Daniels, the Superintendent, and to Dr. C. M.
Wenvon, Protozoologist at the London School of
Tropical Medicine. The bodiesin question were found

(March 1, 1906.

to be mercly mucous casts, modelled, no doubt, in
smaller bronchi of the lung.

This observation is interesting in itself, and in view
also of the note by A. Chautfard, in the Presse Medi-
cale of January 10th, 1906, referring to the eggs of
parasites simulated by pollen in fecal matter. Тһе
ovoid bodies described by Chauffard appeared to be
ova, but as they did not resemble the ova of any
known parasite they were submitted to a searching
investigation, when they were determined to be grains
of pollen from a coniferous plant.

J.C.

A SIMPLE GUIDE TO THE PRESERVATION OF HEALTH
IN бостн Ағшса. By Н. Strachan, C.M.G.,
M.R.C.S., L.R.C.P., P.M.O. Lagos West Africa.

Second Edition.

This is a short pamphlet of no more than seven pages,
published locally, it is presumed for gratuitous distri-
bution ; but it would be difficult to find elsewhere so
much sound advice compressed into so small a space.
Though written primarily for the assistance of Buro-
peans residing in West Africa, it is almost needless to
say that nine-tenths of its dicta are equally applicable
to India and other tropical lands.

Though no more than а page and а half is devoted
to precautions against malaria, it is astonishing how
much has been included in the space; and we are
glad to see that Dr. Strachan strongly recommends
the adoption of mosquito-proof rooms. He admits
that the guaze screens obstruct to some extent the
free circulation of air which is so essential to comfort ;
but points out that “ ће extra safety to health is
worth the extra inconvenience caused by a slightly
increased degree of heat." There is, however, no
reason why houses should not be so built as to be as
comfortable as it is possible to be in such a climate in
spite of their being made mosquito-proof.

The remedy lies in increasing the size of the win-
dows and other openings so guarded.

West African houses are, however, usually extremely
badly planned in this and almost every other respect of
fitness for the climate they have to withstand; but,
doubtless, in West Africa, as elsewhere, sanitarians
such as Dr. Strachan have little or no opportunity of
criticising the plans drawn up by the engineering
authorities, and so have to make the best of the latter's
bad jobs, after they һауе become accomplished and
costly facts. Provided a room be designed with large
openings coming down nearly to the floor, and that
the house be so planned that a thorough current of
air is possible, there is no reason why breeze enough
to hlow the papers off the tables should not find
entry through wire gauze. We are glad to вее, too,
that Dr. Strachan recommends the pertodical and not
the chronic use of quinine as a prophylactic against
malaria, in the form of a full dose (10 grs. quin. sulph.,
or 6 grs. of hydrochlorate) on two consecutive days
weekly. There ean be no doubt that the chronic
quinine taking, which is so often recommended and
practised in West Africa, has a most harmful effect
on the nervous system, and indirectly on the general
powers of resistence to truly climatic influences ; and

March 1, 1906).

that іп view of the life-history of the parasite it is
quite needless to dose one’s self more frequently than is
recommended by Dr. Strachan

Much of the pamphlet is naturally taken up with
the management of tanks. Foreign as it may be to
the popular idea of West Africa as a pathless swamp,
the actual facts of the case are that the rainfall is by no
means excessive for an equatorial climate, and that
some of the most obtrusive discomforts of the country
are the outcome of its liability to prolonged periods
of drought. The surface wells are bad, and in the
absence of regular waterworks, rain-water tanks with
all their admitted liability to pollution are the sole
available supply.

In some years the practically rainless period may
extend to four or five months, even at Lagos, and to
much more than this at Accra, so that the sort of stuff
that is left at the bottom of the tanks at the end of
such a period may be easily imagined, especially
before their management was taken in hand by
thoughtful sanitary experts of the type of the author
of the pamphlet. While, however, the climate is to
һе considered ав а somewhat dry rather than a wet
one when compared with the majority of countries in
the same latitude, its annual rainfall of 73 inches
scarcely qualifies it to pose as а Sahara, and makes
it certain that there must be plenty of good water to
be got by paying for it. The solution of the diffi-
culty lies with the financial authorities, as the
engineers have no doubt excellent plans ready for
adoption if only sufficient money be forthcoming. Let
us hope that these monetary difficulties will soon be
surmounted; for a good and ample water supply is
everywhere the first essential of sanitation, and the
possibilities of “һе Coast''in the matter of health
can never be fully realised until Dr. Strachan is able
to even further abbreviate his pamphlet, by cutting out
his excellent hints ав to the management of rain-
water tanks, on account of the latter having been
replaced by regular water supplies in all centres of
population.

THE CULICID FAUNA OF THE ADEN
HINTERLAND.
By Lieutenant W. S. Parros, І.М.6,
(Reprint from the ** Journ, Bombay Nat. Hist. Soc.," November,
1905, p. 623.)

Тнів paper is а valuable contribution to our know-
ledge of what may be termed the Medical Zoology of a
portion of Southern Asia, that up to now has been
almost unexplored from this point of view.

Hitherto the whole of Arabia has been & terra in-
cognita, and, with small reservations, the same remark
applies to Somaliland and the shores of the Persian
Gulf.

We must confess, however, that we should not have
expected to find the Culicid fauna consisting so largely
of new species.

Of the five Anophilina described, all are claimed as
new, while one of the seven species of Culicines has
also not been hitherto described.

The region is, however, а desert one, where the
area of distribution of species would naturally tend to

THE JOURNAL OF TROPICAL MEDICINE. 13

be cireumscribed, and into which opportunities for the
importation of the forms of neighbouring countries
must be rare.

The descriptions are full and for the most part
excelent, and the figures, though very rough, in-
telligible. Тһе important detail of the banding of the
legs is not, however, described in sufficient detail.

We are not quite clear whether the author adopts
the classification of James and Liston, or that of Mr.
Theobald, as some of the species have the latter's
genera inserted in brackets after “ Anopheles,” while
others have not.

One of the new species, “ Anopheles (Myzomyia)
Jehafi," is described as having the thorax “ covered
with brown-curved scales.” Now it is a characteristic
of Theobald’s genus Myzomyia, that the thorax, except
occasionally on the fore-edge of the mesonotum, should
be devoid of true scales, as the chitinous appendages of
this region are hair-like, and for practical purposes may
be regarded as hairs. The term “ curved scale " has а
special signification in Mr. Theobald’s system of classi-
fication, and if it can be correctly applied to those
covering the thorax of this species, the genus has been
wrongly assigned. The description, in fact, throws it
into Pyretophorus, where I see the author notes it
was placed by Mr. Theobald, who “ suggested it might
possibly be A. cinereus, Theobald.” Judging from the
plate of the wing I should say it was referable to that
species.

It is similarly noted that Mr. Theobald identifies
this author's Anopheles Arabiensis as his А. Welcome:
from the Soudan. Now Mr. Theobald is none too loth
to make new genera and species, and on such a point
as the identification of one of his own species most
would prefer to take his dictum to that of any other
authority, and any attempt to unnecessarily lengthen
the already bewildering list of species is much to be
deprecated.

Lieutenant Patton did not come across Theobald's
Cellia Pharansis during his researches, though the
latter notes that it had been sent him from the Aden
hinterland.

There is nothing surprising in this, but, curiously
enough, the author evidently considers that Theobald
must be referring to some of the specimens sent to the
latter by himself, and does not seem to see that they
must have been contributed by some other collector.

These, however, are details which need not diminish
our congratulations to the author on а good and pains-
taking piece of work. с. M.G.

—9—-- €
Abstract.
TROPICAL AUSTRALIA—IS IT SUITABLE
FOR A WORKING WHITE RACE?
Dy J. S. C. ErxiscToN, M.D., D.P.H.

TropicaL Australia comprises rather more than
one-third of the entire Commonwealth territory. One-
half of Queensland, 523,620 square miles of the
Northern Territory, and the north-western divisions
of Western Australia, are included, totalling in all
some 1,145,000 square miles. The country ranges from
the Расібс to the Indian Ocean, ineludes practically

74 THE JOURNAL OF TROPICAL MEDICINE.

[March 1, 1906.

all ordinary varieties of tropical climate, and is
dominated by the monsoonal winds. The greater part
of it lies between 600 and 1,500 feet above sea-level,
but extensive plateaux exist, covering many hun-
dreds of square miles, at an elevation of over 1,500
feet, and ranging in Arnheim Land to 3,000 feet and
over. Sufficient reliable physical cartography has
been carried out in Northern Australia to effectively
dispose of the old idea that the Northern Territory is
a vast mangrove flat, and the remainder an arid waste
of sand at or near sea-level. Elevation materially
modifies climate, and the breezy tablelands of
eastern North Queensland at least afford for many
months of the year as “bracing” an atmosphere as
can be found anywhere in the world. Р

Drought is а rare phenomenon іп the monsoonal
area, and the great northern rivers testify to the
abundance and regularity of the annual revivification
from this cause. These also afford waterways for
considerable distances into the interior, and drain ex-
tensive areas of good pastoral country.

After discussing what are the objections to the
settlement of a white race in tropical Australia and the
problems to be faced, Dr. Elkington concludes as
follows :—

“Тһе future of tropical Australia appears to lie in
the common-sense of the people, and of their repre-
sentatives in the Legislature. In its present condition
it must continue to form a monument to the lack of
enterprise displayed by Australians, and a perpetual
temptation to other races and people more appreciative
of its varied endowments, and gifted with greater
resolution and insight than we appear at present to
possess. It is no question to be solved rule-of-thumb
fashion by a mere trust in Providence. Tropical
Australia should be & prize for the fittest, and if
suecess is desired, every reasonable precaution will
require to be taken to insure and maintain that fitness.
Ав one possessing some knowledge of the cost and
application of systems of sanitary administration, 1
am of opinion that this portion, at least, of the
necessary administrative organisation will not prove
costly, if gradually and sagaciously installed. Соп-
cerning its economie value, the facts detailed above
will have afforded sufficient indication.

“ Before any definite move can be made more will
require to be accurately known concerning the topo-
graphical and other conditions of the country. From
what can be gathered, however, the institution of an
enquiry should be amply justified. In this age of
land-hunger Australia cannot continue to act as the
dog in the manger. Given sufficient industrial at-
traction, population will soon be forthcoming, and
there appears to be no good reason why that popula-
tion should not be a white one. Should the initial
difficulties appear too great, the alternative of a
coloured population is always feasible; but I, for one,
would regret to think that the national pluck and
enterprise upon which we Australians are rather apt
to pride ourselves is insufficient to enable difficulties
to be faced which have been met and overcome else-
where under less favourable conditions."

————p——— — ——

GOVERNMENT MANIFESTO ON PLAGUE
PREVENTION.

Tue following has been issued by the Home Department:
Calcutta, January 18.

INDIAN

“More than five years have now passed since the
Governor-General in. Council, when reviewing the report of
the Indian Plague Commission, examined, in the light of
the knowledge then available, various measures which had
been proposed or adopted with the object of checking diffu-
sion of the disease, and indicated the considerations of
poliey whieh must govern their introduction in India during
this period. While the efforts of Government officers have
in no way relaxed. and the people themselves have in many
places shown a disposition to acquiesce and even co-operate
in preventive measures which do not conflict with their
social and religious usages, plague has gradually spread to
almost every part of India, and subject to certain seasonal
fluctuations, tends to reeur year after year with undi-
minished virulence. About & year ago. the Government of
India, acting in concert with the Royal Society and Lister
Institute, made arrangements for the appointment of a
scientific Commission, which is now investigating the
causation of plague in Bombay and the Punjab. Pending
the completion of these researches, which may extend over
a long time, and will in any case be directed inainly to the
scientific aspects of the problem. the Governor-General соп-
sidered it desirable to place on record, in a concise form, the
results of practical experience which have been acquired in
the last five vears of actual plague administration. The
Local Governments were accordingly asked for reports
based. as far as possible, on the personal experience of their
officers, on the conditions affecting the origin and spread of
plague, the character of the measures to be adopted against
it. the degree of success attained, and the causes upon which
success or failure depend. The ample materials thus col-
lected place the Governor-General in a position to indicate
those preventive measures which appear, under present con-
ditions, most likely to be successful in the future.

“ The most conspicuous change in the opinion of experts
in India regarding plague since the issue of the Resolution
of July 16th, 1900, is the greatly increased importance now
ascribed to the part played by rats in spreading and keeping
alive the disease. Rats are exceedingly susceptible to
plague, and when once they are infected they usually com-
municate infection not only to man but also to houses which
have undergone a thorough disinfection. It is therefore as
essential to the safety of the community to destroy infected
rats as to segregnte plague-stricken people; in fact, almost
all the evidence regarding the causation of plague may be
regarded as pointing to the rat as the chief agent in its diffu-
sion. For this reason the importance of destroying rats has
been insisted on by the framers of the Paris Convention of
1908, and although European opinion is not unanimous on
the point, the Governor-General considers that experience
recently acquired in India warrants the belief that the
systematic destruction of these animals promises to be one
of the most effective measures that сап be adopted for рге-
venting the spread of plague.

“Observation has also shown that plague is most severe
where the houses of people are crowded together, badly
built and imperfectly ventilated, while it usually spares
those areas in towns where the streets are wide, houses
well built, the alleys and side walks paved, and the drains
properly constructed. It follows that municipalities and
local bodies should be encouraged and assisted to demolish in-
sanitary quarters, to improve the paving of alleys and side-
walks, to neglect no opportunities of widening the narrow
streets, to enforce simple building rules, and perfect their
systems of drainage and conservancy. All go-downs where
grain is stored should be rendered rat-proof, and should be
liable to periodical inspection. Tn theory the disinfection of
both houses and clothing takes a high place among preven-
tive measures, and in cases of pneumonic plague it must be

March 1, 1906.)

THE JOURNAL OF TROPICAL MEDICINE. 75

regarded as imperative; but the great difficulty of carrying
out the process thoroughly in a house casts some doubt
upon its practical utility, and the Government of India
leave it to local authorities to determine the extent to which
it should be enforced with reference to prevalent structural
conditions. In any case, the efficacy of house disinfection
depends entirely upon the methods employed. The fluids
used must be really germicidal, such as solutions of corro-
sive sublimate, суШп, or izal. They must be intelligently
applied under proper supervision, and care must be taken
to prevent reinfection of the building by rats. These obser-
vations apply in their full force only to towns where the
disease has not fully established itself. In villages the dis-
infection of houses is seldom of much use, while in towns,
where plague has become indigenous, the difficulty of com-
pletely excluding rats leads to constant reinfection. Of the
various measures hitherto adopted with the object of arrest-
ing an outbreak of plague none has proved so efficacious as
the prompt abandonment of an infected locality for a period
that varies with local conditions. In the case of villages,
indeed, the evacuation of all houses, accompanied by the
systematic destruction of rats, is probably the only means
of effectually combating the disense. It is, however, essen-
tial that evacuation should be carried out thoroughly. If a
portion of the inhabitants remains behind, the disease will
continue to spread. In all cases where evacuation is feasible,
the people should be encouraged to resort to it, assisted by
the grant of blankets and warm clothing, where necessary,
and by the provision of huts or materials for building
them.

“Тһе evidence which has been collected shows that the
inspection of travellers by railway, road and steamship is
often successful in averting or delaying the spread of plague,
but that the efficacy of this measure depends on the cireum-
stances in which it is applied. It is of most value in pro-
tecting limited areas such as hill stations and places so
situated that inspection posts command all routes of access.
The mere inspection of persons arriving by steamer is,
however, of little use unless the rats on board the vessel are
destroyed or are prevented from reaching the shore. A
segregation camp for the detention of sick is а necessary
adjunct to every inspection station, but no one need be
detained who is not actually suffering from plague. In all
other cases it is sufficient to record travellers’ names апа
addresses and to arrange for their being under surveillance
for five days. Experience has shown that mere contact
with a case of bubonic plague in a railway carriage involves
little danger of infection. The example of prisons proves
that quarantine may be relied upon to prevent the spread of
plague by human beings, but it can seldom be npplied effec-
tually, except by the people themselves, who have some-
times combined to prevent persons from infected places
from entering their villages, and have provided accommoda-
tion for them outside the inhabited site. In rural arcas the
adoption of these measures may properly be encouraged,
but they do not admit of application to towns. Тһе re-
moval of the sick to hospital, while it is eminently desirable
in their own interests, has always been unpopular, and
in cases of bubonic plague the necessity for it may be
avoided. provided that the surroundings of the patient
can be kept clean and free from rats. That the measure
is instrumental, however, in delaying the spread of the
disease is undeniable, and even though segregation may
be relaxed when indigenous cases become widespread,
the first few cases imported into a plague-free town
should, whenever possible, be segregated without delay.
Cases of pneumonic plague, which is directly infectious from
man to man, ought always to be segregated. The segrega-
tion of persons who have been in contact with a patiént
suffering from bubonic plague is often impossible in prac-
tice. When it can be carried out with the good-will of the
people the measure is no doubt useful, but where coercion

ав to be employed more harm than good is likely to result.
In cases of pneumonic plague, however, the segregation of
contacts is necessary, as the risk of infection is extreme.

“Inoculation with the prophylactic fluid now manufac-
tured at the Parel Laboratory is of value, not merely for the
protection which it affords against plague, but also by
reason of its effect in mitigating the violence of an attack.
The extent to which it may be adopted depends upon the
strength of popular sentiment іп ібз favour or against it, and
the Government hope that the people may be encouraged to
have recourse to it.

“ While the experience of the last five years establishes
the utility of the measures enumerated above, it equally
teaches that their application must depend upon ће circum-
stances of locality. the character of the people, the stage
which the disease has reached, and the agency available for
dealing with it. What is necessary in a district free from
plague may be useless or vexatious where plague has
become indigenous. What is effectual in one part of the
country may be inoperative in another. А degree of
control which is acceptable to a particular community may
be strongly resented by the people who observe a different
code of social usage, and in a province with a well-developed
systeni of village officials more can be attempted than in a
province where no such organisation exists. Where condi-
tions vary so widely from province to province, as is the
ease in India, it is manifestly impossible for the Governor-
General to lay down a uniform scheme of plague administra-
tion. The Local Governments alone are competent to
determine what measures are practicable or expedient at
particular times and places, and it is upon them that the
Government of India rely to make the best use of the oppor-
tunities which present themselves for checking the spread
of the disease. Finally, the Governor-General would
observe that in the last resort all preventive measures
depend for their success upon the hearty co-operation of the
people themselves, and that every effort should be made to
enlist their sympathies and to bring home to them, through
their natural leaders and in any other way that may be
practicable, that it rests mainly with them to bring about
by their own action the cessation of plague in India, as it
has long ago disappeared from Europe. When this convic-
tion has been firmly established in the minds of the people,
the task of district officers throughout India will be materi-
aly lightened, but that can only be obtained by carrying
out thoroughly whatever measures it may be decided to in-
troduce, and by impressing upon all officers concerned in
plague administration that when a decision has been arrived
at there must be по hesitation in giving effect to а policy
approved by the Local Government."

————»— ——-

Translation.

PRELIMINARY STATEMENT ON THE RE-
SULTS OF A VOYAGE OF INVESTIGA-
TION TO EAST AFRICA.

By R. Kocu.
(Translated from the German by P. Falcke.)
(Continued from page 45.)
(2) DEVELOPMENT оғ PROTOPLASMA ' (sic) BIGEMINUM.

The Piroplasma bigeminum, the active agent of
Texas fever, is capable of undergoing a peculiar cycle
of development in certain species of tick under parti-
cular climatic conditions.

In order to follow this development one should
examine the contents of the stomachs of ticks removed
from an infected beast which have gorged them-
selves with blood on several successive days.

The pear-shaped parasite, the chromatin of which
has usually already divided into two distinct masses

ө

! Sic іп original. Obviously a misprint in the German
article for Piroplasma bigeminum. (Smith and Kilborne.)

76 THE JOURNAL ОЕ TROPICAL MEDICINE.

[March 1, 1906.

(fig. 3), leaves the red blood corpuscle and becomes
elongated, one of the two chromatin bodies passing to
the anterior extremity of the parasite and forming a
sharp dark point. The other mass of chromatin re-
mains in about the centre of the parasite, and has
a less compact appearance (tig. 4). Ray-like pro-
cesses appear on it near the point; at first two or
three, later on more. At the inferior extremity of
the parasite several rays or processes also often
develop. The parasite has always an angular, radiat-
ing look (figs. 5 and 6). Often it resembles a mace
pointed at one end, and exhibiting a granule of chro-
matin surrounded by stellate rays at the other ex-
tremity (lips. T and 8).

From the second day there are often found, in
addition to the above described forms, others in which
two specimens are connected by their posterior
extremities, looking like one body with a central
piece, and its two extremities furnished with star-like
chromatin granules (fig. 9). ] consider this form to
be referable to some form of vopulation. Besides these,
globular formations appear, the interior wall of which
is strewn at intervals with chromatin, and which in
addition have a point of chromatin at the periphery
(бы. 10). They convey the impression of having
originated from copulating parasites which have cast
off the ray-like processes.

The parasites provided with ravs have a great
tendency to unite into groups of from three to ten
or more specimens, amongst which copulating
couples may often be found. Moreover, one occa-
sionally comes across lougish, oval or pear-shaped
bodies, which, when the plasma is stained blue, ex-
hibit a moderately large nucleus of chromatin of
granular consistency (fig. 11). These forms appear
to me to be a transition to the comparatively
large forms, which are likewise pear-shaped, апа
which I have frequently encountered in the ova of
infected ticks (figs. 12 aud 13). They are three
or four times the size of the piroplasma in the
blood of oxen, and it may therefore be assumed
that other transition forms must exist. These should
be sought for in young ticks. They may, perlmps,
be found in the embryos, or immediately after the
young are hatched, as it is known that the young tick
is capable of conveying infection.

Hitherto I have not succeeded in discovering this
transition form.

I was able to demonstrate the conditions of develop-
ment of Prroplasma bigeminum in Rhipicephalus
Australis, R. Fivertsi, and in Hyalomma zFEgpliwn, but
only in fully developed and gorged ticks and their ova.
I never found them in the larve, nymphæ or un-
gorged adult specimens, though I frequently examined
them.

(3) THe Coast Fever or Oxkx.

The parasites of Coast fever differ in so many essen-
tials from the well-known piroplasima of the ox, dog,
and horse that they are probably not specifically
identical.

They do not exhibit the regular division into two, so
characteristic of piroplasma. Оп the contrary, in
Coast fever the parasites are always found to regularly

divide into four, arranged іп the form of a cross ( -le ).
This never occurs in the real piroplasma, but has been
recorded in the disease discovered by Dschunkowski
in Trans-Caueasian Russia, and which he has called
tropical piroplasmosis.' In horses also there is a dis-
ease with parasites in the form of а cross ? in addition
to true piroplasmosis. It is therefore advisable to
class those diseases in which cruciform parasites
occur in one group.

Another peculiarity of Coast fever is that globular
bodies in large numbers are found in the spleen aud
lymphatic glands; they consist of protoplasm staining
blue, and contain a number of chromatin bodies. (Tie
meaning of these forms is not sufticiently clear, and I
defer their description till the appearance of my com-
plete work.) Even before the parasites have appeared
in the blood these forms are so regularly found in the
spleen and glands that I was able advantageously to
diagnose the disease in slaughtered animals by their
presence.

l also succeeded in discovering the first stages of
development of the parasite of Coast fever which are
undergone in the tick. In this they are analogous to
the Piroplasma bigeminum, as they, too, assume angular
forms provided with rays: ouly they are considerably
smaller and have fewer corners and rays (fig. 14). 1t
is thus proved that the parasites of Coast fever, not-
withstanding the differences alluded to, correspond,
as to their developmental history, with the closely
related true piroplasma.

It must be mentioned, in addition, that the develop-
ment of this parasite had hitherto only been observed
in adult and engorged specimens of №. Australis. This
would seem to point to the inference that in Coast
fever the infection only takes place by means of the
young ticks of this or other species, in which it
may be hoped that the further development of the
parasites may, ere long, be worked out.

(То he continued.)

------о-

aHiscellancons.

THE ESPERANTISTS AND THE BRITISH
MEDICAL JOURNAL,

Тнк British Medical Journal has embroiled itself
with the Esperantists, who have taken deeply to heart
the Editor's description of their philological plaything
as а“ pigeon jargon." No class of medical man has
better reason for desiring a means of international
communication than the student of tropical medicine ;
but he is as little likely to waste his time on an un-
scientific attempt to facilitate it as his stay-at-home
colleagues, for the very good reasons pointed out by
the B.M., that languages are evolved and cannot be
made.

What the Esperantists appear to overlook is that

! By the demonstration of this eross-form I was enabled to con-
firm the distribution of cattle disease, which is very simili
to Coast fever in the countries on the Mediterranean, іп East
Africa, and New Guinea.

*pr, Kudicke demonstrated the same parasites in the zebra,

March 1, 1906.)

there is no need whatever of trying to enhance the
curse of Babel by inventing a new tongue, as the
acquirement of 2,000 words of any language will
enable one to understand and be understood for all
ordinary purposes, and hence all that is required is for
the nations to decide on the medium of inter-com-
munication.

There is a good deal to be said for the Journal's
recommendation of Latin, but this can hardly һе car-
ried out in England until we have improved our publie
schoohnasters and university dons otf the face of
creation; for their system of teaching Latin by com-
mencing with verse, and ending with a vocabulary of
the least useful words and idioms will never give &
vernacular knowledge such as is required for the work-
a-day purposes of conversation. Added to this, their
pronounciation is so barbarous as to be absolutely
unintelligible to any foreigner. It may be admitted,
too, that the richness and flexibility of the language,
and the fact that our terminology is mostly Latin, ofa
sort, makes its use as a scientific Lingua Franca quite
practicable, but it is still probable that the Journal
underrates the difficulty of adapting it to such pur-
poses. Dead Latin, that is to say, the Latin of Cicero,
was evolved to meet the necessities of 100 в.с., and
had already been found quite unsuitable to the necessi-
ties of the fourth century, А.р., as evidenced by the
moans of the “ schoolmen " on what they are pleased
to call the decadence of the tongue at that period.
This, however, is an unscientific view of the case, for the
language had not decayed, but evolved ; and it is doubt-
ful if any stage of a language that is not in the use
of a civilised populace of the present day is really
suitable to our needs.

Nothing but international jealousies prevent the
most desirable consummation of some one modern
language being chosen for the purpose; and however
pitiable the reason шау be, English, French and
German are at once out of court for the very reason
that they are the tongues of “great powers." Why,
then, should not modern Latin, or, in other words
Italian, be chosen ?

Ninety-nine per cent. of classical scholars of all
nations would aequire a sufficient knowledge of this
easy and beautiful language in а tithe of the time that
would be required to enable him to adapt his know-
ledge of dead Latin to colloquial purposes.

So much of the best that has been contributed to
tropical medicine has been written in Italian, that a
working knowledge of that language is indispensible
to all who desire to follow the literature of the sub-
ject; but there is no branch of science in which it
is not rich, and it is needless to say that its non-scien-
tific literature is second to that of no other nation.
Latin is neither dead nor sleeping, but a living reality
in its modern form, and in this way what we have
learned of it would become of real use to us. Let us
hope the question will be considered soon, as Italyis so
rapidly advancing to the rank of a great power, that
before long the claims its language to serve as an inter-
national tongue will have to be ruled “ out of the run-
ning,” and this would be unfortunate for all who have
been at the pains to acquire a smattering of what
should preferably.be spoken of not as dead Latin but
as Aucient [talian.

'C.B., C.I.E., І.М.б., 6 m., Med. Cert.

THE JOURNAL OF TROPICAL MEDICINE. 77

Personal Hotes.
INDIAN MEDICAL SERVICE.

Captains to be Majors.—Cecil Robert Stevens, M.D.,
F.R.C.S., Leonard Rogers, M.D., F.R.C.S., Gordon
Travers Birdwood, M.D., Cecil Charles Stewart Barry,
Ernest Alan Robert Newman, M.D., Jay Gould, M.B.,
Reginald George Turner, James Davidson, M.D., and
John Mulvany.

Lieutenant-Colonel W. A. Manson, I.M.S. is con-
firmed in medical charge of the 11th Lancers.

The services of Captains Hutchinson, Lindesay and
Saigol, I.M.S., are placed at the disposal of the
Bombay, Bengal, and Burma Governments respec-
tively, the last named for plague duty.

Lieutenant-Colonel W. G. H. Henderson, I.M.S.,
reverts to military employ.

Captains W. A. Justice and W. Illius, I.M.S., аге
posted to Madras.

Major C. H. L. Meyer, I.M.S., on relief, to act as
Professor of Medicine and Clinical Medicine and
Therapeutics, Grant Medical College, vice Major L. F.
Childe, M.B., I.M.S., proceeding on leave. Captain
E. Е. б. Tucker, I.M.S., on relief, to act as Professor
of Pathology and Morbid Anatomy, and Curator of the
Pathological Museum, Grant Medical College. Major
C. H. L. Meyer, I.M.S., on relief, to act as First
Physician, Jamshedji, Jijibhai Hospital, vice Major
L. Е. Childe, M.B., I.M.S., proceeding on leave.
Captain H.Bennett, M.B.,C.M., B.Sc., F.R.C.S., I. M.S.,
on relief, to act as Civil Surgeon, Surat. Captain
Е. H. G. Hutchinson, M.B., I.M.S., to be Resident
Surgeon, St. George's Hospital, Bombay, vice Captain
C. H. S. Lincoln, I.M.S., continuing to do duty as
Deputy Sanitary Commissioner, Southern Registration
District. Captain R. M. Carter, I.M.S., has been
appointed to act as Civil Surgeon, Jacobabad, from
November 1st, in addition to his own duties.

Lieutenant А. Е. Hayden, М.В, B.S.Lond.,
L.R.C.P., M.R.C.S., has taken the Montefiore Bronze
Medal and Prize in Military Surgery, and also the
Martin Gold Medal in Military Medicine.

Military Assistant Surgeon М. 8. Harvey, whose
services have been placed at the disposal of this
Government, to be Assistant to the Civil Surgeon,
Naini Tal, with effect from December 8th, 1905, vice
Military Assistant Surgeon С. С. Thompson, appointed
Civil Surgeon, Garhwal.

India Office: Arrivals Reported in London.—Major
J. S. Lumsden, I.M.S. Lieutenant R. F. Steel, I. M.S.
Nursing Sister Miss W. M. Aldridge, C.A.M.N.S.1.
Lieutenant-Colonel J. Brochi Mills, I.C.V.D. Lieu-
tenant-Colonel J. W. Rodgers, IM.S. Captain J.
W. Е. Rait, 1.M.S.

Extensions of Leave.—Captain L. Rundall, I.M.S.,
6 m., Med. Cert. Lieutenant J. №. Н. Babington,
I.M.S., 3 m., Med. Cert. Major Н.А. Smith, І.М.8.,
6 m., Med. Cert. Lieutenant-Colonel L. А. Waddell,
Major F.
Raymond, I.C.V.D., 1 m., Furlough.

Permitted to Return to Duty.—Lieutenant-Colonel
T. К. Mulroney, I.M.8. Captain R. Bryson, І.М.8.
Captain V. St. S. Mores, I.M.S. Major Е. Joslen,
I.C.V.D.

[March 1, 1906.

78 THE JOURNAL OF TROPICAL MEDICINE.

COLONIAL MEDICAL SERVICE.

Brivcer,—J. Е. E. Bridger, M.B. Lond., L.R.C.P.,
М.К.С.5., D.P.H., Medical Officer of Health, Bridge-
town, Barbados.

Croucu.—Dr. J. A. Clough, Medical Officer, Lagos,
takes over the duties of Resident Medical Officer of the
Lagos Hospital.

Frenais.—Dr. А. C. L. La Frenais, L.R.C.P.Edin.,
has been appointed a Government Medical Officer of
British Guiana.

Tavron.— W. I. Taylor, M.D., has left Lagos on
leave.

WisE.—K. S. Wise, M.R.C.S., L.R.C.P., has pro-
ceeded to British Guiana in the capacity of Govern-
ment Bacteriologist, а new appointment connected
with the Public Hospital, Georgetown. Mr. Wise has
resigned his appointment of Demonstrator at the
London School of Tropical Medicine which he had
held for several sessions.

Бомкзтіс.
Віктнв.

Jenngy.—At Quetta, оп January 24th, 1906, the wife of
Major Jenney, І.М.5.. of a son.

Mappox.—At Ranchi, on January 24th, 1906, the wife of
Major Ralph Henry Maddox, Indian Medical Service, of a
daughter.

МеКеснімк.-Аф Jullundur, on January 25th, 1906. the
wife of Captain W. E. McKechine, I.M.S., of a daughter.

MARRIAGES.

MACLAGAN— Макому. —Аф the Cathedral, Lahore, on Janu-
ary 27th, 1906, by the Rev. W. B. Handford, Edward
Douglas Maclagan, I.C.S., to Edith Marony, niece of Colonel
T. E. L. Bate, I.M.S.

WuELaN— LoxGHURsT.—At Peshawar, on January 28rd,
1906, by the Rev. J. A. Cunningham, Captain J. F. Whelan,
Royal Army Medical Corps, to Geraldine Arden, eldest
daughter of the Rev. W. H. R. Longhurst, Viear of Queen-
hill, Upton-on-Severn, Worcestershire.

List oF INpiaN Мешел, OFFiceks ON FURLOUGH.
(Under Civil Rules.)

Showing the Name, Province, and Department, and the
Period from which the Leave was granted.

Anderson, Captain 5., I.M.S., В. Med., to September 25th,
1906.

Anderson, Lieutenant-Colonel A. V., I. M.S., Bo. Med., 20 m.
8 d., September 10th, 1904.

Bennett, Captain V. B., І.М.5., Bo. Med.. to June 22nd,
1908

Browne, Colonel S. H., LM.S., М.В. CLE., B. Мей. T m.
15 d., September 18th, 1905.

Calvert. Major J. T., I.M.S., B. Med., 21 m., June 6th, 1905.

Clarkson, Major Е. C., I.M.S., B.Comm., 17 m., June 16th,
1905.

Close. Major J. K., I.S., U.P. Med., 10 m. 2 d., November
29th, 1905.

Delany, Capt. T. H., LM.S., B. Мед, 17 m. 9 d., April
9th, 1905.

Donovan, Major C., I.M.S.. M. Med., 12 m., March 8th.
1906.

Drake-Brockman, Major Н. B., І.М.5.. В. Med., 19 m.,
May 6th, 1905.

Drury, Major F. J., 1. M.S., В. Med., 9 ın., July 4th, 1905.
Duer, Major C., I.M.5.. B. Med.. 18 m., May 12th, 1905.

I.M... M. Medl., 15 m.,

Fayrer. Captain F. D. S.,
Mareh 3rd, 1906.

Fullerton, Major T. W.
February 18th, 1906.

Наїкіпе, W. M., C.LE.. Bo. Misc., 21 m.. July 80th,
1904.

Henderson, Major S. H., LM.S., U. P. Gaols, 9 in. 14 d.,
January 18th, 1906.

Hugo, Captain H.,
March 6th, 1906.

Irvine, Major T. W., L.M.5., 13} m.. September 29th, 1905.

Kemp, Captain D. C, ТМ... M. Med, 4 m. 7-4.
September 20th. 1905. >

Lumsden, Major J. 5. S., M.B., F.R.C.S., I.M.S., U.P. Med.

Lumsden, Major P. J.. I.M.S.. В. Med., 14 m. 18 d,
September 10th, 1905.

Maitland. Lieutenant-Colonel L, I.M.S.. M. Med.. 12 m.
Mareh 80th, 1905.

Melville, Major H. B., U.P. Med., 20 1., March Ist, 1906.

Miller, Captain A., I.M.S.. M. Med.. 15 m., September
llth, 1905.

Morwood, Major J.,
April 7th, 1905.

Mulroney, Lieutenant-Colonel T. R., P. Med., 23 m. 10 d.,
April 5th, 1904.

Niblock, Captain W. J., LM.S., М. Med., 12 m., March 1st,
1906.

Orr. Major W. H., 1.М.5.,
December 8rd, 1905.

Perry, Captain E. L., I.M.S., P. Med, 9 m., August 15th,
1905.

Prain, Lieutenant-Colonel D., I.M.S., Botanical Department,
19 m., February 1st, 1905.

Rainier, Captain №. R. J., LM.S., С.Р. Med., 7 m. 23 d.
November 19th, 1905.

Rait, Captain Т. W. F., I. M.S., B. Medl., 19 m., March 21st,
1906.

Rogers. Major Е. A., І.М.5., B. Med., 28 m. 2 d., January
14th, 1904.

Rundle, Lieutenant-Colonel C. 5., I.M.S., Burma Med.,
21 m. 7 d., July 28th, 1905.

Seotland, Major D. W., I.M.S., U.P. Med., 21 m., June 26th,
1905.

Shore, Lieutenant-Colonel R., M.D., I. M.S., B. Med., 15 m..
February Ist, 1906.

Smith, Captain Е. A., І.М.5., B. Med., 15 m., February 15th,
1906.

Smith, Major Н. A., 1.M.S., U.P. Med., 15 m. 4 d., July 28rd,
1905.

Stephenson, Captain J., LM.S., P. Med., 18 m. 26 d.
February 4th, 1905.

Stodart, Major J., I.M.S., Burma Med., 4 m., January 4th.
1906

A. LM.S. U. P. Med., 12 m,

LM.S. D.S.0.; В. Med. 9 m.

LM.S. U.P. Med.. 20 m. 7 4,

С.Р. Med, 15 ш. 4 d,

Street, Major A., I.M.8., Bo. Med., 9 m., January 15th, 1906.

Symons, Captain T. H., І.М.5., M. Med., 14 m. 22 4.
August 21st, 1905.

Thomson, Lieut.-Colonel 8. 1., C.LE., І.М.8., U.P. Comm.,
11 m., May 1st, 1905.

Tucker, Captain W. H., І.М.5., М. Med., 10 m. 20 d.,
August 20th, 1905.

Vost, Major W., І.М.5., U.P. Med., 15 m., May 14th, 1905.

` Wilkinson, Major E., LM.S., P. Comm., 21 m., July 5th,

1905.
Wood, Major Н. S.. I.M.S., B. Med., 21 m., March 20th.

1905.
Young, Major W., І.М.5., U.P. Med., 21 m. 21 d., January
19th, 1906.

Магеһ 1, 1906.)

Recent and Current Жега биге,

A tabulated list of recent publications and articles bearing оп
tropical diseases is given below. То readers interested in
any branch of tropical literature mentioned in these lists
the Editors of the JouRNAL oF Tropica, Mepicixe will be
pleased, when possible, to send, on application, the medical
Journals in which the articles appear.

“Bulletin de l'Institute Pasteur,” Т. iv.
BACILLARY DysENTERY.

Médecin Major Ch. Dopter points out that dysentery is
a symptom of several distinct diseases. There 1s, for ex-
ample, а dysentery due to spirilli, another due to Balan-
tidium coli, and a third to bilharziosis. But the two
commonest are the amceboid dysentery of hot countries and
the bacillary dysentery, which is found alike in the hot and
temperate parts of the world. Though repeatedly noted, it
was not till 1898 that Shiga succeeded in distinguishing the
bacillus from the В. typhosus and В. coli. He further de-
1nonstrated its specific character by showing that the serum
of patients agglutinated its cultures. The bacilli are short,
with rounded ends, scarcely motile, not staining by Gram's
method, not liquifying gelatin. The colonies, at first puncti-
form, grow and assume a foliated appearance, with a dark
centre and clear periphery. Two years after Kruse found
the same organisin in cases seen in Westphalia, Since then
Shiga's observations have been confirmed by a large
number of workers in all parts of the world, and he has
clearly demonstrated the specificity of the organism by
producing the disease in rabbits, dogs and pigs. and by
comparing his cultures and their behaviour with strains
obtained from Shiga, Kruse and others. In announcing
their investigations. the authorities quoted soon eame to the
conclusion that, in spite of morphological and cultural re-
semblances, there are really not one, but several, dysenteric
bacilli which differed mainly in their agglutinating power.
It was further shown that they differed also in their fermen-
tive properties, the Shiga-Kruse bacillus failing to ferment
mannite and maltose, while the Flexner-Manille organism
does so. Leutz, however, regards the latter as not patho-
genic, but only an associated organism. Park. Collins and
Goodwin distinguish three sets of organisms : —

(1) Shige's bacillus. Does not form indol. Ferments
neither mannite, maltose, or saecharose. Inoculated animals
yield a serum powerfully agglutinative for this, but only
slightly for the other classes.

(2) Bacili which form indol, ferment the above sugars,
and in which the serum of inoculated animals agglutinates
cultivations of this type and also those of the third sort.

(8) The Flexner-Manille type. which forms indol, ferments
the above sugars,and in which the serum of inoculated animals
agglutinates cultivations of this and the second class, and
also the coli bacilli. Some authors, however, make a more
minute classification, but there appears to be a general
tendency to regard the Shiga-Kruse bacillus as alone specific,
and the Flexner as associated with them. The author then
enumerates and describes in detail the organisms that have
been described up to date, the general conclusion hitherto
arrived at being that cases may be divided into two classes :
First, true bacillary dysentery. caused by the Shiga bacillus ;
and secondly, a variety of pseudo-dysenteria caused by a
variety of pseudo-dysenteric bacilli. He then describes in
detail his own observations on these organisms, and discusses
the clinical and epidemiological evidence, and concludes that
in spite of the arguments brought forward by his pre
decessors, there is no sufficient reason for subdividing
bacillary dysentery.

He admits that in a general way dysenterie bacilli can be
arranged in two groups, but it is inexact to assert that the
Flexner bacillus can be further subdivided. He, however,
regards all forms as really identical, and all equally specific,
and on this account considers that such terms as ** true dysen-
tery,” infantile dysentery, &c., should be abandoned in favour
of the one term, bacillary dysentery.

THE JOURNAL OF TROPICAL MEDICINE. 79

“Journ. of Hyg.," T. јайо. 4, 1905.
SARCUSPORIDIAN FOUND IN THE MUSCLES oF А MONKEY.

Korte, W. E. —These organisms were found in a Macucus
rhesus, and are the first ever found in any monkey. The
parasites are suusage-shaped, surrounded by a capsule which
shows a fine striation perpendicular to its surface and filled
with spores.

“6. R. Soc. Biol.,” Т. lix., 1905.
INTESTINAL CocciDIOsIS OF THE Ох IN TuNIs.

Ducloux, E.—He describes & serious malady principally
affecting young oxen, and often fatal, charactised by severe
diarrhuwa, at first liquid and then sero-sanquinolent. The
lesions are found in the abomasum and intestine. The
epithelial cells of Leiberkühn's glands of the large in-
testine are found to contain coecidii, which are tetrasporo-
evstie and digoie. Similar cases appear to have been recog-
nised in France апа Switzerland.

“Munch. Med. Woch.," T. lii.
PENETRATION OF THE SKIN BY [LARVAL ANKYLOSTOMEs.

Bruns, H.. and Müller, W., obtained positive results in
the case of ten dogs on which the larve were either placed
on the skin or injected beneath it.

Their first two attempts to infect the human subject by
placing the larvæ on the skin of the forearm failed, but two
others, in which the skin was soaked in warm water for half
an hour, succeeded. In the first case eosinophilosis ap-
peared after three weehs and eggs in the stools on the 53rd
day; in the second case after 20 and 46 days respectively.
The authors consider, however, that infeetion by the mouth
is the commoner and more certain method.

* Lancet," February 17, 1906.
Mata FEVER IN INDIA.

Captain W. H. C. Forster, who is Deputy Sanitary Сош-
missioner iu the Punjab, recalls the fact that Wright, at
Netley, demonstrated the specific reaction of Malta fever in
patients invalided from India, and these observations were
confirmed by Lamb and Birt in India. Doubts were, how-
ever, thrown on the accuracy of these observations, and
“at the beginning of the present vear it was officially held
that Malta fever had not been proved to exist as an endemic
disease in India." Lamb and Pais have, however, recently
removed all doubt on the subjeet by isolating the Microccocus
melitensis from the spleens of Indian cases. "These writers
inter alia described cases oceurring among the 14th Sikhs at
Ferozapur, and in view of the work of Dr. Zammit and Major
W. Horrocks on goats in Malta, Captain Forster decided to
repeat their observations on the goats supplying milk to the
14th Sikhs. The result was that 4 out of 88 goats examined
gave a positive reaction. and that two of these, which were
taken for further observation to the Pasteur Institute,
Kasauli, were found to yield milk infected with the specific
organism of Malta fever. Any doubts as to the occurrence
of the disease in India may therefore be considered to be set
at rest.

eee eee
Motes and Hews.

Proressor Косн starts for East Africa early іп April.

The chlorine-free culture medium for the Bacillus
lepre, by the use of which Captain Rost, I.M.S., in
Rangoon, claimed to have succeeded in cultivatin
the pathogenie organism of leprosy, has been tested
by Dr. Frank Tidswell in the laboratory of the Leper
Asylum of the Government of New South Wales, but

80 THE JOURNAL OF TROPICAL MEDICINE.

[March 1, 1906.

without success. The stringy, heavy deposits, de-
scribed by Rost did not appear, and though there were
a few of what appeared to be leprosy bacilli in the
first culture, none appeared in the second.

It will be noted that this confirms the negative
results obtained in a test last year, instituted at the
Pasteur Institute, Kasauli. We hope, however, that
Captain Rost will not be discouraged from continuing
his experiments, which were conducted in a truly
scientific spirit, as the practical therapeutic results
of the treatment he based on them were, according
to independent medical testimony, undoubtedly remark-
able, whatever may bave been the merits of the theory
on which they were based.

Enteric IN INDIA.

The (Indian) Pioneer devotes a leading article to the
the closing of the controversy between Sir Thomas
Gallway, P.M.O., in India, and Dr. Leigh Canney,
in the columns of the Times, as to the etiology of
typhoid fever. Dr. Canney advocates the theory that
water carriage is practically the only vehicle of infec-
tion that need be taken into practical consideration ;
while Sir Thomas represents what is undoubtedly the
opinion of the vast majority of medical observers who
have had to deal with typhoid in India and in many
other tropical countries. No one, of course, denies the
importance of drinking water as a potential vehicle, but
it is an undoubted fact that though cantonment water
supplies in India have now almost universally been
raised above suspicion, their steady improvement
has not been followed by any proportionate diminu-
tion in typhoid. Water is only one, in fact, of a
number of possible vehicles, and in India flies and
dust are probably more often implicated than drinking
water, and it is in guarding against these sources of
infection that further improvement may be looked for.

PLAGUE AND SMALL-POX IN RANGOON.

During the last month there were 128 cases of
plague, with 126 deaths.

The number of cases of plague for the year ending
the 4th ult. in Rangoon, where the epidemic began
on February 4th, 1905, is 2,969, with 2,672 deaths.
There were in January 425 cases of small-pox in
Rangoon, being the largest number yet known.

The Indian plague returns for the week ending
January 27th show 3,747 deaths, compared with 4,240
in the week preceding. The principal figures are:
United Provinces, 958; Bengal, 896; Bombay Presi-
dency, 707; Punjab, 381; Central Provinces, 484;
Burma, 136.

The immunity of Europeans continues to be one
of the most noticeable features of the plague epidemic.
Last year in the Bombay Presidency, where the
disease carried off over a quarter of a million people,
only nineteen Europeans in all were attacked, of
whom ten died. In the previous year, in the same
region, where 316,000 deaths took place, only eight
were amongst Europeans.—Pioneer Mail, February
9th, 1906.

PURE WATER FOR TRAVELLERS.

In the Tropics and Sub-Tropies where water-borne
diseases are so prevalent, and wherever water is
suspected of being impure, any apparatus that really
purifies water, rendering it sterile and yet leaving it
pleasant to the palate and good for the health, must
needs be of the highest value and importance. Even
the best of filters have their limitations, the objections
to them are well known. Tbe “Сет” Pure Water
Still, of which an illustration is given, removes all im-
purities—germs and mineral matter—by the effective
process of distillation. The still isin three parts: In
the lowest the water is boiled and vapourised, the
vapour rises, and striking on the top
part, which is filled with cold water,
is condensed and trickles into the
middle section, whence it is drawn
off into a bottle. The still has been
approved by high medical authority,
and its value has been proved by
travellers in Persia, Africa, China,
and elsewhere. It is made entirely
of metal, there is no rubber or me-
chanism to get out of order; it is
simple, light, portable, effective, and
satisfactory. ‘The “Сет” Supplies

in every way
Co., Ltd., of 121, Newgate Street, London, will send
particulars of the still to any of our readers who

may enquire. Of course, this still is as uscful to resi-
dents as to travellers. Indeed, a great many “ Gem ”
stills are constantly in use even in Great Britain, in
many parts of which the quality of the ordinary water
leaves much to be desired.

PLAGUE.
PREVALENCE OF THE DISEASE.
Cases. Deaths.
India.—Week ended Jan. 6th ... 5,184 4,278
» „13th ... 5,029 4,240
2: » 20th ... 4,652 3,938
A »Q2"th ... 4,478 3,747
js Feb. 3rd .. 6,116 5,042
Hong Kong.—W eek ended Feb. 3rd 2 2
н , 10th 6 6
w „ 17th 5 4
M „ 24th 19 12
Mauritius. еек ended Feb. 16th 1 1
DOE: 0 0

South Africa. —No cases of plague.
"-———————— іссе»
Alotices to Correspondents,

1.—Manuscripts sent iu cannot be returned.

2.— As our contributors are for the most part resident abroad,
proofs will not be submitted to those dwelling outside the United
Kingdom, unless specially desired and arranged for.

3.— To ensure accuracy in printinz it is specially requeste
that all communications should be wntten clearly.

4.—Authors desiring reprints of their ccmmunications to
JOURNAL оғ TropicaL MEDICINE should comm nicate with the
Publishers.

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PLATE

MEDICINE,

MARCH 125, 1906.

To illustrate Dr. ANDREW BALFOUR'S article, ‘‘ A Начповгерагіпе of Mammals and Some Notes on Trypanosomiasis in the Anglo-Egyptian Soudan."

Bale Danielsson, Ltd., London

JOURNAL OF TROPICAL

MEDICINE, MARCH 15, 1906.

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To illustrate Dr. ANDREW BALFOUR's article, “А Himogregarine of Mammals and Some Notes оп Trypanosomiasis
in the Anglo-Egyptian Sudan."

Baie & Danielsson, Ltd

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., London.

March 15, 1906.)

Original Communication.

A HA MOGREGARINE OF MAMMALS AND
SOME NOTES ON TRYPANOSOMIASIS IN
THE ANGLO-EGYPTIAN SUDAN.

By ANDREW Batrour, M.D., B.Sc., M.R.C.P.(Edin.),

D.P.H.(Camb.).
Director, Wellcome Research Laboratories, Gordon College,
Khartoum. i
A HÆMOGREGARINE OF MAMMALS.
H. jaculi—H. balfouri (Layeran).
Being one of the Craggs Prize Essays recently awarded by the
London School of Tropical Medicine.
[The first part of this paper was published in the Journal of
August 15th, 1905.]

WniLE carrying out work in connection with try-
panosomiasis, І have had occasion to make numerous
examinations of the blood of the jerboa, or desert rat
(Jaculus jaculus, or J. gordoni, as I believe it has been
renamed) (fig. 1).!

Fig. 1.

In the first blood examined I was surprised to see
that a large proportion of the red blood corpuscles
harboured an unpigmented and non-motile parasite.
In the stained specimen it was at once apparent that
we were dealing with some kind of trophozoite.
Twenty-nine jerboas have up to the present been
examined, and in all of them, with the exception of
two very young animals, this parasite has been found.
Specimens were sent to Professor Laveran, who at
once declared the parasite to be a hemogregarine,
and has kindly informed me that the discovery is
one of much interest. He has further urged me to
publish some notes upon its life-history, although my
observations are yet far from complete.

The Appearance of the Parasite.—' The trophozoite
in the fresh blood appears as a pale, hyaline, homoge-
neous body, slightly curved and with rounded ends
(sausage-shaped), lying either apparently free or in
the remains of a red blood corpuscle. The latter may
be represented only by a bow uniting the two poles of
the parasite, just as it is sometimes seen in the case
of malarial crescents. The free forms, I believe, owe
their condition to a total destruction or absorption of

' We are informed that Jaculus Gordoni has been distinguished
from J. jaculus on account of differences of coloration, though
it is quite possibly merely a local race of the Іаёќег. —Е4. J. Т. M.

THE JOURNAL OF TROPICAL MEDICINE. 81

the substance of the erythrocytes which once con-
tained them. As stated, the parasite is non-pig-
mented and non-motile, and I have found it to be
rather resistant, remaining to all appearance un-
changed in sterile citrated blood for a period of
seventy-two hours, both when kept at room tempera-
ture (about 36°C.) and at 22°C. It is to be noted,
however, that it altered somewhat in its staining re-
actions. As a rule, it measures from 5:6 to 7 и in
length, and from 14 to 28 и in breadth. The
number present has been found to vary considerably.
There may be six or seven, or even more, present in
each microscopic field (Leitz ос. 4, oil imm. у), or
only a few may be found in the whole blood smear.

Staining the Parasite —On staining by the Leishman-
Romanowsky method, in exactly the same way as for
malaria protozoa, the structure of the parasite be-
comes at once apparent, and the shape, as described
above, well defined. A large oval nucleus, consti-
tuting, as а rule, about one-third of the organism, is
seen to be present, situated generally in the centre of
the parasite and stretching right across it, so that
there is a deep blue-staining area ne nucleus) in
the middle, and a faintly staining blue area with a
rounded end on either side. Occasionally, but rarely,
and then usually under special conditions, spherical
chromatin dots may be found in one or other of these
pale polar areas. Іп stained preparations it is common
to find that no vestige of the red blood corpuscle
which originally harboured the parasite remains
(Plate I., с), but careful search will nearly always
reveal one or two parasites with portions of the red-
staining erythrocyte adhering to them. All that may
be present is a thin, red, curved line stretching from
pole to pole across the slight concavity of the parasite
(Plate I., a). Sometimes, especially if the blood be
citrated, the relation of the parasite to the blood cell
which contains it is beautifully shown. A process of
absorption of the cytoplasm of the red cell evidently
goes on, and in a severe infection there must be a
considerable destruction of erythrocytes. The animal
host, however, does not seem to suffer in health. I
have kept a jerboa with a considerable infection for
three months in the laboratory, and it remained well
and lively throughout the whole period. Two others
died in captivity, exhibiting violent ante-mortem con-
vulsions, and it is worth noting that these rodents do
not stand handling well, and must not be supplied
with water.

In the peripheral blood it is customary to find all
the parasites at or about the same stage of develop-
ment. True, they differ somewhat in aspect. Thus it
is not uncommon to find the nucleus situated at one
pole, so that half the parasite stains a deep blue and
the other half avery faint blue. Again, one end of
the parasite may be pointed, so that the body is club-
shaped. This is probably due to alteration during the
preparation of the blood smears. In the heart’s blood
of a jerboa which died naturally I found two distinct
forms, a large swollen variety (11:2 и by 4:2 и),
in which the greatest increase had taken place in the
light-staining part of the protoplasm, and a form like
those already described (Plate I., d). 18 was very
noticeable that the nuclei of the former, often of a
triangular shape, stained a deep Romanowsky purple,
and frequently did not stretch wholly across the para-

89 THE JOURNAL OF TROPICAL MEDICINE.

site, and in the large pale-staining area three or four
spherical chromatin dots were often to be observed.

Professor Laveran has seen this preparation, and
points out that such peculiarities in morphology fre-
quently occur. He does not regard these as special
sexual forms. At first I was inclined to consider the
parasite as being allied to the halteridium of birds.
I noted, however, that it was not pigmented, was not
curved so much as the halteridium forms, and never
exhibited the spore formation at either end as does
Halteridiwm danilewskyi.

Endoglobular Hamogregarine of this Class not Found
Previously iu the Red Corpuscles of Mammals.—As
Professor Laveran kindly pointed out to me, and as,
indeed, was soon apparent from a study of the litera-
ture, especially Professor Minchin's treatise on the
sporozoa, this parasite of jerboa closely resembles the
Hemogregarinide of cold-blooded vertebrates. This
fact is of extreme interest, as I am unaware of any
endoglobular parasite of this class having been de-
scribed in the blood of mammals. Bentley (1) has
recently produced a paper on a leucocytozoon of the
dog in Assam, but I understand there is some doubt
as to his parasite, also described by James (2), which,
moreover, affects the leucocytes. The classification
of this order of parasites given by Professor Minchin
is as follows :—

“ Order Hemosporidia (Danilewsky).

“ Sub-order I. .Наетовротеа.

“ Genus i. Lankesterella (Labbé, 1899) for Dre-
panidium (Lankester). The hemogregarine is not
more than three-quarters the length of the blood
corpuscle it inhabits.

‘Genus ii. Karyolysus (Labbé, 1894). The hamo-
gregarine does not exceed the corpuscle in length.

* Genus iii. Hemogregarine (Danilewsky, 1897),
(syn. Danilewsky-Labbé, 1895).

“Тһе body of the parasite when adult exceeds the
corpuscle in length, and is bent on itself within it in
a characteristic manner like the letter V."

Now the parasite of the jerboa in question does
slightly exceed the corpuscle in length, but is only
slightly curved. It looks as a rule as if it had out-
grown its corpuscle, and sometimes the remains of
what has evidently been а distended and distorted
corpuscle can be seen lying around it. The large,
swollen, and bloated forms are much larger than the
corpuscles which originally contained them, and are
found lying free. Оп several occasions, and especially
in fresh preparations from the bone-marrow, I have
noted forms slightly turned up at one end and looking
like an incomplete letter V. I have not been able to
demonstrate this appearance in stained specimens.

Laveran's classification, in which the genus Нато-
gregarine is made to include Drepanidium and Karyo-
lysus, is more simple, but whichever be adopted, it
would seem that this parasite is undoubtedly а
hasmogregarine, and I propose to give it the provisional
name of Н. jacult,' though it is quite possible it may
be found in other mammals. Indeed, I have recently
discovered what seems to be the same parasite in the
mononuclear leucocyte of the Norway rat (Mus

decumanus) in Khartoum (Plate І., f.). It is probable.

! Professor Laveran has recently written me to say that he
has given the name of H. baifouri to this parasite.

[March 15, 1906.

that it exists as а leucocytozoon in the rodents, but
further observations are required. I have once found
free forms in smears from the splenic pulp of а
Norway rat.

Reverting to the parasite of the jerboa, a study of
its life-history has further indicated its relation to the
Hemogregarinide, for I have succeeded in finding two
further stages, i.e. : — :

(1) The free, motile vermicule form.

(2) The stage of schizonts in the form of cytocysts.

In one instance only have I found the free
trophozoite. I discovered two such forms in the
peripheral blood of а jerboa, which showed the
endoglobular trophozoite in fair numbers and which
had some injections of the serum of a water-buck in
connection with the trypanosome work.

A Free Motile Form of the Parasite.—This free
form is in length about three times the diameter of
a red blood corpuscle, is pointed at both ends, and
moves very slowly through the blood, progressing by
a series of contractions of its cytoplasm, the so-called
" euglenoid" movements. Ав a result constrictions
appear in the body of the parasite, as many as three
having been seen présent at one time. These, so to .
speak, run along the body of the parasite, which there-
after assumes its usual cylindrical shape and glides
steadily across the field, always proceeding in one
direction and with the same end in front. It pauses
for greater or longer periods, undergoing various
alterations in shape.

If it encounters a clump of red blood corpuscles
it disappears among them, producing only a slight
agitation amongst the erythrocytes, which it pushes
out of its way. Granules are visible in the posterior
part of the body. No flagellum has been seen nor
anything to suggest the extrusion of a gelatinous
thread, as occurs in the case of some of the gregarines.
I have been fortunate enough to secure a stained
preparation of this free trophozoite, the appearance of
which further demonstrates its resemblance to 8
hemogregarine (Plate I., b.).

Anteriorly there is в somewhat sharp-pointed area
staining a light blue and in which close to the nucleus
a chromatin dot is visible. Following this clear area
comes a very lengthy, oblong, deeply stained nucleus.
At one point it showed a constriction similar, no doubt,
to those seen in the fresh preparation. It had been
killed, fixed, and stained in the act of progression.

Behind the nucleus is a lengthy, light-staining area,
terminating in a pointed’ extremity. This area stains
a light blue with the Leishman stain and exhibits a
cluster of chromatin dots, arranged in a somewhat
rosette form immediately behind the nucleus. I noted
a single central dot with six others arranged in a circle
around it. A few similar dots, irregularly arranged,
are also visible close to the posterior extremity.

Measurements :—

Total length eee

Length of the nucleus

Length of anterior light area

Length of posterior light area

Greatest breadth ... d
The nucleus, it may be said, stretches completely

across the body, entirely separating the anterior from
the posterior moiety. The broadest part of the

March 15, 1906.)

THE JOURNAL OF TROPICAL MEDICINE. 83

parasite is towards the posterior end of the nucleus.
In most cages a third stage can be readily demonstrated.
This is chiefly seen in the liver aud kidney, organs
where the circulation is slow, and will probably be
found also in the bone-marrow and brain. Indeed,
some smears of the bone-marrow have shown what
were probably empty cytocysts. In thick smears
from the liver and kidney well-defined cysts are
found, the walls of which are apparently formed by
the remains of cells of these organs which have
been destroyed by the parasitic growth (Plate II.).

These cysts vary much in size. The largest I
have noted occurred in a liver smear and measured
39-6 „ by 33:6 „. А common dimension appears to be
about 22:4 u by 16:8 д, but many smaller cysts occur.

It is usual to find some of these cytocysts empty, or
at the most containing a little residue protoplasm, but
& certain proportion are found to contain merozoites
(Plate IL), readily recognisable by their shape and
nuolei, and somewhat resembling the trophozoite stage
in the blood. The nuclei, however, are comparatively
small, and in many cases the merozoite appears to be
longer and more pointed at the ends than the endo-
globular trophozoite.

Schizont Forms.—Early schizont forms also occur,
in which the protoplasm contained within the cyst
wallhas not been differentiated and stains more or
less uniformly. Sometimes darker-staining portions
indicate the future nuclei of the merozoites. When
complete division has taken plese some residual pro-
toplasm remains behind, and the whole condition is
very like that which has been described by Labbé (3)
in the case of Karyolysus lacertarum. Sections of the
liver stained by the Giemsa method show all stages of
the schizonts. Mitosis of the nuclei and the forma-
tion of daughter nuclei are well seen.

Appearances are very like those presented during the
schizogony of some of the Coccidia, notably Adelea
ovata are exhibited, and the whole condition from the
invasion of the liver cell to the bursting of the cyst
and the freeing of its contents can be traced. Тһе
merozoites in а ripe cyst сап be seen to be arranged
side by side nearly all round the periphery of the
central undifferentiated mass of protoplasm which
remains as the residuum.

. By what channel the hepatic cell is invaded has
not as yet been determined, but it is probably through
the capillaries.

The interesting appearances presented by these
liver sections, which were kindly prepared for me by
Mr. Richard Muir, of the Pathological Department,
University of Edinburgh, and required detailed study,
are further confirmation, if any were required, that
this parasite of jerboas is а hemogregrine.

Laveran (4) has pointed out that the schizont stage
of these parasites in reptiles is passed in the liver, and
Labbé has given much attention to this subject. I
have not yet been able to decide whether dimorphism
occurs, and if micro- and macro-merozoites can be dis-
tinguished, but it is probable that such will be found
to be the case.

Before seeing the liver sections I was under the
impression that the non-sexual cycle was as follows:
The trophozoite is set free from the erythrocyte as the
travelling vermicule, which eventually penetrates a

cell of the liver or kidney, and gives rise to schizonts
in the form of cytocysts. In these the merozoites are
formed which, after certain changes, eventually escape
into the blood stream, invade red blood corpuscles,
and so restart the cycle of schizogony.

So far, however, one has not been able to see any-
thing like the travelling vermicule in the liver sections.
The form invading the hepatic cells looks like the
trophozoite of the peripheral blood, or, at the most,
one of the swollen forms already mentioned.: Ів it,
then, possible that the travelling vermicule plays.no
part in this cycle? This is possibly so; or, again, as
Labbé asserts, for Lankasterella and Karyolyeus an
isogamic conjugation may take place between two of
these free forms, and it may be the zygote so formed
which can be seen penetrating the liver cells. Many,
however, disbelieve Labbé's conclusions, which have
not been confirmed by the observations of Hintze (5) on
Lankasterella, so possibly the free trophozoite directly
invades the liver cell and becomes the schizont, while
the free vermicule is intended to play в part in an
extracorporeal sexual cycle. This leads us to consider
the habits of the jerboa and the parasites which it
harbours.

The rodent is & nocturnal animal, living in holes in
the desert, remaining invisible throughout the day, but
found hopping about in the evening and on moonlight
nights. It exists far away from any water, which it
does not seem to require, and its food probably con-
sists of the minute seeds of the small plants which
contrive to exist in sandy wastes, The animal is easily
caught in traps baited with millet.

Both fleas and mites are found on the jerboa.
The species of Siphanoptera present has not been
determined, but I have dissected and examined
the internal organs of engorged fleas taken from in-
fected animals. My observations have been limited,
but, so far, though I have found unaltered parasites in
the blood from the stomach of a flea, nothing has
been seen which suggests that a stage is passed in
that insect. Further dissections are required. Some
blood containing endoglobular trophozoites was placed
in the acid citrate solution devised by Rogers (6) to
stimulate the conditions present in an insect's stomach.
Though kept in this medium for over forty-eight hours
аб room temperature, no change took place in the
parasites, save that their cytoplasm became more
granular. i

I have not be able to examine the mites, which are
extremely minute and not very often present. Ав the
jerboa is nocturnal, I thought it well to chloroform
one during the night, and аф once examine its blood
and organs. I failed to find the vermicule form or
anything but the free and endoglobular trophozoites.

It should be said that to the naked eye there is no
morbid appearance presented by any of the viscera.
The spleen seems never to be enlarged, and, as far
as can be told, the liver does not appear abnormal.

Further, it may be stated that numerous free forms
(trophozoites or merozoites) are usually present in
smears made from the liver, kidney and bone-marrow,
and to a less extent in those from the spleen.

Professor Laveran writes me to say that he has
now found the same parasite in jerboas from Tunis, во
that no doubt much information will soon be forth-

84 THE JOURNAL OF TROPICAL MEDICINE.

[March 15, 1906.

coming regarding this interesting parasite of mammals.
It will be of special interest to determine if it really
exists as а leucocytozoon in Mus decumanus, or
whether in the case cited the mononuclear leucocytes
were merely taking on а phagocytic action, or
whether the parasite found in the Norway rat is
another distinct variety.

In concluding this paper, I would record my sincere
thanks to Professor Laveran for his kind interest and
advice ; my indebtedness to Dr. Beam, chemist to the
laboratories, for the photomicrographs ; to Mr. Muir
for the drawing of the vermicule; and to my
laboratory assistant, Mr. Friedrichs, for his useful
aid in the work.

REFERENCES.

(1) British Med. Journ., May 6th, 1905.

(2) *' Scientific Memoirs by Officers of the Sanitary and Medical
Departments of the Government of India," New Series, No. 14.

(3) Arch. Zool. Erp. et Gén. (3), ii., 1894.

id C. В. Soc. Biol., Paris (10), v. (1), 1893, and (11), i. |1),

(5) Zool. Jahrb. Abth. f. Anat., xv., 4, 1902.

(6) Lancet, June 3rd, 1905.

боме Notes ON TRYPANOSOMIASIS IN THE ANGLO-
EGYPTIAN SUDAN.

In the British Medical Journal of November 26th,
1904, I published a preliminary note on the above
subject. This article referred to the fact that I had
found trypanosomes in the blood of a donkey from the
Bahr-el-Ghazal, that Head (1) had discovered similar
parasites in mules from the same region, and that in
smears from the blood of Shilluk cattle which he had
submitted to me for examination I had found these
flagellates. Since that paper appeared a considerable
amount of information has been obtained, and a good
deal of research work has been carried out in the
laboratories upon what is a very important subject in
a country like the Sudan. The following are the chief
points to which I wish to direct attention :—

(1) The prevalence and distribution of trypanoso-
miasis in the Sudan.

(2) The presence in cattle of a small trypanosome
which Laveran has declared to be a new species, and
which he has named T. nanum.

(3) The question as to whether equines, or at least
mules, are liable to a double infection by two different
species of trypanosomes, or are the hosts of a T.
dimorphum resembling that which affects horses in
Senegambia.

(4) The great frequency of hwmorrhagic ulcerative
lesions of the stomach in trypanosomiasis and their
significance, also the comparative frequency of intes-
tinal ulceration.

(5) The occasional presence of spirilla in these
gastrie lesions, both in the blood clot adherent to the
uleers and in the ulcerated surfaces.

(6) The action of chrvsoidin as a therapeutic agent
in trypanosomiasis.

(7) The therapeutic action in trypanosomiasis of the
blood serum of wild animals (big game), whose habitat
is in trypanosome-infected areas, а line of research
suggested by Dr. Sheffield Neave (vide infra).

(1) Ав regards Prevalence and Distribution.—There
can be little doubt that in the Southern Sudan, that

is to say, in the region south of the tenth parallel of
latitude, trypanosomiasis exists to a very considerable
extent. An illness known to be due to the bites of
tsetse-flies, and affecting donkeys, horses, mules, and
possibly camels, has been recognised in the Bahr-el-
Ghazal province since that distant region was visited
after the reconquering of the Sudan. Expeditions
have experienced considerable losses in transport
animals from this cause. Again, and more recently,
sick and emaciated animals have been coming from
the Upper Sobat district, and especially from the
neighbourhood of Itang, а station on the Baro River,
in Abyssinian territory.

Old records also speak of animals dying from fly-
bite on the upper reaches of the Blue Nile, but accounts
are so vague, both as regards the nature of the illness
and that of the fly said to cause it, that no definite
conclusion can be reached regarding the prevalence
of trypanosomiasis in that region. No cases have
been sent me from the Blue Nile provinces, and
I have not received s amples of tsetse-flies from these
parts, nor seen them between Roseires and Wad
Medani, where the river is more or less bordered by
bush and forest. In the Northern Sudan, the region
of sandy wastes, as pointed out in the preliminary
note, trypanosomiasis has not been found to exist;
but no great number of examinations have been made,
and investigations upon frogs, lizards, and a large
number of birds have yet to be conducted. Dr.
Sheffield Neave, Travelling Pathologist to the Labora-
tories, has been working down Nile from Gondokoro,
and has found trypanosomes іп at least three species
of Nile fish, in а lizard, in kites, and in vultures.
These finds in birds are especially interesting in the
light of Novy's and M'Neal's recent researches. (2)

For the purpose of gathering information and
material regarding the trypanosomiasis of Shilluk
cattle, I accompanied Colonel Griffith, the Principal
Veterinary Oflicer, to Taufikia, near the mouth of the
бора River, and 522 miles south of Khartoum. Тһе
journey was undertaken іп Jauuary, 1905, and at
Melut, fifty miles north of Kodok (late Fashoda), &
herd of Shilluk cattle was inspected. Three sick
animals were picked out and examined. In the blood
of one of these I found a trypanosome identical with the
parasite found in Shilluk eattle at Khartoum which
had come from the Kodok region. Nothing was found
in the blood of the other two animals, but it is prob-
able they were suffering from the disease, as they
presented the characteristic symptoms, t.e., extreme
anemia of the mucous membranes, weakness, emacia-
tion, and some running from the nose. At Melut we
received vague information as to the presence of a fly-
belt & considerable distance inland, and were told that
the cattle became infected after the rainy season, t.e.,
in August. Оп these cattle, as in those at Khartoum,
large numbers of the tick called Amblyomma variegatum
were found, as well as flies of the genus Hippobosca.
It may be said at once that examination of these
insects has always proved negative, but, as will be
shown, the trypanosomes are never very numerous in
the blood of cattle.

! The recent discovery of G. morsitans in Southern Kordofan
probably explains the prevalence of tsetse diseases in this district.

March 15, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE. 85

A herd which had just been imported from the
north showed no signs of disease.

At Kodok a small herd was seen, and one sick cow,
which eight months previously had come from Melut,
was examined. It was distinctly thin and anemic,
but no parasites were found in its blood.

At Taufikia six separate herds of cattle were in-
spected, the bloods of twelve sick beasts were examined,
and trypanosomes were found іп one animal only—a
cow from Abyssinia—which had recently aborted and
was in a dying condition.

This trypanosome proved to be Т. nanum. Three,

sick mules, coming also from near Itang, were found
to harbour trypanosomes. These were not the same
species of parasite as those found in cattle, but appear
to be identical with those discovered by Head in mules
from the Bahr-el-Ghazal. A dog was inoculated from
one of these mules and brought to Khartoum, where
it developed trypanosomiasis. It was from this strain,
carried on by successive passages through animals,
that I have been able to study the parasites of the
disease in mules. The cow from Melut was also
brought to Khartoum, and will be again mentioned in
due course. At Taufikia a monkey (Cercopithecus
sabaeus), & bat, and a black and white crow were
examined, with negative results.

Out of three sparrow-like birds examined, two
showed halteridia in the blood.

It is difficult to base any conclusions on such
limited observations. The trypanosomiasis of cattle
is a chronic disease to all appearance, and it will be
some time before its prevalence is correctly gauged.
In equines the malady appears to be common in the
Bahr-el-Gbazal, where С. morsitans is found, and
probably exists to а considerable extent on the Upper
Sobat. On the mules at Taufikia large numbers of a
species of Stomoxys were found, biting fiercely, spe-
cially in the evenings. No opportunity of properly
examining these flies was afforded. In one, which
was dissected, no trypanosomes were found, but several
hours had elapsed before its stomach contents were
examined. One may here refer to human trypanoso-
miasis, which so far has not been encountered within
the confines of the Sudan, though, as previously
noticed, Dr. Neave (3) found Leishman- Donovan bodies
in the spleen of a boy coming from Meshra, in the
Bahr-el-Ghazal. At Taufikia I found that a Sudanese
battalion was being recruited to some extent from
Uganda, and discovered that twelve men had come
from Kampala, close to Entebbe, a centre of the
disease. Some of these men exhibited enlarged cervical
glands. They were tested by blood examinations, gland
puncture, and, in one specially suspicious case, inocula-
tion into a monkey (Cercopithecus), but with wholly
negative results. Later they were sent for observation
to Khartoum, and were re-examined, but no trypano-
somes were found. The presence of these men at
Taufikia, however, served to draw attention to what
was undoubtedly a source of danger. Recruiting from
Uganda has been abolished.

Lieutenant Gray (4) has shown that the country imme-
diately south of Gondokoro is not of the kind likely to
harbour С. palpalis, and neither Dr. Neave nor I saw
anything of tsetse-flies on the Upper White Nile. As
G. morsitans haunts the forest districts of the Bahr-

el-Ghazal, there is nothing to prevent G. palpalis being
likewise an inhabitant, and Dr. Neave's trip through
that region may serve to settle this important
question.’

(2) The Disease in Cattle.—Cattle trypanosomiasis
has been studied in Khartoum, Melut, and Taufikia.
The disease appears to be of a chronic nature, the
principal symptoms being extreme anemia, especially .
visible in the blanched, glistening, conjunctival sur-
face, weakness, emaciation, running from the nose,
and occasional dripping of urine. The last condition
is probably dependent on muscular weakness. Plate
lIL, fig. 1, gives a good idea of an animal suffering
from the disease. Notice the dull, listless, half-
closed and sleepy eye, the prominent ribs and hip-
bones, and, what is rather constant, the atrophic line
in the shoulder hump. In the later stages the head
is held low, and towards the end there is complete
collapse, the animal lying down and refusing to rise,
the skin cold, the coat roughened, urine and faces
passed involuntarily, and the respirations noisy and
rapid. At this stage the animal may take food, and,
indeed, failure of appetite does not at any time seem
to be asymptom. Careful examination failed to detect
enlarged glands towards the root of the neck, but one
is apt to be deceived by feeling the subcutaneous
gelatinous exudation which is found to exist post
mortem. The first ox from which specimens were
obtained died some fifteen miles from Khartoum.
Smears of the peripheral blood, liver and spleen were
submitted to me by Captain Head. In all of these I
found the small trypanosome since named Т. папит
by Professor Laveran. Captain Head also brought in
some of the cerebro-spinal fluid, which was centrifuged,
and in the sediment streptococci, possibly due to con-
tamination, and altered and amceboid forms of the para-
site, were found. The latter resembled those described
by Plimmer and Bradford (5)in bone-marrow in cases of
nagana, and by Castellani (6) as occurring in the cerebro-
spinal fluid in sleeping sickness. They were few in
number and stained feebly. А somewhat pear-shaped,
flagellated form was the most striking.

The second ox also died at a distance. In.smears
made from its blood trypanosomes were fairly
numerous. The stomach, which has been placed in
spirit, was the only organ brought to the laboratories.
Attached to it was a small’ piece of omentum. Оп
opening the stomach, a very curious condition of pig-
mented ulceration was disclosed, affecting the mucous
membrane (Plate III., fig. 2). Scattered about were
dark areas with thickened edges raised above the
surrounding mucous membrane. The surfaces of
these areas were flat and slightly depressed, and con-
sisted of what was afterwards found to be altered blood
clot. No smears were made from these areas, but
sections were cut and examined. Beyond a severe
bacillary invasion and the appearance of considerable

! Dr. Neave did not find G. palpalis, but it has been reported
asexisting аб Wandi, in the Lado Enclave, and at Mvolo, іп
the Bahr-el-Ghazal. The report requires confirmation. I have
recently heard that Major Bray, of the Egyptian Medical
Service, has sent to Khartoum a specimen of а fly taken near
Mvolo. It is believed to be С. palpalis by Captain Ensor, who
examined it, and is my informant.

86 THE JOURNAL OF TROPICAL MEDICINE.

erosion and destruction of the mucous membrane,
nothing was found.

The following are my notes on the condition :—

Examination of Abomasum or Fourth Stomach—
Cardiac End.—Nothing noticeable externally. In a
small piece of attached omentum there are two en-
larged glands about the size of peas, rounded, elastic

. to the touch, purple in colour externally, and deep
purple on section. The mucous membrane is of a
uniform dark slate colour, no ecchymoses ate present,
but there are some dark patches, possibly due to
post-mortem changes. Studded over the surface of the
mucous membrane are spots of intensely black pig-
ment (Plate III., fig. 2). Each of these, in most in-
stances, seems to surround a tiny punched-out hole,
and the pigmentation is most marked in the central
depression. A few black granules can, as a rule, be
squeezed out from the central pits. These granules
were found to consist of altered blood. Where the
patches are more advanced they present the appear-
ance of ulcerations. Most of these are more or less
circular and depressed, but some are in the form of
ulcerated streaks, and all are intensely black. In
addition there are a few patches of superficial pig-
mentation in which there is no ulcerative process.

Central Portion.—The condition is very similar, but
the patches are larger, some of the ulcerated ‘ streaks ”
being 3 inch in length. In one or two places the
ulcerations appear to have healed, leaving depressed
and whitish scars surrounded by areas of slight
pigmentation.

Pyloric End. — Nothing noted externally. The
mucous membrane shows a general pigmentation of
the surface in the form of little circular shallow pits
with pigmented walls, the pigmentation being very
slight. In addition, pigmented ulcers similar to
those previously described are present in considerable
numbers, and in some instances a regular plug of the
black material fills up the ulcer, and rises above the
surface of the mucous membrane. There are also
present the superficial pigmentations already men-
tioned, some of which are associated with slight
erosion. Where ulcers are marked their edges are
thickened. The ulcerative process and the pigmenta-
tion are confined to the mucous layer. In no instance
does perforation seem to have occurred. Size of
largest ulcer, $ inch by } inch. .

At the time I did not think that these ulcerations,
which rather recalled the lesions produced by the
swallowing of a corrosive poison, were in any way
connected with the trypanosomiasis. Since then I
have had reason to alter that opinion, as will be seen
when we consider the experimental work with the
trypanosomes of mules. Lieutenant Gray, whom I
met on his way to England from Uganda, informed
me that he had recently found a similar condition of
ulceration in the stomachs of natives dead of sleeping
sickness.

The third ox is that shown (Plate IIL, fig. 1). The
blood was taken at Khartoum on October 30th, and
as many as two trypanosomes were found in some
fields. The animal was kept and well fed. On
November 4th fresh and stained blood films were
examined, but no parasites could be demonstrated.
Thereafter, though the blood was centrifuged and

[March 15, 1906.

examined, and though the animal was subjected to
four days' partial starvation, trypanosomes were not
again found. Eventually, as the owner wished to
slaughter the ox, it was exchanged for Ox No. 4, which
was examined on November 23rd, when & considerable
number of trypanosomes were found, as uae ав Six
per cover-glass preparation being present. This ox
continued to show the parasites in its blood, and
gradually became thinner and weaker.

On December 3rd it was found to be very weak,
with marked ans&mia and dribbling urine. The urine

„апа feces were examined for blood, but none was

present. The fæces were slightly tarry in consistence,
and this and their colour suggested the examination.

On December 4th the ox was found to be in extremis.
Тгураповотев were slightly more numerous in the
blood, and as it was feared the animal might die
during the night it was slaughtered and an autopsy
performed immediately.

The principal points noted were :—

(а) The extensive subcutaneous, gelatinous, and
pale yellow exudation. Nearly every part of the sub-
cutaneous connective tissue was in an oedematous,
watery condition, which was most marked where the
skin was loose, i.c., in the dewlap, behind the shoulders
and in front of the haunch.

(b) The presence of enlarged, purple, hemorrhagic
glands about the root of the neck.

(c) The great and general enlargement of the
mesenteric glands, which were also, though to a less
extent, hemorrhagic in nature.

(d) The presence of а certain amount of chronic
meningitis affecting the pia arachnoid, the pia being
somewhat adherent to the surface of the convolutions.
There was little thickening of the membranes, and no
appearance of encephalitis; indeed, the brain appeared
markedly anemic. The stomach, which was distended
with food, presented no ulcerative condition, but con-
tained “һо” of a different kind to any І have seen
iu the Sudan. The intestinal tract was normal.
There was nothing special to note with regard to the
spleen and liver, which were neither congested nor
enlarged. The heart's blood showed trypanosomes.
Fluid from the lateral ventricles of the brain and from
the cerebro-spinal fluid showed nothing in the way of
trypanosome infection. Bile taken with aseptic pre-
cautions from the gall-bladder contained a short stout
bacillus in considerable numbers, but no flagellated
parasites.

The cow at Melut was picked out by the natives as
being ill. Тһе blood was collected in tubes containing
citrate of soda solution. Such blood showed try-
panosomes, though these were only found after some
searching.

The Abyssinian cow which aborted at Taufikia, and
was in a dying condition, also had trypanosomes in
its blood, but they were not at all numerous. Time
did not admit of a post-mortem examination in this
case.

The trypanosome concerned is a small one. It is
not very active in fresh films, and I have never seen
one traverse the whole field of the microscope. The
motion is undulating, combined with a vigorous slash-
ing to and fro of the anterior part of the body, which
tapers to a very tiny flagellum. Rippling and what

March 15, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE. 87

may be termed spreading movements have also been
observed. The parasite advances usually with the
narrow end in front, but this motion is often reversed,
and I һауе seen one move a considerable distance,
pushing aside the erythrocytes with its blunt posterior
end. A fact which is very noticeable is that the try-
panosome tends to adhere to the red blood corpuscles.
Even in a thin field this is seen, the parasite seeming
to take a delight in butting and boring at the erythro-
cytes. Frequently it gets beneath them and is lost to
view, the agitation it produces being the only clue to
its presence. Having studied this trypanosome, both
in the living and stained condition, and having con-
ducted a few inoculation experiments on laboratory
animals (vide infra), I became convinced that this was
either a new and undescribed trypanosome, or was
identical with the parasite of cattle found by Bruce,
Nabarro, and Gray, on the shores of the Victoria
Nyanza in Uganda. Stained specimens were sent to
the Liverpool School of Tropical Medicine, but I learn
that unfortunately the stain had faded and could not
be repeated with success. In the meantime I had
sent unstained films to Professor Laveran, (7) to whom
І аш much indebted for his kindly interest, and who,
in the Proceedings of the Biological Society of Paris
of February 24th, describes the stained trypanosome,
which he regards, provided further experiments prove
it to be peculiar to cattle; as а new species, and
which, on account of its small size, he has named
Т. nanum? l

His interesting description of these parasites is as
follows :— 3

* The trypanosomes measure 10 to 14 4 in length,
by 4 to 2 „ in breadth. Their structure is that of the
flagellates of the genus Trypanosoma, although, con-
trary to the rule, the protoplasm is prolonged on the
anterior part іп such а way that there is no free part
of the flagellum, or the free part of the flagellum is
extremely short. The undulating membrane is very
straight, and in consequence but little apparent. The
posterior extremity is conical, not drawn out, and in
other respects varies somewhat. The oval nucleus is
situated near the centre of the body of the parasite.
The rounded centrosome, rather large, occupies a
position close to the posterior extremity. The proto-
plasm is homogenous without granules.

* Some forms a little longer than the others show
two centrosomes and a flagellum, divided to a greater
or less extent, proceeding from the centrosomic in-
sertion.”’

He proceeds to point out how different in mor-
phology is this trypanosome from Т. brucei and
Т. evansi. He compares it with Т. theileri, the giant
trypanosome of South African cattle, and concludes
by remarking that while very distinct from 7’. theileri,
T. папит approaches it in being peculiar to cattle, so
far as is at present known.

I have little to add to the above description.

The photo-micrograph (Plate III., fig. 3), for which
I am indebted to Dr. Beam, Chemist to the Labora-

'Ihave since found & very similar parasito in the blood of
mules.
2 I.e., the “ dwarf" trypanosome.

tories, gives a very fair idea of Т. nanum, multiplied
1,250 diameters. It shows it to be a short trypano-
some with hardly any free flagellum visible, but is not
quite typical, in that the posterior moiety is rather
broader than is usually seen.

I append measurements I have made of a form
whose total length was 14 4.

From posterior end of body to centre o

centrosome " et 2 ias

From centre of centrosome to nucleus ...

Nucleus a E -— ^

From nucleus to beginning of flagellum

Free flagellum sd Es s Vis

Breadth behind nucleus ій ee

I agree that the protoplasm is homogeneous, though
it sometimes stains irregularly, as evidenced (Plate
IIL, fig. 3), while in forms kept in vitro granules
appear, for the most part anterior to the nucleus. In
such forms the vacuole in the neighbourhood of the
centrosome may be found large and very evident.
Sometimes a portion of the free edge of the undulating
membrane is clearly visible, bunched, as it were, upon
the back of the trypanosome, and looking like a loop.
As a rule, however, the undulating membrane can
scarcely be seen, save in the living parasite. I have
worked with specimens stained by the Leishman-
Romanowsky method, which answers admirably if the
stain be strong and staining prolonged.®

I have carried out a few experiments in vitro which
may be mentioned here, though the study of the try-
panosome is yet far from complete, owing to lack of
material and press of other work. Hence cultivation
experiments have not yet been attempted.

In citrated blood kept at a temperature of 22° to
93° C. no change in the trypanosome was visible after
twenty-four hours. They remained lively and stained
well. After seventy-two hours at a temperature of
25° C. changes were observed to have occurred, the
posterior ends of the parasites having become swollen,
while the organisms were sluggish and evidently
degenerating.

Trypanosomes disappeared in twenty-four hours
from sterile citrated blood which had been exposed to
a temperature of 16? C.

The trypanosomes from the Melut cow remained
alive in non-sterile citrated blood at a temperature of
about 35° C. for twenty-four hours. They underwent
longitudinal division, forms with two centrosomes and
two nuclei being seen. In these the undulating mem-
brane was more apparent than usual.

Inoculation Experiments——From Ox. No. 1, 05
cc. citrated blood, i.e., about 0:25 сс. blood, was
inoculated subcutaneously into a monkey (Cerco-
pithecus sabaeus) on October 30th, 1904.

On the same date a rabbit received 1 cc. of citrated
blood. These animals never show any symptoms of
the disease, and though their bloods were repeatedly
centrifuged in the hematocrit tubes, and carefully
examined both in the fresh and stained condition, no
trypanosomes were found.

From Ox No. 4, on November 23rd, a rabbit
received 2 сс. of blood containing & considerable

Корен Hee tee
He C» Os bd 2d
кекке

з Equal parts of thefluid stain and distilled water allowed to
act for twenty minutes or even longer.

88 THE JOURNAL ОЕ TROPICAL MEDICINE.

[March 15, 1906.

number of trypanosomes, six to the microscopic field
(employing Leitz obj. 6, oc. 4, without ocular dia-
phragm), and a monkey (Cercopithecus) received 1 cc.
The result in the case of these animals was also
negative, though they remained under observation for
two months.

On December 4th a brown pariah dog received
2:5 cc. of fresh blood subcutaneously at a time when
trypanosomes were fairly numerous.

A black pariah dog received as food large pieces of
the liver and spleen and several of the large glands,
all soft food be it noted. У

These experiments also proved absolutely negative.

On December 29th the last-mentioned rabbit hap-
pened to be killed accidentally. A post mortem was
performed immediately, but no trypanosomes were
found in the blood or in any of the organs. It would
appear, then, that dogs, rabbits and monkeys (Cerco-
pithecus) are not liable to infection with 7. nanum.
As it was desired to institute further experiments, the
cow from Melut was brought to Khartoum, arriving
there on March 4th, 1905, along with her calf. The
blood of both animals was examined, but no trypano-
somes were present.

In the case of the cow this fact, taken in conjunc-
tion with what was found in Ox 3, seems to prove that
the parasites are in the habit of disappearing from
the peripheral blood. Possibly spontaneous cure may
occur.

The cow was in very poor condition, and presented
allthe symptoms of the disease, but repeated centri-
fuging of considerable quantities of blood failed to
reveal the parasite. Тһе animal has been under ob-
servation for nearly a month, and trypanosomes have
never been demonstrated. Later examinations made
down to the end of June all proved negative, and the
animal being well fed, steadily improved in health and
appearance. On March 7th, 1905, 4 cc. of the cow's
fresh blood was inoculated subcutaneously into her
calf. At the time of writing (March 27th, 1905)
trypanosomes have not been found in the blood of the
latter. Nor were they discovered up to the time of
the last examination in June. The fact that, as &
rule, there are not many parasites in the blood of
cattle makes the investigation of Т. папит rather a
tedious matter, and explains to some extent the
imperfections of the research which has so far been
conducted.

(3) The Disease іп Mules.—For the study of try-
panosomiasis in mules there have been available the
stained slides of blood prepared by Captain Head from
mules which were brought from the Bahr-el-Ghazal.
The main source of material was, however, found in
the three mules suffering from the disease at Taufikia.
As stated, a dog was inoculated from one of these
animals and brought to Khartoum, where it developed
the disease. Іп the mule the chief symptoms of
infection are the hanging head, the dull and listless
eye, the roughened, staring coat, the prominent ribs,
the general aspect of hopeless resignation, and the
hind-leg projected from the body, а sign of weakness
and giddiness. Тһе blood of the mules seen аб
Taufikia literally swarmed with trypanosomes, aud
was thin, greasy, and difficult to spread on the slide.
One animal died, but had decomposed before we got

word of its decease. Тһе death of & second enabled
a post mortem to be performed. Тһе most marked
change was in the meninges, which were much thick-
ened, the dura being very adherent to the skull. The
brain was congested, and the cerebral vessels were
gorged with blood. Elsewhere but little was found,
the spleen not showing any increase in size or marked
congestion. The liver was fatty. Unfortunately the
stomach was not opened, a regrettable oversight on
my part. It looked healthy viewed externally. There
was no gelatinous, subcutaneous exudation, nor was
the connective tissue cedematous. From the third
mule the dog was inoculated, about 4 cc. being given
subcutaneously on January 16th, 1905. On January
22nd trypanosomes were for the first time found in
this dog’s blood.

Slides of the mule’s blood were sent to Professor
Laveran, who describes the forms found in the same
article as that in which he deals with T. nanum, the
cattle trypanosome.

After remarking that the parasites were very nume-
rous, he proceeded to distingush two types (fig. 4):—

(а) “ Small forms measuring 12 to 14 4 in length,
by 14 » to 24 шіп breadth. These trypanosomes
recall very much the appearance of the small forms of
Т. dimorphum. Тһе protoplasm is prolonged as far as
the extremity of the flagellum, which in consequence
does not exhibit a free part. The undulating mem-
brane is more developed than in T. nanum, but causes
the parasite to present an even more ‘ stumpy ' aspect.
The nucleus is situated sometimes in the centre, some-
times at the junction of the posterior with the middle
third. The protoplasm contains chromatin granules,
and these are sometimes very numerous. Forms in
process of division are encountered with two centro-
Somes and one nucleus, two centrosomes and two
nuclei, &c.

(b) “ Large forms measuring 21 to 30 » in length, by
2 и in breadth. These forms, in which the flagellum

March 15, 1906.)

exhibits a very long free portion, bear a great resem-
blance to Т. evansi. Тһе posterior extremity is
usually elongated, the protoplasm is homogeneous and
with but few granules. Forms undergoing division by
separation into two elements are found. It is to be
noted that intermediate forms between the small and
large trypanosomes are wanting.”

From a study of numerous preparations, both fresh
and stained, I am in a position to add a few additional
notes to the above. In fresh blood both forms of try-
panosome can be clearly made out. The long forms
are much the more active, darting rapidly hither and
thither, lashing vigorously with their flagella and displac-
ing the red corpuscles. They can advance with either
the anterior or posterior end in front, though their longer
excursions are made with the flagellum “ going on
before.”

Occasionally one of these long active forms may be
seen to traverse the field of the microscope, but this is
notcommon. The body of the trypanosome frequently

Fic. B

bends upon itself, so that it presents the appearance of
a tiny corkscrew for the fraction of a second—-then
stretching out, the parasite shoots across some space
amongst the corpuscles, and plunges, writhing and
lashing, amongst a startled group of erythrocytes. In
the fresh state the undulating membrane is not very
well defined in these long forms. They do not
present a granular aspect. The short forms, on the
other hand, are, as a rule, distinctly granular, and are
more sluggish in their movements. They tend to
hang about the same spot, and their excursions are
limited, rather resembling those of 7. nanum. They
also can advance with either end in front, but their
body movements are more of a rippling or undulating
type. It often looks as though a series of shivers was
running along the protoplasm. Their undulating
membranes are well marked, and the rounded posterior
ends are very distinct. On staining with Leishman-
Romanowsky, used strong and for a considerable

THE JOURNAL OF TROPICAL MEDICINE. 89

time, as in the case of Т. папит, the differences in
structure between the two forms are well emphasised.
Points to which Laveran, in his short note, does not
refer is the well-known ‘‘ pike-head”’ form of the
posterior end of a typical long trypanosome, and the
fact that the centrosome of the long form is not as
large as that of the small. In some of the short
forms the nucleus seems almost to touch the centro-
some, while “ bunching " of the undulating membrane
is often well seen. J have noted curious forms,
possibly distorted, with square-cut posterior ends, and
more than once have seen a short form with no
granules visible.

As a rule the granules are in the posterior moiety,
ie., between the nucleus and the centrosome. In
some instances the possession of these chromatin
granules is almost the only point enabling one to dis-
tinguish this trypanosome from T. nanum. I have
also noticed dividing forms, and it is not uncommon
to find two short forms lying with their posterior ends
in close contact, this being probably the terminal stage
of a division (fig. B.).

In the mule’s blood I did not observe conjugating
or agglutinating or involution forms. I agree that the
long forms measure from 21 и to 30 м, but some are
as narrow as 1:4 » at their thickest portion.

I append a very average set of measurements :—

From posterior end to centrosome 2:8 и
From centrosome to nucleus T к
Nucleus 25% 2:8 и
From nucleus to root of flagellum... e. 424
Flagellum 6 to 104

There is much variation amongst these long forms,
but ава general rule the flagella stain admirably and
complete measurements can easily be made.

Here are the figures for one of the short forms of a
total length of 14 » in which the nucleus was at the
junction of the posterior and middle thirds :—

From posterior end to centrosome 144
From centrosome to nucleus 144
Nucleus (large) .. Р e. 9:84
From nucleus to root of flagellum | ws uS di
Flagellum 1:4 и

I have found short forms to vary in length from
12 u to 154 и, and in breadth from 1:4 и to 2:5 м,
As Professor Laveran points out in 7. dimorphum,
the trypanosome of horses іп Senegambia, there
also exist two forms, a long and a short. He
asks if this and the mule trypanosomes are identical.
He regards this as possible, but mentions the fact that
while the short forms of the mule trypanosome re-
semble the short forms of Т. dimorphum, the long
forms of the former differ a little from those of the
latter, mainly as regards the flagella, which as a rule
are short in T. dimorphum. Не adds, however, that
variations occur, and that Dutton and Todd have
described free flagella in the large form of T. di-
morphum. Not only are they described but they are
figured both іп photo-micrographs and coloured
plates, and I must say that my first impression was
that I was dealing with T. dimorphum, or something
very like it. To my mind the long forms more re-
sembled the long forms of T. dimorphum than they
did T. evansi, but then my comparisons were made
from photographs and coloured drawings. Laveran

90 THE JOURNAL ОЕ TROPICAL MEDICINE.

[March 15, 1906.

goes on to state another hypothesis, namely, that the
mules may have been infected with two different
species of trypanosome, and he cites the work of
Cayalbon who, in the French Sudan, found horses to
be the victims of a double infection (8).

There seems no reason why this might not occur as
regards the short forms: one at once thinks of 7.
nanum, as the mules had come from the Itang district
along with the herd of cattle amongst which was the
cow harbouring those flagellates, and which aborted
and died as already described.

In order to try and settle this vexed question, if
possible, without proceeding to cultivation methods,
and also to enable one to test certain therapeutic
measures, animal inoculations have been conducted.

I do not propose to consider these in detail. Dogs,
monkeys (Cercopithecus), gerbils, jerboas, rabbits and
a goat were employed and numerous experiments were
performed. As а result, I was led to think that these
mule trypanosomes were really Т. dimorphum, but
this belief has been somewhat shaken by the discovery
of a small trypanosome existing by itself in the blood
of mules coming from the Bahr-el-Ghazal. It is diff-
cult to be certain, and in any case the tendency is to
follow Koch (9) and pay less attention to differences in
species, and more to the presence or absence of patho-
genicity.

(4) These inoculation experiments served to show
how frequently ulceration of the gastric and to a less
extent the intestinal mucous membrane was present
post mortem. References to such a condition are not
wanting in the literature. Dutton and Todd (10) found
stomach lesions in a baboon dead of trypanosomiasis,
while Musgrave and Clegg (11) record the presence of
intestinal ulcers and ulcers in the ceca of animals
dead of surra in the Philippines.

As a rule, however, attention does not seem to have
been paid to the condition of the alimentary tract, and,
as far as I know, when lesions have been noted smears
have not been taken nor any further examination
performed.

My number of post mortems in the cases of experi-
mental animals now totals seventeen, and in nine of
these gastric congestion or ulceration or both were
present. In one case there was a marked ulceration
of the caecum and lower end of the ileum, in another
Peyer’s patches were congested. I do not think this
can be a mere coincidence. A similar condition was
found in the stomach of a Shilluk ox infected with
Т. nanum, and I am inclined to think, especially since
hearing of Lieut. Gray’s observations, that such lesions
will be found to be common in trypanosomiasis.

As to their significance, one scarcely likes to hazard
an opinion, but the thought that naturally arises is
whether this condition may not indicate an effort on
the part of the parasite to leave its host. Biting flies
are regarded as the usual medium by which trypano-
somes leave the body of an infected animal, though
Rogers (12) has shown that the ordinary house-fly will
serve the purpose in the case of open wounds, and
fleas and other blood-sucking insects are effective as
agents of transmission.

At the same the life-history of the trypanosomes of
mammals is still obscure, and, so far as I know,
despite the recent work of Koch at Ubebe, it has never

been definitely settled whether or not they pass a stage
in the flies or other insects which serve as carriers.
I understand that Lieut. Gray’s recent work in Uganda
bears on this subject, but I have not had an opportu-
nity of seeing it. It is, then, not possible that the
parasite may escape from the body in some different
manner? If во, may the gastric and intestinal lesions
not be evidence of such exit? The condition found in
cachexial fever due to the Leishman bodies will at
orice occur to any interested in this important subject.
At the same time, we are immediately met with the
argument that no one has ever found trypanosomes in
the stools of infected animals, nor have such stools
been definitely shown to be capable, on injection, of
producing the disease. Lingard, it is true, states the
contrary, but he is generally regarded as having been
mistaken, and Musgrave and Clegg, who paid special
attention to this point, deny that the stools can convey
infection. Rogers also refutes Lingard's contention.
In the face of all the evidence which has been accu-
mulated and the absence of any experiments with the
stools of inoculated animals, one is not justified in put-
ting forward any theory.

(5) It is, however, interesting to note that on several
occasions, both in the case of dogs and of monkeys,
spirilla (fig. С) have been found in the blood clots

Fia. C.

covering the ulcers or in smears made from the ulcer-
ated surfaces. These spirilla, which are somewhat
blunt at the extremities, measure from 2:8 л to 7:7 u
in length, are very actively motile, and possess from
four to seven short undulations. There is a general im-
pression found chiefly on Sohandium's (13) work, that
trypanosomes and spirilla will be found to be very
closely related, if they are not indeed merely different
stages in the life of one parasite. Moreover, Theiler,
in South Africa, has found trypanosomes and spirilla
existing together in the blood of cattle, and Petri (14)
has found the same thing in birds. Тһе spirilla which
I describe are short forms, and have not the typical

March 15, 1906.)

pointed ends of, say, Spirochete obermeieri. For
all that they are undoubted spirilla, and I have not
found such present in the stomach or intestines of
animals uninfected with trypanosomiasis. I think the
observation is one of considerable interest. At present
it is nothing more, but it seems worth while following
up the matter.

(6, 7) The therapeutic value of chrysoidin and of
blood serum. I propose to deal very briefly with
these points in this paper. I was led to employ
chrysoidin, a yellow aniline dye, and chemically the
hydrochloride and di-amido-azo-benzene, because try-
pan red and malachite green had been used with some
success, and because I had previously found chrysoi-
din (15) to be very lethal in dilute solutions to fish and
to the ciliated embryo of Schistosomum hematobium.
Further, I had found that it possessed, atleast as
regards fish, a special affinity for the central nervous
system, staining the brain and spinal cord an intense
yellow. I found the same to be true of the soluble
form (chrysoidin extra), prepared by the Aniline
Manufacturing Company, of Berlin, in the case of the

. gerbil (Gerbillus pygargus, Liun.).

For the most part I have used Merck's chrysoidin,
"1 grain of which in 10 се. of distilled water consti-
tutes а saturated solution.

Preliminary experiments in vitro showed that in
& proportion of 1 in 500 it killed the trypanosomes
of mules practically instantaneously, at the same time
slightly colouring them. Оп staining such dead
trypanosomes by the Romanowsky method they were
found to take the colour badly and to have swollen
posterior ends. They looked as if they had shrunk
into themselves. In a strength of 1 in 6,000 some
trypanosomes were observed to die in five minutes.
Others though retaining their motility become rounded,
and these also died after forty-five minutes, After
four hours only one living trypanosome could be
found. Though lively it had changed in shape and
looked like an involution form. Although weaker
mixtures, even 1 in 30,000, killed some of the parasites
many were found to survive. In all cases controls
were performed, and the blood was mixed with sterile
citrate solution. No agglutination was observed. The
dye was not so lethal as І had hoped, but I resolved
to give it a trial, and employed it in the case of dogs,
monkeys, and gerbils. Without entering into details,
it may be said that as regards the trypanosome of
mules the results have been somewhat disappointing.
True the dye profoundly alters the parasites in the
peripheral blood and sometimes causes their tem-
porary disappearance, but I have been unable by its
use to prolong the lives of infected animals or to
greatly modify the course of the disease. It has been
given subcutaneously and intravenously without
marked smears, but it is worth while remembering
that Laveran found T. dimorphum very resistant to
the action of trypan red.

Dr. Neaves (16) employed chrysoidin in a case of
human trypanosomiasis from Uganda, and found it
caused the parasites, which were numerous, to dis-
appear wholly from the peripheral blood and the juice
of the affected cervical glands. I was able to confirm
his observations, but succeeded in inoculating a mon-
key (Cercopithecus) by injecting several сс. of blood

THE JOURNAL OF TROPICAL MEDICINE. 91

taken from a vein. The disease, therefore, was not
cured, but the results have been somewhat hopeful, as
the patient has greatly improved in condition (fig. D), and

Fic. 1).

chrysoidin does not cause the unpleasant staining of
the mucous membranes which is one of the draw
backs to the use of trypan red. The dye is easily
given by subcutaneous injection, and, if it can so greatly
diminish the parasites in the peripheral blood, may
yet establish itself as a useful agent in preventing the
transmission of the disease.

Dr. Neave proposed testing the therapeutic effect
of the blood serum of wild animals from trypanosome-
infected districts on experimental animals inoculated
with trypanosomiasis. He sent me a sample of blood
serum from a water-buck free of trypanosomes. It
arrived in good condition, a small quantity of car-
bolic acid having been added to it as a preservative.

I proceeded to test it i» vitro, and found that, added
in equal quantities to citrated blood containing the
trypanosomes of mules, it caused agglutination in the
form of irregular rosettes, the motility of the try-
panosomes composing the rosettes remaining. After
thirty minutes there was marked agglutination.
Disintegration and death of the parasites also ос-
curred.

І employed the serum in varying doses in the case of
monkeys and gerbils, and in some instances found
that it produced a remarkable effect on the parasites,
completely disintegrating them, so that on staining

92 THE JOURNAL OF TROPICAL MEDICINE.

nothing was to be seen except the centrosomes with
flagella attached.

Here again, however, I have been unable to modify
the disease or prolong life. Indeed, large doses of the
serum have apparently hastened the end, producing
convulsive seizures, possibly due to the sudden and
extensive destruction of the parasites accompanied by
the liberation of toxins.

Further work is required before anything definite
can be said regarding the merits of chrysoidin and
of this blood serum method.

REFERENCES.

(1) Head, Journ. Comp. Path. and Therap., Edinburgh and
London, 1904, September 30th.

(2) Journ. Infect. Dis., Chicago, 1905, March.

(3) Brit. Med. Journ., London, 1904, May 28th.

(4) Lancet, London, 1905, February 25th.

(5) Brit. Med. Journ., London, 1903, June 20th.

(6) Veterinarian, London, vol. 1., xxii., p. 648.

(7) Compt. rend. Soc. de Biol., Paris, 1905, February 24th.

(8) Laveran and Mesnil, ** Trypanosomes ct Trypanosomiasis,"
Paris, 1903.

(9) Brit. Med. Journ., London, 1904, November 26th.

(10) ** Thomson Yates Laboratory Report," Liverpool, 1902.

(11) “Surra in the Philippines,” Report, Washington, 1903.

(12) Indian Med. Gazette, Calcutta, September, 1904.

(13) Lancet, London, 1905, March 25th.

(14) Journ. Hygiene, Cambridge, 1905, April.

(15) Brit. Med. Journ., London, 1904, December 26th.

(16) Lancet, London, 1905, June 17th.

--------Ф----

“С. В. Soc. Biol.” T. lix., 1905.

INFECTION WITH THE NORTH AFRICAN SURRA BY
COHABITATION,

Roger, J. The dog in question had been kept along with
dogs infected with the equine trypanosomiasis of Algeria
from January 25th to April 8th, but the method of contagion
was not discovered.

* Annales de L’institut Pasteur,” xix.
SOME ATTEMPTS TO CULTIVATE THE BACILLUS oF LEPROSY.

Neil, Emile M. P., claims to have cultivated the В. (ерге
outside the human body but could not maintain his cultiva-
tions. More or less success was obtained with a variety of
inedia, but the most successful was a bouillon made with
250 grms. of veal in 750 grins. seu-water and 250 grms. dis-
tilled water. Make distinctly alkaline, and add 40 grins. of
glycerine, 8 of glucose, 10 of peptone and 20 of agar. Place
in the cooler and add 1 part of yolk of egg to 4 parts of
gelose in each tube.

* Journal of Hyglene," vol. vi.
FLAGELLATE PARASITE FOUND IN CULEX FATIGANS.

Ross, Major Ronald, C.B., F.R.S., recalls certain observa-
tions made by him іп 1898 on certain *amnebuhe and
Hagelluhe," found in the intestines of mosquitoes, and
suggests that the organisms found in mosquitoes by
Schaudinn, and believed by him to be a stage of the Haltert-
dium danilewskyt of the little owl may really be quite
distinct parasites, having no connection with the avian
hiematozoon.

It is obvious, however, that it is equally possible
that the protozoa referred to by Professor Ross may
not, as he supposes, be purely mosquito parasites, but
шау really be a developmental stage of the biematozoa
of some vertebrate. Тһе question, however, шау be
safely left for tho two distinguished protozoologists to
discuss and settle between them.

(March 15, 1906.

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THE

Journal of Tropical Medicine

Marca 15, 1906.

LIVERPOOL SCHOOL OF TROPICAL
MEDICINE.

REporT FOR 1905.

Тнк Seventh Annual Report of the work of this
School shows that it continues to fulfil, in an emin-
ently satisfactory aud creditable manner, the purposes
for which it was founded.

Whether regarded from the point of view of the
practical and scientific training it affords to a large
number of medical men, or the yet higher platform of
original research, the School authorities have every
reason to be satisfied and proud of their achievements.
The publications emanating from the School have
advanced our knowledge in many directions, and en-
hanced the reputations of the several contributors.

The “ Mary Kingsley Medal" has been bestowed
by the School authorities upon Sir Patrick Manson,
K.C.M.G., F.R.S. ; Colonel David Bruce, C.B., F.R.S. ;
Dr. Laveran, and Professor Koch. The Liverpool
School of Tropical Medicine has sent out expeditions
to several parts of the Tropics, costing some valuable
lives, and involving the expenditure of large sums of
money. So important have these expeditiens proved
that the publication of a complete list of the several

March 15, 1906.)

THE JOURNAL OF TROPICAL MEDICINE. 98

undertakings is deemed worthy of being reproduced,
as a testimony of their consequence and of the suc-
cess attending them.

EXPEDITIONS.

The First (Malarial) Expedition: Major Ronald Ross,
C.B., F.R.S., Dr. Н. Е. Annett, Mr. E. E. Austen (of the
British Museum) and Dr. Van Neck (of Belgium), despatched
to Sierra Leone in the summer of 1899.

The Second (Malarial) Erpedition : Dr. Б. Fielding Ould,
despatched to the Gold Coast and Lagos, in the winter, 1899.

The Third (Malarial) Expedition: Dr. H. E. Annett,
Dr. J. E. Dutton and Dr. Elliott, despatehed to Northern
and Southern Nigeria in the spring of 1900.

The Fourth (Yellow Fever) Expedition: Dr. H. Е.
Durham and thelate Dr. Walter Myers, despatched to Cuba,
and to Para in Brazil in the summer of 1900.

The Fifth (Sanitation) Erpedition : Major Ronald Ross,
С.В., F.R.S., and Dr. Logan Taylor, despatched to Sierra
Leone in the early summer of 1901.

The Sirth. (Trypanosomiasis) Expedition: Dr. J. E.
Dutton, despatched to the Gambia in the autumn of 1901.

The Seventh (Malarial) Hxpedition: Dr. C. Balfour
Stewart, despatched to the Gold Coast in November, 1901.

The Eighth (Sanitation) Expedition: Major Ross, de-
spatched to Sierra Leone on February 22nd, 1902.

The Ninth (Malarial) Erpedition : Major Ross, accom-
panied by Sir William Macgregor, K.C.M.G., the Governor
of Lagos, despatched to Ismailia, September 11th, 1902.

The Tenth (Trypanosomiasis) Expedition: Dr. J. Е.
Dutton and Dr. J. L. Todd despatched to the Gambia and
French Senegal on September 21st, 1902,

The Eleventh (Sanitation) E.rpedition: Dr. M. Logan
Taylor, despatched to the Gold Coast from Sierra Leone on
October 11th, 1902.

The Twelfth (Trypanosomiasis) Expedition: Dr. J. E.
Dutton, Dr. 7. L. Todd, and Dr. С. Christy, despatched to
the Congo Free State on September 23rd, 1908.

The Thirteenth Expedition: Professor Rupert Boyce,
M.B., F.R.S., Dr. Arthur Evans, M.R.C.S., and Dr. Herbert
H. Clarke, M.A., B.C.Cantab., were despatched to Bathurst,
Conakry and Freetown on November 14th, 1904, to report
on the Sanitation and Anti-inalarial Measures in practice at
the towns visited.

The Fourteenth Expedition: Lieut.-Col. G. M. Giles,
M.B., F.R.C.S., Indian Medical Service (Rtd.), and Dr. К.
Ernest McConnell, M.D. (Canada), despatched to the Gold
Coast on December 81st, 1904.

The Thirteenth and Fourteenth Expeditions were sent to
West Africa in appreciation of Sir William MacGregor’s
great services to health and sanitation in West Africa.

The Fifteenth (Yellow Fever) Expedition : Dr. H. Wolfer-
stan Thomas and Dr. Anton Breinl, despatched to the
Amazon in April, 1905. Both members of the Expedition
вопы yellow fever and Dr. Breinl had to be invalided

ome.

The Sixteenth (Yellow Fever) Expedition: Professor
Boyce, F.R.S., despatched to New Orleans in August, 1905,
to observe the work of the United States Medical Authorities
in dealing with the outbreak of Yellow Fever there. Pro-
fessor Boyce subsequently visited British Honduras at the
special request of the Colonial Office, to make a report on
the conditions existing in that Colony with reference to a
recent outbreak of Yellow Fever.

The paragraph in the Report referring to the death
of Dr. J. Е. Dutton, whilst engaged upon scientific
work on the Congo, is a fitting testimony to a dis-
tinguished man who lost his life in the cause of
humanity.

Tae Late Dr. J. E. Durron.

It was with the deepest regret that the Committee learned
of the sudden death of Dr. Dutton, Walter Myers Fellow, at
Kosongo, on the Congo, on February 27th, while actively

engaged in the investigation of trypanosomiasis and tick
fever. In 1903, Dr. Dutton, accompanied by Dr. Todd, pro-
ceeded to the Congo to investigate trypanosomiasis and other
tropical diseases. Towards the end of 1904 they had reached
Stanlev Falls, and independently they were able to demon-
strate the cause of tick fever in man—a discovery made a
few weeks previously by Ross and Milne in the Uganda
Protectorate. Further, they were able to prove the trans-
ference of the disease from inan to monkeys by means of a
particular species of tick. During these investigations both
observers contracted the disease. Тһе last letter received
from Dr. Dutton was dated Kosongo, February 9th, when
he seemed in excellent spirits. In his death, the Tropical
School and the University have suffered the loss of a most
brilliant graduate. Although only twenty-nine years old, he
had already won a recognised position throughout the
scientific world.

Educated at the King's School, Chester, Dr. Dutton pro-
ceeded to the University of Liverpool, where he rapidly
made his way, and in 1897 he was appointed to the George
Holt Fellowship in Pathology, which gave him the oppor-
tunity for research. Dr. Dutton entered the Royal Infirmary,
where he acted as house surgeon to Professor Rushton
Parker and house physician to Dr. Caton. In 1901 һе was
elected to the Walter Myers Fellowship in the Tropical
School. His first expedition to West Africa took place in
1900 when, with Dr. Annett, he visited Nigeria. In 1901 he
proceeded alone to the Gambia, and drew up a most com-
prehensive and useful anti-malarial report which has proved
of the greatest service to that colony. It was during this
expedition that he identified in the blood of a patient of Dr.
Forde, the Medical Officer of Bathurst, a trypanosome
belonging to a group of animal parasites which had hitherto
been found only in animals. He accurately described and
named it. Subsequently he found the same organism in
numerous other patients in the Gambia and elsewhere. It
сап hardly be doubted that this brilliant discovery of the
first trypanosome in man by Dr. Dutton was an important
step in leading to the discovery of the cause of sleeping
Sickness, whieh was subsequently shown by other observers
to be due to the ваше parasite. Іп addition to his discovery
of Trypanosoma gambiense, he also described several other
trypanosomes new to science. In 1902 he proceeded with
Dr. Todd to Senegambia, and drew up a report on sanitation,
which was presented to the French Government, and further
papers on trypanosomiasis which were published. Тһе
present expedition to the Congo was sent out in 1903. Dr.
Dutton was accompanied by Dr. Todd and Dr. Christy, the
latter returning to England in June last.

It will be seen from this account that, although only
twenty-nine, Dr. Dutton had accomplished a vast amount of
useful work, and had advanced in a most striking manner
our knowledge of medicine. Medical science has lost one of
its most promising and distinguished men. The City of
Liverpool mourns the loss of one of its most gifted students,
and his colleagues in the University and the Royal Infirmary
have lost one who combined with a great intellect а charm-
ing personality, which made him beloved by all.

About 900 cases of various tropical diseases have
been treated at the special ward of the School in the
Royal Southern Hospital since the School's opening,
including cases of sleeping sickness. Students
receive their clinical instruction in this ward.

Students to the number of 150 have already taken
out the course of instruction. These students have
been medical officers of nearly every nationality, and in
almost every case have been men holding responsible
official positions in tropical countries, who have
realised the value of what may still be considered as a
new departure in medical research.

-_—- Ф. —

94 THE JOURNAL ОЕ TROPICAL MEDICINE.

[March 15, 1906.

еріс.

Lectures on Tropicau Diskases. Being the Lane
Lectures for 1905. Delivered at Cooper Medical
College, San Francisco, U.S.A., August, 1905.
By Sir Patrick Manson, K.C.M.G. London:
Archibald Constable and Co., 16, James Street,
Haymarket, S. W. 1905. Pp. 230. Illustrated.
Price 7s. 6d.

Every medical man interested in tropical medi-
cine will welcome this volume. It is needless to say
that the subject is presented in that fascinatingly
educative style of which Sir Patrick Manson is master.
Not only are the several diseases described with
accuracy as regards their pathology, etiology, prophy-
laxis and therapeutic treatment, but from the first to
the last page the subject matter is presented in & forin
which teaches one to regard tropical pathology, aud
all that appertains to it from the higher platform of
public health and racial welfare. Of the ten chapters,
under which the lectures are arranged, the first six are
devoted to descriptions of such diseases as Epiphytic
Disease of the Skin, Ankylostomiasis, Dracontiasis,
Endemic Hemoptysis, Bilbarziosis, Filariasis,
Malaria, Trypanosomiasis and Sleeping Sickness ;
Kala-Azar and other diseases of lesser importance in
regard to their epidemicity. Chapters VII. and VIII.
deal with the Diagnosis of Tropical Fevers: Chapter
IX. is concerned with Treatment. Тһе last chapter
is the one to which medical men, acquainted with
tropical ailments, will turn, namely: '' Problems in
Tropical Medicine." Under this heading the reader
will find а wealth of suggestions and scientific deduc-
tions which must prove stimulating to thought and
research. Yellow Fever, seeing that the lectures were
delivered to an American audience, naturally occupies
considerable space in the matter of ‘ Problems," but
the treatment of this subject has direct bearing upon
the principles to be followed in research in other
diseases and in other countries. Sir Patrick, discuss-
ing the Creole immunity to yellow fever, adopts “ав
& working hypothesis that there are two strains of
yellow fever virus, one of great virulence, one of little
virulence. Specifically the same, they are mutually
protective. "They differ only in their respective patho-
genicity. The relationship pertaining between them
recalls that between small.pox and vaccinia, and the
native in the endemic area acquires his immunity
against the virulent disease from having had the non-
virulent disease already." It is useless, however, at-
tempting to quote jottings from a book which is a
consecutive whole, and every word of which is interest-
ing, educative, and a stimulant to the pursuit of re-
search and observation. The book will remain a
classic, long after many of the subjects it deals with
are further elucidated, for the store of knowledge it
embraces and the suggestions as to future investigations
it contains are no mere ephemeral speculations, but
deductions founded on a logical basis which increased
knowledge may prove to correct but cannot upset.

Тне West Arrican Роскет Book.

The West African Pocket Book is a happy idea. It
is not merely in name but in form and style a pocket

book which any one travelling can always carry about
in the pocket. We have nothing but praise for its
contents. lt is intended as a guide for newly appointed
Government officers, and has been compiled by direc-
tion of the Secretary of State for the Colonies. Within
fifty-nine pages it gives concisely and in simple
language excellent information and directions as to
outtit, personal hygiene, food and drink, care of
quarters, travelling and bush life, precautions to be
taken against malaria, and treatment of some of the
more common diseases and aocidents when the help
of a medical man cannot be obtained. Тһе pocket-
book is worthy of every commendation, and the
Colonial Office are to be congratulated on its issue. It
is to be obtained from Waterlow and Sons, London.

——— ————————
Correspondence,

THE TEETH OF CENTRAL AFRICAN NATIVES.
To the Editor of the JouRNAL OF TRoPICAL MEDICINE.

SIR, In your issue of October 2nd last there are some
remarks by a Dr. G. A. P. Ross on the teeth of Central
African natives. I did not see the article to which he refers ;
I have not long been a subseriber to your Journal.

I beg to correct the following statement with reference to
the Angoni tribe: viz., “ Their food is entirely vegetable,
consisting of rice, mealies, and ufa (mealies and Kaffir corn
mixed.)"

Probably the older of the men he examined had never
heard of rice in their boyhood. Until a few years ago rice
was only grown at one station on the western shore of Lake
Nyassa, where its cultivation was probably started (and cer-
tainly encouraged) by Н.М. Administration. Р

Тһе Angoni are almost entirely confined to the highlands,
where they can hardly grow rice. so it must be rarely that
rice enters into the Angoni villager’s diet. Of course as a
European carrier rice would be the usual ration.

Presuming “mealies and Kaflir corn" to mean Indian
corn and millet respectively. it does not follow that because
these are their ordinary food that they take them mixed and
call it “ufa.” as the writer states. “Ufa” is simply the
native name for flour, and шау be made from maize, millet,
or other smaller native grain. This flour, with beans, veget-
able marrows, wild green herbs, and whole maize roasted
ана cob in the embers of а fire, or as separated grains оп a
shovel, like coffee-beans often are, is the daily dietary of
natives in the villages.

Again, they are not vegetarians from choice: they keep
goats and pigs, and some have sheep and cattle, while their
poultry sleep in their houses with them ; and not only do
they eat meat whenever they can get it, and eagerly join а
shooting party as carriers, but one may often see a gang of
Angoni labourers after the day's work hunting the grass for
field rats and mice for the evening stew-pot, and Europeans
cats often disappeared for the same purpose.

It will be seen, therefore, that it is rather because prac-
tically the whole grain is eaten by natives, and to their care
of the teeth, than to absence of meat from their diet, that
must be held to account for the high percentage of good
teeth amongst Central African natives.

I am, &c.,

East Africa, J. E. S. Orp, M.D.

February 6th, 1906.

ABSENCE OF FEVER IN QUARTAN MALARIA.

To the Editor of the JOURNAL оғ TroricaL MEDICINE.

DEAR бін, Reading the interesting remarks of Dr. Well-
man in your issue of February 1st ult., concerning absence

March 15, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE. 95

of fever in quartan malaria, the following observations may
be of interest.

This country varies enormously in the malarial index in
different parts, the index being 100 per cent. to 80 per cent.
in low-lying, wet situations and in parts of Jerusalem ; in the
upland villages Ramallah, for instance, the splenic index, is
only 4:8 per cent. (in 232 children, 10 years and under).

(1) A Jewish woman, showing quartan rosettes in the
peripheral blood in hospital, had had no fever for several
days; the spleen was considerably enlarged, and there was
well-marked cachexia.

(2) A girl of 12 vears or so, after severe attacks of fever,
denied any rise of temperature for over two months; she
was very cachectic, had enlarged spleen, and showed nu-
merous pale rings and crescents in the blood.

(8) Two other patients. showing sparse quartan and ter-
tian parasites, had had no fever for ten and twelve days
respectively.

(4) A healthy European, engaged in archeological work,
оп the first day of fever showed numerous tertian forms,
including spores and equally numerous gametes. This leads
to an interesting query as to the date of appearance of
gametes in tertian fever; so far as I have seen, crescents
are not seen until seven days from onset of fever. This
patient had had no fever for months to my knowledge.

Another point of interest is, that whereas malaria is very
little in evidence in winter (one case per diem or less),
almost all of these have proved to be quartan in character
under the microscope, and Dr. Masterman, working in
Jerusalem, has noted the same in а marked manner, from
clinical evidence. In this country there would seem to be
no preponderance of tertian fever in spring, as in Italy, or of
subtertian malaria in autumn, when tertian fever ів com-
monest.

I am, yours faithfully,

Ramallah, Jerusalem, JOHN CROPPER.
February 15th, 1906.

—— eo

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species of cassia, introduced by Dr. O'Sullivan Beare,
has obtained considerable reputation as a therapeutic
agent in the treatment of blackwater fever and of
ordinary malaria. Messrs. Parke Davis have prepared
а fluid extract which ensures stability of dosage and
portability without deterioration.

(2) Antimalaria Tablets.—Each tablet contains:
quinine sulph., 3 grains ; powdered nux vomica, gr.};
powdered capsicum, gr. $; and extract of hyoscyamus,

. 3. The components of this tablet are eminently
suitable for tropical residents; the introduction of
capsicum harmonises with the ideas entertained by
native practitioners in the Tropics as to the virtues of
“ spices "' in decoctions prepared by them.

(3) Warburg's Tincture Tablets.—Each tablet re-
presents а fluid drachm of the Warburg's well-known
tincture. There can be no doubt of the efficacy of
Warburg’s tincture in the treatment of febrile ail-
ments in tropical countries, more especially when
marked gastro-hepatic derangements accompany the
illness. Its efficacy in remittent malaria is undoubted.

(4) Acetozone in solution is powerfully germicidal,
and possesses the advantage of being non-toxic. At
the strength of 1 in 1,000 in typhoid, 1 in 2,000 in

dysentery and cholera, and 1 in 3,500 in intestinal
fermentation, acetozone has proved highly beneficial.

(5) Hamabic Hypophosphites is an elegant prepara-
tion, palatable and suitable in debility and anemia,
especially when these are the result of acute and sub-
acute illnesses.

----<о---

Hotes and lets.

BERMUDA.

The Medical Board appointed to enquire into the
medical qualifications of persons desiring to register
as medical practitioners in Bermuda consists of:
Eldon Harvey, F.R.C.S8.Eng, L.R.C.P.Edin. ;
Dudley Cox Trott, M.B., B.C.Cantab., F.R.C.S.Eng.,
бс., &c.; and William Eldon Tucker, M.B., B.C.
Cantab., «с.

--------“Ф----
PLAGUE.
PREVALENCE OF THE DISEASF.

Cases. Deaths.
India.—Week ended Jan. 27th — 3,747
ii Feb. 3rd 6,116 5,049
T" » 10th 7,116 5,890
S. Africa.— Week ended Feb. 3rd 0 0
Р „ 10th 0 0
Mauritius.—Week ended Feb. 8th 1 1
5 » 15th 1 1
» ж 22nd 0 0
3 » 29th 0 0
Hong Kong.—Week ended Feb. 3rd 2 2
n » 10th 6 6
; „ L7th 5 4
25 » 24th 19 12
Кқ March 3rd 8 7

---------Ф--

Becent and Current Literature.

A tabulated list of recent publications and articles bearing on
tropical diseases is given below. To readers interested in
any branch of tropical literature mentioned in these lists
the Editors of the Journal. OF TRoPICAr, MEDICINE will be
pleased, when possible, to send, on application, the medical
journals in which the articles appear.

Sec. I., “Kwai Medical Journal,” Johan, December 31, 1905.

EXPERIMENTS ON DOGS DURING KAK'KE (BERI-BERI)
INVESTIGATIONS.

Baron Takaki fed three dogs on vegetable diet (including
rice) and three dogs опа diet containing beef. The dogs fed
on vegetables only increased in weight markedly at first,
but later became thin, feeble, lost sensation and motion in
the hind limbs and died. The dogs fed on beef and vege-
tables gained in weight more slowly and remained healthy
and strong. Takaki concludes that increase in weight is no
evidence of health.

“Bemaine Médicale,” September 13, 1905.
MALARIAL PERITONITIS.

Gillot, V., describes a case of acute peritonitis occurring in
а patient in whom the malaria parasite was found in the
blood. The peritonitis yielded to treatment by quinine.

96 THE JOURNAL ОЕ TROPICAL MEDICINE.

“ Presse Medicale,” December 30, 1905.

Ova IN THE INTESTINAL PARASITES ; TECHNIQUE OF
OBSERVATION.

Letulle, M., recommends for the diugnosis of the presence
of ova in the fieces, that (а) in the case of a fluid stool, after
centrifugalisation a drop of sediment is taken for examina-
tion; (b) solid feces are first dissolved in water, and then
treated as in the ease of a fluid stool. Тһе ova possible to
isolate in this manner are those of (1) Ascaris lumbricoides,
(2) Oryuris vermicularis, (8) Bothriocephulus latus, (4)
Trichocephalus dispar, (5) Ankylostoma duodenalis, and
(6) Bilharzia hematobium. In his paper, Letulle gives
careful drawings of the ova of these parasites.

* American Journal of Medical Sciences," January, 1906.

Thomas, J. B. Report on the action of various sub-
stances on pure cultures of the Ameba dysenteriae and
cholera spirilla. The following laboratory experiments bv
Thomas are interesting, and may be of clinical value :—

(а) The following retarded the growth of Ameba dysen-
ferie and cholera spirilla in thirty minutes: Acid tannici,
1 іп 100; quinine sulph.. 1 in 1,000; eupri sulph., 1 in 2.000 ;
potassium permanganate, 1 in 4.000.

(5) Retarded the growth within thirty minutes: Quinine
sulph., 1 in 500; protargol, 1 in 500; argyrol. 1 in: 500;
potassium permanganate, 1 in 2,000; argenti nitrate, 1 in
2,000.

(с) Destroyed amceba in fifteen minutes, with only slight
effect on cholera spirilla: Thymol, 1 in 2,500.

“ Gazetta Degli Ospedali edelle Cliniche,” January 7, 1906.
Conti, A. А clinical note in a case of chronic spasm of
the region of the aecessory nerve of Willis due to malaria.

“Journal American Medical Association,” February 3, 1906.

(1) Wilkinson, Н. В. '* Leprosy in the Philippines, with
an Account of its Treatment with the X-rays." Wilkinson
finds that treatment of one leprous spot produces improve-
ments in spots in other parts of the body which in their
progress advance parallel to and just as complete as in the
spot exposed to the X-rays. He therefore assumes that the
leprosy bacilli are killed by the treatment, and that their
bodies, reabsorbed into the blood, are the innnunising and
curative factors. He finds the more pronounced the cure
the better does the X-ray treatinent serve—a phenomenon
he explains by the fact that the more pronounced the
disease the more bacilli are present, and, therefore, the more
immunising agents, in the form of dead bodies of bacilli, are
produced. А parallel immunisation is that provided in
plague by using injections containing the dead bodies of the
plague organisms ; in the case of leprosy, however, as treated
by X-rays, the culture medium is not produced in the
laboratory, but is no other than the human body itself.

(2) Gorgas, W. C. "Mosquito Work in Relation to
Yellow Fever in the Isthmus of Panama.”

“Arch. f. Protistenk.,” T. vi.
REPRODUCTION OF CLEPSIDRINA OVATA.

Schnitzler, H., continues the work of Piihler on the same
species of. gregarine, and concerns himself mainly with the
details of the ehanges undergone by the nucleus after the
encystment of the coupled adults. He describes the forma-
tion of a very small spindle of division in each nucleus when
all the chromatin and the nuclear membrane have disap-
peared, and also the mitoses of the reproductive nuclei
during division. He confirms, with further details, Pähler’s
deseription of the phenomena of nuclear reduction by the
throwing out of a polar globule which characterises the
maturation of the sporoblasts or gametes (a unique in-
stance amongst the gregarines) Lastly, he figures and
describes the isogamic reproduction of the gametes in pairs.
Each couple gives origin to one of the eask-shaped sporo-
eysts with eight sporozoites, which is a ehuracteristie of the
genus Gregarina,

[March 15, 1906.

He was, however, unable to work out the evolution of the
other form of cyst which is formed by a single gregarine,
but suggests that the difference in the size of the sporo-
сухіх is connected with these solitary eneystments.

“ Arch. Zool. Expér.,” 4th Series, T. iv., 1906.

RESEARCHES ON THE REPRODUCTION OF THE MoNocysTID
GREGARINES.

Brasil, Louis. follows the development of these parasites
from encystment to the formation of the sporocysts. Не
states that, at any rate, in the four species of Monocystis
found in earth-worms which he has examined the gametes
are anisogamic. In this they resemble two others of this
venus infesting the body cavity of certain marine annelids.
The author describes with great саге the origin and structure
of the asters. their division into two, the formation of the
directive spindles, the elimination during the first division
of a great part of the nuclear chromatin and the division of
the residual chromatin amongst the daughter nuclei.

* Sitzungsber d. К. pr. Akad. d. Wiss.," T. xlvi., 1905.
SprEcrrIc DISTINCTIONS BETWEEN TRYPANOSOMES.

Koch. Professor R., draws attention to the difficulties of
distinguishing between trypanosomes generally, and espe-
cially of those that act as pathogenic organisms in mammals.
Their pathogenic character cannot, however, be used to
distinguish them, as the animal employed in such a test
might have acquired immunity. The key of the difficulty,
he believes, lies іп comparing not merely the adult forms,
but the various evolutionary stages which they undergo,
As an example, he compares the evolutionary stages of
T. brucei іп Glossina morsitans and G. fusca. with that
of T. gambiense іп G. palpalis. In both cases there are
found in the digestive tubes of flies that have imbibed in-
fected blood two very distinct forms: the one sort plump,
with abundant, easily stained plasma and а round, spongy
nucleus; the other elongated and thin, with scanty, ill-
staining protoplasm and a dense, rod-like nucleus. Judging
from analogy, the former are the female and the latter the
male elements. Now the two species can easily be distin-
guished as follows :—

Female Forms.—T. brucei: Blepheroplast or centro-
some round, and about 1 m in diameter. Т. gambiense :
Elongated transversely, and 2:5 m 5 by 1:5 m.

Dimensions, —- Female forms: Brucet, 25 р by 86 4;
gambiense, ЗТ p by 8 р. Mule forms: Brucei, 40 & by
20:1 а; gambiense, 34 u by 085 м.

“6. К. Вос. Biol." T. lix.

FREQUENCY OF TRYPANOSOME INFECTION IN Rats
AND Mick.

Sabrages, J.. апа Murntet, L. All the specimens of
Mus rattus examined at Bordeaux were found to be in-
fected, but none of those of M. decumanus or of mice. On
the other hand, a big M. decumanus taken at Tours was
found to be infected.

Rotices to Correspondents,

1.— Manuscripts sent іп cannot be returned.

2.—As our contributors are for the most part resident abroad,
proofs will not be submitted to those dwelling outside the United
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4.— Authors desiring reprints of their communications to the
JOURNAL OF TRoPICAL MEDICINE should communicate with the
Publishers.

5.—Correspondents should look for replies under the heading
“ Answers to Correspondents.”

April 9, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE. 97

M — M—M———————————————————————————————M——————————
————————————————————————————————

Original Communications.

ON A HEMIPTEROUS INSECT WHICH PREYS
UPON BLOOD -SUCKING ARTHROPODS
AND WHICH OCCASIONALLY ATTACKS
MAMMALS (MAN).

By Е. C. WzrLMAN, M.D.
Benguella, West Africa.

SoME months ago I mentioned (1) an insect, called by
the Angola Bantus “ Ochindundu," which preys upon
blood-sucking ticks. The specimen upon which I
based my remarks was taken in the act of feeding
upon в very important tick of the region (Ornitho-
doros moubata) which is one of the carriers of human
spirillosis. I have since learned that the insect itself
inflicts a very painful and even dangerous bite. The

specimen was sent to the British Museum, but, having '

heard nothing of it, I suppose it must have been lost
en route. Since I have on several occasions referred
to the insect (2), I shall here give (as well as I can in
the absence of the anticipated report from the Museum
and without access to a library) & few notes on the
appearance, probable systematic position, bionomics,
and pathologic significance of the animal.

Systematic Position AND DESCRIPTION.

The insect under consideration belongs to the
Hemiptera (Bugs) falling among the Heteroptera.
Here it is to be placed with the Geocores (Land bugs),
thus allying it with bed-bugs, squash-bugs, &c. 1t
belongs to the family Reduviide (3). This family is
related on the one hand to the Nabide, and closely on
the other to the Emeside. The Reduviide are dis-
tinguished by having the front femora somewhat
thickened, but much less than half as wide as long.
Two ocelli are often present. The rostrum is short,
three-jointed, attached to the tip of the head, and with
the distal end, when not in use, resting upon the pro-
sternum, which is grooved to receive it. The species
are many. While I, of course, cannot definitely place

x 2.

Ета. 1.—Ornithodoros moubata, Murray, %.

the species studied by me without access to descrip-
tions and specimens of its allies, yet I have no hesita-
tion in saying tbat it closely approaches Reduvius
(Opsicaetus) personatus, L. I have no description of
R. personatus by me, but my impression is tbat the
first two pairs of legs in the last-named bug are less
thickened than in the case of the “ Ochindundu,” and
other differing anatomical details very possibly exist.
The * Ochindundu” is, like R. personatus, black in
colour, but the first two pairs of legs are of a bright
red hue. I have recently captured a similar insect
which is entirely red. I present a rough sketch (fig. 2)
of the “ Ochindundu," made when the bug was first

discovered. Having, as I have said, sent the original
specimen to the British Museum, I cannot offer а
better drawing.

Bionomics.

The “ Ochindundu" preys upon ticks, catching them
and sucking, by means of its powerful piercing pro-
boscis, the blood with which they have filled them-
selves. The insect is provided with curious paddle-
like structures on its first four legs, which are

Fic. 2.—The “ Ochindundu," Маё. size.
evidently designed for holding securely the tick upon
which the creature feeds, the ** Ochindundu " sitting,
as it were, upon its hind pair of legs during the pro-
cess. Тһе attitude taken while sucking blood from a
tick is shown in fig. 8. The only tick which I have
actually seen in the clutches of the insect is Ornitho-
doros moubata, Murray. Тһе substance of my note
sent with the specimen forwarded to the British
Museum is as follows :—

“Т found this insect June 22nd, 1905, while studying the
tick sent to the Museum some time ago (O. moubata,
Murray) The bug was running about on the sticks com-
posing a pig-sty where I was collecting ticks. Му attention
was attracted by its singular appearance and movements.
Suddenly it entered a large crack in a stick and remained
for some seconds. I could not clearly see whatit was doing,
во I had the stick split open, whereupon I found the insect
in the position figured in the following sketch, hold.

Fio. 8.-- The “ Ochindundu," showing the position it assumes
in the act of sucking blood from a tick (O. moubata). Nat. size.

ing & tick with its first four legs, and sucking blood from it,
for which purpose it had inserted its proboscis deeply into
the tick. The animal was so intent on its prey, that I was
able to carry it to a house without disturbing it and to
observe its actions for some time, and also to exhibit it in the
act of sucking blood from the tick. When placed in a kill-
ing bottle, it withdrew its proboscis from its prey, but still
clutched it with its legs. I mounted it in this position, and
the wound may be seen in the tick near the margin of its
body.”

T have not determined its life-history. In some
members of the Heduviide hexagonal masses of eggs
are deposited in any convenient spot, numbering as
many ав seventy or even more, and the nymphe differ
markedly from the adults. Not having seen the meta-
morphosis of the “ Ochindundu," І do not know if it
be (like R. personatus) covered in its immature stages

[April 2, 1906.

98 THE JOURNAL OF TROPICAL MEDICINE.

with the viscid substance which causes particles of
dust and small fibres to adhere not only to the body
proper, but also to the legs and antennz of the last-
named insect, giving to it the weird appearance from
whence has come its popular name of the Masked Bed-
bug Hunter. The predaceous habits of the “ Ochin-
dundu" are to be expected, since other members of
the family live on arthropods and even higher animals,
including man. One species (Prionidus cristatus)
feeds—both its nymph and imagines—upon all other
insects it can capture, either in the larval or adult
state, occasionally even overcoming and destroying its
own kind. А powerful venom is injected into the
victim when the strong proboscis is inserted, and it
dies almost instantly. The bug then sucks the juices
out ofits prey and drops the empty skin (4).

PATHOLOGIC IMPORTANCE.

The natives state that the “ Ochindundu” regularly
infests kraals and compounds for the sake of preying
on ticks. This would seem to be reasonable, since
many Reduviide are (as has been mentioned) preda-
ceous, living on the ingested blood of hæmophagous
arthropods, e.g., В. personatus hunts the bed-bug
(Acanthia lectularia). The “ Ochindundu " thus may
prove to be an unpaid assistant to the tropical sani-
tarian, helping him in the laudable task of combating
the worst of all African vermin, which infests not only
native lines, but is sometimes even found in white
quarters. Another point which is worth mentioning is
that the natives also state that the “ Ochindundu ” it-
self inflicts а bite which far exceeds in painfulness
that of the tick upon which it feeds. I have seen
several natives who claim to have been bitten by it.
One of them was seen while he was still suffering from
the effects of the bite. They compare its bite to that
ofa poisonous snake. These statements are borne out
by what I can learn of the habits of other closely
allied species. А variety of В. personatus is stated to
cause intense pain by its bite, and it is said that when
unskilfully handled it always bites. Its bite, like that
of the “ Ochindundu," is said to be almost equal to the
bite of à snake, the swelling and irritation lasting for
about а week. In some cases it has even proved fatal.
Another species (Conorhinus sanguisugus), known іп
America as the Big Bed-bug, sucks human blood at
first hand. Like the two insects just mentioned,
C. sanguisugus inflicts a most painful wound, and its
bite has been known to be followed by very serious
results, the patient not recovering from the effects of
it for nearly a year (5). It is very probable that
“ bites” attributed to scorpions, spiders, wasps, &o.,
аге in some cases inflicted by the ** Ochindundu" and
its allies, of which latter I have collected three distinet
species, which I hope to have determined as soon as
opportunity offers. Three possible ways in which
tropical Jteduviide may attain pathologic importance
occur to one :—

(D By their
creatures.

(2) By reason of their own venomous bites.

(3) Through their conceivable transmission of dis-
ease either directly by their own bites, or indirectly
through other animals wounded and infected by
them. `

destruction of disease-carrying

SUPPLEMENTARY NOTE ON THE “ OCHINDUNDU."

Just as I am posting the MS. of this paper I have
received a letter from Mr. Austen, of the British
Museum, who, writing uuder the date of November
3rd, 1905, assures me that my collections which I
feared were lost have safely reached the Museum. 16
will now be possible to publish a determination of the
bug above described by me, which I hope will appear
іп an early number of this Journal.

REFERENCES.

(1) Wellman. “Тһе Ochibopio Tick, &c.,” Hep. to Am.
Soc. Trop. Med., 1905.

(9) Id. “Оп Ornithodoros moubata, &c.," Ibid., 1905. Id.
** An Insect which Preys upon Ticks” (‘‘Notes from Angola,”
Noto xv., JOURNAL TROPICAL MEDICINE, 1905).

(3) Claus. ‘ Lehrbuch der Zoologie."
(4) Comstock. * An Introduction to Entomology.”
(5) Ibid.

HORSE-FLIES (TABANIDZ) AND DISEASE.
By Ernest E. AUSTEN.
Zoological Department, British Museum (Natural History).

Ir we except the Simulide, which consist but of a
single genus, numbering, so far as our present know-
ledge goes, considerably less than one hundred species,
and the Hippoboscide, the few species of which are
permanent parasites of mammals and birds, the horse-
flies, or Tabanide, are the only family of Diptera in
which the blood-sucking habit is, with a few possible
exceptions, universal in the female sex. For, even
among the mosquitoes, which will doubtless at once
suggest themselves to the mind of every one who reads
the previous sentence, there are many species—and,
as the family Culicide is at present constituted, even
some genera—of which the diet is all that the most
ardent vegetarian could desire. But horse-flies possess
yet other claims to attention. Not only are the
Tabanid: among the largest of all families of Diptera,
already including as they do the enormous total of
nearly sixteen hundred described species, but the flies
themselves are of relatively large size. Lastly, like
mosquitoes, horse-flies are practically ubiquitous.
Although they probably did not contribute to the
* infinite torment of flies" that added to the horrors
of * The Defence of Lucknow," there are few spots on
the earth’s surface where horse-flies are absent; and
from Alaska to Tierra del Fuego, from Siberia to
Ceylon, Cape Agulhas, and the South Island of New
Zealand, they force their unwelcome attentions on
men and animals alike. In many parts of Africa
they are especially abundant. The swarms of “ serut-
flies " (under which name are included several species
of Tabanus) encountered on parts of the Upper Nile
have made life burdensome to many a traveller, from
the days of Sir Samuel Baker to the present time;
and the many new species of Hematopota recently
received from Angola and Uganda seem to show that
the African continent must be regarded as the head-
quarters of that bloodthirsty genus.

In view, therefore, of the interest now being ex-
cited by blood-sucking Diptera as actual or potential
disseminators of pathogenic organisms, it may be

April 2, 1906.)

THE JOURNAL OF TROPICAL MEDICINE. 99

worth while to devote a few moments to a considera-
tion of the evidence tending to incriminate the Taban-
ide. Truth to tell, horse-flies, though often regarded
with suspicion, have not yet been conclusively proved
to be the regular conveyers of any form of disease
among domestic animals or man in any part of the
world. It is important to distinguish between the
* regular " conveyer of a disease-causing organism
and a mere accidental carrier. In the case of malaria,
sleeping sickness, tsetse-fly disease, and, almost
certainly, yellow fever, each malady is conveyed by
certain blood-sucking Diptera, and in no other шау.
But when the bacilli of a disease such as anthrax
are carried on the mouth-parts of a blood-sucking fly,
the insect is merely a fortuitous agent. That a
Tabanid or other biting fly which has sucked the
blood of an animal suffering from anthrax may
convey the disease to а human being, or to another
domestic animal, is quite possible. The author is
informed by Lieutenant-Colonel C. T. Bingham (late
І.5.С.), that іп Burmah mahouts believe that anthrax,
which is prevalent among elephants, is carried by
Tabanide, and on one occasion Colonel Bingham
observed Таһапій4е among a number of flies on an
elephant which had died from anthrax. The evidence
for and against the conveyance of anthrax by flies
has been well summarised by Nuttall, who, how-
ever, as the result of his researches, is ''struck by
the very few positive cases recorded of anthrax
arising from the bites of flies.”? Nuttall considers
that it is probable that infection by this means is
* the exception and not ће rule.’’* In India, Rogers
has succeeded experimentally in trausmitting surra (а
disease of horses, cattle, and camels, caused by the
parasite Trypanosoma evansi, Steel, and closely akin
to the African nagana, or tsetse-fly disease) by means
of the bites of horse-flies, but the insects were used
merely as inoculating needles, and transmission was
direct.

In the South of France (littoral of Var à Cavalière),
Louis Léger has recently met with & new flagellate
parasite (described by him under the name Herpe-
tomonas subulata) allied to T'rypanosoma, in the ali-
mentary canal of Tabanus (T. glaucopis, Mg., %) and
Haematopota.' The writer in question states that the
parasite is not common, and that he has met with it
only four times in sixty specimens of the genera
mentioned, collected in autumn on horses and cattle.
It should be noted that species of Herpetomonas are
parasitic not only in blood-sucking flies, but also in
non-biting forms, such as Musca, Sarcophaga, Pol-
lenia, and Fucellia ; but, apart from the settling of
flies on abraded surfaces or wounds, it is, of course,
only blood-sucking forms that are capable of infecting

! Ч. Н. Е. Nuttall, M.D., Ph.D. “Оп the Rôle of Insects,
Arachnids, and Myriapods, as Carriers in the Spread of Bac-
terial and Parasitic Diseases of Man and Animals. A Critical
and Historical Study," Johns Hopkins Hospital Reports, vol.
viii. (1899), pp. 1-155, Plates I.-III.

2 Op. cit., p. 2. ? Op. cit., p. 11.

* Louis Léger. “бағ un nouveau Flagellé parasite des Taban-
ides," Comptes Rendus Hebdomadaires des Séances de la So-
ciété de Biologie, T. lvii., No. 87 (December 30th, 1904), pp.
613-615 ; figs. in text.

vertebrates, should the parasites be found to pass
part of their life-cycle in a warm-blooded animal.

In the French Sudan, according to Laveran,* who
quotes L. Cazalbou,® the disease of dromedaries at
Timbuctoo, known as mbori, and that termed sownaya
or souma, at Ségou, which affects horses and humped
cattle coming from Macina, both of which diseases
are trypanosomiases, are propagated by Tabanus
diteniatus, Macq., and Т. biguttatus, Wied., var. Pro-
fessor Raphaél Blanchard has recently? given reasons
for suspecting Tabanus nemoralis, Mg., and Т. nigritus,
Fabr., two South European species which are met
with in North Africa, to be the disseminators of a
trypanosomiasis which affects dromedaries in Algeria.
Within the last few months it has been stated by
Pécaud, in a paper оп a trypanosomiasis of the
Middle Niger (which, he says, is undoubtedly the
same malady as that of Cazalbou at Ségon, referred
to &bove, and attacks horses, mules, donkeys, and
cattle), that “ the animals especially attacked are those
living in the vicinity of the Niger or its aftluents
(marigots). There are no Glossina [tsetse-flies] in
this region, and consequently Tabanidie must be
charged with propagating the disease.” А bare. state-
ment such as this that tsetse-flies are absent from
а district in which they might well be supposed to
occur, falls very far short of scientific proof that the
malady is disseminated by horse-flies. More than
once in recent years have species of tsetse been shown
to be abundant in localities in which they had pre-
viously been declared non-existent; and even should
there be no tsetse on the Middle Niger, some
other biting fly, such as Stomorys or Simulium,
may abound there. Still, it may be admitted that
there is at least a case for enquiry. Тһе part
played by tsetse-flies in the dissemination of sleeping
sickness, as well as nagana (tsetse-fly disease of
animals), shows us that if horse-flies are capable of
conveying organisms-that are pathogenic to domestic
animals, they may quite conceivably perform similar
réle as regards human beings, and it is hoped that
this little paper may have the effect of directing the
attention of readers of this Journal to the question of
“Таһапіфө and Disease."

THE ANATOMY OF THE BITING FLIES OF
THE GENUS STOMOXYS AND GLOSSINA.

By Lieut.-Colonel G. M. бте, І.М.5. (Retired.)

In the fifteenth report of the Liverpool School of
Tropical Medicine, p. 14, published last year, the
writer made some note of a trypanosomiasis of horses
existing in Kumassi which appeared to be conveyed
by a species of Stomoxys. Bodies which he regarded
as an evolutionary stage of the parasite were found in
the fluid taken from the stomach of a fresh insect
dissected on the spot, but, unfortunately, the visit was

> Comptes Rendus des Séances de l'Académie des Sciences,
T. exxxix. (séance du Octobre 31, 1904), p. 661.

в Recueil de Médecine Vétérinaire, October 15th, 1904.

7 Archives de Parasitologie, T. viii., No. 4 (1904), рр 578-579.

* Comptes Rendus Hebdomadaires des Séances de (а Societe de
Biologie, T. 1x. (January 19th, 1906), p. 59.

100

THE JOURNAL ОЕ TROPICAL MEDICINE.

[April 2, 1906.

so hurried, the object of our visit to the “ Coast”
-being mainly to examine into the actualities and
possibilities of anti-malarial sanitation, that little more
could be done than to carefully prepare a number of
the flies for subsequent microscopical examination.

The examination of this material has since been
undertaken, but though bodies have been met with
which it seemed might be referable to protozoal para-
sites, Prof. Minchin, to whom they have been sub-
mitted, does not consider that they represent stages
of a trypanosome.

At an early stage of the work it became evident that
some comparison with flies known to be free from
disease of the sort was imperative, and it was neces-

Fig. 9.

Fig. 1.—Stomoxys calcitrans from Malta.

Ето. 2.—Same species from the New Forest.

Fic. 3.—-“ Blotched” form Stomoxys from Kumassi.

Ето. 4.—Stomorys occidentalis from United States.

Ета. 5.—Stomorys sps. from Algiers and Jamaica, much re-
sembling the blotched form.

Ета. 6.—'* Banded " form Stomoxys from Kumassi.

Fic. 7. — Stomoxys sp. from Indian Terai.

Fic. 8.—Stomoxys sugillatrix from South America.

Fic. 9.— Stomoxys sp. from Gambia, possibly St. sitiens, Ron-
dani, from Abyssinia.

sary to turn aside and examine English specimens of
the same genus which are, fortunately, fairly easily
obtainable ; and some comparison with the flies of the
genus (Glossina was clearly desirable. This piece of
work took up much time, and as has been seen, remains
the only solid result for the labour involved.
Meanwhile a report by Prof. Minchin on the
anatomy of the tsetse-fly has appeared in the Proceed-
ings of the Royal Society, V. B. 76, 1905, p. 531, and
a similar paper on that of Stomoxys, by Lieut. Е.
Tulloch, R.A.M.C., is in the press. The present com-
munication, therefore, is devoted mainly to such points
as are not covered in these communications, which
will be quoted whenever possible, though some repeti-

April 2, 1906.)

tion may be unavoidable. Му thanks are greatly due
to Prof. Minchin for giving me advance proofs of
Lieut. Tulloch’s valuable paper. It may be noted
that the word “ stomach” in Prof. Minchin’s paper
should, he wishes to state, read proventriculus. Asa
matter of fact, it is very difficult to avoid ambiguity in
the use of terms such as “ stomach,” Strictly speaking,
the diptera have no “stomach” in the sense of a
localised dilatation of the upper part of the mid-gut.

In the mosquitoes, what is called the “ stomach ” is
the entire mid-gut, with the exception of the narrow
anterior part contained in the thorax and forepart of
the abdomen. In the Muscida, including the species
under consideration, there is no stomach in the sense
of a localised dilatation, but the anterior part of the
mid-gut forms a long tube of sausage form, and has
distinguishable characteristics from the parts behind.
Lowne, in his classical work on the blow-fly, calls this
the “ chyle stomach," and the continuation of the tube
as far as the point of entry of the Malpighian tubes
the ‘ proximal intestine," while, between this and the
commencement of the rectal valve is a short piece of
intestine which he speaks of as the “ metenteron,”
distal intestine, or hind gut. What Professor
Minchin speaks of as the “ sucking stomach " Lowne
usually calls the crop, and as it is diffi-
cult to ascribe any aspiratory function
to this organ the former term is to be
preferred, although it is placed in the
abdomen, and not in the neck, like the
crop of a bird.

These explanations are necessary,
as frequent references to Professor
Minchin’s account of the anatomy of
Glossina are necessary to avoid need-
less repetition of work already per-
formed, but Lowne's terminology will
be adopted in the account that follows.

The genus Stomoxys includes a small
group of biting flies, which resemble
each other so closely that their distinc-
tion is an extremely difficult matter.
It appears to be truly cosmopolitan,
species or races being reported from
all parts of the world. Тһе type
species may be taken as 5/ототув
calcitrans, which is common іп all
parts of England, especially where
horses are allowed to run wild, as
in the New Forest, where it is locally
known as the “forest horse-fly,” and the pony
owners have an erroneous idea that it is peculiar
to the neighbourhood. It has been found also
in Malta, North Africa, and Jamaica, and Ніев
from the Indian Terai closely resemble it, as also
does St. enos from New Zealand, and St. vernon from
British Columbia. St. occidentalis from the United
States, and St. suggillatriz from South America, are
also closely similar.

Curiously enough the flies brought by me from
Kumassi, and collected together from a swarm that
was tormenting the animals in the horse lines there,
included two fairly distinguishable forms.

As Mr. Austen, of the British Museum, is shortly
undertaking an examination of this genus, and careful

THE JOURNAL OF TROPICAL MEDICINE.

101

drawings are being prepared for the purpose, it was
decided not to attempt to name these forms, but to
speak of them for the present as the “ blotched,” and
' banded” forms respectively. The former closely
resembles C. calcitrans, while the latter is much like
some specimens in the Museum derived from the
island of Mauritius.

The accompanying rough figures give some idea of
the markings of these various forms and of the close-
ness of their resemblance to each other, but does not
pretend to close accuracy or proportional size, as any
attempt to do so is clearly superfluous in view of the
fact that the task is at present in the skilful hands of
Signor Terzi.

I am inclined to think, however, that a means of
distinction is to be found in the flagellum of the
antenna or arista, as it is usually called by
dipterologists. This structure is provided with a

discrete fringe of long hairs, and I find that the
number of these varies in the different forms, as well
as sometimes in the sexes of the same species.
Besides the long hairs, there are a number of shorter
ones which may be spoken of as accessory hairs, and
in Stomoxys calcitrans these are much longer than in
either the “ blotched `” or “ banded " forms.

The above figures will illustrate my meaning
better than much description.

The long main hairs spring more from the dorsal
side of the arista, as it is usually carried by the insect,
and so project almost directly upwards, while the
accessory hairs are arranged along its inner side, and
project inwards and upwards. In specimens mounted
in balsam both ranks are forced more or less into the
same plane, and are so represented in the figures.
Besides the two principal ranks the proximal half or
more of the arista is closely clothed with hairs, which
in some cases are as long as those I have termed the
accessory hairs, but neither these nor the ex-
tremely close dress of fine hairs that cover the
antenna proper are represented in the camera

109

THE JOURNAL ОЕ TROPICAL MEDICINE.

[April 2, 1906.

lucida drawings.
noted, simple.

A glance at the drawings shows that the three
forms can be quite easily distinguished, and moreover,
that the “ banded " Kumassi Stomoxys resembles the
English St. calcitrans more than the “ blotched ” form,
which resembles the latter more closely in colouration.
Both sexes in the ‘‘ banded ” insect have ten principal
hairs, whereas in the blotched one there are but
eight in each sex, and the entire arista is shorter pro-
portionally to the last joint of the antenna. In both
sexes on each of these forms the accessory hairs are
quite short. Stomozys calcitrans has seven principal
hairs in the $ and nine in the 4 , and may be further
distinguished from the banded form by the comparative
smallness of the fork formed between the termination
of the arista and the most distal principal hair. Тһе
accessory hairs are also very much longer than in
either of the other forms, especially in the male, а
further peculiarity of which is that the next but
longest principal hair is provided with а small branch
about half-way in its length. Ав far as observed these
characters appear to be constant, but the series
examined is not numerous enough to speak with
certainty on this point. Тһе remaining forms men-
tioned have not been examined, as they were British
Museum specimens, and it is hardly possible to pro-
duce an accurate drawing for comparison without
mutilating the specimen so as to be able to mount
the antenna in balsam.

The antenna of Glossina, & drawing of which is
reproduced from Mr. Austen's monograph, as will be
seen, differs entirely in having compound principal
hairs. Among the flies recently sent to the Museum is
а Stomorys from the Gambia, easily distinguishable by
the brilliant white marking of the frons, and which
answers fairly to the description of St. sitiens from
Abyssinia.

The principal hairs are, it will be

Rondani's description is, however, too brief to
admit of certain identification without comparison with
his types. Besides this there is a form from Somali-
land which much resembles my ‘“ banded form," in
marking, and as far as can be made out in the
armature of the arista, but is easily distinguished by
the pinkish colour of the lighter markings on the
frons. On the whole, however, it seems improbable
that more than half-a-dozen forms will require to be
distinguished.

The genus Stomorys was founded in 1762 by
Geoffroy “ L'Hist. abregeé des Insectes," ii., p. 538),
with the following definition: ‘ Antenne patellate

seta laterali pilosa, os rostro sululato simplici acuto,
ocelli tres." He notes further its close superficial
resemblance to the common fly, but remarks that ‘ its
more widely separated wings and its shorter abdomen
give it à look that make it easily recognisable to close
observation. In France it is commonest in autumn,
and he points out that this probably is the origin of
the old French saying, “les mouches d'automne
pignoient." His figure is unmistakable.

A more modern definition is to be found in Schiner's
“ Fauna Austriaca," i., р. 577, but is no better suited
to the requirements of modern classification, as it is so
planned as to include Hematobia, which differs from
Stomorys in the easily recognisable character of having
the palpi nearly as long as the ргоһовсів, whereas іп
Stomoxys they are of quite insignificant dimensions.

The venation of the wing presents nothing very
characteristic, and is so closely similar in the various
forms that it is unlikely to be of much service for the
distinction of species. Moreover, owing to the wing
being far from flat it is difficult to so mount specimens
as to obtain strictly comparable outlines for com-
parison.

Stomoxys, banded form, 4. Venation of wing.

Just as in the case of the common house-fly, the
tropical forms on Stomoxys are considerably smaller
than the English insect. Тһе two sexes resembleeach
other so closely that it is difficult without close
examination to distinguish them from each other,
especially as both males and females are equally blood-
thirsty, and a gorged male often distends its abdomen
to such an extent as to look much like a gravid female.
The most prominent point of difference is that the
space between the eyes is much wider in the females.
Examined casually the abdomen differs but little in
the two sexes, but a closer examination reveals the
point that while that of the female ends in a papilla-
like ovipositor, the hypopygium of the male is tucked
under him in much the same way as that of the female
crab. On closer examination the male genital
apparatus proves to be of a very complicated
character, and this, too, may prove of service in classi-
fication.

(To be continued.)

HYPNOTIC SUSCEPTIBILITY OF THE
NEGRO RACE.
By С. №. Ввахсн, M.B., C.M.Edin.
St. Vincent, B.W.I.
THERE being, as I believe, but little so far recorded
of therapeutic hypnotism in negroes, the included
figures may be of interest to those practising in

April 9, 1906.)

THE JOURNAL ОҒ TROPICAL MEDICINE.

tropical climates, who will take the trouble to verify
the utility of hypnotism.

I do not propose to give any results of therapeutic
suggestion, but merely to indicate the psychological
fact of the degree of susceptibility of the black race
to hypnotism.

For the purpose of obtaining a percentage, notes
were kept of a 100 consecutive persons of pure negro
blood who were tried under various conditions
favourable or otherwise to hypnotism. Of these it
was found that 87 were influenced at the first sitting.
Of the 13 who failed, two whom it was desirable to
hypnotise were influenced at the second try. The
other 11 were not tried again. Of these last one was
а case of mania, one a child of feeble intelligence, and
two very aged doting persons. All these four were
not subjects who could be expected to be influenced.

The method employed was almost invariably simple
persuasion to sleep, aided usually by stroking of the
forehead, or, in a few cases, by fixation of the eyes by
the finger or other object.

In two cases of mania fascination was resorted to,

and failed with one. Passes were tried without
success on the two cases of mania and on the imbecile
child. In some instances persuasion addressed to
several persons at once and indirect persuasion (of
another person) have been used. The latter was un-
successful on one occasion only, and that was with
one of the dotards.

Unintentional hypnotism has occurred more than
once, though none of those so influenced are included
among the 100 cases.

Compared with the results among whites in Europe,
where 80 to 84 per cent. are found susceptible after
many tries, these figures show that the negro is dis-
tinctly more susceptible. It might be inferred that a
more expert hypnotist would find the negroes sus-
ceptible to the extent of nearly 100 per cent.

So easily influenced do I find my black and coloured
patients that at hypnotic cliniques all the patients in
the room were hypnotised simultaneously. Those
who had previously attended fell asleep at the bare
command, while new cases, by imitation and рег-
suasion, were asleep іп а minute or less. In this way
ten persons have been operated upon at once, and
there is probably no limit except that of accommo-
dation.

It is probable, that given the attitude of expectancy,
such as that of persons desiring medical treatment,
a Liebault or Bernheim could hypnotise to sleep as
many blacks as could hear and understand him, as
readily as an expert prestidigitator hypnotises his
entire audience into visual illusions and sometimes
hallucinations.

The ages and sexes of the 100 cases referred to are
shown in the table below :—

Age | тар Not fnfusnieed

3 to 14 years ... wo TF 0 1
TA И КР СЕ 0 1
21,,60 , .. ..14 81 1 5
Over 60 , .. .. 7 1 4 1
33 54 5 8

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Journal of Tropical Medicine

APRIL 2, 1906.

A TROPICAL MEDICAL ASSOCIATION.

Has the time arrived when it is possible to found
an association of medical men interested not only.
in Tropical Medicine, but in the position Tropical
Medicine 4в а definite branch of General Medicine
should take and aspire to? The question has been
brought keenly home to .me by the difficulty en-
countered on several occasions of obtaining permission
to hold a Section of Tropical Diseases at the annual
meetings of the British Medical Association. The
Section of Tropical Diseases has on several occasions
been omitted by the authorities to whom the alloca-
tions of sections at the annual meetings of the Associa-
tion have been entrusted, and it was only by representa-
tion and persuasion that а tardy acquiescence to hold
the sectional meeting was obtained. .

This year, again, at the meeting at Toronto, a
Section of Tropical Diseases is omitted ; and although
the writer has represented the matter both to Canadian
authorities and to the Council of the parent Associa-
tion, nothing has come of it.

The reply on several occasions has been that Tropical
Diseases might be considered under the auspices of
or ав а sub-section of the '* Medicine " Section. Апу
one acquainted with the impossibility of dealing with
all the papers sent to the Section of Tropical Diseases
at the annual meetings, is aware that to include

104

THE JOURNAL ОЕ TROPICAL MEDICINE.

[April 2, 1906.

Tropical Diseases in any other section or sections
is calculated to prevent men interested in Tropical
Diseases attending the meetings. Not only is it that
there is no time for the papers to be read, but when a
subject appertaining to tropical diseases is brought
forward, the medical man who reads the paper or
opens the discussion wishes to have the matter laid
before experts, and before those interested directly
in the disease or investigation he has undertaken.
The Section of Tropical Diseases in connection with
the annual meetings of the British Medical Association
bas been а pronounced success. The numbers attending
the Section, even remembering the scattered constitu-
ency from which it is gathered, have frequently been
larger than any other section of the annual meeting ;
and the importance and scientific value of the com-
munications may surely, without prejudice or exag-
geration, be stated to be of superlative importance.

From yet another point of view are the practitioners
in the Tropics deserving of full recognition at the
annual meetings. The number of medical men directly
interested in Tropical Medicine amounts to some 6,000,
and they form the largest section of qualified medical
practitioners on the British Register whose interest is
centred in any single subject. Of the 34,000 men
on the register, some are interested in general medicine,
some in surgery, others in gynecology, obstetrics,
skin, eye, throat, ear, nose, epidemiology, anatomy,
physiology, pathology, nervous diseases, ambulance
work, dentistry, or other sections provided at the
annual meeting; but no single section can show so
large а body of men on the British Register to whom
one single section presents so singular an adhesion
a8 that of Tropical Diseases.

The writer is led to believe that in expressing the
above opinions, he is merely voicing those of most of
the members of the large body of British practitioners
interested in Tropical Medicine, for the need of some
metropolitan rallying point for our numerous but
scattered body is sufficiently obvious. Assuming such
& society to be formed, it would of course be well to
seek affiliation with the British Medical Association,
as such a step would enable the association to make
their voices heard in the councils of the parent society.

The writer desires, before proceeding further in the
matter, to have the opinion of medical men to whom
this question is one of importance. Many subjects of
supreme consequence to the State and to the individual
would be dealt with by such an association, and in time
it ought to become one of the most important of the
several departments of medicine, both scientifically and
ethically.

The readers of this Journal who wish their names
to appear on the General Committee of “А Tropical
Medical Association," should send in their names, ad-
dressed to the writer at the office of this Journal, 89,
Great Titchfield Street, Oxford Street, London, W.
It is to be distinctly understood that the contemplated
association is not a separate association, independent
of the British Medical Association, but one intended to
promote the interests of Tropical Medicine within the
parent Association, and constituted so that the wishes
of medical practitioners in the Tropics may be authori-
tatively and collectively expressed.

JAMES CANTLIE.

ANTI-MALARIAL SANITATION IN INDIA.

THE short “ Editorial " which we reproduce below
from the columns of the Indian Pioneer is a gratify-
ing proof of progress in the education of public opinion
in India on the subject of the possibilities of anti-
malarial sanitation.

The facts, indeed, as therein quoted from Major
Duke’s report, are of a kind to convert the most scep-
tical, and we congratulate our influential lay contem-
porary on its altered attitude with respect to the
question ; for it is not so long ago that the Pioneer and
the army of “ common-sense " correspondents whose
letters found a favourite home in its columns, found it
hard to sufficiently express their contempt for those
who believed it possible to sufficiently diminish the
number of mosquitoes to effect а corresponding diminu-
tion in the sick list of malaria. The measures adopted
by Major Duke, it will be noted, are in no way novel,
but are simply those that have been recommended from
the first by Major Ross and those who have associated
themselves with him in the campaign. Now that the
Pioneer has been converted, we may perhaps hope that
the Indian Government may follow suit, and that
perhaps in ten or twelve years or so we may hear of
its undertaking general adequate measures for the pro-
tection of our troops in cantonments and of the civil
population of our great Indian towns.

“The report of the Medical Officer in Baluchistan for the
year 1904, though late in issue, contains at least one fact
that is worth recording. In Baluchistan, malaria is ‘ at
once the greatest primary cause of illness, and indirectly
gives rise to a large proportion of the ill-health expressed in
other terms." To show what can be done by preventive
measures Major Duke quotes the records of the Shahri
Railway Hospital, which is largely attended by the civi
population of the tahsil and bazaar and villages near. The
average annual number of malarial cases treated between
1898 and 1900 was 2,827, and in 1900 there were 3,227 cases.
The following year the number rose to 3,876 cases, and in
1902 special anti-malarial measures were enforced. Quinine
was distributed, surface drainage and the kerosining of pools
were adopted, and the malarial cases fell to 2,722. Іп 1908
these measures were continued, and in addition, the cultiva-
tion of rice within a mile of the tahsil was prohibited, and in
that year the cases fell to 1,792. In 1904, with the continu-
ance of these measures, there was a further fall to 957 cases.
At the same time, in the dispensaries above and below Shah-
rig, in the last-named year, there was in the one case a
steady and in the other a great increase in malarial cases.
Thus 1904 was evidently not a healthy year in the district,
and there is no evidence of any exodus of population. The
effectiveness of the anti-malarial campaign is thus clearly
established.”

--о----

Translation.

PRELIMINARY STATEMENT ON THE RE-
SULTS OF A VOYAGE OF INVESTIGA-
TION TO EAST AFRICA.

Ву R. Kocu.
(Translated from the German by P. Falcke.)
(Continued from page 76.)
(4) TSETSE-FLIES AND TRYPANOSOMA.

I nave met with four different species of the genus
Glossina during my expeditions. These are Glossina
fusca, G. morsitans, G. pallidipes and G. tachinoides.

April 2, 1906.)

THE JOURNAL OF TROPICAL MEDICINE.

105

In addition, G. palpalis has been fouud in the islands of
Victoria Nyanza belonging to German territory by Dr.
Feldmann, and probably also С. longipennis, which I
caught during my journey by the Uganda Railway
between Voi aud Tsavo Stations, not far from the
German frontier. Thus six out of the eight species of
Glossina hitherto described occur in the German Kast
Africa.

It has hitherto been taken for granted that G.
morsitans is the carrier of tsetse disease. This species,
however, is only found in certain tracts of the Pro-
tectorate, particularly in the north and south, be-
tween the great lakes; in the middle, its place is filled
by G. pallidipes.

G. tachinoides, the smallest of the Glossina, appears
to be widely distributed, but only appears in small
numbers. On the other hand, I һауө encountered
G. fusca in great numbers wherever tsetse disease is
prevalent.

I was first successful in discovering specimens of
G. fusca infected with trypanosomata, and in the
following manner. On examining the flies under the
microscope I noticed that the proboscis was always
filled with a liquid which, by pressure on the bulb
of the proboscis, could be squeezed out in the
form of a clear droplet. As it might be presumed
that the fly, in puncturing, injects this droplet under
the skin of its victim, and that infected flies must have
trypanosomes in this liquid, I examived the drops
exuded from a number of specimens microscopically,
and actually found numbers of trypanosomes in a
few cases. The circumstance that the liquid was
quite devoid of red blood cells, that the trypanosomes
were much more numerous than they ever are in the
blood, and that they exhibited various stages of deve-
lopment, led one at once to the conclusion that these
flies do not transmit the disease direct by injecting the
blood of a sick animal into a healthy one; but that
conditions here are similar to those that exist in
malaria parasites, i.e., that the trypanosomata undergo
a stage of development in Glossina. Тһе correct-
ness of this assumption was fully verified when the
flies, whose probosci contained trypanosomes, were
more minutely examined. Sections of the stomach,
even when quite devoid of blood, contained large
numbers of trypanosomes in different stages of deve-
lopment. They are either entirely absent from the
intestine, or are only present in very small numbers.
I have never been able to definitely establish the
presence of trypanosomes in either the glandular
organs, the Malpighian tubes or elsewhere than in the
situations mentioned.

Іп all nearly sixty flies containing trypanosomes
were examined, including one specimen each of
G. morsitans and G. pallidipes.

It appears to me, therefore, a foregone conclusion
that in German Kast Africa the tsetse disease is
transmitted not only by G. morsitans, but also by
G. pallidipes, and particularly by G. fusca, which
quite coincides with my observations on the distribu-
tion of these species.

As far as I have made out, the cycle of develop-
ment of the trypanosome in the Glossina is as follows:
The trypanosomes ingested with the blood, the number
of which, under natural conditions, is very limited,

soon multiply in the stomach by longitudinal division,
and also increase in size. The degree of growth will
be best seen by a comparison between fig. 15, which
represents a trypanosome from the blood of an ox,
and fig. 16, which shows a trypanosome from the
stomach of an infected Glossina. Simultaneously a
remarkable differentiation sets in.

Part of the large trypanosomes become thick and
plump, with а rich blue-staining plasma, and ex-
hibit a rather large, rounded chromatin body of loose
consistency (fig. 16). Other portions of the parasites
are exceedingly slender, and their plasma does not
take the blue stain, but possess a long, thin, dense
chromatin body (fig. 17). Sometimes опе type
predominates, sometimes the other, and in different
parts of the same preparation close aggregations of
each form may be met with.

(To be continued.)

зеге ы bs

Abstract.

THE PREVENTIVE TREATMENT OF Diseases (Les Médi-
cations Préventives). By Dr. L. Nattan-Larrier.
1 vol. іп 16. Bailliére et Fils, Paris.

The history of preventive medicine commences
with inoculation for small-pox and vaccination, but
in 1880 the work of Pasteur and of Toussaint opened
up a new field of research by demonstrating that the
inoculation of а modified microbic culture might
confer a specific immunity on animals. The principle
of preventive bacterio-therapeutics has been definitely
established since 1881. In 1885 Ferran published the
good results which he had obtained by treating cases
of Asiatic cholera by means of a vaccine derived from
cultures of the comma bacillus; and although his
statements were at first treated with much scepticism,
they would appear to have been since confirmed by
Haffkine's researches. The remarkable discoveries of
Behring and Kitasato in 1890 of the antitoxic sera
resulted in the serotherapeusis aud seroprophylaxis of
diphtheria and of tetanus. Since then the question
has advanced with giant strides, and (as will be
shown in this book) it is now possible by means of
injections of serum or of modified cultures to arrest
the development of diphtheria, plague, cholera, enteric
fever, tetanus, and possibly also puerperal fever. Im-
munisation by serum is a passive immunity, whilst
immunisation by modified cultures is an active im-
munity.

{For want of space I shall limit my remarks to
those on Plague, Cholera, Enteric Fever, and Yellow
Fever, as they apply more especially to warm climates.
—J. Е.М.

PLAGUE.

Two specific methods have been proposed and
employed to combat plague: one of these we owe
to Yersin, namely, immunisation by anti-plague
serum ; the other, due to Haffkine, consists in the
inoculation of cultures killed by heat. We will now
consider each of these two methods.

І. Preventive Serotherapeusis of Plague. -- The
earliest researches of Yersin, Borrel, and Calmette

106

demonstrated the immunising power of the anti-plague
serum. In January, 1897, Roux was able to state in
the Académie de Médicine : “ Hitherto the serum has
only been tried in the case of confirmed disease.
According to what has been observed in animals,
it ought to be still more efficacious in the prevention
of plague than in its cure. It would therefore appear
necessary, when a case of plague has suddenly ap-
peared in a house, for all persons who are exposed to
contagion to be injected with serum as a preventive
measure. Yersin thinks this is an efficacious measure
against the diffusion of the disease." Cases of pre-
ventive serotherapeusis soon became numerous, the
dose of the serum usually amounting to 10ce., which,
however, appeared to confer immunity for only four-
teen days. It is therefore necessary to renew the
preventive injection every twelve days in the case
of individuals who remain in the epidemic focus ; this
necessity is the more imperative, as, although the
morbidity is lessened, the mortality remains as high
in the case of individuals whose immunity is ех-
hausted as it is amongst those who never underwent
any preventive injection. In consequence of the short
duration of the immunity conferred by the serum, and
of the need for the revaccination to be repeated several
times & month, Simond and Yersin were of opinion
that ‘‘ sero-vaccination was not applicable in practice
for an entire population, although an excellent method
to be adopted in individual cases or in families."

II. Inoculations by Sterilised Cultures.—Haftkine’s
method seems on the whole to answer best lor
an extensive prophylaxis of plague, as it can be ap-
plied to a whole population ; it has been largely used
in India with the sanction of Government. The
rationale consists in cultivating the Bacillus pestis in
bouillon, under a layer of butter for a month, and then
enclosing the culture in tubes, which are now sealed
and heated for an hour at 72? C. ; the culture enclosed
in these tubes is then ready for inoculation purposes.

The duration of the immunity conferred by injection.

varies from four to six months, and, in апу, case,
does not extend to the year, although Haffkine has
noted some cases where it would appear to have been
prolonged even up to two years; however, the general
opinion in India is that immunity may be considered
as exhausted at the end of three months, and therefore
those individuals who reside in plague-stricken regions
renew their inoculation every three months.

The French opinion, held by Calmette, Salimbeni,
and Yersin, is that immunisation only commences by
slow degrees, after a period in which vaccination
favours the action of the plague bacillus. The British
opinion is notably different, for it maintains that the
period which elapses before the acquisition of immu-
nity does not exceed twenty-four hours. The injection
is somewhat painful, and although followed by general
lassitude, frontal headache, a marked rise of tempera-
ture, &e., for a period varying from twelve to forty-
eight hours, is not accompanied by serious results.
The febrile reaction is the greatest objection raised
against inoculation, and seriously militates avainst the
wholesale vaccination of the population with Haftkine's
plague-prophylactic fluid, The dose should not be
less than 5 cc., and the operation is usually repeated
in two or three weeks' time.

THE JOURNAL OF TROPICAL MEDICINE.

[April 2, 1906.

Conclusions arrived at.—Both methods of preventive
treatment are efficacious.

The serotherapeusis, although more rapid and more
certain in its action, only confers a transitory immu-
munity, and therefore can only protect the individual
from contagion by repeated inoculations, which is a
diflicult matter when one has to deal with the whole of
the population ; on the other hand, it is an excellent
method for individual prophylaxis, such as in the
case of the medical personnel, the employees of the
sanitary services, or the families of the patients.
Sero-vaccination, when combined with isolation and
disinfection, holds high rauk among the methods
of defence against plague.

Major M. B. Bannerman ended his report in 1902
on the application of Haffkine’s method with the
following remarks: “Тһе inoculation is absolutely
innocuous: inoculations made during the period of in-
cubation of plague in many cases exercise an abortive
action on the disease. Inoculation confers immunity
to a high degree; and if, in spite of the inoculation,
an individual is attacked by plague, his chances of
recovery are much greater.”

Hafikine’s method probably still requires to be per-
fected, but it already answers to a great extent to the
desiderata of a preventive treatment applicable to a
large number of individuals when an entire country
is threatened with an invasion of an epidemic of plague.

CHOLERA.

In 1885 Ferran announced his method of vaccina-
tion against cholera, which reduced the mortality by
exactly one-half. Since 1894 Haffkine's method has
given even more remarkable results, although no
oflicial pressure was used, and only those individuals
were vaccinated who freely consented to undergo this
treatment. Haffkine’s method consists of a double
inoculation with an interval of five to eight days; the
Jirst injection at first consisted of cultures of the
comma bacillus sterilised by the addition of carbolic
acid, hut this method has been replaced by the use of
living cultures attenuated by heating up to 72? C. ; the
second injection is a culture of high and constant viru-
lence obtained by а continuous series of “ passages ”
of the bacillus through the peritoneum of guinea-pigs,
the comma bacillus thus acquiring a virulence which
is twenty times stronger than before. Immunity is
exhausted after one year.

The symptoms of anti-choleraic vaccination consist
in a localised wdema at the seat of injection, which
is painful to the touch, accompanied a short rise of
temperature, but no serious accident has ever been
caused thereby. Wherever cholera has been suffi-
ciently scattered and prevalent so as to lead one to
suppose that the whole of the population has been
equally exposed to infection, and wherever the mor-
tality has been high, in every instance this mortality
has been greatly reduced in the case of the inoculated.
A preventive anti-choleraic serum has also been tried,
but it has hitherto proved less useful than the vaccine
in those regions in which cholera is endemic, but the
question is not yet definitely settled.

Enteric FEVER.

I. Serotherapy.—Although the anti-typhoid serum
of Professor Chantemesse possesses undeniable pre-

April 2, 1906.)

THE JOURNAL OF TROPICAL MEDICINE.

107

ventive properties, it has rarely been employed prophy-
lactically, во we cannot yet ascertain to what extent
preventive serotherapy will enter into practice.

II. Wright's Vaccine.—The vaccine employed by
Wright to obtain immunity against typhoid fever is
somewhat allied to Haffkine’s vaccines; both consist
of cultures sterilised by heat, but whilst the microbes
are inoculated by Haffkine, Wright decants his cultures
and only injects their toxins. The process of the
preparation of the vaccine may be summed up thus:
Culture of Eberth's bacilus for a fortnight in the
drying-stove at 37? C., sterilisation at 65°, addition
of one-half per ceni. of lysol. The filtered liquid is
used for inoculation ; its degree of virulence is such
that the inoculation of 5 ec. entails in twenty-four
hours the death of a guinea-pig weighing 250 grammes.

The dose varies from 4 to % cc., this latter being
the dose most suitable when an interval of several
weeks must elapse between inoculation and exposure
to infection, and when one cannot resort to inoculations
in succession. Оп the other hand, when inoculation
is practised in the very midst of the epidemic a weaker
dose must be employed, and after an interval of one
week a second injection must be given, but in a
stronger dose. The inoculation may be given in the
hypochondrium, or any other part where there is an
abundance of loose connective tissue. The injection
of a medium dose does not usually give rise to any
well-marked symptoms, and the patient ought to
return to duty in three days. When too strong a dose
has been injected the general symptoms become more
severe, but without causing immediate danger.

Immunity is produced more or less rapidly, accord-
ing to the dose of vaccine employed; when a very
feeble one has been given, immunisation may be
produced in about twenty-five hours ; for this reason,
in epidemic centres a feeble dose should first be given,
and this should be followed by a second one. The
duration of immunity conferred by Wright’s vaccine
does not exceed one year, and may begin to decrease
after six months.

Conclusions.—Wright’s method, without entailing
any danger for the inoculated individuals, seems to
give very favourable results, viz., considerable diminu-
tion in the number of cases, and relative mildness of
the enteric fever which may develop, in spite of the
injection. The inoculation may be dangerous if the
person is inoculated with too strong a dose whilst he is
in the fever zone when the epidemic is at its height, as
he is then more likely to contract the disease. Wright's
vaccine is especially indicated in the case of troops
employed in Colonial expeditions.

YELLOW FEvkn.

. The researches of Marchoux, Salimbeni and Simond,
if still far from solving the question of preventive
serotherapy and in yellow fever, nevertheless bring
some important contributions to this questions as they
have carefully ascertained the period during which the
patient’s serum contains the organism of the disease,
and have sought to discover to what degree the blood
of yellow fever patients might contain immunising
substances. These researches on the preventive sero-
therapeusis of yellow fever were undertaken (a) by
means of virulent blood, sterilised in various ways ;
(b) by means of serum from convalescents, this

serum no longer containing the agent of yellow fever,
but being endowed with immunising properties.

(a) On the third day of the disease the blood of the
yellow fever patient contains the pathogenic agent, an
invisible microbe, capable of provoking yellow fever ;
the inoculation of 5 cc. of serum is sufficient at this
period to give yellow fever ; but if heated up to 55° C.,
this serum becomes harmless, but still preserves its
immunising properties.

(b) After the fourth day the blood of the patient is
incapable of transmitting the disease ; it was therefore
thought that this sudden disappearance was accom-
panied by the presence of immunising bodies in the
serum. The injection of serum from a convalescent
patient may indeed confer immunity on a healthy
subject; but this serum only retains this property
during a period of twenty-six days, after which it can
only confer partial immunity. However, these admir-
able results cannot as yet be considered as entirely
confirmed, and their prophylactic measures, although
of the highest importance, must still be considered as
in the experimental stage only. J. E. NicHoLsoN.

EXTRACTS FROM COLONEL ООВСАВ”
MONTHLY REPORTS FROM THE CANAL
ZONE, PANAMA.

By Isaac Brewer, M.D.

TRYPANOSOMA IN Rats ом THE Івтнмов OF PANAMA.

DuniNG the month of November, 1905, Dr. Arthur I.

Kendall, Acting Chief of the Board of Health Labora-

tory of the Canal Zone, examined 1,563 rats, and

found 278 infected with Trypanosoma lewisi.

During the same period he examined 547 mice, in
39 of which he found trypanosomes.

MALARIAL PARASITES.

According to the monthly reports issued by Colonel
Wm. C. Gorgas, Chief Sanitary Officer of the Isthmian
Canal Commission, 1,942 blood examinations were
made from September 1st to December 31st, 1905.

Malarial parasites were observed as follows :—

Single tertian E 779
Double tertian ... ze Е e 17
JBstivo-autumnal А А 764
Quartan ... е ns 224 hs 4
Mixed infections Не Ж .. 78

PanastTES IN FÆCES.

The following results of 394 examinations of stools
made by the Sanitary Department of the Isthmian
Canal Commission during September, October, and
December, 1905, are tabulated from the monthly
reports issued by Colonel Wm. C. Gorgas, Chief
Sanitary Officer of the Canal Zone :—

Ova of Uncinaria duodenale 101
Ova of T'ricocephalus dispar 104
Ova of Ascaris lumbricoides — ... e. 098
Ameæba dysenterie is» 25% .. 80
Rhabdonema strongyloides ds se 21
Cercomonas intestinalis... im зе” 219
Balantidium colt... zs е 224 9
Myiasis ... os m s M 2
Trichina spiralis See ves al 1
Bacillus dysenterie —— ... $us 555 9

Negative ... ae 26s oe .. 116.
In 2,512 analyses of urine during the same period
hemoglobinuria was observed 13 times.

Review.
Brnoop-suckiNG Fons AND How то Сошкст THEM.
By E. Е. Austen.

The British Museum have issued a second edition
of this valuable pamphlet, which should be in the
hands of every tropical practitioner.

Although in the main a reprint, a description of the
Leptide has been added, as this family occasionally
exhibits bloodthirsty habits. We should have liked,
however, a figure of one of the alleged blood-sucking
species, so as to know them when we see them.

Other notes, for example, on the Implication of
Stomoxys in the transmission of Surra, have been
added, which show how careful Mr. Austen is to keep
the pamphlet up to date.

A further addition is a note by Lieut.-Col. Giles
on the preservation of insects intended for histological
examination.

The pamphlet is published at the nominal price of
3d., and Mr. Terzi’s beautifully drawn and accurate
figures are alone worth а great deal more than the
small outlay ; and the additions, though not extensive,
are sufficient to make the acquisition of the new edition
desirable.

We were somewhat surprised, therefore, when a
copy of the old edition was tendered us on demanding
one at the Catalogue counter of the Museum. We trust
this was due to delay in furnishing the salesman, and
not to a desire to “ work off” the old stock. Such a
petty economy would һе much to be deprecated, as it
might, for example, easily result in the museum losing
specimens of the Leptide owing to the attention of
collectors not being drawn to them.

---------

Correspondence.

To the Editor of the JournaL оғ TropicaL MEDICINE.
Drar SrB,—In a recent copy of the Journal Dr. Wellman
referred, in his ** Notes from Angola," to the treatment of
so-called ** malarial ulcers” by local applications of quinine.
May one enquire how the application is made? Is it the
emulsion in cod liver oil that is used (see Lancet of 1902),

or is there some fresh method of application ?
Yours, «с.,
W.D.G.

——— 9» —————

Arnos and Remedies.

CyproL—a distillation of Cypress oil—is commended
as an excellent remedy in Whooping Cough. Е. A.
Rogers, 327, Oxford Street, London, supplies the pure
concentrated oil—Cyprol, as well as an essence, a
liniment, and pastilles prepared from the oil.

GastRopyNIC—a compound enzyme palatinoid – а
combination of Pancreatin Pepsin and Laetophosphate
of Lime, prepared by Messrs. Oppenheimer, Son and
Co., Limited, London, seems an etfective remedy in
dyspepsia. Тһе ingredients are in equal quantities of
one grain in each palatinoid, and one to three palati-
noids may be given after meals in cases of ordinary
dyspepsia.

THE JOURNAL OF TROPICAL MEDICINE.

[April 2, 1906.

Xaxa—an acetyl-salicylic acid, issued by Messrs.
Burroughs Wellcome and Co. in five-grain tabloids—
appears to possess the therapeutic properties of salicylic
acid and its salts without unpleasant after-effects.

For the relief of pain fifteen grains of “ Хаха” may
be given at a single dose, with ten-grain doses repeated
in one hour until three or four doses have been given.

— MP ———

Books and Papers Received.

We have received “ Тһе Doctor's Handy Reference
List " from Messrs. Pulman aud Sons, 24-26, Thayer
Street, Manchester Square, London. This is a useful
compendium, and affords exact information concerning
asylums, sanatoria, convalescent homes, nursing
homes, «сс.

——9————
Flotes and #05.

PrAGUvE has broken out in Seistan, in Eastern Persia,
the frontier province of that country towards India.
The nature of the disease has been confirmed by bac-
teriological information, but it is said that the disease
is not spreading. Captain Kelly, I.M.8., has been
specially sent from Quetta to render assistance.

A splendid example of the warm affection that
grows up between the people of India and their
European medical officers is afforded by the munifi-
cent donation of 10,000 rupees (£670) which has been
received by the Central Committee of the Countess of
Dufferin's Fund from Brig.Surg. J. Law, Indian
Medical Service (retired). The interest on this sum,
in aecordance with the donor's desire, will be annually
expended in the Central Provinces where he spent the
greater portion of his service. Hetired Indian medical
officers are seldom too well off, especially if they have
passed most of their time in the Central Provinces,
which is one of the least prosperous parts of our
Indian Empire. In point of fact, the proceeds of the
private practice of the men stationed there are much
on & par with Mr. Bob Sawyer's, which readers of
“ Pickwick” may remember might be “put into a
wineglass and covered over with a gooseberry leaf.”
Viewed in comparison with the colossal donations to
charity of financial magnates, the sum may not appear
large to European eyes, but it probably represents far
greater personal sacrifice. With such warm feelings
existing between doctors and their Indian patients it
is hardly wonderful that the native chiefs and wealthy
civilians should view with strong resentment the
petty-minded restrictions on private practice inflicted
on the Service by the late Viceroy, Lord Curzon. Ав
an old Sikh Sirdar remarked the other day anent this
question : “ It is very hard that a man should not be
allowed to do what he likes with his own." There is
no more libellous assertion than that the Indian is
lacking in the virtue of gratitude, for their folk-lore
and epic literature conclusively show that a generous
recognition of benefits received is regarded by them as
the first requisite of the heroic character.

April 2, 1906.)

** UNIFICATION.”

A correspondent of the British Medical Journal of
March 17th (S. С.) makes a number of thoroughly
practical suggestions on the organisation of our Im-
perial medical services. While regarding *'Scalpel's "
remarks on “ Surgery іп the R.A.M.C.,” in the same
journal for December 25th, as quite uncalled for, there
can be no disputiug the assertion that efficiency,
whether in surgery or hygiene, is largely а matter of
practice, and that during peace time the work of the
military surgeon is rather that of sanitary specialist
than of an operative surgeon. Hence, could it be
arranged, the plan of combining our military and
colonial medical services, as advocated by ** S. G.," could
hardly fail to promote efficiency in each service, and
would probably be popular with the best officers of
both.

S. G. writes as follows :—

“ SURGERY IN THE К.А.М.С.

“І have read ‘Scalpel’s’ remarks on surgery in the
R.A.M.C. in the British Medical Journal of December 28rd,
1905, p. 1682. There is no doubt that lack of opportunity
is the great bar to efliciency in surgery among men of the
R.A.M.C. As a remedy I would propose a dual medical
service, one for India and one for home and the Colonies. I
think the present dual service for India a mistake. I would
do away with the R.A.M.C. there and make the I.M.S., in-
creased in strength, responsible for the care of the army,
British and native. The smaller civil surgeries and dis-
pensaries I would hand over to assistant surgeons and
hospital assistants.
reserve for this class, sufliciently strong in numbers and
thoroughly trained in professional work. In like manner 1
would make college appointments and the care of the large
civil surgeries, the charges of gaols, &c., prizes for the
officers. Here, again, we would have a magnificent reserve,
capable of taking the field, fresh from the charge of hospital
where as much surgery is done as in most of the large
London hospitals. АБ present a young officer of the
ҺА.М.С. comes to India where everything is new to him.
Tropical diseases present phases and symptoms which are
strange and unknown to him. During his first year he is
beginning to get a grasp of his new duties. During his
second and third years he is perfecting himself in the know-
ledge of tropical surroundings and diseases, and by the time
he has grasped them and thoroughly understands them back
he goes to England, where, perforce, he forgets many of the
valuable lessons acquired during his Indian tour. The
question of attendance on the men of the various regiments,
batteries, &c., to be transferred to the Home Establishment
could be easily arranged for by handing these duties over to
medical officers of this new service going on leave. This
would also be an immense boon to them and save them the
terrible expense of passages for themselves and families,
which so often makes such inroads on their slender resources.
The Home Medical Service I would run on much the sume
lines as the Indian, making the Colonial Medical Service its
reserve and the colonies its training ground."

Although nominally civilians, many colonial
surgeons, especially in the African colonies, see far
more fighting than usually falls to the lot of an officer
of the R. A. M.C., and it is unjust that they should be
debarred from the honours and glories incidental to a
military career. Moreover, the special sanitary train-
ing of the R.A.M.C. would be as valuable to the ofticer
when acting as a colonial civil surgeon, as the increased
experience in ordinary medical and surgical practice
would be to him when serving in a military capacity.
Most important of all, it is difficult to see how in any

THE JOURNAL OF TROPICAL MEDICINE.

Here we would have a magnificent .

109

other economical fashion a suflicient military medical
reserve can be secured for our Colonies.

His remarks on India are equally to the point.
Owing to linguistic difficulties, it is indispensable that
all branches of public service of that dependency
should join for continuous service, and the medical
departments are the only branch in which this is not
euforced. Тһе officers of the Royal Engineers serving
there, for example, “ elect for continuous service in
India," and it is only in the medical department that
we find the extraordinary spectacle of two distinct
sets of medical officers, óne only of which is capable
of serving with all corps of the army, while the other
is quite unavailable for service with the native
regiments that form three-fourths of our Indian army.

Tae “ Sanitas” Company, LIMITED.

At the Annual General Meeting (28th in number)
of the “ Sanitas " Company, Limited, held at Locksley
Street, Limehouse, London, E., on March Ist, Mr. C.
Т. Kingzett, F.I.C., F.C.S., presiding, the Chairman
remarked upon the steady growth of “ Sanitas” in
public favour, and while it was still regarded, from an
all-round point of view, as the standard disinfectant
(being the only preparation which combined in itself
all the properties that could be desired for sick-room
and household applications), it was necessary for the
Company to meet competition from all sides. Hence,
as the result of long investigation in their laboratories,
the Company was about to introduce a new disinfec-
tant to be known as “ Bactox," which would favourably
compare with the strongest known bactericides hither-
to available, having a guaranteed co-efficiency of from
thirteen to forty, as compared with pure carbolic acid.
It was described as & neutral non-corrosive, sapona-
ceous preparation, and having regard to its great
germicidal strength and price would be found cheaper
in use and as strong as, or stronger, than auy compet-
ing article on the market, and devoid of all objection-
able qualities. They would, therefore, in future, be
able to offer to the public and sanitary authorities the
choice of the best disinfectant for household and sick-
room purposes on the one hand, and the strongest
germicide for rough disinfecting and surgical use on
the other hand.

———————————

Personal Motes.

R.A.M.C.

Tux following R.A.M.C. officers have been selected for in-
creased pay: Lieutenant-Colonels Townsend from July 22nd,
Woodhouse from August 26th, and Rowney from October 4th,
1905.

Colonel Leake, R.A.M.C., embarked in the Sicilia, on Feb-
ruary 3rd, returning to India from sick leave.

Lieutenant Webb, R.A.M.C., remains at home on extended
leave until August next.

Lieutenant-Colonel Reade, R.A.M.C., comes out on posting
to the Secunderabad Division.

Lieutenant-Colonel J. B. Winter, R. A.M C., on his arrival
from England, will be attached to the Meerut Station Hospital
for duty.

Colonel Trevor, R.A.M.C., is appointed Hon. Surgeon to the
Viceroy, vice Colonel W. S. Pratt vacated.

INDIAN MEDICAL SERVICE.

Major L. Rogers, I. M.S., Officiating Professor of Pathology,
Medical College, Calcutta, is allowed privilege leave for twenty-
seven days, with effect from February 19th or subsequent date.

110

ТНЕ JOURNAL OF TROPICAL MEDICINE.

[April 2, 1906.

Captain J. M. D. Megaw, I.M.S., Officiating Resident Physi-
cian, Medical College Hospital, Calcutta, is appointed to act as
Professor of Pathology in the Medical College, during the ab-
sence, on leave, of Major L. Rogers, I. M.S.

Captain Н. B. Steen, L.M.S., Officiating Civil Surgeon, is
placed on special duty at the Medical College, with effect from
January 10th.

Captain C. Е. Weinman, I.M. 5., Officiating Civil Surgeon, is
placed on special duty in connection with plague in Belear, from
December 25th, 1905.

Captain Н. M. Melhuish, L.M.S., whose services have been
placed at the disposal of this Administration, is appointed to
officiate as Superintendent, Central Jail, Jubbulpur, during tlie
absence on leave of Captain Е. D. Browne, I. M.S.

Captain V. Е. Н. Lindesay, I. M.S., is allowed privilege leave
combined with leave out of India for thirteen months and
twenty days, viz., privilege leave for one month and twenty
days, and leave out of India on medical certificate for the re-
maining period, with effect from November 10th, 1905.

Major F. O'Rinealy, I. M.8., Officiating Civil Surgeon of Dar-
jeeling, is confirmed in the appointment with effect from Sep-
tember 23rd, 1905, vice Major F. P. Maynard, I.M.5.

Captain R. L. Hagger, I.M.S., furlough for eight months.

Major A. E. Roberts, I.M.S., is confirmed as Secretary to the
Director-General, 1. M.S.

То be Major : Captain Herbert St. John Fraser.

Lieutenants to be Captains: William Samuel Jagoe Shaw,
Charles Seymour Parker, Harold Holkar Broome, Frederick
Norman White, Charles Gibbons Seymour, Davis Heron,
Thomas Corrie Rutherfoord, Henry Crewe Keates, Leethem
Reynolds, Ernest Charles Taylor, Richard Arthur Needham,
Dwarko Prasad Goil, James Kirkwood, and Alfred Whitmore.

Home Department.—Colonel Macrae, 1.M.S., is confirmed as
Inspector-General, Civil Hospitals, Bengal, and Colonel King,
I.M.S., as Inspector-Geueral, Civil Hospitals, and Sanitary
Commissioner, Burmah, both with effect from April 29th.

Major Lamont, 1. M.S.. Professor, Lahore Medical College, is
granted furlough out of India from March 20th to June 30th
next. Captain С. E. Charles, I. M.S., officiates as Professor of
Anatomy, Lahore Medical College, vice Major Lamont.

Captain W. M. Houston, I. M.S., to act ав Personal Assistant
to the Surgeon-General with the Government of Bombay. Cap-
tain Ј. Н. McDonald, I.M.S., on relief, to act as Presidency
Surgeon, Second District, and Marine Surgeon and Superin-
tendent, Lunatic Asylum, Colaba. Dr. F. M. Gibson, Medical
Officer, attached to the Plague Research Laboratory, Parel, is
granted three months’ priviloge leave combined with twenty-
one months’ furlough from the date of relief.

Privilege leave for two months and twenty-one days, in com-
bination with furlough for eight months and nine days, is
granted to Captain F. І). Brown, I.M.S., Superintendent, Cen-
tral Jail, Jubbulpur, with effect from the afternoon of February
14th.

India Office : Arrivals Reported іп London.—Captain J. W. Е.
Rait, I.M.S., B. Major C. E. L. Gilbert, I.M.S. Major
C. R. M. Green, I.M.S., B. Lieutenant-Colonel R. J. Baker,
I.M.S. Captain F. D. Brown, I.M.S. Captain R. L. Hagger,
I.M.S. Major R. H. Castor, I.M.S.

Extensions of Leave.- -Captain D. C. Kemp. I. M.S.; M., special
and study leave commuted to furlough on Med. Cert. for one
year. Captain Н. B. Meakin, 6 m. Med. Cert., R.A.M.C. Major
Н. Austen-Smith, I. M.S., B., was on study leave from October
9th, 1905, to February 9th. 1906. Captain E. L. Perry, I.M.8.,
B., was on study leave from September 1st, 1905, to December
31st, 1905, 4 m., М.С. Lieutenant-Colonel J. Maitland, I. M.S.
M., 6 m., M.C., the period beyond 3 m. and 17 days being extra-
ordinary leave.

UNCOVENANTED MEDICAL DEPARTMENT.

Mr. S. Higginbottom to be Superintendent of the Government
Leper Asylum at Naini iu the Allahabad District.

COLONIAL MEDICAL SERVICE,

LgHrELDT.— К. Н. Lehfeldt, D.Sc.Lond.. B.A.Camb., Pro-
fessor of Physics in the Transvaal Techuical Institute, Johannes-
berg.

Ginns.-—H. J. Gibbs, L.R.C.P., M.R.C.S.. М.Р.С.,
Surgeon to the Тап Toch Sing's Hospital. Singapore.

SINGER, —C. Singer. M.B., B.C.Camb., Resident Medical
Officer to the Government General Hospital, Penang.

Resident

DOMESTIC.
Ввтнз.

Graves --At Kaimptee, C.P., оп February 24th, 1906, the wife
of Major D. Н. Graves, 1.М.6., of a son.

MARRIAGES.

A marriage has been arranged between Captain Cecil Mad-
dock, Indian Medical Service, 43rd Erinpura Regiment, son of
the late Canon Maddock, M.A.. Fellow of Clare College, Cam-
bridge. aud Alice Edome. daughter of the late Rev. T. J. Mon-
son, М.А., and the Hon. Mrs. Monson, of Ashlyn, Leighton
Buzzard.

A wedding took place at Dehra Dunn on February 5th be-
tween Captain George Hutcheson, Indian Medical Service,
eldest son of Colonel Hutcheson, Indian Medical Service, re-
tired, and Miss Lilian Annette Reynolds, youngest daughter of
Mr. and Mrs. Reynolds, of Chandbagh, Dehra Dua.

CLARKE- -ADAMs. At St. George's Church, Agra, on February
15th, 1906, by the Rev. W. Kitching, М.А., Chaplain of Agra,
Captain J. B. Clarke, Royal Army Medical Corps. to Violet
Grace Seymour Adams, M.B., C.M .(Edin.).

Вовке REID.-—At Christ Church, Rawal Pindi, on Wednes-
day. February 21st. 1906, by the Rev. H. A. C. Herbert, Cap-
tain Bernard Bruce Burke, R.A.M.C., to Anne, younger
daughter of Surgeon-General A. Scott Reid, C.B.,1.M.8., Prin-
cipal Medical Otticer. Northern Command.

CAMERON — HoBINsON.-. At the Cathedral, Bombay, on Friday,
February 16th. 1906, Alexander Cameron, M.B. (Lon.), Indian
Medical Service, second son of Alexander Cameron, M.D., of
Cleethorpes, Lincolnshire, to Charlotte Eccles Mostyn, third
daughter of the late Arthur Robinson, Esq., of Kemp Town,
Brighton, and of Mrs. Robinson, Olton, Warwickshire. (Indian
papers, please copy.)

SourHon—Youna.- At St. Thomas's Cathedral, Bombay, on
February 16th, 1906, by the Rev. Harold Foote, Captain
Charles ‘E. Southon, I.M.S., 57th Rifles, Е.Е. Peshawar, to
Agnes MeLeod, younger daughter of John H. S. Young, Esq.,
Edinburgh.

List ок InpIAN MEDICAL OFFICERS IN MILITARY EMPLOY

ON FURLOUGH.
Showing the Name, Regiment, or Department, and the Period
for which the Leave was granted.
Armstrong, Lieutenant-Colonel H., I.M.S., 8 m., September

30th, 1905.

Babington, Lieutenant J. W. H., I.M.S., 9 m., fr. September

27th, 1905.
Browne, Lieutenant Н. H., I.M.8., 1 y., fr. March 17th, 1905.
Clarkson, Major Е. C., І.М.8.
Donovan, Major C., I. M.S.
Eyre, Lieutenant-Colonel, M.S., І.М.5.,

23rd, 1905.
Fayrer, Captain J. D. S., І.М.б.
Fooks, Major H., I. M.S., 18 m., fr. March 28th, 1905.

, Captain A. B., I. M8., 1 y., fr. October 26th, 1905.

Gilbert, Major C. E. L І.М.5.
Hamilton, Captain №. G., І.М.8., 1 yr., fr. October 5th, 1905,
Hirsch, Lieutenant L., I. M.S., 15 m., fr. March 21st, 1905.
Hodgson, Lieutenant Е, C., I.M.8
James, Captain S. P., I.M. 5,
Kirkpatrick, Captain H. ,І.М.8
ud Captain W., I. M.S. 5%

1 y., fr. September

99 m. 1 d., fr. September 25th,

СЕТА Captain У. E. H., I.M.8.

Lister, Captain A. E. J., 'LM. S., 16 m., fr. February 12th,
1905.

Lumsden, Major J. S. S., I.M.S.

MacKelvie, Captain M., I.M.S.

Maddock, Captain Е. C. G., І.М.8.

Mason, Captain W. G., I.S.M.D.

Meakin, Captain Н. B., I.M.8., 18 m., fr. March 23rd, 1905.

Miller, Captain A., I.M.S.

Orr, Major W. H., I.M.S.

Parker, Lieutenant C. S., I.M.S., 1 y., fr. August 28th, 1905.

Perry, Captain E. L., I. M.S., 33га Punjaub.

Pinchard, Captain M. B., I.M.S., 1 y., fr. August 12th, 1905.

Rait, Captain J. W. F., І.М.5.

Rodgers, Lieutenant-Colonel J. W., I. M.S., 52nd Sikhs.

Rundall, Lieutenant L., I.M.S., 24 m., fr. September 17th,
1904.

JOURNAL OF TROPICAL MEDICINE, APRIL 2, 1906.

THOMAS EDMONSTON CHARLES, M.D., LL.D.Edin., F.R.C.P.Lond.

April 9, 1906.)

Russell, Major A. К. P., I.M.S.

Shore, Lieutenant-Colonel R., I.M.S.

Steel, Lieutenant R. F., Т.М. 8.

Stephen, Captain L. P., т.М.8.,1 i fr. June 24th, 1905.

Swaine, Lieutenant. Colonel C. L, .M.S.

Sweeney, Lieutenant-Colonel T. u I.M.S.

Tate, Captain G., I.M.S., 1 yr., fr. October 3rd, 1905.

Waddell, Lieutenant- Colonel L. A., C.B., C.LE., I.M.S., 24 m.,
fr. October 21st, 1904.

Willcocks, Captain БК, D., I. M.S., 13 m., fr. May 27th, 1905.

——— 3,95 ——————

PLAGUE.

PREVALENCE OF THE DISEASE.
Cases. Deaths.
India.—Week ended Feb. 17th 8,926 7,362
B iy » 24th 9,420 8,312
March 3rd 10, 27 8,770
5. Africa. —Week ended Feb. 17th 0
» 24th 0 0
Hong Kong. —Week ended Mar. 3rd 8 7
» » 10th 15 16
is » 17th 7 7
3s » 24th 15 15
Mauritius.—Feb. 11th to Mar. 17th 0 0
Week ended ,, 24th 9 0
Japan (Formosa).— Jan. 1st to 31st 48 38
Brazil (Pernambuco).—
January 24th to 31st ie 1 0
Peru.—January 2186 to 8188 .. 21 10
-----о-

OBITUARY NOTICE.

Тномав Ермомвтох CHARLES, M.D., LL.D.Edin.,
F.R.C.P.Lond., Honorary Physician to the
King; Surgeon-General, I.M.S.

Іт is with sincere regret, which will be shared as a
personal sorrow by many of our readers, that we have
to record the death of Dr. T. Edmonston Charles, at
Flushing, near Falmouth, at the none too ripe age
of seventy-two

Dr. Charles was the son of а clergyman of the
Established Church of Scotland, and was born in
Calcutta in 1834, but in accordance with the usual
custom, was at an early age sent home for education.

Electing the medical profession as his future career,
he entered the University of Edinburgh, and graduated
as M.D. and L.R.C.S. in 1855. His early connection
with India naturally led to his deciding to follow his
father's footsteps to the “land of regrets,” and ac-
cordingly in the following year he joined the medical
service of the Hon. East India Company.

The young medical recruit’s admission to the service
came just before the most exciting period of Anglo-
Indian history, and before he had been a year in the
service he found himself in the thick of the desperate
struggle for existence that occupied the years 1857
to 1859.

His old friend and brother officer, Sir Joseph
Fayrer, who contributes to the British Medical Journal
a long and sympathetic notice, gives the following
abstract of his services :—

“Soon after arrival he was attached to the lst
Bengal Fusiliers, served with them during the

THE JOURNAL OF TROPICAL MEDICINE. 11

campaign of 1857-8, and took part іп the celebrated
march from Dugshai to Umballa. He was in medical
charge of 400 men of that regiment and two squadrons
of H.M. 9th Laucers, forming the advanced brigade of
the army; was present with the regiment at the
battle of Badlee ka Sarai on June 8th, 1857, and
throughout the entire siege of Delhi till its final capture
on September 20th. He accompanied the column
under Brigadier J. G. Gerrard, C.B., into the Rewaree
District against the Jeypore and J odhpore rebels, and
was with Sir Thomas Seaton, K.C.B., during his
operations in the Doab ; was present at the action of
Gungeyree, the battles of Ruttialee and the affair at
Mynpoorie. He was with the army on its second
advance on Lucknow under Lord Clyde, and was with
the storming party of the lst Bengal Fusiliers, who
took the enemy's first position at the Chuker Kotee
and other points in their line of defence. He was
present throughout the rest of the siege of Lucknow,
and subsequently with the column under Sir Hope
Grant, K.C.B., in Oude. He was mentioned in the
despatch of Major Hume of September, 1859, and re-
ceived the Indian medal, and clasps for Delhi and
Lucknow. He was appointed Garrison Assistant
Surgeon, Allahabad, 1859, Officiating Garrison
Surgeon in 1859, and First Assistant to the General
Hospital, 1860. Soon after this Charles returned to
Calcutta and joined the General Hospital, where he
held an important post. On the retirement of Dr.
Wilson, of the Medical College of Bengal, from the
post of Professor of Midwifery and Obstetric
Physician, Charles was appointed in his place. He
continued to perform the duties of this office for
many years with great success and with much benefit
to the cause of medical education in India. Not
only as an obstetric but as a general physician Dr.
Charles met with great success, and obtained a large
practice in the Presidency. The trying and responsible
duties of this work in an Indian climate in time
produced their natural results, and rendered it
necessary for him to resign, in 1880, an appointment
which had been to him the source of much рго-
fessional repute and its consequent advantages.”

One of his last services to didis was the founda-
tion of the Eden Hospital, Calcutta, which has
since become one of the most important gynæco-
logical institutions of the empire.

Retirement to Dr. Charles, however, by no means
implied а cessation of work, which, indeed, in а man
of less indomitable energy would probably have
resulted in downright illness, but was simply &
transfer of his labours to more favourable climatic
conditions. Не settled first at Cannes and after-
wards at Rome, and was busily engaged in practice in
each of these favourite resorts. With all this he
found time to show himself a learned archeologist
and an enthusiastic mountain climber. After twenty-
two years' more work in these fields of activity, finding,
as most men must at an earlier age, that а man of
sixty-eight can scarce expect to be able to work as
hard as younger men, he decided to retire to the mild
climate of Falmouth, were he remained until the end
of an exceptionally strenuous life. In Flushing, close
by the old Cornish town, he found a charming resting
place, an old Georgian villa, with a sunny garden run-
ning down to the beautiful estuary of the Penryn river,

112

THE JOURNAL ОЕ TROPICAL MEDICINE.

‘April 2, 1906

where his trim 3-tonner lay moored. Неге the
veteran might often be seen amongst his roses or
busied in demonstrating the marvellous mildness of
the climate by cultivating tropical plants in the
open. With such surroundings it was characteristic
that he should become & keen yachtsman, and winter
or summer, blow high, blow low, scarce а day passed
without his passing several hours afloat. Besides this
he showed active interest in the local medical and
scientific iustitutions, and but a few days before his
death was asked to permit himself to be elected as
President of the South-western Branch of the
British Medical Association. His contributions to
medical literature were numerous and valuable,
notably his revision of the Sydenham Society's trans-
lation of Marchiafava, and Bignami’s work on malaria.

To such of us of a younger generation who en-
joyed the pleasure of his personal friendship, nothing
could be more stimulating than the example and
conversation of one who, in spite of failing physical
strength, showed himself to the last conversant with
the latest developments of tropical medicine. Like
most truly lovable men, Dr. Charles could be a
sturdy fighter when he chose, especially when his
strong sense of right and justice was aroused in the
interests of others, and perhaps his last contribution
to medical literature was his able statement of the
facts of the unfortunate dispute as to priority between
Prof. Grassi and Major Ronald Ross. So conclusive
was his handling of the question that it practically
secured the verdict of scientific Europe in Ross’
favour, and the controversy practically died a natural
death from the date of its issue.

Dr. Charles had been failing in physical strength for
some time, but the end came rather suddenly.
During the last few months he had had several
short attacks of fever, possibly recrudescences of
malaria, and these left him very anemic. Still,
when his old comrade, Sir Joseph Fayrer, visited
him he could find no signs of organic disease, and
there is no doubt that Dr. Charles’ pathetic diagnosis
of his own case was quite correct : ‘‘ I am quite well,
only the machinery is worn out.” It is consolatory
to know that his last days were marked by but little
suffering, and that his end was such as must be
desired by all men of science: to retain intellectual
activity to the last, and to pass away simply because
the physical organism had not rusted but worn out.

Through the kindness of Mrs. Charles we are enabled
to present our readers with a striking portrait of this
veteran tropical physician, who was, we know, the
personal friend of so many of our readers.

-----т---

Recent and Current Miterature.

А tabulated list of recent publications and articles bearing on
tropical diseases is given below. To readers interested in
any branch of tropical literature mentioned in these lists
the Editors of the JOURNAL OF TROPICAL MEDICINE will be
pleased, when possible, to send, on application, the medical
journals in which the articles appear.

* Annales de l'Institut Pasteur," 1905, p. 715.
Schneider, L. E., and Buffard, M., after examination of
affected animals on both continents, state that the trypano-
somiasis of horses and donkeys in Algeria is identical with
the ~ dourine " met with in various countries of Europe.

* Zeitschr. f. Hyg.," T. 1i., 1905.
YELLOW Fever ім BRAZIL.

Otto, M., and Neumann, R. O. There is comparatively
little newin this memoir, which contains the usual descrip-
tions of Stegomyia, &e.. with some excellent plates. They
succeeded in carrying some of these mosquitoes to Ham-
burg, and breeding them in a hothouse through a certain:
number of generations. "They find that eggs kept dry on
filtering paper lose their vitality comparatively quickly if the
temperature of the air is high, but survive some time if it
be cooler. However, they do not think that there is any
danger of their breeding on board ship even in the case of
wooden vessels, as bilge water is too salt for the larve to
live іп. They also conducted some experiments to ascertain
the possibility of infected mosquitoes being carried about in
luggage, and come to the conclusion that there is little or
no danger of such an occurrence. They did not succeed in
discovering any new specific organism, and, like many
others, quite failed in their attempts to cultivate the
Bacillus icteroides, nor did they have any better fortune in
experimenting with the 4 u bacillus of Durham and Myers.

“Journal American Medical Association,” February 3, 1906.
TREATMENT OF CHOLERA.

Ussher, C. D.. acting upon Koch’s suggestion that quinine
should be tried in the treatment of cholera, has met with
marked success in the outbreak of cholera in the Philippines ;
as many as 90 per cent. of the patients recovering. The
plan of treutinent was as follows: Sulphate of quinine ten
grains every hour until the rice-water stools disappeared,
and bile is passed in the motions. For suppression of urine,
friction of the limbs, hot fomentations, dry cupping over the
loins, and sweet spirits of nitre are useful. When evidences
of the circulation failing supervened, subcutaneous saline
injections prove beneficial. The sulpho-carbolates of zinc,
lime, and soda in equal quantities, given at intervals of from
two to four hours, are efficient when irritability of the bowel
persists, with a foul odour of the evacuations.

* Revue Suisse de Zoologie,” 1905, p. 415.
SoME TAPEWORMS OF THE CHIMPANZEE.

Bourquin, Ј. As the anthropoid apes have been found
useful in experiments in connection with the investigation of
sleeping sickness, the above reference may be of interest to
those engaged in the investigation of that disease.

* Yierteljahrschrift der Naturforschenden Gesellschaft
Zurich," 1908, p. 163.
MIGRATION OF TrIcHINA EMBRYOS.

Stüubli, C., who is in agreement with the previous ob-
servations of Akanazy, traces the embryos from the gut into
the lymph channels and so to the thoracic duct, whence
they are carried into the blood-vessels, and во to the muscles,
where they become encysted. Naturally, the most active
muscles being most vascular, arrest a disproportionate share
of the intruders.

Hotices to Correspondents,

1.— Manuscripts sent iu cannot be returned.

2.— As our contributors are for ihe most part resident abroad,
proofs will not be submitted to those dwelling outside the United
Kingdom, unless specially desired and arranged for.

3.—To ensure accuracy in printing il ıs specially requested
that all communications should be written clearly.

4.—-Authors desiring reprints of their communications to the
JOURNAL OF TROPICAL MEDICINE should communicate with the
Publishers.

5.—Correspondents should look for replies under the heading
“ Answers to Correspondents.”

April 16, 1906.)

Original Communications.

AN INSECT ENEMY OF THE DISSEMINATOR
OF HUMAN TICK FEVER IN ANGOLA.

By Ernest E. AUSTEN.
Zoological Department, British Museum (Natural History).

AMONG в consignment of blood-sucking and other
insects received in August last from Benguella,
Angola, and forwarded by Dr. F. Creighton Wellman,
isa specimen concerning which the sender wrote as
follows: “ I found this insect on June 22nd, 1905,
while studying a tick, Ornithodoros moubata, Murray,
specimens of which I sent you some time ago. It was
running about on the sticks composing а pig.sty,
where I was collecting ticks. Му attention was
attracted by its singular appearance and movements ;
suddenly it entered a large crack in a stick, where it
remained for some seconds. Since I could not clearly
see what it was doing, I had the stick split open,
when I found the insect holding a tick with its four
anterior legs (which you will see are provided with
curious paddle-like structures evidently designed for
this purpose) and sucking blood from it by means of
its powerful piercing proboscis, which it had inserted
deeply into the tick. The animal was so intent upon
its prey that I was able to carry it to a house without
disturbing it, and to observe its actions for some time.
T also exhibited it in the act of sucking blood from the
tick to Mr. W. E. Fay, B.A., & former student at the
London School of Tropical Medicine. When placed in
a killing bottle the insect withdrew its proboscis from
the tick, but still clutched it with its first two pairs of
legs. I mounted it in this position, and you will
пов the wound in the tick near the margin of its

о y."

The specimen referred to in the foregoing interesting
note by Dr. Wellman is à hemipterous insect, or bug,
belonging to the family Reduvitde, and to the species
known ав Phonergates bicoloripes, Stál. It is still
grasping its victim in the manner described above, but
the tick has become shrivelled and distorted in conse-
quence of drying. Тһе subjoined sketch will, how-
ever, perhaps make the position of the destroyer and
its prey, аз well as the general appearance of the
former, sufficiently clear.

Phonergates — bicoloripes,
moubata, Murray.

Stal, preying on Ornithodoros

The following is a brief description of Dr. Wellman's
specimen of Phonergates bicoloripes, & species which
was originally described from “ Caffraria,” and of

THE JOURNAL OF TROPICAL MEDICINE.

113

which the Museum collection includes three examples
from the Zoutpansberg district of the Transvaal.
Length, 184 mm. ; width of thorax at base of wings,
54 mm.; width of abdomen (on which, when insect
is at rest or walking, the wings lie closed one over the
other like the blades of a pair of scissors) 5 mm.
Colour : thorax metallic purple; wings (which when
closed conceal abdomen when insect is viewed from
above) deep velvet-black; hind-legs bluish-black ;
front and middle femora and front tibia coral-red,
with tips of femora, and base and tip of front tibiæ,
black; middle tibie, brownish. The front and, to
& lesser extent, the middle femora are swollen. The
tips of the front and middle tibis are provided on the
underside with a large spongy pad, which assists the

insect in obtaining а firm grip of its prey.

The bugs of the family Reduviide prey, as a rule,
upon insects of all kinds, and the writer is informed
by Mr. W. L. Distant that he has even seen а
specimen preying upon а weevil, 1.6., a beetle belong-
ing to the family Curculionide, the intense hardness
of the chitinous covering of which is well known.
It is, of course, possible that by this time Dr. Wellman
has met with other instances of Phonergates bicolortpes
attacking Ornithodoros moubata, but it is extremely
unlikely that the bug preys especially upon the tick
in question. In all probability the specimen observed
by Dr. Wellman happened to alight close to a tick,
and seeing the latter crawliug at once pounced
upon it.

SUGGESTIONS FOR THE MAINTENANCE OF
HEALTH BY WOMEN IN THE MISSION
FIELD.

Ву Mary A. D. ScnanLiEB, M.D.Lond., B.S.

Tue subject сап be considered under the following
heads :—

(1) Preparation for Work in the Mission Field.

(а) A good rest and general “ getting fit.”

(6) Examination and care of teeth, eyes, skin.

(c) Medical examination and advice.

Special examination of intending wives.

(2) Selection of Candidates.

Reasons for declining offers—age, disease, defects,
deformities, nerves, bad family history.

(8) Allocation of Candidates to Special Work.

(4) Care of Health on Active Duty.

(a) Clothes, food, drink, purification of water.

(b) Choice and construction of houses ; selection of
site.

(с) Amount of work, exercise, aud rest.

(d) Care of minor ailments—chills, slight fever,
diarrhoea, toothache. :

(е) Dangers of mosquitoes, flies and ticks.

(f) Annual holiday.

(g) Daily dose of quinine.

(5) Care of Health when on Furlough.

(a) Medical examination and advice on arrival.

(b) Choice of locality for holiday.

! Paper read at the Medical Officers of Missionary Societies
Meeting, March 20, 1906.

114

(с) No deputation work оп short пода, and none
on long leave until health is re-established.

(d) Medical examination some months before ex-
piration of leave. Р

The maintenance of health in the Tropics depends
greatly on

(1) Tae PREPARATION FOR WORK.

Among the essentials of this preparation are the
enjoyment of a good rest and the careful getting of
body and mind into their best possible condition.

Many young women who offer themselves as candi-
dates for mission work have already been considerably
strained by other work or study. Many of them are
teachers or medical students, some of them clerks,
accountants, or domestic servants. Іп all such cases
it is essential that an interval of several months
should intervene between the old work and the new.
If this precaution is neglected, the candidate may go
out at the expense of the society, only to cause dis-
appointment by an early breakdown.

It may be suggested that each society’s medical
adviser should enquire into the candidate's recent
circumstances, work, and method of life. This would
lead to advice about a holiday and where to take it.

. It must be remembered that many candidates have
poor homes in crowded cities, and that a holiday spent
in hard work in such surroundings is certainly not a
“holiday” as intended by a medical officer or ап
advisory board.

It may be considered Utopian, but really each
society should have its “ home of rest," to which it
could send its candidates and missionaries when
necessary. This might possibly be arranged in con-
nection with the hostel or training college which many
of them already possess.

Medical Examination.—Of course each society has
its medical officer, and several of them have advisory
boards which have been the means of greatly lessen-
ing the death-rate of such missions as the Universities’
Mission to Central Africa, and others working in
specially unhealthy climates.

Many applicants for missionary service are over-
strained from study and other causes and hence a
preparatory term of rest is very essential to prepare
them for the strain of tropical research.

Many of the great missions publish information as
to the preservation of health in the form of a printed
letter or pamphlet, but it is perhaps desirable that in
each number of the missionary magazines there should
be a short paper dealing with some practical point,
such as the influence on health of mosquitoes, of
excessive rainfall, imperfect protection from the sun,
errors in diet, clothing and housing. No doubt the
magazines are intended to arouse interest in the work
of the mission, but they are so much read by the
missionaries themselves that they would be good
channels for the diffusion of information on such
important subjects.

It also seems as if the committees of our societies
need to be begged to consider more carefully the
reports of their medical officers, and to give effect to
their recommendations in the selection of candidates.
They should also consider their advice as to the cor-
rection of certain defects, especially those of the eyes

THE JOURNAL OF TROPICAL MEDICINE.

[April 16, 1906.

and teeth, and as to the necessity for vaccination in
all cases, and of inoculation with typhoid or plague in
some special instances.

In the case of young women proposing to go out
out as the wives of missionaries, there should be а
special investigation as to their fitness for maternity.
The external measurements of the pelvis should be
carefully taken with calipers, and, if any obvious
deformity exists, а further examination under anss-
thesia may sometimes be proposed: loss of valuable
lives and much hindrance to work being saved if it is
clearly understood that in any given case the wife of
& missionary is likely to need specially skilled assist-
ance, and must therefore go for confinement to some
centre where such assistance сап be secured.

(2) SELECTION оғ CANDIDATES.

In the selection of candidates the medical officers
of missions are greatly assisted by the excellent tables
of questions supplied by most missions, unfortunately
not Бу ай. These questions should be as minute and
searching as are those proposed by life insurance
societies. This precaution, is the more imperative
because candidates, in their zeal for service, some-
times, it may be unconsciously, give a most misleading
account of their health and physical capacities.

There are certain facts in a candidate's history
which must lead to rejection, while a still larger
number make it necessary to give her acceptance only
in the event of her fulfilling certain conditions. Among
the former are unsuitability of age. Candidates who
are too young and immature are a constant care to
the older members of the mission, and they are spe-
cially liable to certain forms of illness. Candidates.
much above 30 years of age are generally unsuitable,
because they fail to adapt themselves easily to trying
climatic and social conditions; they have become
more or less set in their habits of life, and do not
readily alter them, as is really necessary in the different
conditions of climate and surroundings.

The older candidates, as в rule, find more difficulty
in learning new languages, and are less fitted to
understand the philosophy and religion of those to
whom they are sent. Judgment may be better in
middle life than in youth, but memory, power to
learn, adaptability, and readiness of sympathy are
less. Besides all this, there is a constantly increas-
ing chance that organic disease or chronic error of
function may be present, rendering the individual less
able to withstand the evil influences of bad climate
and poor food.

Another point to be carefully considered is the
existence of some defect which is likely to impair
usefulness, such as lameness, lateral curvature of the
spine, flat feet, and any marked deformity.

Amongst the causes of conditional acceptance
which may be noted are certain defects which impair
usefulness, chiefly those of the special senses, such as
deafness and errors of refraction. Deafness in even
a minor degree makes the acquirement of a new lan-
guage difficult, and defective eyes are unduly tried
by unfamiliar symbols of language. To all this must
be added the fact that when general vigour diminishes
under the influences of bad climate, inadequate or
unsuitable food, and trying work, all special dis-

115

April 16, 1906.) THE JOURNAL ОЕ TROPICAL MEDICINE.

abilities become more evident, and lead to breakdown
just as surely as do constitutional unsoundness or
attacks of illness. Probably people who have sharp
hearing and normal sight are quite unconscious of
their advantages in the battle, and do not know how
much more difficult things are for less favoured
colleagues. Unless, therefore, such defects can be
remedied, the candidate should be rejected in justice
both to herself and to the society.

The undesirable possession of “nerves,” ог the
being, what people call, with unfortunately a certain
degree of approbation, ‘‘ very sensitive and highly
strung,” is generally a bar to effective and enduring
work, whether in community or as an isolated mission-
ary. Itisa very serious question as to how far the
prolonged and heavy burden of modern education is
responsible for this condition. This is not the place
to discuss the distribution of responsibility among
mental traiving, the unconscious education of home,
апа real hereditary peculiarities, but no matter how
produced, such a condition of the nervous system is a
very real hindrance to work, whether at home or
abroad, and should be regarded as being sufficient to
debar а candidate from acceptance.

In the same category must be put bad family history,
especially if that family history be а nervous one. No
doubt the different parts of the mission field have
different characteristics, and there are certain portions
of it that are specially trying to the nervous system,
е.7., Japan, North China, and Burmah. This leads оп
to the next subject —

(3) ALLOCATION OF CANDIDATES TO SPECIAL Work.

No doubt in many instances a candidate offers for
some special work, and wishes, for instance, to be sent
to Japan; but surely an essential part of the duties of
the medical advisers to the societies is to consider the
fitness of the candidate not only with reference to
mission work in general, but for that special branch
which she is anxious to undertake. To send a girl of
obviously unstable nervous constitution to Japan
would appear to be as wrong as to send another who
has already suffered from malarial infection to the
"West Coast of Africa. All tropical climates have
certain drawbacks in common, such ая heat, undue
moisture, presence of mosquitoes and other undesir-
able insects, but in addition there are peculiarities in
nearly all these climates, and in advising societies as
to the allocation of missionaries, it is desirable that
the medical officers should know all that is possible
for them to know as to these peculiarities, and also
that they should study each individual case with a
Y to distributing the material as suitably as pos-
sible.

(4) Carm or HEALTH on Active Dury.

There is a very regrettable waste both of life and
health which is not really unavoidable. Тһе climate
in which the worker finds herself may be far from
ideal, but in too many instances the missionaries,
especially the younger missionaries, appear to abso-
lutely court disaster. They remind one so much of
the fatal remark made by Lord Methuen at the com-
mencement of the South African War ; he said: “ This
18 & war in which it will not be etiquette to take

cover"; there spoke no doubt the courageous and
gallant commander, but not the wise and successful
leader of men.

Probably all doctors who have seen much of young
women missionaries in the Tropics have found in them
an heroic disregard of the most obvious precautions
which ought to be taken as a matter of duty and com-
mon-sense by all residents in tropical climates. Some
of this recklessness may be due to fiery zeal, beautiful
and impressive, but not useful, which is more or less
inherent in young people, but much of it is also due
to the appalling ignorance of sanitation, hygiene, and
physiology, во common in the present day. “Тһе
people is destroyed for lack of knowledge, how
shall they know unless they be taught," and who is
there to teach them. In our schools, whether for rich
or poor, everything is taught, from the alphabet to the
piano with the exception of what really concerns the
pupils to know, their duty to God and their duty to
man, including their own bodies. How can we expect
people who live in rooms habitually over-heated and
ill ventilated to understand the value of fresh air?
How can we expect girls who have never been in the
kitchen and who know nothing about food to make
thrifty and intelligent mistresses of missionary families
or wise home-sisters to a community.

Ав to the question of drink, there is no doubt that
the great majority of people working in the Tropics
would be much the better for avoiding the use of
alcohol as a beverage. Missionaries generally comply
with this rule, probably more from a desire to seta
good example to their scholars and converts than from
motives of hygiene; there is, however, no doubt of
the folly of taking alcohol in climates where the inevit-
able weariness and lassitude are so likely to lead
people on from a harmless minimum to a maximum
which is incompatible with health of body or mind.

To maintain health in the Tropics many habits of
daily life need revision. Ordinary English folk eat too
much meat, and, indeed, too much food altogether.
The attempt to do this in a tropical climate is sure to
lead to disorders of digestion and chronic ill-health.
Plenty of milk, bread, butter, vegetables, and fruit,
with relatively little meat, would be a more suitable
dietary than the heavy breakfast, lunch and dinner
which is usual with Europeans in India.

Another very serious danger to health in the mission
field is the difficulty of procuring good milk and pure
water.

Milk is not attainable in some places, in others it is
very poor in proteids and in fats ; in nearly all stations
itis liable to contamination with dirty water, or by
being drawn from unwashed udders by dirty hands.
The wonder is, not that typhoid, dysentery, and other
microbial diseases are conveyed by milk, but that
any one escapes infection. The only way to guard
against such illness is for some responsible person to
see the cows milked and to insist on the observance of
all reasonable precautions. С

The storing of milk is a difficulty only less urgent
than ensuring its original purity. In hot countries
milk is a highly putrescible fluid and rapidly becomes
unfit for use. This difficulty, like the difficulty of
guarding against its containing germs of tubercle and
other diseases, is met to some extent by boiling or

116

THE JOURNAL OF TROPICAL MEDICINE.

(April 16, 1906.

sterilising. Neither of these methods is wholly satis-
- factory, for even sterilisation affects the food value of
the milk.

Water is the staple drink and also the most frequent
vehicle of disease. The source of water supply,
whether river, well, or tank, is too often open to the
grossest fouling; one and the same collection of water
being used as sewage carrier, ав washing ground, and
as drink for man and beast.

The carelessness of all concerned, Government,
missionaries, European residents and natives, is mar-
vellous. The merest common-sense should enforce the
rule, “Тһе rain to the river, the sewage to the soil,”
but no, those who should know better allow the sewage
to enter the river, while the rain collects in shallow
depressions round the houses. Typhoid, cholera,
dysentery and malaria follow in the ordinary course
of Nature, and those whose ignorance and carelessness
have caused the catastrophe talk of heroic self-sacri-
fice and the deadliness of the climate—truly ‘the
people is destroyed for lack of knowledge."

The water supply can never be trusted, and the only
safeguard is to drink none that has not been boiled
and kept covered from dust and other sources of con-
tamination.

Choice of Houses, Construction of House, Selection of
Sites.—In well-settled countries, such as many parts of
India and China, the individual missionaries find their
houses ready for occupation, and have no responsi-
bility as to choice of site or construction of house. А
heavy responsibility does, however, rest upon those
who choose the house itself. From a desire that the
missionaries should live as much as possible amongst
their people, the heads of missions too often select
houses in the native quarter of the town. Such houses
are very likely to be built on native principles of sani-
tation and comfort, which it is needless to say are
neither suitable nor desirable for Europeans. In
many cases they are in immediate proximity to the
open gutter, which serves the purpose of a general
sewer; ventilation is conspicuous by its absence, and
there is & general want of convenience and comfort.
Far worse than this, there are the many diseases which
are immediately communicable from man to man,
either directly or through the mediation of mosquitoes,
flies, ticks, Яс. Europeans living in the native quarter
are exposed to all these dangers, and also suffer from
the absence of open spaces, proximity to the country,
or the sea-shore.

Of course, every one understands the desire of the
missionaries to be near their work and amongst their
people; much fatigue and expense is saved by not
having to make journeys to and fro, and another in-
ducement is undoubtedly the hope that by living &
Christian life in the midst of their heathen neighbours
their example may be like “ the city set on a hill which
cannot be hid." АП the same, it is to be feared that
the balance swings entirely towards evil rather than
good, for it is not possible for Europeans living under
such cireumstances to maintain their health, and with
the loss of health comes loss of efficiency, and in many
instances loss of temper and of many of the moral
qualities which are во necessary in dealing with the
heathen and with converts. It should therefore be a
matter of principle with those responsible for such

matters, that missionaries' houses should be sufficiently
removed from native quarters to enjoy an abundance
of air and sunlight; they should, if possible, have
upper rooms in which to sleep; the trees should not
be permitted to grow too close to the house; and all
shallow tanks and puddles should he filled in. Beyond
all these things, it is necessary to see that the servants’
quarters are as far removed as possible from the house.
It is now well known that mosquitoes are the carriers
of malarial infection, and that few native children are
not hosts of the malarial parasite; if, therefore, the
servants' quarters are near to the house, there is
nothing to prevent the mosquito from carrying the
malaria from one to the other.

There is real sense as well as economy in having
but little furniture and no hangings in tropical houses.
Any curtain or garment hanging up is simply a hostel
of which the mosquito avails itself freely ; sheets and
clothing having been hung in the sun to dry ought to
be folded up and put away into bureaux or boxes, for
when they hang in the sleeping rooms they become a
positive danger.

Itis а distinct advantage to have fine woven wire to
fit into the windows and doors, made so that they can
be open in the day and closed at sundown. The mos-
quito is chiefly a nocturnal creature, and ought, if
possible, to be excluded from the dwelling.

An excellent modern device is а sort of small tent
of gauze within which a chair and table can be placed.
This enables any one to read or write without the
annoyance and danger of being bitten by mosquitoes.
Among minor safeguards are the rubbing of the skin
with oil of lavender and the wearing of high boots,
putties, or gaiters.

It often happens that in breaking fresh ground and
laying the foundations for a new mission station, the
responsible head has to choose a site which shall be
suitable for the mission houses. This should be, if
possible, on a sloping ground with no houses above it.
The servants’ quarters should be a considerable dis-
tance away and at alower level. It is also most
desirable that there should be no half-way house
between the European and native quarters, for the
mosquito is capable of flying about 500 feet., it then
settles on some vantage ground, and gathers strength
for a further flight. Abundant provision should be
made for dealing with refuse and with household
slops. It is absolutely immoral to permit excreta and
rubbish to foul running water or to enter a lake, tank,
or well. There is no doubt that the earth system is
the only one practicable, but this demands very care-
ful management or the heavy rain will wash away
both earth and excreta, fouling all the ground in the
neighbourhood.

Another point that should engage the earnest at-
tention of the selector of a site is that there should be
no swamp or marsh in the neighbourhood. There was
a great deal of unconscious wisdom in those of old
time who spoke of malaria as ‘‘ marsh fever," for al-
though it is by no means a miasma or an emanation
from marshy soil, yet shallow and stagnant water
affords в breeding ground to the mosquito, which is
itself the cause of the scourge.

Tt is curious to look back to one's student days and
to remember how we were cautioned to advise

April 16, 1906.)

THE JOURNAL OF TROPICAL MEDICINE.

117

travellers to encamp to the windward of groves of
trees or of running water; of how they were advised
to kindle fires between themselves and the marsh, and
how it was supposed that the deadly miasma was of so
particulate a nature that it it did not readily pass
through the meshes of a mosquito net, in the same
fashion as it was known that fire-damp did not pass
through the closely woven wire gauze of the miner's
safety lamp. All these facts were true, but our inter-
pretation of them was erroneous.

In the matter of the construction of a house much
must depend upon the materials available, but it has
been abundantly proved, especially in the history of
the Universities’ Mission to Central Africa, that the
health of the missionaries is much more stable in well-
built houses whose walls are thick, whose foundations
are well laid, and in which there is an abundance of
air without draught and without exposure to wet
mists. No doubt pucka-built houses are more ex-
pensive, whether they be fashioned of bricks, stone, or
rubble faced with chunam. There was no doubt cheap-
ness, immediate economy, and perhaps some romance
in living in wattle and daub huts thatched with palm
leaves; but after all, nothing in the mission is so
valuable as the health and lives of its members, and
therefore no expense within reason can be considered
extravagant which really secures their safety.

Amount of Work, Exercise, and Rest.—There is
no doubt that owing to zeal and enthusiasm out-
stripping discretion, many missionaries, and еврө-
pecially the younger members, are extremely careless
about their health. When they first come out they are
in most instances quite ignorant of the dangers of the
climate, and even if they understood they would be
disposed to think that their good intentions would pro-
tect them from harm. It is very difficult to persuade
new-comers that the tropical sun is deadly, and that
it is not safe to walk out (except in the very early
morning and evening) without the protection of pith
helmets, white-covered umbrellas, and dark glasses.
It is also difficult to make new-comers understand that
active and outdoor work ought to be accomplished as
far as possible in the cool of the morning or evening,
while the middle of the day should be devoted in part
to learning the language or other mental occupations,
and that, having in view the very early hour of rising
in the morning, some two or three hours should be
spent in rest.

Another danger which is not generally appreciated
at its right value by the young and enthusiastic is that
work of all kinds should be taken quietly and steadily,
that there should be no rush or worry over it. Some
of the young missionaries feel that every day spent in
the acquisition of the language is a day lost to their
Master's service, and they consequently are anxious
either to scamp this most necessary part of their
preparation, or to work во hard that eyes and brain are
alike overstrained and injured. No one can say how
many bours a day any one ought to work, this must be
& personal question, for whereas one individual can
work at the language with impunity for five or six
hours & day, other less mentally robust individuals
cannot do more than two or three hours without danger
of “ knocking up.”

Exercise is а duty greatly disregarded, especially by

women in tropical climates; they suffer much from
lassitude, and the slightest exercise is liable to be ac-
companied by profuse perspiration, and by development
of prickly heat; they are therefore disposed to shirk
physical exertion as much as possible. This, of course,
leads to indigestion, constipation, and frequently to
sluggishness of the liver and headache. Unfortu-
nately most people have an idea that these ailments
are to be remedied by drugs, and they are very un-
willing to follow the natural and proper course of
increasing their exercise ; others have a belief that any
exercise beyond ordinary walking, such, for instance, as
croquet, lawn tennis, and cricket, are of the world,
worldly, and unworthy of the enthusiastic and devout
missionary. It is quite necessary to persuade them
that so long as they are under earthly conditions they
need to take ordinary care of their health, and that
the form of exercise which is found to promote that is
the one by which they can best honour God.. It
appears to be greatly a matter of habit, for thousands
of Europeans keep themselves in excellent health even
in malarious and trying climates by taking regular and
steady exercise, by working reasonably, by resting
sufficiently, by eating suitable food, and in one phrase
by “ walking in the paths of physiological righteous-
ness."

Care of Minor Ailments, Chills, Slight Fever,
Diarrhaa, Toothache.—There is a good old saying,
“ Take care of the pence and the pounds will take
care of themselves,’ and one would fain remind
missionaries and other dwellers in tropical lands
that if they would attend to slight ailments there
would be a much better chance of remaining free
from grave disease. Many an apparently trivial
indisposition is either the commencement of real
trouble, or at any rate prepares the way for cata-
вігорһе; e.g., a heedless new-comer finds it delight-
ful to sit on the roof of the house or on the verandah
after the evening meal; they attribute no impor-
tance to their damp garments and perhaps chilly
sensations; it is not until fever or other serious
trouble develops that they can be brought to realise
the unwisdom of their pleasant rest.

All rapid chilling of the skin, and dampness, even
although slight, is of far more importance in tropical
than in temperate climates, and ought to be carefully
avojded, chiefly by wearing thin woollen garments
next to the skin, and by providing light woollen or
silken wraps to put on when driving after sundown,
sitting out, and after getting hot with taking
exercise.

A very slight deviation from health in the matter
of indigestion or of diarrho should be carefully
treated by rest and by minute regulation of diet.
Of course the old wives’ fables about the diarrhoea
which became cholera can be classed with the similar
fable of a quinsy which became diphtheria. We know
that grapes do not grow from thorns, nor figs from
thistles, but the gastric and enteric catarrh may pre-
pare the soil for the germination of the vibrio of
cholera, just as the inflamed tonsil is & ready breeding
ground for Loefller's bacillus.

Perhaps the heading of toothache may excite a
smile, but it is one of the most harrassing aud in-
capacitating of ailments, and seriously interferes with

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THE JOURNAL ОЕ TROPICAL MEDICINE.

[April 16, 1906.

the duties and happiness of life, and not only so, but
when abscesses form at the root of the teeth and a
condition of pyorrhea alveolaris develops, the
individual's standard of health will certainly be
greatly lowered, and it is very probable that serious
illness may follow. Dr. William Hunter has taught
us the intimate connection between some forms of
pernicious anemia and oral sepsis, while other ob-
servers have pointed out a similar connection between
oral sepsis and a form of rheumatoid arthritis.

(e) Dangers of Mosquitoes, Flies and Ticks. —Enough
has probably been said of the dangers of mosquitoes
and of some of the methods of minimising them, but
a brief resumé may be useful.

It is now generally recognised that mosquitoes are
the intermediate hosts of the parasites which cause
malaria and yellow fever. Many experiments have
been made, and the evidence inconclusive, men may
live safely in the most malarious districts provided
that they can protect themselves from the bites of
mosquitoes. On the other hand, people may be bitten
by infected Anopheles here in London, and will in
due time develop malaria.

The great problems are :—

(1 How can the Anopheles be prevented from
breeding near human habitations ?

(2) How can Europeaus defend themselves against
the bites of these small assassins ?

The Anopheles breed in shallow and stagnant water,
therefore houses should not be built near any swamp
or marsh, nor on ground in which there are shallow
depressions liable to be filled by rains; the neigh-
bourhood of irrigated lands is specially to be avoided.
АП marsh-land should be drained, if possible ; puddles
and shallows should be swept out and dried. Some-
times coating with a film of paraffin is easier. All
windows and doors should be fitted with fine wire
gauze shutters, which must be closed at sunset. Тһе
rooms should then be fumigated, and all parts of the
sleeping rooms should be thoroughly searched and
flapped with towels to disturb and kill any sleepy
mosquitoes. АП beds should have sound and good
mosquito nets, and a portable canopy should be used
by each individual in the evening—a canopy under
which a table and chair can be placed.

Any one walking out after sunset should protect the
feet and ankles with gaiters or putties, and all exposed
parts of the body, such as the face and hands, should
be smeared with lavender oil.

As said before, native huts must not be built near
European houses, and native children must not be
allowed about the house or verandahs.

It is also certain that disease may be propagated
by various kinds of flies, and there is а fever known
as “tick fever." One of the commonest troubles in
some parts of the mission field is a particular form of
purulent conjunctivitis, the infection of which appears
to be carried by eye-flies. Іп this case, again, the fly
would appear to be, at any rate, the agent by which
the infection is transferred from natives to Europeans.

(f) The Annual Holiday and the Home Leave.—
These breaks in mission service are absolutely essen-
tial to the maintenance of health and of efficiency.
Most workers find that a yearly holiday is essential
even in a temperate and healthy climate, still more

is it urgently needed by those who work under the

great strain and stress of a hot, moist climate, com-

bined with heavy work, much anxious responsibility,

and constant exposure to disease. In most cases a

healthy holiday may be had each year by a visit to

the hills, or by going for a sea voyage. Leave time .
should be enforced after two years’ service in excep-

tionally bad climates and after five years in less trying

stations.

(9) Daily Dose of Quinine.— When living in really
malarial districts and on the march, it is right to take
daily doses of quinine—two grains with the early tea,
and one or two after lunch and dinner. Few people
cannot take quinine in some form, and even the large
doses which are necessary to prevent ап expected
attack may be taken without unpleasant consequences
if mixed with hydrobromic acid. It is to be remem-
bered that when once malarial infection has been
established a recrudescence is easily provoked by
chill, exposure to the sun, fatigue, and indigestion.

A patient suffering from malaria must be carefully
protected from being bitten by mosquitoes, for they
suck in the germs of the parasite with the blood of
the invalid, and subsequently inject them with their
saliva into other people. In this sense, and in this
sense only, is malaria infectious.

(5) Саке or HEALTH WHEN ON FuRLOUGH.

(a) Medical Examination and Advice on Arrival.—
It is impossible to urge too strongly that every mis-
sionary should be seen by the medical officer of the
mission immediately on return from abroad. Cases
constantly occur in which missionaries who have been :
invalided home at the end of their term of service fail
to report themselves on arrival. The idea is that
merely coming home will cure their ailments, and
consequently they drag on, their dysentery becoming
chronic, their malaria smouldering, and tbeir anemia
scarcely relieved. They think they ought to be well,
and act as if they were well, eating ordinary diet,
incurring considerable fatigue, and steadily preparing
themselves to join the ranks of the non-efficiente.

If all missionaries were seen and examined on
return and submitted their ‘health history" to the
medical officer of their society, they would receive
valuable advice and treatment which would generally
ensure the re-establishment of their health, and enable
them to return to the field with renewed health and
capacity for work. In some few cases the medical
ofticer or the advisory board would report that the
missionary was unsuitable for the foreign field, and
should be employed at home or struck off the active
list. Such a decision, although no doubt reluctantly
made and full of sadness, would often save the life of
the missionary, and would defend the mission from
serious pecuniary loss. No one should be permitted
to return to the field who had suffered from black-
water fever, frequent attacks of ordinary malaria,
repeated attacks of dysentery, and, above all, those
whose nervous systems could not stand the storm and
stress of climate and work.

The medical officers would also be able to advise
returned missionaries as to work while on leave.

Some missionaries wish to employ part of their
holiday in study ; for instance, men desiring to take

April 16, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE.

119

holy orders, men and women doctors anxious to obtain
superior qualifications or increased experience. In
many cases this may be permitted, and the medical
officer will be able to offer advice as to opportunities
for study and possibility of assistance. In other
cases the missionary may be able and willing to do
deputation work, or otherwise to assist the society
while at home, but no one should be permitted to
work without heing examined and passed as fit.

(5) Choice of Locality for Holiday.—Another point
on which advice is likely to be needed, but is not
likely to be sought, is on the subject of where to spend
the holiday. Many missionaries are members of poor
families, their relations live in small houses, badly
situated and badly found in all respects. All of us
can remember instances in which the weary, toil-
worn missionary returns to а poor and comfortless
home, to worse food than she had while at work in
the field, and sometimes to be the domestic drudge, or
the willing but most unsuitable nurse to a home
invalid. Can it be wondered at that furlough so
spent fails to do good, and that the missionary's sub-
sequent record is disappointing? Modestly and simply
as our brothers and sisters live in the field, inferior
though the meat, bread and milk undoubtedly are, yet
they enjoy perpetual open-air life, a comparatively
abundant service, and a blessed absence of pecuniary
cares. When they come home, the advantages of
climate are sometimes greatly minimised by the cir-
cumstances of their homes. Some one on the home
staff should know the circumstances of each member
of the mission, and should be in a position to offer
hospitality for а portion of the leave at а hostel or
home of rest connected with the mission.

It might be possible in some missions to have a
holiday fund from which grants could be made in
certain cases to enable those who could not otherwise
afford it to go to the country, seaside, or wherever
the medical officer might think best.

(c) No Deputation Work on Short Furlough and none
on Long Leave until Health is Re-established.—When
missionaries come home for really short periods, say
for six months or less, it is not desirable that they
should do any deputation work. Their time for rest
and refreshment is short, and should be spent in
recovering health and elasticity; the policy of per-
mitting them to work during short leave is mistaken
and shortsighted. When the leave is longer, depu-
tation work may be permitted, but only when sanc-
tioned by the society’s medical adviser. Some people,
men as well as women, have no gift for public
speaking, and suffer acutely from nervousness on such
станов They should not be subjected to this
rial,

(4) Medical Examination some Months before Ex-
piration of Leave.—Finally, no missionary should be
permitted to return to duty without the written sanc-
tion of one of the society's medical officers. This
sanction should be sought in good time, otherwise
unnecessary expense and annoyance are caused by
the preparation of outfit and the securing of a
passage.

Usually two months will amply suffice, for it is
pretty certain that а missionary due to return to work
in October should be able to pass the medical exami-

nation in August. It would usually suffice for the
society to nominate a trustworthy practitioner in the
nearest town to the place where the missionary was
living.

SOME STRIKING FACTS ABOUT AN
EASTERN CITY.

Ву R. Н. BnEwRIDGE, M.A., М.В.Охоп., B.Sc.T.ond.,
Bangkok, Siam.

SITUATED at the mouth of а very large river and in
about the same latitude as Madras, is a city with
about three-quarters of a million inhabitants. At
least half of these are Chinese, and the remainder, with
the exception of some other Asiatics and a few Euro-
peans, is made up of Siamese. Bangkok, for that is
the name of the city, is surrounded by flat, low-lying,
very marshy country, and has a mean temperature of
about 83:5? F., and a rainfall of 46:5 inches. Strong
winds do not prevail, and there are many collections
of water with & constantly smooth surface most con-
venient for the breeding of mosquitoes. Moreover,
there are vast hordes of mosquitoes and many
Anopheles among them. Everything would seem to
have been arranged by Nature to promote malaria, yet
there is very little in the town itself. Severe cases
come in from the country, but among the genuine
town-dwellers malaria is certainly far from common.
An American doctor, of nineteen years' experience,
stated lately that he did not think he had seen twenty
cases of malaria among genuine town-dwellers. Sucl
& Statement is open to criticism, but it serves to show
that malarial fevers are infrequent.

Tt is not possible to get the mortality figures or case
incidence of any disease—there are no such records.
However, by collecting the experience of credible Euro-
pean doctors in charge of the police, army, navy, jails,
&c., &c., ashrewd guess шау be formed.

The laws and regulations for the care of the public
health are easily described. There are not any.
Docketed away somewhere in a dusty pigeon-hole
there may be some, but for all practical purposes the
layman is never made to know them.

Running along the front of the houses аге open
drains, into which it would appear anything may be and
everything is thrown. These drains empty themselves,
when they are not stagnant, into the various canals,
&nd the canals intersect the whole city, forming one of
the chief methods of communication.

Many houses face on these canals and derive their
water supply from them, and that not after any
method of filtration, but directly. Such water is used
not only for all domestic purposes, but also for cooking
and drinking.

The central jail,in which are approximately 2,000
prisoners, empties its surface water and liquid refuse
into a canal about the size of that in Regent's Park,
London. The jail takes its water supply from the
same canal, and аба place some few yards from the
position of the sewage outlet.

For the general use of the town there is no water
supply other than the canals. True, one or two arte-

120

THE JOURNAL OF TROPICAL MEDICINE.

[April 16, 1906.

sian wells have been already bored, but as yet they do
not seriously, if at all, atfect this statement.

Typhoid and Cholera. Typhoid is not а common
disease, and cholera, though continually present, does
not assume the proportions of even & moderate
epidemic.

Be it known that the stench from the open drains is
truly dreadful, and that during the dry season, when
the canals are quite empty at low water, the flushing of
many of them is practically a negligible factor. Yet
it is quite usual to see men, women and
children living and having their being alongside these
drains, and in this atmosphere of stink. Moreover,
they look and seem well.

Plague has recently appeared among us, and some
European doctors predicted and feared terrible conse-
quences. А case of plague has occurred here and there
at lengthy intervals, but the records have not yet
attained epidemic proportions, yet everything would
seem to be in favour of the plague.

Some parts of the city, notably the Chinese quarter,
is crawling with humanity. Here land is sold by the
squareinch. Everything that can be called a house is
full from the floor to the ceiling, and the mainway be-
tween the houses is but a narrow path. There is no
drainage, no water supply, no anything, and, strange to
relate, no plague. Why, no one knows.

To deal with such a place according to the most
elementary ideas of sanitation means its entire destruc-
tion as the only possible beginning, and this would
cost about six times the annual revenue of the country.

Bangkok would be to a man of fixed ideas about
sanitation nothing less than an awful nightmare, and
yet it is not over unhealthy. Indeed, the general look
of the European women and children is better than in
many well-cared for stations in India. They are not
pasty-looking and tired, and they are not ill.

It is difficult to resist asking one's self the question,
whether it would not be unwise to interfere here, and
graft а partial European system, almost inevitably
indifferently carried out, on the present order of going.
Now, there would seem to be some sort. of natural bal-
ance set up between the contending micro-organisms,
and that in the fight for existence among themselves
they are protecting us'' humans." To alter the whole
place immediately, and put everything under human
control, is impossible. The necessary engineering work
is lengthy and the cost enormous. Half measures
may mean а disturbance of the already existing bal-
ance, and the ultimate result a less healthy city. It
must always be recognised that to disturb a natural
arrangement unless you can see far ahead may in the
end be most disastrous.

Witness the island of Jamaica. То kill the rats in-
festing the sugar cane the mongoose was introduced ;
the rats were exterminated ; the mongoose then be-
came a plague, and has got rid of all the lizards, harm-
less snakes and small birds. As & consequence insect
pests abound, and among them is a troublesome tick,
which destroys the cattle. This tick having had all its
enemies removed by the mongoose flourishes luxuri-
antly. The last state of Jamaica is worse than the
first. Bangkok may repeat the history of Jamaica.
Improvements may not lead to such satisfactory re-
sults as were anticipated.

Give Bangkok closed drains and all that goes to
make up a sanitary paradise, and Bangkok may during
the years of changing have epidemic plague and epi-
demic cholera, and malaria in plenty. Be that as it
may; constituted as it is to-day, without any efficient
machinery to ascertain the numbers, and causes of
death, without any drainage, without any water
supply, without any registration of accredited
apothecaries, much less doctors, without, in fact, any-
thing but the barest skeletal beginnings of medical
control, Bangkok has all the possibilities of becom-
ing a very volcano of pestilence, and perhaps a fort-
night of unusually cold weather, or something equally
trivial, will start the eruption.

-----о----

SEA Уоулавв FoR InvaLips.—The discussion on
“ Sea Voyages for Invalids," published in the Journal
of Balneology and Climatology, January, 1906, provoked
a number of opinions as to the advantages and dis-
advantages of sea travel for invalids. The consensus
of opinion, including that of Dr. Robert W. Felkin,
who opened the discussion, seemed to be, as a rule,
against the treatment. He stated that the principal
ailments which precluded a sea voyage are: (a) The
strength of the patient—if there is too great ex-
haustion it is better to keep him on land; (b) grave
dyspepsia; (c) hepatic enlargement; (d) cardiac
dilatation; (e) pyrexia or any inflammatory con-
dition; (f) any tendency to hemorrhage; (0)
epilepsy ; (л) insanity; (2) pregnancy; (k) patients
suffering from eye diseases; (l) any kidney disease;
(m) phthisis, except, perhaps, in the very first stages,
and I think even then such а patient should occupy а
deck cabin alone." Dr. F. Sandwith’s remark that :—
“The doctor who sent many patients to sea was
generally one who had not done much travelling in
bad weather,” succeeded best perhaps in summing up
the situation. Chloretone was mentioned by Dr.
Leonard Williams as the drug which had proved most
successful in alleviating sea-sickness.

The Geographical Journal, for March, 1906, contains a
useful abstract of a paper by Dr. J. Hoffman, in Petermanns
Millellungen, 1005, Nos. 4-7, on Minimum Temperature in
Tropical Africa. The area dealt with is the south equatorial
region, more particularly the high plateaux of East Africa.
The author discusses the effect on the minimum of tempera-
ture of elevation, distance from the sea, rainfall and winds
throughout the year, and attempts to deduce some general
laws therefrom. He finds that the minima diminish with
distance from the coast, and increase of latitude, but the
variation with altitude cannot be stated simply, as the dimi-
nution is affected by many disturbing factors.

The facts are different, e.g., for stations on a mountain
range, on a plateau, or on the slope of an isolated peak rising
from a plain; the general law of diminution for elevation
holding good least of all for a mountain region cut up into
valleys. Humidity and cloudiness are also disturbing factors
as illustrated, for example, that under these circumstances
a minimum of 89929 F. was observed at 2,076 feet, near
Rinvenzori, whereas во low a temperature had never been
recorded up to 6,230 feet on Kilimanjaro.

The important question as regards agriculture, of the
limits of night frosts is also considered and the conclusion
arrived at is that, near the equator, there is no good evidence
of actual frost at any height under 6,500 feet, though cold
nights approaching freezing point are not uncommon.

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April 16, 1906.)

Business Rotices.

1.—The address of the JOURNAL ОҒ TROPICAL MEDICINE is
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THE

Journal of Tropical Medicine

APRIL 16, 1906.

THE DAILY RANGE OF HEAT AND HUMIDITY
IN TROPICAL COUNTRIES.

OF the different meterological data that are required
for the comparison of climates, there is no one as to
which so much misapprehension exists as to that of
humidity. The reason of this is to be found in the
fact that direct quantitative figures are absolutely use-
less for comparative purposes, as such figures convey
no idea whatever of the dampness or otherwise of a
place. Even in the heart of the Sahara, the actual
weight of watery vapour present in the air seldom, if
ever, is as small as it is in London during a November
fog; but in spite of this, the fierce dryness of the
desert in June rivals for inconvenience the damp
misery of a “ London special.”

The reason of this is that the amount of water that
the air can carry without deposition varies with the
temperature, and that it is only when the air approaches
saturation that the sensation of damp is conveyed.
Under other conditions, watery vapour is as ** dry " as
any other gas, for our sensations inform us not as to
absolute but to relative dampness. Macaulay’s school-
boy would probably have been aware of this had he
belonged to the present generation; but what is not
generally recognised is the corollary that, with the
daily changes of temperature, relative humidity is
constantly changing from hour to hour, and that con-

THE JOURNAL OF TROPICAL MEDICINE.

121

sequently observations from different places are in no
way comparable unless they are taken at correspond-
ing hours of the day. For strict comparison of places
widely differing in latitude, it is not sufficient that they
should be taken at the same hour of the day, as owing
to the great differences in the length of the daylight
hours at different latitudes, observations at the same
hour are only exactly comparable at the equinoxes.
At all other times of the year equatorial climates are
made to appear comparatively too dry in the winter
and too moist in the summer, as for comparative pur-
poses, where only one or two observations are taken
during each day, it is essential that they be taken, not
at the same hour, but at the same interval from sun-
rise and sunset. Observations such as this, necessita-
ting different times of observation for each month, are,
however, almost out of the question in actual practice,
and fortunately, within tropical and subtropical limits
the day does not differ sufficiently in length to seriously
vitiate the comparison of observations taken at fixed
hours. But even in stations under the same flag, the
hours of observation vary greatly, and nowhere more
so than in our British colonies, so that it cannot be
too clearly understood that comparisons of relative
humidity are usually utterly fallacious unless it be clearly
recorded that they are taken at the same hour, or that
careful and somewhat difficult corrections be made to
compensate for the different times of observations.

In bumidities of about one-third of the possible
water - holding properties of the air, it happens
that a rise of one degree Fahrenheit in tempera- y
ture corresponds almost exactly with a fall of 1 per
cent. of relative humidity, and it is therefore con-
venient to commence our study of the normal curves
of these two climatic factors with an example of a
climate of this sort. The number of stations where
hourly observations of sufficient duration have been
taken is but small, and we are therefore somewhat re-
strieted in our choice; but the case of the climate

1

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1—4—31—3—33-H

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Fic. 1.—Diagram of diurnal variation of temperature and
humidity at Pachmari during March. The figures on the left
refer to percentage humidity, those on the right to temperature
(Fahrenheit). Тһе heavier horizontal border lines indicate
the hours of darkness,

192

THE JOURNAL OF TROPICAL MEDICINE.

[April 16, 1906.

of Pachmari, in the Central Provinces of India, for
March, which is graphically represented below, will
serve sufficiently well for our purpose.

The first point that strikes the eye in examining
these curves is their almost perfect symmetry, which
is the more remarkable as they are plotted from the
data of a single month; and we may be sure that in a
term of years the curves would smooth out to perfect
regularity. This is, of course, only what is to be ex-
pected from the ordinary law of physies, and is merely
an expression of the fact that the absolute amount of
watery vapour in the air can vary but little from hour to
hour, save in exceptionally circumstanced localities, such
as those influenced by diurnal land and sea breezes.

It will be noticed that both curves start from the
mean line about 8 a.m., and leave it in opposite direc-
tions. At first very rapidly and then more slowly, till
they respectively reach their maximum and minimum
points, which in the case of temperature is reached
about 2.30 p.m., and of humidity shortly after, at 3 p.m.

From this time the changes are slow until 5 p.m.,
after which the fall of temperature and rise of humidity
are extremely rapid until 8 iu the evening, the mean
line being crossed about 7 p.m.

From this time the temperature falls and the
humidity rises steadily till 6 a.m.; after which, with
the rising of the sun, both lines turn steeply
back to regain the mean again at 8 a.m. It will
also be noticed that while the curves of the heat
of the day form bold and fairly symmetrical loops,
those of the cooler hours are quite different, the fall
of temperature being very slow in comparison with
the rapid rise after dawn. Now, 7, 8 and 9 in the
morning are very favourite fixed hours for taking
meteorological observations, and it will be observed
that two observatories placed side by side at Pachmari,
one of which observed at 7 алп., while the other did so
at 9, would record relative humidities of 40:5 per
cent. and 28:5 per cent. respectively, while the differ-
ence between 7 and 8 a.m. is quite suflicient to give
an entirely erroneous impression of the comparative
dryness.of the two really identical places. It might
at first sight be thought that a single observation
taken about 8 алп. would give a very close approach
to the mean temperature, but a moment's inspection
of the curves shows that they аге so steep at both of
the points where they cut the mean line that a very
trifling lack of punctuality would seriously vitiate the
results, as the conditions change at these times of the
day as much in a few minutes as they do in an hour
when approaching the maxima and minima. Many
observatories take their observations at 9 a.m., 3 p.m.
and 9 p.m., but on this plan two of the three observa-
tions are too near the mean to be at all independent of
exact punctuality, and the mean of the three will neces-
sarily be much іп excess of the true mean. `

At Cairo and some other first-class observatories,
observations are taken at бапа 9 a.m., 3 and 6 p.m.,
and midnight; and such a series gives a close ap-
proach to the true mean of the year, but it cannot be
trusted in the case of individual months, as a very
casual test of the plan brought to light months in
which these data yielded results as much as 9:5 per cent.
different from their true mean, which is no better than
is afforded by the mean of the maximum and minimum

humidities alone, without taking any other data into
the ealeulation. Оп entire years indeed, mean humi-
dities caleulated on this latter plan seldom err by
more than 1 per cent., so that though for annual
figures the plan of five observations may be admitted
to give a closer approach to the true mean, its advan-
tages over the simpler method are quite inconsiderable.

But elaborate observations of this sort are only
possible in observatories of the first class, and we are
probably well within the truth in surmising that the
stations where they are taken might be numbered on
the fingers for the entire British Colonial empire.

Moreover, unless they be supplemented by separate
figures obtained on some simpler plan they are quite
as useless for purpose of comparison with the great
bulk of stations as those of the humblest observatory
with its single part-time observer, from whom at
most but two daily observations can be expected. We
have already seen that morning and evening observa-
tions are undesirable, because at these times of the
day the changes are so rapid as to lay them open to
many fallacies, not the least of which is that even in
sub-tropieal regions the varying length of the days
will bring about considerable differences in the ap-
parent results of different months.

We are thus reduced to observations taken near the
maxima and minima, but one of these occurs at night,
and the other in the busiest hour of the day, and so
cannot be reasonably expected from part-time observers.

We are reduced, then, to the necessity of employing
self-recording instruments ; and as thermographs and

Jother continuously recording instruments are expen-

sive, delicate, and troublesóme to manipulate, we are
praetieally reduced to the employment of maximum
and minimum thermometers which are open to none
of the above objections.

In other words, it is proposed to employ wet bulb

/ maximum and minimum thermometers, and to emplo

these in conjunction with the corresponding dry bulb
instruments to calculate the maximum and minimum
humidities. The only objection that can be advanced to
this proposal isthat the wet bulb extremes donot always
coincide in time with those of the dry bulb. Now,the
principal reason of this is that wet bulb thermometers
move more slowly, and therefore have а tendency to
lag behind the dry instruments, but the same objection
may be taken to all hygrometric observations deduced
from these instruments at any possible time or combi-
nation of times; and though irregular factors may
slightly vitiate the advantages of the proposed plan in
fickle climates, such as that of England, an examina-
tion of the above and following curves, as well as
many others that have been plotted, shows that this
source of error cannot be considered as of any practical
importance in the case of hot climates. Moreover,
in the case of temperate climates the irregular factors
of this source of error necessarily have & tendency
to correct each other in any at all extended series of
observations, even such as а month. Above all, the
results of the plan would be strietly comparable, &
character entirely wanting in our meteorological re-
turns as at present constituted.

The accidental relations of a change of 19 F. in
temperature, corresponding to 1 per cent. of relative
humidity is, however, confined to very dry climates.

April 16, 1906.)

Under conditions of greater moisture, the percent-
age of humidity alters much more rapidly than the
temperature, as expressed in degrees Fahrenheit; so
that at humidities of about 65 per cent. а change
of 1? Е. corresponds to a change of 2° Е., and in ordi-
nary equatorial and insular warm climates, the pro-
portion is even higher, and may reach as high as
9:4 per cent. of humidity to the degree Fahrenheit;
though in exceptional cases, as in the almost saturated
climates of tropical hills, there appears a tendency for
the ratio to fall as saturation is approached.

These relations between changes of temperature
and moisture appear to be fairly constant, and are
represented by the diagram below (fig. 2).

ET
i

Fic. 2.—Curve illustrating the relation between the ranges of
temperature and humidity at varying degrees of atmospheric
moisture. The horizontal borders are graduated to percentage
humidity, the vertical to the factor by which an alteration of
temperature must be multiplied to obtain the corresponding alter-
ation in relative humidity, e.g., the curve cuts the vertical of 30
percent. at 1‘, at which humidity an alteration of 1° F. corres-
ponds to a change of 1 per cent. relative humidity, while at 63
per cent. humidity a change of 1° F. is associated with that of 2
per cent. relative humidity.

The information so afforded is necessarily only
approximate, and has been obtained in a purely
empirical manner, but is really of practical value,
when it is desired to make а comparison of data
collected at different hours, the more as the mean
temperature does not appear to notably affect the
ratio, at any rate within the climatic limits we are
considering. On this account it is commonly more
convenient in diagrams to plot the changes of humidity
on half of the scale of those of temperature, and this
plan is adopted in fig. 4, the last of the instances plotted.

Moist air is a much better conductor of heat than
dry air, and also obstructs radiation, much heat being
absorbed instead of passing through it. Changes of
temperature are therefore much less rapid in moist
climates, and the diurnal range of temperature much
smaller. These differences are graphically illustrated
in the contrasted ranges of temperature and humidity
of the very dry climate of Jaipur in Rajputana for the
months March, April and May, with those of Rangoon
in Burmah for the months July, August, and Sep-
tember, though the mean temperatures of the two
stations (78:79 Е. for Rangoon and 84:19 for Jaipur)
during those periods do not differ greatly. The mean
humidity of Rangoon, however, during the period
In question is 92:7 per cent., while that of Jaipur
is but 33:5 per cent.

THE JOURNAL OF TROPICAL MEDICINE.

123

There are, however, other factors at work in the
production of uniformity of climate than can be gauged
by hygrometers installed at or near the ground level,

Ето. 3.— Graphic representation of the hot season in Jaipur,
contrasted with the wet season in Rangoon. Asin the last figure,
temperature (Fahrenheit) and percentage humidity are plotted
on the same scale. The lines with ringed nodes refer to Ran-
goon.

the principal of these being the amount of cloud which
is determined by the hygrometric conditions not of the
lower, but of the upper regions of the atmosphere
which do not, by any means, necessarily correspond.

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Еіо. 4. —The above curves show the relation between tempera-
ture and relative humidity fora mean day calculated from hourly
observation throughout the year. The heavy lines are the
means of three years’ observation at Mauritius, the dotted the
same for Hong Kong. In each case the curves of tempcrature
are indicated by the nodes being marked by small circles, The
curves of temperature are plotted at 2° Е. for each 1 per cent.
relative humidity. The lighter lined curves are those of
December and June for Mauritius for relative humidity.

194

[April 16, 1906.

THE JOURNAL ОЕ TROPICAL MEDICINE.

The finely divided particles of water that form
clouds and fogs are far less transparent and diathermic
even than moist air; andthe former not only greatly
tempers the heat of the day, but also form a protective
roof, which prevents loss of heat by radiation at night.

These differences are well shown in fig. 4, in which
the diurnal changes for the means of the year are
plotted for—the islands of Mauritius and Hong Kong
respectively. An even more striking contrast might
have been afforded by the extremely uniform climate
of Batavia, but there the daily variation is so small
that on the scale the diagrams are reproduced,
the lines would be inconveniently near the mean
lines for exact inspection. The mean humidities of
the two islands, it will be seen, differ only by less
than 1 per cent., and their mean temperatures suftici-
ently approach to each other for practical comparison.
It will be thus seen that provided we are furnished with
the maximum and minimum of temperature and
humidity, and the average amount of cloud, we can
form a very close estimate of the character of a
climate and of its effect on the human system—apart
from endemic diseases which usually depend on the
quite different question of the geographical distribution
of parasites, though these in their turn are necessarily
much influenced by climatological conditions which
thus, after all, are mainly responsible for the healthi-
ness or sickliness of any given locality.

G. M. Се.
-----о---

THE IMPERIAL INSTITUTE.

Tue fourth number of the third volume of the
“ Bulletin" of the Imperial Institute, just issued,
gives a short account of the present position and
the work of what promises to be an eminently useful
institution, when once it is in full working order.
The Imperial Iustitute was founded as а national
memorial of the Jubilee of Queen Victoria, and
opened by Her Majesty in May, 1893. Іп 1900 the
building became the property of the British Govern-
ment, and in 1902 the management of the Imperial
Institute was assigned to the Board of Trade. Sir
Cecil Clementi Smith, G.C.M.G., and Sir Alfred
Bateman, K.C.M.G., have been appointed a managing
committee, and Professor Wyndham Dunstan, F.R.S.,
Director of the Imperial Institute at South Ken-
sington.

The principal object of the Institute is to promote
the utilisation of the commercial and industrial re-
sources of the Empire, by arranging exhibitions of
natural products of the various parts of the empire,
and providing for the investigation and dissemination
of scientific, technical and commercial information re-
lating to them. The work of the Institute is now con-
ducted by the Commercial Intelligence Branch of the
Board of Trade, which is located at 73, Basinghall
Street, London, E.C., and by the Emigrants’ Informa-
tion Office in Westminster.

Thirty-cight colonies and dependencies have their
economic products arranged on a geographical system
in the galleries of the Institute. A Bureau of Informa-
tion has been opened to facilitate the supply of general
information and the distribution of literature. А
Scientitic and Technical Department, consisting of well-

appointed laboratories, deals with the investigation of
the new or the imperfectly known products of the
colonies and of India, with a view to their utilisation
in commerce; and British Consuls are encouraged to
transmit natural products of the countries to which
they are appointed. In the Institute is an excellent
library as well as reading rooms, and three specially
appointed rooms termed colonial conference rooms.
The Cowasjee Jehanghier Hall is used in common
by the Institute, the India Office and the London
University for lectures, meetings and conferences.
Nor does the work of the Imperial Institute end
with these, for the British Women’s Emigration
Association and the Colonial Nursing Association
(Room 5) have had оШсев portioned off for their use
and occupation. The “Quarterly Bulletin of the
Imperial Institute” is a valuable publication, and
not only announces the work being carried on at the
Institute, but supplies technical information concern-
ing many of the less known natural products of the
British Colonies and of India. In the volume just
published we find reports on ‘Cotton from the
Federated Malay States,” “ Fibre of Asclepices Semi-
lunata from Uganda,” “ Lokesi" fibre from North-

Western Rhodesia, ‘Black Damar Resin from
Assam," and several other articles of high economic
value.

The “ Bulletin,” price 1s., is obtainable at Messrs.
Eyre and Spottiswoode’s, Fleet Street; Messrs. G
Street and Co., Cornhill; or at the Imperial Insti-
tute, South Kensington.

SIXTH INTERNATIONAL DERMATOLOGICAL
CONGRESS, NEW YORK, SEPTEMBER, 1907.
President: Dr. James C. Wuite, Boston, U.S.A.

To the Editor of the JovRNAL or TRoprcaL MEDICINE.

Drar Sir, —The Organising Committee of the Sixth

International Dermatological Congress to be held in New
York, September, 1907, has selected as one of its topics for
discussion Tropical Diseases of the Skin. Can you, perhaps,
suggest someone in Great Britain or your colonies to report
on the subject from a dermatological standpoint ?
Very truly yours,
Јонм A. Forpycr, M.D.

80, West 40th Street. New York,

March 8th, 1906.
| Will those intending to take part in the discussions оп
Tropical Diseases of the Skin at New York, in September,
kindly communicate with Dr. Fordyce direct ?—Ер. J. Т. М.)

--------

Abstract.
CONDITIONS AFFECTING THE LOCATION
OF MISSIONARIES OR THEIR RETURN
AFTER FURLOUGH?

By С. Г. Harrorp, M.D.
Principal, Livingstone College, Leyton, London, E.
THERE are few questions more difficult to decide
than those which relate to the influence of climate on
the health of individuals. ‘This is even the case with
our own little island ; and when we are called upon to

! Read before the Medical Otlicers of Missionary Societies,
January, 199.

April 16, 1906.)

advise those who may be called upon to take up work
in distant regions of the world, the complexity of the
problem is very largely increased from the fact that
uniformity of climate does not exist throughout any
large territory in any part of the world. )

In the selection of suitable candidates for service in
the mission field, although we may notall be agreed as
to the exact points which should lead to disqualifica-
tion, we are at one in requiring that candidates for
foreign service should be physically sound.

It must be remembered, however, that the mission
field is a wide one, and there are candidates who would
be totally unfitted for work in some regions who might
be able to do useful service in other parts, so that we
need to use great discrimination in the selection of
countries to which each Missionary may be permitted

to go.

It will probably be best to adopt a geographical
order, and to note the prominent characteristics of
those countries to which Missionaries are most com-
monly sent, and in so doing we may select first the
continent of Africa, which presents some of the greatest
difficulties of climate, though parts of it may be
ineluded under the healthy regions of the world. It
may be considered in five sections: (а) West Central
Africa, including Senegal, and Niger and Congo basins ;
(b) East Central Africa, including Upper Nile districts
and Zambesi basin ; (c) highlands of Central Africa ;
(d) South Africa ; (e) North Africa.

(a) West Africa. — West Africa has the unenviable
reputation of being the most unhealthy part of the
world, and by West Africa we mean the coast districts
extending from the Senegal to the Congo, and including
the country drained by these two rivers and the Niger.
Probably the occurrence of very grave forms of malaria
апа the prevalence of blackwater fever account for
much of the unhealthiness of the climate, but the
houses are not, as & rule, carefully constructed, and
often are built in close proximity to insanitary native
huts; the food supply is in few instances well developed;
there are no health resorts to which Europeans can
readily go nearer than the Canary Islands, and there
are little opportunities for exercise and recreation.:

(b) The East African districts present very similar
conditions to those found in West Africa, but the form
of malaria is perbaps not quite so malignant, and there
are better opportunities for obtaining change for re-
cruiting health.

(c) Highlands of Central Africa.—Certain parts of
Central Africa have proved to be much more healthy
than the coast districts. This is the case in Uganda,
where European Missionaries have been at work, and
very few deaths from climatic diseases have taken
place, and very few have been invalided home. In the
high plateaux of eastern equatorial Africa even better
health conditions are to be met with, and some of
these appear to be quite suitable for European colo-
nisation. Тһе same sort of conditions are to be met
with in the Shire Highlands in British Central
Africa.

(d) The elimate of South Africa is, in many ways,
better than England, and in some parts would suit
constitutions to whom the European winter is trying ;
malaria and bowel disorders occur in certain districts,
but these may be largely prevented with care.

THE JOURNAL OF TROPICAL MEDICINE.

125

(e) North Africa possesses an ideal winter climate,
but the summer months are exceedingly hot. If it is
possible to take а holiday іп а cooler region duriug the
months of July to September, the climate may be
suitable for many who could not work in a tropical
climate.

Palestine and Syria.— What has been said about
North Africa applies to а certain extent tothese parts,
but it should be remembered that malaria is very pre-
valent in Palestine at certain seasons of the year, and
owing to defective sanitation in the chief cities, there
is great risk of contamination of the water and food
supply, апа thus bowel disorders are frequent, and
epidemics of cholera are not unknown.

Arabia, including Turkish Arabia, possesses а very
hot elimate, and in some seasons it is intensely hot,
whilst here, again, sanitation is almost unknown.

Persia possesses а fairly temperate climate, and,
apart from bowel disorders, there is very little climatic
disease.

India.—The houses in India are more generally
suited to the climate, whilst there is usually a good
food supply, and good sanatoria can be found in the
principal hill stations, which сап be reached by a
good railway system.

South India, with which we may include Bombay
and the Central Provinces of India, is distinctly
tropical; the east coast is more trying than the
west, and there is more malaria in the east.

North India possesses а fairly temperate winter
climate, and many Europeans pay visits to India
during this season with very slight risks to health.

Apart from the definite hill stations, it is probably,
true to say that the United Provinces possess the best
climate. The Punjab, Sind and Rajputana probably
rank next in point of view of healthiness, though the
heat here is often most intense. Probably the most
unhealthy is Bengal.

Burmah may be classed with Bengal on the point
of view of climate, whilst the health conditions of Siam
and the Straits Settlements may be compared with
those of South India.

China possesses even а greater range of climate
than India, but the sanitary conditious are bad, and
there is, therefore, а tendency to bowel disorders.
There is also a special strain on the nervous system in
China; and Missionaries to China should have no
tendency to mental or nervous disorder, either here-
ditary or acquired.

South China is distinctly malarious, and might be
classed with Bengal. North China, on the other hand,
has an intehsely cold season, and is fairly free from
any climatic diseases.

Japan.—The climate of Japan cannot be regarded as
an unhealthy one, but there is one difficulty which
must always be kept in view in selecting workers for
Japan, viz., the great tendency to a curious form of
headache, which is often spoken of as “Japan
head."

America.—In the American continent our chief
attention must be directed to the tropical regions
which are to be found in Central America and to the
north of South America. The health conditions in
many parts are exceedingly unhealthy, and may be
compared with East Africa, though the prevalence of

126

yellow fever must be taken into account, which does
not occur in East Africa.

Tropical Islands.—Each of the important tropical
islands has some special features of its own, and
particularly with reference to the distribution of
malaria. Naming the most important, we may men-
tion Madagascar, Ceylon, East Indian Islands, and
the West Indies. These are usually more healthy than
similar regions on the continent. Й

Cold Climates.—There appears to be little climatic
disease in cold regions, such as in the northern dis-
tricts of North America, but there are great hardships
to be endured, which require considerable powers of
endurance.

The Return of Missionaries after Furlough.—There
are many causes which may prevent the return of
Missionaries to different parts of the field.

Individuals who suffer froin persistent attacks of
malignant malarial fever should be regarded as unsuit-
able for malarial climates. Repeated attacks of black-
water fever should be regarded as a disqualification,
and one particularly severe attack may, however, be
regarded as equivalent to several slight attacks.

Continued diarrhea is one of the most serious con-
ditions which affect the prospects of useful service in
the Tropies, and unless a permanent and satisfactory
cure can be obtained, there must be no thought of
return to the mission field.

Persistent nerve troubles, such as sleeplessness,
headache, or any tendency to mental weakness, are
signs of danger which must not be disregarded, espe-
cially as they are likely to be accentuated by further
residence in the Tropics.

Other cases will be found in which there appears to
be some particular idiosynerasy which renders the
individual unsuitable for work in one country or loca-
tion, and yet which might not debar him from work in
another climate. А reference to some of the climatic
conditions of the different countries may help in finding
the most suitable location.

———99—————

ерісі.

J. Courmont, of Lyons, on the “Atmosphere,” and
C. Lesieur, of Lyons, on “Climatology,” in a
Treatise on Hygiene, published by P. Brouardel
and E. Мовпоу, T. 1., fascic. i., pp. 194. Paris,
J. B. Bailliére. 1906.

The characters of the atmosphere are studied from
the standpoint of publie health. Теп pages are de-
voted to its chemical and twenty-three to its physical
properties; the characters of free and confined air
being separately considered. Another ten pages are
given to the question of inorganie dust and the
methods of dealing with dust nuisances, after which
living organic dust—the bacteriology of the air, in
fact—is considered in the final thirteen pages. Тһе
variation according to season and altitude in these
living forms of dust, the transmission of diseases
through the agency of the air, and the natural means
of purification by time, drying, and by the sun’s light,
are all brielly considered, so tbat the article is one
which treats systematieallvy] of a subject which has
hitherto been but scantily dealt with in text-books.

THE JOURNAL OF TROPICAL MEDICINE.

M. Leisieur's article on climatology is necessarily
too brief to include more than a bare sketch of his
subject, and so wisely devotes most attention to
temperate European climates, but some notice of hot
and cold climates is also included, and the last five
pages are devoted to the question of adaptation to
climate.

miu ne ec rm

Correspondence,

THE REVIEW OF HUGGARD'S HANDBOOK OF
CLIMATIC TREATMENT.

To the Editors of the JOURNAL OF TROPICAL MEDICINE.

Утик, Not until two or three days ago did I see your issue
of February 15th, in which vou courteously inserted my
letter criticising vour Reviewer's notice of my book. But by
printers’ errors in the placing and in the omitting of quota-
tion marks, I aim made to adopt the Reviewer's standpoint.

In these circumstances I beg permission once more, and
finally, so far as I am concerned, to place the point at issue
before your readers.

According to my exposition the comparative coldness of
the upper layers of the atmosphere is mainly due to the
physical laws of the expansion of gases, a body of doctrine
as fundamental in modern meteorology as is the doctrine of
gravitation in astronomy. But according to your Reviewer
"this law explains only the rather exceptional case of up-
hill winds." An exactly equivalent criticism in astronomy
would be that the law of gravitation explains only the fall of
apples То the Heviewer's mind the true reason of the
comparative coldness of the upper layers of the atmosphere
is “ the universal operation of the law of selective absorp-
tion."

In reply to my criticism your Reviewer quotes the first
two paragraphs from Hann's Exposition of the Causes of
the Vertical Decrease of Temperature, in which Hann points
out * that the storage of heat at the bottom of the atmos-
phere results from the peculiar behaviour of this atmosphere
towards solar radiation. This process has been called selec-
tive absorption.”

That the special storage of heat in the lower layers of the
atmosphere accounts for the comparative coldness of the
upper layers may be claimed by your Reviewer as a dis-
covery of his own. At any rate this explanation does not
appear to have struck Hann, who, a page or two after your
Reviewer's quotation (Handbuch der Klimatologie, 2nd ed.,
1897, vol. i., p. 264), continues as follows :—

“ Therefore the general law holds good: Ascending masses
of air cool at the rate of 1° C. for each 100 metres of eleva-
tion, so long as no condensation of water vapour takes place ;
conversely, descending masses of air become warm at the
same rate.

“If we imagine the air masses of the atmosphere so
thoroughly mixed in a vertical direction that every particle
of air had several times passed through the whole height of
the atmosphere, the fall of temperature would then be found
to be 1° C. for each 100 metres of height. At this rate of
decrease of temperature a rising or a falling mass of air
would, at each level, encounter its own temperature, that is
to say, it would in each level be in equilibrium, having no
tendency to rise or to fall. This is the condition of indiffer-
ent (convective) equilibrium,”

That the actual rate of cooling in the lower layers of the
atmosphere is much less rapid than theory would lead us to
expect is explained partly by selective absorption and partly
by the heat set free through the condensation of moisture.

In his Lehrbuch der Meteorologie, 1901, p. 161, Hann
says: “Тһе more recent balloon journeys have shown in
fact at heights over 6 to 8 kilometres а fall in temperature
of 08-99 C. per 100 metres; and this proves that at

April 16, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE.

127

these heights vertical movements of the air must be very
frequent, since they almost determine the temperature of
these high layers.

Thanking you in advance. .

I have the honour to be, Sirs,
Your obedient servant,
WirnLiAM R. HUGGARD.

Davos-Platz, March 23rd, 1906.

[At the urgent request of Dr. Huggard we departed from
the general rule of all publications, scientific or otherwise,
that a reviewer's comments are privileged.

At first sight this rule might appear to be unfair to the
reviewed, but it is obvious that but for its existence, either
reviewing would fall to the level of uniform inane compli-
ment, or much of the space of periodicals would be occupied
with discussions interesting only to the combatants con-
cerned. We therefore propose to adhere rigidly in the future
to the wholesome general rule, and if any author is not pre-
pared to accept our review of his work, for what it may be
worth there is no need for him to forward it for review.

The present instance is a good case in point, as it has in-
volved printing long extracts from a standard work access-
ible to everyone. Both reviewed and reviewer, of course,
are perfectly aware of the rudimentary fact that gases get
hot when compressed, and cool when they expand, but if
this determined the temperature gradient for different eleva-
tions the fall of temperature in ascending would be much
more rapid than it is, and the actual usual gradient is deter-
mined by the action of selective absorption. We have
equally no doubt that Dr. Huggard thoroughly understands
this, but he has failed to make it clear inthe book reviewed,
in which “selective absorption ” isnot even mentioned in
the index. It is not enough, however, for an author to
understand his subject, as he fails in his object unless he
succeeds in making others do so. This discussion must now
be closed.—Ep. J. Т. М.)

-------<>--

Рглоов AND FLEAS.

THE Indian Plague Commission are said to have
definitely proved that rat fleas are the normal vehicles
of infection in animals, and probably in man. This
has been arrived at by shewing that animals protected
by fine wire gauze remain immune in plague-infected
buildings, while unguarded controls contract the disease
in large numbers. Although Ogata as far back as 1897
shewed that the titurated fleas of rats were infective,
the theory of insect transmission has been generally
“ pooh-poohed," and much of the credit of bringing the
matter again to the fore is undoubtedly due to Capt.
Glen Liston, І.М.8., whose paper in the Indian Medical
Gazette, of February, 1905, may certainly be considered
the new starting point of the now triumphant theory.

—— 9 —————
Hotes and Fetus.

METEOROLOGICAL stations are to be instituted under
the Indian Meteorological Department at Pharo and
Gyantse in Tibet, and as these are our only present
stations heyond the Himalayan watershed, the gain
to meteorological science can hardly fail to be of the
first importance, especially in connection with the
supposed relationship between the snowfall of Cen-
tral Asia and the intensity of the south-west
monsoon.

Mr. Huan CLEMENTS’ FORECAST FOR THE
SoutH-west Monsoon oF 1906.

Omitting a number of illustrations of the in-
fallibility of his methods based on the weather in
Bombay, we reproduce from the columns of our
contemporary, the Allahabad Pioneer, the following
letter on the forthcoming monsoon :—

* The south-west Indian monsoon is not а mag-
nified land and sea breeze, as stated in all pseudo-
scientific works, but is caused by the tidal action
of the moon and the sun forming depressions to the
north of India, towards which the air from the
Indian Ocean is drawn by the great inequality in
the barometric pressure.

** From the position of the moon and the sun at any
moment I am enabled to localise the depressed area all
over the world, and thus predict unsettled and · wet
weather. For each place there are certain lunar and
solar celestial positions correlated with periods of
depression and rainfall.

* ж ж ж

“Іп accordance with my calculations of the height
of the barometer and rainfall for each day, may I
venture to predict that the south-west monsoon will
break on May 16th, 1906, and continue off and on till
August 13th? There willbe some rain again after the
first week in September and at the end of August.

“It wil be windy round the British coasts on
January 3rd, 11th, 22nd, and 29th, 1906.

“ДА. My prediction of mild and cold periods
from November 21st has been amply verified.

“В. Тһе Daily News of December 21st, 1905,
contained my Christmas forecast, and proved accurate
in every detail.

* Huen CLEMENTS.

‘‘ Newton House, Burry Road,

“ Dulwich, S.E.,
** December 31st, 1905."

The above extracts may be of interest to such of
our readers as reside within the limits influenced by
the south-west monsoon, especially as by the time
this issue reaches India the performance of the
monsoon of 1906 will be *'just agoing to begin,"
and they will be able to compare the actual facts
of Nature with the predictions of the prophet. Тһе
objections held by ordinary students of meteoro-
logical science to Mr. Clements' theories are suffi-
ciently obvious, and are based on the facts that іп
the first place, although an atmospheric tide un-
doubtedly exists, the wave so produced is so feeble
that it can only with difficulty be recognised in
barometric records; and again, it is difficult to see
how & series of phenomena regularly recurring every
lunar month can account for a seasonal phenomena
lasting some five or six of these periods. Oceanic
tides can be foretold with a mathematical certainty
which was recognised in proverbial folk.lore long
before the facts had been reduced to tabular state-
ment; but quite the reverse is the case with the south-
west monsoon, which has hitherto defied the efforts of
the scientific weather forcaster in a manner that has
led the Indian public to regard his predictions with
rather more amusement than confidence.

Of course, the official meteorologists would be the

198

first to admit the inadequacy of our present knowledge
and means; but even if Mr. Clements chances to hit
the mark on the present occasion, it would require
several years of success to convince those who have
most deeply studied the question to look upon a
successful guess as other than a coincidence.

eee M

Recent and Current Literature.

A tabulated list of recent publications and articles bearing on
tropical diseases is given below. To readers interested in
any branch of tropical literature mentioned in these lists
the Editors of the JouRNAL OF TROPICAL MEDICINE will be
pleased, when possible, to send, on application, the medical
journals in which the articles appear.

“Journ. Roy. Met. Society,” 1906, p. 21.

GENERAL FEATURES OF THE PRESSURE AND WIND CONDITIONS
OVER THE TRADES-MONSOON ÁREA.

Dallas, W. L., epitomises the results of ten years observa-
tions from ships' logs, and land stations, recently collated by
the Indian Meteorological Department, within an area of
82? N. to 12° S. and 407-140? Е.

These show that, taking the whole area, pressure is
highest in January and lowest in July, while the wind is
strongest in the latter month; but shows, unlike the pres-
sure, not а single maximum in January, but double minima
about March and October.

The apparent discrepancy is due to the undue preponder-
ance of the northern latitudes, and the contrast in the distri-
bution of sea and land of the belts north and south of the
line. Even, however, if two 4? belts N. and S. of the equator be
taken; the double oscillation, corresponding to the position
of the vertical sun is very ill-defined, and moreover, in both
zones, there occurs a minimum in April but there is none to
correspond with it in October, nor do the pressure maxima
occur at the solstices.

The pressure changes from month to month are much less
symmetrical than might be expected. They are smallest at
the two solstices, when the sun remains practically station-
ary over lat. 21° for two months, and largest between May
to June and September to October, as a result of the large
temperature changes then occurring over the large land
surfaces of Southern Asia.

The distribution of pressure in each month in the included
area is then ‘discussed, but these are best studied in the
appended graphic representation.

It will be observed that the pressure changes lag a great
deal behind the sun. In spring and autumn the curves аге
saucer-shaped, the lowest pressures being between the
equator and 10 S°., and as a result, the winds north of this
area have a marked northerly component, and those south
of it a southerly ; but in April the distribution changes, and
there comes into existence a steady decrease of pressure
from lat. 30? 5. to 22" N., while the high pressure area in
809 N. is very slight and unimportant. From May to
August these changes are maintained and intensified, there
being a steady gradient from 80° S. to 80? N., which is at its
steepest in July, when it amounts to nearly three-quarters
of an inch of mercury, but there is a smaller second maxi-
mum of a quarter of an inch in December, with interposed
minima in February and November, when the range of
gradient is no more than 1:7 inch. Тһе calms of these latter
months and the strong winds of-February are easily under-
stood by following the curves for each month.

The most important point in the paper, however, is that
the author quite rejects the old theory that dominates many
of the past official memoirs of the Indian Meteorological
Department.

These were to the effect that the monsoon current is due
to an impulse in one spot, like a jet of steam issuing from a

THE JOURNAL OF TROPICAL MEDICINE.

[April 16, 1906.

closed reservoir. For example, in а Memorandum, written
in 1891, these views are stated as follows :—

“ Hence the advance or extension (or burst of the moon-
soon) takes place from South to North, and therefore cannot
be explained as а mere indraught to а hot area. The
phenomena rather indicates that there is а vast resistance
to be overcome, and that when this is effected by a force
from the rear, the massive current moves forward and in-

vades India."

ТІНЕ NE

ІШ ЛИНИЯ
TEE EA

RR

TENE A.

:
Г
ў

3
È
|
|

-
a
|
|

Ву means of а table showing the barometric gradients
from zone to zone, and the mean wind force, the author
shows that the observations discussed afford no evidence of
any such “tempestuous obstacle overcoming onslaught,”
and that “ а general agreement between the pressute differ-
ences and the mean force of the wind obtains throughout
the whole area and throughout the whole monsoon period,
and the velocity and strength of the winds of the circulation
appears to be regulated by the ordinary rules of the differ-
ences of barometric gradient, and not, at any time, by a
single impulse imported to the rear of the aerial current."

Rotices to Correspondents,

1.—Manuscripts sent iu cannot be returned.

2.—As our contributors are for the most part resident abroad,
proofs will not be submitted to those dwelling outside the United
Kingdom, unless specially desired and arranged for.

3.—To ensure accuracy in printing it is specially requested
that all communications should be written clearly.

4.—Authors desiring reprints of their communications to the
JOURNAL oF TROPICAL MEDICINE should communicate with the
Publishers.

5.—Correspondents should look for replies under the heading
‘ Answers to Correspondents.”

Мау 1, 1906.)

THE JOURNAL OF TROPICAL MEDICINE.

129

Original Communications.
NOTE ON THE TINEA IMBRICATA IN
BRAZIL. .

By Unyssgs PanaNHos, M.D.
Assistant in the Pasteur Institute; Physician о the Charity
Hospital ; and
CanaMURIE Pars Leme, M.D.

Director of the Laboratory of the Chemical Institute of
Sdo Paulo.

Tue first casesof Tinea imbricata recognised in
Brazil were observed by one of us during a scientific
excursion ordered by the Government of Sáo Paulo
in Brazil. The first case which, by its evident symp-
tomatology, induced us to make the diagnosis of Tinea
imbricata was observed in a native of the Carajas
tribe inhabiting one of the islands of the River Ara-
guaya in the State of Goyaz.

Among the Carajas Tinea imbricata is very com-
mon. They call 15“ roóro," which, in their language,
means ‘the flying disease," because they think that
hostile tribes blow it in the direction of their huts to
cause them harm.

The natives of Brazil generally employ for the cure
of this illness the bark of the root of pinjossara,
which is no other than the plant called Осайа perdiceps
of Baill.

One of us was present at the moment of this appli-
cation for the treatment of the Tinea imbricata among
the indigenes, which, on account of its great originality,
deserves to be mentioned.

The bark of the root of the Ocalia perdiceps is
placed in maceration in cold water. On the following
day the patient undergoes the application of this medi-
cine, which consists in friction over the whole body
with the macerated bark, after which the patient is
exposed during half an hour to the action of the sun's
rays, and washed afterwards іп cold running water,
his skin being then rubbed all over with the ashes of
the same plant.

The consequences of this treatment are not long in
appearing; the skin becomes reddish, being formerly
of a bronze colour; the patient becomes agitated,
the temperature rises, and sometimes delirium is
observed, which often reaches frightful proportions.
This state of things lasts from four to six hours.
Sleep comes on, and on the following day the patient
awakes quite calm, his general condition is good, and
the appearance of his skin visibly modified, the large
scales fall off, a slight glossy scaling being then
observed.

On the third day after this application the same
treatment is repeated, but then the reaction of the
organism is weaker.

The treatment is thus continued every three days
till the complete recovery of the patient. The reaction
of the patient always preserves an inverse proportion
to the number of applications.

The positive result of this native treatment, though
empiric and excessively violent, is undeniable. The
treatment of the native Curicy, the first patient whom
we observed and a typical case of Tinea imbricata,
proves it thoroughly.

Submitting himself to the indigenous treatment, he
recovered in our presence from his illness, which did
not repeat itself, as the man accompanied our scientific
excursion as far as the State of Para, returning in our
company to Sáo Paulo without the least sign of re-
appearance of his dermatosis.

Tinea imbricata exists in Brazil, as we have observed
personally, in the States of Goyaz, Matto Grosso,
Minas Geraes, and Sáo Paulo.

In the State of Goyaz it rages along the banks of the
River Araguaya ; in Minas Geraes it exists in the city
of Uberaba and its neighbourhood, and in Matto
Grosso among the natives on the left bank of the
Araguaya.

In the State of Sáo Paulo, where we һауе. better
observed it, Tinea imbricata is found on the banks of
the River Pardo in Yardinopolis, Sarandy, Visconde,
Coronel Orlando, and in the populous city of Batalaes.

Tinea imbricata in Brazil attacks every race. We
had opportunities of observing it in individuals of
the yellow гасе, in natives, among the white people,
and negroes. Age and sex have no influence whatever
upon it. Among our observations cases occurred at
the ages between 12 and 50, and the prevalence in
either sex is not remarkable.

Social position presents no difference in liability ;
we have observed the disease in individuals belonging
to the lowest class of society, but, on the other hand,
we have also seen patients who belonged to the highest
ranks, living with all comfort and having the best
hygienic conditions.

Тһе disease in Brazil presents itself in the classical
manner so accurately described by Sir Patrick Manson
in his valuable works on the subject. 'The dispo-
sition of the scales of the skin as a collar, their position
resembling that of the tiles on a roof, is quite accurate.

On examining our patients we have always found
the parasite described by Tribondeau. For the re-
cognition of the parasite the following process may be
employed.

The scales of Tinea imbricata are treated by alcohol
at 40? for five minutes, and afterwards with sulphuric
ether in a test tube, which should be shaken several
times, After having washed the scales with sulphuric
ether, treat them with а solution of potasium in
distilled water in the proportion of 10 per cent.,
keeping them iu that solution until they are disin-
tegrated.

The scales are then washed several times with dis-
tilled water, being left in that liquid for some time to
entirely free them from the excess of potassium.

After this nothing more is needed except to spread
the scale on a slide, which, under the microscope,
presents the leptophyton much more transparent and
hyaline than the cellular elements. The scale being
separated by the process we have described, and the
preparation being fixed a calore, we can stain it.

The colouring substances employed are any of the
aniline stains.

After having coloured the preparation, we wash it
with alcohol and distilled water, examining it imme-
diately with the microscope. One of us, in the re-
searches made in the Pasteur Iustitute of Sáo Paulo,
obtained good results with the method of double
colouring advised by Jeanselme. Having fixed the

130

THE JOURNAL ОЕ TROPICAL MEDICINE.

[May 1, 1906.

scales of the Tinea imbricata by othylic alcohol and
crystallisable acetic acid, the preparation being free
from all greasy substance, is plunged for twenty
seconds in a solution of 1 in 100 of eosine orange, and
afterwards discoloured by means of а few drops of
alcohol at 60°; the preparation is then plunged for
one minute in an aqueous solution of toluidin blue
of 1 in 100 and discoloured once more by means of
alcohol till the scale gets a clear colouring, after
which the preparation is clarified by means of xylol
and examined microscopically.

On the specimens coloured by the Jeanselme pro-
cess one сап see the mycelium filaments of the
parasites clearly stained іп dark blue on the epidermic
cellular elements, coloured yellowish-red.

Superior to the method of Jeanseline, just described,
is the following, mentioned by one of us in the
JoURNAL or Ткор:сА, МерісімЕ, of December, 1905.

This method consists in washing the suspected
scale in winter-green essence and Roux mixture; in
its disassociation in an ammouiacal solution of 30 per
cent., and its colouring by means of litbined aniline
blue prepared by a special process. The preparations
obtained by this method have a rare precision and
show the presence of the parasites, even if these
are in minute numbers. They are superior to the
methods of colouring in toluidin blue (Jeanselme),

or eosined alcohol (Besson), or vesuvine (Trebondeau)

aud safranine (F. Noe).

In our researches we have always observed, as
already stated, the parasite of Trebondeau. The con-
stituent elements are ramified and in great number ;
each one of them is formed of cubic or rectangular
articulations of various sizes. Where the ramifica-
tions can be descried the mycelium elements present
a single body resembling the letter T or Y.

We have investigated with the greatest care to
ascertain the starting point of the Tinea imbricata in
Brazil, but, unfortunately, all our researches have
been failures. It is a current opinion among people
inhabiting the infested localities that the Tinea imbri-
cata is derived from water, and shows itself in persons
who bathe in the rivers. All that is but a supposi-
tion; it is, however, convenient to observe that the
disease has its principal centres in villages situated
on the banks of rivers.

One of us has devoted himself to investigations so
ав to know how far the popular idea regarding the
diffusing of the Tinea imbricata through river bath-
ing is true, but nothing has been proved up to the
present respecting the subject.

Tinea imbricata is, in our opinion, increasing in
Brazil. Тһе fact of its being unknown up to a
short time ago denotes it was rare in past periods.
It used to attack only the natives, or persons inhabit-
ing those places where physicians were not to be
found who were acquainted with tropical dermatology,
and who did not make the true diagnosis of the
illness. Actually it is quite different, because the
disease exists in the populous centres where its greater
diffusiou is readily understood.

We have tried, on our patients suffering from Tinea
imbricata, most of the forins of treatment advised.

We have obtained good results by the application
of wet boric compresses, followed by friction with

black soap and the use of Goa powder, advised by
Branel.

The application of an iodine liniment recommended
by Patrick Manson has benefited some patients ; but
what has given the best results, in our cases, is the
bark of Ocalia Perdiceps adopted in the indigenous
method.

The general lines of our method are: (1) А general
tepid bath with an alkaline solution of one kilogramme
of sodium acid carbonate diluted in twenty litres of
water. (2) A lotion with the following mixture: Bark
of Ocalia perdiceps, 50 grammes; glacial acetic acid,
15 grammes; glycerinated water (10 per cent.), 985
grammes ; let the whole macerate during two days and
then filler. We employ, before making use of this
medicine, an alkaline solution to soften the scales
and thus facilitate the introduction of the parasiticide
medicine to the cellular elements. During this treat-
ment we recommend to the patient а liberal regimen.
We add also to this, tonic remedies such as iron,
arsenic and strychnine. With this treatment the
results obtained are quite encouraging.

MOSQUITO NOTES.
By Lieut.-Colonel б. М. Gives, I.M.S. (Rtd.).

I.—Nore on А бмлгл, COLLECTION or MOSQUITOES
FROM BanHaIN IN NORTHERN ARABIA (SHORES
oF PERSIAN GULF).

IT is a curious coincidence that an incidental remark
on the scantiness of our knowledge of the mosquitoes
of the Arabian peninsula in our last issue had hardly
gone to the press, when I received from Dr. A. Bennett
one of my collecting boxes with a small collection of
mosquitoes from the Island of Barhain.

Unfortunately, too many specimens had been crowded
into the box, so that some have suffered a good deal
in transit, and it is possible that it may include more
species than those enumerated below.

It includes only one specimen of the Anopheline,
a female Nyssorhynchus metaboles (Theobald), rather
darker than most of the specimens in the British
Museum collection, but this is probably the result of
rubbing.

There are a number of specimens of a Mansonia,
which represent, I fear, a new species.

Of the ten specimens, eight are males and two
females.

Mansonia Arabica, sp. n.— Wings unspotted, but
brindled ; clothed with large broad scales, many having
the characteristic “ bracket " form ; these are mingled
white and black, the former largely preponderating ;
fringe scales entirely white.

Thorax dark brown grounded, clothed with white
ferruginous and almost black curved scales, which very
probably produce a definite ornamentation which
appears to reproduce the two pale stripes of Mansonia
dorsalis (Meig.). .

Abdomen generally pale, clothed with a mixture of
white, with a few ferruginous scales, the former form-

Мау 1, 1906.)

ing an almost pure white median line, while the latter
are mainly confined to the sides. In addition, there
are on all but the last segments a pair of L-shaped
dark brown spots, the horizontal limbs of which form
ап apical dark border to the segments, interrupted by
the median white line.

Legs brindled, with black, white, and ferruginous
scales, giving a generally rather dark effect, with
snowy knee spots, and three fairly broad, articular,
ferruginous bands on the tarsi (rather variable).

Proboscis dark at the tip and absolute base, and
quite pale in the middle, but still not definitely banded.

Head mainly covered with white, forked scales.
Antenne of 4 ferruginous, of 9 with almost white
plumes. Palpiof 4 almost white, with darker spots

ЕСС 4

Mansonia arabica, (1) Portion of 1st longitudinal vein.
(2) A broad scale from one of the hinder veins. (3) Lateral
scale from anterior fork. (4) Venation.

at the joints and in middle of the long second joint;
of 9,dark brown. Scutellum with white and ferru-
ginous scales; pleura ferruginous, with some white
tufts; venter mainly white scaled ; sides of abdomen
densely fringed with long brown hairs. А fairly large
mosquito.

The female has & median, ferruginous abdominal
stripe, and the L-shaped spots so large as to be almost
continuous laterally, and in both the marking is gener-
ally darker than in the male. І

In Мг. Theobald's classification I conclude that this
species would be placed as a Grabhamia, as it is
strikingly like our English species dorsalis, which is
included by Mr. Theobald in that genus. In the %
the resemblance is specially close. I confess, how-
ever, that I am unable to distinguish the limitations of
Grabhamia, as the distinction between it and his
Teniorrhynchus on the one hand, and Mansonia on
the other, do not appear to be quite apparent.

The genus Mansonia, if not too rigidly defined, is
que a natural one; and as regards the wing, the

efinition I should prefer would be that the veins
should be prominently, but not necessarily, entirely
clothed with large broad scales. This would admit of
the inclusion of a considerable number of species, such
as fasciolatus, which Mr. Theobald places in Tenior-
rhynchus. The asymmetry of the so-called bracket
scales is in most cases more apparent than real, and
is more commonly an effect of perspective. It is

THE JOURNAL OF TROPICAL MEDICINE.

131

erroneous, too, to assert that in any Mansonia there
are no median scales, as stated in Mr. Theobald’s
definition of his genus. Unrubbed specimens must,
of course, be selected, but what is actually the case is
that in the more typical species the median as well
e the lateral scales have assumed the peculiar broad
orm.

In the present species this is only commencing,
though when separate and flattened out, the median
scales are considerably wider than they appear in the
camera lucida outline of the figure. Another character
of the genus is that the species are brindled, with
mixed scales of contrasting colours, not only on the
wings, but more or less over the entire body, and
especially on the legs.

A somewhat striking character of the venation of
the present species is the exceptional shortness of
both the fork-cells.

The two remaining species included in the collection
are almost cosmopolitan, for the warmer parts of the
world, being :—

(2) Stegomyia fasciata, Fabr.
but two of which are females.

(3) Culex fatigans, Wied. Twelve specimens, eight
of which are females and four males.

II.—Dr. Adolf Eysell kindly sends me a reprint of
the forty-ninth report of the Natural History Clubs of
Cassell, entitled, “ Sind die, Culiciden eine Familie ? ”'
(Are the Culicide а Single Family?). Не first takes
up the consideration of the genera Corethra and
Mochloryz, which are now usually placed as a sub-
family (the Corethrina) of the Culicidie, and gives
excellent reasons for deprecating their inclusion with
the true gnats, with which probably most naturalists
who have studied these insects will agree. It may be
remarked that it was only after considerable hesitation
that I decided to include descriptions of these insects
in my “ Handbook of the Gnats or Mosquitoes,” and
I believe that Mr. Theobald felt a similar hesitation
when preparing his monograph.

Our ultimate decision to do so I personally regard
as a mistake, which unnecessarily extended the scope
of our books. These insects, in fact, are not gnats at
all, their mouth-parts differing entirely from the
piercing apparatus of those insects, and should really
be considered midges with a wing venation that
chances to resemble that of the Culicide.

Possibly this is a case of mimicry, though, as is
often the case, it is difficult to see what advantage
accrues to the midge from its resemblance to the
gnats. His proposal, however, to promote the Core-
thring into & distinct family, instead of transferring
them to the Chironanide, may not, however, command
such general approval, and still more his proposal to
adopt the same course with regard to the Anopheline,
for if, apart from the Anopheline, the Culicide are not
a single family, and, it may be added, a remarkably
natural one, it is difficult to understand what consti-
tutes family resemblance.

It is perhaps only a natural evolution of the process
which is rapidly reducing our conception of genus to
the level of species, and each naturalist’s decision
must depend on his conception of the limits of these
extremely elastic and ill-defined terms. It is obvious,
however, that it only requires a sufficient extension of

Ten specimens, all

132

the process to leave each species in a separate class
of animated Nature by itself, and then I suppose we
should have to start off again with the process of
sorting it by instituting generoids, familoids, or some
such nomenclature.

He has also been good enough to send me a reprint
of his articles on the mosquitoes in Dr. C. Mense’s
“ Handbuch der Tropenkrankheiten," which gives in
comparatively short compass & thoroughly up-to-date
epitome of the morphology of the family, methods of
dissection, collection, preservation, general principles
of classification, &c., ав well as а short account of the
life-history of the malarial parasite. It is well and
liberally illustrated, though some of the photographs
are not quite as convincing as might be desired, and
certainly in some cases might advantageously be
replaced by drawings.

——— 9 ————

“ Centralblatt für Bakterlologie Parasitenkunde und
Infectionskrankheiten," xxxix., p. 280.

ScnisTOSOMUM JAPONICUM.

Looss shows that Schistosomum Cattoi, Catto, 1905, is
only à synonym for S. Japonicum, Katsurada (1904); the
employment of the newer name (S. Cattoi) should there-
fore be dropped, and the older be always employed in
speaking of this parasite.

* Journal of Infect. Dis.," 1908, p. 577.

Itis well known that plague bacilli are occasionally met
with enclosed in & capsule, and W. B. Wherry has met with
the same peculiarity m а cocco-bacillus isolated from the
liver of & plague rat. The oval capsule stained red with
Romanowski ; and cultivations answered to all the ordinary
tests of B. pestis.

* Archives de Zoologic. Exper.,” 1908, p. 101.
RESEARCHES ON THE HAPLOSPORIDLE.

Caullery, M., and Mesnil, F. The haplosporids are an
order instituted by the authors in 1899. Тһеу are sporozoa
allied to the microsporidia, but with quite different spores.
These are always mononuclear, with large, easily demon-
strated nuclei, and the cell plasma quite undifferentiated,
and with no trace of polar capsule.

The authors have combined their own work with that of
others on similar types, and propose the following classifi-
cations.

They divide the order into three families :—

(1) Haplosporidiide. Spores with double envelopes, the
inner denser and furnished with an opening, closed by а
valve in Haplosporidium, or open in Urosporidium, in
which it also has а long tail-like process and a lateral wing.
Parasitic in annelids.

(2) Bertramiide. Spore envelopes without opening.
Genus Bertramia and probably Ichthyosporidium, one of
the species of which inhabits the stomachs, and the other
causes large tumours in certain fishes, but is as yet
insufficiently known to be definitely placed.

8) Celosporidiide,in which the entire parasite encloses in
a dense membrane, while the mononuclear spores developed
within it remain nude. 16 includes, besides the type genus,
Polagcaryum, Sternbell, and Blastulidium, Perez.

The authors enumerate many other genera which they
believe come within the order, and believe that the Haplo-
рое are nearest to the Sarcosporidia, but approach also
the Microsporids апа Rhizopods, and perhaps to the lower
fungi, such as the Chytridinee. The human parasite re-
cently described in a nasal polypus by Minchin and
Fantham, it will be noted, is & Haplosporid.

THE JOURNAL OF TROPICAL MEDICINE.

(Мау

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THE

Journal of Cropical Medicine

May 1, 1906.

IS MALARIA AS BLACK AS IT IS PAINTED?

Turre is an old tale, anent one of the old Georgian
medical worthies—Abernethy, if memory serves us
aright—that when posed by any difficult complication,
he was accustomed to declare that “it was all gout.”
Nor, if we may judge from the writings of Haig and
his school, is the doctrine by any means dead ; for,
indeed, the tendency of specialists generally to claim
all disease as their own is proverbial.

For tropical countries malaria has, in this respect,
always taken the place occupied by gout in temperate
climates. Long before Laveran discovered the malaria
parasite, the verdict of the tropical physician has gener-
ally been “ it is all malaria,” and the prominence that
disease has recently attained as the pioneer of our
knowledge of human protozoal disease has only added
to its pre-eminence in this respect.

We have always been familiar with such terms as
malarial rheumatism, malarial iritis, phlebitis, and
what not, but it is tolerably certain that had these
cases presented themselves to a European physician,
suffering from what may be called the gouty bias, his
diagnosis would have differed from that of his tropical
colleague only in the substitution of the word “ gouty”
for “ malarial.” :

Analysing the reports of such cases, we generally
find that, beyond coincidence, the evidence in favour
of the need of any qualifying word to that specifying
the disease is remarkably scanty.

Мау 1, 1906.)

The maladies so described are usually of a sort that
are rarely fatal, and even in cases that prove so, no
evidence whatever is adduced to show that the malarial
parasite is in any way responsible for the lesions re-
corded.

Take the case of “ malarial” rheumatism: to the
uninitiated they would appear mere ordinary cases of
lumbago, sciatica, pleurodynia, aud so on, such as are
met with in all parts of the world.

The etiology, almost universally accepted elsewhere,
is that they are due to the sudden chilling of the
affected part, which brings about а congestion of the
little sensory nerve bulbs that are scattered between
the fibres of muscles, and especially amongst those of
their tendinous insertions.

The reduction of temperature which thus irritates
these very delicate structures is usually sharp, but of
short duration, and leaves no visible impression on the
surrounding structures, and as there has been no
general chill, the patient, apart from his muscular
pains, is little the worse, and shows no constitutional
symptoms whatever. If resident іп а hot country, he,
doubtless, has suffered more or less from malaria, and
may be debilitated from the strain of prolonged resi-
dence in a tropical climate, and these drawbacks may,
no doubt, render him less capable of withstanding
chills and other accidents, but this does not give us
the right to regard his symptoms as a special and
distinct variety of the disease from which he is suffer-
ing, still less to reduce the latter to the position of a
mere symptom, indicative of malarial poisoning. Are
we really to suppose that because a case of muscular
rheumatism, occurring in a hot climate, may happen
to have had one or more “touches of fever,” his
system is so “saturated with malaria" that the
capillaries supplying the end bulb of the afferent
nerves from his muscles are choked with parasites, or
what are we to believe? Muscular rheumatism is
very common in hot countries, because they have just
the climates which most expose people to sudden
chills. What need, then, is there of dragging malaria
into the question ?

Direct and obvious complications and sequele of
really severe malarial infection belong to quite a
different category, and are not the class of case we are
considering. It is the subtle workings of ‘latent
malaria" with which we are now concerned.

Another and more significant question, the import-
ance of which is steadily forcing itself upon our at-
tention is: How much of what we have been accus-
tomed, clinically, to regard as malaria, is really of that
nature ?

For many years after Laveran made his great dis-
covery our instruments and methods were so defec-
tive that but few succeeded in convincing themselves
of its validity, and even after we had reached the stage
of conviction, born of seeing undoubted parasites in
fortunate preparations, our successes were usually so
few, in proportion to our failures, that no one dreamed
of regarding a negative result as in any way conclusive
of the absence of malaria.

Fresh blood in a tropical climate is one of the most
unstable of tissues, and with the utmost care to secure
uniformity of method, two films from the same drop-
let of blood often present post-mortem changes of so

THE JOURNAL OF TROPICAL MEDICINE.

133

different a description as to render any comparison
obviously untenable. Under such circumstances what
was to be read as an abnormality due to the presence
of parasites, and what a fallacy due to post-mortem
changes ?

At this time malaria was, for us, like the first French
Republic, “ опе and indivisible,” and the puzzle was
made all the worse by our meeting consecutively with
different species of the parasite.

For these various reasons, the profession, even when
convinced of the truth of Laveran's discovery, was, for
purposes of diagnosis, generally driven back on the
“ clinical method." If one found parasites, well and
good, the case was undoubtedly malarial; if not, it
might, or might not be so, but few would reject the
diagnosis on the strength of mere failure to find para-
gites.

With improvement in the methods of making and
staining blood films, the physical diagnosis of malaria
has become & comparatively easy matter, but there is
still considerable reluctance to rely on the absence of
parasites for а negative diagnosis, even after repeated
examinations.

As recently as 1904, Powell, of Bombay, in the
Indian Medical Gazette, 1904, p. 41, reporting on
the examination of 3,413 cases of fever, found para-
sites present in 2,542 cases, and adds that, ‘of the
remaining 761 cases, a definite diagnosis by clinical
methods was made in 531, leaving 214 cases of fever
whose cause is uncertain." Here, then, are at least
this number of cases of indeterminate fever, which
only а few years ago would undoubtedly have been
ascribed to malaria; but what of the 531 cases dia-
gnosed by “ clinical methods," and what real ground
18 there for assuming them to be malaria at all ?

Nothing more than that the general symptoms
corresponded with one or other type of the very large
group of feverish cases, which we were accustomed to
diagnose as malarial in the days before we had any
physical means of discrimination to rely on.

Added to this, it is now well established that, especi-
&lly in children, malarial parasites may be present in
the peripheral circulation, without producing any rise
of temperature or other overt symptoms of ague; so
that it does not absolutely follow that а fever is
entirely, or even mainly, due to malaria because the
parasites of that disease can be demonstrated in the
blood. Everyone of any extended tropical experience
well knows that malaria often shows itself as an
&wkward complieation of any condition, whether
morbid or traumatic, that throws a severe strain on the
organism. This is notably the case in some epidemics
of pneumonia on the very malarious Punjab frontier,
where the coincidence of the two infections may be
so general as to be almost the rule. That the added
weight of the malarial recrudesence is far from im-
proving the patient's chances goes without saying, but
still, one does not regard the case as other than one
of pneumonia, nor would it be fair to do во; and yet
one might easily conceive the advancement of the
thesis that the epidemic was one of ‘ malarial” pneu-
monia, and not merely of pneumonia with more or
less common malarial complication.

Another point that presents itself is the compara-
tive rarity of serious cases of malaria in ordinary

134

THE JOURNAL OF TROPICAL MEDICINE.

[May 1, 1906.

tropical practice. Far more than nine-tenths of those
met with are what are commonly spoken of as
** touches of fever,” lasting from a day to a week, or
even more. Most of these are undoubtedly malarial,
the parasites, usually of the “ sestivo-autumnal ” type,
presenting themselves at the correct period, and dis-
appearing coincidently with recovery. They are,
moreover, mostly fairly amenable to quinine. Every
now and again, however, a severe prolonged case of
fever presents itself, in which quinine has no effect
whatever. In the early stage, before the patient has
been saturated with quinine, parasites may have been
recognised in the blood, or they may not, and the case
is diagnosed as malaria ‘‘ by clinical methods " ; but
apart from customary habits of thought, what better
ground is there for regarding the prolonged pyrexia as
due to malaria, than in the case of pneumonia, with
malarial complication.

So obvious is the fact that the vast majority of cases
of malaria are of a very trifling character, that in the
days before agglutination tests released us from so
many perplexities, the diagnosis of malaria in the case
of serious illness in a European was officially regarded
in India with considerable suspicion, and it was con-
sidered as almost axiomatic that such cases must be
referable to typhoid fever.

The mildness of the majority of attacks is equally
proverbial in Africa, and the question naturally arises
whether the serious fevers, occasionally epidemic in
India, and the even more serious, but usually quite
different, blackwater, and fulminating hyperpyrexia
of Africa, have really any causation in common with
the mild disease with which we are so familiar.

It is most significant that the severe fevers of India
are usually quite different from the serious African
fevers, for though hemoglobinuria is occasionally met
with in the former country, such cases, apart from this
symptom, are far from otherwise presenting the clinical
picture of blackwater fever.

It is notorious that malarial parasites are often con-
spicuous by their absence in that disease, and it must
be repeated that their occasional association with the
conditions above indicated definitely proves nothing
more than complication; for if the discovery of para-
sites be equivalent to proof of malarial causation, then
amputation of the leg and child-birth must often own
a similar etiology.
` Gradually, too, the origin of some of these indeter-
minate fevers is being elucidated. The final demonstra-
tion of the presence of Malta fever in India, noticed in
a recent issue, accounts for a certain percentage of the
serious cases that for want of a better diagnosis were
mistaken for obstinately recurrent malaria. It is
noteworthy that Bentley, of Assam, in the Indian
Medical Gazette, 1902, p. 337, advanced the theory that
kala-azar is really Malta fever, and his opinion was
confirmed by Major D. Semple, of the Kassauli
Pasteur Institute, by means of the agglutination test.

* Kala-azar" is always the malady that happens,
for the time, to be in fashion, the native words really
referring to any serious chronic malady, but it is clear
that some of the cases, so-called, must be Malta fever,
though the Leishman-Donovan parasite is now more
in vogue, and doubtless does really account for a con-
siderable number of the heterogeneous collection of

cases brought on for treatment as kala-azar. Not so
long ago the very investigators who are now most
eager to make Leishman-Donovan parasitism and
kala-azar synonymous were equally insistent of the
theory that it was uniformly malarious in its etiology.
A considerable percentage of cases, so-called by the
natives, undoubtedly are chrovic malaria, but more
undoubtedly are referable to a variety of other chronic
tropical maladies.

In view of the fact that malaria has already heen
deprived of kala-azar, will it be at all surprising
should blackwater fever, and many of the other
serious conditions now thought to be malarial, share
the same fate?

Again, scarcely а month passes without our meeting
with notices of protozoal parasites which are not
malarial in the strict sense of the term. For example,
W. Leonard Braddon, in the Indian Medical
Gazette, 1903, рр. 168, 213, 291, describes a “ mycoid
body found in the red corpuscles in a form of re-
mittent fever, prevalent іп the Malay States ” (vide also
the JOURNAL OF TropicaL MEDICINE, November 15th,
1901). Again, Jennings, in conjunction with Prof. A.
Lingard, describes in the Indian Medical Gazette,
May, 1904, a form of fever associated with a parasite
they believed to be a piroplasma, and which was
prevalent at a season when Anopheletes are practically
absent. қ

Jennings’ human hematozoa may or may not be
piroplasma, as Lingard’s conclusions in particular
appear to be doubtfully received by the majority of
protozoologists, but there is no practical doubt of the
actuality of the parasites observed by Major Jennings,
or of the validity of his general arguments as to their
non-malarial nature, for these cases of cold weather
and dry season fever, associated with the colourless,
non-pigmented parasites, have long been a puzzle to
many Indian observers, though they have, of course,
been generally regarded as representing some phase of
the malarial organism.

It would be easy to prolong this list, but the object
of this article is not to produce a bibliography of the
subject, but to suggest a judicial frame of mind in our
consideration of the numerous cases, slight and serious,
in which, though no parasites are evident, or in which,
if present, do not correspond with any accepted stage
of the known species of malarial hematozoa, but in
which we have hitherto been too ready to take refuge
in the time-honoured old diagnosis of 416 is all
malaria.”

The question is by no means purely academical, as
it is well known that many of this class of fevers are
rather harmed than benefited by quinine, and it is
very desirable that we should be able to save the
patient а needless course of the drug, by reaching some
means of arriving at an early and definite diagnosis.

THE ZNDIAN MEDICAL GAZETTE ON
*" GROWSING."

THE current. (April) number of the Indian Medical
Gazette pays us the compliment of printing in extenso
our leading article on some of the causes of dissatis-
faction in the Indian Medical Service, which appeared
in our issue of February 1st.

Мау 1, 1906.)

That the editor of our contemporary agrees to differ
from us is only what might be expected, as the Gazette
is а good deal more than less an official publication,
which no officer on the active list would dream of
using as а means of ventilating his grievances, and
hence is іп а bad position to know what are the
genuine sentiments of the rank and file of the service
whose lot is cast up country, far away from Calcutta
and the knot of men who, whether by luck or good
management, occupy still desirable appointments in the
second city of the Empire. Тһе editor does not under-
stand how the figure of thirteen men passed over for
promotion on account of age was arrived at, and
probably his information as to the age of officers quali-
fied for promotion by their position on the list is more
exact and up to date than ours, but for the purposes
of our argument it matters nothing whether the
&ccurate figures be 13 or 15 or 9. He admits that
four men who were regarded as “іп the running"
were so passed over.

The gist of our complaint is that the Indian Govern-
ment has hitherto given but scant encouragement to
original research, and that the present rules as to
superannuation bear hardly on men who have worked
hard to specially qualify themselves for the service by
taking house surgeoncies, honours examinations, and
other post-graduate work.

With the above exception no attempt whatever is
made to traverse the facts on which the complaints are
based, though a lamely apologetic attempt is made to
palliate them. Meanwhile, it remains an undoubted
fact that no man who devotes really adequate time to
his student career can reasonably expect promotion.
As to the proposed remedies, opinions, of course,
differ, as those who have been shrewd enough to enter
young on a minimum qualification are naturally in
favour of the existing state of things, but on the
general indictment the writer of the Gazette's editorial
is, so far, alone.

His contemptuous reference to officers who prefer to
remain in military employ, whose fate, he says, is like
to be ‘ professional deterioration and finally, perhaps,
supersession," appears to us to be, to say the least, in
very doubtful taste, and will certainly not be relished
by the very large section of the service so employed.
He appears to forget that some one must perform the
duties he so deeply despises, and that causes far other
than laziness may determine ап officer's prefer-
ence for that branch of the service. Asa matter of
fact, however, а very fair share of promotion very
properly falls to men on the military side, and though
far from being enthusiastic admirers of the Indian
Government's methods of dealing with its medical
officers, we see no reasons for imputing to it the cynical
injustice, implied in the editorial comment of our con-
temporary, of treating its military surgeons as an in-
ferior and almost reprehensible body of men. He
takes us to task also for failing to notice the hard case
of the Sanitary Department, but all in good time.
Pressure of space has prevented our returning to the
subject during the last few issues, but we hope shortly
to draw attention to a few other curled petals in the
rose-bed of the Indian Medical Service.

THE JOURNAL OF TROPICAL MEDICINE.

135

ANEMIA IN PORTO RICO.

A Commission, consisting of Drs. Jgaravidez, King,
and Bashford, has been engaged in the investigation
of Porto Rican anamia since March, 1904. The
Commission has issued а preliminary report of the
work accomplished from June 1st to November, 1905.
In all, 18,865 patients were treated by consecutive
doses (usually 5) of thymol, or beta-naphthol, for the
expulsion of the Ankylostomum duodenale (uncinaria),
with the result that the large majority were cured.
The Commission finds that 99 per cent. of cases of
uncinariasis contracted the disease by way of the
skin; ground itch on the feet and ankle being the
indication that infection has taken place. The
prophylaxis of the disease is to be secured by making
the wearing of shoes compulsory ; by insisting upon
all infected persons using a latrine; and by, if pos-
sible, causing all workers on the soil to wash their
hands and clean their nails before eating. It is satis-
factory to know that the Commission is to be con-
tinued, and that the good work already done may be
hoped to be amplified and extended.

MALTA FEVER IN SHANGHAI.
By AnTrHUR SrANLEY, M.D., B.S.Lond., D.P.H.
Health Officer of Shanghai.

In view of the Editorial in the JOURNAL оғ TROPICAL
МерісІмЕ of December 15th, 1905, which tends to
show that Malta fever is rare elsewhere than in Malta,
the following laboratory notes may serve a useful
purpose: During 1904 nine specimens of blood from
suspected cases of Malta fever were examined, and
seven of these gave the Widal reaction with the Malta
fever organism. During 1905, of twenty-seven speci-
mens from suspected cases of Malta fever, ten gave the
Malta fever reaction. The Malta fever organism used
in the laboratory was obtained originally from the
Lister Institute, and the dilution of the blood used for
the test was never less than 1 in 50. The blood was
furnished from cases in Shanghai and from the
Yangtse ports. Clinically the cases were reported as
corresponding to Malta fever. It is proposed to ex-
amine the specimens of blood giving negative results
with the typhoid bacillus for the Malta fever reaction,
as the type of cases reported as typhoid fever in
Shanghai аге so mild (case fatality 10:2), and show
such a tendency to relapse as to suggest the possibility
of some of the cases returned as typhoid fever being
Malta fever.

[In consequence of the great pressure on our space,
we have been compelled to omit the Colonial Reports
from the present іввие.-Ер. J.T.M.]

-----жФ----

RHINO-PHARYNGEAL LESIONS ‘IN YAWS.
To the Editors of the JourNaL oF TropicaL MEDICINE.

Sirs,—The excellent paper in your Journal of February
15th, 1906, from the pen of Dr. James Farquharson Leys,
deals with a disease which was brought to the notice of
the profession іп my treatise on yaws, published in
1891. I was then of the opinion that the rhino-pharyng:.

186

THE JOURNAL ОЕ TROPICAL MEDICINE.

(Мау 1, 1906.

lesions, which I described, were later manifestations of yaws,
and, though I could not trace the connection between this
disease and the symptoms so described with scientific
conclusiveness, I remember that there was at the time no
doubt in my mind of the relationship which I assigned to
them, any more than there would have been as regards
syphilis and similar manifestations of the latter affection.

Dr. Nicholls, in his “ Report on Yaws in the West Indies,”
1894, attributed these symptoms to tuberculosis, which, he
said, was very prevalent in the district in which they oc-
curred, but this is the only reason which he gives for con-
sidering them to be of tuberculous origin. As yaws, how-
ever, is far more prevalent there than tuberculosis, it would
seem to me that the argument, based on coincident preva-
lence, would be far more in favour of a frambcesial than of a
tuberculous origin. Iam not aware that those who attri-
bute these symptoms to syphilis adduce any better reason
than the above in support of their theory. As Dr. Leys has
pointed out, these lesions are met with in places in which
syphilis is rarely seen or has never existed. Dr. Daniels en-
countered them in Fiji, where there is no syphilis, and he
certainly had no reason to assign them to tuberculosis,

I wish to explain at this point that the destructive ulcera-
tion of the nose and palate which I attributed to yaws did
not attack bone. In this fact there appears to be a differ-
ence between Dr. Leys’ cases and mine. When I met with
the only case in the district in which the bones of the nose
and palate had been destroyed, I wrote to Mr. Hutchinson
on the subject, requesting his opinion, and he assured me
that his experience had led him to the conclusion that lupus
could safely be excluded in such instances, as it never at-
tacked bone, and that he considered the case to be one of
syphilis. Dr. Nicholls refers to the same case in his report
already alluded to as an example of syphilis in a yaws
patient.

It would seem from Dr. Daniels’ description of the naso-
palatine symptoms which he observed in Fiji that the lesions
in his cases were limited, as in mine, to a destructive ulcera-
tion of the soft tissues and that, in this respect, they also
differ from the conditions mentioned by Dr. Leys, who
states that ‘‘ the disease begins in the soft parts, but after
reaching the soft palate, and eating its way through its
entire thickness, attacks the bone of the palate and nasal
septum, finally destroying these entirely.”

While in Dr. Leys’ cases the destruction of tissue was so
extensive as to attract the attention of a casual visitor, the
noseless condition of the patient revealing his disease, in
mine there was practically no outward manifestation of the
affection.

I would not, however, conclude that the lesions in the
patients in Guam had a different origin from those observed
by me in Dominica, or by Dr. Daniels in Fiji. It is possible
that the same cause, owing to peculiar conditions, had pro-
duced в severer form of the same disease in the first-men-
tioned place, whether the symptoms be those of a special
local disease or a later manifestation or sequela of yaws.
It would be strange if, supposing the symptoms to be those
of a disease, sui generis, or rather of two different local
special diseases, the lesions in one affection should be limited
to the soft parts, and in the other should include both them
and the bony structures.

Is there anything in European pathology which can guide
us towards an opinion as to the nature of these symptoms ?
Certainly, considering the ages at which they appear and the
absence of any evidence of hereditary syphilis, it is not at all
probable that syphilis can account for them in the majority
of the cases in which they are observed. Of the thirty cases
seen by Dr. Leys during 1904, as many as seventeen were
school children. On the other hand, similar lesions are
sometimes the result of scrofulous influence. Cases have
been reported in which an obstinate ulceration of the
pharynx in scrofulous children has extended to the tissues of
the soft and hard palate as well as to the nares, until the
nose falls in and the greater portion of the soft and hard

palate are destroyed. Can the lesions under consideration
have had a similar origin? The general condition
of the patients so afflicted does not certainly suggest
a scrofulous taint. “Тһе patients," says Dr. Leys,
“remain muscular, well fleshed, and well blooded,” nor
were there any signs of scrofula in those who came
under my observation.

Dr. Leys very naturally points to the fact that these
lesions have only been found in certain places and not in
others in which yaws prevails as extensively, as a proof that
they are not connected with yaws. He instances Nevis as a
place in which yaws has been particularly prevalent for a
number of years and in which such symptoms have never
been observed. It is certainly the case that at the time I
met Dr. Leys, I did not remember having met any case in
Nevis in which there was any ulceration of the nose or palate.
I have since then, however, found notes of three cases which
have been under my care—patients aged 15, 17, and 19 re-
spectively—in which the septum of the nose has been ulcer-
ated, and a hole left in it the size of a sixpence. The
mucuous membrane is studded with small encrusted
tubercles. This condition, it will be urged, does not in any
way resemble the severe destructive ulceration of the nose
and palate which is under consideration. This is true; but
may it not bea milder form of the same process? (I was
informed by the mother of one of the patients, a muscular,
well-developed young fellow, aged 19, that he had never
had yaws.) Is it not possible that the severity of such
lesions may be proportionate to the severity of the other
symptoms of yaws? Yaws, as I have seen it in Nevis, is
very different from that disease as it came under my notice
in Dominica. Here, in Nevis, the cases are all in children
under 12 years of age, and the cutaneous lesions (except the
initial ulcers) consist only of '*squames"' generally, and
occasionally of papules. Nowhere have I seen any of the
granulomata with crusts which are so commonly observed in
Dominica—both in children and adults. This difference may
be due to the fact that the children affected with yaws in
Nevis have received more regular medical care than those in
Dominica, and that they have been treated with small doses
of mercury, which have modified the symptoms of the
disease ; or it may be that the affection in Dominica, owing
to climatic conditions (greater dampness, &c.), is of & more
virulent type. Allowing, therefore, that the destructive
ulceration of the nose and palate is due to yaws, we should
expect to find this condition most pronounced in places in
which the other symptoms of the disease are most virulent,
and vice versa.

Another point to be remembered in this connection is the
possibility, to which I have already drawn attention in a
previous paper, viz., that yaws may manifest itself both as
a local as well as a constitutional disease. While the
“ squames " and papules of yaws may be cutaneous mani-
festations of the constitutional affection, the encrusted
granulomata and the later symptoms may be the result of
the local action of the yaws microbes. Similarly the de-
structive ulceration of the nose and palate may be caused
by these microbes acting directly on the tissues in places in
which the disease exists in its most virulent form.

Your obedient servant,
J. Numa Бат
(Medical Officer, Nevis, B.W.I.)
———9—————

Tue second International Congress on “ School
Hygiene" will be held in London on August 5th to
10th, 1907.

Proressor R. Boyce, F.R.S., delivered an address
on “Тһе Prophylaxis of Yellow Fever, as the Result
of the 1905 Epidemic in Central America and New
Orleans,” at the International Medical Congress
in Lisbon

Мау 1, 1906.)

Translation.

PRELIMINARY STATEMENT ON THE RE-
SULTS OF A VOYAGE OF INVESTIGA-
TION TO EAST AFRICA.

Ву R. Kocu.
(Translated from the German by P. Falcke.)
(Continued from рауе 105.)

THE conditions thus resemble those of the malaria
parasite, which at the commencement of their sexual
stage also exhibit a similar differentiation; they, too,
having some forms poor in plasma, with plentiful close
chromatin, and others rich in plasma but with loose
chromatin. I conclude, therefore, that here, too, we
have an instance of sexual differentiation, the forms
rich in plasma representing the females, and the
slender ones, poor in plasma, the males.!

Whether or not these forms copulate, or whether,
as in the malaria parasite, microgametes are first
formed, I cannot say, but so far as my observations
go the latter process appears the more probable.

In the hindmost part of the stomach, moreover,
forms are found which appear to me to represent the
further development of the fertilised females. These
are very large trypanosomes which possess only one
blepharoplast with its flagellum, but several nuclei.
The number of nuclei is sometimes two, mostly four
(figs. 18 and 19), and in a few cases even eight.

Nuclear fission is, indeed, known to occur even in
the simple (asexual) multiplication of trypanosomes,
but in such cases the number of blepharoplasts, with
their flagella, always equals that of the nuclei.

It stands to reason, therefore, that we have to do
with something else than simple fission, as here the
blepharoplasts do not multiply, but only the nuclei.
Although I have not witnessed the process, I consider
it likely that these multi-nucleated trypanosomes split
up into a corresponding number of parts, and so form
the extremely minute forms which I have so frequently
met with in infected flies.?

These latter are simple globular cells, with a single
nucleus (fig. 20), and exhibit all transitions to those
with nucleus and blepharoplast, to which a flagellum
is afterwards superadded (figs. 21 and 22). The
shape then becomes elongated, and more and more
like the trypanosome. Usually these young forms
may be recognised by the blepharoplast being placed
anteriorly to the nucleus, towards the flagellar end
of the organism (fig. 23). It is only later that it
moves near to the nucleus and gradually makes its
way to the posterior end of the trypanosome.

Besides these, other forms appear for which I can
as yet furnish no satisfactory explanation. One of
these consists of longitudinal bundles of long, thin
trypanosomes which are often rolled up, and look as
if they were produced by the segmentation of a large

‘In my detailed work I shall mention in how far these sexual
forms have been seen by other observers.

2 Rabinowitsch has already seen the same young forms in the
trypanosoma of rats, moreover Novy and M'Neal have observed
them in their cultures of trypanosomes ; possibly also Castellani
saw them in the cerebro-spinal fluid of sleeping sickness
patients,

THE JOURNAL OF TROPICAL MEDICINE.

137

cell. There are also tape-like trypanosomes, often of
remarkable length, with obtuse extremities. In these
forms the blepharoplast is placed anteriorly and the
flagellum is very short (fig. 24).

lt may be remarked that in the fluid squeezed from
the proboscis of the fly there are, besides other
forms, nearly always some trypansomes which re-
semble the trypanosomes of the blood of infected
animals in size and appearance. It may be assumed
that infection is transmitted by these. I failed to
iufect rats by means of the trypanosomes from the
stomach of flies.’

As vet, too, I have failed to get any positive results
by making Glossina feed on animals infected with
trypanosomes. When the flies were fed on oxen
which had just been attacked with tsetse disease, and
harboured many trypanosomes, most of the parasites
disappeared as the blood was digested. The try-
panosomes refused to develop, &nd no permanent
infection of the flies was found to result. It was only
when the flies were made to bite beasts (oxen, mules)
which had been long infected, and only incidentally
harboured a few trypanosomes in their blood, that a
few flies became infected. I am therefore inclined to
suspect that all blood trypanosomes are not capable
of infecting Glossina, but only such as bappen to be at
some stage with which we are as yet insufficiently
acquainted. It seems probable that the infective type
of trypanosome is to be found in those large game
animals which are little susceptible to tsetse, such as
antelopes and buffaloes.

Thave frequently found infected flies in regions where
they could have been infected by no other agency
than that of large game, in the blood of which, as is
well known, only very few trypanosomes are present.
In the Lungera Valley, where the highest percentage
of infected flies was found (17:4 per cent.), there were
no oxen, and only very few antelopes. Оп the other
hand, there were goats and sheep which were
apparently quite healthy, but most of them had a
few trypanosomes in their blood.

In regard to the Glossina themselves, it should be
noted that the males as well as the females suck blood,
and that both sexes become infected and are capable
of conveying infection.

G. fusca flies and bites by night. In order to keep
this species alive for any length of time they
should be given the opportunity of sucking blood
every two or tbree days. The males of G. fusca usually
sit on shrubs and bushes or on the ground by the way-
side. The females are shier than the males, and
only appear when they scent animals. Hence flies
caught away from animals аге mostly males. Amongst
the flies caught on animals (mules, asses, oxen) there
are always some females, and occasionally they may
be as numerous as the males.

The females do not lay eggs like most other diptera,
but а single whitish larva, which in а few hours
changes into в pupa. G. fusca gives birth to only
a single larva аба time, at intervals ranging from ten

?The Sleeping Sickness Commission likewise had ncgative
results in their experiments to transmit the trypanosoma from
G. palpalis to monkeys. ** Reports of the Sleeping Sick-
ness Commission of the Royal Society," No. vi., p. 286.

138

to twenty days, according to the temperature of the
the air, so that the females produce but two or three
progeny inamonth. The propagation of the Glossina,
therefore, is very slow compared to that of most
insects. This appears to be the weakest point in the
cycle of infection of the trypanosomes, and may, per-
haps, offer a standpoint for an effective method of
combating trypanosome diseases.—( Deutsche Medizi-
nische Wochenschrift, November 23rd, 1905.)

==. аф

JOURNAL OF THE R.A.M.C., Арк, 1906.

REPORTS OF THE COMMISSION APPOINTED BY THE
ADMIRALTY, THE WAR OFFICE, AND THE CIVIL
GOVERNMENT OF MALTA, FOR THE INVESTIGA-
TION OF MEDITERRANEAN FEVER, UNDER THE
SUPERVISION OF AN ADVISORY СОММІТТЕЕ OF
THE ROYAL SOCIETY.

(Reprinted by permission of the Royal Society and
Colonial Office.)

I.—Goats as A Means оғ Provaacation оғ Meni-
TERRANEAN Fever. By Major W. H. Horrocks
and Captain J. Crawford Kennedy.

ABSTRACT.

In Part ILI. of the Reports of the Commission a
preliminary note was published on this subject, in
which it was shown that goats in Malta suffer from
Mediterranean fever, and excrete the Micrococcus meli-
tensis in their milk aud urine.. The further study of
this subject may be divided into the following parts :—

(1) Examination of goats living in pens (а) іп the
immediate neighbourhood of Valletta and Sliema, and
(b) in the more remote parts of the Island.

(2) Experiments made to determine the possibility
of infecting animals by feeding them on milk cultures
aud infected milk

(3) Experiments to determine the mode in which the
goats themselves become infected.

(4) Experiments to determine whether it is possible
to destroy the M. melitensis by Pasteurisation of the
infected milk. i

General Summary of Results.

(1) Judged by the serum reaction, 41 per cent of
the goats in Malta are infected.

(2) Ten per cent. of the goats supplying milk to
various parts of Malta appear to excrete the M. meli-
lensis in the milk.

(3) The excretion of the specific microbe may con-
tinue steadily for three months without any change
occurring in the physical character or chemical com-
position of the milk, and without the animal exhibiting
апу signs of ill-health.

(4) Some infected goats may lose flesh and their

coats may become thin; they may also suffer from a
short hacking cough. A febrile condition, however,
has not been observed.

(5) Goats may have a marked blood reaction (1—
ШЕ): and yet never excrete the M. melitensis іп the
inilk.

(6) If the blood serum or milk does not agglutinate

THE JOURNAL OF TROPICAL MEDICINE.

[May 1, 1906.

the М. melitensis, the specitic microbe is not found in
the milk.

(7) There is no constant relation between the amount
of agglutinins in the milk or blood and the excretion of
M. melitensis in the milk ; but the higher the dilution
of the serum which agglutinates the M. melitensis, the
greater is the probability of finding the M. melitensis
in the milk.

(8) The excretion of the M. melitensis in the milk
may be intermittent, appearing for a few days and
then disappearing for a week or more.

(9) A blood reaction may exist for some weeks before
the М. melitensis is excreted in the milk.

(10) 1f blood cannot be obtained, the milk reaction
with the M. melitensis (Zammit's test) is a good indica-
tion of infection.

(11) The milk agglutination test is а surer indication
of the M. melitensis being excreted in the milk than
the serum reaction. ы

(12) Monkeys and goats сап be infected by feeding
with cultures of M. melitensis isolated from milk, and
also by feeding with infected milk itself.

(13) The incubation period in feeding experiments
appears to vary between three and four weeks.

(14) Monkeys infected by feeding sometimes suffer
from a typical wave of fever and lose flesh, at other
times they show no obvious signs of ill-health, and may
even gain in, weight.

(15) When monkeys become infected by feeding
with milk the lymphatic glands always contain far
more colonies of the M. melitensis than the spleen.
This fact suggests that the specific micrococci con-
tained in the food are carried to the lymphatic glands
and there undergo considerable multiplication. It has
not yet been proved that the mesenteric glands are
always infected at an earlier date than the femoral and
axillary glands, but Experiment IV., feeding with milk,
shows that this may be the case at times.

(16) It has been demonstrated that goats may be-
come infected by feeding on dust polluted with urine
from cases of Mediterranean fever. The excretion of
M. melitensis in the milk resulting from such infection
is à late phenomenon, only appearing about seventy-
four days after the blood reaction has developed.

(17) It has not been possible yet to convey infection
from goat to goat by means of mosquitoes or Stomoxys
calcitrans. If mosquitoes do carry the infection, it
seems more probable that the microbe is transferred
from man to goat, than from goat to goat.

(18) Agglutinins may be transferred from the mother
to the foetus in utero. Pregnancy appears to follow a
normal course in infected goats.

(19) Pasteurisation (68° C. for ten minutes) destroys
the М. melitensis present in infected goats’ milk.

П.--Тнк IncipENcE oF MALTA FEVER AMONGST THOSE
EMPLOYED iN THE МплтАВҮ HosPrTAL, VAL-
LETTA, DURING THE YEAR 1905. By Captain J.
Crawford Kennedy, R.A.M.C.

Kennedy finds some evidence of the transmission
of Malta fever by mosquitoes; of the liability of per-
sons engaged in nursing, night duty, and cleaning
latrines to contract Malta fever; and of the greater

Мау 1, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE.

139

prevalence of the disease in the Valletta Hospital staff
compared with other hospitals in Malta.

ПІ.-Тне Ратноакхіс MOSQUITOES OF JAMAICA.
By Major F. M. Mangin, R.A.M.C.

In Jamaica, oue has unequalled opportunities of
making the acquaintance of certain species of this
group of the diptera, each of which in itself is the
carrier either of malaria, filariasis, or yellow fever,
respectively. The species alluded to are: Culex fati-
gans, the carrier of filariasis; Stegomyia fasciata
and S. mosquito (Robineau-Desvoidy), the carriers
of yellow fever; and the five species of Anopheles
found in this island; these are— Anopheles puncti-
pennis, Arribalzagia maculipes, СеШа argyrotarsis,
and Cyclolepidopteron grabhamii, together with Cellia
albipes, the commonest form of Anopheles. In addi-
tion, there are numerous other species of Culex, but
these are not yet proved to be pathogenic.

CENTRES
Miscellaneous.

SANTYL—A NON-IRRITATIVE INTERNAL
ANTI-GONORRHGIC.

By Dr. Н. Воттзтетх.
Hamburg.

(Translated from the German by P. Falcke.)

Dr. Viera, of Ludwigshafen-on-the-Rhine, reported
on “ The Mode of Action of the Balsams " in the Medi-
zinische Klinik, No. 5, 1905, and made а statement
regarding the preparation and effect of a new balsam,
i.e., santyl. According to these statements this drug
is preferable to other balsams on account of its non-
irritative qualities and its tastelessness. Up to the
present R. Kauffmann reports on forty-five cases treated
with santyl (Monatsheften f. prakt. Dermatologie). Не
states that santyl is а remedy possessing the advan-
tages of a new santal preparation, while also exhibiting
the specitic effects of salicylic acid; it is, in addition,
free from the unpleasant after-effects of other balsams.
Santyl is, moreover, odourless and tasteless, and can
be taken as oil in the form of drops. It has yielded
good results in the case of female patients with
gonorrhea. Sensitive women who could not swallow
the capsules, and objected to other preparations on
account of the taste or smell, took santyl in drops
without aversion. In santyl, also, the irritative effects
on the kidneys are less than in the former prepara-
tions. In my total of sixty patients treated with
santyl only two complained of slight transient sensi-
tiveness in the region of the kidneys. One patient
refused to take the oil, asserting that he had an idio-
syncrasy against all kinds of oils. Recently, also,
santyl can be obtained in capsules, but it is seldom
used in this form except in exceptional cases;
travellers, for instance, prefer them in this form on
account of their convenience. The progress that
santyl represents must not be under-estimated. In
those cases, also, in which, for obvious reasons,
secrecy has to be maintained, it does not betray the

patient by any evil odour, as is known to be the case
in the other sandal preparation.

I would like to call attention to the fact that I have
only taken fresh infections under consideration, as, in
chronic gonorrhea, the effects, аз а matter of course,
are not so striking. For acute gonorrhea, with its sub-
jective disorders, santyl is an actual specific, and is
particularly valuable when the course of the infection
is severe and there are marked symptoms of inflam-
mation. Kauffmann observed favourable results in
posterior gonorrhea, and my experience confirms his
opinion. Eighteen cases of gonorrhea of the posterior
urethra, which I treated with santyl, ran a light course
without complications. The urine also rapidly be-
came clear, and only in one case did I find it neces-
sary to exhibit santyl combined with urotropin, as
has been recommended by others.

Statements are frequently made that one drug or the
other is able to cure acute gonorrhea without local
treatment. Other authorities, on the contrary, assert
that gonorrhoea cannot be cured by means of internal
remedies only. Р. Meiszner is most positive, and
writes as follows in his “ Experiences with Arhovin " :
“ It must be understood from the start that a treatment
for gonorrhoea which is wholly internal is impossible.
Internal preparations for gonorrhoea must therefore
only be regarded as adjuvante." Kauffmann is no less
energetic in his assertions that it is impossible to cure
gonorrhoea without local treatment, and all objective
observers will agree with him. If this standpoint is
taken, and it is justified by practical experience, the
effect of balsams will still be valued, but to a limited
extent. The subjective disorders which very fre-
quently trouble patients can mostly be removed by the
balsams.

The effect of the various balsam preparations which are
used in the treatment of gonorrhwa is about the same,
whether balsam, copaib:we, or ol. santali is used. Gonosan,
which has recently been highly recommended, is said by
some authorities to possess anwsthetic properties; never-
theless, other sandal preparations which do not contain
kawa (such as santyl) also remove the pains. "There is one
great difference between the various balsam preparations,
namely, the accessory effects. Copaiba balsam frequently
causes exanthema, and has therefore been abandoned in
favour of sandal 01], in which cutaneous symptoms occur
much less frequently. Sandal oil, however, also has several
disadvantages, ay is well known. Apart from the rough
taste which is covered by taking this preparation in capsules,
disorders of the stomach or renal pains occur in quite one-
third of the cases. The same applies to gonosan. I cannot
say that I have observed that it has less unpleasant after-
effects than pure Eust Indian sandal oil ; it is also not pleasant
to take, ав it contains 80 per cent. of pure sandal oil.

In santyl the principal ingredient of sandal oil,
santalol, is chemically combined with salicylic acid,
producing a neutral and almost tastless oil. Santyl is
chemically analogous to salol, which is the salicylic
acid combination of phenol. Such combinations pass
through the stomach almost unchanged and are only
split up and absorbed in the intestine. ‘The disagree-
able effects on the stomach are thereby correspond-
ingly decreased. Santyl can be demonstrated in the
urine as early as one hour after it has been taken.

T have used santyl altogether in sixty cases of acute
gonorrhea. It is not necessary to give the histories
of the disease, but I may remark that amongst my cases

140

(May 1, 1906.

THE JOURNAL OF TROPICAL MEDICINE.

there were several particularly severe ones in which
santyl gave the most satisfactory results. In two cases
also with terminal hematuria convalescence set in
soon, the hemorrhage ceasing in two and three days
respectively, while the pain during micturition, which
at first was very great, quite disappeared.— Medi-
zinische Klinik, No. 11, 1905.

SANTYL-KNOLL.

A new sandal wood preparation for the internal
treatment of gonorrhoea bas been introduced by Knoll
and Co., 274, St. Mary-at- Hill, London. The prepara-
tion may be taken in drops or capsules ; it is free from
disagreeable smell and taste, and does not cause gastro-
intestinal irritation nor offensive eructations.

——— 9——————

Reviews.

Вені-Вені.--“ OBSERVATIONS IN THE FEDERATED
Maray States on BERI-BERI” By С. W.
Daniels, M.B.Camb., M.R.C.8., late Director,
Institute for Medical Research, Kwala Lumpur,
F.M.S. E.G. Berryman and Sons, Blackheath
Road, London, S.E. 1906. Рр. 105. Price 3s. 6d.

Published as Part I. of vol. iv. of “Studies from
Institute for Medical Research, Federated Malay
States," Dr. Daniels work on beri-beri is deserving of
close attention. The recent works on beri-beri by
Dr. Hamilton K. Wright, Dr. Travers, Dr. Braddon,
Dr. Haviland, Dr. Durham, Dr. Т. 5. Kerr, and many
other observers, are reviewed and considered in all their
bearings, and their several theories and conclusions
judicially handled. Every sentence in Dr. Daniels’
observations is written with evident care, having due
regard for the work and opinions of others, and a keen
appreciation of their efforts to elucidate the cause of
beri-beri. It is impossible to quote from a book in
which every paragraph bears directly on the context,
for the argument is so closely and precisely followed
that extracts would be meaningless. We can only
state the general conclusions arrived at by Dr. Daniels.
These are :—

(1) “ That beri-beri is an infectious disease. Аз a
rule, a short period of incubation and a period of ex-
posure of less than three months is requisite for full
development of the disease where the ‘ endemic index ’
is high.

(2) “ That there is no definite proof that an inter-
mediate host is required, but the balance of evidence
is against its being conveyed by earth, air, water, or
food, or contamination with sewage or other fecal
matter.

(3) ** That there is some evidence that for a short
period only after the occupation of small spaces, beds,
bedrooms, «с., the ‘poison’ or carrier of infection
may remain.

(4) “ That food, either as regards quantity and
quality, its nature or relative proportions, may have

an effect on the susceptibility of the patients, though
the proofs are not conclusive, but is not the causative
agent.

(5) “ That if an intermediate host for the unknown
parasite is required, it must be either a cimex or a
pediculus. That pediculi as carriers would better
explain the incidence of the disease than any other
blood-sucker.

(6) “That a closer enquiry into the earlier stages of
the disease is required. That where opportunities for
such an enquiry occur, renewed attention should be
bestowed on the blood and tissues, with & view to
determining the presence or absence of any protozoon.

(7) * Prophylaxis. That in view of the failures of
various attempts at disinfection of buildings and places,
and of various modifications of diet to have marked
effects, more attention should be paid to limiting the
chances of personal infection, and that particular
attention should be paid to the personal cleanliness,
freedom from vermin, and isolation of early or trivial
cases of the disease. i

“Тһе importance of the disease, affecting as it does
the imported labour of the country, causing prolonged
sickness and frequently death, cannot be over-esti-
mated in a rich country so spareely populated as the
Federated Malay States. There is evidence that the
disease is less common and less fatal than & few
years ago; but directly, and as а complication of
other diseases, it is still the main cause of the high
mortality in the healthiest period of life, amongst the
Chinese.

“ Every earnest endeavour to improve the conditions
of life that has been made in the past has resulted in
an improvement. The number of cases is diminishing,
and the mortality from the uncomplicated disease less
than ever.

“Тһе scope of the enquiries has, as a result of the
observations of numerous workers, been diminished,
and the prospects of an early solution of the cause of
the disease and of its mode of propagation may be
confidently anticipated by future workers at no distant
date.”

We congratulate Dr. Daniels upon a book which is a
model of scientific literary effort, and one which places
our knowledge of beri-beri of to-day accurately
before us.

o

Acw Ynstruments, Ke.

ILLUSTRATED Рвісе List oF ÉLECTRO-MEDICAL
ArPARATUS.—K. Schall, 75, New Cavendish Street,
London, has sent us an excellently illustrated cata-
logue of electro-medical apparatus. The address will,
no doubt, be useful to readers.

Beck, К. and T., Ltd., 68, Cornhill, London, have
introduced а new form of “ Ehrlich” Eyepiece for
counting blood corpuscles which fits their “ London”
Microscope.

May 1, 1906.) .

THE JOURNAL OF TROPIOAL MEDIOINE.

141

Drugs unb Remedies.

HETRALINE: A Urinary Disinrectant. — Dr. del
Amo, in a paper on the antiseptic value of hetraline,
states that, in doses of seven grains, repeated four times
daily, this drug was useful in cases of bacteriuria. In
acute and chronic cystitis, catarrhal urethritis, and the
urethritis due to stricture, hetraline is as effective as
urotropin, and has the advantage of being less
irritating to the tissues.

Medical Hotes.

Tre EDIBILITY oF THE SPLEEN.

The reason why the spleen, of all abdominal solid
organs, is practically the only one not used for human
food, is ditficult to explain. Dr. Williams, in Amert-
can Medicine, February 10th, brings forward a plea for
its consumption, and states that when stewed the
spleen is pleasant to taste; it must be cooked and
eaten when quite fresh. Considering the physio-
logical importance of the spleen, it is peculiar it has
never been used either as a medicinal agent nor as a
part of ordinary diet.

CHOLERA.

In the Philippines cholera is spreading, especially in
the villages along the coasts and on the rivers. As the
villages drain directly into the rivers, a continuance of
the epidemic is probable.

SMALL-POX IN CALCUTTA.
Between December, 1905, and March 1st, 1906, it
is estimated there have been 5,000 cases of small-pox
in Calcutta.

CREEPING DISEASE.

Moorhead, J.D., in the Teras Medical News of Feb-
ruary, describes a skin affection in a boy, aged 5, said to
be suffering from Brazilian worm in his foot, which
has been given the name ''ereeping disease." The
infection was believed to come from а family from
Brazil The worm travels in the layers of the
epidermis at the rate of from 4 to 1 inch in twenty-
four hours, leaving a raised line of epidermis about $
inch wide. The treatment consisted of excision of the
part at the point where the worm is advancing, or by
freezing this neighbourhood with ethyl chloride spray.

SEVERAL readers of the Journal have asked for infor-
mation concerning the meaning of the opsonic index.
Stated shortly, it may be explained as follows:
Wright and Douglas have shown that washed leuco-
cytes possess по phagocytic power when brought іп
contact with staphylococci, but if normal serum or
blood plasma is first added to the staphylococci and
then brought in contact with washed leucocytes, the
phagocytic action of the leucocytes is re-established.
This power seems resident in в substance contained in
the serum termed opsonin; to ascertain the opsonic
power of a given specimen of blood. the volume of
serum is added to equal volumes of a bacterial suspen-
sion and of washed leucocytes. After this mixture
has been incubated at 37? C. for fifteen or twenty

minutes, microscopic specimens are mounted, fixed
and stained, and the bacteria within the leucocytes
eounted. The number of bacteria within the leuco-
eytes divided by the number of leucocytes counted
gives the opsonio index.

——— 9S —————

Hotes and Hels.

THE growing of cotton in the Federated Malay
States is attracting some interest. The cotton, al-
though of qualities somewhat inferior to Egyptian
cotton, is stated to be of fair quality, and it is hoped
the cultivation may prove remunerative.

MaLARIA AND Mosquitors.—In Barbados

the

‘absence of Anopheles mosquitoes and of malaria is a

fact which is well known. The explanation of this
phenomenon has been lately attempted to be explained
by Mr. C. K. Gibbons to the presence of a small fish,
known locally as “ millions” (Girardines versicolor),
which preys on the larve of mosquitoes.

Yet another medical journal was added to the long
list of American medical journals on January Ist,
1906, when No. 1 of vol. i. of the Bulletin of the
University of Nebraska appeared. Henry B. Ward
contributes an elaborate paper on “ Filario loa."

YELLOW Fever.—Gorgas states that he has known
the Stegomyia mosquito live 150 days in captivity.
RESULT OF THE EXAMINATION FOR THE DIPLOMA OF

TROPICAL MEDICINE, UNIVERSITY OF LIVERPOOL,
HELD ON Manca 26, 27, AND 28, 1906.
Examiners.

External Examiner, Colonel D. Bruce, C.B., Е.В.8.;
Internal Examiners, Professor Б. Ross, C.B., F.R.S.,
D.Sc., F.R.U.C. ; J. W. W. Stephens, M.D.; C. J.
Macalister, M.D., C.M.; В. Newstead, A.L.S,
F.E.S., Examiner in Medical Entomology.

Тһе following candidates have been recommended
for the Diploma in Tropical Medicine :—

Е.А. Arnold, M.B., D.P.H.
J. B. Bate, L.S.A.
J. Dundas, M.B. .
N. Faichnie, Major R. A.M.C., M.B.
D. F. Mackenzie, M.B.
A. Pearse, Major R.A.M.C., D.P.H.
R. D. Willcocks, Captain I.M.S., M.B.
RESULT oF THE Examination, LONDON SCHOOL оғ
TROPICAL MEDICINE, 20TH SESSION, APRIL, 1906.

The following candidates passed the examination for
the Certificate in Tropical Medicine.

Captain S. Anderson, I.M.S., M.B., C.M.Glas., 1896,
with distinction.

H. E. Arbuckle, M.B., Ch.B.Edin., 1900, with dis-
tinction.

Captain В. H. Dutcher (U.S. Army, M.D.Coll.
Р. and 8. Columbia University, New York), with
distinction.

G. J. Pirie, M.B., Ch.B.Aber., D.P.H. 1905 (Colonial
Service), with distinction.

А. G. Eldred, M.R.C.S., L.R.C.P. (Colonial Service).

142

THE JOURNAL OF TROPICAL MEDICINE.

(Мау 1, 1906.

Н. Kramer, М.В., Ch.B.Edin., 1902.

P. H. MacDonald, M.B., Ch.B.Edin., 1899 (Colonial
Service).

B. Moiser, M.R.C.S., L.R.C.P., M.B.Lond.,
(Colonial Service).

A. Reid, M.R.C.S., L.R.C.P., 1900, D.P.H.Durh., 1902,
M.B.Durh., 1903.

W. Rogers, M.B., B.Ch.Edin., 1900 (Colonial Service).

W. E. Ruttledge, M.R.C.S., L.R.C.P., 1900.

A. L. Wykham, M.D.Howard Univ., 1887, L.S.A., L.M.

1904

Tae “ Uttra Microscope.”

The ultra microscope, designed by Liedentopf and
Szrgmondy, and constructed by Zeiss, has had no
better success in detecting the organism of yellow
fever than the familiar oil immersion. The idea of
this instrument is not, strictly speaking, to bring into
view, but to notify, the presence of bodies too minute
for recognition by ordinary microscopic vision. Such
bodies appear as shining points without any definite
outline. But even in normal serum the points are
so numerous that it is impossible to draw any con-
clusion as to the presence or absence of specific
organisms.

The instrument has been tested in yellow fever
by M. Otto and R. O. Neumann, who have recently
made an expedition to Brazil to study that disease,
but with no better result than their predecessors, except
perhaps that they have bearded the lion of disease
without loss of life or health, which alone should be a
matter of congratulation in the case of a malady to
which so many investigators have fallen victims.

Protection BY SERUM AND TOXIN.

A good deal of work is being done in various
laboratories with the view of producing an anti-
trypanosomiasis serum and to those interested in the
subject the following references of recent works may
be useful. In the current issue of the Bull. de
UInstitut Pasteur abstracts are given of the follow-
ing papers on this subject: Dresing, in the Archiv.
f. Schiffs. ш Trop. Hyg., October, 1905, p. 497;
Schilling, Zeitschr. f. Hyg., 1905, p. 149; and
Kleine and Mollers, Zeits. f. Hyg., 1906, p. 999.
The results are encouraging, distinct immunity being
evidenced in experimental work, but their attempts to
protect transport animals do not appear to have been
во satisfactory, and the injections themselves do not
appear to be entirely without danger.

In the same issue abstracts are given of two papers
on the production of immunity against cholera infec-
tion by S. Seikouski and by K. Schmitz in the
Persglad lekaroki, 1905, р. 746, ей seq., and the
Zeitschr. f. Hyg., December, 1905, p. 1, respec-
tively, but neither appear to have succeeded in con-
ferring immunity of sufficient duration to be of
practical use in dealing with cholera.

In countries where cholera is endemic, or, at least,
where the danger recurs every year, nothing short of
an immunity as long as that conferred by vaccination
against small-pox is likely to be extensively adopted,
ав it is too much to expect people to undergo the by
no means considerable inconvenience and even risk of
4 protective inoculation every few months or so, and,

in à minor degree, the same remark applies to the
case of plague.

It must be remembered that for & certain length of
time susceptibility is increased by the whole class of
protectives which rely on the introduction of toxins,
and that even the injection of the serum of immune
animals is not without its dangers, so that for prac-
tical purposes what is required in either toxin or
anti-toxin is that its effects should last long enough
to be available for use at times when the plague pro tem
is not epidemic.

FRENCH AND ENGLISH MORTALITY AND SICKNESS ON
THE Согр Coast.

The Lancet of February 8rd contains an instructive
&bstract of the health statistics of the French tropical
colonies based on a report in the Archives de Medecine
et de Pharmacie Militaires for January, 1906, from
which we extract the subjoined table :— .

EUROPEANS NATIVES
і French ҰС TQ 4M DIA “Іі” E ~
colonial troops д
stationed at— | 86 i8 2 = 5% FE! E 3 | 28
= £I = mecs 132
£2 | 2,125 | 821 BE | 318;
<n | nk А S8 | 42 | ZA AA
I
1903 | |
Western Africa 18602 1,81, 214 179915 982 | 12:8
Annam-Tonkin 10,248 | 586 9248 118:3 [13,777 21:9
China Reserve 2,771 845 | 115 1014 | 1,987 478 94
Brigade
China Army of 1,672 | - 924 101 6ro - - -
Occupation |
Cochin China .. 2,121 1,282 33-0 205°5 1,625 1,008 , 478
Madagascar 4,812 1,091 | 176 | 1872 | 7,202 87 12:9
Réunion .. .. 802 878 | 104 92:8 — o; — —
Martinique .. 914 1,611 | 109 2144 - = -
New Caledonia 728 365 1282 796 - - -
T: ЖЕСІ 108 835 0 19:4 -- 2 -- жн
St. Pierre and 14 13| 0 0 = i = -
Miquelon t
India .. .. .. 4$ 0 0 ) 0 142 795 70
Tchad.. .. .. 4% | 956 9227 188 750 811 | 923
Guadeloupe .. 178 29,192) 115 4045 — = |-—
Guiana .. .. 194 644 51 9422 - | - 1 -
1
26,550 993 | 198 1897 ЕС 598 |187

It is interesting to compare French results with
British in West Africa.

The French troops so employed are, it must be
remembered, a long service corps, composed of men
who have already gone through the term of military
service compulsory on every Frenchman, and so
contain none of the callow youths which the
exigencies of recruiting compel us sometimes to send
to India, and though probably a distinctly younger
body of men than our British colonial officials, will
be, like them, men in the prime of life, and therefore
fairly comparable, especially as the principal causes
of death and invaliding are of а sort that attack all
ages with tolerable uniformity. It is further to be
noted that in addition to the sickness indicated
above, all of which was of a serious character,
a very large number of men, equivalent to 306-9
per thousand of strength, were treated for slight
ailments “à la chambre.” Against the comparative
youth of the Frenchmen, too, may be placed
the fact that like “ Tommy Atkins,” “ Piou piou ” is

Мау 1, 1906.)

probably a less careful person than civilians of good
social position.

In the same year (1903) the mortality, &c., of
Europeans on the British Gold Coast was returned as
below :—

3

e T z

How Employed = * = aa д
5 á 2 fà | sk
Z a © A a

= А z
Officials .. a m 328 5 | 25 153 767
Mercantile Firms, &c... 33^ 19 18 858 537
Mining Companie 1,043 20 92 19°2 | 8823
Missions .. sy T 92 2 2 217 217
Totals 1,796 39 137 217 763

By a curious coincidence the total number of the
two populations compared differs but little, and the
mortality per thousand coincides almost exactly.
The French invaliding is, however, more than double
of ours.

A further point worthy of note is that however
insalubrious a place must be where men are under
medical treatment for ailments, great and small, four
times in the year, the West Coast is almost a
sanitorium compared with Cochin China, with a
mortality of 33 and an invaliding roll of 205:5 per
thousand, and is distinctly better than Tonquin.
Now, the French Possessions in the Malay Peninsula
actually march with ours in Upper Burmah, and it is
hardly likely that the frontier that divides our pos-
sessions demarks any particular difference of in-
, salubrity.

Most medical men who have practised in the East
know that storax (sz/aras) is regarded as a most
potent drag by the kaids and haqims, but few would
be prepared to hear that India imports thirty tons of
it annually, or that it is of sufficient commercial
importance to render the question of its adulteration
desirable by a Government official. However, Mr.
D. Hooper, of the Indian Museum, has taken up the
matter, and has discovered by chemical analysis that
a large quantity of the drug is adulterated with pine
resin. А papern the subject has lately appeared,
giving the results of the investigation, and the States-
man understands that the attention of the authorities
has been drawn to the subject, so that care might be
exercised in the future to obtain supplies of storax
from authentic sources.

Tae Bombay Census.

The municipal census calculations have not yet been
completed, though promised for Saturday at noon.
Roughly speaking the population is put at 960,000, an
increase of 190,000 on 1901.—Pioneer Mail, February
16th, 1906.

From the same journal we extract the following
report of а speech by Lord Lamington on the virtue
of cleanliness. If all our Indian Administrators held
as sound and practical views on sanitation as the

THE JOURNAL OF TROPICAL MEDICINE.

143

Governor of Bombay: there can be no doubt that
the history of hygiene in India would be more satis-
factory than it has been.

“ Bombay, February 8th.

“ His Excellency the Governor, speaking last night at the
annual meeting of the Bombay Sanitary Association, said
that that Society and the St. John Ambulance Association
proceeded on nearly the same lines—one was to meet a
sudden emergency and the other was to inculcate the prin-
ciples of proper sanitation, so that the lives of people in a
great city like Bombay might be better preserved. If I
remember rightly, he continued, it was аё а meeting two
years ago that a speaker declared that we had awakened the
‘hygienic conscience’ of the people, and from what I have
been able to see for myself since my advent in your midst
this has been strictly borne out. I cannot see myself that
the people themselves lack in cleanliness either in their own
persons—I am talking generally—or in their houses; but
every one ought to extend their horizon and recognise their
obligations not only to themselves but also to their neigh-
bours and by practising the virtue of cleanliness they
not only benefit themselves but their neighbours and
help to preserve public safety. Мап does not live
alone ; he has work in co-operation with his neighbours.
Our duty is to persuade them to keep the outside of their
houses as clean as they keep their own particular room.
There is another matter—that of better ventilation. То
my mind, it is brought home to us day by day by the medi-
eal authorities in every country, in every part of the world,
that you cannot have too much fresh air. It is most deplor-
able even when I go round my own lines in Government
House to see how, after а certain hour every little window is
barred and barricaded as though they expect an attack from
а foreign enemy. There is no possibility of fresh air, and
whatever germs there are in this vitiated room go on multi-
plying. There are two great principles in which the majority
of people want educating. One is to keep the outside of
their houses or chowls clean, and the second is not to be
afraid of fresh air."

We also extract an article on Professor Klein’s new
prophylactic for plague, which is of interest as indi-
cating the trend of expert opinion in India on the
merits of the new agent as compared with that of
Haffkine’s, which has been so long in use in that
country.

“ Professor Klein’s report to the Local Government Board
on his new plague prophylactic was forwarded to one of the
leading experts upon the subject, who writes as follows :—

““Тһе experiments at present recorded are neither suffi.
cient nor complete enough for an opinion to be formed as to
the ultimate utility of this vaccine. It seems, however, that
the results of the experiments do not sufficiently warrant
the claims to superiority in comparison with the vaccine
prepared by Haffkine. There is no doubt that Haffkine's
method of prophylaxis has had a considerable amount of
success. The Indian Plague Commission reported favour-
ably on this method, and it is generally admitted that
inoculation of this vaccine diminishes the incidence of
attacks of plague, and that the mortality among inoculated
persons is considerably less than among those not treated.
The question as to the duration of the protection afforded is
difficult to decide. It is probably not less than three
months. There are certain disadvantages in this method
which have prejudiced many against its use. Protection is
not conferred on those inoculated for some days after the
treatment, and during this period there is an increased sus-
ceptibility to an attack of plague. Consequently there is
doubt as to whether its use in the presence of an epidemic
is advisable. The protection afforded is not always com-
plete, and is of short duration. Thus, while this vaccine is
a valuable means of protecting temporarily against plague.

144

it is not a method of much practichl use іп face of an epi-
demic of plague. It not infrequently occurs that after
inoculation the individual suffers from severe symptoms
somewhat resembling those of the disease itself.

““Тһе new prophylactic of Klein does not appear to solve
any of the present difficulties. His material is highly toxic.
Like most other vaccines, it contains the dead bacillary
bodies and their toxins. It also contains many other un-
known constituents, the result of the inflammatory reaction
of the tissues. The immunity conferred by its application
is doubtless principally due, as in the other vaccines, to the
toxins and the dead bacilli. It has not yet been ascertained
at what time after the inoculation the immunity is estab-
lished, and for what period it persists. Klein found the
immunity present one to thirteen weeks after inoculation,
a time limit which is inferior to that established by Haff-
kine’s vaccine. The possibility of standardising the prophy-
lactic by injection into rats is of value, but it is equally
possible to standardise Haffkine’s vaccine by injection into
the guinea-pig. The new method described by Professor
Klein is doubtless a means of affording protection against an
attack of plague, but until many more experiments are com-
pieted to establish the nature and extent of this immunity
it is premature to claim superiority over the other existing
methods of vaccination. It is not simply a question of
obtaining a cheap, easily prepared material. То combat
plague, especially under the conditions which exist in India,
there has yet to be discovered either a serum with curative
properties or a vaccine which will confer a rapidly estab-
lished and durable immunity, and be attended with no
danger to those treated.’ ”

It may be remembered that in our issue of February
15th we reproduced a letter to the Pioneer from а corre-
spondent in the Punjab on the occasional poisonous
effects of the stalks of the millet known as jowar, when
used as fodder for cattle, the writer stating that the
people believed the poisonous action to be due to the
presence of ** small worms.” The Pioneer Mail of Feb-
ruary 16th contains a second letter from a Burmese
official, which shows that the same view is held by the
natives of far-away Burmah. It is well known that
many insects are poisonous, so that it is by no means
impossible that the native agriculturists may be correct
in their belief, and the question is certainly worthy of
investigation by the economic entomologist, if India
chances to possess such a functionary.

CATTLE FEEDING ON JowaR STALKS.

““Srr,—With reference to your article on cattle being
poisoned by eating jowar stalks in your issue of January
18th last, and a letter from ‘W.’ in your issue of January
18th on the same subject, the following may be of interest :—

“Тһе Settlement Officer, Magwe District, Upper Burmah,
in his Settlement Report, seasons 1897-1908, remarks: ‘In
years of drought, when the plant (ie. jowar) becomes
stunted and dried up, the stalks are poisonous to animals,
and cattle sometimes die from eating them. In this district
(Pakkoka) jowar is one of the main crops, and, of course,
jowar stalks are used as fodder. The Burmans here tell me
that in years of drought, before the ear has unfolded itself,
an insect gets into the stalk ; while so inhabited the stalks
are poisonous, and, if eaten by cattle or ponies, cause death
within a few hours. The insect appears to leave the stalk
when the “ear” opens, which it would naturally do, of
course, on the cessation of the drought. ”

А NEW JOURNAL FOR TROPICAL VETERINARY
MEDICINE.

As for many years past it has been felt that there
existed a distinct want for a scientific publication deal-

THE JOURNAL OF TROPICAL MEDICINE. |

(May 1, 1906.

ing with veterinary pathology in the Tropics, certain
officers of the Indian Civil Veterinary Department
have undertaken the publication of a quarterly peri-
odical entitled the Journal of Tropical Veterinary
Science, the first issue of which, dated January,
recently made its appearance. Each number will, as
far as possible, consist of original articles of scientific
interest, with the exception of such pages given up to
reviews and extracts from current literature as may
appear to demand attention. Each of the three
Editors—Major Н. T. Pease, the Principal of the
Punjab Veterinary College, Captain Baldrey, the Pro-
fessor of Sanitary Science at the same Institution, and
Mr. R. E. Montgomery, I.C.V.D., who is now on
special duty investigating camel diseases—contribute
articles to the first number, while Professor A. Lin-
gard, Imperial Bacteriologist to the Government of
India, has two articles. The journal is published by
Messrs. Thacker, Spink and Co., and is excellently
got up, clearly printed and illustrated with plates and
diagrams. The annual subscription, including postage,
is Rs. 12.8.—Pioneer Mail, February 28th.

Tar MepicaL (Lucknow) CoLLEGE Funp.

At a largely attended meeting held here and pre-
sided over by Mr. Н. М. R. Hopkins, І.С.8., Col-
lector, Rs. 17,000 were subscribed on the spot towards
the Memorial Medical College, Lucknow. The principal
speakers were Mr. Hopkins, and Syed Alay Nabi,
B.A., and Munshi Narayan Pershad, M.A., Vakils.
More subscriptions are expected.

Ргласе WORK АТ THE PAREL LABORATORY, BOMBAY.

During the past eight months, the Health Depart-
ment have been engaged in trapping, poisoning and :
collecting rats, with the result that over 30,000 rats
have been collected and sent to the Parel Laboratory
for bacteriological examination every month, the
Plague Research Commission supervising the work
there. The report on the result of the examination of
each rat is sent daily to the Executive Health Officer.
When a rat is found to be infected the house or
gully where it was found is marked “Р.Б.” with the
date, so that the premises and neighbourhood may be
under observation. Тһе Plague Commission are now
working at Parel, and visit as many of the infected
places ав possible to collect material for their
work. Cards are provided which are filled in by the
district registrars giving information in detail about
the rats and infected places, and the condition of the
locality and its plague history. On an average, 1,100
rats have been examined daily at Parel, and the result
sent at once to the Health Department. The propor-
tion of infected rats recently increased from 2 to 20
per cent.—Pioneer Mail, March 28th, 1906.

Dr. Claus Schilling has been appointed head of the
newly founded department of tropical diseases and
hygiene established in Berlin in connection with the
Institute of Infectious Diseases.

Seismic disturbances and prolonged drought have
prevailed in several of the West Indian Islands;

Мау 1, 1906.)

St. Lucia and St. Vincent have suffered from severa
earthquakes, and drought has been especially preva-
lent in Barbados, British Guiana, Grenada, and
Trinidad.

THE PREVENTION OF YELLOW FEVER.

The Colonial Oftice authorities have issued a concise,
practical, and clearly written eight-page pamphlet on
* The Prevention of Yellow Fever." The general
directions are based upon the assumption that *' yellow
fever can be absolutely suppressed by the application
of simple, practicable, and non-costly methods," de-
voted to the prevention of infection of human beings
by the bites of the Stegomyia mosquito. The pamphlet
is illustrated by drawings of the Stegomyia fasciata
and of the larve of Stegomyia.

His Excellency the Governor-General of the Sudan
has directed that a Commission be appointed to in-
vestigate the possibility of the extension of ‘ sleeping
sickness" into Sudan territory. Тһе Commission to
be as follows: Lieut.-Colonel G. D. Hunter, D.S.O.,
P.M.O.E.A; Dr. Andrew Balfour, Director Wellcome
Research Laboratories, Khartoum ; а British medical
оћсег, Egyptian Army, or medical inspector, Sudan
Medical Department, or such members as may be
hereafter appointed.

Points to be Investigated.

(1) To ascertain the distribution of various species
of tsetse-flies or other biting flies in the Sudan.

(2) To ascertain if the disease at present exists in
Sudan territory. If so, to determine the exact areas,
and to what extent the distribution of the disease
coincides with the presence of the tsetse or other
flies in these areas.

(3) A systematic investigation of the blood of a
population in an infected district.

(4) А thorough and complete research into the
character of the disease, especially as regards its
origin and spread.

DEATH оғ А PoruranR ростов.

The death took place, оп the night of the 21st inst.,
of Rai Bahadur Doctor Ram Lal Chuckerburty, who,
for more than a quarter of a century, was one of the
leading medical practitioners in Oudh. He was much
beloved, admired, and trusted by all communities. He
succumbed to an attack of plague, after suffering for
six days. His age was 65. Не leaves behind him a
widow, three sons, and three daughters. His remains
were carried in a special train to Cawnpore for crema-
tion on the banks of the Ganges.—Pioneer Mail.

The University of Allahabad has been directed by
the Government of the United Provinces Agra and
Oudh to consider the question of forming а faculty of
medicine.

The Government of Bombay has appointed a mixed
committee, under the presidency of the Surgeon-
General with Government of Bombay (Civil Depart-
ment), to investigate the prevalence of malarial and
other fevers in the city. According to municipal
statistics the deaths from these causes have varied
from 7,513 in 1880 to 2,333 in 1903.

THE JOURNAL OF TROPICAL MEDICINE.

145

Personal Hotes.

R.A.M.C.

The following otticers of the R.A.M.C. аге to command the
Station Hospitals named: Lieutenant-Colonel S. С. Allen, Kala-
bagh; Lieutenant-Colonel R. G. Hanley, Kaldanna; Major O.
R. A. Julian, C.M.G., Cherat; Major R. Holyoake, Solon;
Major б. Scott, Gharial ; Major Т. W. Gibbard, Barian prd
Captain Ғ. 5. Walker, Khyra Gali and medical charge of the
School of Musketry, Changla Gali ; Captain Н. W. Long, Upper
Тора; Licutenant J. A. Turnbull, Khanspur; Lieutenant A. W.
Gater, Ghora Dhaka: Lieutenant S. M. W. Meadows, Cliffden ;
Lieutenant R. Н. L. Corduer, Hara Gali; Lieutenant Н. T. M.
Wilson, Lower Topa.

INDIAN MEDICAL SERVICE,

India Office: Arrivals, &c., of Medical Officers; Reported in
London during April.—Lieutenant-Colonel 2. B. Gibbons, Cap-
tain J. B. Christian, Captain S. Evans, Captain L. Reynolds,
Captain А. ХУ. C. Young, Lieutenant-Colonel R. H. Charles,
Lieutenant-Colonel P. D. Pank, Major L. F. Childe, Major F.
G. Maidment, Captain H. M. Cruddas, Captain H. W. Illius,
Captain F. N. White, Lieutenant G. F. Harkness.

Nursing Sisters. —Miss B. Crane, Miss D. L. T. Moore.

Extensions of Leave.— Major H. E. Drake Brockman, 6 m. ;
Captain W. Lapsley, 3 m. ; Professor Haffkine, 6 m. ; Major J.
G. Jordan, study leave, 3 m. 25 d.; Major H. Austin-Smith,
study leave, 1 m. ; Major G. Е. W. Ewens, study leave, 8 m. ;
Captain R. E. J. Lester, 5 m. ; Major E. V. Hugo, to July 2nd ;
Major J. Stodart, 5 d. ; Captain H. H. Brown, 6 m.

Permitted to Return to Duty.—Captain V. B. Bennett, Lieu-
tenant E. C. Hodgson, Major E. Hugo, Lieutenant-Colonel J.
A. Cunningham, Major J. Stodart, Surgeon-General W. L.
Gubbins, A.M.S.

Postings.

Captain Battye, I.M.S., acts as Consul-General, Meshed,
during the absence of Major Sykes, I.S.C.

Major Duke, Civil Surgeon, Bikanir.

Major Robinson, Resideucy Surgeon, Jaipur.

Major G. B. Hunter, services lent, Punjab Jail Department.

Lieutenant-Colonel R. E. S. Davis officiates as Inspector-
General, Prisons, Burmah.

Major J. P. Penny ofticiates as Civil Surgeon, Rangoon.

Captain E. R. Rost to charge of Plague Hospital, Rangoon.

Captain W. V. Coppinger officiates as Civil Surgeon, Mymen-
singh.

Lieutenant A. D. White holds additional Civil Medical Charge
of Buxa Duar. 3

Lieutenant-Colonel W. A. Quaile, Civil Surgeon, Jubbulpur.

Major А. G. Hendley, Civil Surgeon and Superintendent Jail,
Sangor.

Major B. R. Chatterton officiates as Surgeon Superintendent,
Presidency, General Hospital, Calcutta.

Major J. G. Gordon, Civil Surgeon, Chittagong.

Captain C. С. Seymour оћсіаѓев as Civil Surgeon, Cachar.

Major D. R. Green, Civil Surgeon, Khasi and Jantia Hills.

Major C. Milne, Civil Surgeon, Fyzabad.

Lieutenant-Colonel T. R. Mulroney, Civil Surgeon, Karnal.

Captain T. G. Stokes, for the season to Pachmari.

Captain C. G. Seymour to Civil employ, Eastern Bengal and
Assam (temporary).

Major Bird officiates as Professor of Surgery, Calcutta.

Captain J. R. Tyrell has been placed on plague duty in Ajmir-
Merwara.

Captain E. D. Greig has been placed on special duty in Central
Research Laboratory, Kasauli.

The following I. M.S. officers have been granted leave :—

Major R. G. Turner (furlough, privilege, and study leave),
17 m. 17 d., from April 10th.

Major J. Chaylor White (privilege and urgent private), 6 m.,
from March 30th.

Major G. M. Smith (privilege and furlough), 16 m.

Lieutenant-ColonelJ. R. Adie (study), 6 m.
` Lieutenant-Colonel Charles, Professor Surgery, Calcutta, fur-
lough, 12 m.

Major Green, Civil Surgeon, Muzaffarpur (furlough), 2 y.

Captain А. Moorhead (combined leave), 8 m.

Captain H. Illius (general leave in India), 1 y.

Captain Wilson (combined and study), 18 m.

THE JOURNAL

146

OF TROPICAL MEDICINE.

[May 1, 1906.

Captain H. Hamilton, С.В. (privilege leave), 90 4.

Captain А. Leventon (combined leave), 20 m. 18 d.

Major C. R. M. Green (combined leave), 2 y.

Major G. W. F. Braide (combined leave), 7 m.

Captain R. P. Wilson (combined and study leave), 18 m.

I.M.S. Retirements. — Lieutenant-Colonel Banerjee, Lieu-
tenant-Colonel J. A. Dalal, Lieutenant-Colonel Н. Mariett.

-ə-----<--
Prescriptions.

For Factau NEURALGIA.

В Butyl-chloral gr. 3 to 5.
Tinct. gelsemium ... m 5 to 10.
Glycerini - m xxx.

Aq. anethi ... А .. Md 388.
For one dose. Repeat at required intervals.
gested by W. H. Wynn.)

To PREVENT INTESTINAL FERMENTATION.
В. Careful dieting, and calomel thrice daily in doses
оғ; to x, grain. (W. Н. Wynn.)
ACUTE DYsENTERY.
R. J. Windle recommends :—
No. 1.
В, Chloral hydrat.

(Sug-

grs. XX.-XXX.

...

Liq. opii. sed. mxx.
Aq. M As 5i.
Syrup. aurant. zii.

No. 2.

B Раз. ipecac.
Aq. chloroformi 5i.
Mucilag. tragacanth. q. S.

No. 2 is given ten to fifteen minutes after No. 1.
URTICARIA.
To allay itching apply :—

gr8. XX.-XXX.

Қ, Acid. thymic .. grs. xv.
Acid. carbolic grs. ххх,
Menthol ... ats grs. iv.
Eau de Cologne ee
Sp. camphor | ts ай 3 iijss.

—Progrés Médical.
———— —————

Recent and Current Biterature.

A tabulated list of recent publications and articles bearing on
tropical diseases is given below. To readers interested in
any branch of tropical literature mentioned in these lists
the Editors of the JOURNAL OF TROPICAL MEDICINE will be
pleased, when possible, to send, on application, the medical
Journals in which the articles appear.

* Münchener Med. Wochenshrift,” January 2, 1906.
Although antivenin is always used in Austria in cases of
snake-bites by vipers, in Austria a ready means of treatment
is described as follows: Application of a tourniquet, an
elastic constriction is applied on the proximal side of the
bite, and 20 се. to 80 ec. of a 1 in 22 solution of chlorinated
lime in water is injected into and round the seat of the bite.

This treatment seems to be efficacious.

** journal American Med. Association,” March 10, 1906.

Tur DIBOTHRIOCEPHALUS Larus (THE Broap TAPEWORM
1х Minnesota, U.S.A. )

Nickerson, 5. D., reports а case of infection by the broad
tapeworm, occurring in a patient resident in Minnesota.
Hitherto such cases were believed to be importations from
Northern Europe, and the case deseribed by Nickerson was

in a child of З years of age, born in Minnesota of Finnish
parents, of whom the father was known to have suffered
from the worm.

Infection by the broad tapeworm occurs through the
injection of the larvie (plerocercoid) embedded in the flesh
of certain fresh-water fishes. As fresh-water fish are not im-
ported into America from Finland, the conclusion seems to
be that some native American fish must harbour the larvie.
Moreover, it has been proved that infection of American
fish by the larve of Dibothriocephalus is possible, and it
only requires the arrival of an infected адат population
from districts (Finland. Scandinavia, Poland or North
Germany) where the disease is prevalent, to understand how
the eggs and larvw can travel by the sewers into inland
fresh-water lakes or streams, and so infect the fish. As how-
ever, it is only when fresh-water fish are eaten raw, or parti-
ally cooked, that the disease can be conveyed, it is difficult
to understand how human beings become infected, although
domestic animals, such as cats and dogs, would be liable to
harbour the parasite.

“ Le Caducée,” March 3, 1906.

“Cutaneous Eruptions of Malarial Origin, and What
they Foretell" (Les Карона cutanées du paludisme ; consé-
quences А en tirer au point de vue des manifestations de
cette affection). Ву Surgeon-Major Claude.

As in the case of the majority of intoxications and
of general diseases, malaria has also its cutaneous mani-
festations. Dr. Billet was one of the first to describe
them, and as his observations on malarial febrile erythema
were all supported by an analysis of the blood of the
patients their origin is undeniable. Dr. Coste, who is
in charge of the military hospital at Arzew, has also
quite recently made a study of the cases of dermatitis of
malarial origin which absolutely resemble, by their eruptive
characteristics, the rash of measles. Malarial urticaria has
been noted by Lespinasse in the Sudan; Vacari has also
observed several forms of it.

Surgeon-General Moty attributes to malarial infection
certain cases of cutaneous gangrene, closely allied to urti-
caria, which he accounts for as follows: Obstruction of the
capillaries by pigmented leucocytes, want of nutrition in-
duced thereby, and necrosis of the tissues.

Ап analysis of the blood should always, therefore, be made
toconfirm the truth of their malarial origin, but this for
many reasons is not always practicable in malarial climates ;
microscopes are not always ready to hand, and their carriage
offers many difficulties. In any case, cutaneous manifesta-
tions, generally of a febrile character, should always, when
they occur in a tropical or marshy district, be considered as
possibly malarial in origin. But we, for our own part, are of
ап opinion that they have also an importance as forerunners
of further phenomena ; they may, indeed, be premonitory
of а severe, and even very dangerous, attack of acute malaria ;
in chronic malaria, on the other hand, the eruptions seem to
foretell, at an early date, & return of & true febrile attack,
similar in all respects to the acute form of ague.

The following notes leave no doubt in this respect; they
have been condensed, and only the main facts are here
recorded :—

(1) Mrs. X., а recent arrival at S., a very malarial spot
in the province of Oran, was laid up in August, 1904, with
ап acute attack of ague. One of these attacks was accom-
panied by an erythematous eruption over the body gener-
ally, extending in patches even to the face; the fever subse-
quently took on a continued type. Suddenly, attacks of
hiwnoglobinuria developed, the eruption disappeared, and
death took place on the fifth day.

(2) Zouave, N., stationed at S. for several months, has
never had ague; in September, 1908, he was admitted to
hospital with acute malaria, Whilst in hospital he developed
shingles on the left side of his chest. Тһе next day he was
seized with a pernicious attack. The patient died in a few
hours, in spite of injections of quinine, &c.

(8) S. (of Spanish extraction) was admitted to hospital at

Мау 1, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE. 147

Daya in August, 1903, with acute ague. During an attack
an erythematous rash appeared on his trunk and face. As
delirium set in, he was taken back to his house by his
friends. The eruption ceased the same day that he returned.
The patient died the next day in convulsions in gpite of all
care.

The rapidity with which all these three cases of cutaneous
manifestations were followed by a fatal termination is truly
worthy of note. Fortunately, in chronic malarial patients
the eruptive manifestations do not appear to be of such
serious import; this statement is borne out by the following
cases :—

(1) X., an army surgeon, since his return to France from
Algeria, has suffered from several malarial attacks, which
were more frequent than when he was abroad; at times he
suffers from a severe pain in the regions of the left brachial
and cervical plexuses. One evening he was suddenly seized
with an attack .of urticarial eruption, limited to both hands
and both forearms ; there was ап unbearable itching for two
days, then the uticarial rash disappeared, but the patches of
skin seemed as if wine-stained. АП these symptoms disap-
peared, but X. was seized with a true fit of ague, with all its
three stages. Three months later the same symptoms were
repeated in an identical manner. Quinine had but little effect
unos on the rash or the attacks of ague which followed
them.

(2) Captain N., of the 3rd Zouaves, stationed in France
for the last year, was seized one evening in March, 1905,
with general prurigo, also with urticarial patches on the
upper limbs and оп the neck. He consulted the surgeon on
duty and informed him that, in consequence of this mani-
festation, he would suffer іп a few hours from а long and
sharp attack of ague. True enough, ten hours later the
premonitory rigor commenced. The attack was followed
by prostration which lasted four days. This oflicer stated
that this was always the case after the urticarial attacks,
whilst when there was no eruption he was always able to
return to his work immediately after the ague fit was over.

(8 and 4) Two similar cases to the above in non-com-
missioned officers were also recorded ; these were both old
malarial subjects.

It would, therefore appear that the following conclusions
may be applicable in all cases of malarial intoxication of
whatever date:— .

(1) All cutaneous manifestations occurring in a malarial
subject would appear to foretell a more or less serious
relapse.

(2) With a view to meeting the gravity of this relapse, all
therapeutical means should be employed immediately on the
onset of the eruption, although in all our own cases they
appeared to us to be of little effect; but further trials might
be made in this respect.

* Verhandlungen der Deutsch. Zoolog. Gesellschaft,”
1908, р. 16.

On THE FECUNDATION OF THE PROTOZOA.

Schaudinn emphasises the modern view of the nuclear
dimorphism of these organisms, concluding that “іп all
protozoa, whose cycle of evolution and fecundation is known,
a dualism of the somatic and reproductive nuclear consti-
tuents may be recognised at some stage of development.”
Applying these ideas to the complicated structure of try-
panosomies, and especially to that of Trypanosoma noctua,
he identifies the flagellar apparatus of a trypanosome as
equivalent to the macro-nucleus or vegetative nucleus of an
infusorian, but does not include the smaller nucleus or
blepheroplast with the flagellum in this homology.

The two chromatin masses of the trypanosome, i.e., the
nucleus proper and the blepheroplast, are for him the equiva-
lent of the infusorian micro-nucleus, both being, he points
out, mainly formed of reproductive elements. In the pro-
cess of evolution, the large nucleus throws off its vegetative
elements in the form of chromatin, while the small nucleus
develops the locomotive apparatus, so that the two сош-

bined represent the primitive element of the infusorian ; and
Sehaudinn concludes that the trypanosomes exhibit a double
nuclear dimorphism.

It may be remembered that Schaudinn divides the oókinets
of Halteridiun noctue, which develop in the mosquito into
trypanosomes, into male, female, and indifferent forms. The
female forms are large with a big nucleus, and the locomo-
tive apparatus and blepheroplast but little developed. Тһе
male forms, on the other hand, are small with small nucleus,
and large locomotive parts and blepheroplast. Не thinks,
therefore, that the large nucleus contains mainly male, and
the blepheroplast female elements.

This sexual distinction originates in the earliest develop-
ment of the oókinets. In all there is а division of the
nucleus of copulation into a large and small nucleus, the
former aborting іп the males, and the latter in the females,
while in the intermediate forms both persist. He em-
phasises the peculiarities of copulation in 7. moctue—
quantitative and qualitative nuclear reduction (expulsion
of male and female substances, and reduction of the number
of chromosomes to one-half; persistence of male and female
centrosomes ; and independent unions, two and two of the
male nuclear elements of the male with the female nuclear
elements of the female.—(Trans. of F. Mesnil's abstract in
the Bulletin de l'Institut. Pasteur.)

* Transactions of the Liverpool Biological Society,"
1908, p. 278.
Fish PARASITES.

Johnstone, J., describes a considerable number of trema-
todes, cestodes, an echinorhynchus and а sporozoan from a
number of common edible fishes, and his paper has neces-
sarily a comparative interest for all engaged in the study of
helminthology.

“ Atti. К. Ассай. Lincei de Roma,” 1905, p. 411.
CUTANEOUS INFECTION BY ANCHYLOSTOMUM.

Pieri, Leno, concludes that шап is infected either by
swallowing the mature larvie of (or by penetrating the
skin) the Uncinaria americana as well as U. duodenalis,
being both capable of infecting man by either route.
The same remark applies also to Dochmius trigonocephalus
and D. stenocephalus of the dog, but in this animal infection
by penetration of the skin is the more eflicient route of in-
fection.

“6. B. Acad. des Sciences,” схіі., p. 1204.
IDENTITY OF SUBRA AND Мвоні.

Laveran, Prof. Experiments conducted by Vallée and
Panisset show that bovines immune to the surra of Mauri-
tius are also so against mbori, the trypanosomiasis of drome-
daries in Timbuctoo. M. Laveran now shows that, conversely,
a goat immune to mbori is also so to Mauritius surra, thus
placing the identity of these diseases beyond question.

“ Centralblatt f. Bakter.," I., Origin, 1908, p. 43.
SPREAD OF PLAGUE THROUGH THE AGENCY OF INSECTS.

Hunter, W., of Hong Kong, points out that insects have
long been suspected as possible vehicles of plague infection.
For example, in 1498, Archbishop Knud wrote that the
approach of plague is heralded by a change of weather with
thick fogs and the appearance of swarms of flies. He dis-
cusses at length the potentialities of flies, mosquitoes, lice,
fleas, and cockroaches in this respect, and the organs of
these insects in which the virus may be carried; and the
mechanism of infection by the fouling of clothing, food, &c.,
or by biting. His conclusion is that insects are actually
capable of transporting plague to long distances, but that
there is little to choose between biting and non-biting in-
sects in this connection, as he believes that the danger of
bites from insects that have been on plague patients is
greatly exaggerated, and that the really important point is
that many insects are capable of infecting food, clothing, and
furniture of all sorts.

148

THE JOURNAL OF TROPICAL MEDICINE.

"Мау 1, 1906.

EXPERIMENTS ON THE TREATMENT OF TRYPANOSOMIASIS BY
MEANS оғ ANILINE COLOURS.

These experiments form the subject of an inaugural dis-
sertation by Ewald Franke, and were conducted under the
superintendence of Prof. Erlich, who himself, in conjunc-
tion with Shiga, had already made some experiments with a
a dye called trypanroth. Ап injection of this dye appears
to cure mice infected with “ caderas," and Franke now finds
that immunity lasts for twenty-one days after the cure.
Neither malachite green nor ethyl green proved as effective
as trypanroth. Even better, is a combination of arsenic and
trypanroth suggested by Laveran.

Franke also cured а monkey (Cercopithecus callitrichus)
by & combination of arsenic and another dye which he
merely speaks of as being “ near" trypanroth. Тһе serum
of this monkey was also proved to possess parasiticide and
agglutinating powers.

* Indian Medical Gazette," April, 1906.
Тен Days’ PigMENTARY Fever or BENGAL.

Cobb, Lieut.-Colonel R., says: This form of the in.
determinate fever of India occurs during the hotter part of
the year, and is characterised by "continued fever," lasting
from eight to ten days, and the presence of a peculiar pig-
mentation of the face which follows the febrile attack. It
usually seems to occur in persons who have been exposed
to great heat, and the onset appears to closely resemble an
attack of influenza, apart from the more usual catarrhal
symptoms of the latter. The pigmentation is “ bat-shaped,"
taking the same form as the eruption of lupus erythematous.
No parasites are found in the blood, nor is the livér or
spleen affected. А detailed uccount of a typical case and
short notes of twenty-nine others are given by way of
illustration.

This is an interesting instance of the differentiation
оға class of cases that undoubtedly, till lately, would
have been put down to the credit, or rather discredit,
of malaria.

“ Bull. de l'Institut Pasteur," T. 4, p. 241.
Summary of papers presented to the Annual Meeting of
the Society of American Bacteriologists at the Univer-
sity of Michigan.

Norris, Pappenheimer and Flourney, preliminary com-
munication on the infection of white rats with spirochetes,
and on the multiplication of the latter in a liquid medium.

With the blood of a case of relapsing fever they succeeded
in infecting both monkeys and white rats. The latter when
infected by subcutaneous inoculation showed more or less
numerous spirochetes in their peripheral blood for the next
two or three days, and these persisted from one to three
days. Beyond splenic engorgement, the rats did not seem
ill, and there were no relapses. They succeeded in as many
as twenty-five serial infections, and the infected rats acquired
immunity, but though their serum, mixed with infective
blood, retarded the evolution of the spirochetes, it was
useless when injected а few days before. Тһе authors
observed nothing indicative of longitudinal division, and
believe that proliferation takes place transversely, and that
the spirochetes are really nearer to the bacteria than to the
protozoa ; nor could they find any sign of either cilia or
undulating membrane. Тһе spirochetes in а small quan-
tity of infective blood added to citrated human or rat blood
multiplied considerably, and this could be repeated once,
but no more. Citrated infective blood retained its infecti-
vity for six hours аб the temperature of the laboratory.

TRYPANOSOMES OF MOSQUITOES.

Novy, F. G., MacNeal, W. J., and Torrey, H. N., of the
University of Michigan. Ав the result of their work on the
cultivation of the trypanosomes of birds, the authors main-
tain that the flagellates observed by Schaudinn in mos-
а are not, as the latter thinks, evolutionary stages of
the endoglobular parasites of the birds, but cultivations in
vivo of trypanosomes present in the blood of the birds

experimented with. They, therefore, try to show that
irypanosomata can live and multiply in the intestine of
mosquitoes under forms EES тт mdi with those which
can be got in vitro.

Mosquitoes (800) were caught and fed on animals ascer-
tained to be free from hwmatozoa. The intestines of 15
per cent. of the mosquitoes contained flagellates, the lumen
of the intestine in some being quite obstructed with masses
of rosettes of flagellates with the flagelle in the centre.
Several ditlerent trypanosomes were found, Crithidia fasi-
culata and a form perhaps identical with Herpetomonas
subulata being the commonest. Owing to the presence of
bacteria, cultivation of these flagellates was difficult, but
the Herpetomonas was isolated in company with a small
coccus and the Crithedia together with a yeast; and these
cultivations remained for six months in the laboratory, while
in the others the flagellates were crowded out by the
bacteria. These cultural forms ure identical with those
of the mosquitoes, ¢.g., the blepheroplast is always in front
of the nucleus and, under both conditions, the Herpetomonas
has two characteristic diplosomes in the hinder part of the
body.

The results of inoculations of animals with the cultures
were negative. When mosyuitoes are fed with Trypano-
soma brucei or T. lewisi, these parasites persist for
more than twenty-four hours in the intestine of the mosquito,
and retain their infectiveness for rats. The authors believe,
therefore, that the trypanosomes found in the stomachs of
tyetse-flies, fleas, &c., are really cultural forms, the blephero-

last being in front of the nucleus. They conclude, there-
ore: (1) That these forms can be cultivated in test tubes ;
(2) that the herpetonads found in flies and mosquitoes
are really cultural trypanosomes, and that further researches
will demonstrate the hzematozoa, from which they originate ;
(8) The Crithidia, on the other hand, have no undulatory
membrane, and for the present may be taken to represent a
distinct genus.

Novy, E. G., and Knapp, К. S., describe a method of
isolating trypanosomes from accompanying bacteria.

* Ann. Inst. Pasteur," December 12, 1905.

Emile-Weill, P., details various attempts to cultivate the
Bacillus lepre in в variety of media, and comes to the
conclusion that success depends on the presence of human
tissue elements included in the leproma, as in only two
instances of cultivations on yolk of egg did the bacilli survive
after having digested those cells.

* C. R. Soc. Biologie,” T. Ix., p. 291.

Sergerit, Edm. and Et., describe, under the name Herpeto-
monas algeriense, а flagellate often found in the intestine
of Culex pipiens and Stegomyia fasciata, bred in the
laboratory at Algiers. In its motile form it has an elongated,
pyriform body, with a flagellum, which arises from a centro-
some placed behind the nucleus. Besides these there are
spherical motionless forms with long flagella. ^

Besides these they have found in an old preparation made
in 1901 froin theintestine of Anopheles maculipennis another
flagellate, with a very long fusiform body, pointed behind
and rounded in front, with a long lash, which resembles
Herpetomonas jaculum, discovered by Leger. The same
preparation also contained a number of spirochetes.

Rotices to Correspondents,

1,—Manuscripts sent in cannot be returned.

2.—As our contributors are for the most part resident abroad,
proofs will not be submitted to those dwelling outside the United
Kingdom, unless specially desired and arranged for.

8.--То ensure accuracy іп printing it ıs specially requested
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4.—Authors desiring reprints of their commuuications to the
JOURNAL OF TROPICAL MEDICINE should communicate with the
Publishers.

5.—Correspondents should look for replies under the heading
“ Answers to Correspondents.”

Мау 15, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE. -

149

Original Communications.

THE PURU OF THE MALAY PENINSULA.

By T. D. GiMLETTE, M.D.
Awarded a Craggs’ Research Prize, 1905,
London School of Tropical Medicine.

А DISEASE known by the Malay name of puru has
never been described in detail from the Malay Native
States before, and although it is very common among
Malays, nearly all our information concerning it has
bitherto come from the group of islands which forms
the Malay Archipelago.

This wholly unmerited neglect by residents on the
mainland in the description of puru has probably been
partly due to the tardy exploration of this part of
Further India, whioh was only commenced lately [1],
partly to the natural reticence of the natives and the
suspicjon with which the Malay peasantry regarded
the prying eye of Western medical science, but o
to want of independent medical observers With time
and opportunity for special investigation.

. Until quite recently the prevalence of puru in
British Malaya, seems to have even escaped the at-
tention of the Federated Malay States Government,
but this, again, is probably owing to the fact that the
disease does not interfere much with labour, which is
mainly carried on by Chinese, and, speaking generally,
because it does not permanently injure the health of
the Malay to any extent. The natural tendency of the
disease is towards spontaneous cure. Death ftom

puru is unusual ; it is seldom fatal, unless during теғу.

early childhood or in advanced old age. . .

А period of seven years' service in the Government.

of the Federated Malay States, spent in the States of

Pahang, Selangor, and Perak, has given me experience

_ of puru, and a further residence of over two yeara in
Kelantan, а Malay State hitherto unexplored by

students of tropical medicine, and one in which this.

disease is most prevalent, has afforded me an unusual
opportunity for observing it under purely native con-
ditions. My contention is that the puru of the Malay
peninsula is identical with the West Indian and
African yaws aud the Fijian coko, and that it has no
real relationship with syphilis. І

Tue History оғ Puru.

The earliest references which сап be taken ав bear-
ing upon puru are by Bontius in 1718, who seems to
have recognised it in the Molucca Islands as the
amboina pocks [2], and by Marsden, who mentioned
a native disease called nambi in his “ History of
Sumatra " (1811) [3]. i

Many years later, Charlouis, who described fram-
bæsia from Java ав polypapilloma tropicum [4], gave
one of the local native names as nambie. But up till now
(1886) even Hirsch had been led from want of records
to assume that the mainland of Further India had
been little, if at all, visited by frambæsia or yaws (51.
Ten years later a definite outbreak was reported from
Assam [6] , and yaws has quite recently been described
as being very common in Siam [7].

In 1898, Dr. Brown described puru from Penang as

lupus contagiosus malayorum [8], and in an annota-
tion on this important paper, Dr. T. Colcott Fox drew
attention to the similarity of puru to yaws, but finally
concluded that puru was the same as Oriental sore,
and in 1897 the name was given as a synonym of that
disease in Allbutt’s ‘System of Medicine" [9]. It
has since been shown that the appearance of some
true Oriental or Delhi sores is by no means so
characteristic as one would expect it to be from
descriptions given in books [10]. l

Dr. Barker, of the Sarawak Civil Service, was the
first to identify puru with yaws from Kuching in
1898 [11], and Dr. Connolly, of the Federated Malay
States Civil Service, wrote a valuable memorandum in
the same year, on the occurrence of yaws іп Kinta, а
district in the Federated Malay States [12]. · Раги is
given as а synonym of yaws in Scheube's “ Diseases
of Warm Countries” [19] (1903), and Dr. George
Pernet (1904) has mentioned the puru of the Malay
States under the heading of yaws [13], as well as Dr.
G. W. Daniels, the Director, Institute for Medical
Research, Federated Malay States, who has included
it among the commoner diseases of Malays [14];
but with these important exceptions there are few,
if any, direct references to the prevalence of the
disease in the Malay peninsula.

THe Етшюгоаү or Punv.

The true infective agent of the disease has not yet
been recognised,.and in a review of the etiology of
puru, little or no support can be relied upon from any
in-patient hospital statistics. Cases either under the
name of puru or of yaws are seldom included in the
retarns of the Federated Malay States hospitals. The
reason is that although the Malay native attends
readily as ап out-patient at any convenient and
charitable dispensary, or possibly clamours for
medicine on the visit of a European to his village, yet,
notwithstanding the many opportunities for further
improvement offered by Buropean hospital treatment,
the peasant fails to this day to be attracted by the
benefit of treatment іп a hospital ward, and generally
applies for admission in a spirit of tolerant euriosity
and in а desultory fashion, which is merely the
effect of а momentary enthusiasm or the result of a
personal attachment.

Under these circumstances it is impossible to col-

. lect hospital statistics which are of any great value.

There is no medical literature: The only knowledge
is that of the individual. The Malay medicine man
(bomor) and the witch doctor (pawang) is for the most
part but a native magician or a veteran wiseacre.
They say naively that puru (literally a sore), like
small-pox, comes from the smoke of hell fire! I have
obtained, however, a good deal of general information
from these native physicians.

Age.—Puru is one of the most common diseases of
Malay children, but it is rare among infants; and it
is, I think, seldom seen as early as the eighth month
of life.

-It is common to find puru in almost any Mala
village (kampong) among little children who—albhough
probably still at the breast—are able to walk alone
and are exposed to contagion. The disease is not,
however, confined to children, and may occur at any

150

THE JOURNAL ОЕ TROPICAL MEDICINE.

[May 15, 1906.

age, except at birth. Out of fifty individual cases
noted in the out-patient registers of the Duff Develop-
ment Company's hospital at Kuala Lebir in the
interior of Kelantan (from July, 1903, to July, 1905),
twenty-four were children whose ages ranged from
four to twelve years. The others were all adults who
applied for relief mostly during the first year of the
establishment of the hospital (1903), suffering from
the later manifestations of puru of the foot.

Ser.—Puru appears to attack either sex with equal
frequency, but in adults lesions of the foot are more
common among males.

There is а variety called puru kochi (literally,
Cochin China sore), which is said by Malays to attack
the genital organs only, and to be more common
among the female sex, but not necessarily confined
to women. Dr. C. W. Daniels has suggested to me
. the possibility of puru kochi being akin to sclerotising
granuloma of the pudenda. It is rare, and has not yet
come under my personal observation.

Басе. —Тће permanent native population suffers out
of all proportion to the many inhabitants of the native
states of the Malay peninsula. It is no exaggeration
to say that at least 90 per cent. of the Malays in
Kelantan are attacked by puru. Europeans appear to
be exempt, but I have seen it among Chinese, Java-
nese, Siamese, and more rarely in Sikh and Dyak
settlers. In the Federated Malay States it appears to
me to be uncommon among Tamil immigrant children.
I have seen it among the wild aboriginal inhabitants
(Sakui-Semang) of Kelantan, It is common among
them, and in the Kuala Lebir district is known in
their dialect by the name of “ choh.”

Heredity. — In this disease heredity has apparently
no influence. Children are never born with puru,
even if one or both of their parents suffer from the
disease at the same time, Риги is never seen during
the forty days of the Malay puerperal state. There is
no evidence, in fact, of congenital puru among Malays,
who hold that the disease is always acquired. Abor-
tions as the result of puru are almost unknown, unless
during а very severe attack. Intermarriage and con-
sanguinity do not seem to have any influence. Among
hereditary antecedents there аге no diseases from
which Malays commonly suffer which seem to have
any relation tothe etiology. Tuberculosis is, I think,
on the whole, as-infrequent as leprosy among the
country people. Lupus appears to be unusual in the
Federated Malay States.

Physical Geography.— The Malay peninsula lies
between the Straits of Malacca on the west and the
China Sea on the east. It is made up of a number of
native states, which are divided into eastern and
western by a range of mountains which runs like
а backbone nearly through its entire length. The
height of the various peaks of the range varies from
3,000 to over 7,000 feet above sea-level.

The most important of these states are under British
protection. They are the States of Perak, Selangor,
Pahang, and Хенгі Sembilan, which were confederated
in 1897, and have since been known as the Feder-
ated Malay States. They are situated in the centre of
the Malay peninsula, and are bounded on the north
and north-east by Province Wellesley and the Malay
States of Kedah, Patani, Kelantan, aud Trengganu ;

on the south by Malacca and the State of Johore;
and on the east and west by the China Sea and the
Straits of Malacca respectively.

The population of the Federated Malay States
numbers approximately 665,000 persons.

Kelantan is the most important of the other Malay
states. It approaches Siam, being between lat. 5° 40,
and 6° 20', north. It is bounded on the north by the
Malay Straits of Legeh and Patani—dependencies of
Siam adjoining Singgora, the southernmost point of
the kingdom of Siam.

Climate.—The Malay climate is hot, moist, and very
equable, making the peninsula a hotbed for fostering
parasitic diseases of the skin, especially tinea imbri-
cata, which is indigenous among many others. The
average mean temperature in the shade may be said to
be—maximum from 85:0? Е. to 88:0? F., and mini-
mum from 70:0? Е. to 72:0? Е. The highest maximum
may be taken at 96:0? F., and the lowest at 68:0? F.
The rainfall is large ; over 100 inches per annum is
the rule in most Malay states. Any division between
wet and dry seasons for the year is very indefinite.

Geographical Extension.—AÀs regards the Malay
peninsula, puru is probably universal, although it
may be more common in some places than in others.
It occurs in all the states of the Federation, especially
in Pahang, and is very prevalent in Kedah and Kelan-
tan. It has been observed as far north as Legeh and
Patani. In Trengganu puru is said to be even more
abhorred than small-pox, on account of its persistent
and chronic nature. i

Hygiene.—The personal hygiene of the Malays is
good. Country people bathe at least twice a day, but
there is often much to be desired in the cleanliness
of their attire. Children at the age at which puru is
common wear little or no clothing.

Social position has probably no influence at all as
& predisposing cause of puru among Malays. Іп
Kelantan it is as common in the dwellings which
form the native palaces as among the cluster of huts
which make up the smallest hamlets. His Highness
the Rajah of Kelantan, for example, has suffered from
puru as a child, and the princes frequently contract

uru.

E The hygienic conditions of Malay life are similar,
however, both in the high-born and in the low-born
native as regards house accommodation. The sanitary
condition of nearly all their houses is bad, and,
although they are raised from the ground, they are
ill-drained, ill-lighted, ill-ventilated and ill-cleaned.
The daily household slops (mostly dirty liquid refuse
from cooking) are thrown through loose bamboo floor-
ings and allowed to soak into the ground beneath, so
as to form а permanent slush under the kitchens.
On the other hand, in the rural districts, where for
the most part puru is very prevalent, it is very often
common for natives to dwell upon bamboo rafts,
which are made in the form of house-boats. The
mass of the Malays, in fact, live either on rafts or
in comparatively small huts built along the banks of
the rivers. The Malay states are well watered by
innumerable rivers and streams, and it is fortunately
seldom necessary, therefore, to store water in this part
of the East. mA :

The only instance of the bad effect of stored water

Мау 15, 1906.)

іп the Federated Malay States is, I believe, ап epide-
тіс of zine poisoning which occurred in Pahang in
1900 among a half company of Sikh soldiers, which
might have been attributed to the climatic effect on
the corrugated iron roof from which a supply of rain-
water was derived [18].

Preceding Iliness.—At first sight puru apparently
possesses an analogy to syphilis, but it is never
thought by Malays that there is any affinity between
these two diseases. There are many specific charac-
ters by which to distinguish them. Neither is a
protection from the other, nor do they vary in inverse
ratio. It ів only a previous attack of puru that pro-
tects the individual from a recurrence of puru.

It is fitting to mention here that.—making due
allowance for many errors in the definitions of Malay
nosology—many of the manifestations of venereal
disease, ав it occurs among dark races in warm
climates, are well known to Malays.

Gonorrhea is generally known in Malay as sakit
kenching (lit. sakit, sick, and kenching, urine), or as
karang.

Venereal buboes are referred to in many states as
mangga, which literally means а mango. Curiously
enough, the Chinese also call them suai or mangoes.
Syphilis is known in Kelantan as seduwan or seduwan
sundal (seduwan, a bad disorder; sundal, a bare-faced
harlot), or in other places as sakit prempuan (prem-
puan, a woman). Three stages of seduwan sundal
are recognised: (1) The original manifestation in man
or woman on the genital organs; this is followed by
(2) seduwan bunga (bunga, lit. a flower or pattern on
anything), which attacks the gums and face, and is
supposed by Malays to be due to infection (uwap, lit.
vapour or steam) ; and (3) seduwan angin (angin, lit.
wind), which especially affects the joints and bones.

The term stong or restang is commonly applied to
destructive ulceration of the nose,’ such as occurs in
tertiary syphilis. These diseases are all of common
occurrence.

Other Observations and some Native Ideas.— The
contagion of puru is well known. Malays say that
children who play about together catch it from one
another, but though two or more children in the same
family may contract puru at the same time it does
not necessarily run through the whole family. A
second attack is said never to occur in the same
person. Many hold that a kind of immunity is estab-
lished in later life by the occurrence of the eruption
in a rotation of three crops before the age of 3 years.

Isolation is never thought of, but natives avoid
contact with the discharges of puru, and do not care
to eat with people who may be afflicted with the
general eruption. It is thought to be unwise to bathe
immediately below any one suffering from puru of any
kind, and many Malays are careful to bathe up stream,
or away from people who are engaged in washing their
sores or those of their sick children at the time.

Deliberate inoculation is never practised among
them. The attack frequently follows on some slight
scratch or abrasion, but it is said that the sores of the
Malay kudis (lit. scurf), a kind of generic name given
to ulcers as well as to scabies, or kudis gatal (gatal,
to itch), and other sores of like appearance, are liable,
on occasion, to take on the characters of puru sores.

THE JOURNAL OF TROPICAL MEDICINE.

151

Leech-bites, although very common in jungle districts,
do not receive much attention in this connection, but
there is a belief among some Malays that the sores
caused by contact with the fresh ''getah," or live
sap of a common fruit tree called in Malay pokoh
machang (the horse mango, Maqnifera fotida), is a
ready vehicle for inoculation by puru should there
happen to be cases in the neighbourhood.

‘Sores on the lips and about the mouths of children
may often be caused by eating the acrid fruit of this
wild mango. The juice of the durian blossom (Durio
zibethinus, L. Malvacese) is also blamed in the same
way. These trees, however, are seldom avoided in
consequence. Puru is well known to attack people
both before and after they have suffered from small-
pox. Small-pox is common in the uncivilised states,
and educated Malays in the Federated Malay States
often attribute the decline of puru (in Selangor, for
example), ав well as the apparent immunity of Euro-
peans and their children, to the fact that, as a rule,
all European residents and their children are more or
less well vaccinated in childhood. Malay children,
however, who have been well vaccinated readily con-
tract puru, and it is more practical to account for the
apparent immunity of Europeans and their children
by explaining that they аге not very much exposed
to the contagion of puru.

It would be exceptional for European children to
have many native playmates in places where puru
was common. Asa matter of fact, most Europeans,
by reason of the refining influence of civilisation, are
reluctant to come into personal contact with the
loathsome-looking sores of puru. The advance of
civilisation among the Malays in this respect, together
with the influence of modern sanitation, should tend
towards the check of the disease. In the civilised
states of Selangor and Perak puru used to be far
more common in the towns than it is at present.

Malays do not appear to associate the idea of flies
or insects being possible agents in spreading puru, and
although their expression, “bagi lalat chari puru"
(as the fly seeks the sore), is used in conversation, it
is applied more in the sense of the English saying,
« Where the carcase is there will the eagles be gathered
together." Тһе common house-fly (Musca domestica
is not very prevalent.

Malays live rather poorly, the peasants mostly on
boiled rice and dry salted fish, but diet does not appear
to have much influence in the causation of puru.
Native settlers, especially Chinese, favour a far more
liberal diet.

In Kelantan, the practice of eating а home-made
condiment of badly preserved sea-fish is very common.
It is made by pounding two kinds of small fish (in
Malay, bilis and kikih), salting them, and adding a
little water. The young fish are chosen, and the raw
preparation is kept for forty days, and when in a state
of decomposition is ready to be eaten with rice. It is
called ** budu " and * peda" in Pahang. Dr. Hanitsch,
the Curator of Raffles Museum, Singapore, has kindly
identified these fishes for me. The larger of the two,
ikan kikih, is Equla edentula, which is distributed
in the Red Sea, Seas of India, Malay Archipelago and
beyond. The smaller, ikan bilis (lit., ikan, а fish), is
Engraulis indicus. It is very common about Singa-

152

THE JOURNAL OF TROPICAL MEDICINE.

[May 15, 1906.

pore, belonging to the family Clupeide, which comprises
herrings and sardines.

Some Malays in Kelantan attribute the prevalence
of puru in this state to the comparatively large amount
of budu which is consumed by Kelantan Malays. The
custom, however, seems to be peculiar to the eastern
and northern states and to be in no way responsible
for the origin of puru.

In Kelantan a very widespread and fatal disease
occurs among fowls. It is characterised by an
eruption about the beak and eyes, often leading to
blindness. I have not, however, been able to trace
any clinical resemblance between it and puru as it
occurs in human beings.

THE CLINICAL CHARACTERS OF PURU.

Puru is universally recognised by Malays as being
a specific disease. Тһеу have carefully observed the
constant groupings of its symptoms and have given
differential terms to its various manifestations. The
most prominent of the well-marked clinical characters
is. the appearance of the eruption of the puru sores as
it occurs in Malay children. .

The disease attacks otherwise healthy and robust
children, and observers with any experience of puru
cannot fail at sight to recognise the eruption of puru
sores in Malay children owing to its constant and
uniform appearance. In the later stages of the disease
it is not во easy to speak во definitely nor to recognise
the sequence of the symptoms.

There is a stage of incubation, efflorescence, decline
and sequel, but Malay children are seldom seen during
the early stages of puru. In adults, again, the eruption
of sores is more likely to be seen among foreign native
settlers. Malays have mostly experienced it in child-
hood. The incubation period is therefore difficult to
determine. It is given off-hand by most Malays as
being twenty days. The attack is generally preceded
by an ill-defined constitutional disturbance which
causes some slight fever, as well as rheumatic-like
pains in the bones, back and limbs. These symptoms
are occasionally delayed or suppressed through chills,
and it is said that the prodromal pain in the bones is
then very pronounced and the backache equal in
severity to the pains of small-pox. The joints in such
cases are tender and swollen quite early in the disease.

The initial puru breaks out all over the body asa
miliary papular eruption (“ ketut ” in Malay), and often
in successive crops. It is attended with great itching,
so much so as to give occasion for the Malay proverb,
* Orang yang puru gatal tubohnya neschaya menggaru
juga Кегја-пуа " (A man whose body is itching with
puru will always be engaged in scratching it). І
doubt, however, if the itching is sufficient to keep
Malays from sleeping. Children often complain of
feeling chilly at this early stage of the disease; they
are feverish, peevish, and disinclined to bathe. Тһе
ећогеѕсепсе of puru, known in Malay as the “ bunga ”
(a blossom), develops gradually from the primary
papular eruption. The ‘ point d'appuie " is most
often at some simple scratch or small sore from which
springs what is known in Malay as the “ puru ibu,”
or mother sore. This is formed by a combination of
several papules and is generally the largest sore as well
&s thebestdeveloped and the most persistent. Itismost

often found below the waist, on the foot, leg, or thigh,
but it may occur on the wrist or hand. This par-
ticular clump of papules may assume a horseshoe
shape, or may develop into a large sore, as in fig. 1.

Malays always fancy the ''puru ibu” to be the
initial sore, and they often think it is а misfortune if
it should disappear early in the disease. It is often
the last sore to heal. Malays also think that it is im-
possible to arrest the development of the “ puru ibu”
and so prevent puru from spreading over the body and
subsequently affecting the joints.

The *' bunga puru," or efflorescence of the disease,
originates from the papular eruption and seems to
spring up like seed planted, as 16 were, beneath the
skin and to grow up into & crop of tubercles which
gradually bursts through the skin and expands into а
number of discrete lesions, which ultimately become
the typical clinical features of puru. Many of the
original papules, on the other hand, involute and sub-
side. There seems to be no reason (such as irritation
from scratching, &c.) for some of them to develop into
puru sores while others, and perhaps the majority of
them, disappear. Ав they develop they are moist by
reason of a glairy, thin, scanty, but rather sticky dis-
charge, and on eutaneous surfaces they gradually dry
up and generally form sores which are covered with a
hard, tenacious, dirty, yellowish crust. Puru sores at
this stage are those which are most commonly met
with. Pus, unless formed by irritation, is not as а
rule found under the crusts, and in four or five in-
stances I have found the discharge to be either alka-
line or neutral to litmus paper.

. The sores are scattered over the face, neck, trunk,
&nd extremities. They are more or less dispropor-
tionate and vary very much —from a grain of maize to
a betel nut, for example—in point of size. They are
often flattened out, but always seemed to be indolent
and insensitive. Ву soaking of the crust of a small
and rather old typical sore the reddish and roughly
granular contour of the swelling may be exposed. It
is not unlike a raspberry in appearance. Multiple and
typical examples may be seen in the armpits and on
the penis.

Irregular-shaped sores are very common at the
angles of the mouth, at and about the nostrils, on the
buttocks, and about the anus and genitals. When
the eruption is well out the general health is prac-
tically unaffected, particularly when the sores have
dried and scabbed over. They seldom ulcerate to any
extent. I have never seen them transformed into
“ sloughs.” 8

The disease does not attack the viscera, so far as
can be judged without the aid of post-mortem
examinations; the nervous system and the larynx
appear to be exempt. There is certainly no specific
affection of the eye in puru ; deep lesions of the tongue
do not occur, but the sores are said to attack the
mucous membrane of the mouth. I think this, how-
ever, must be rare. The symptom is known as
* guwan ” or “ serawan" in children. It has possibly
been confounded with “ thrush.” Тһе occurrence
of an attack of puru for the first time in old age is said
to be grave.

Puru sores heal very slowly on their own accord,
and when they are at last beginning to decline they

Мау 15, 1906.)

shrink and gradually disappear, leaving either dark
purplish transient strains or a few dark superficial
scars.

The disease is of long standing ; it frequently lasts
for one or two years, but often for a much longer
period. Sometimes the initial papular eruption be-
comes scurfy (* puru sekam "), and in other cases it
тау develop in places into a serpiginous eruption
(“раға kretas”). When the eruption comes out
slowly constitutional symptoms (“ senggai рига”) are
complained of, such as malaise, simple periostitis of
the long bones, and painful swelling of the wrist,
fingers, and other joints. These symptoms are not
at all uncommon in adults. During the decline of the
disease, reminders in the shape of tiresome sores may
crop up long after the original sores have ceased to
recur. This is, I think, especially noticeable with sores
of the foot, which are very common in adults who
have suffered from puru in childhood. They generally
occur on the sole and are very painful until they
have burst through the epidermis. The pain is said
to be much aggravated in the bare-footed native by
contact with the dung of the buffalo and chicken. In
Kelantan they are especially common during the durian
(the thorny fruit) season in July and August, and for
that reason, I believe, are called “puru durian.”
These foot sores are also. seen in children.

А kind of xerodermia, or keratosis of the skin, as
shown on the hands in fig. 2, also occurs on the
foot, and is ascribed to puru. In appearance it is like
dirty parchment paper, but the dry skin frequently
cracks and causes painful fissures. This must not be
confounded with the common affection of the feet,
known locally as *'burok chelapah” (lit., burok,
rotten; chelapah, soiling by the tread). It is due to
walking barefoot on gravel or sand.

Although puru as a disease is liable to be very per-
sistent and recrudescent, Malays never acknowledge
any lesions of deep nature, such as nodes, chronic
dactylitis, chronic arthritis, and deep ulcers, as being
sequels of puru. Lesions of the kind shown in fig. 24
and Plates XX XIX. and XCI. of the New Sydenham
Society's Atlas [15] are very common among Malays.
I do not think, however, that in the case of the Malay
peninsula one is justified in attempting to fit these
facts into a clinical description of puru. They appear
to me to be manifestations of syphilis.

(To be continued.)

THE ANATOMY OF THE BITING FLIES OF
THE GENERA STOMOXYS AND GLOSSINA.

By Lieut.-Colonel б. M. Gms, I.M.S. (Rtd.).
(Continued from p. 102.)

THE distinguishing generic characteristic of Stomoxys
is, however, the form of the proboscis, which, though
presenting a strong general resemblance to that of
Glossina, differs so markedly in outline that it can be
recognised at a glance.

The organ is shaped dike a radish, with a bold curve,
convex on the dorsal aspect, and is slightly swollen
at the tip. With the exception of the ends of the
labella, which are clothed with long thin hairs, the

THE JOURNAL OF TROPICAL MEDICINE.

153

surface is almost nude. It is connected with the
lower part of the face of the insect by means of a soft
membranous piece consisting of the combined bases
of the labium and maxille, and bears on its dorsal
aspect, close to the face, the short, single-jointed

Fia. 13.— Profile outline of proboscis of Stomoxys. p, palp ;
h, dotted line indicating position of hypopharynx and labrum ;
ap, apodeme or sclerite which articulates with the fulcrum and
serves as a jointed point of support to the proboscis. Semi-
diagrammatic.

maxillary palps. This soft basal portion is about a
quarter the length of the main radish-shaped part of
the organ, and its length and flexibility permits of
ample motion in flexion and extension, and to some
extent also of protrusion and retraction, the necessary
stability of the radish-like part being afforded by a
pair of slender chitinous rods, the furca, which arti-
culate with the fulera, at their proximal ends, and
distally, with the bases of the lancets. r

Through the axis of this flexible basal portion runs
a chitinous tube, continuous behind with the buccal
cavity, and in front with the grove of the lancet, which
in this insect consists of the labrum only.

Fig. 14.— Head of Stomoxys in profile.

The above rough sketch gives a fair idea of the
organ in the position it is usually carried by the in-
sect, but the basal portion is often flexed backwards
almost against the base of the head, and on the other
hand the trunk portion can be extended so as to
almost touch the antenne.

A glance at the profile outline below shows that it
would be difficult to plan a sheath for the lancets less
suited to act for itself as a piercing organ. The labella
form an ostentatiously blunt extremity to the organ, and
are furnished with delicate hairs and elaborate tactile
organs, while the abrupt thickening of the basal four-
fifths makes it clearly impossible that it should ever
act as a rapid piercing organ, if, indeed, it could be in
апу way possible to employ it as-such. No boring in-
strument that I know of, devised either by Nature or
by man, has this form, and when, for want of a better

154

THE JOURNAL OF TROPICAL MEDICINE.

(Мау 15, 1906.

tool, one is driven to try to use a piece of steel of this
shape as an awl, one at once finds how utterly un-
suited it is foy the purpose. Let any one who doubts
this try to sew leather or canvas with an ordinary
packer’s needle, which is efficient for the workman’s
purpose, merely because the sacking he works with
is of so open a texture as to be almost a net, and yet
the tool is better shaped than the proboscis of Stomoxys,
as would soon be seen if one tried to sew sacking with
a needle so shapen. Those who have been driven
by emergency to use an ordinary sewing needle for
suturing the human skin will fully appreciate the
force of these arguments, though a sewing needle has
a far more delicate point than the proboscis of this
fly, and the needle, for strict comparison, should have
its point broken off. The labrum, on the other hand,
which has a point fashioned exactly like that of the
ordinary and very business-like hypodermic needle, is
as admirably adapted for piercing as the labium is the
reverse, aS may be seen from the accompanying
camera lucida outline of the two organs drawn from
a fly in which the labrum happened to lie separate
from the sheath.

Ета. 15.—Outline of head of Stomoxys seen from side and
rather from above.

Let us now examine more closely the structure of
this organ. The proboscis in the ordinary resting
position of the parts as seen in the living insect shows
nothing but the labium, or lower lip, the function
of which, as already noted in a preliminary communi-
cation to this Journal, is, I maintain, simply that of
a sheath to the true piercing apparatus. The main
part of this consists of a radish-shaped mass, already
sufficiently described, and this supports a pair of
small lobular organs, the labella, which, apart from
the relative proportions of the parts, resemble the
larger expansions which are so familiar to us in the
favourite popular microscopic object usually labelled
as the ‘‘tongue of the blow-fly.” These lobes are
obliquely articulated with the slightly constricted
trunk of the proboscis, and in the fresh state can be
made to separate by pressing the proboscis down on
an object slip or other resisting surface. When in
this position, it is needless to say that the labella
make the labium even more obviously impossible as
a piercing organ than when folded together in their
ordinary posture of rest.

If we now proceed to dissect the separated proboscis
it will be found that it is not difficult to separate the
black outer coating, except from the labella, and that
when this is done, we are left with a delicate plate of
chitin (sclerite) which forms a sort of median antero-
posterior septum, and on either side a great mass of
muscle which takes origin from the chitinous furca,

which just reach up to the beginning of the thickest
part or bulb of the proboscis, and is inserted into the
anterior part of the median scleriti by tendinous fibres
of varying length. Hence if the proboscis be detached
by cutting it off immediately behind the bulb the
muscular mass separates from the containing integu-
ments with the greatest facility owing to its being left
quite without hinder attachments. Behind, however,
there is nothing to prevent the median sclerite from
sliding back between the furca.

If we now examine a specimen from which the soft
parts have been removed with caustic soda, it will be
found that.the outer skin, in spite of its blackness and
deceptively solid appearance, is thin and flexible, and
is, moreover, wrinkled transversely at fairly regular
intervals. These transverse folds run almost trans-
versely round the basal part of the proboscis, but to-
wards its extremity, run rather forward on the ventral
side to meet together in broad V’s. These transverse
lines give to the entire organ a close resemblance to a
leech, which is much heightened by the remarkable
similarity of general contour, and it is impossible to
interpret them in any other way than that they are
the outcome of habitual infolding which, exactly
as in the leech, permits of the whole structure being
shortened.

If we now examine a transverse section of the organ
it will be found that it consists of a solid conical mass,
the anterior side of which is grooved with a narrow
rabbet, the depth of which, however, is not more than

Ета. 16.—Transverse section of proboscis of Stomoxys at
about mid-length. л, Hypopharynx; l, labium ; irm, labrum ;
т, muscle; s, median sclerite; ё, trachee. Camera lucida,
semi-diagrammatic.

one-third of the thickness of the cone. Dividing it
into two lateral halves is the median sclerite which is
stouter on its ventral than on its dorsal edge, and lies
immediately under the skin of the groove dorsally,
while the stout ventral margin has attached to it
two delicate septa which run off on either side to the
great muscular masses and serve to separate the
ventral median from the two great lateral air sacs.
The entire width of this sclerite is little more than
one-third that of the diameter of the cone, and as its
thin dorsal edge is close under the rabbet, while the

May 15, 1906.]

THE JOURNAL OF TROPICAL MEDICINE.

155

ventral edge is almost a third of the diameter of the
organ from the ventral integuments and separated
from them by the great ventral median air chamber.
Lying on either side of the axis of the cone are
two great trachese which break up in front into
branches which appear to open into the two antero-
lateral air sacs. Behind and in front of each trachea
are extremely slender muscles, the hinder rather the
thicker, the function of which I am unable to make
out, but conjecture that they are in some way con-
cerned in keeping the crease between the labellæ from
outfolding under the air pressure of the pneumatic
sacs. In the dorsal portion of the section within the
ale forming the sides of the rabbet are seen a number
of obliquely divided muscular films. There are two
sets of these which serve respectively to separate
and to bring together the labelle; so with the dif-
ference that the prehensile lobes of the labella are
lateral and symmetrical instead. of different and
antero-posterior, the whole proboscis presents some
resemblance to that of an elephant, though the
labella are, of course, relatively far larger. What
purpose a pair of soft, hinged flaps can serve, when
considered as the point of an awl, is difficult to
understand, and it 1s for those who assert that the
funetion of this elaborate mechanism is simply to
pierce the skin, as а bradawl is driven into а plank,
to show what may be the object of all this complica-
tion, and what may be the function of the various
musoles and other parte concerned.

А minute description of even the external anatomy
of the labella would alone occupy а lengthy paper, for

Fro. 17.— Labella of Stomoxys seen from ventral side to show
the rank of large teeth. To avoid confusion, the complicated
ranks of plates behind them are not represented, and only a couple
on each side of the pellate hairs of which about a score are
Scattered over the end and sides of each labellum. On the
left side is shown the rank of grapnel hooks, and on the right
the position of these is onl indicated by small circles so as to
show better the double rank of long bristles,

% is provided with so great a variety of hairs, plates
and sense organs that it is extremely difficult. to
Tondeuse an adequate account of: it. into moderate
Imits. Internally it is simple enough, ће entire

space, with the exception of some muscular fibres
which are inserted into the bases of some of the larger
plates or teeth, being occupied by а large air sac con-
tinuous with those of the main trunk of the proboscis,
so that the point of this reputed borer is formed by
an air cushion.

Viewed ventrally, with the labella slightly separ-
ated, it will be seen that the most prominent struo-
tures are a row of strong leaf-shaped blades or teeth
which project inwards and forwards towards each
other, so that in the natural position of rest they are
folded together and cannot engage the skin of the
blood-yielding animal except when the labella are
spread out to full expansion. They are four or five
in number on either side (I am not sure of the hind:
most, which may belong to another rank of plates),
and are the only at all powerful teeth that are to be
found, though it is difficult to see how they éan effect
a sufficiently large wound to admit of the rest of the
structure following them. On the other hand, it is
easy to see that they сап form efficient holdfasts if
the labella are pinched together after they have
entered the skin when they have been applied to it
with labella expanded.

Outside these is а row of very obvious grapnel
hooks. These are arranged in pairs, with the excep-
tion of the hindmost, which is single, each pair
being opposite an interspace between the leaf-shaped
blades. Finally, outermost of all, is & double row
of rather long, stiff bristles. Quite behind, on either
side of the fold between the labella, is a large papilla.
The whole of the tips and outsides of the distal
third of the labella is sprinkled with very peculiar
pellate hairs of extremely delicate structure. There
are а score or more of these on each, but a couple
only have been drawn to show their relative size, as
to do more would needlessly confuse the figure:
Their function is probably sensory, and it is con-
ceivable that they may be gustatory organs, as the
membrane of the little shield at the end is excessively
delicate. From their form and delicacy it is obvious
that they would never outlast the labella being once
forced into the skin. pai

To obtain an idea 'of the complex system of
plates and structures behind these it is necessary
to make a dissection so as to clear away one

Fic. 18.—Side view of the end of proboscis of Stomoxys, the
integument and muscles being removed to show the median
sclerite. =

labellum, and іп doing во, Бу. clearing away the
integuments of the supporting trunk, it is easy to
establish that the true support of the labella is the
median sclerite- (S). already described.’ When this

156

has been done it will be seen that inside the large
leaf-shaped blades are two or more ranks of ex-
tremely delicate lancet-shaped structures. Next to
these a row of tufts of short dense bristles, and
inmost а rank of stout bristles. Оп the most anterior
part is a dense mass of minute hooks. Personally,
І regard these curious structures as having the func-
tion of sufficiently abrading the surface to admit
of the character being tested by taste, but there is
nothing whatever in their size and form, or in the
fact of their presence, to suggest that they are in any
way concerned in any deep piercing of the skin of the
animal that yields blood to the fly, for “ teeth " of
this sort are to be found on the labella of all Muscidae,
such as the common house-fly, and which certainly
are quite incapable of doing anything more serious
than of licking the surfaces of what they feed upon.

I cannot give the exact reference, but if any one
cares to look up the files of Science Gossip of the
early eighties, he will find a series of very еее
papers оп these teeth of flies, which are illustra
by some very beautiful coloured plates, and will find
that many of the most harmless flies have much more
formidable teeth than those with which Stomorys is

provided.
(To be continued.)

RHINO-PHARYNGITIS MUTILANS.

By С. W. Branca, M.B., C.M.Edin.
Medical Officer, Colonial Hospital, St. Vincent, B. W.I.

Омрек this title, in the JOURNAL or TRoPICAL MEDI-
CINE for Febru 15th, 1906, Dr. Leys describes a
condition which he suggests is a distinct disease. Ав
one with some experience of practice in the Тгорісв and
of this particular condition, I wish to raise а protest
against this manufacture of new diseases out of the
manifestations of syphilis.

A mere pathological entity should not be put forward
as в disease sui generis. By this process we have had
several diseases created out of tuberculosis. Syphilis
of the nerve system has provided locomotor ataxia,
басо paralysis, &c. But perhaps the most fertile

eld for the discovery of new tropical diseases is
syphilis of the skin.
onsidering the incalculable importance to the
human race of the recognition of syphilis, and the
difficulty as yet of confirming diagnosis by any certain
test, it is most inadvisable to claim independence for
any condition, which may reasonably be attributed to
ву en until its etiological individuality can be estab-
ished.

Far better is it to treat everything as syphilis than
to miss the diagnosis of half the cases of syphilis. In
the Tropics, at least, this is true, where perhaps two-
thirds of the sickness is syphilis.

This destructive rhino-pharyngitis is extremely
common in some parts of the West Indies. Those of
us who do not attribute it to syphilis call it, with Dr.
Rat, a tertiary of yaws.

Of all works on yaws, that of Dr. Rat is perhaps the
best. He is a careful and conscientious observer, but,
as can be seen by his laborious compilation of previous
writings, he is limited by his reverence for tradition

THE JOURNAL OF TROPICAL MEDICINE.

[May 15, 1906.

and authority. This, however, could not detract from
the accuracy of his descriptions, and I believe any one
who reads his report with au open mind must see that,
after all, yaws is only syphilis, as Jonathan Hutchin-
son says in his preface to Rat's report. ІН

We аге yet at the threshold of the arcana of syphilis,
though the disease would seem to be as old as Pithe-
canthropus, and is clearly referred to in the Chaldean
epic of Izdubar. 4

To understand this protean disease we must realise
that various factors intervene to determine its mani-
festations. We can appreciate some of these. The
races or individuals who tax their nerve systems suffer
from nerve syphilis, which is comparatively rare
among negroes. ,

The negro, with his highly specialised and active
skin, displays an exuberance of eruptions rarely seen in
Europe. The labourer exposed to injuries develops
grave bone lesions. The women in St. Kitts, who
habitually gratify the desire of sailors for pedicatio
mulierum, get stricture of the rectum.

Some of the determining factors we have yet no
knowledge of, others we can now guess at. .

In yaws Castellani found a spirochzte morphologi-
cally identical with Spirocheta pallida and one or
more of the refringens type. If we assume for the
present that S. pallida has ап etiological significanoe
in syphilis, then the other spirochetes, or perhaps
bacteria, may be the determining factors explaining
the form of the yaws eruption.

I find in dirty sores, which have no apparent rela-
tionship to syphilis or yaws, spirochætes of one or more
types which are identical with those I find associated
with pallida in yaws. I think I can recognise sores
in which these spirochetes will be found.

Some cases of another kind of sore have been ob-
served associated with great cedema, but not inflamma.
tion of the legs. These are considered by myself and
another man who has seen them with me to be due
to tertiary syphilis. But they showed a marked
identity and distinctness of features, and one finds
another spirochæte in such swarms that the secretion
consists almost entirely of the organisms, with very
few pus cells.

Until the relationships of S. pallida and Cytorrhyctes
luis to each other and to syphilis are worked out,
or until some other certain test of syphilis is estab-
lished, we have no right to foist a new disease on
an already overburdened list. It must be possible,
first, to exclude syphilis by the absence of some essen-
tial element. .

Dr. Leys tritely calls attention to the disproportion
in numbers of his cases and those of Dr. Rat in
Dominica to the populations, and compares the fre-
quency of syphilis of the palate and pharynx in a large
European community. I noticed in а hospital report
for 1902 (Colonial Reprints, Medical Reports, 1904),
that destructive rhino-pharyngitis was exceedingly
common on the leeward side of St. Vincent, while on
the windward side destruction of the face took its
place. Syphilis is equally prevalent on both sides of
the island, but the land conditions are very different.
The leeward side consists of deep ravines with
numerous streams; there is dense tropical growth and
combined heat and moisture.

Мау 15, 1906.)

These same conditions obtain in Dominica, in parts
of St. Lucia, in Grenada, but not in Nevis nor Anguilla,
and hardly at allin St. Kitts. Since he left Dominica
Dr. Rat has been stationed in St. Kitts and Anguilla,
and is now in Nevis. He has not observed the destrue-
tive rhino-pharyngitis in these places.

I have no doubt that Guam provides the conditions
I have attributed to the leeward of St. Vincent, and
shall be interested to hear from Dr. Leys, whose ad-
dress is, necessarily, a changing one.

Syphillis and yaws are excessively prevalent in all
West Indian colonies. Syphilis more so where yaws
is not much accredited, as in St. Kitts and St. Vincent
yaws, that is, the framboesial eruption, is certainly, I
admit, more prevalent under the same conditions re-
ferred to as favourable to rhino-pharyngitis.

Since reading Dr. Leys’ paper I took the first oppor:
tunity of examining smears from a case of “leeward
sore throat,” as I have been in the habit of calling this
condition. There was present in small numbers 8
spirochate, other than pallida, іп a scraping from the
active edge of the ulcer. Pus from the surface did net
show any spirochates. d

I shall pursue this enquiry as opportunities present.

My suggestion is that 1& may be varieties of spiro-
chetes which determine the form of the manifestation
of syphilis in.the case of yaws which is & secondary,
and in rhino-pharyngitis mutilans and my “ cedematous
sore foot," which are tertiaries.

А :

* Annales de l'Institut Pasteur,” Paris, vol. xx., No.1. -
. YELLow Евувв AND MOSQUITOES.

Marcheoux and Simond, in their second report of the
French Yellow Fever Commission in Brazil, state that the
Stegomyta fasciata is the only mosquito known which does
not die after depositing its first batch of eggs. The female
may lay several batches of eggs. Infection of the mosquito
by heredity, although possible, is not general. Stegomyia
do not feed on the black vomit, stools, or blood from the
hemorrhages occurring in yellow fever patients, unless
compelled to by want of other food. Тһе larve of Stegomyia
developing in water in which dead infected mosquitoes
have been thrown do not acquire the power of infecting
man. In only one case was hereditary transmission
experimentally proved: and the resulting infection of man
was very mild. The Stegomyia fasciata mosquito, kept at a
temperature of 68° F., loses power of infecting. The virus
of yellow fever has been artifically transmitted from one
mosquito to another in the laboratory, but successive pas-

8 proved negative. During the incubation stage of
yellow fever, mosquitos cannot become infected.

* Bulletin et Memoire de la Société Méllicate der Hépitaux de
Paris," February 1, 1906.
QUININE FORMATE.

Lemoine, G. H., advocates in the early stage of malarial
attacks an hypodermic injection of quinine formate, 8 grs.
in 1 oz. of water.

* L'Echo Médical du Nord,” February 26, 1906.
TREATMENT OF ORIENTAL SORE.

Malméjae, F. As the result of experience at Biskra, the
author finds the best local treatment is boiled distilled
water at a temperature of 60° C. (140° F.). When crusts are
present a stream of water is allowed to flow on these,
especially into the edges and cracks. A dry antiseptic
dressing is then applied. The treatment is repeated twice
a day for a week, the crusts usually separate in two or
three days; at the end of a week only one dressing a day is
required.

THE JOURNAL OF TROPICAL MEDICINE.

157

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|^ THE ` e pre
Journal of Croptcal Medicine
, ` May 15, 1906.

A LESSON IN PRESERVATION OF HEALTH
IN THE TROPICS.
REPORT OF THE PRESIDENT OF THE SAPELE SANITARY
Boarp, December 31, 1905.

Sır Raura Moors, when authorising the arrange-
ments laid before him for sanitary work here, gave it
as his opinion that three years should show whether.
the scheme to be applied was of value or not. These
three years have now been completed, and I am glad
to say that the experiments of making a Local Sanitary
Board has proved a success, and further, to tell you
that as a consequence a Local .Board is about to be
made at the town of Ko Ko further down this river,
where Europeans are now also residing.

The supreme obstacle to systematic and continuous
work in tropical West Africa is the rapid changing
that sometimes takes place in the personnel which has
to carry out the work, and it is for this reason that a
Board composed of traders and officials was constituted,
because it was seen that a Board would not “ go away,”
and further, that it would have a continuous know-
ledge of the policy to be pursued. You will appreciate
how great the change amongst individuals sometimes
is, when I tell you that during the three years the
Board has existed there have been five, I might almost
say six, different administrators holding the office of
High Commissioner, four different officers have acted
as Divisional Commissioner, four others have acted
as District Commissioner of Sapele, four others as
Assistant District Commissioner, and, moreover, there
have been three District Medical Officers here ; finally,

158

with the exception of the doctor who started the whole
scheme and has recently returned here, there is not a
single member of the present Board who was also
a member of the Board when it started.

The triumph of the Board is that not only has
it lived through all these changes and done good
work, but also that the local changes, with possibly
one exception, were not due to ill-health.

The Board acts in four ways: Firstly, it acts by
actually carrying out sanitary work, removing vegeta-
tion, surface water, &c. ; secondly, it acts as an object-
lesson, inspiring bush.clearing, &c., even where a sani-
tary board does not exist; thirdly, it acts by interest-
ing Europeans in sanitation, and ав а corollary in
quinine-taking as а preventive of malaria; fourthly,
in proving the value of а sanitary board, it supports the
arrangements for creating one at Ko Ko.

During the time the Board has been at work it has
succeeded in dealing with almost the whole area of the
reservation; and although parts of this area are not
finally finished, yet а considerable portion around the
European dwellings has been completed, and the work
done will in future require only to be kept up.

The Board has tried many ways of employing
labour; local boys, boys from the Benin country and
the Ejor country have been tried, also prison labour,
and the conclusion that has been come to ie that
no matter what labour is employed, it is best to give
out the work as piecework, either to individuals
or native contractors.

I have here certain figures gathered from the records
of the Sapele District Medical Officers, and from them
it will be seen that the healthiest time of the year here
at Sapele used to be, and still is, the rainy season.
This is the period of lowest maximum temperature.
The figures, expressed graphically, show that the curve
of the sick list falls as the maximum temperature falls
and the rain curve rises. The sick list curve is now
altogether so near zero that it is difficult to appreciate
its undulations, but June, which is always one of the
heavy rain months, this year had no European inhabi-
tant sick during its entire length.

We are fortunate in having no death among the
bona fide European inhabitants of Sapele for more
than three years, this, though а thing to be thankful
for, must not be considered too much, for that death
will occur both at home and abroad we all know only
too well. Іп the Blue Book for 1904, relatively a
large number of deaths are shown under the name of
Sapele, but these deaths occurred in people living in
outlying parts of the district, and not to inhabitants of
the reservation.

What these vital statistics mean, put commeroially,
is this, that for a cost of 9s. per month for each Euro-
pean of Sapele Reservation for the year 1905, his
chances of being sick have been reduced from five and
four-fifths times each year to one and two-fifths each

ear..

И А new firm has commenced business ор part of the
land cleared and reclaimed by the Board, and I have
reason to believe that the rent paid by it will be given
to the Board to be expended in still further work.
There is а lot still to be done ; keeping down the vege-
tation is itself a labour like rolling a big stone up an
endless hill.

THE JOURNAL OF TROPICAL MEDICINE.

[May 15, 1906.

During the incoming year, however, the question of
disposal of refuse or water supply might, with ad-
vantage, be considered. In any event, I am confidently
hoping the future members of the Board will be keen
to maintain the record, namely, that in spite of an
increasing European population the amount of sick-
ness decreases, and that they will cause the Board to
remain in the sound financial condition it has always
enjoyed. Franz STAHL, President.
Table showing Number of European Residents under Medical

Treatment.
(1st, before the Board. 2nd, after the Board.)

i tf a "E

= $ 51%

| AE s |3 E Е

11% з 8205

5 8 | РА &

(190 8 8 6 6 5 8 4 8 9 5 8 9
1st 11901 12 9 10 4 5 6 4 10 10 12 9 10
(1000 1 12 12 8 5 4 4 4 7 5 9 6

. (1909 719 810 812 6 5 6 4 5 8
2nd 1194 5 8 8 2 8 3 2 2 8 5 8 4
(1905 8 4 1 4 4 0 3 1 8 1 4 3

Table showing Average European Population for the Year
1900-1905, including actual Number of Deaths.

Population Deaths
1900 £x "m m 14 .. 9
lst (шш .. Es ox 15 1
1902 а zy DE 17 2
1908 4% ac ae 19 0
2nd {3904 "m ee m 23 0
1905 56 25% "m 25 0

Balance Sheet of the Sapele Local Sanitary Board,
December 31, 1905.

Dr. . Cr.
8 в. d. £ s. d.
To balance on hand 26 12 3 | By Bush .. .. 1418 0
» Special Govern- » Swamp clearin
ment grant.. 75 0 0 and bush 45 15 0
, Rates on com. » River front and
found paid 67 10 0 drain clearing 35 0 0
т, пе .. 2210 0 | ,, Sobo gang .. 110 0
$55 Grant— part of » Eddy—monthly 84 15 0
fine paid by , » Balance in hand 84 14 3
Messrs. Pin- !
nock, Ltd., for
taking u
clearedground 25 0 0
£216 12 8 £216 12 3
-------о--
Correspondence.

“ HORSE-FLIES (TABANIDA) AND DISEASE.”
To the Editor of the JouRNAL or TropicaL MEDICINE.

бін,-Іп my article under the above heading in your
issue for April 2nd last, I unfortunately omitted to mention
that in Algeria it has been shown by Drs. Edmond and

tienne Sergent, by means of experiments upon laboratory
animals, that Tabanus (Atylotus) nemoralis, Mg., and T.
(Atylotus) tomentosus, Macq., are capable of transmitting
the trypanosome of the disease of dromedaries, called Debab,
which occurs from Morocco to Syria, and more than deci-
mates the Algerian camels. In most of the experimenta
transmission was direct, but in one case, in which: six or
eight specimens of Tabanus tomentosus were used, әп
interval of twenty-two hours had elapsed since the flies had.

Мау, 15 1906.)

bitten an infected rat. Actual experiments upon camels do
not appear to have been made, but the natives of North
Africa always assert that the disease is transmitted by
Tabanide, and camel.drivers declare that the two species
mentioned above, which apparently are far more common in
Algeria than any others, are especially dangerous to camels.
The disease, which is almost invariably fatal, commits great
havoc among animals that have passed the summer in a
locality where horse-flies are numerous, but among others
that have spent the time in а place where Tabanida@ are
almost absent its incidence is slight C.f., “ El.Dehab
Trypanosomiase des dromadaires de l'Afrique du Nord,”
by Drs. Edmond and Etienne Sergent (Annales de
VInstitut Pasteur, Т. xix., January, 1905, рр. 17-48). My
thanks are due to Dr. Edmond Sergent for he kindness in
drawing my attention to the very interesting and important
paper in question.
I am, &c.,
Ernest E. AUSTEN.
British Museum (Natural History),
Cromwell Road, London, S.W.,
April 28th, 1906.

-------о-

Abstract.

Carnion’s DisEASE: VERRUGA PERUANA AND ITS
BacrEBI0LOGY. Ву Dr. М. О. Tamayo (La
Cronica Médica, November 30 and December 15,
1905.) Translated by M. D. Eder.

Dr. Barton, in 1899, isolated a bacillus from the
spleen in several cases of pernicious fever in Carrion’s
disease. He described the bacillus, pointed out its
differences from the B. coli, and concluded that it was
the specific causal agent of verruga peruana.

We have examined all cases of this disease that we
have been able to find in the hospitals of Lima during
the last few years; they number thirty in all..

Our studies confirm Dr. Barton's researches, in во
far as that the: organism he described is indeed fre-
quently present in such cases. Clinically, the thirty
cases may be divided into two groups :—

(1) Those where fever was the main clinical symp-
tom. This comprises most cases.

In twenty of these cases bacteria were found in the
blood during pyrexia, which, by their morphological
and cultural characteristics, belong to the paratyphoid
group.

In periods of apyrexia in most cases the bload did
not contain the organisms (see Case 10). l

o Those without fever.

n these cases no bacilli were found. Our cultures,
whether made from patient's blood, from the juice of
the warts, or fragments of these growths, remained
sterile.

The bacteriological work consisted in :—

(a) Microscopic examination of the blood and fluids
of patients.

(9 Cultures from the blood on different media (we
used a sterile Pravaz syringe for withdrawing blood
from the veins, the skin being previously carefully
disinfected).

(с) Inoculation on various animals—guinea-pigs,
rabbits, Chinese dogs (Canis caribeus), three horses,
and one monkey. m

(d) In fatal cases we made cultures from the blood

THE JOURNAL OF TROPICAL MEDICINE

159

of the heart, spleen, liver, pulmonary veins, and from
portions of bone marrow.

Pure cultures are easily obtained from the blood of
febrile patients. The bacillus grows rapidly on pep-
tonised broth, agar, gelatine, &c., at 37°. The blood
does not arrest the growth of the organisms
(Eberth's bacillus). No bacillus was found in the
blood under the following circumstances : —

(i.) In the apyrexial variety, where other symptoms
were prominent, ¢.g., copious eruptions, progressive
anemia, arthralgias. There was no question here
of the fever being latent.

(ii.) In slightly febrile cases.

(iii) Transitory rises of temperature in cases that
were running a typically afebrile course.

Inoculation experiments with pure cultures gave the
following results :—.

(1) A few drops! inoculated into the subcutaneous
tissue of rabbits weighing 1,500 to 2,000 grammes
frequently killed them, the animals dying with all the
symptoms of acute septicemia.

(2) Intraperitoneal inoculations usually caused
death with post-mortem signs of acute peritonitis.

(3) In some cases intravenous injections did not
cause the death of the rabbits. After a few days of
fever and signs of septicemia the animal recovered ;
there was at no time any eruption. When the
animals were killed some months afterwards, no
eruption, external or internal, was found, nor did we
find any pathological condition, either recent or old.

Guinea-pigs are also very susceptible to inoculations.
Intravenous inoculations produce a rapidly fatal sep-
ticæmia.

Dogs are more resistant. Intravenous injection of
small quantities of a virulent culture give rise to
fever which disappears in a few days. Repeated
inoculations can be made until the animal becomes
immune. The serum is then agglutinative for the
same bacillus. Careful observation during many
weeks showed the animals to be perfectly healthy.

Horses.—Injections of high potency and virulence
were made into the jugular veins of three horses.
Two recovered completely in a few days after having
had some signs of a slight septicemia. No granulo-
mata or other effects appeared. The third animal
died of acute septicemia; it had received a large dose
of a hypervirulent culture.

Small Monkey (Ateles ater).—Repeated inoculations
with the blood withdrawn from the verruge, and with
cultures of Barton's bacillus, gave no results. After a
few days of slight septiceemic trouble he recovered
perfectly, and is still in the Institute in complete
health. His serum readily agglutinates the bacteria
taken from the verruge. ;

To this experimental work we must add a few re-
marks on the clinical aspect of the febrile cases which
is so very similar to that of typhoid fever. Note the
general apathy, the dry tongue with its light band of
fur, the tenderness over the epigastric and the hypo-
chondriac regions. Diarrhoea is a fairly constant
feature, and resembles in every particular that in
enteric. The temperature chart is characteristic of
enteric ; there is at first a gradual daily rise; then a

! The vagueness is in the original.

160

THE JOURNAL ОЕ TROPICAL MEDICINE.

(Мау 15, 1906.

ANALYSIS OF TwENTY-SIX CASES OF VERRUGA PERUANA.
(In four others the clinical notes are not obtainable.)

| : Ne Result of |
rel red bloc nO d ! 2
Хо ои t pb 6 orpus cles mU Result History Post mortem
І а П
| " zu RE _ FX =
|
1 | Continued Scanty 985 | + Recovery | Severe diarrhea ; headache; liver
and spleen enlarged ; insomnia.

2 че .. | None $55 es + Died Severe diarrhoea; prostration : arti-

cular pains; spleen and liver en-
larged ; severe anemia, '

3 » .. None during} 1,800 + 3 Severe diarrhoea; prostration; ce-; Few warts on
life—a few phalalgia ; insomnia border of
found in spleen.
spleen post
mortem

4 i Discrete Е + Recovered .. | Severe diarrhea; vomiting ; tender
miliary abdomen ; albumin; anemia.

5 35 None 2,400 t Died . | Severe diarrhea ; vomiting ; insom- | Nothing special.

nia ; arthralgia ў

6 РЯ . | Miliary апа | 1,900 Died of tuber- | Arthralgia; prostration; spleen and
nodular culosis .. liver enlarged.

7 | Hyperpyrexia, | None 4% Made post | Died .. | Laveran's organism found during | Nothing special.

42°C. mortem life; diarrhea ; vomiting; com-
from blood plicated by malaria
of heart +
8|Continued .. ^5 Post x .. | Intense anemia; epistaxis; diar- 3s 5
mortem + rhoea ; cephalalgia ; articular pains
spleen and liver + т”

9 | Remittent Four days 1,700 + » .. | Cephalalgia; arthralgic pains іп
before death bones.

10 5% .. | Appeared | 1,400 + 5 Cephalalgia; arthralgia ; diarrhoea ;
after Apy- liver and spleen enlarged. The
rexia _eruption disappeared; the patient

relapsed, dying in а few days.

11 | Present .. | None ..! 8,500 om 55 Constipation ; then diarrhoea Negative.

eart)

12 | Slight .. | Extensive Negative .. | Recovered .. | Subicteric tinge; liver enlarged;
nodular spleen not palpable; digestion

i normal ; cephalalgia ; arthralgia.

13 | Continued None ae қ Ровінуе "t Tenderabdomen;diarrhea; vomiting.

14|None .. .. | Abundant й Negative .. " Negative.

15 | Slight .. га 3: 27, 2 A m ^g Е Anemia; digestive apparatus normal,

16 | Continued .. | None 2,000 | Positive .. 5 | Diarrhoea ; liver enlarged ; insomnia;
prostration.

17 js Extensive ы » The granulomata suppurated, and
there was found in the pus the
B. paratyphoid and а fluorescent
bacillus.

18 | None . |Fourmonths’ Negative .. "m Nearly the whole body was covered

duration with the eruption ; slight epistaxis.

19 | Very slight .. | Nodular .. 35 ss i А

20 | Intermittent .. Us A M .. | Repeated blood examinations. La-
veran's organism was not found.

21| None .. zv 5% .. | 1,048 АА РЕ `

22 TIME ..| Present ..| 1,200 а » Severe epistaxis ; diarrhcea ; prostra-

| tion ; enlarged liver and spleen.

23 ТЕКЕ .. | Miliary .. е T РР .

94 | Slight .. 2% E A Я " з» Cephalalgia; pain in bones; three
weeks after arriving at the endemic
centre.

95 | None .. .. | Nodular .. T 5s .. | Negative.

26 ». tee m 5 vs v 35 .. | Pains in joints,

period of continued fever; finally, as convalescence
ensues, the fever, synchronous with the attenua-
tion of all the other symptoms, becomes remittent. The
average duration of the fever is twenty-five to thirty
days (Odriozola, “ La Maladie de Carrion ”).

It must be noted that there is no connection
between the fever and the order of the appearance of

(a) Thousands per cubic millimetre.

the granulomata. Sometimes the fever ends just
when the verruga appears; sometimes the reverse
holds good— the verruga disappears and fever com-
mences. Ч

To sum ар our results :—

(1) Barton's paratyphoid bacillus is found only in
cases of pernicious fever of Carrion's disease.

Мау 15, 1906.)

161

THE JOURNAL ОЕ TROPICAL MEDICINE.

(2) Inoculations do not give rise to verrugæ, but to
a typhoid septicsemic state.

(8) Carrion’s pernicious fever is а typhoid or para-
typhoid disease, attacking the patients suffering from
verruga.

(4) Barton’s bacillus is not the pathogenic agent of
verruga peruana.

(5) Barton’s bacillus gives rise to a secondary
infection occurring during an attack of verruga, which
attack predisposes to the infection. This secondary
‘affection has all the clinical characteristics of enteric
fever.

—————»——————
Rebich.

THE MANAGEMENT OF A PrAGUE Еріреміс. Ву E. Е.
Gordon Tucker. Calcutta: Thacker, Spink and
Co., Government Place. 28 pp. Illustrated.
Price 1:8 rupees.

The substance of this concise book appeared in
Indian Public Health. 'The object of the writer is to
present in a readily followed statement the steps to be
taken by а medical officer placed in charge of a town
or district stricken with an epidemic of plague. The
subject is dealt with under the following headings:
(1) The Termination of the Period of Quiescence ; (2)
The Arrival of the Primary Infecting Agent; (8) The
Stage of Sporadic Atypical Cases; (4) The Stage of
Local Place Infection ; (5) The Early Epidemic Stage ;
(6) The Fastigial Stage of the ‘Epidemic; (7) The
Stage of Decline; (8) The Stage of Residual Infection;
(9) The Commencement of the Period of Quiescence
and a Temporary State of Local Immunity. An excel-
lent book, that will prove a great help to any medical
man placed in charge of an outbreak of plague in any
part of the world.

------

Bruas and Remedies.

TREATMENT OF BLACKWATER FEVER.—The Bipala-
tinoid, prepared by Oppenheimer, Son and Co., 179,
Queen Victoria Street, London, E.C., for use in the
treatment of blackwater fever, continues to give satis-
factory results. i

Full particulars have been reported upon no fewer
than twenty-one consecutive cases of recovery, without
a single death, and without sequelæ or complications
of any form of urinary suppression. This experience
is encouraging and unique, and we hope to hear of
further cases in which this bipalatinoid has been used.
It will be remembered that it was the Principal Medical
Officer of British Central Africa who suggested the
treatment to Messrs. Oppenheimer in the first in-
stance.

“ TABLOID ": Soprum CrrRATE.— Messrs. Burroughs
Wellcome and Co. have prepared a sodium citrate
“Tabloid,” grs. 2 (0:13 gm.), for use in cases in which
either the mother's milk or cow's milk does not suit
the infant.

The digestibility of cow's milk is greatly assisted by
the addition of sodium citrate. The explanation of the

action which is commonly given, is that the acid
caseinogen and the calcium salts of milk in presence
of the gastric juice form a thick casein clot. If sodium

‘citrate be added to the milk, it combines with the

caseinogen to form a sodium compound less dense and
more absorbable than the calcium caseinogen com-
pound in the normal milk clot. The calcium salts in
the milk unite with the citric acid of the sodium
citrate and the resultant calcium citrate is diluted by
the stomach contents and absorbed. Thus the intro-
duction of sodium citrate increases the digestibility of
cow’s milk in a remarkable manner, allows the absorp-
tion of the calcium salts, and greatly enhances the
food value of the milk.

c
Blotes and Hews.

W. J. К. Simpson, M.D., F.R.C.P., D.P.H., Pro-
fessor of Hygiene, King’s College, London, and Lec-
turer in Tropical Hygiene at the London School of
Tropical Medicine, has sailed for Singapore to serve
on a Commission to enquire into and report upon the
sanitary condition of Singapore. The appointment
was made by the Colonial Office acting on behalf of
the Government of the Straits Settlements. Professor
Simpson’s excellent work, whilst engaged on similar
commissions in South Africa and Hong Kong, is fresh
in our memories, and we anticipate equally brilliant
results from the present Commission.

Surgeon-General James Pattison Walker, who died
recently, at the age of 86, joined the Medical Service
of the East India Company in 1845. He served with
distinction during the Mutiny, and amongst other
important positions he occupied the Chair of Hygiene
in the Calcutta School of Medicine.

Whilst H.M.S. Black Prince was on view to the
public, the ship was visited by 21,000 persons. No
less than £1,100 was received for the benefit of the
Seamen’s Hospital Society and the Poplar and West
Ham Hospitals.

Surgeon-General Spencer, I.M.S. (retired) has been
appointed Honorary Surgeon to the King.

To remove rust from instruments, according to the
Pharmaceutische Zentralblatt, rusty surgical instru-
ments are (1) placed for twelve hours in saturated
solution of stannous chloride; (2) rinsed in water;
(3) laid in a hot solution of soda soap; (4) dried ;
(5) or rubbed with absolute alcohol and (6) prepared
chalk. Another method is to lay the instruments in
kerosene. As a preservation against rust, paraffin oil
may be applied as follows: The instruments, after
being dried and warmed, are laid in а solution of
1 part paraffin and 200 parts benzine. Subsequently
the benzine is allowed to evaporate before the instru-
ments are laid aside.

The British Association meet at York on August 1st.
1906

162

ASSOCIATION OF MEDICAL OFFICERS OF MISSIONARY
SOCIETIES.

The above Association was formed in March, 1904,

on the initiative of Mr. W. McAdam Eccles, Dr. С. F.

Harford, and Dr. J. N. Kelynack, and now includes, as
members, medical representatives of practically all the
foreign Missionary Societies.

The object of the Association is the discussion of
subjects relating to the selection of missionaries as
regards their physique and to all matters concerning
the preservation of their health abroad.

Meetings take place quarterly at the various
members’ houses, and amongst others the following
have opened discussions: Sir Patrick Manson, Dr.
S. Н. Habershon, Colonel T. Н. Hendley, І.М.8.,
Dr. C. F. Harford, Mrs. Scharlieb, M.D., and Wm.
McAdam Eccles, M.S., F.R.C.8.

PANAMA.

Deaths from Yellow Fever and Malaria, in the city
of Panama, since 1884. Taken from Report of De-
partment of Health of the Isthmian Canal Com-
mission for July, 1905.

Deaths from Deaths from
yellow fever. malarial fever.

1884 491
1885 174 687
1886 281 497
1887 Ms 259 481
1888 zn 82 448
1889 55% 33 249
1890 nis 0 198
1891 225 17 178
1892 Jye 1 133
1893 1 142
1894 er 0 137
1895 Р 0 138
1896 € 0 168
1897 v 45 203
1898 sis 0 161
1899 "ET 87 190
1900 2 109 178
1901 idu 5 184
1902 oh 202 - 562
1903 К 51 178
1904 see 8 zs 162
1905 iv. 27 os 97

Average ... 66 264

LIVINGSTONE COLLEGE.

On Thursday, May 31st, Livingstone College,
Leyton, E., celebrates its Commemoration Day. The
programme of proceedings is as follows : —

The chair will be taken at 3.30 by J. A. Simon,
Esq., M.P. for the Walthamstow Division of Essex,
unless prevented by his official duties.

An address will be given by James Cantlie, Esq.,
F.R.C.S., and by the Rev. J. E. Watts-Ditchfield,
Vicar of St. James-the-Less, Bethnal Green.

_A short statement as to the progress of the College
will be made by the Principal, Dr. Harford.

THE JOURNAL OF TROPICAL MEDICINE.

[May 15, 1906.

Personal Hotes.

INDIAN MEDICAL SERVICE.

India Office: Arrivals of Indian Medical Officers in London.
—Lieutenant-Colonel P. D. Pank, Lieutenant-Colonel J. Sykes,
Lieutenant-Colonel A. C. Younan, Captain W. H. Kenrick,
Captain А. Т. Pridham.

Extensions of Leave.-- Lieutenant.Colonel A. V. Anderson,
6 m., Med. Cert. ; Major A. К. Р. Russell, 4 m., Med. Cert. ; Cap-
tain L. Hirsch, 5 m., Med. Cert. ; Captain R. D. Willcocks, 4 m.,
Med. Cert.

Permitted о Return to Duty.—Lieutenant-Colonel Н. Arm-
strong. )
Postings.

Dr. H. A. Macleod to Civil Surgeon, Saharanpur.

Major G. Y. С. Hunter ofticiates as Superintendent, Central
Jail, and Civil Surgeon, Montgomery.

Captain C. J. Robertson Milne, Superintendent Central
Lunatic Asylum, Lahore, in addition to his other duties.

Captain L. В. Scott, services lent to Government of Assam.

Captain N. S. Wells, services lent to Jail Department, Bengal.

Colonel A. M. Crofts, at disposal of Home Department.

Captain H. Ainsworth to Plague Duty, Lahore.

Major G. B. Irvine, Civil Surgeon, Jhelum.

Captain G. E. Charles officiates, Prof. Anatomy, Lahore.

Leave. :

Major R. J. Marks, privilege leave, 2 m. 24 d.

Lieutenant-Colonel W. Coates, Med. Cert. and privilege, 7 m.

Major A. H. Nott, furlough and privilege leave, 17 m.

Major R. H. Maddox, combined leave, 18 m.

DOMESTIC.

Вівтнв.

OxrEY.— At Seoul, C.P., on April 5th, the wife of Captain J.
С. 8. Oxley, оҒа son.

COLONIAL BERVICE.

J. B. Addison, M.R.C.8., L.R.C.P., is acting as Chief Medical
Officer of the Seychelles.

*Dr. E. W. Blyden will terminate his five years’ engagement
with the Government of Sierra Leone on July 1st, 1906.

*Dr. J. D. Bolton, of Mauritius, has been appointed Govern-
ment Medical Officer of the Dependency of Rodrigues.

R. Denman, M.R.C.8., L.S.A., D.P.H., Chief Medical Officer,
Seychelles, is on leave.

А. Nicolle de Gruchy, M.B., C.M. Edin., Assistant Medical
Officer, Seychelles, has been transferred to Southern Nigeria as
Medical Officer.

а. Е. Leicester, M.B., C.M. Edin., Assistant at the Institute
for Medical Research, Selangor, Federated Malay States, is at
present acting as District Surgeon in Selangor.

*Dr. А. J. McClosky, District Surgeon, Selangor, Federated
Malay States, is on leave.

* Name not entered in the “ Medical Directory " for 1906.

[Reference is made to the fact that the name is not entered
in the ‘‘ Practitioners Resident Abroad " list in the hope that all
medical mén abroad may see to it that their names are duly
entered in this list. —Ep., J.T. M.]. f

Colonial Economic Hotes.

Antiaua.—The area of the cultivation of cotton
was considerably increased during 1905. Owing to
deficient rainfall both the cotton and sugar crops
suffered. ——— i

Вавваров.-- Cotton cultivation is extending.
Banana growing has received a check, as no profits are
being obtained; regular mails and proper cool storage
in all ships can alone restore the banana industry.

British Gurana.—lt is proposed to appoint a
Royal Commission to enquire into the condition of
the Colony generally.

Montserrat has had a record cotton crop.

Мау 15, 1906.)

Жасы and Current Literature,

A tabulated list of recent publications and articles bearing on
tropical diseases is given below. То readers interested in
any branch of tropical literature mentioned in these lists
the Editors of the JounNAL, or TROPICAL MEDICINE will be
pleased, when possible, to send, on application, the medical
journals in which the articles appear.

“Nature,” December 25, 1905.
Тне PuLsE oF THE ATMOSPHERIC CIRCULATION.

Shaw, Dr. Few of those whose lot is cast in the regions
south of the Equator which are swept by the “Trades”
have any idea that there can be any connection between
the force of the wind current and the weather at home in
England. And yet the above very interesting and sugges-
tive paper advances strong reasons for believing that such
is the case. Dr. Shaw himself regards his hypothesis as
“too speculative for an official report," but “too suggestive
to be altogether ignored,” and the gist of the thesis is that
strong southern trade winds are associated with wet weather
in England and the neighbouring parts of the world.

This conclusion is based on the analysis of several years
of anemometer records from the Island of St. Helena—and
the curves plotted from these data correspond so closely
with those of English rainfall that one can scarcely fail to
agree with Dr. Shaw in the conclusion that the “ connec-
tion ean hardly be pure coincidence." The seasonal curves
of the two sets of data correspond very closely, the minima
of both falling in April, though the principal maximum of
English rainfall, which occurs in October, lags a little behind
that of the force of the trade wind which is found in
September. What is even more remarkable is that the
otherwise bold curve is in both cases broken by а second
small rise in April. It is also undoubtedly the case that
years of weak trade winds at St. Helena are associated with
drought in England. ' ko

More than this, however, cannot be affirmed, ав the pro-
verbial fickleness of English weather makes the comparison
disappointing when followed up in detail; so that, undoubt-
edly, other and disturbing factors are at work, and, as Dr.
Shaw points out, *the transformation of energy in rainfall
is on а vastly greater scale than that displayed by the trade
winds." In any ease, the observation seems promising, and
emphasises the urgency of greater attention being devoted
to colonial meteorology.

** Geographical Journal," February, 1906, p. 182.
CLIMATIC FEATURES OF THE PLEISTOCENE Ice Аве.

Albrecht, Peuck, Prof., bases his treatment of the subject
on physio-geographical research, considering that attention
has hitherto been too exclusively devoted to theoretical
astronomical speculations, and to supposed alterations in
the earth’s axis of rotation. He shows that the snow-line
“arches” across continents being higher inland than on
their shores, the present level for Europe being almost 7,000
feet for littoral and 9,000 feet for inland localities. Now, in
the Ice Age, what is now central Europe was near the sea,
and at that time the snow-line for littoral regions was no
more than 8,000 feet or less. The diminution of mean
annual temperature required to produce such an effect need
not, however, have been at all as great as one might
Imagine, “ we are entitled to assume that a rather slight
decrease of, say, 2? to 8° C., if connected with a diminution of
the summer temperature will cause an ice age. Such а
decrease will cause also changes in the amount and dis.
tribution of precipitation and the glaciations themselves will
influence climatic conditions by uliering the distribution of
air pressure and the arrangement of the isothermic lines.”

е lowering of temperature was world-wide, being found as
dran d in New Zealand as in Europe; and in latitudes
stt OW for glaciation to result, & rainy period was sub-

ituted. In addition to the two great glaciations that

THE JOURNAL OF TROPICAL MEDICINE.

163

occurred in the Permian and Pleistocene periods respectively,
there have been minor variations of mean temperature, which
have merely resulted in extension and contraction of existing
glaciers in temperate regions; and of corresponding epochs of
moisture and of desiccation in the warmer parts of the globe.
At present the glaciers are contracting and the desiccation
of the interior of the continents is in progress, but probably
in course of time the opposite process will be substituted, as
it appears that four hundred years ago the limits of the
glaciers were very much as they now are, though there has
been an intervening period of extension.

Meanwhile, however, the drying up of the continents is
seriously diminishing the available habitable area, as, for
example, in the Kalahari Desert, where, within the last fifty
years the well-known lake Ngami has disappeared, and
тапу river-beds have dried up.

“ Roussky Yratch,” December 24, 1905.
PLAGUE IN MANCHURIA.

Klognitski found cases of plague in a small settlement on
the Chinese Eastern Railway, in Manchuria. The popula.
tion numbered 152, and 15 persons developed plague, of
whom 13 (86:6 per cent.) died.

It was impossible to trace the origin of the outbreak, or
to prove that the rats or mice in the neighbourhood were
infected. е

“ Annales d’Hygiéne et de Médecine Colonial,” No. 3, 1908.
E PHAGEDÆNIC ULCER.

Bouffard. The ulcer extends slowly in tissues slightly
bruised, but spread rapidly when there has been severe
contusion. The presence of the phagedenic bacillus is the
primary cause. Secondary infection of other bacteria,
usually streptococci and staphylococci are always found
when the ulcer is spreading rapidly. When there is no
secondary infection the ulcer tends to diminish. Тһе ulcers
last from a fortnight, at least, to three months or more.
The pus from the centre of the ulcer is not inoculable
when inserted under the skin or into the peritoneum of
dogs, cats, gazelles, or monkeys, nor could incised or con-
tused wounds in these animals be infected. These investi-
gations were carried out in Somaliland. After treating
over 800 cases, the author finds the best results аге attained
with the following treatment. Ulcers of an inch diameter
are swabbed with tincture of iodine, or of perchloride of
iron. They are then swabbed with 1 in 200 very hot
aqueous solution of cocaine. Larger ulcers are treated
with 1 in 1,000 permanganate of potash, by means of a
bath for the limbs, and irrigation for ulcers on the trunk,
and at night the permanganate is used in fomentation.
The disappearance of the phagedrnic bacillus from the
ulcers is coincident with the flattening of the edges,
the lessening of the discharge, the pus, from yellow in
colour and of an offensive odour, becomes white and
odourless, and the base is red without any necrotic tissue.

. When this occurs 1 per cent. solution of pierie acid is used

for irrigating and dressing.

“Quarterly Journal of Tropical Veterinary Science,”
January, 1906.
(І) A New SPECIES oF TRYPANOSOMA FOUND IN THE BLOOD oF
Rats, TOGETHER WITH А New METRICAL METHOD oF
STANDARDISING THE MEASUREMENTS OF TRYPANOSOMATA.

Lingard, A., has given the name of Trypanosoma longo-
caudense to a new species of trypanosome met with in the
blood of the white-bellied house rat (Мия nivetventir)
whose habitat is the lower Himalayan ranges. The trypano-
some in question was also found in one instance іп Мия
decumanus, and some other varieties of rats, apparently
hybrids. The T. longocaudense was never found alone in
the circulation, but always concurrently with some other
well-recognised species of trypanosome. The chief pecu-

164

THE JOURNAL OF TROPICAL MEDICINE.

[May 15, 1906.

din

liarities of the new trypanosome are: (1) The inordinate
length of the posterior extremity; (2) the thread-like
sinuosity of the posterior extremity of the body; (3) the
abrupt end of the body anteriorly; (4) the distance of the
blepharoplast from the posterior extremity of the parasite.
The organism can progress with either extremity forward.
Lingard's points of measurement for trypanosoma are :—

“-

1
J

a b e d e
(b) blepharoplast ;
nucleus; (d) end of body protoplasm ; (e) free flagellum.

(a) Posterior extremity; (c) nutritive

(II.) OBSERVATIONS ON BILHARZIOSIS AMONG ANIMALS IN
INDIA.

Montgomery, R. E., describes a new species of schisto-
somum under the name of Sch. indicum, which he found
in the horse and in the donkey. He gives a full description
of the male and female parasite, and the anatomical lesions
they cause.

(IIL) TRYPANOSOMIASIS IN THE CAMEL. Р

Pease, Н. Т., deals with this subject, under the name of:

Tiliarsa surra (Tiliarsa, i.e., three-year disease, is one of the
many local names bestowed on surra disease), at considerable
length. He considers that the surra of camels is caused by
the conveyance of trypanosomes from infected to healthy
camels by bites of the Tabanide. :

(IV.) THROUGH WHAT AGENCY IS THE TRYPANOSOMA EVANSI
CARRIED FROM ONE SURRA SEASON TO ANOTHER?

Lingard, A., points out that equine surra appears during
the rainy season (June and July) in Bombay, declines during
the cold season, апа reaches the minimum of prevalence
during January and February, and then totally disappears
for a few weeks, Egquines (horses, donkeys and mules) all
succumb to the spontaneous and inoculated forms of surra,
but domestic bovines are capable of resisting spontaneous
and inoculated trypanosomiasis (Т. evansi), and of carrying

the parasite in their blood for periods exceeding a year when:

derived from previous cases of spontaneous equine surra.
It would seem, therefore, that by these bovines surra in-
fectivity is carried over from one season to another.

“ Archives de Médecine Navale," February, 1906. —
ERADICATION OF YELLOW FEVER IN HAVANNA.
Le Méhauté, Dr. (French Navy), in the course of his
medical notes on the places visited during the late cruise of
the French Naval Training Ship Duguay-Trouin to the

West Indies, gives a clear and concise history of the eradica- .

tion of yellow fever in Havanna, and a brief but excellent
description. of the organisation of the Sanitary Services—

both land and maritime—of the Island of Cuba. The results ,

of the adequate prophylactic measures taken show that
yellow fever has completely disappeared from Havanna,
that small-pox no longer exists there, and that the mortality
from malaria has gradually decreased from 1,907 in 1898,
and 909 in 1899, to 151 in 1908; furthermore, that the
general mortality of the island has also been diminished,
thus showing how the sanitary conditions of a country may
become ameliorated under the combined action of good
hygiene and judicious prophylaxis.
MALARIAL INFECTION AND ITS TREATMENT.

Gros, H., Dr. (French Navy), here completes his able and
careful practical study of malaria, which has been running
through several recent numbers of these Archives. He
now describes the treatment of chronic malaria and the
methods of prophylaxis to be adopted, and lays down the

lines for future preventive sanitary legislation against

malaria.

On тне Present MALARIAL EPIDEMICS OF THE HIGH
PLATEAUX OF MADAGASCAR. .
“ Apropos des épidémics palustres actuelles.des hauts plateaux
de Madagascar." By Dr. Fontoynont, Professor at the School
of Medicine, Antananarivo, D.T.M., Paris.

In the last quarterly issue of the Revue de Médecine et
d' Hygiene Tropicales for the period ending December 31st,
1905, Dr. Fontoynont states that the belief that endemic
malaria was severe on the coast-line, but essentially benign
on the high plateaux, was formerly a correct one, but that
nowadays this is no longer the case, and that it must be
confessed that the arrival of the French in Imerina has
been the starting point for deadly malarial epidemics, which
for several years have shown no tendency to diminish. One
fact is always at once noted by an impartial observer, and
that is that malaria has not increased in severity in equal
proportions amongst the natives and Europeans. Whilst
the mortality is stationary—and even decreasing— with the
victors, it shows, on the other hand, a very marked increase
amongst the vanquished enemy. 3
' А second fact is the progress made by endemic malaria,
which is yearly advancing to the eastward, describing an
ever increasing and approaching curve round Antananarivo.

How can we account for this? By two factors which,
united, have reacted on each other, but which, isolated, -

. would not have produced the same results. The first is due

to the large numbers of the people who had to leave their
homes and emigrate to the unhealthy regions along the
coast; they there acquired malaria, and on returning after-
wards to their own villages transmitted—-through the inter-
mediate agency of mosquitoes—their hematozoa to those
inhabitants who had stayed at home. The second is the
dissemination of the germs, mainly due to the Malagassy
custom of “ Night-guards”; in every village, at night, а
number of able-bodied men, in due proportion to the
number of inhabitants, are obliged to pass the night outside

` their dwellings in order to watch over the public safety, and

to prevent attack by armed marauders; these men, wearing
only a cloth garment, with their beacon light, are the
marked-down prey for countless swarms of mosquitoes ;
and as every man must take his turn at this night duty
and offer himself as a resigned victim to the bites of the |
Anophelina, the most practical way of propagating malaria
is thus ensured — almost with the facilities of a mere
laboratory experiment. In those regions where the nipat

as

guard has been put down, and where the population
not moved, malaria has remained absent, although it was
on the increase in the neighbourhood. Antananarivo

formerly had few mosquitoes, consequently it had little
ague, but when the mosquitoes became more abundant,
malaria increased; this increase was the natural con-
sequence of a large portion of land in the very heart of
the city having been expropriated for the site of a future
railway terminus; this land has ceased to be cultivated,
became water-logged, and afforded splendid breeding places
for mosquitoes, which now began to swarm; this was soon
followed by & rapid rise in the number of malarial cases,
with an increasing death-roll from this cause. The con-
clusions to be deduced are obvious, as are also the
remedies. which, to economise space, are not here repro-
duced (J. E. N.).

Motices to Correspondents,

1.—Manuscripts sent іп cannot be returned.

2.—As our contributors are for the most part resident abroad,
ated will not be submitted to those dwelling outside the United

ingdom, unless specially desired and arranged for.

8.—To ensure accuracy in printing it is specially requested
that all communications should be written clearly. .

4.—Authors desiring reprints of their communications to the
JounNAL or TRoPICAL MEDICINE should communicate with the
Publishers. ў р

6.—Correspondents should look for replies under the heading
“ Answers to Correspondents.” е =

June 1, 1906.)

THE JOURNAL OF TROPICAL MEDICINE.

165

Original Communications.

NOTES ON DISEASES MET WITH IN SOUTH
SYLHET, INDIA.

By А, B. Daueetry, C.M., M.D., D.P.H.

Malarial Fever, Quinine and Pregnancy.—The preg-
nant woman is, perhaps, not more liable to malarial
fever than other people, but when she does become
infected the attack is apt to be more severe, and
relapses are more frequent than in others, a condition
which increases the strain of pregnancy and leads
to ansemia and а general low state of health. If
the patient is left untreated, or if she refuse treat-
ment, as many of the natives of India do, believing
that all drugs are detrimental to the unborn child,
miscarriage often occurs, either from the high tempera-
ture produced by the fever, or from the severe anemia
with its cardiac trouble and consequent dropsy.

But even in cases where repeated attacks of fever
have taken place during the period of pregnancy, and
have gone on right up to the time of delivery, it is
remarkable how little the infant seems to have suffered
thereby; as a rule, it is well nourished and normal in
every respect, and, fortunately, is not born infected with
the Hemameba malarie. This fact, of the arrest of
the materies morbi of malarial fever by the placenta
is a wonderful thing, and shows that the placenta
must act like а fine filter, allowing fluids to pass, but
keeping back all particulate matter. It is suspected
that occasionally the foetus may be attacked in utero,
and it is sometimes stated that infants a few hours
old have shown recurrent rises and falls of temperature
that appeared to have a malarial origin, and since the
period of incubation would be too short to allow of a
post-natal infection, one is forced to conclude that the
infection took place before birth ; but such cases are
rare, and would seem to require further observation to
confirm them, although it may well be that a placenta,
damaged in some way, might allow the parasite of
malaria to pass from the mother to the child.

These cases of pregnancy, complicated by malarial
fever, frequently cause anxiety to the medical atten-
dant, who fears for the safety of the mother if the
fever continues, and who hesitates to give quinine for
fear of causing abortion. This belief that quinine
should be given very sparingly to pregnant women
is widespread, and some practitioners would even with-
hold it altogether and treat the fever with antipyretics
only ; but it seems to me that the danger of producing
в miscarriage by giving quinine is very much exagger-
ated. I hold that quinine should be given in doses
sufficient to control the fever, whatever the quantity
required may be, and that there need be little fear
of anything untoward happening. On the contrary,
one sees cases where timidity in the use of quinine
may be legitimately charged with the occurrence of
dangerous or even fatal symptoms in the mother, or
the birth of a child immature, or showing chronic
brain trouble. I have given quinine during four
months in doses of from 5 to 15 grains in the twenty-
four hours without any untoward result, and I believe
that it is only within the last ten or fourteen days of
the end of pregnancy, when uterine contractions are

"maternal passage.

normally beginning to occur, and the cervix is begin-
ning to become obliterated, that quinine may tend to
stimulate these contractions; but by this time no
harm will follow, even though labour be started a day
or two earlier than otherwise it would have been,
Pharmacology teaches that the action of a full dose of
quinine upon the cardiac muscle and ganglia is to

iminish the force and frequency of systole, and to
lower the blood pressure, effects which, if they may be
applied in the case of the uterus, would suggest a
retarding rather than an accelerating influence on that
organ.

Malarial Fever during the Puerperium.—The strain
of parturition is apt to bring on an attack of malarial
fever in a subject who has been previously infected.
A febrile disturbance within the first few days after
delivery always makes the medical attendant anxious,
and it is a relief to know that there may be a consider-
able rise of temperature without serious import in'&
patient known to be subject to attacks of malarial
fever. The following case is of some interest in this
respect :— Eog

Mrs. S., primipara, confined at 4.30 a.m., no nurse
nor doctor present. Pains came on two hours pre-
viously ; birth easy, child small, no laceration of

{

Pulse not over 80, and respiration not affected.

When seen at 6.30 a.m. placenta
not yet delivered, but lying loose in upper part of
vagina and easily removed ; condition of mother and
child normal, breasts contained a little milk. On the
second day the temperature began to rise, and there
seemed to be a little more tenderness over the uterus
than usual, but the lochial discharge was natural and
free from odour, and the general condition of the
patient was very good. A douche of carbolic (1-100)
was now given twice а day as a safeguard, although
the fever was not considered to be due to sepsis, and
five grains of quinine every morning. In spite of this
the temperature kept up, one day reaching 104° F.,
and continued with irregular remissions for about
a fortnight. But during all the time the patient's
general condition was very good; she could eat and
sleep well, her milk came, the lochial discharge
remained sweet, and the involution of the uterus was
not checked. I had treated her for several attacks
of malarial fever during her pregnancy, and undoubt-
edly this was a recrudescence of that fever brought
on by parturition. The slight uterine tenderness that
appeared to be present may have been caused by the
fever, for I have noticed as an early sign of an impend-

166

THE JOURNAL OF TROPICAL MEDICINE.

[June 1, 1906.

ing attack of malaria that joints and muscles which
had been much in use shortly before, such as the
adductors of the thigh in riding, or the elbow or
shoulder in tennis, were the first to ache and were
more tender to the touch than other parts. The
character of the temperature chart is not much help in
cases of malarial fever occurring in those who live in
the Tropics, for it is rarely typical, being interfered with
by the frequent taking of quinine and other causes.

A Case of Chyluria.—A coolie, Sakramuni, had been
on the same garden for several years, and was to all
appearance in usual health, when suddenly he began
to pass milky-white urine. There was no difficulty in
micturition, no uneasiness about bladder, no abdominal

ain, and his general condition was as good as that of

is class. Physical examination disclosed nothing
of note; there were no enlarged glands, the spleen
could not be felt, there was no abdominal tumour, and
the temperature was not raised. The urine varied in
milkiness from time to time, being usually clearest in
ihe morning, but never free from it alltogether. It
was opaque, milky-white in appearance, deposited a
thick curd-like layer half the depth of the glass, with

Sketch of Filaria Embryo, x 800, lying in midst of granular,
fatty cells in urine.

GED

Oval body in urine, possibly a developing filaria ovum.

а thinner, more opalescent layer above, alkaline in re-
action and contained much albumin. There was no
tinge of red in it. Microscopically it was seen that the
urine was crowded with masses of highly refracting,
round, granular cells, like lymphocytes, which varied
somewhat in size and mostly cleared up on treating
with ether; no red blood cells were seen. Naturally,
one was on the look-out for the presence of filarie in
the urine, but I examined a good number of films
before I succeeded in finding one. The specimen
found was slightly damaged towards the head, but
otherwise was quite distinct and unmistakeable, but
I could not determine to what species it belonged.
It was, of course, not alive when examined, as the

specimen of urine had been passed several hours
previously.

The foregoing drawing shows the parasite, multiplied
about 300 times, lying in the midst of the granular,
fatty cells.

The elongated, oval body outside the drawing was
also seen, but what it represents I do not know, unless
it be a developing ovum. І have not seen а drawing
of the ova of the filaria in any of the books on the
subject, so I may be wrong.

The patient went on in much the same condition,
able to do his work, and showing no other signs of
filarial infection for eight months. Blood films taken
at this time failed to discover any filarie in the blood
either by night or day, but there was ап excess of
eosinophile corpuscles, as many as 11 per cent. on one
occasion. At the beginning of July the urine began to
be much clearer, although it still contained albumin
and the same granular lymphocytes as before; and
now there appeared a well-defined, lobulated swelling,
occupying the right iliohypogastric region, slightly
tender and giving an impression of fluctuation on deep
pressure. His general health also began to deterio-
rate, he had fever, constipation and a foul tongue, and
the blood showed a slight increase of leucocytes.
exploratory operation was suggested to the patient but
his friends would not consent, so he drifted on, gradu-
ally becoming weaker, and died three weeks later of
exhaustion ; diarrhoea set in at the end and the urine
was said to have become blood-stained. No post-
mortem examination could be obtained. Whatever the
actual pathological condition was, it would seem that
the communication between the lymphatic system and
the urinary channels became blocked, or nearly so,
thus leading to an improvement in the condition of the
urine, but being at the same time detrimental to the
general condition of the patient. The lobulated
tumour that developed was the result of this blocking,
and probably was an enormously distended lymphatic
varix, or a mass of enlarged deep iliac or sacral lymph
glands. It may be mentioned that filarial disease in
any form is very rare in tea-gardens in Sylhet, at any
rate, the grosser manifestations, such as elephantiasis,
lymph scrotum, and the like are hardly ever seen, but
it may exist in masked forms, such as the condition
known as circumscribed cedema of the extremities
described by me in this Journal, October, 1900, and
suspected to be caused by a filaria.

Cerebro-spinal Meningitis.—Hirsch, in his handbook,
in 1886, says that hitherto this disease has been con-
fined to temperate and subtropical latitudes, and that
the Tropics and the Southern Hemisphere have escaped
altogether. Біпсе that time several outbreaks have
taken place in different parts of the world, and notably
during last year in the United States of America, but
still the disease seems to remain restricted to much
the same limits as Hirsch described at that date. Ав
regards India, I have never seen any account of this
form of meningitis having arisen ав ап epidemic, but
that isolated cases do occur from time to time I think
there is no doubt. At intervals during the past four
or five years I have met with obscure cases which pre-
sented many of the signs of cerebro-spinal meningitis,
such as muscular rigidity, retraction of the head and
в deepening coma, always ending in death, but as
they were always а good way off one had few chances
of seeing them or of following up their history in &

June 1, 1906.)

THE JOURNAL -OF TROPICAL MEDIOINE.

167

satisfactory manner. The more acute symptoms of
the onset and early stage of the disease are usually
over before. the patient is seen, and the thing that
strikes one most about these cases is that they look
seriously ill without evident cause; the temperature
may be only slightly above normal, the pulse is slow
rather than fast, there is neither cardiac nor pulmonary
trouble, diarrhoea and vomiting are unusual, the
absence of a wound excludes tetanus, and the symptoms
are not those of sunstroke or cerebral apoplexy, yet
the patient looks dangerously ill. І

Not long ago I met with а less acute case which
gave me a better opportunity of following up the his-
tory and the course of the disease.

Liloo, a Hindu woman, had been ill for ten days
when I saw her on July 22nd, the chief complaint
being severe pain in the occipito-spinal region, diffi-
culty in walking, and general weakness. She was dull
and apathetic, speech slow, pupils equal, temperature
100° F., could stand only with help, had tremors of
the leg muscles, no paralysis; heart, lungs, and
abdominal organs normal. Four days later the
symptoms were more marked; the right arm and leg
showed greater stiffening than the left, sensation in
these parts was diminished, and the right knee-jerk
was absent, but there was no facial paralysis and no
retraction of the neck. Ап attempt was made to get
a drop of spinal fluid, but without success at this time.
Blood films did not show leucocytosis. On August
5th further developments had taken place : the patient
was now semi-comatose, the head was drawn back-
wards and slightly towards the right shoulder, the
eyes were turned upwards, outwards, and to the right,
there was tightness of the hamstring muscles, but
Kernig's sign was not well marked, pulse slow and
very weak, respiration shallow, there was no rise of
temperature, and I did not notice а skin eruption.
There was tenderness along the spine, ав shown by the
patient shrinking when the skin was being disinfected
for lumbar puncture. On this occasion I succeeded
in getting а few drops of cerebro-spinal fluid. Under
the microscope this showed a few flakes of epithelium,
and in two specimens several micrococci were dis-
covered ; these lay together either in groups of two or
groups of four amidst some particle of broken-down
cells; they were rounded or oval in shape, and when
stained with methylene blue had a clear space round
them, but no definite capsule. I had no Gram's
etain available to try its effect.

The patient gradually sank, and died on August 9th,
four wecks from the beginning of the illness. А post-
mortem examination was not made.

I have short notes of four other cases, of which two
were boys, one а middle-aged man and one а young

шап; all were fatal, and all had the cardinal signs of
this disease—sudden onset, marked depression, pains
in spine, retraction of head, stiffness of muscles,
ending in coma and death within а few days. Іп one
only was the temperature high, it reached 106? F.
shortly before the end. ;

One would like to follow up such cases as these
more closely, but the lack of opportunity of seeing
more of one's patients, owing often to the long dis-
tances to be traversed and the trying circumstances
surrounding work in the Тгорісв, will be readily under-
stood by all who have practised in hot countries.

Morbus Maculosus Neonatorum. — The following
seems to be a case of this rather uncommon disease.
An infant, three days after birth, developed bleeding
from the mouth and anus. When І saw it on the
fourth day the hemorrhage from the mouth had
stopped, but dark red blood was still oozing from the
anus. The confinement had been uncomplicated,
and the child had not received any injury; it looked
healthy and well nourished, and showed no signs of -
syphilitic disease, and there was no jaundice. There
was no history of lues in the parents, and there were
several more children in the family, all healthy look-
ing. Liquid extract of ergot, in 3 minim doses thrice
daily, was given, and the bleeding had ceased within
ten days and did not recur.

Diet and Health.—It is a common cry of vegetarians
and other food faddists that flesh food is not a neces-
sary part of the dietary of man, and they point to the
case of whole races who are said to subsist on a rice
diet alone, and are yet able to preserve perfect health.
Like many other general statements on subjects made
by those who do not have а firat hand knowledge of
the facts, that statement is only partly true, and it
may be of interest to record my experience among
many thousands of tea-garden coolies, extending over a
period of nine years, with reference to this point.

I shall take ansemia, which is а general result of
of many different deleterious causes, as the test of
health. Ansmmia is a very common trouble amongst
tea-garden coolies in many parts of Assam, and some-
times becomes so rife that it seriously interferes with
the work of a garden. Women, of course, suffer more
than men, probably on account of the stress of
pregnancy aggravating the condition, and it is no
unusual thing to see a woman well advanced in
pregnancy unable to stand or to lie down, and re-
clining in a sitting posture, with feet and legs swollen,
the abdomen half full of fluid, the hands cedematous,
the face so swollen that she can hardly see, the con-
junctivee and tongue of marble whiteness, bruits all
over the chest, and fluid at the base of the lungs, a
condition, in short, tbat if not soon relieved must
speedily prove fatal. Nature usually sends relief by
causing abortion; gradually the dropsy becomes
absorbed, and in a few weeks the patient has returned
to her normal state—a state, however, which is always
one of relative anzmia.

That is, of course, an extreme instance, but it is
by no means an uncommon one, апа there are all
degrees of severity leading up to that; while the
men suffer almost as frequently, if a little less
severely, The causes of this anemia are various, but
I am not at present dealing with them. Now, a short

THE JOURNAL OF TROPICAL MEDICINE.

[June 1, 1906.

acquaintance with tea-garden labourers teaches one
that not all races of coolies suffer equally, and here it
may be noted that Hindoo coolies differ from one
another in race and language as much as a High-
lander from a Cornishman, or a Welshman from а
man of Norfolk; one sees that the dark-skinned
coolie, such as the Santhal, who spends all he earns
on food and drink, and eats fish, flesh and fowl, al-
most never suffers from anemia; while the fairer-
skinned coolie from the North-West Provinces, who
hoards up every pice he can get, lives on food almost
wholly of a vegetable kind and shuns the flesh of
animals like a plague, falls an easy prey to the disease
whenever his small reserve of energy is exhausted by
a trifling illness.

The conditions in which these two distinct types
live are absolutely identical, and both are imported
from a distance to work on the tea-gardens, so that
both have to become acclimatised, so to speak; the
only difference lies in the nature of their food. The

` strong, black coolie feeds well on a mixed diet and is
hardly ever a prey to anemia, while the other, who
lives on a vegetable regimen, is nearly always
below par, facts that would seem to support the
proposition that man best maintains his strength on a
mixed diet. Iam quite well aware that these two
types have probably had a very different origin, that
the Santhals are, perhaps, an aboriginal race, and that
the coolies from the North-West have very likely
sprung from a mixed Aryan stock; but for many
thousands of years both have lived and worked
under the same Indian sun, and it seems to me
that the great difference between them lies in the
nature of their diet, and that this is sufficient to ex-
plain the presence and the absence of anæmia in the
two races.

Medicine and Witcheraft.—One meets with many
instances of the belief in witchcraft amongst the
Hindoos, and the methods employed to counteract the
supposed influence of evil spirits are very interesting,
although it is often difficult to get at the bottom of
the matter, because the people themselves are half
ashamed of their superstition, and are afraid to say
much about it for fear of being ridiculed. The fol-
lowing incident is interesting, for more than one reason.
One night, during a sharp thunderstorm, the lightning
had been attracted by a papya tree, about 12 feet
high, which was growing near a native hut, and
striking the ground entered the house and ploughed
up а zigzag furrow across the floor of a room іп
which two men were sleeping. The lightning had
passed within two feet of the wooden bed on which
they lay and most of its force had been spent in the
ground, but a portion of it had glanced aside towards
the feet of the two men and passed up their bodies,
having been attracted, possibly, by some empty oil tins
that were standing near the head of the bed.

One of the men escaped with a little singeing of
the hair on his legs and chest, but the other did not
fare so well. The lightning had singed him, like the
other, but had then struck the right side of his head,
entered thé ear and stunned him. When І saw him
he was still in a dazed condition but quite conscious,
was able to answer questions slowly, and complained
of pain in the right ear; there was a slight oozing of

blood-stained fluid from the meatus, and on throwing
in the light it was found that the drum was torn
across. There were no gross signs of brain injury
apparent then or afterwards, but he continued in a
depressed state for many weeks, though he was able
to go about and seemed otherwise well. Now comes
the witchcraft part of it, which probably explains &
good deal of the melancholia from which he suffered.
Although he and his friends were quite well aware
that the injury was done by the lightning, yet in their
own minds they connected that physical phenomenon
with a demoniacal origin. They believed that an evil
spirit, or ** bhoot ” as they call it, had taken up its abode
within him, and they recollected that a short time
before he had passed a burying ground on his way
home one night, and the inference was easy that some
ill-disposed spirit, lurking about, had found him an
easy prey, and had taken advantage of his being
asleep to enter his body in that forcible fashion. So,
as it was desirable to expel this unwelcome guest as
speedily as possible, and seeing that the doctor sahib
did not believe in such supernatural visitants and
could only treat natural effects by natural remedies,
the patient’s friends took council together how best
to attain that end.

Accordingly, they hired the services of а band,
composed of drums, cymbals, and other more or
less noisy instruments, formed a circle round the
patient, and then let loose their witch-compelling din.
At the same time one of their holy men stuffed ghee,
or clarified butter, into his ears, for everything that
comes from the cow is pure and sacred, and held the
victim's nose over а smoking lamp of incense in order
io make his quarters too hot for the demon. Тһе
“ bhoot,” however, appeared to be in no hurry to quit,
for this performance went on for many nights, and at
the end of it the patient was no better than at the
beginning. Finally, I heard that he went в good
distance off to be treated by someone renowned as an
exorciser of evil spirits, and that after a time he
returned with a lighter pocket, if not with a lighter
head.

The Evil Eye.—There would be many a sudden
death if a look would kill, but, fortunately, it is not
во, although the belief in being “ overlooked " by the
“evil eye" to one's harm is not dead, and is still
met in places where one would hardly expect to find
it. Among Eastern peoples it still strongly exists,
and the following instances will show some of the
means adopted by the Hindoos to avert this evil
influence. When a person receives a cut on the
leg or arm, or suffers from an ulcer, one of the first
things he does is to tie round the limb a cord of
twisted human hair, to which, very often, a small shell
is attached. The purpose of this is to prevent the
sore from spreading over the limb and over the body,
thereby causing death, an event which he thinks
would happen if some ill-disposed person were to
“ overlook ” him with the evil eye whilst he is suffering
from his wound. It is not easy to see what dis-
enchanting virtue can lie hidden in a snail shell or a
band of twisted bair, unless the comparatively long-
lasting nature of these has something to do with it.

Here is another custom practised by some, the

meaning of which is explained differently by different

June 1, 1906.)

THE JOURNAL OF TROPICAL MEDICINE.

169

people. The mothers apply a black dye or pigment
round the eyelids of their infants after the child is
old enough to be taken out. The black substance is
said to be a natural earth dug from some of the hills,
but I believe any black pigment will serve the pur-
pose. The explanation of this practice varies; some
say that it is only done for looks’ sake, some that it is
to protect the delicate young eyes from the strong
light and the glare of the dry ground, while others
admit that it is done to annul the intentions of any
evil-minded person who might be envious of her
neighbour's pretty child and overlook it for its harm.
The first of these reasons is hardly sufficient, for their
dark skin throws the white of the eye into sufficient
relief without tbe artificial aid required for that pur-
pose by the belles of the West. The second explana-
tion, that it protects the eyes from the glare, has
something to be said for it, for I have noticed in
white dogs when one eye lies in the midst of a black
or brown patch, and the other is surrounded alto-
gether by a white ground, that the former eye is strong,
and free from inflammation, while the latter is very
often the seat of a chronic conjunctivitis. The greater
amount of pigment in the skin of the dark patch
seems to diminish the irritating effects of the light
and glare. However, as the black eyes of the natives
rarely suffer from this cause, the third explanation
would seem, perhaps, to be the right one, namely, that
it protects the child against the “ evil eye."

Another example may be given. When riding
about one often sees near a busti, or native croft, as
it may be called, & clay cooking-pot with а few
white lines and circles painted over its bottom,
hanging mouth downwards high up on the end of a
bam pole; this too, I believe, is intended as а
protection against the “evil eye." The design on
the upturned pot, which seems always to be an
old one with & black bottom, is two white lines
crossing one another, with a small white circle in each
of the four triangles thus formed, a rough imitation,
perhaps, of a buman face with four eyes, and intended
to attract the glance of the “ evil eye," thereby divert-
ing its malign influence from the house and its
inmates: а spell, doubtless, not less potent than
ours of hanging up & horse-shoe by the door-lintel.

А possible explanation of the origin of this practice
has occurred to me. When the rice harvest has been
gathered in the straw is built up in round stacks which
have а pole running up the centre to keep them up-
right. Since these stacks are never thatched the
heavy rains would get in at the top around the pole,
and rot the straw, and to prevent this & small clay
cooking-pot is put over the top of the pole, so that the
rain is diverted all round. At the end of the year,
when the straw has been used up, the bare pole is
left standing with its hat at the top like a very
tall mushroom with a very small head, and it thus
forms a rather striking object, and in course of time
it would probably occur to someone looking about for
а prominent point of advantage whereon to inscribe
his anti-charm that here was the very thing, so
that by and bye the cymbal would be set up alto-
gether independent of its original purpose.

Scapegoat.—The old Hebrew custom of lay-
ing the sins of the people upon a goat and turning

it adrift into the desert still exists to some extent
among the Hindoos, who resort to this device in
order to rid their family of illness. Since а goat is
rather too expensive for а poor man's purse he
utilises a chicken instead. The “ bhoot” which is sup-
posed to be the cause of the person's illness is
exorcised into the hapless chicken, a red mark is
then put on its forehead, and it is taken well out
into the jungle and allowed to escape. Тһе disease
is expected to go with it, and its former owner
feels no qualms of conscience to think that some
innocent mortal happening across the ''scapegoat'
may become a new victim. But the danger there-
from cannot be very great, for I know a sahib who
once stumbled over one of these escaped chickens,
and, taking pity on it, put it in his pocket and
brought it home, unwitting of the risk he was running,
and he is yet alive and well. Another ingenious if
equally unkind device to rid one’s self of an illness and
foist it on another is to set down a pair of wooden
shoes belonging to the patient hidden from sight at
a point where two paths raeet. Strings are fixed to
the shoes and to wooden supports at the sides of the
road, so that the first person coming along steps
into the trap, the threads break, and the patient is
cured of his disease at the expense of the newcomer.
It is chiefly during epidemics and in long illnesses
that resist medical treatment that belief in demoniacal
possession gains the upper hand of the people, and
compels them to resort to charms and incantations ;
at other times they are quite ready to seek the help
and carry out the methods of modern medical
science.

THE ANATOMY OF THE BITING FLIES OF
THE GENERA STOMOXYS AND GLOSSINA.

By Lieut.-Colonel G. М. Grues, I.M.S. (Rtd.).
(Continued from p. 156.)

Or the pseudo-tracher of the “tongue” of the
commoner flies I have as yet discovered no trace, but
behind the leaf-shaped blades are two other rows
of five strongly chitinised teeth of nearly as large
size as those first described. Of these the one next
to them has teeth with ende like that of a cheese-
cutter, while the innermost has a point curiously
serrated on one side, and a number of short, stout,
intensely black-blue bristles may be also added, but a
complete description of this wonderful structure would
exceed all reasonable limits. То conclude the descrip-
tion of the labium, it will thus be seen that, though
somewhat stiffened by its median sclerite, it is quite
without any basal support, as the median sclerite
tapers away to nothing at the base, and the external
integument, though deceptively dense to external
appearance, is really soft and flexible, and specially
creased to admit of its being shortened in the same
way ав an accordion.

If we now turn to the upper lip or labrum, we find
a structure formed exactly on the model of a hypo-
dermic needle, and in every way as admirably adapted
for piercing as the labium is obviously impossible for
such a function. It differs from the familiar surgical

170

instrument only in the detail that the tube is incom-
plete, a narrow slit running along its entire ventral
surface to the point, where it expands, so as to
make the organ end in a point, like that of a peu.
It forms, however, fully three-fourths of & complete
tube, and the remaining fourth, as will be seen by
reference to fig. 16, is completed by the dorsal surface
of the hypopharynx, It must be remembered that
all members of the fly family are provided with a
similar apparatus, the difference being merely one of
relative length.

Though in reality continuous with the delicate
membrane that at first forms the upper wall of the
tubular buccal cavity, the dense chitin of which it is
composed ends abruptly at a line a little before the
base of the labium, and its two corners articulate with
a pair of sclerites, named by Lowne the apodemes of
the labrum, which in their turn articulate with two
cornua projecting forwards from the chitinous skele-
ton of the cephalo-pharynx, called the fulcra by the
same writer. These apodemes are rod-like structures,
which closely resemble the human clavicle in form ;
and the fulcrum is a hollow frame of chitin of rather
curious form. Behind it may be taken as continuous

f сі.

ар

Fic. 19.—I. Semi-diagram showing the chitinous skeleton of
the labrum, or upper lip: ap, apodeme of the labrum;
cl, chitinous plate uniting epistome with the clypeus ; d, distal

cornua of fulcrum; f, fulcrum; irm, labrum. II. The fulcrum
drawn in perspective. ILI. Point of labrum ; and 1V., end of
hypopharynx at the same higher magnification.

with the pharynx, but in front the sides are open,
while the dorsal and ventral aspects are prolonged as
two plates, the upper one of which turns upwards to
fuse with the clypeus, and so affords an immovable
connection with the chitinous exoskeleton for the
front of the head. This plate is pierced by a large
foramen which gives passage to the nerves and tracheæ
of the trunk, and also for an air chamber continuous
in front with those of the labium and behind with
those of the head and of the body generally. Тһе
lower plate, on the other hand, is shaped much like
the half of a butcher's tray, the handles of the tray
being represented by the two cornua which again
articulate with the proximal ends of the apodemes.
The labrum is therefore connected with the skeleton
of the head by the intervention of two joints, movable
only in flexion and extension, and each capable of
being moved or fixed by appropriate muscles. The
poiut of the labrum is bevelled, and the edges of the

THE JOURNAL OF TROPICAL MEDICINE.

[June 1, 1906.

resulting pen-like structure are each armed with two
keen but not very trenchant teeth of such а form 85
to equally facilitate rapid withdrawal and insertion.
When in function the slit in the ventral aspect of the
tube is closed by the apposition of another structure,
the hypopharynx. This springs from the floor of
the mouth, level with the base of the labrum, and
is a prolongation of the salivary duct. It consists
of a delicate but fairly stiff tube, the dorsal side of
which is produced laterally to form two ale, which
curve backwards in such a way as to form a fairly
deep groove on its dorsal side. Seen in section (fig. 16,
h), it is seen that the tube is comparatively small in
proportion tothe thickness of the walls, but it must
һе endowed with considerable elasticity, as was shown
by & curious accidental experiment.

I had placed an entire insect in water (from spirit),
with the view of dissecting the proboscis, and had
spread apart its three components, when, under my
eyes, the hypopharynx began to swell and lengthen,
till it protruded a long way beyond the labella, and at
last it snapped in the middle, after which the pieces
rapidly resumed their original size. The orifice of its
tube, I conclude, was in some way obstructed, and
osmosis had done the rest. Sections of the entire
proboscis show that the ale fit into a curious slot in
the edges of the labrum and so convert it into a
complete tube through which the blood is drawn into
the cesopbagus.

The arrangement recalls in many ways that whereby
the outer case of a cycle tyre secures itself to the rim
of the wheel, which in this case is represented by the
һурорһагупх, but is designed to make the resulting
tube withstand not positive, but negative pressure.

As already indicated, I do not believe that in Stomorys
the labium has any share in piercing the skin, but
that it acts as a protective sheath to the more delicate
lancet, and supplies the muscular force whereby the
latter is driven into the skin. This, the writer believes,
is effected in the following manner: By means of the
various hooks and blades of the labella it attaches
itself to the skin of the animal to be operated on, and
then by a contraction of its powerful longitudinal
muscles forcibly shortens itself, so that the labruin is
made to protrude and, guided by the labella, is thrust
into the skin. With a little trouble it is possible to
imitate this in a fresh fly to some extent by handling
the labium with the needles so as to make it lengthen
and shorten. As there is no bending out of the way
of the labium, such as occurs in the mosquito, it
appears to the observer exactly as if the labium itself
had entered the skin ; the illusion being something on
the principle of the stage dagger.

It must be remembered that the parts are none too
large, and that any one attempting to watch the pro-
cess cannot put his head too near, for fear of disturbing
the fly, added to which, when animals are bitten, the
fur further interferes with the possibility of seeing
exactly how the operation is performed. To watch the
process to any purpose would require the use of a
powerful hand lens, and this is, of course, out of the
question.

From the comparative point of view, the anatomy
of the proboscis of Glossina closely resembles that of
Stomozys, but differs remarkedly in many details. At

June, 1 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE

171

their bases, the resemblance between the two pro-
bosces is fairly complete, and the foregoing description
of the chitinous skeleton of the mouth-parts might
here stand almost as well for those of Glossina, but
here the resemblance ends. A very cursory examina-
tion shows that the visible parts of the proboscis

drm Б

Fic. 20. — Proboscis of Glossina palpalis.
labrum.

1, Labium ; irm,

(labium) consist of two distinct parts, a large basal
bulb, as thick or thicker than the base of the labium
of Stomorys, and a long, extremely slender rod ending
in a blunt end, slightly bent backwards, so as to form
an instrument exactly like а French urethral bougie.
This slender part is densely chitinised and hence very
stiff, but the bulb has a thin flexible integument like
that of the other species. Moreover, the pair of large
muscles which largely fill up the bulb, instead of
remaining muscular nearly to the end of the proboscis,
terminate in two delicate tendons which run through
the entire slender portion to be inserted into the base
of the labella.

The form of the hypopharynx and its relations with
the labrum are entirely different from any other fly I
have examined, and conclusively show the correctness
of the general opinion that the entire slender part of
De proboscis is introduced into the wound in the
skin.

In Stomozys and the other flies as yet examined by
me, the apposition of the labrum and hypopharynx
forms a tube through which the food of the insect is
conducted to the cesophagus, but between these two
parts in Glossina there is no tube, because the apposed
parts are moulded to exactly fit each other.

Fic. 21.—Tranverse section of the proboscis of Glossina
palpalis at almost mid-length. h, Hypopharynx; l, labium ;
irm, labrum ; ¢, tendons of the contractor muscle of the bulb
enclosed in tubular chitinous canals in the substance of the
labium. Note.—The ventral side of this figure is uppermost.

As will be seen from the figure, the hypopharynx is
a solid rod of semilunar section, with a rib running
down its flat ventral face within which is the salivary
canal. The convex dorsal side fits closely against
the labrum, which is wrapped round it, the edges of
the latter extending beyond its own, and inverted so as
to form quite five-sixths of a complete tube. In some-
what similar manner the labium is wrapped round the
labrum, the edges of the former overlapping those of

the latter for quite a quarter of the circumference of
the tube formed by their apposition. The slot on the
dorsal surface of the labium therefore forms rather
more than half a circle, and opposite the slit between
the edges of the labrum runs a minor groove of the
same width. Both walls of the labium are very thick
and densely chitinised, especially in the middle line,
and it it further strengthened by infoldings of chitin
which support the sheaths of the long tendons of the
contractors of the bulb.

The thickness of the slender part of the proboscis is
less than 0:04 mm., and its length 1:4 mm.; that of
the bulb 0:57 mm., and that of the part of the labium
that projects beyond the labrum in the position of
rest 0:17 mm.

An examination of the above drawing (fig. 20),
however, shows at once that the labium, with its
blunt, bougie-like end, is quite unsuited for piercing
the skin, while the labrum is eminently adapted for
doing so. A shortening of the length of the bulb by
even a third of its length, through the action of the
powerful contractor muscles, would suffice to bring
the cutting point of the labrum beyond the blunt end
of the labium ; and assuming the latter to be fixed to the
skin by means of the jagged teeth of the labella, would
enable the former to make a wound into which the
labium could be introduced like a probe. Once intro-
duced, a sawing alternate action of protrusion and
retraction of the labrum would enable the entire
apparatus to penetrate to its full depth with com-
parative rapidity, as the mouth of the wound would be
at the same time enlarged by the saw-like edges with
which, it will be noticed, the sides of the labium are
provided. The labella are smaller and certainly much
more rigid than in Stomorys. Judging from spirit
specimens, one would say that they were anchylosed
to the trunk of the labium, but probably in fresh
specimens they can be separated to a moderate extent.
Hausen’s description and figure of the labella in Mr.
Austen’s monograph of the tsetse-flies appears quite
accurate, and as he suggests that some part at least
of their armature is brought into action by the pro-
trusion of the elastic membrane carrying them, it
seems probable that he also regards the labella as
capable of but little separation. ,

In the position of rest the united ends of the labella
form a perfectly smooth, probe-like instrument, as the
somewhat complicated armature of teeth and blades,
with which they are provided, are entirely hidden
between them. Even when protruded, however, it is
difficult to imagine any method by which they could
effect a wound large enough for the organ on which
they are carried to follow them.

We will now proceed to some description of the
organs contained within the head.

In the middle line, just above the roots of the
antenne, will be seen a minute foramen. This is the
opening of a rather extensive cavity which extends
backwards under the vertex nearly half-way to the
occiput, and is nearly as wide as it is long. It has
also a considerable depth, and from its floor two large
median processes project into its interior, besides
which there are sundry median and lateral diverticula.
The whole cavity has a dense chitinous wall, and is
closely beset with short conical hairs. The presence

172 THE JOURNAL OF TROPICAL MEDICINE.

of this cavity gives rise to appearances somewhat
difficult to interpret in section, unless one is aware
of its existence. This cavity is the inverted frontal
sac, and in the pupa is everted to form a large bulla,
by means of which the operculum of the pupa case is
burst open to admit of the escape of the imago, but it
does not appear to serve any function in the latter, so
that its significance is entirely developmental.

Fic. 22.—Vertical section of head of Stomoxys, semi-dia-
grammatic. bc, Buccal cavity ; cd, duct of crop; сі, subcesophageal
cerebral commissure ; cs, supra-cesophageal cerebral commissure ;
h, hypopharynx ; l, labium ; Irm, labrum ; mg, midgut; o, ocel-
lus and its nerve; oe, esophagus; p, pharynx; pd, dilatator
muscle of pharynx; pg, proventricular ganglion; pv, proven-
triculus; sd, common salivary duct ; tg, thoracic ganglion.

The buccal cavity is contained in the base of the
proboscis, its anterior boundary, where the hypo-
pharynx springs from the floor of the lower wall,
being opposite the thickest part of the bulb. It is
quite a narrow cavity, and is strengthened by trans-
verse chitinous fibres, and it may be said to end and
the pharynx to commence at the point where the soft
flexible root of the proboscis begins. From this point
the pharynx runs nearly vertically upwards in the axis
of the head to а point opposite the middle of the large
second antennal joint. Here it becomes the cesophagus
and bends sharply backwards, in the longitudinal axis
of the insect, to pierce the cerebral commissure, narrow-
ing to an extreme tenuity, and then runs backwards
and downwards through the neck to the under-surface
of the proventriculus.

The pharynx is the true aspiratory organ by means
of which the blood of the victim is sucked. It is of
considerable size, being a quarter of a millimetre
across at its widest part; but in the position of
rest is a mere slit, the anterior and posterior surfaces
being in contact. The slit is not, however, straight,
but nearly semilunar, with the convexity backwards.

The concave ventral surface is formed of a dense
plate of chitin, and is practically immovable, though
it is steadied by a pair of lateral musoular bands. The
anterior or dorsal surface, on the other hand, is soft
and flexible, and inserted into it on either side are the
powerful dilatator muscles which spring from the
interior of the ridge which bounds the recess below of
the hollow in which the antenn lie.

When these muscles contract they must neces-

{June 1, 1906.

sarily draw forward the flexible anterior wall of the
pharynx ; and as, from its density, the posterior wall
cannot follow, it must needs convert the closed slit
into an open cavity of oval section. In some respects the
arrangement resembles that of the Culicide, but in
them there is a localised elastic bulb which can be,
like the pharynx of Stomozys, actively dilated; but in
that genus there can be no elastic contractility, and
the return to the slit form of lumen must be through
the agency of the pneumatic pressure of the great air
sinuses with which the organ is surrounded.

In the above figure of a median sagittal section,
the dilatator of the pharynx should, strictly speaking,
not be represented, as there is a considerable interval
in the middle line between the two planes of muscle,
but to save an additional figure their direction is indi-
cated by broken lines. The transverse section here

Ето. 23.—Horizontal section of head of Stomoxys. dm, Dila-
tator muscles of pharynx; e, lower edge of eyes; fb, fat body ;
p, cavity of pharynx; sd, salivary duct.

depicted will, however, serve sufficiently to indicate the
true position of these muscles.

When piercing the transverse cerebral commis-
sure, the cesophagus contracts to a lumen of no
more than 0:015 mm.; and behind it the tube
again dilates, but is compressed instead of depressed.
The common salivary duct, from its origin at the
base of the hypopharynx, follows the course of the
buccal cavity and pharynx, at a little distance from it
ventrally, and ends by dividing into the right and left
ducts at a point about level with the apices of the
&ntenns. This ів a good deal further back than as
indicated by Hansen, and still more in contrast with
the bifurcation in Glossina as stated by Prof. Minchin.
Hansen (fig. 21, pl. 8, of Austen's monograph) also
figures a large salivary reservoir.

It may be gathered from the context of his memor-
andum that he relied on his interpretation of the parts
ав seen in optical section through the integuments,
and this probably accounts for the illusion, for the
writer has no hesitation in stating that no such dila-
tation exists, as the duct has been followed in an un-
broken series of sections from the hypopharynx to its
bifurcation at the point indicated, and it nowhere ex-
ceeds 0:09 mm. in diameter. As far as can be made out,
the spiral fibre which strengthens the duct in many
diptera is wanting here. Shortly after entering the
thorax the ducts cease to be chitinous and become
glandular. In fig. 22 the size of the duct is
intentionally exaggerated so as to make its position
clearer.

The salivary ducts, after division, run together in

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contact, close under the soft ventral integument of the
head to the neck, and so do not follow the stomodeal
capal, whieh is, however, accompanied in its passage
through the cerebral commissure by a pair of tracheæ
of about the same calibre as the salivary ducts, and by
two nerve fibres.

Speaking generally, the anatomy of the head of
Glossina appears to coincide closely with that of
Stomoxys, but Prof. Minchin notes that the salivary
ducts bifurcate further forwards. The most striking
point about the brain of these and other flies is its
large size, which must be relatively considerably larger
than that of most of the lower vertebrates. There do
not appear to be any details of special interest in the
brain of either Stomoxys or Glossina, and as a large
number of papers are easily available on the dipterous
brain, any further description is quite superfluous. A
very excellent account will be found in. Lowne’s work
on the Blow-fly vol. ii., p. 453, and a shorter state-
ment in Prof. Minchin’s paper on Glossina in
the Proc. Roy. Soc., vol. B., 76, p. 532. Before quit-
ting the head it may be well, however, to add a few
words on the histology of the principal organs.

(To be continued.)

THE PURU OF THE MALAY PENINSULA.
By T. D. біміктте, М.р.
(Continued from page 153.)

Тнв VARIETIES AND COMPLICATIONS OF Роко.

Marars distinguish the varieties of many of their
diseases by a number of clinical names. For example,
small-pox, which is common among them, has been
given—under the name of “ penyakit ketumbohan "—
no less than eleven different descriptive namea, ac-
cording to the appearance of the pustules. Again, the
average intelligent Malay will recognise at least seven
different varieties of ringworm. Puru is divided in the
same way into several varieties, the chief of which
are: *'Puru siput” or “ puru kechar” (“siput ” and
“ kechar,” a shell); “риги mata kerbau” or * puru
kerbau ” (“ mata,” an eye; “kerbau,” а buffalo);
“puru sekam” or “ риги dedak” (chaff or Б
“ puru kretas " (paper); “риги kochi " (Cochin China
sore); “puru tapak anjing” (“ tapak,” a footprint;
“anjing,” a dog); “puru pitis” (a small coin); also
“puru parang” (4 parang,” а chopper) and “риги
kenam.” Puru of the foot is generally known as
“ bubol,” but it is frequently referred to in Kelantan
as “puru duriyan." ‘ Bubol” has been somewhat
fancifully divided into “ bubol sarang” (“ sarang,” а
nest) ; ‘‘ bubol malai ” (aigrette) ; “ bubol susoh ayam ”
(“ susoh," а spur; “ayam,” a chicken), and “ bubol
bubok ” (bubok,” a wood maggot).

Of these Malay varieties, “ puru. siput ” is charac-
terised by its rupial-shaped sores, and is perhaps the
most common. It is considered to be the most benign
form. It is not painful, and the sores heal easily.
An example of “ puru siput ” is shown in fig. 1.

_ ' We have to apologise to Dr. Gimlette, inasmuch as we were
in error announcing his valuable communication as а Craggs
Research prize essay.—Ep. J. T. M.

THE JOURNAL OF TROPICAL MEDICINE.

173

“ Puru mata kerbau ” is common. The sores are
very large, but heal readily. Kelantan Malays call
this the real puru. It may be combined with “ puru
pitis.” :

. “ Puru sekan " is especially irritable with regard to
itching.

“ Puru kretas ” is distinguished from other forms
of puru by the general superficial character of the
eruption. Itis only skin deep, gyratory, very painful,
and difficult to cure. It is the worst kind known and
may cause death. It may be combined with '* puru
mata kerbau."

“ Puru tapak anjing ” is another bad kind of puru.
It is very painful, and leaves large, though insig-
nificant, scars, either similar to а dog's footprint or
very irregular in shape. The sores аге supposed to
occur on the body, placed in the way a dog leaves
marks after walking on the sands—here some and
there some, and none in the middle.

Puru kochi has been mentioned under etiology. It
is referred to in an old Malay dictionary as the vene-
real disease [16]. “ Puru kochi ” is said to be chronic.
It is not considered fatal, although no native medicine
willcureit. Itis also called “ puru glang besi ” (glang,
lit. a bracelet or anklet ; besi, iron).

Puru kenam: in Kelantan “kenam” is said to
occur when small children get lumps y kenam ") all
over their body. It appears as circular red spots,
and it is interesting to note that it is sometimes
known as “ роги Burma.”

Puru parang is said to complicate other sores, and
to be recognised by its deep ulceration. It occurs on
the foot, and is said to attack old people.

There are various other unimportant so-called
varieties. l

Intercurrent diseases are generally the cause of
death. A first attack of puru in old age is always
serious. Young children may succumb, although
rarely, to asthenia. Cellular abscesses may form. Scars
are indefinite, but it is exceptional to find villagers who
have not had puru early in life, and who cannot point
in later life to some dark scar left by the disease. The
old scar of “ puru ibu ” is well remembered by Malays,
as are vaccination marks by Europeans. It resembles
in appearance the scar of scalds or burns of the third
or perhaps fourth degree, except that it is dark in
colour. Scars are sometimes definitely depressed, and
when on the face may cause contractions of the
mouth known in Malay as “ sipit mulut” (“ sipit, ”
puckered ; “mulut,” mouth). Permanent deformity
of the limbs and ankylosis of joints may also be the
result of puru. This disfigurement is very common,
and is known as “ birat " in Malay.

Tue Пілоховів oF Рово.

_ . Doubtless if the nature of puru were not well under-

stood many cases of it might be classified as syphilis,
because at first sight there seem to be many points of
resemblance. Both rank among affections the study
of which is. mainly clinical; both are constitutional
diseases with a period of incubation, efflorescence and
decline ; each is conveyed by direct inoculation, and
followed in a slowly running course by the occurrence
of remainders, and perhaps sequels with a tendency
towards spontaneous cure. Puru is so well known to

174 THE JOURNAL ОЕ TROPICAL MEDICINE.

[June 1, 1906.

Malays, however, that they are unlikely to confound it
with any other disease. They know that syphilis can
be passed on from father or mother to their children,
but hold that puru is always acquired.

The diagnosis is chiefly based on the combination
of the characteristic eruption with itching, on the
peculiar insensibility of the tubercles, on the general
uniformity of their aspect, and on the limitation of

Fic. 1.—Mehpih— Case 1—showing the puru ibu.

the constitutional disturbance. There is only one
disease— called *'supia" іп Kelantanese Malay, and
“ sang kai she toy " in Chinese—which might be mis-
taken for puru. This is confined to children, and
occurs about the head, neck, and scalp. It appears to
be similar to impetigo contagiosa, and, except for the
clinical appearance of the honey-coloured scabs, to
have but little real resemblance to puru. Puru does
not attack the foetus. Even when it occurs in infants

before the age of eight months, it hardly ever causes
an increasing cachexia with terminal diarrhea. The
peculiar hue, physiognomy and “ snuffles”’ of syphilitic
infants are wanting. The puru ibu, again, differs essen-
tially from the primary sore of syphilis, in being
generally made up of a collection of multiple tubercles
which is not prone to ulcerate, but likely to last through-
out the disease. This is in marked contrast to the single
sloughing sore of primary syphilis as it is generally
seen in Malaya. I have never seen inflammatory
sore throat (“sakit kailan” or ''kekail" in Malay)
in puru. Polymorphism and symmetry never strike
the every-day observer in any of the skin lesions of any
of the varieties of puru as they may do in syphilis.
Itching is the rule and alopecia the exception. Bone
lesions are, I think, rare. It is difficult, indeed, to know
to which stage of syphilis the Malay puru may be
compared to in detail. Although, as in Case 3, a
child can infect its mother with puru if unprotected,
people who have had puru can contract syphilis, and
others (as in Case 4) who have had syphilis can
contract puru.

European practitioners must, I think, be familiar
with examples of syphilis acquired by Englishmen
returning home from the Malay peninsula. Puru,
however, is probably unknown to them. In the one
case the disease, if acquired from a Malay, is probably
due to some chance infection. In the other, a
European, unless converted to Mohammedanism, could
never, I think, live in sufficiently close contact with
Malays so as to acquire the disease for a certainty.

CLINICAL CasES OF Puru.

Case 1. Puru in a Malay: Child. — Mehpih, a
girl, aged about 9, Kelantan villager, born at Duson
Nyor in the interior of Kelantan.

Father and mother dead; no brothers or sisters.
Patient was first seen at Dusun Nyor (lit. the garden
of coco-nuts) on June 13th, 1905; she is said to have
been ill with puru mata kerbau for more than six
months. The sores are almost confined to the legs
and the back and inner side of the thighs. For the
most part they are soft, yellowish-white, and moist.
The secretion from all the moist sores (about five
or six in number) was found to be alkaline. Some
of them were inclined to bleed on being scraped.
The child is anemic, bnt otherwise the general
health appears to be unimpaired. She has lost the
sight of the right eye owing to an accident. There is
no apparent enlargement of the spleen on palpation,
although malaria is very common among Kelantan
children.

Puru is very prevalent in this village. Out of about
forty inhabitants, fourteen or fifteen children are ill
with puru mata kerbau. Examination of blood smears
taken from some of them, as well as from the patient
(in the forenoon), proved to be negative.

Several smear preparations made from the sores on
June 13th, and again on the 21st, were stained by the
Romanowsky and other methods, but nothing dis-
tinctive was found by me under tbe microscope beyond
а number of round granular cells which stained
readily with basic dyes. There were no large cells
and micrococcus-like bodies which have recently been
described by Surgeon-Captain James [10], Dr. Homer

June 1, 1906.)

THE JOURNAL OF TROPICAL MEDICINE. -

175

Wright [17], and others, as occurring in tropical
ulcer or Delhi sore. This child was treated by the
local application of zine and mercurial ointments
mixed together, and when last seen on July 24th,
1905, the sores, with the exception of the puru ibu,
had nearly all healed.

Case 2. Puru in а Chinese—Hap Hoy, а
mining coolie, native place Hong Kong, married, no
children, was admitted into the Duff Development
Company's Native Hospital at Kuala Lebir, Kelantan,
on April 1st, 1905.

Family History.—¥Father died of some chest com-
plaint about 50; mother alive and well; no brothers ;
one sister in good health. Has never seen any cases
like his own among friends or relatives in China.

Previous History.—Emigrated from China eleven
years ago, and, with the exception of malarial fever,
has always been in good health.

Stayed in Singapore for five years, was in Pahang
for two years, and at Tomoh for four years, when he
got ill and went from there to Kelantan. Не never
had syphilis nor gonorrhea ; has not had sexual con-
nection for more than twenty months ; has never had
& sore on the penis before. Is accustomed to take
a little samshu (Chinese spirit), also chandu (opium
prepared for the pipe).

States that he knows two fellow-countrymen at
Tomoh who have the same disease all over their
bodies, and that it is very common among the Malay
children of that state. Did not livein the same house
with the other Chinamen. Has eaten “budu” (a
Malay eondiment made of decomposing fish) when
there was no better sauce to be procured.

Present lliness.— About six months ago was cut-
ting firewood in the jungle and scratched the foot at
the right ankle. A week previous had felt unwell
and feverish. The ankle was painful; the scratch
itched a little and presently became sore. Four or
five sores then developed, and in about forty days
they coalesced and reached their present horseshoe
shape and size, which is (April 5th, 1905) 6:35 em.
by from 9:54 cm. to 0:63 em. Later on the foot was
painful on walking any distance. .À month after-
wards again felt feverish, and the eruption came
out on the forehead and scalp. А sore came next on
the left side of the prepuce; it itched and he
scratched it. In two months' time sores had formed
on the right eide of the prepuce. Up till now he had
continued at work, but then the sores attacked the
nose and eyelids. Тһе nasal sores spread out
gradually at the nostrils until they reached their
present size, namely, on April 5th, 1905, nearly 10:16
em. by 19 em. Had then to stop work as a mining
сооПе оп account of pain in the bones and in the
joints, and decided to come to Kuala Lebir. The
sores are now (April 5th, 1905) drying up. No fresh
ones have appeared for about а month. Тһе last to
appear were on the back.

On Examination.—The eruption is known in Malay
as puru, and it has the characteristics of the disease
as shown in fig. 4, which was taken on April 3rd and
5th, 1905. There is no apparent enlargement of liver
or spleen. There is sympathetic femoral bubo in the
right groin, but it is unlikely to suppurate. No other
glandular enlargements. The foot sore is suppu-

rating under а thick scab. The discharge is acid
to litmus paper, but that from the sores on the penis
and forehead is alkaline. Two tubercles were removed
from the back under cocaine, as well as one from the
prepuce. Prior to examination, these nodules were
placed for twenty-four hours in 30 per cent. alcohol
(in filtered water), then for the same time in 70 and
90 per cent., and finally in absolute alcohol. The
result of the коров examination is given under
the heading of pathology.

The sores were dressed with Scott’s dressing and a
mixture of iodide of potash, 5 grains, three times a
day, administered by the mouth. The sore on the
ankle was dressed with chlorinated soda lotion.

By the end of the month a great improvement іп
the general health had taken place. The pains in the
limbs and joints had entirely ceased. On May 25th
another tubercle was removed from the hairy part of
the chin, andcarbolic acid, pure, was applied to the cut
surface, because it seemed as if puru sores were form-
ing at the site of the former incisions. They all
healed naturally, however, in the end. In June, the
iodide was increased in dose to 10 grains and 5 minims
of lig. arsenicalis were added to the mixture. The
patient improved daily, but only up to a certain point.
He was next given mercury internally, the liq. hydrarg.
perchloridi, in half-drachm doses for two weeks, but as
he appeared to be still losing ground under this
treatment it was discontinued, especially as some of
the old eruption (which had apparently been cured)
began to recur. Various local applications were then
tried, including the application of tincture of iodine,
ichthyol vasogen, thymol ointment, and white pre-
cipitate ointment, but without much success. He was
finally treated with zinc and mercury ointment alone,
and appeared to derive most benefit from it.

(To be continued.)
——— —————

** Archiv. f. Protistenkunde, T. vii., pp. 1-74, with 162 figures
text.
ON ALTERNATION OF GENERATIONS AND CHANGE OF HosT IN
TRYPANOPLASMA BoRELLI (LAVERAN AND MESNIL).

Keyoselitz, Gustav. This is a long and very complete
memoir, covering much the same ground as has been de-
scribed by Brumpt, though the author differs from the latter
in many points, notably in regarding the species found in
a variety of freshwater fishes as all referable to the above
species, the intermediate host being the leech, Pisciola
geometra. Both the fish and the leeches often succumb to
the infection, the most striking symptom in the fish being
anemia, while the colour of the leeches alter and their
clitellar region becomes swollen.

He never once succeeded in infecting one fish from another
even of the same species, and believes that the supposed
successes of other authors were really cases of relapse of an
old natural infection, and, though he was equally unsuccess-
ful in his attempts to infect fish through the agency of the
leeches, he describes in great detail a cycle of evolution
which closely follows that described by Schaudinn in the
case of Trypanosoma посіие, so that under natural con-
ditions it is probable that this leech acts as a true inter-
mediate host, and forms the agent of infection. For fuller
abstracts of this paper vide F. Mensil in the Bulletin de
L'Institut Pasteur, April 15th, 1906.

176

THE JOURNAL OF TROPICAL MEDICINE.

(June 1, 1906.

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Journal of Tropical Medicine

June 1, 1906.

7
PROFESSOR ELIE METCHNIKOFF.

(The Harben Lectures.)

Tue Royal Institute of Public Health has from time
to time brought distinguished men from several parts
of Europe to London to deliver the Harben Lectures.
The course for this year has been given by Professor
Metchnikoff, of the Pasteur Institute, Paris, and it is
scarcely necessary to add that a great scientific treat
has been afforded us. The subjects chosen for the
three lectures were, on May 25th, “Тһе Hygiene of
the Tissues of the Organism,” on May 28th, “Тһе
Hygiene of the Intestinal Tract,” and on May 30th,
“ Syphilis.”

In the lecture оп “Тһе Hygiene of the Tissues,”
Professor Metchnikoff expounded his views іп a con-
densed form, and defended the service the phagocytes
render in procuring immunity, a service which is being
largely claimed for à soluble substance circulating in
the blood and met with in other body liquids—the
opsonin of Wright.

This advocacy of a humoral action is based on the
belief that microbes in the blood must be impregnated
with opsonin before the phagocytes can attack them
and destroy them. The róle the phagocyte plays in
the destruction of pathogenic microbes, if this belief be

true, is only of à passive character, and dependent on
the preliminary action of the opsonin. Metchnikoff is
not inclined to acknowledge the superior potency of
opsonin in comparison with the phagocyte in procur-
ing immunity. Не states that there can be no doubt
that, under artificial conditions, and outside the body
when the phagocytes are weakened they do not show
their functional activity to such advantage as inside
the body ; but left to themselves in a liquid deprived
of all opsonic substances, the phagocytes surround the
microbes, only instead of doing this in a quarter of
an hour, it takes them perhaps an hour or two to
accomplish the act.

That the living body remains apparently healthy in
spite of its containing pathogenic microbes would
appear now to be a fact. A man may be the host of
diphtheria bacilli, cholera vibriones, the Bacillus
typhosus, and other bacteria, without necessarily
developing the corresponding diseases. It is even
possible to introduce tetanus spores into an animal so
peculiarly sensitive to tetanus as the guinea-pig with-
out the animal acquiring the disease. When, however,
the guinea-pig so infected is placed under unfavour-
able conditions, as by exposing it to a very high
temperature, the resistance of the animal is overcome
and the disease asserts itself.

Human beings may serve as bacilli carriers without
they themselves being the subject of the disease which
the bacilli may give rise to in others; this fact is of
superlative interest and importance in the study of
epidemiology, and is one calculated to divert our
attention to other sources of infection than to those
we are accustomed to view with suspicion, such as
milk, water, and other articles of food and drink.

Metchnikoff sums up his conclusions on this subject
by stating that all observations on immunity against
infective agents points to the belief that this
phenomenon is the result of phagocytic action, or, in
other words, that immunity is a function of the cells.
Of substances which hinder phagocytic action, opium
and alcohol are perhaps the chief, but he also incul-
pates quinine as a poison to the white blood cells.
Increased resistance towards pathogenic microbes is a
departmeut of prophylaxis which promises to play an
important part. Issaeff, some ten years ago, showed
that increased resistance could be procured in guinea-
pigs by injecting these animals with such liquids as
normal saline solution, urine, and serum. R. Petit
has recently employed heated horse serum in his
gravest operations. In a case of abdominal section
оп а woman, on whom he operated for multiple
fibromata of the uterus, complicated by inflammation
of both adnexa and by suppurative pelvic peritonitis,
Petit poured into the abdominal cavity before suturing
the abdomen about 30 grammes of heated horse
serum with successful results. Several other surgeons
have followed Petit’s example, and in cases of
abdominal and pleural operations the use of heated
horse serum has been eminently satisfactory.
Miculiez, by introducing subcutaneously injections
of a solution of nucleinic acid twelve hours before
operation, showed that an increase in the number of
white blood corpuscles in the blood occurred, reaching,
in one instance, to as many as 24,000 per cubic
millimetre.

June 1, 1906.)

THE JOURNAL OF TROPICAL MEDICINE.

177

Whether it be heated horse serum, anucleinic acid,
or other substances that are employed, Metchnikoff con-
siders that they all act in one way. The influence
they exert is not brought about by an increase in the
seusitising substances nor by a production of opsonins,
but by enhancing the phagocytic reaction.

By the establishment of the thesis that the phago-
cytes are our arms of defence against the infective
germs which beset our bodies, Metchnikoff contends
that the first step forward in the hygiene of the tissues
has been made, and that a secure foundation stone
has been laid on which to build our knowledge and
experience.

------Ф----

MALARIA IN CUBA AND PANAMA.

W. С. Goraas, M.D., Chief Sanitary Officer, Canal
Zone, Panama, stated at the annual meeting of the
American Society of Tropical Medicine on March 24th,
1906, that while the percentage of fatalities is not
nearly so great as from some other tropical diseases,
the amount of incapacity caused by malaria is very
much greater than that due to all other diseases com-
bined. He drew attention to the deleterious effect of
unchecked malaria upon soldiers during a campaign.

The effect of the eradication of mosquitoes, upon the
number of cases of malaria was very noticeable in
Havana. For many years the average number of
deaths from malaria amounted in Havana to 350;
in 1901, the first year of the anti-mosquito campaign,
the number of deaths from malaria amounted to 151
only ; in 1902 there were 77 deaths from the disease ;
in 1903 about 50, and during subsequent years it
averaged about 40. In the hospital at Ancon, Panama,
in the six months ended March, 1906, Colonel Gorgas
had personally treated 1,055 cases of malaria with
only five deaths. The ZEstivo-autumnal variety pre-
dominated, and quinine was the invariable mode of
treatment. Of twenty cases of hemoglobinuric fever
n Fi eight months ended March, 1906, only three

ied.

THE PLAGUE.
PREVALENCE OF THE DISEASE.
Cases. Deaths.
India.— Week ended March 10th 10,665 9,058
m » 17th 18,325 10,722
3 » 24th 17,240 15,464
А » 8186 18,996 11,823
35 April "7th 23,055 19,727
" » 14th 20,478 17,673
3 » 21st 19,674 17,679
m » 28th 17,885 15,633
May th 15,892 13,295

Hong Kong.— Week ended Mar. 31st 27 25
5 April 7th . 24 22
5 » : 14th 21 23
i » 21st 24 27
» » 28th 58 759
5s May 5th 61 58
12th 96 89
19th 90 83
26th

” ”
» ”

” ”

Persia.—Plague continues in epidemic form іп Eastern
Persia (May 29th).

Arabia.—Plague has been declared at Jiddah (May
30th).

Egypt.—During the week ended April 15th, 35 cases
of plague were recorded in Egypt, chiefly in the
Minieh and Keneh provinces.

E e

Reviews.

THe NATURE AND TREATMENT OF CANCER: SOME
Metuops оғ HYPODERMIC MEDICATION IN THE
TREATMENT OF INOPERABLE CaNcER. By John
A. Shaw-Mackenzie, M.D.Lond. Third edition,
revised and enlarged. London: Bailliére, Tindall
and Cox, Henrietta Street, Covent Garden, 1906.
Pp. 99. Price, 2s. 6d. net.

Every practitioner will welcome this concise account
of the treatment of cancer by modern methods. The
principal remedies dealt with are Chian turpentine,
soap and ox-gall, and trypsin. The results given are,
to say to the least of them, encouraging.

Tue ANIMAL Parasites oF Man. A Handbook for
Students and Medical Men. By Dr. Max Braun.
Third, enlarged and improved edition, with 294
illustrations in the text. Translated from the
German by Pauline Falcke. Brcught up to date
by Louis W. Sambon, M.D., Naples, and Fred V.
Theobald, M.A. London: John Bale, Sons and
Danielsson, Ltd., Great Titchfield Street, Oxford
Street, W., 1906. Price, 21s. net.

Parasitology is assuming so important and prevail-
ing a position in medicine that for several years to
come it will be assigned the foremost place amongst
the several accessory departments of scientific research
and study. It is essential, therefore, that an authori-
tative text-book should be in the hands of medical
men.

Dr. Мах Braun’s well-known work on the “ Animal
Parasites of Man” has, it is to be feared, been capable
of being read by only a very few practitioners owing
to lack of knowledge of German, and we are thankful
to the translator and to the publishers, who, at a great
sacrifice of time and of money, have now given us an
English edition of this important work.

Braun’s work is the best book on the subject, and it
has been translated by Miss Falcke, on whom we, in this
country, have come to largely rely for accurate trans-
lation of German medical and scientific books into
English.

The chapter on parasites in general is a liberal
education in itself, and were the student of general
medicine to advance no further than this chapter in
his reading he would be placed in а position to grasp
the importance of the subject, and to lay a foundation
on which to base a scientific knowledge, во as to enable

178

THE JOURNAL OF TROPICAL MEDICINE.

(June 1, 1906.

him to enquire more carefully into any branch of the
subject he may be interested in.

The protozoal, the primitive, parasites, are in many
ways, perhaps, the most interesting; chiefly on the
ground that they are of all parasites the most closely
studied at the present time. Amongst the pro-
tozoa we find the rhizopoda, of which the various
amceba are best known; the flagellata, represented
by trichomonas, cercomonas and trypanosoma; the
sporozoa, of which the gregarinida and the large
group coccidiida are of high importance, and yet better
known the Plasmodium malarie of Laveran. The
flat-worms (platyhelminthes) and the thread- worms
(nematodes) are more familiar to the general reader,
and the student of tropical medicine will take special
interest in the filaria and the ankylostoma. Of the
various groups of arthropoda, the arachnoidea, from
the fact that the several species of argas and of orni-
thodorus are included amongst them, are of special
interest at the moment. A separate chapter is de-
voted to mosquitoes and the various flies, including the
tsetse- flies.

The illustrations are clearly represented and their
accuracy incontestable. The study of parasitology is
yet in its infancy, but before its literature becomes
too voluminous it would be well for present-day
students to master the contents of this book so that
the subject may be readily understood and followed.
We are indebted to Dr. Sambon for his careful revision
of the chapters on protozoa, cestodes, and nematodes ;
and to Mr. Theobald for his exposition on the trema-
todes, arthropoda and several other sections of the
work. We congratulate the publishers upon the
general appearance of the book and for supplying
us with a clearly printed text.

The thanks of the profession are due to the pub-
lishers, the translator, and to Dr. Sambon and Mr.
Theobald, for placing within our reach an authoritative
text-book on an important subject.

------о>--

Brugs anb Remedies.

HELMITOL, & powerful urinary antiseptic, is a pre-
paration of the Bayer Company, Limited, 19, St.
Dunstan’s Hill, London, Е.С. In the treatment of
cystitis, foetid urine, and in troubles associated with
enlarged prostate, it is excellent. In gonorrhea hel-
mitol internally, combined with local injections of
protargal, is efficient.

SorvRoL (thyminic acid) іп З or 4 grain doses daily
after meals is a new remedy for gout, introduced
by Allen and Hanbury, Limited, 37, Lombard Street,
London, E.C.

------о--

Hotes and "tos.

An “ At Home" at the Royal Albert Dock Branch
of the Seamen’s Hospital Society, on Saturday, May
19th, was attended by about 200 executive officers of
&ll the London and many provincial hospitals The

occasion was the completion by Mr. P. Michelli,
Secretary of the Seamen's Hospital Society, of his
year of office as President of the Hospital Officers'
Association, and amongst those present were Sir
Francis Lovell, Sir Frederick Young, Capt. Tunnard,
Mr. Keith D. Young, the Society's architect; Mr.
W. R. Pite, architect to the new King's College Hos-
pital; Dr. Harford, of Livingstone College; Dr. C. C.
Choyce, Medical Superintendent of the Dreadnought
Hospital; Capt. Worlidge; Mr. Walter Alvey, Honorar
Secretary Hospital Officers’ Association; and Mr.
Charles Т. Walrond, consulting engineer St. George's
Hospital and the Children’s Hospital, Great Ormond
Street, and several others. The Hospital and the London
School of Tropical Medicine in connection therewith
were open to inspection, details of the building being
given by Mr. Keith D. Young. A lantern demon-
stration was given in the theatre of the School and a
demanstration of microscopic specimens of the
parasites of malaria, sleeping sickness, &c., was given
by Dr. Stanton in the laboratories. Speeches were
delivered by Sir Frederick Young and others, and
opportunities were afforded for visiting vessels of the
P. and O. and Ocean Lines.

SPREAD oF Leprosy By Insects.—Dr. W. Т.
Goodhue, Superintendent of the Molokai Leper
Settlement, states that he has found the Bacillus
lepre in the female mosquito—Culex pungens—and in
the bed-bug—Cémez lectularius. The fact that the
leprous bacillus has been found in insects is not, we
believe, new ; what we are anxious to know is whether
these insects play a part as intermediate hosts, and
what cycle of evolution, if any, takes place in their
economy.

W. С. Goncas, Chief Sanitary Officer, Isthmian
Canal Commission, Panama Canal Zone, in a report
dated Ancon, April 16th, 1906, states: The health
conditions continue excellent. No quarantinable
disease occurred in the Zone during March, No
case of small-pox has occurred within the last year.
The last case of plague occurred seven months ago,
and the last case of yellow fever over three months
ago. Among the 25,000 employees we had 78 deaths,
10 among the whites and 68 among the negroes. Of
the 10 whites 5 were from the United States. Of
these 5 only 3 died from disease, 1 from pneumonia,
and 2 from dysentery. The two principal causes of
death among the employees were malaria, 22, and
pneumonia, 17. Тһе disease that caused the next
highest death-rate was dysentery, 8, and the next after
that accidental traumatism, 4. The March in which
the French had the largest number of employees on
the Isthmus was the March of 1885, when they had
16,755 men on their rolls. During that month they
had 9 deaths from yellow fever in Ancon Hospital.
How many deaths occurred outside of that hospital
they had no means of finding out. During March of
1906, with our force of 25,000 men, which is the largest
we have had, we had not a single case of yellow fever
on the whole isthmus. But the best measure of the
health of a body of men is the average number daily

June 1, 1906.)

sick. We had іп our hospitals from our 25,000
employees, on each day for the month of March, an
average of 491 sick men, which would give us a rate of
19-65 per 1,000, an exceedingly good showing.

Coton1an Nurses DECOBATED.— Mrs. Duncan
Urquhart and Miss Margaret Graham have been
decorated by the Order of St. John of Jerusalem in
England. Their names were brought to the notice
of Mr. Chamberlain, then Colonial Secretary, by the
Principal Medical Officer of Southern Nigeria, for the
excellent work they did during the recent expeditions
апа for the devotion and self-sacrifice shown by them
on all occasions. Mrs. Urquhart and Miss Graham
have been admitted honorary nursing sisters and are
entitled to wear the Maltese Cross of white enamel of
the Order of 8t. John.

MosQurTOES.—Culez solicitans will breed in no other
place than salt water. То get rid of this mosquito it
ів necessary to drain the salt-water swamp lands along
the coast where this mosquito prevails.

TRACHOMA IN MontREAL.—Amongst 1,000 emigrants
from Europe, one half of which were composed of
панар Jews and Syrians, 150 cases of trachoma were
ound.

------о---

Personal Hotes.

COLONIAL MEDICAL SERVICE.

Dr. Derwent Waldron, Senior Medical Officer, Gold Coast
Colony, has arrived in England on leave of absence.

—— 9 ————

Becent and Current Literature.

A tabulated list of recent publications and articles bearing on
tropical diseases is given below. To readers interested in
any branch of tropical literature mentioned in these lists
the Editors of the JOURNAL OF TROPICAL MEDICINE will be
pleased, when possible, to send, on application, the medical
tournals in which the articles appear.

“Transvaal Medical Journal,” March, 1906.

Maynard, С. D. “ Some Observations on the Protozoal
Diseases of the Blood, with Special Reference to the Piro-
plasma Bigeminum.” А

Of forty-five cows inoculated with the blood from a heifer
which had recovered from an experimental attack of red-water
disease, 4:4 per cent. died. Of forty-three cows in the same
herd which were allowed to contract the disease naturally,
1177 per cent. died. The cows showed а reaction (first) on the
tenth day, and also a reaction (second) on the twenty-fifth day
after experimental reaction. In regard to the appearance of
Piroplasma bigeminum in the red corpuscles, Maynard is. of
opinion that when two parasites appear in a cell the explanation
is to be frequently found, not in the division of an originally
single parasite, but in a double infection by two young para-
sites. The two parasites may be gametes about to con-
jugate to form a zygote, so that a sexual cycle, as well as an
asexual cycle, might be assumed to occur in the one host. А
prolonged observation, however, failed to demonstrate any
union of pairs, but on the other hand, the mother parasite
extruded from its substance a small mass of protoplasm which
grew in size, and finally bocame free from the parasite and the

THE JOURNAL OF TROPIOAL MEDICINE.

179

red corpusole in which the parent was contained. In addition
to the extrusion of these daughter cells the parent parasite also
undergoes several divisions within the red corpuscles before the
daughter cells are extruded. Тһе frequent appearance of two
chromatin masses in the pear-shaped parasite seems to suggest
а nuclear division prior to conjugation. Тһе possibility, there-
fore, of а sexual as well as an asexual cycle in piroplasma
infection would seem a feasible interpretation of the phenomena
observed, and of the clinical symptoms and behaviour of this
disease generally. From the fact that conjugation in certain
forms of the tertian malaria parasite has been stated to occur,
Maynard suggests that the peculiarities of malignant malaria
seem to demand some such interpretation not accounted for
by the theories explaining the symptoms of simple malaria.

“Journal of the American Medical Association,”
March 24, 1906.

Vedder, E. В. “Ал Examination of the Stools of 100
Healthy Individuals, with Special Reference to the Presence
of Entameba Coli.”

The Ameba coli has been found by Schaudinn, Craig and
others in from 20 to 65 per cent. of the stools of healthy
individuals in different parts of Europe. Vedder, from observa-
tions made in the Philippines, recently found that of Americans
in the Philippines 50 per cent., and 70 per cent. of the natives
of the Philippines harboured the parasite. As these were
healthy persons the observation helps to confirm the belief
that the Ameba coli is not а pathogenic factor in the production
of dysentery.

Vedder classifies the characteristics of the dysenteric and of
the normal amæœbæ as follows :—

Entamoba Dysenteric. Entamwba Coli.

BIZE.
25-30 microns. (Not a distinguishing feature.) 10-20 microns.

HAPE.
Spherical when resting.

COLOUB.
A Opaque greyish.
PROTOPLASM.
Ectoplasm andentoplasmeasily Ectoplasm and entoplasm dis-
istinguished. tinguished with difficulty.
Ectoplasm very refractive. Ectoplasm not refractive.
Ectoplasm finely granular. Entoplasm homogeneous.
Entoplasm coarsely granular. Entoplasm finely granular,

PSEUDOPODIA.
Large and easily distinguished. Entirely ectoplasm. Hard to
Certain ectoplasm and en- distinguish.
toplasm.

Usually some other shape.

Greenish.

VACUOLES.
Vacuole absent usually.
Never more than one.

NUCLEUS.

Often absent. When present Almost invariable, with well-
structure of nucleus hidden defined nuclear membrane
except in stained speci- and other structure.
mens. Nuclear membrane
not well defined.

Changes position markedly.

Many vacuoles.

In moving organism retains its
relative position.

RED CORPUSCLES INGESTED.
None observed.

MOTILITY.
Often absent, and when pre-
sent, of limited extent and
short duration.

Many.

Great progressive motility.

“ П Policlinico,” Rome, Мау, 1906.

Tue CRREBRO-SPINAL FLUID IN CERTAIN CASES OF PERNICIOUS
Forms oF MALARIA.
* I] liquido cefalo-rachidiano in alcuni casi di perniciosa
malarica.” Ву Dr. Nicola Pende.
According to Dr. Pende the study of the cerebro-spinal
fluid in malarial infection has been entirely overlooked,
which is the more remarkable as the examination of this

180

liquid is now undertaken in nearly all morbid processes
complicated by severe nervous symptoms, from which list
malarial infection cannot well be excluded.

Two indications are now specially sought for in the study
of the cerebro-spinal fluid. The one is essentially a clinical
one, or an aid to diagnosis; the other is essentially a
scientific one, relating to the physio-pathology of the
cerebro-spinal fluid, in the hope of finding therein a key to
the mechanism of the symptoms due to the neural axis.
With this double object in view, Dr. Pende undertook some
researches on the cerebro-spinal fluid in malarial cases,
restricting himself for the present to the more severe forms
of the disease, i.e., the pernicious forms. The severity and
diffusion of the iestivo-autumnal attacks which were recently
noted in the Roman hospitals supplied him with many cases
for observation; nevertheless, in many instances, he ex-
perienced some considerable difficulty in obtaining the fluid,
either because the pernicious condition of the patient was
a contraindication for the lumbar puncture, or because the
quantity so obtained was insufficient, or was not perfectly
clear owing to the admixture of blood. For these reasons
the present remarks apply only to five cases of pernicious
attacks of malaria, specially selected for their nervous
symptoms.

Each examination of the cerebro-spinal fluid included not
only the cito-diagnostic formula, but also, as far as possible,
the principal physico-chemical properties. A bacteriological
examination was unnecessary owing to our certain knowledge
of the etiology of malaria; in each instance the following
were specially sought for :—

(1) The state of compression of the fluid.

(2) Appearance and chromo-diagnosis.

(8) Density.

(4) Crioscopic point.

(5) Hemolytic power.

(6) Amount of albuminoids.

(7) Fibrinous reticulum.

(8) Amount of chlorides.

(9) Sediment, especially with regard to the cito-diagnostic
formula.

The fluid extracted never exceeded 20 cc. The cases
occurred in women of all ages, who were received between
June and December, 1905, into the Hospital of St. John
Lateran. A series of control experiments, conducted on the
identical lines, were carried out in perfectly normal cases
who had been admitted to the surgical division of the same
hospital.

For the study of the compression of the cerebro-spinal
fluid a special form of manometer was used. Тһе crioscopic
point was determined by Beckmann's apparatus; Bard's
process was employed for studying the hemolytic power;
the amount of chlorides was obtained by the Wolhard-
Salkowski method; lastly, for the cito-diagnostic examina-
tion, Nikiforoff s reagent was employed for fixing the slides,
which were then coloured with thionin or with hematoxylin
and eosin.

The results obtained from the examination of the cerebro-
spinal fluid of healthy women was ав follows :—-

The pressure varied enormously ; the density was 1007 to
1010; the congesting point - 065; albumen, constantly
present; percentage of chlorides, 0:8 per cent.

Some clinical notes on the several cases of pernicious
attacks now follow, but want of space prevents their inser-
tion here.

* * * * *

As & result of these observations, Dr. Pende states that
the cerebro-spinal fluid шау present, in certain cases of
pernicious malarial attacks, alterations both in its physico-
chemical properties and in its cito-diagnostic formula.

One constant feature was noted in all the cases, viz., a
more or less diminution of osmotic tension. It is important
to note that the hypotonic condition of the cerebro-spinal
fluid has, until now, been considered almost pathognomonic
of meningitis, whether tubercular or oerebro-spinal, but as

THE JOURNAL OF TROPICAL MEDICINE.

(June 1, 1906.

has been seen, this same hypotone may be found also in the
severe nervous forms of malarial infection.

In two of the cases lymphocytosis was superadded.
Thus malaria in its severe forms has to be added to the
somewhat lengthy list of morbid processes, accompanied by
lymphocytosis of the cerebro-spinal fluid.

The percentage of chlorides in the majority of cases was
diminished.

Ав regards the chromo-diagnosis, in one case the liquid
was yellowish, and in another it showed a bright green
fluorescence.

Dr. Pende considers the serious disturbances which the
cerebral circulation undergoes, owing to the heaping-up of
the parasite-infected corpuscles in the capillaries, as suffi-
cient to explain the origin of the above-mentioned modifica.
tions. The alterations of the endothelium of the capillaries
and the obstruction of many of these by parasitiferous
thrombi may be the cause of some of the blood elements

assing from the capillaries themselves into the perivascular
ymphatic spaces, and from these into the arachnoid cavity,
which elements may produce the diminution of the mole-
cular concentration of the cerebro-spinal fluid, or the pres-
ence of blood corpuscles, or lymphocytosis, or yet again, the
presence of pigment, and perhaps also of toxic substances
already existing in the circulating blood.

As to the question whether the alterations of the fluid can
enter into the pathogenic mechanism of the nervous
symptoms of pernicious fevers, little as yet can be said
definitely, for the physio-pathology of the cerebro-spinal
fluid has not yet furnished us with sufficient experimental or
clinical data to solve this problem.

* Centralb.. f. Bakter.," 1, Origin., T. xl., p. 290.
RESEARCHES ON BacILLARY DysENTERY.

Ludke, H. The author has studied the agglutinins and
precipitins of the bacillus of dysentery. Their behaviour,
when treated with strongly agglutinating serums of the
Shiga-Kruse and Flexner bacilli respectively, leads the
author to believe that the latter is a variety of dysenteric
bacillus which appears only in certain epidemics.

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1.—Manuscripts sent in cannot be returned.
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5.—Correspondents should look for replies under the heading
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June 15, 1906.)

Original Communications.

SUBHEPATIC ABSCESS.
By James Слмтілк, M.B., F.R.C.S.

Tae classification of abscesses of the liver, which
for the past ten years I have adopted as & means of
clinical differentiation, would appear to hold good as
experience extends. The terms suprahepatic, intra-
hepatic, and sub- (or infra) hepatic abscesses have
more than а mere anatomical or descriptive conveni-
ence and significance, more even than a clinical
import, for investigation has served to establish a
pathological basis of some reliability.

The examples of subhepatic abscess which havecome
under my notice have been few, five in all, four of
which occurred in patients of my own. By a subhepatic
abscess I do not merely mean that pus from the liver
has simply pushed its way downwards to the under-
surface of the liver, and there opened into a neigh-
bouring organ or into the peritoneal cavity, but that
the abscess originated on the under-surface of the
liver, between the peritoneum and the liver substance,
and involved the neighbouring liver tissue secondarily.

In three of the five cases of subhepatic abscess, the
pus drawn off at the operation was proved to be sterile.
This is in no way characteristic or exceptional, for in 32
out of 47 suprahepatic abscesses I have operated upon
the pus has also been found to be sterile. On the other
hand, the abscesses originating intrahepatically have
almost, without exception, been proved to contain
bacteria in the pus drawn off when the abscess is first
opened. I do not refer to the amceba, which we
meet with in the wall of every collection of liver pus,
ав it is in the wall of most abscesses connected with
the abdomen, and is therefore without specific patho-
logical significance.

A subhepatic abscess may occur in persons who
dwell in the Tropics or who have never been out of
Britain. Of the cases in question the habitat of the
patients was ав follows :—

No. 1, an American sailing ship captain, who,
whilst his ship was lying in Hong Kong harbour,
developed a subhepatic abscess. No 2, a lady
who had resided some years in Alexandria. No. 3
а man who had never left Britain. No. 4, a sailor
who belonged to the Royal Navy. No. 5, & man
who had never left Britain. Subhepatic abscess has
no pathological relationship with dysentery or any
form of intestinal flux, although in two of the cases the
patients confessed to diarrhoea but not to dysentery.

In four of the cases the collection of pus was on the
under-surface of the right half of the liver, to the
right of the gall-bladder ; in the fifth case the under-
surface of the left half was involved.

History of a Typical Case of Subhepatic Abscess.—
The patient becomes conscious of a discomfort in the
neighbourhood of the right rib cartilages, intermittent
at first but in time becoming more persistent ; the dis-
comfort is most marked during the day, and lying
down affords relief. As в гше the pain is referred to

the neighbourhood of the gall-bladder, and at first, апа.

indeed later, the signs and symptoms appear to indi-
cate gall-stones, or an inflammatory affection of the
gall-bladder. Occasional attacks of fever, passing off

THE JOURNAL OF TROPICAL MEDICINE.

181

in sweats, occur, and if the patient has been in a sub-
tropical or tropical country, malaria may be (and has
been) suspected to be the cause. The indefinite
nature of the ailment leads to delay in diagnosis and
to the necessary treatment; for a tender spot with
some fulness beneath the right rib cartilages may be
ascribed to kidney, liver, gall-bladder, pancreas, or
bowel. The mobility of the swelling points to the
possibility of a movable kidney ; the general disturb-
ance with pain in the region of the liver suggests
hepatitis or perihepatitis or hepatic abscess; the
situation and shape of the swelling, the local pain, and
the fever accompanying the condition, would seem to
definitely point to a cholecystitis; but malaria, malignant
disease of the hepatic flexure of the colon, pancreatic
cyst and hydatid, have each and all been suggested as
explanations of the indefinite clinical signs and
symptoms which obtain when a collection of sub-
hepatic pus occurs. Е

The further general signs and symptoms it із need-
less to recount, a collection of pus anywhere in the
upper part of the abdomen will give rise to occasional
vomiting, furred tongue, loss of appetite, a markedly
fluctuating temperature, rigors, sweatings, disturb-
ance of the bowels now loose now constipated, and so
on. There is no one sign or symptom, when a swelling
occurs in the epigastrium or right hypochondrium, that
can determine the diagnosis, nor any group of signs
or symptoms which may not bear in the present state
of our methods of clinical diaguosis, a plethora of
interpretation.

Given, however, а distinctly painful spot on the
under-surface of the liver associated with constitu-
tional disturbance and pyrexia, and, it may be, a
blood examination suggesting pus, an exploratory
incision ought to be made without hesitation.

Case 1.—Captain of a sailing ship, aged 42, plying
between New York and Hong Kong, developed a sub-
hepatic abscess. The captain lived on board ship,
which had been lying in Hong Kong harbour from
November to March before the abscess was detected.
The patient was operated upon with the idea that he
was suffering from cholecystitis. When the abdomen
was opened a sausage-shaped swelling was found lying
parallel to and 14 inches to the right of the gall-
bladder. The wall of the abscess cavity was stitched to
the abdominal wall and the abscess cavity opened and
drained. The abscess extended almost the whole
breadth of the liver in an antero-posterior direction.
The patient returned to his ship in twelve days, sailed
on the thirteenth day, and only withdrew the drainage
tube some six weeks later whilst on the voyage. He
made a perfect recovery.

Саве 2.—A lady, aged 31, married, опе child, had had
several attacks of “fever” and diarrheain Egypt. When
seen in London there was a movable swelling be-
tween the right hypochondrium and the right lumbar
regions ; the spleen was enlarged, the liver dulness
increased downwards, febrile attacks with irregular
temperature and malarial parasites in the blood. I
diagnosed the case as one of malaria with movable
kidney. Subsequently, when the swelling was exposed,
it proved to be a subhepatic abscess, identical in
situation and in character with Case 1. The patient
recovered.

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[June 15, 1906.

Case 3.—A man, aged 38, resident in London for ten
years, who had at one time served in the army
in Malta, but have since never left the British
Isles, The clinical evidence all pointed to the
presence of pus in the gall-bladder, but when the
abdomen was opened, an abscess reaching from the
anterior to the posterior border of the liver parallel
and to the right of the gall-bladder was found. The
abscess was opened and drained by an opening both in
front and behind near the angles of the ribs. The
patient recovered.

Саве 4. The Effect of Sterile Pus in the Cavity of
the Abdomen.—A sailor, aged 35, recently in the
Royal Navy, had to leave his ship with all the signs
and symptoms of liver abscess. At first he refused to
be operated upon, and it was not until the severity of
the illness became alarming that he consented. On
cutting down upon the swelling in the right hypo-
chondrium an abscess was found on the under-surface
of the liver; the wall of the abscess had attained
adhesion to the peritoneum in the right lumbar region,
and the pus extended as low and as far back as the
upper end of the right kidney which was incor-
porated with the swelling. Moreover, the pus had
burst into the cavity of the peritoneum. Тһе contents
of the abdomen from diaphragm to pelvis were covered
over by a slimy, muco-purulent-looking fluid. There
were no signs of peritonitis, no adhesions, no flocculent
pus, nothing except this passive effusion of slimy,
muco-purulent-looking fluid in great quantity. Тһе
pus from the abscess cavity and the semi-fluid material
from the surface of the peritoneum were examined
bacteriologicaliy, and both were pronounced sterile.
This is, so far as I know, the first recorded case of the
kind, and it is of special interest.

The treatment in this case consisted of free incisions
in the abdomen in right and left lumbar regions, and
in the middle line below the umbilicus, flushing the
abdominal cavity with saline solution, and the inser-
tion of large drainage tubes. Тһе liver abscess was
drained separately. The patient is now (June 11th,
1906) convalescent.

CasE 5. — A man, aged 37, resident all his life in
Britain, had signs and symptoms of abscess of the
liver in 1904. ‘The abscess was not operated upon,
and the pus burst upwards through the lung. The
expectoration of pus ceased, and the patient for a time
was fairly well. After four months the local signs and
symptoms returned, and again he went into hospital ;
no operation was performed, and again he seemed to
recover, but without any expectoration of pus. He con-
tinued to have hepatic pain and fever at intervals
until May, 1906, when I found him with increased
temperature, an epigastric swelling, local pain, and
general discomfort. After five days he came into
hospital, by which time the swelling had disappeared,
the temperature had fallen to normal, and the patient
said that the day before he came into hospital he had
passed at stool a large quantity of ‘‘the same material
he had on a previous occasion coughed up.” It was
plain the abscess had burst into the bowel, the colon in
all probability. So far as I can learn, this is the only
instance of a hepatic abscess which has been known
to burst in two directions, namely, upwards through
the lung and subsequently downwards into the bowel.

When cut down upon, an abscess was found on the
under-surface of the left half of the liver near the
posterior border; the liver, stomach, and colon being
adherent to the wall of the abscess. The treatment
consisted in exposing the swelling, packing the wound,
and at the end of a week opening and draining the
cavity. The pus from this abscess was sterile—a
peculiar and most unexpected condition, seeing that
there had been a double source of possible contamina-
tion, namely, by way of the lung and by way of the
bowel. The patient is still under treatment.

THE ANATOMY OF THE BITING FLIES OF
THE GENERA STOMOXYS AND GLOSSINA.

By Lieut.-Colonel G. M. Gites, I.M.S. (Rtd.).
(Continued from p. 173.)

THE cesophagus, after its commencement in the
pharynx is a rather delicate tube. As seen in fig. 24,
A, it is lined with an extremely delicate membrane,
which is probably smooth in the fresh state, but is
much wrinkled as seen in a transverse section on
account of the shrinking action of the reagents
employed on the softer tissues. In some of the folds
thus produced there will always be found minute
bodies which stain strongly with nuclear dyes and
possibly are nuclear bodies. The main thickness of
the walls of the tube is, however, formed of a ring of
faintly granular material which shows fairly clearly a
longitudinal striation, as seen in transverse section.
These fibres are probably muscular. In the same
sheath with these and lying always towards the lumen
of the tube are some oval nuclei provided with a dis-
tinct nucleolus.

Fra. 24.—a, portion of wall of free cesophagus in transverse
section: В, transverse section of the cesophagus as it passes
through the nerve collar.

There are rarely more than two of these, usually
almost opposite each other, in a fairly thin transverse
section of the organ, and I believe them to be muscle
nuclei. Outside these are some scattered cells of
about the same size as these muscle nuclei, but they
do not seem to be concerned in the structure of the
tube, and are more probably lymph cells.

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THE JOURNAL ОЕ TROPICAL MEDICINE.

183

The narrow portion of the osophagus, when it
passes through the nerve collar, has a very different
structure. The muscular and chitinous coats are both
зо thin as to be barely perceptible, and the place of
the small nuclei, to be seen between the folds of the
chitinous inner lining of the first part, seems to be taken
by a continuous coat of large cells which have the
appearance of epithelial elements. The lumen is here
stellate in transverse section, and, on account of the
size of the above-mentioned cells, extremely con-
tracted.

The histology of the nerve centres does not differ
from that of other diptera, a prominent character of
which is the smallness of the component cells. In
the layer of grey matter that surrounds the white com-
missural masses, two distinct forms of cells can be
distinguished. In one of these, which one would be
inclined to believe motor in function, the structure
consists of multipolar cells, usually about the diameter
of a human leucocyte. They have large nuclei, but
still possess a considerable volume of protoplasm.
Their prolongations give off fibres which occasionally
can be traced for some distance. A good example of
a ganglionic mass of this structure is to be found on
the surface of the ventral nerve cord in the middle

Fic. 25.—A, Portion of the ventral commissure and of the
motor median ganglionic mass in that situation; c, com-
missural structure; g, motor ganglion cells; e, elements
embedded among the commissural fibres. B, Cortical layer of
anterior surface cerebral lobe.

The greater part of the sides of the cerebral masses
is occupied by the ganglia of the compound eyes, the
retinula of which are continuous with the cerebral
mass, but this has been too frequently described to
render desirable any further description here. An
account, running to some 70 pages, will be found in
Lowne’s work already quoted, commencing p. 515.

On the anterior surface of the brain, however,
between the compound eyes, is a ganglionic layer
which is probably sensory in function. The component
cells of this are quite different from those of the pre-
sumed motor areas, the cells being smaller (about the
diameter of a human red blood corpuscle) and appar-
ently for the most part quite without prolongations,
though a few scattered cells of larger size show an
irregular outline, which suggests the existence of these.
There are four or five rows of these, and between them
and the white matter lies a row of very small and
distinctly multipolar cells. The outer surface of the
brain is bounded by a membrane formed of closely
adherent spindle-shaped cells, with large oval nuclei.
In other places the thickness of the ganglionic masses

may be as much as 20 or 30 rows of cells deep. In
using the word “ row " it is not implied that the cells
are arranged in regular strata, as their disposition is
quite irregular, but refers merely to the number of cells
which may be counted in the width of a section. In
specimens stained with borax carmine, a number of
black pigment granules will be seen in these cells, and
impart to them a very characteristic appearance, which
is useful in recognising similar ganglion cells, in other
situations than the brain, as, for instance, in the sub-
cuticular tissue, beneath the sense organs of the
antenna, but in staining with hematin and most of the
aniline dyes, they cease to be distinguishable, on
account of similarity of colouration with other deeply
stained granules. Between the various bands of fibres
of the white matter, may be found a number of gang-
Попіс masses, composed of cells of each of the above
descriptions, though the motor type predominate.
Lastly, scattered between the fibres are a number of
large clells or nuclei (e), presenting a large, clear,
central area, and round their periphery a number of
deeply staining granules, but these are probably not
nervous structures at all, but of a trophic function.

In Mr. Austen's monograph of Glossina, mention is
made (p. 63) of a sense organ placed near the base of
the third joint of the antenna, but without any detailed
description of its structure. In the corresponding
position in the antenna of Stomoxys a similar organ
is to be found, which, though I have made no exami-
nation of it in the former genus, has probably a similar
structure. Judging from Lowne’s figures, this organ
is represented also in the blow-fly, but differs some-
what in details of structure.

In Stomorys the aperture of the organ is oval and is
hidden by closely set, long, flexible hairs. This slit
opens into a sausage-shaped saccule, within which is a
T-shaped projection which springs rather from the
anterior side of the saccule, the stem being short and
the top of the letter long and generally conforming to
the outline of the cavity, so that it appears as an
isolated piece in transverse sections that pass else-
where than in the plane of the stem. The whole of
this cavity is lined with peculiar stiff hairs, the bases
of which are short and conical, while they end in a
long bristle. These chitinous structures overlie
a layer of ganglionic cells, from each of which a
fibre runs to a hair, while proximally each ganglion
cell receives a fibre from a ganglionic enlargement of
the antennal nerve, which fills up the greater part of
the cavity of the second antennal joint. The function
of the organ is probably that of hearing. In addition
to the saccule the whole surface of the organ is covered
with sensory hairs, each of which has a similar nerve
supply, and in the neighbourhood of the sacule are a
number of peculiar sense organs of a quite different
character. A number of these are to be found
amongst the bases of the long soft hairs that guard the
mouth of the saccule, while many others of con-
siderably larger size are contained in a porous plate
on the outer face of the antenna which is com-
paratively free from hairs. Though varying a good
deal in size, even in the porous plate, they all have
essentially the same structure, and consist of an
ovoid crypt, communicating by means of a pore with
the exterior, and springing from the base of which is

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THE JOURNAL ОЕ TROPICAL MEDICINE.

[June 15, 1906.

а club-shaped body which fills most of the interior of
the crypt. From the club-shaped end of this body
springs a soft conical hair, the fine termination of
which projects into the pore. Two rows of very
large organs of this sort are also to be found on the
posterior face of the antenna. The nervous supply of
these peculiar structures is exactly similar to that of
the other hairs. They are believed to be olfactory
organs, but in view of their graduated size it would be
open to any one to suggest that they are chordotonal

Fic, 26.—The sense organs of theantenna. (1) Diagrammatic
longitudinal section ; (2) transverse section, x 950 diams. ;
(3) vertical section of position of outer wall of antenna, x 700
diams.

organs. That certain insects lose the sense of
smell, when deprived of their antenne, has been
fairly proved by Lubbock and others, but as to which
of the various sense organs found on the appendage
may serve this or that function must always remain
a matter of pure conjecture.

The thorax in all diptera is little else than a solid
mass of muscle. If we snip off with sharp scissors,
the legs, with а little of the ventral wall of the
thorax, the ends of a number of vertical bundles are
seen cut across. These are the coxal muscles of
the three pairs of legs, and if these be separated in
the middle line there will be seen opposite the
anterior legs a sausage-shaped mass
of considerable size, the great tho-
тасіс ganglion. Clearing this away
and just under its anterior end

will be seen a nodule of the size | & ы

of a small ріп” head, and closer
inspection will show that there ex-
tends backwards from it a glistening
tube which is most characteristically
marked with closely placed mam-
milations. This is the mid-gut, and
lying on it will be seen three
delicate tubules, the middle and most
delicate of which is the crop duct
and those at the sides the now
glandular salivary glands. The
mid-gut can be traced forwards be-
yond the nodule, and with suflicient
care can be shown to be соп-
tinuous with the cesophagus, as it
escapes from the nerve collar. The
nodule is placed at the junction of
the stomodeum with the mid-gut,
and is known as the _ proventri-

culus, & very peculiar organ, which will be described
in detail further on. If these parts be removed it
will be seen that all else is muscle. Pressing apart
the masses in the middle line, layer after layer (four
in all) of longitudinal muscle can be clearly seen, filling
up the greater part of the space. Further out there
аге numerous more or less obliquely vertical bundles.
The whole constitute the muscles of flight; for the
wing roots are not acted on directly by the muscles,
as is the case with the ventral appendages, but in a
very indirect manner by their action in producing an
alteration in the form of the chitinous exoskeleton of
the thorax, and thereby actuating а complicated series
of sclerites whleh are connected with the wing roots.
Any attempt to describe these muscles and their
action here is, however, clearly out of place; and
indeed, though much has been written on the subject
it is very doubtful if any one has yet solved the problem
of their mechanics.

The thoracic ganglion is mainly contained in the
mesothorax just above its sternum, but the oval ends
extend before and behind into the contiguous portions
of the pro- and meta-thorax. Sections show that there
are three principal ganglionic masses: a median com-
missural ganglion, which is divided into three parts,
and lateral ganglia which are so continuous as to
leave but little indication of the original separation
into the ganglia of the three thoracic somites. The
lateral branches of the ganglion have separate sensory
and motor roots, and ends behind in a median and
lateral branches which extend into the abdomen.
There does not appear to be any difference in the
anatomy of the nervous system from those of other
flies, and those who desire a description of its details
should consult some standard work on general dip-
terous anatomy, such as Lowne.

The proventriculus is a very peculiar structure
which forms a sort of three-way junction between
the csopbagus, crop duct, and mid-gut, and is
situated in the prothorax, lying upon the cephalo-
thoracic nerve cord and the front of the thoracic
ganglion. Apart from certain differences of mould-
ing, it is essentially the same in all Muscidz, so

2

777)
“ау улие Of fp

7

Fic. 27. — (1) Camera lucida drawing of a sagittal section of the proventriculus of
Stomoxys and its connections, x 50 diams.; (2) and (3) freehand drawings of the
proventriculi of Glossina palpalis and Stomoxys calcitrans respectively viewed from
below ; Its, IIts, first and second sternal sclerites; cd, crop duct; mg, mid-gut ;
о, esophagus ; рг, proventriculus ; tg, thoracic ganglion.

June 15, 1906.)

THE JOURNAL OF TROPICAL MEDICINE.

185

that our description of the organ will, with a few
added words as to differences, serve equally well for
Stomoxys and Glossina. The body of the organ con-
sists of a fairly thick-walled bulb, from the dorsal
surface of which springs the mid-gut, while the crop
duct and cesophagus are connected with the ventral.

As will be seen from an inspection of fig. 1, the
organ in Stomorys closely resembles a retort, the beak
of which is formed by the mid-gut.

The cesophagus and crop duct, which really form
a continuous tube, give one the impression of entering
the under-surface separately, as seen in dissecting, but
do not really do so, the illusion being produced by the
actually continuous tube being tucked up into the funnel-
shaped aperture in the lower surface of the proven-
triculus.

In Glossina the junction is T-shaped, and there is a
distinct vertical duct which runs up from the upper
surface of the junction between the cesophagus and
crop duct, so that, even to the dissector, the continuity
of the latter is quite obvious. In both genera, how-
ever, the vertical diverticulum enters the proventri-
culus by piercing the centre of a very peculiar
structure, which has exactly the form of a bone button,
the sewing which would attach such a button to the
cloth being represented by a stout peduncle, through
which the vertical diverticulum passes to enter the
cavity of the proventriculus. Concealed beneath the
margin of the button is an annular thickening of the
floor of the cavity, which is formed of peculiar clubbed
cylindrical epithelial cells.

Ј Ф J
Ета. 28. —(1) Transverse section of proventriculus, x 200 diams ;
(2) transverse section of salivary glands ; c, chitinous lining mem-
brane; f, fat body; mg, mid-gut; c, esophagus; ро, cavity of
proventriculus ; sg, salivary gland.

A ring of somewhat similar structure, in the middle
of the upper surface of the button, surrounds the
almost punctiform opening of the vertical diverticulum.
The lining, indeed, of this curious structure presents
а sort of epitome of the various types of epithelial cell.
Both surfaces of the remainder of the button are paved
with cubical cells; outside the thickening beneath it
the floor of the cavity is composed first of cubical and
then of columnar cells ; the lowér part of the vault is
composed of elements of the squamous form, and these

change again to the cubical type, which, in its turn,
gradually changes to the much larger irregular glan-
dular type of cell which lines the commencement of
the mid-gut.

The cesophagus and crop duct may be taken as
chitinous stomodzal tubes, and it is a curious circum-
stance that this chitinous lining is continued through
the vertical diverticulum into the proventriculus, and
lines its entire cavity, though there appears to be no
organic connection between this lining and the epithe-
lial coat already described.

Though extremely delicate the structure is per-
fectly definite and continuous; and though fluids
doubtless easily osmose through it, it seems rather
difficult to understand how the products of the epithe-
lial waste are disposed of. Taking the structure as a
whole, it is difficult to resist the idea that it must, in
some way, have a valvular function, though it is
difficult to say how. The button is а solid mass of
epithelia, and a most careful search through many
series of sections has entirely failed to demonstrate any
muscular components. The only way in which the
puncture can be imagined to be closed by the struc-
tures as they stand is that the ring of club-shaped
epithelia, beneath the button, if secreting actively,
might swell and so cup the button more deeply, and
that any such alteration of form would certainly tend
to close the puncture. Weismann believes it to be
glandular, and Lowne regards it as a gizzard, and
there can be no doubt, as the latter points out, that it
is homologous with the gizzard of manducatory in-
sects, but it is difficult to see what a blood-sucking
insect wants with such an apparatus, and as a matter
of fact, but little changed red corpuscles of the
victim are constantly to be found on the mid-gut.

In Stomoxys the proventriculus opens into the mid-
gut by & very narrow opening, followed immediately

) by a bulb-like dilatation ; after which the gut contracts

to а uniform diameter for the rest of its passage
through the thorax, but no such dilatation appears to
exist in Glossina. In this genus, too, the button is
oval instead of circular, and the entire organ is oblong
with rounded corners and very slightly contracted in
the middle. In addition to this (fig 27, 3), whereas іп
Stomoxys the organ is convex below in all directions,
in Glossina the sides are curled round to protect the
cesophagus and crop duct, so that, seen from below, it
has much the form of а Spanish priest's hat. М

The salivary ducts, almost immediately after enter-
ing the thorax, change from minute chitinous tubes to
large tubular glands, and run back below the ceso-
phagus to the sides of the proventriculus, and then
below the digestive tubes to the abdomen. They are
0:08 mm. іп diameter, and are lined with a cubical
secretory epithelium, the components of which assume
& keystone form on account of the smallness of the
lumen. They have large nuclei with prominent
chromatin fibres, and show neither anything in the
way of а basement membrane nor any chitinous
lining (fig. 28, ?).

On the dorsal side of the digestive tube, and lying
in absolute contact with it, is the aorta, but the peculi-
arities of its structure will be better described in con-
nection with the abdominal dorsal vessel.

(To be continued.) -

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THE JOURNAL OF TROPICAL MEDICINE.

[June 15, 1906.

THE PURU OF THE MALAY PENINSULA.
Ву T. D. бімгетти, M.D.
(Continued from page 175.)

Case 3. Puru in a Malay Adult. — Mehlimah,
female, Kelantan Malay, aged 47, married, twelve
children, was first seen on April 14th, 1905, at Lubok
Kawahin Kelantan. Тһе patient states she has been
ill for about a year, and has been inoculated with
* puru mata kerbau” by her youngest child, aged
about 2, who, with his sister, aged about 6, is now
recoveriug from the disease. She says that all her
children have had puru, but up till the present time
she herself had not had it. Her husband suffered from
it in boyhood ; à married sister, however, has not yet
had puru.

The patient looks ill. The eruption is sparse. She
is crippled and complains of great pain in the hands
and feet, and in the wrist, elbow and knee-joints. The
joints are swollen and very tender. She is kept awake
at night by the pains, and has been confined to the
house for many months. She is still suckling the
youngest child. Оп the left breast there is a tlattened
puru tubercle covered with a dark dry scab. There
are some similar lesions on the abdomen about the
level of the umbilicus, where the child would naturally
be held in nursing. The shin-bones are much swollen
and tender, as well as the phalangeal joints. The
scar of the “puru ibu” in this case was on the
right shin. The ibu sore had healed before the decline
of the other sores, which, with the exception of those
on the body, had mostly come out on the neck. This
patient was given a mixture containing iodide of
potash, 10 grains, night and morning, and an oint-
ment composed of ung. hydrarg. 1 drachm, and zine
ointment to 1 ounce. She was greatly benefited by
it, and by the end of April was free from pain and
able to walk alone. At the end of May the sores had
all healed.

Case 4. Puru in a Sikh.—Pak Singh, a Sikh, of
no occupation, aged 39, was adinitted to the General
Hospital at Kuala Lipis, Pahang, on February 2nd,
1900. He had been ill for a few days, and was
supposed to be recovering from chicken-pox. He was
removed to an isolation ward, where the eruption
developed into one which was generally recognised as
puru. The patient gave a definite history о!
primary syphilis, and was not discharged until
April, and then only partly cured, although treated
with mercury as well as iodide of potash during
the whole of March.

This case appears to be analogous with the clinical
case of the sea dyak given by Dr. Barker in his report
from Sarawak.

Tue PATHOLOGY oF PURU.

There is little in the pathology of puru which
has not already been described under the heading
of frambcesia or yaws.

The disease being seldom fatal, it is impossible to
record the result of any post-mortem appearances,
more especially because post-mortem examinations are
almost prohibitive among Malays owing to religious
custom and strong racial prejudice.

Microscopical Appearances of Puru Tubercles. —Some
of the growths which were removed from the chin
and back of Case 2 were sent to the Institute for
Medical Research, Federated Malay States, and were,
by the courtesy of the Government, examined by Dr.
С. ХУ. Daniels, the Director of the Institute. His
report is as follows :—

“ Tubercle from Back.—Nodule mainly composed of
a round-celled growth in the tissue, covered almost
completely by altered epithelium. Тһе growth is not
one mass, but is formed of a series of nodules of irre-
gular size and shape loosely connected by fibrous
tissue.

“On tracing the epithelial layer from the normal
skin аб the edge of the nodule we find that over the
tumour it is more irregular in thickness and that the
papillary processes are larger and very irregular. АП
the layers are altered. There is no properly formed
keratinous layer and none of the intermediate cells іш
process of keratinisation. The epithelial cells over the
tumour are swollen, stain irregularly, and are often
vacuolated.

“They are not arranged in definite layers and the
palisade arrangement of the deepest layer is poorly
marked.

“The growth itself is composed of round cells with
scanty protoplasm. Тһе cells and nuclei stain well
with basic stains. Mitosis is common and there are
no areas of necrosis, easeation, or suppuration. The
cells vary & little in size and occasionally much larger
cells with single nuclei are seen. In the depth of the
growth there is some thickening of the fibrous
stroma. The growth is supplied with blood-vessels.

“ Tubercle from the Chin.—This specimen is from a
more hairy part and hair follicles extend through the
growth. It differs from the other specimen in that
the growth is less abundant and the fibrous stroma
more so and that the hair follicles extend through the
depth.

“Мо micro-organisms were found in the deeper parts
of the sections of the growths."

This description agrees with the most recently pub-
lished account of the microscopical appearances of
frambcesia or yaws tubercles [20]. It is important to
note that no congener of the Spirochete pallida was
found. The original sections are sent with this paper.

THE TREATMENT OF Роко.

Malays have given much attention to the treatment
of puru, both with drugs derived from their own flora
and by the use of à few imported medicines, but their
efforts, which are mainly empirical, have not proved
very successful in every-day practice.

In the hope that & definite therapeutic preparation
might be made out of one or other of their local pro-
ducts, I recently sent some notes to the Therapeutical
Society of London, on some of the methods employed
by Kelantan Malays in the treatment of puru. Botani-
cal specimens of most of the plants referred to were
sent to England with the paper. They were all
obtained in Kelantan, most of them from a hamlet—
Kampong Kutan—near Kota Bharu, the capital.
These original notes, with additions, are now embodied
in the present essay.

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, wmsuruoaq ерер I} Jo ning eu, “ГІ ‘лаяти “171 54 Paw aean о,

"ӘЗ ША OY jo uoap[qo
eqs 3aourv nand jo әопәргләл4 ay} Эпімоцв ‘uvzavpoy ш ‘IOAN unsng 7% sAvpeyy Jo dno13 y—"¢ "Ід ‘nand jo вәлов оца Sulmoys “6 esu) әуелдегі OL —"p "org

‘906T ‘ST ANAL ‘ANIOIGAN 'IVOIdOHL AO TYNUNOL

June 15, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE.

187

Native Therapeutics.—]In the earliest stage of the
disease the only native form of treatment employed
for the relief of the prodromal fever and muscular pain
is the superstitious Malay practice of “ menjampi,” or
charming by incantations.

The medicine for the first stage of puru is said by
native Malay doctors to be the leaf of the merbor (?),
plant and those of the jenera (2) rotan jenerang
(Demonorops draco (L. Palm:ee], the dragon's blood).
These leaves are chewed up and spat on to the swell-
ing or ibu.

It is generally held by Malays, however, that active
treatment is of no avail until the full development of
one or more puru sores has been attained. The
sore which is often watched with the object of timing
the commencement of treatment is the “ puru ibu,” or
mother sore. When this so-called parent sore is
developed, their most valued remedy is the external
application of a latex or kind of gum which is called
“geta hagu” in Kelantan, or “getah jintan "іп Pahang.
This is obtained from a climbing jungle creeper known
in Kelantan as “ akar agu ” (** akar,” a root, the generic
name for scandent or creeping plants) und is very like
Hunteria rorburyhiana, though uncommon. It is
prized by Malays, especially a red variety, and, like
many other of their medicinal plants, is protected and
cultivated. The latex is obtained by cutting the live
stem and mixing it with water to allow for its inspis-
sation, and it may be bought in this form in the native
market at Kota Bharu in Kelantan. The remedy is
smeared day by day on the sores of the general erup-
tion. So far as my experience in Kelantan goes,
** getah agu ” causes the sores of puru to shrink andis
of value as a local application.

Another latex which is valued is collected from a
jungle creeper called “akar gam" (Wüloughbeia
firma) ; in this case the remedy is obtained by incising
the fresh fruit or the stem. It is generally known
under the name оѓ“ buah gam " or “ gehan ” (** buah,”
a fruit), and is commonly applied to tlie sores of puru
in the same way as “getah agu.” In some cases in
which the sores are chronic and do not respond to
treatment the fruit is gathered, dried, then roasted aud
powdered, being finally made into a paste with a little
water for local application. In other cases of chronic
and recurring sores, the ashes obtained by burning
the stem of “ rotan sega badak ” (Calamus orantus) are
used. ‘Rotan,” in Malay, is a generic name for
rattans of the genera Culamus and Demonorops.

Another local Malay remedy is well known under
the name of '*terosi," sulphate of copper. In the
general treatment of puru, ''terosi" is reduced to
fine powder, and then mixed with palm oil or with
а latex called “getah pulai," which is obtained by
cutting the stem of the young pulai tree (Alstonia
macrophylla). External applications of this kind con-
taining ''terosi" cause a great deal of pain, prevent
sleep, and on this account are not often used,
rarely if ever being employed in the early stages of
puru. With the object of preveuting pain these
applications are sometimes prepared by first burn-
ing the ''terosi" in a slow fire until it is blackened,
then pulverising and mixing it into a paste with
either cocoanut oil or the juice of the common
lime fruit called “limau nipis " (Citrus acida).

The most important of all the Malay drugs for
sale in the Kota Bharu market is ''tuba tikus,"
which, like terosi, is imported by way of Singapore.
“Таһа tikus” is pure arsenious acid ог white
arsenic, generally seen in rather odd forms which
seem to be due to its having been collected from
the flues of some dveing works. The name appears
to be used idiomatically by Malays; ''tuba," is the
name of a jungle plant, the root of which pos-
sesses certain stupefying properties; “tikus ”
signifies a rat. It is used externally in the treat-
ment of puru, either by itself in the form of a
powder, or as an addition to various kinds of
roughly made “pastes” which are prepared from
certain native plants. These vegetable “pastes”
aro freshly made as occasion demands; in one
instance by grinding down with a little water the
root of a wild red vine, called in Malay “ puchok
merah " (“ merah,” red), а plant which is identical
with Leea rubra, and in another case by treating in the
same way the root of a low shrub called “ chekor
manis " (Sauropus albicans); ** manis" is the Malay
for sweet, or light in reference to some colours.

“Таһа tikus" is used as a poison by criminals,
and is not administered internally as à medicine by
Malays. It is the ** berangan puteh " of Java.

Тһе sulphurets orpiment and realgar are also
used in puru, but all the external applications con-
taining arsenic, being caustic, are much disliked on
on account of the pain which they occasion.
“Tuba tikus,” like **terosi" may be burnt and
applied in the same way, either with or without oil.

* Mali puchok merah ” is given by the mouth for
puru, as well as being used externally, and among
other internal remedies are “melor hutan,” а wild
jessamine (Jasminum bifarium ; Oleacee) and the black
variety of kemantu. This latter is a tree of Indian
origin (Clausena ехсатаѓа). It is called ‘ pokoh
kemantu hitam,” or the black kemantu tree, “ pokoh”’
meaning a tree, and “hitam” black. There are
other varieties of this tree which are not used in
medicine. ‘Akar jela batu” is also administered
internally for puru; but there is no fixed dose. In
each case the roots of these plants are ground down
оп a “batu asah " (a stone оп which medicines are
pounded or ground down) and then infused in cold
water. Occasionally а mixed infusion is used in puru
of kemantu hitam and “tuko takal” (Baccaurea
wallichii; Euphoribiace), a jungle tree which is fairly
common.

The only treatment of the disease by Malays when
it affects the joints is by the constant application of
“ayer tawar,’ or plain water over which certain
charms have been said.

In Kelantan sovereign remedies are common. A
typical native prescription is as follows: Take the
knee-cap of a tiger, the bones of a duyong (the
dugong), the bones of a goose, the bones and horns of a
Kambing gurun (a very rare wild gout, Nemorrhedus
bubalinus), the horns of & rusa, & wild dcer (Cervus
unicolor), while still soft (lembong); add belirong
bang (sulphate of arsenic), and chendana janggi (red
sandal-wood), and mempus harimau (a kind of wood).
Grind these ingredients down with some boiling rice
water (ayer dideh), take a small amount of ashes

188

THE JOURNAL OF TROPICAL MEDICINE.

[June 15, 1906.

from the hearth, mix, and administer the draught by
the mouth.

Various applications are made for puru of the foot.
The following method of treatment known as “ tanak
puru" (*tanak," to cook) is а favourite one with
some Kelantan Malays. А small round hole about a
foot in depth is made in the ground, and a slow fire is
kindled at the bottom of it; half a cocoanut shell
with a hole in it, or a suitable piece of bamboo, is then
fitted over the red-hot embers. On the top of this
improvised вегесп the affected foot is rested in such
а way ав to expose the sore to the heat of the
smouldering fire. Kemantu leaves are often put on
the fire ав well as those of “kedondong,” а tree
belonging to the genus Canarium ; in addition to the
leaves the bark of the latter is sometimes burnt on
the embers. Relief of pain is obtained after three or
four lengthy exposures.

Lime, which is commonly used in betel chewing, is
also & popular remedy for puru of the foot. It is
mixed with oil or with the juice of “keladi puyoh,”
a common Malay ariod of the genus 44locasia (Typhoatum
rorburghii), and plastered on to the sores. Stones
may be heated and applied as hot as can be borne.
The actual cautery in the shape of red-hot iron nail
is occasionally used, and even excision is attempted by
means of “ parangs"" or rough iron choppers which
are usually used by natives in felling brushwood.

It is of general interest to note that the drugs used
in puru are not used by Malays in their treatinent of
syphilis. Тһе chief Malay drug used for syphilis is
“ pokoh restong " (Майасив sp.) which grows wild,
but is often cultivated, and it is praised by natives as
being a valuable medicinal product. Тһе root is used,
mostly in the form of a lotion, especially in cases of
ulceration and destruction of the nose. This as well
as “trong pipit puteh” (Solanum indicum) is also
given internally for syphilis, but they are not employed
in the treatment of puru. “Puteh,” in Malay,
literally means white, and the word ** trong" is used
to designate the plants of the Sulanacee.

Hospital Treatment.—At the present time puru is
rarely, if ever, treated in the isolation wards of the
Malay peninsula. It is hardly necessary to dilate
upon the importance of isolation in the case of a
directly contagious disease of this nature. I think it
may be assumed that some isolation of puru cases
(although prophylactic treatment of this kind must
always be difficult among Malays) may be eventually
achieved in these hospitals.

Preparations applied locally of mercurial ointment
will be found of great value in the treatment of the
disease, especially in combination with zine ointment.
Sores which are healing during the decline of the
disease are generally benefited by daily applications of
tincture or liniment of iodine. Риги of the foot is
often relieved by the application of pure carbolic acid
or sulphate of copper. І have not found alkaline
lotions of sodium bicarbonate to be of much benefit.
Iodine of potash is generally of great value, especially
during the stage of *''senggai puru." — It quickly
relieves, as a rule, the rheumatic-like pains if given in
doses from 5 to 10 grains (to adults) twice or thrice
daily. Attention to general hygiene and cleanliness
is nearly always indicated. The syrup of iodide of

iron is often of great service in the treatment of puru
during childhood. l

Although my practical acquaintance with the disease
is limited to the Malay peninsula, I would conclude
that puru is identical with framboesia or yaws, and I
would plead that this tropical disease should at least
rank as a nosological entity іп the medical returns
of British Malaya.

I ain indebted to Mr. Н. М. Ridley, F.L.S., Director
of the Botanic Gardens, Singapore, for his kindness in
classifving very many of the drugs, and to Mr. P.
Burges, M A., Government Analyst, Straits Settle-
ments, for his examination of the mineral known as
“tuba tikus,” or ratsbane; also to Mr. R. W. Duff,
Managing Director of the Duff Development Company,
Limited, to Mr. H. W. Thomson, Assistant Adviser to
His Highness the Rajah of Kelantan, and to Ungku
Sayid Hussein, a member of the Kelantan nobility, for
their cordial collaboration.

I must,also thank Dr. C. W. Daniels, the Director
of the Institute for Medical Research, Federated
Malay States, for making the examination of the
pathological tissues and for many kindly and valuable
criticisms.

е
REFERENCES,

[1] Нсон Currrorp. “ Further India," London, 1904.

(21 Вохтіов. “Пе Medicina Indorum," 1718.

[3] Marspen. “History of Sumatra," p. 156, London, 1811.

[4] * Selected. Essays,” p. 291, The New Sydenham Society.
London, 1897.

[5] Hirsch’s * Handbook of Geographical and Historical
Pathology." vol. ii., p. 197, The New Sydenham Society, 1885.

[6] PowELL. British Journal of Dermatology, No. 98, vol. ii.,
No. 12.

(11 JEANSELME.
Paris, 1904.

[8] Brown,
No. 6

(91 ALLBUTT. ‘System of Medicine," p. 486, vol. ii., London,
1897.

[10] James. “ Scientific Memoirs by Officers of the Medical
and Sanitary Departments of the Government of India," No. 18,
new series, Calcutta, 1905.

[11] * Medical Report on the Sarawak Government Hospitals
and Dispensary, 1598,” Kuching, Sarawak, 1899.

[12] British Medical Journal, vol. i., p. 1588, 1898.

[13] G. Ревмет. “Тһе Differential Diagnosis of Syphilitic
and Non.syphilitie Diseases of the Skin," p. 152, London, 1904.

[14] DawrELS. '' Studies from Institute for Medical Re-
search, Federated Malay States," vol. iii., part i., p. 59, Singa-
pore, 1904.

[15] “An Atlas of Illustrations," Fasciculus xiv., The New
Sydenham Society, London, 1902.

[16] Crawfurd's ** Malay Dictionary," London, 1852.

[17] Wrigur. Journal of Medical Research, vol. x., No. 8,
new series. vol. v., No. 3, pp. 472-482, December, 1903, Boston,
Massachusetts, U.S.A.

[18] British Medical Journal, vol, ii., p. 615, 1901.

[19] Scnevune. “Тһе Diseases of Warm Countries," English
translation, second revísed edition, p. 290, London, 1903.

[20] WooLEx. “ Frambcesia: Its Occurrence in Natives of
the Philippine Islands,” Bureau of Government Laboratories,
Serum Laboratory, No. 20, October, 1904, Manilla, 1904.

[21] Therapeutical Society Transactions, 1905, third session,
Loudon.

“Cours de Dermatologie Exotique,” p. 161,

British Journal of Dermatology, No. 56, vol. v.,

JOURNAL OF TROPICAL MEDICINE, JUNE 15, 1906.

Outline figures of fleas possibly concerned in the transmission of plague.

June 15, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE.

189

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THE

Journal of Tropical Medicine

JuNE 15, 1906.

THE HYGIENE OF THE ALIMENTARY
CANAL.

PnRorEssoR МЕТСНМІКОЕЕ chose the subject of
“The Hygiene of the Alimentary Canal,” for his
second Harben Lecture. The etiology of appendicitis
formed a prominent part of the lecture, and Metchni-
koff's opinion is that intestinal worms are the most
frequent cause of the disease. Не cited instances in
which Trichocephali, Oxyures and Ascarides have been
found in the appendix, and drew attention to the pre-
valence of appendicitis in families and persons sub-
jected to identical domestic environment. It is not
necessary for belief in this opinion that the worm be
actually found іп the appendix either at operation or
at post-mortem examination, for, after having caused
inflammation in the appendix, the parasites frequently
leave the appendix and thus may not be found there
at the time of the operation. There сап, of course, be
no doubt that an intestinal worm need not impair
health in any way, just as many mosquitoes, fleas, and
ticks шау prick man and animals without causing
anything more than a transitory and not painful itch-
ing. But, on the other hand, it is equally certain that
the bites of intestinal worms may lead to just as much
evil as the pricks of Arthropoda carrying pathogenic
microbes.

In the appendix the parasite sets up а zone of
inflammation accompanied by an effusion of white

blood cells and the presence of different bacteria; the
mucous membrane is attacked and the parasite
(oxyuris or other worm) inoculates a microbe which
produces a fatal infection. Тһе róle of the parasite ін
therefore similar to that of a flea which inoculates
man with the plague bacillus. As an argument against
this theory of the causation of appendicitis, it is
asserted that the Chinese and certain other peoples
never suffer from appendicitis, in spite of the frequency
with which intestinal worms are found in them. It
may, however, be stated (1) that post-mortem examina-
tions are but rarely carried out in China, except in
some few centres where European doctors practise ;
(2) that appendicitis is frequently a mild ailment, and
European doctors are seldom called in; (3) the state-
ment that appendicitis is so rare amongst Chinese
requires confirmation.

The disinfection of the intestine Metchnikoff con-
siders to be a simple matter, and can be produced by
keeping a careful watch on our food and drink; both
should at least be boiled before being consumed. He
refutes the belief that boiled water is either tasteless
or harmful, and contends that boiling is insufficient
for sterilisation—there always remain spores of Bacillus
subtilis and some others—but the ova of parasites
and the pathogenic microbes will be destroyed, almost
without exception.

Among fruits, strawberries are chiefly condemned as
parasite introducers, from the fact that they touch the
ground or litter when growing. In connection with
this legend the use of strawberries as a cure for sprue
would require justification, seeing that the fruit comes
in contact with an already damaged intestine. As an
intestinal disinfectant lactic acid is recommended by
Metchnikoff as the most efficient, and he states that—

* Among the useful bacteria the place of honour
should be reserved to the lactic bacilli. They produce
lactic acid, and thus prevent the development of
butyric and putrefactive ferments, which we should
regard as some of our redoubtable enemies. It has
been shown by an extensive series of experiments,
which we cannot here treat of in detail, that certain
lactic ferments easily accustom themselves to live in
our intestines, and thus produce a beneficial influence.
They prevent putrefaction, and thus diminish the ex-
cretion of sulphonic acid esters. These same ferments
help to regulate the functions of our intestine and
kidneys, rendering valuable service to the entire body.

* One can take such carefully selected lactic fer-
ments either in milk that has become acid under their
influence or in the form of & powder or compressed
‘tabloids.’ Dr. Tissier employs them in the treatment
of the various intestinal troubles occurring at any age.
To this end he advises the use of cultures of lactic
microbes made in lactose peptone water.

*: Ав putrefaction in the alimentary canal represents
one of the causes of the general wear and tear of the
human body, it was only natural to suggest the
method that I have just referred to as а means of
combating it. This method may now be summed up
in a few words. It consists in the consumption of
foodstuffs not contaminated with microbes or entozoa,
and in the introduction into our alimentary canal of an
artificially cultivated bacterial flora, foremost among
which are the lactic acid microbes.”

‘June 15, 1906.

190 THE JOURNAL OF TROPICAL MEDICINE.
HOW TO RECOGNISE THE SPECIES OF

PULEX POSSIBLY CONCERNED IN THE
TRANSMISSION OF PLAGUE.

Tux theory that fleas are concerned in the trans-
mission of plague is one of some standing, but was for
a considerable period generally discredited, as it
seemed that laboratory experiments failed to confirm
its probability.

Of late the theory has, however, come once more to
the front, owing largely to the able advocacy of Cap-
tain W. Glen Liston, I.M.S., who contributed to the
Bombay Natural History Society a paper on the
subject, read on November 24th, 1904. А revised
copy of this paper appeared in this Journal in the
issue of February, 1905, p. 43, and an earlier note on
the fleas of rats, contributed by Dr. Tidswell, may be
found in the volume for 1903, p. 232.

It is not our purpose to enter into any detailed
description of the various species that may possibly be
concerned in the transmission of plague from the rat
to man, but as neither of these papers was illustrated,
and no easily recognisable figures can be referred to as
readily accessible, it is thought that it may be of
service to our readers to furnish them with reliable
outlines of the five species that are most likely to be
met with in the course of any investigation of the
subject. The material from which the drawings were
made cousists of a number of slides presented to the
writer by Captain Glen Liston, and partly of some
rat-fleas collected by himself in Plymouth.

All are mounted as microscopic objects in balsam
on ordinary slides, and hence are probably a good
deal more compressed than the living insects would
be, or than is the case in specimens preserved in
spirit. The depth of the drawings from dorsum to
venter is therefore, probably, in all cases more or less
exaggerated. The various specimens were most
kindly identitied by the Hon. Mr. Charles Rothschild,
the well-known authority on the group, to whom the
writer desires to express his most grateful thanks for
his pains in this respect, as well as for his help in
indicating the points that should be most emphasised
in preparing outline figures of fleas, and for the loan
of his unique specimen of the larva of Pulex cheopis,
the species which is indicated by Captain Liston as
the most probable culprit in the matter.

The fleas are a small group of parasitic insects, the
Aphaniptera, which are generally regarded as a sub-
order of the Diptera, though it cannot be said that
the relationship is a very obvious one, as, not only are
the wings represented only by small scales on the
meso- and meta-thorax, placed just above the coxe,
but the hinder pair are usually the larger, and in no
way resemble the halteres of the Diptera. Added to
this, the mouth-parts are very different, notably, in
possessing, in addition to the palpi, a second pair of
jointed appendages.

Although no monograph of the Pulicide appears to
have been as yet attempted, the total number of
species must be considerable, as most genera of main-
mals and birds appear to have their own fleas, which
are but rarely found on alien hosts. This, however,
appears to be rather a matter of preference than of

necessity, as, if pressed by hunger, fleas will attack
almost any species, and as they always quickly desert
their host after the death of the latter, other animals
and human beings are, under the circumstances, very
apt to be attacked by species that ordinarily neglect
them. Тһе significance of this trait of their habits
in relation to the transmission of plague is too obvious
to need further comment. `

On this account, not only may the fleas of cats, rats,
and even birds be found on men, but the fleas of the
latter шау be met with on rats, and of course the
fleas of mice and other rodents find a comparatively
congenial home.

For our purposes, however, there are five species
whose ready recognition is like, ere long, to become
a matter of vital importance to the medical practi-
tioner. These аге: Pulex irritans, usually harbouring
on man ; Puler felis (often referred to as P. serraticeps),
commonly harboured by dogs and cats, but quite com-
monly mot with on the human subjeot, as well as on
rats, squirrels, and a variety of other animals; Puler
cheopis, the common rat-flea in India, which, accord-
ing to Captain Liston, appears to have а preference
for Mus rattus ; Ceratophyllus fasciatus, common on
rats in all parts of the world, and showing, according
to Liston, а preference for Mus decumanus; aud
Ctenopsylla musculi, normally harbouring on the
mouse. Іп distinguishing between the above, the
following points need alone be noticed :—

(1) The presence or absence of eyes. These organs
are very rudimentary in all fleas, the compound eyes
of the majority of insects being absent in the entire
suborder. In Ршег, and allied genera, simple eyes
allied to those of the young nematocerous larva occupy
the position of the usual facetted eyes, but they are
always small, and can hardly be capable of anything
more than the bare appreciation of light. It is some-
times rather difficult to determine whether а species
be blind or otherwise, as & pigmentary mark some-
times occupies the position of the eye, and шау, of
course, even really represent it, as the eye in its most
rudimentary form is nothing more than a patch of
pigment. Ctenopsylla musculi, the only blind species
on our list, is, however, fairly obviously eyeless, and
so can easily be distinguished from the rest.

The second point requiring particular notice is the
presence or absence of serrated edges to certain
sclerites, notably the inferior border of those forming the
sides of the head, and the posterior border of the tergum
of the prothorax. In this latter position they have the
appearance of a spiked collar. Mr. Rothschild has
recently described a flea possessing a mesothoracic
collar of this sort, but this need not concern us here
Lastly, the posterior borders of some of the abdominal
terga may show a tendency to this form of armament,
the anterior segments of one of our species, Ctenopsylla
musculi, possessing from one to three teeth on either
side, but these are not easily made out in specimens
mounted in balsam.

Fleas of the same species vary so widely in size that
this character is practically valueless for purposes of
identification.

Theso points being duly noted, our five species may
be tabulated as below :—

I.—Species possessing obvious eyes.

June 15, 1906.)

(а) With both the inferior border of the head
and the hind border of the prothorax
serrated.

(1) Pulex felis.—Hight serrations to lower
border of head, the hindmost much
smaller than the rest. Prothorax with
eight serrations on either side. Tarsal
claws of moderate size, but stout.

(р) Lower border of head unarmed but prothorax
serrated.

(2) Ceratophyllus | fusciatus. — Prothoracic
collar with ten serrations on either side.
Tarsal claws small and delicate. The
profile of the head curves down much
more sharply to the vertical than in
preceding or following species.

(c) Species with neither inferior border of the
head nor the prothorax serrated.

(3) Puler cheopis.—Tarsal claws short and
delicate, antipygideal bristles long.

(4) Pulec irritans.—Tarsal claws long and
scythe-like, antipyzideal bristles short.

II.— Blind species.

(а) With the inferior border of the head and
the prothorax alike serrated.

(5) Ctenopsyllu. musculi.—Inferior border of
head with 4, and posterior border of
prothorax with 11 serrations. Tarsal
claws small and delicate. Profile of
head sloping markedly backward, after
it turns downward, producing an outline
like that of the head of “ Ally Sloper”
of the comic papers.

We could have wished to complete the list with
representations of the fleas harboured by monkeys,
the familiar Indian verandah squirrel, and the
Himalayian marmot, all of which animals are prob-
ably occasionally concerned in the spread of plague,
but material is lacking. Perhaps some of our readers
ean supply us with the desired specimens, which
should be sent, preferably, preserved in spirit.

Pulex cheopis is believed by Mr. Rothschild to be
essentially peculiar to the hotter parts of the globe,
but it is certain that it can maintain itself in temperate
climates, as a specimen was taken by the writer on a
rat caught in Plymouth. As a great naval arsenal, and
considerable seaport, the town is in constant com-
munication with all parts of the world, so that it is
easy to understand its reaching there on a rat imported
by some ship. Тһе fact, however (which has already
been published in ап entomological periodical), is
extremely significant of the dangers to which seaports
are exposed. G. M. G.

—————9——————

R. ROCH ON TUBERCULOSIS.

Ix the Nobel Lecture, published in the Lancet, May
26th, 1906, Professor R. Koch drew attention to the
infectious nature of tubercle, and to the necessity for
notification of the disease. He stated that Bovine
tuberculosis and human tuberculosis are different from
one another, and in connection with the combating
of tuberculosis it is only the tubercle bacilli emanatiug
from human beings that have to be taken into account.

THE JOURNAL OF TROPICAL MEDICINE.

191

Of tubercular persons, it is only those who suffer from
laryngeal or pulmonary tuberculosis, and whose sputa
contain bacilli that are dangerous to those around them
in а noteworthy degree. This form of the disease was
even called the “ореп” іп contrast tothe “closed ” form,
in which no tubercle bacilli emanate from the body ina
dangerous form. In the open form of tuberculosis the
patient is dangerous only when he is personally un-
cleanly, or becomes far advanced and more or less
helpless in the disease.

The measures hitherto adopted for the arrest of
tuberculosis are: notification, hospitals, sanatoria,
and the instruction of the people as to the danger
of tuberculosis. Of these the first and last are the
most essential. “ We must demand notification for
tubereulosis " is Professor Koch's view, and all epi-
demiologists will agree. In a certain way notification
is really taking place, as pulmonary phthisis is treated
in many hospitals. The benefit of sanatoria is
doubtful, and it is only in the early stage of tubercu-
losis that treatment in a sanatorium is of real use.

*PHILIPPINE JOURNAL OF SCIENCE,"
Fesruary, 1906.
INOCULATION AGAINST PLAGUE.

SrroxG has inoculated man with attenuated Bacillus
pestis with promising results. In all, 42 persons have
been treated with one twenty-four-hour agar slant
culture of the living bacillus, suspended in 1 cc. of 0:85
per cent. saline solution. The material was injected
deeply into the deltoid muscle. Strong used a culture
of attenuated strength, having obtained two attenuated
cultures of the bacillus from Professor Kolle, and
made use also of a three-year-old culture, started in
Manila, still further reduced in strength, according to
Otto’s method.

After the injection the patient had slight pains at
the seat of inoculation and a febrile state for a day or
two, but no serious complications, either locally or
constitutionally, resulted.

Of the several sera used as prophylatie or curative
agencies in plague, the best known are: (1) Yersin,
іп 1894, prepared an anti-toxic serum by injecting the
bacillus of plague into horses, and killed before use, by
heating to a temperature of 136? Е. (2) Haffkine, in
1897, used & pure culture of the bacillus in bouillon con-
taining ghee, the bacilli being killed by exposure to а
temperature of 1589 F. for an hour. (3) КоПе and
Otto, in 1902, inoculated guinea-pigs with attenuated
living plague bacilli, and showed that these animals
ean be rendered immune to plague. (4) Strong, as
stated above, has now adopted Kolle and Otto's
method for human beings; the only special warning
he gives is that every care must be taken in the
preparation and attenuation of tlie virus.

YELLOW FEVER.

THE members of the French Commission for the
study of yellow fever have issued their report. The
conclusions are: (1) That the Steyomyia fasciata is
the agent by which yellow fever is transmitted, thus
confirming the observations of Reed, Carroll, Lazear,

192

and Agramonte. (2) The mosquito can only acquire
power of infection by biting yellow fever patients
during the first three days of the patient’s illness.
(3) Twelve days must elapse after the mosquito has
imbibed the virus before its bite can infect human
beings. (4) The infected mosquito retains its power
of infecting man as long as it lives, namely, twenty to
thirty days. (5) The S. fasciata requires human
blood for the development of her eggs. (6) The first
generation of the offspring of an infected mosquito
seems capable of transmitting yellow fever fourteen
days after reaching full development.

The micro-organism of yellow fever has not been
isolated, but the following observations were made:
(1) The organism does not exist in human blood after
the fourth day of yellow fever. (2) It passes through
the Chamberland filter F., but is retained by filter B.
(3) The organism is destroyed by exposure to a tem-
perature of 131° F. for five minutes. (4) The blood
serum loses power of infection after exposure for forty-
eight hours to air. (5) When defibrinated blood is
protected from the air the serum retains its potency
after five days but not after eight. (6) When dead
infected S. fasciate are injested by non-infected S.
fasciate infection results ; but this infection only holds
good for the first feeding.

As regards immunity, the members of the Commis-
sion conclude that: (1) An attack of yellow fever yields
immunity usually permanent in this character; should
в second attack occur it is of a mild type. (2) Serum
kept at 131° F. for five minutes confers a relative
immunity when injected into human beings. (3) The
same is claimed for defibrinated blood kept under
vaseline from air for eight days. (3) No race is
naturally immune, but the mosquito seems attracted
by certain skins.

Isolation of the patient and destruction of the
Stegomyia fasciata seem to be the chief points in-
dicated in warding off the spread of yellow fever.

The members of the Commission favour the idea
that the micro-organism is of the nature of a
spirillum.

EXPERIMENTAL Мү1А818 IN GOATS, WITH А STUDY OF
THE Lire CYCLE or THE FLY USED IN THE
EXPERIMENT AND A List oF Some SIMILAR
Noxious Піртева! By Е. C. Wellman, M.D.,
Benguela, Angola, West Africa.

ABSTRACT.

Dr. Wellman, in elucidation of this subject, em-
ployed a fly pronounced by Mr. E. E. Austen to be a
species of Sarcophaga, near regularis, Wied. The
animal experimented upon was a native goat of Angola.

The goat was chloroformed, placed under a mosquito
net, and the nostrils of the goat painted with water in
which pieces of putrid meat were soaked. Some 70
flies were then liberated beneath the mosquito net.
The flies could be seen to settle upon the goat's nostrils.
On the second day the goat appeared to be ill, it was
killed on the third day, when the posterior nares and
the frontal sinuses were found to be extensively

! А paper sent to the American Society of Tropical Medicine.
pap y

THE JOURNAL OF TROPICAL MEDICINE.

(June 15, 1906.

eroded, swarming with maggots, and the air passages
covered with a thin, glairy, foul-smelling pus. Тһе
experiment was tested by control animals. Dr.
Wellman concludes that men and animals might be
invaded by the fly in question under certain circum-
stances. A man sleeping in the open, especially if
suffering from ozena, would be liable to be attacked by
the fly; апу uncovered wound would also become
affected.

A list of Diptera convicted of causing human myiasis
is given by Dr. Wellman :—

Clyclorrapha — Schizophova — Muscidae — Calyptrata.
Oestride.

Gastrophitus. Horses and man.

Hypoderma. H. bovis, man. H. diana, deer and
man.

Dermatobia. The larve of D. cyaniventris is the

“Ver Macaque” of tropical America, and in man
causes painful boils, occasionally attacking the eyes;
also Hypoderma bovis reported by Scheube.

Sarcophagide.

Sarcophaga. S. carnaria, S. magnifica, and S. rufi-
cornis occasionally deposit their larve in wounds of
man (India). A species of this genus (S. sp. near
regularis) is the fly used in the experiment detailed in
this paper.

Sarcophila. Man and animals.

Auchmeromyia. А. luteola, in Angola, and another
species (А. depressa), cause cutaneous myiasis in
Natal.

Ochromyia. The larva of O. anthropophaga is the
“Ver du Cayor,” which in Senegal produces cuta-
neous inflammation and swelling.

Мивсіде.

Musca. Larve of Musca sps. occasionally are passed
in feeces or found in wounds.

Calliphora. In intestines of man and animals.

Compsomyia. The larva of C. macellaria is the
* Screw-worm ” of tropical America. `

Lucilia. L. sericata is the cause of “ maggot ” in
sheep. The larvæ of several species of Lucilia have
been detected in wounds and ulcers in man and
animals.

Anthomyide.

Anthomyia. The larve of A. canicularis not seldom
get into the stomach and intestines of man, through
eating raw vegetables.

Hydrotea. In the fæces of human beings.

Homalomyia. In the intestines of man, being passed
alive in the fæces. Osler gives a case of infection by
H. scalaris in Louisiana.

. Hylemyia. In human excreta.

------о--
Correspondence.

To the Editors of the JounNAL or TRopicaL MEDICINE.
“ZAMBESI ULCER.”
(Letter from Dr. F. C. Wellman.)

Sins,— May I be permitted to remark in your columns on
the criticism of the article by Mr. І. E. Ashley-Enuile with
the above title (this Journal, September 15th, 1905), which

June 15, 1906.)

Mr. J. E. S.
number ?

While I am not acquainted with the exact region described
by Mr. Ashley-Emile, yet I have had some experience with
skin diseases in the same latitude--from the Portuguese
west coast to the head-waters of the Zambesi—and have
often seen the common ulcers described by him (vide my
“ Notes from Angola,” Note xviii., this Journal for Decem-
ber 1st, 1905, p. 344). I have also seen a number of cases
of cutaneous myiasis, and am not inclined to regard the осса-
sional presence of dipterous larvie in ulcers in the light of an
etiological “ discovery." As for the impression conveyed by
the author's paper, i.e. that ** Zambesi ulcers” are always
connected in the first instance with the presence of muscid
larve in the skin, such an opinion is not confirmed by my
observations west of his district, where all ulcers, especially
early ones, were closely scanned for Guinea-worms. On the
other hand, I should say that the presence of the larvie was
exceptional.

I believe the author is right, however, in stating that the
usual larva seen under the skin in this part of the world is
distinct from Bengalia depressa (which, however, is also
seen, but more rarely), for my specimens taken in the in-
terior of Angola in nearly the same latitude, are certainly
not to be identified with that species. Neither are they, on
the other hand, to be confounded with the muscid larve,
Blanchard’s description of which is quoted in the article
under discussion. Regarding this point, Dr. L. O. Howard,
Chief of the Bureau of Entomology at Washington, writes
(May 10th, 1905) to the Secretary of the American Society
of Tropical Medicine concerning my specimens in the fol-
lowing words: “Тһе larva removed with a pair of forceps
from under the skin is most interesting. It appears not to
be a Muscid, but its affiliations are with the Sarcophagide,
the true flesh-flies ; but I know of no record of the occur-
rence of a larva of this family under the skin of a human
being. Still, new things are coming up all the while, and
we may have here something absolutely novel" Тһе Sar-
cophagide are important pests in this region, and I have
seen the vivaparous females depositing their larve in
wounds. I have also recently produced experimental de-
structive myiasis in goats, using Sarcophaga africa, Wied.
and 5. albofasciata, Macq. (vide the Journal of Medical
Research, vol. xiv., No. 2, January, 1906, p. 439).
seem probable that Mr. Ashley-Emile is dealing with some
such flv as the above, or possibly with Muscide, as he
believes. In any event, his finding of the larvæ, presumably
in а number of ulcers, оп the Zambesi (he, unfortunately,
gives no figures) is an interesting observation, in spite of
the unscientific and pompous manner in which it is an-
nounced, and, although he is unjustified in including without
evidence (and without reference to the work of Harman,
Ogston, and others, cf., also my memorandum in this
Journal for April 15th, 1905, p. 118), the veldt sore of other
places in his category of maggot-caused phaged:ena, yet it is
to be hoped that fly larve will now be carefully looked for
in all cases of African ulcer. j

While waiting for confirmatory evidence, however, since
in my own contiguous district cutaneous myiasis is not
uncommon, while the formation of ulcers around the larve
is, to say the least, very rare, and as I have seen no other
evidence, in the course of considerable study of such con-
ditions, to justify one in predicting a causal relation between
the two conditions, I am unable to accept Mr. Ashley-
Emile's etiological theories regarding veldt sore as estab-
lished even for Zambesia, and agree with Mr. Old in
suggesting that he should go over his work again, giving us
case records, statistics, and what other exact data he has by
him, instead of hasty generalisations and self-congratulatory
phrases.

Hoping that you will pardon my occupying so much of
your valuable space. Yours, &c.,

South Angola. F. CREIGHTON WELLMAN.

April 15th, 1906.

Old offers in your February 15th, 1906,

THE JOURNAL OF TROPICAL MEDICINE

It would |

193

Report. І

SHANGHAI HEALTH DEPARTMENT.
ANNUAL REPORT For 1905.

ARTHUR STANLEY, M.D., B.S.Lond., in his annual
report, just issued, on the health of Shanghai, states
that “ the past year has been the healthiest on record.”

The death-rate amongst the 11,497 Europeans resi-
dent in Shanghai amounted to 11:2, as against 12:9 in
1904. Amongst a Chinese population of 452,716 the
death-rate during 1905 was 14-2, compared with 19:2
during 1904.

Small-por has been much less prevalent than for
some time past; amongst Europeans, 41 cases were
notified and 14 deaths registered ; amongst Chinese,
246 deaths, as against 759 in 1904.

Cholera was unknown in Shanghai during 1905.

Typhoid fever attacked 50 Europeans, of whom 7
died. Dr. Stanley is of opinion that Malta fever
occurs in Shanghai, in fact, in a recent letter to this
Journal he substantiated the fact, and believes that
several cases regarded as typhoid were really Malta
fever infection.

Diphtheria. — Two deaths only occurred from diph-
theria amongst Europeans although 22 persons were
attacked. The reason for this low death-rate is no
doubt due to the more general use of antitoxin, which
is now produced in the Shanghai Health Laboratory.

Scarlet fever, & rare disease anywhere in Asia,
except in Asia Minor, seems to have come to Shanghai
to stay. Five cases were notified in 1905, in one of
which the disease proved fatal.

Tuberculosis heads the list of fatal diseases, both
among foreigners and natives, due to а great extent,
no doubt, to overcrowding.

Plague cases were not met with in Shanghai during
1905.

Malaria of the benign tertian type occurred in
Shanghai, but no deaths from the disease were re-
ported. Anopheles sinensis is the variety of mosquito
prevalent.

Dengue reached Shanghai in September of 1905,
but the cases were neither numerous nor serious.

Beri-beri attacked 7 persons only, of whom 4 died.
The municipal gaol was practically free from the
disease during the year in question.

Dysentery caused but one death; there were three
liver abscesses amongst Europeans.

The work at the Public Health Laboratory is evi-
dently highly efficient, and the Health Department
must be congratulated upon the extent and thorough-
ness of the work of sanitation which is rapidly bring-
ing Shanghai to the forefront as a healthy place of
residence for Europeans and for Chinese.

——— 9 —————
1201008.

Tue Mepicat Diseases оғ Eaver. By Е. М. Sand-
with, M.D., F.R.C.P. Part I. London: Henry
Kimpton, 13, Furnival Street, Holborn, E.C.,
1905. Pp. 316.

Dr. Sandwith has given us a book of a kind which is
rare nowadays. It is written іп а manner which

194

€ THE JOURNAL OF TROPICAL MEDICINE.

goes far to refute the accusation we are wont to hear
frequently repeated, that medical literature in recent
times has disassociated itself from all attempts at
literary style. Тһе whole book is interesting, and the
matter is clothed in & manner at once fascinating and
educative.

The opening chapter on “Тһе Medical History in
Egypt” shows a wealth of research and knowledge of
which it is well known Dr. Sandwith is master. The
chapter on Typhus reminds us that this disease still
prevails in countries less favoured hygienically than
our own. Where extreme poverty and ignorance of
publie hygiene obtain, there will typhus flourish, &nd
until these are overcome typhus will continue.

Relapsing fever is traced historically, and at the
present time when spirillar parasites are being dis-
covered to be the cause of many ailments, it is well to
have a description of its typical signs and symptoms.

Dr. Sandwith is of opinion that Egyptian town
dwellera now suffer more from enteric fever than they
did fifteen or twenty years ago. This is an experience
in accordance with that of medical men in most
tropical and sub-tropical countries. Whether this is
due to more careful diagnosis, to Europeans carrying
infection thither, or to an immunity acquired by
natives in early years of life through having had the
disease, is a matter of opinion at the present time.

Mediterranean Fever was not recognised in Egypt
until 1883, when Dr. Sandwith recorded a case of the
disease. Since then Mediterranean fever has been
met with both amongst Europeans and natives.

Infectious Jaundice (Weil's disease) occurs as a rule
only amongst the poorer classes of the community,
but during epidemics of the disease any and every
class are attacked. Dr. Sandwith is of opinion that the
disease is carried by mosquitoes or other insects.

Scarlet fever is occasionally met with in Egypt, and
measles is fairly prevalent.

Small-pox has committed fearful ravages in the
Sudan during recent years, and in Lower Egypt
during 1903 there were 2,118 cases reported, with
394 deaths from the disease.

Egypt is not free from an occasional outbreak of
mumps.

Plague.—No mention of plague is contained in
Egyptian papyri, but from the time of the third
century B.c., the disease would appear to have
recurred in Egypt at intervals, up to the present day.

Bilbarziosis specially appertains to Egypt, for it was
Dr. Bilharz, at Kasr-el-Ainy Hospital in Cairo, who
first discovered the connection between hematuria
and the Bilharzia parasite. The association between
urinary calculi and this parasite, also first determined
in Egypt, has revolutionised our idea of the pathology
of these calculi.

A full description of Anchylostomiasis is welcome ;
and here, again, we have to thank an observer in Egypt,
Dr. Looss, for his careful work on the subject, and
for his brilliant observations on the mode of entrance
of the larve of Anchylostoma by way of the skin.

The chapter on Pellagra closes the first volume,
which is characterised by an accuracy of statement, а,
clearness of diction, and a knowledge of medical
history ns rare as it is pleasant to meet with.

(June 15, 1906.

Tae British Guiana MEDICAL ANNUAL por 1905.
Edited by C. P. Kennard, M.D.Edin., M.R.C.S.
Eng. Price 5s. Printed by “Тһе Argosy”
Company, Limited, Demerara.

We welcome this admirable medical annual, and
congratulate the Editor and contributors upon the
excellence of their volume.

CoNTENTS.

(1) “ Anehylostomiasis." By the Hon. J. E. God-
frey, M.B., С.М Edin., Surgeon-General.

(2) “Preliminary Notes on the Mosquitoes of British
Guiana.” By the Rev. J. Aiken, M.A., and E. D. Row-
land, M.B., C.M. Edin.

(3) “ Report оп Small-pox.” Ву J.
L.R.C.P. & S.Edin., L.F.P. & S.Glas.

(4) “Acute Anemia.” Ву C. P. Kennard, M.D.
Edin., M.R.C.S. Eng.

(5) “Тһе Criminal Insane and the Insane Criminal.”
Ву P. M. Earle, L.R.C.P. & S.Edin.

Teixeira,

(6) “On Cataract Disease in British Guiana.” By
A. Wylie, M.A., M.B., B.C.Cantab., M.R.C.S.,
L.R.C.P. Lond.

(7) “Тһе Value of Bsta Naphthol in Treatment of
Anchylostomiasis.” Ву Q. B. De Freitas, M.R.C.S.
Eng., L.R.C.P.Lond.

. (8) “ Typhoid Fever."
Edin., M. R.C.S.Eing.

(9) “Тһе Climate of Peter's Hall District and its
Effects on the Inhabitants.” By J. E. Ferguson,
M.B., C.M.Edin.

Part Il.—Clinieal Notes.
Wylie, De Freitas, Earle,
Kennard.

Part I[I.—Transactions of the British Guiana
Branch of the Medical Association for 1904 and 1905.

Anchylostomiasis.

The measures by which the disease can be stamped
out are stated by Dr Godfrey to be :—

(a) The diagnosis of every case.

(b) The treatinent of every case.

(c) The destruction of fæces of persons known to be
infected.

(d) The prevention of contamination of the land
round and about the labourers' residences, and the
fields in which they work.

(e) The prevention of contamination of the drinking
water.

(7) The distribution of leaflets containing a simple
narrative of the disease.

(9) Making it an offence for any person to defecate
on any part of the land except those portions set apart
for the purpose.

By C. P. Kennard, M.D.

By Drs. Douglas,
Boase, Teixeira, and

Dr. Aiken, in his article, enumerates the British
Guiana mosquitoes (from Theobald) as follows :—

Myzomia lutzit; Stethomyia nimba; Cellia argyro-
tarsis, sub-species, C. albipes; Meyarhinus hemor-
rhoidalis, M. separatus; Janthinosoma musica, J.
lutzii; Stegomyia fasciata, S. luciensis; Culer
teniorhynchus, C. serratus, C. confirmatus, C. nubilis
C. scholasticus, C. flavipes, C. fatigans, C. serratus ;
Melanaconion atratus vel Culex atratus ; Teentorhyn-
chus fulvus or Culex fulvus, Т. confinnis, T. fasciolatus ;

June 15, 1906.]

Mansonia tittilans: Dinocerites cancer ; Uranotenia
pulcherrima ; Ædeomyia squammipenna ; Hemagoqus
cyaneus, П. ^albomaculatus ; Dendromyia | ulocoma,
D. asullepta, D. (quasi) luteoventralis ; Runchomyia
frontosa; Sabethes remipes ; Sahethoides confusus ;
Goeldia fluviatilis.

Рнтніві IN THE CITY OF CALCUTTA DURING THE
Year 1905. Т. Frederick Pearse? M.D., F.R.C.S.

By a more careful notification of the causes of death
in Calcutta, Dr. Pearse has been enabled to come to
more definite conclusions concerning the prevalence
of phthisis in that city than has been hitherto pos-
sible. A paragraph from the report places the result
of the investigation strikingly before us. ‘ Perhaps
the most striking feature shown by our investigations
is the excessive prevalence of phthisis amongst
females. Among males the death-rate was only 1:4
per 1,000, which is almost as low as the general rate
for England (viz., 1:3 рег 1,000), whilst amongst
females the rate was more than double, viz., 2:36 per
1,000. Equally noticeable is the extreme prevalence
of the disease amongst Mahommedan females, the
rate for whom works out at no less than 4-6 per 1,000.
In England the death-rate is higher among males than
among females. Mahommedan males had an only
slightly higher rate than Hindus. The high death-
rate from phthisis in „Calcutta is entirely due to the
fatality of the disease amongst females. Mahommedans
of both sexes, however, suffer more than Hindus.”

------
ею Sustruments, %.

Messrs. Mayer AND MELTZER, 71, Great Portland
Street, London, W., have sent us their catalogue of
instruments used in the practice of laryngology,
rhinology, and otology. The catalogue is a very
complete one, and shows the careful attention Messrs.
Mayer and Meltzer have paid to this branch of
surgical appliances. Accompanying the catalogue is
а handsome extract from “ hospital work in London,"
with illustrations showing the work rooms of the firm
and their general hospital fittings.

55.2. сі: 42.
Hotes and "lets.

Rats AND PrAGUE.—Àt a meeting of the Lahore
Plague Managing Committee it was resolved that an
epitomised copy in pamphlet form of the article in the
Civil and Military Gazette of March 24th regarding
the transmission of plague by the rat-flea be printed
and distributed through the medium of the various
plague sub-committees.

WE are glad to know that the proposed South
African Medical Association is likely to prove a success.

LirEuTENANT-COLONEL GILES asks us to inform his
correspondents who may be sending him entomological
material, that his address has been changed to 3,
Elliott Terrace, The Hoe, Plymouth.

THE JOURNAL OF TROPICAL MEDICINE.

195

Personal Hotes.

India Office: Arrivals in London of Indian Medical Officers.
— Major J. Chaytor White, Captain W. H. Henrich, Major
К. G. Turner, Lieutenant-Colonel О. Н. Channer, Captain
а. О. T. Groube, Lieutenant-Colonel C. J. Parkies, Captain
J. D. Graham.

Promotions :

The following Promotions are made in the Indian Medical
Ѕеггісе. — Majors P. Hehir, L. J. Pisani, W. R. Edwards, С.
MacTaggart, G. I. H. Bell. I. Daly, H. Fookes, E. Hudson,
A. W. Dawson; and W. Н. Robson to be Licutenant-Colonels ;
and Captains G. Lamb, Н, Burden, С. Н. Bowle-Fvans, I.
Fisher, К. S. Peek, S. A. Harris, E. C. Macleod, C. Thomson,
D. W. Sutherland, aud W. Selby, to be Majors.

Leave.
Major С. T. Birdwood, 2 m. 12 d.
Major W. D. Sutherland, 15 m. combined leave.
Postings.

Captain H. G. Walton, from Sitapur to Agra.

Captain J. Stephenson to be Civil Surgeon, Shahpur.

Captain D. H. Е. Cowen to be Civil Surgeon, Murree.

Captain L. В. Scott ofticiates as Civil Surgeon, Cachar.

Captain P. F. Chapman, from Civil Surgeon Chihindwara to
Akola.

-----о-

Geographical Distribution of Disease.

As information arrives we publish, under this heading, the
principal diseases met with in tropical ала sub-tropical
countries, so that those interested in the Geographical Dis-
tribution of disease may have a means of gathering informa-
tion concerning the prevalent ailments in different parts of
the world.

Philippines.

Cholera.—Manila has been free from cholera since
February 21st. During the present outbreak, which
commenced on August 23rd, 1905, there have been
282 cases of cholera with 250 deaths from the disease
in the city of Manila. In the provinces there were
3,742 cases of cholera reported, with 2,407 deaths.

Leprosy.—Two cases of leprosy, which were treated
with the X-rays, and in which the symptoms dis-
appeared for a considerable time, have proved dis-
appointing, a relapse having occurred in hoth cases.

Small-pox.—Tue provinces of the Philippines, in
which vaccination was thoroughly carried out, have
remained almost free of small-pox, but in unvaccinated
districts the disease has prevailed extensively lately.

-------т-

Recent and Current Literature.

A tabulated list of recent publications and articles bearing on
tropical diseases is given below. To readers interested in
any branch of tropical literature mentioned in these lists
the Editors of the JOURNAL OF TROPICAL MEDICINE will be
pleased, when possible, to send, on application, the medical
journals in which the articles appear.

TSETSE-FLIES AND TRYPANOSOMES.

Minchin, Prof. E. A., who, it may be remembered, was
deputed to Uganda by the Royal Society to study the rela-
tions between Trypanosoma gambiense and Glossina pal-
pelis, gives, in his pamphlet of eight pages, the results he
has obtained at Entebbe, in association with Lieutenants
Gray and Tulloch, К.А.М.С. Previously to his joining them,
these two officers believed they had discovered evolutionary
forms of the Т. gambiense in the flies.

196

THE JOURNAL ОЕ TROPICAL MEDICINE.

[June 15, 1906.

Minchin’s results are, however, somewhat disappointing,
ав һе believes the forms they observed have no connection
with the trypanosome.

Some 8 per cent. of the tsetse-flies found in the small
island of Kimmi were infected with these supposed evolu-
tionary forms, two distinct species, one resembling the
trypanosomes of birds and the other that of mammals, being
distinguishable ; but no corresponding vertebrate host could
be discovered, and inoculation of animals capable of har-
bouring T. gambiense gave negative results. Оп this
account it appears more probable that these forms, which
are of the Herpetomonas type, are really special parasites of
the tsetse-tlies, like the herpetomonads of ordinary flies
which do not suck blood.

Some were also found in a Glossina born in the labora-
tory, and which had been fed only on the blood of a domestic
fowl, so that it seems probable that these herpetomonads
can be transmitted by hereditary infection.

Attempts to infect flies by causing them to bite infected
animals gave doubtful results. Changes resulting in the
differentiation of what seemed to be male and female types
went on for forty-eight hours, but then the process came to
an abrupt halt, and by the end of seventy-two hours few or
no trypanosomes remained in the stomach or demonstrable
by dissection, though it is possible that sectionising may
yield different results. We are therefore still without any
proof of the existence of any developmental cycle within
the tsetse at АП comparable with that of the malarial para-
site in the mosquito. If any such cycle take place, it is
presumable that the infection of the fly would require &
certain interval for development, after feeding with infected
blood, but no such periodicity can be shown to exist. Тһе
Glossina can, however, undoubtedly act as a simple vehicle.
Thus experimenting with rats seriously infected with а
irypanosome (probably T. Brucei) by causing flies fed on
them to bite healthy animals, four successes were ob-
tained out of five experiments, while using Stomorys only
one success in four resulted. It is further noteworthy
that while the trypanosomes survive seventy-two hours in
Glossina, they persist but twenty-four hours in Stomorys.

Prof. Minchin therefore inclines to the belief that the
tsetse acts simply as a vehicle, and points out that if it
really played the part of an intermediate host, the spread of
the disease in human beings would probably be far more
rapid than it is.

“ Zeits. f. Hygiene,” T. lii., p. 31, with 2 plates.
THE PaTHOLOGIcAL Нівтоһовү оғ EXPRRIMENTAL МАСАМА,

Sauerbeck, Ernst. Тһе author compares the pathological
histology of trypanosomiasis with that of tropical spleno-
megaly from the Piroplasma Donovani. Не examined the
organs of rats, guinea-pigs, rabbits and dogs infected with
Trypanosoma Brucei, but found nothing to add to the results
of previous investigators. In the blood no degenerative
processes are normally observable in the trypanosomes, but
such are commonly to be found in the internal organs,
notably in the spleen, lymph glands, bone-marrow, and liver,
and less markedly so in the lungs.

The author regards the amceboid and other forms described
by Plimmer and Bradford, and which they considered as
stages in a complicated system of evolution of the parasite,
as merely of the degenerative character, and further points
out their close resemblance to the Leishman-Donovan
bodies. Prof. Mesnil, commenting on the paper in the
Bulletin of the Pasteur Institute, however, points out that
though the resemblance between the two forms is unde-
niable, it cannot warrant our regarding tropical spleno-
megaly and trypanosomiasis as belonging to the same
category of disease. The Leishman-Donovan bodies are a
normal and definitive form for the human organism, and,
despite the fact that cultivations of the P. Donovant
give rise to flagellate forms, never include any trace of
Hagellate forms іп vivo. The smaller bodies found in try-

panosomiasis, on the other hand, are no part of the evolu-
tion of the parasites, but are merely stages of their
degeneration, which rapidly disintegrate, while the Leish-
man-Donovan bodies maintain a perfect integrity. The
involution forms of the trypanosomes are usually intra-
cellular, and in course of digestion by phagocytes and
Sauerbeck’s own descriptions clearly show that the histo-
logical changes in the organs are due to proliferation of the
latter, but he nevertheless insists on the complete resem-
blance between these histological elements and those found
in tropical splenomegaly.

The phagocytic action of the mononuclear cells can be
demonstrated by making an intraperitoneal injection of
trypanosomes. The macrophages engulf the perfectly
mobile parasites, which take a rounded form in their interior,
and the same process evidently occurs in phagocytic organs,
which behave in this case exactly as they do in malignant
carbuncle, typhoid fever, or plague.

* Atti della Socleta per gli Studi della Malaria,” T.vi.,
Rome, 1905, 666 pages.

The volume is made up of the reports for 1904 of a
number of writers who for the most part concern themselves
with the results of preventive measures for malaria.

On the railways protection by metullic gauze for em-
ployees continues to be favourably reported upon, but it is
pointed out by V. Polettina that for private individuals the
expense is prohibitive, except in the case of the well-to-do.
This contributor also considers that the dangers of rice
cultivation are exaggerated, but it is obvious that this
opinion may be based on local peculiarities of the district
under his observation.

A large portion of the volume is occupied with reports on
the results of the prophylactic administration of quinine,
and the opinions of the various writers appear to be uni-
formly favourable. In many cases the sickness among the
unprotected was three times as great as among those taking
quinine, and in view of the large numbers treated, many of
whom must have occasionally forgotten to take their dose,
this must be considered highly satisfactory. р

The annual cost per head, according to G. Soliani, is
about 2.20 lire, or 1s. 10d.

The ‘year’s results are summed up by Prof. Celli in an
able article. Judged by effects on the general population,
the year 1904 was a bad one. In the north, benign tertian
predominated, but in the south the Roman Campagna
malignant tertian was commonest. Cases of quartan fever
where irregularly distributed. In an epidemic, cases of
relapse are always more numerous than those of primary
infection. In the Roman hospitals cases of relapse were
very common in July and August, and diminished suddenly
in September, whereas usually relapses are most common in
September and October. Primary infections were most
numerous in July and August.

Although many contributors witness to the efficacy of
Koch’s method of large doses every eight or nine days,
Prof. Celli appears to give hie verdict in favour of the daily
administration of moderate doses of 6 or 8 grains.

Rotices to Correspondents,

1.—Manuscripts sent in cannot be returned.

2.—As our contributors are for the most part resident abroad,
proofs will not be submitted to those dwelling outside the United
Kingdom, unless specially desired and arranged for.

8.--То ensure accuracy in printing it is specially requested
that all communications should be written clearly.

4,—Authors desiring reprints of their communications to the
JouRNAL оғ TRoPICAL MEpicINE should communicate with the
Publishers.

5.—Correspondents should look for replies under the heading
“ Answers to Correspondents.”

July 2, 1906.)

@niginal Communications.

A FURTHER REPORT ON MEASURES TAKEN
IN 1901 TO ABOLISH MALARIA FROM
KLANG AND PORT SWETIENHAM IN
SELANGOR, FEDERATED MALAY STATES.

By E. А О. Travers, M.R.C.S., L.R.C.P.,
State Surgeon, Selangor, and
Matcotm Watson, M.D., D.P.H.,
District Surgeon, Klang.

THE measures taken to abolish malaria from Klang
and Port Swettenham in 1901 and 1902 by the ex-
termination of mosquitoes by means of extensive
. drainage and other operations tending to do away
with their breeding grounds, have been fully reported
on in the JOURNAL or TropicaL MEDICINE of Sep-
tember 15th, November 10th, and December Ist,
1908, and April 1st, 1904.

It is proposed in the present article to show that the
expenditure undertaken by Government, with a view
to improving the bealth of the inhabitants of these
towns, has been fully justified by the results which the
experience of the last four years justifies us in con-
cluding will be of a permanent nature.

For the information of those who have not read the
previous articles on this subject, a brief account of the
works carried out may be of interest.

Port Swettenham.—An area of about 110 acres,
formerly low-lying, swampy land covered with man-
grove trees, has been cleared and carefully drained.
In the neighbourhood of the railway, Government
buildings, and town site, a considerable area has been
filled in and levelled, partly to do away with the
breeding grounds of mosquitoes and partly to provide
building sites. The whole area not occupied by build-
ings or roads is now covered by grass.

The total expenditure on works other than the
preparation of building sites has been (to the end of
1905) £7,000, and the annual cost of upkeep of drains,
&c., is approximately £40, for clearing earth drains
and for town gardeners, £100.

Klang.—The area affected by the operations is about
882 acres. Twenty-five acres of virgin jungle and
80 acres of dense secondary growth (in places 30 to 40
feet high) have been cleared and 36 acres of perma-
nent swamp have been drained. The areas cleared
are now mainly under grass.

The total expenditure to end of 1905 has been
£8,100, and the cost of annual upkeep is about £60
for clearing earth drains, and £210 for town gardeners.

As will be seen by the following statistics of cases of
malaria treated at the District Hospital, Klang, the
improvement in the health of the inhabitants of the
areas treated began immediately after the completion
2 the drainage and other works, and has continued to

ate.

Table showing the number of cases of malaria
admitted to the Klang Hospital from Klang Town and
Port Swettenham, as compared to the number of cases
admitted from other parts of the district :—

THE JOURNAL OF TROPICAL MEDICINE.

197

i
1904 | 1905

129 48 98 | 13

1
Residence 1902 , 1908

—— —— —— —— — — — ——

Klang .. 5% - .. 894
*KlangandPortSwettenham 88
Port Swettenham .. .. 184
Other parts of District 197

Total ..

1901

70 , 21 4
204 150 | 266

E
' 858

b |

|
je ex |
.. | 807 | sos 1919 | 298 | 876

AAI BEES ACER RTT АЕ а T PT TN ST YAT Анов SE A TE ELS IESE Vatt
* Certain persons lived some nights in Klang and some in
Port Swettenham.

The following table shows the number of deaths
from fever and other diseases which have occurred at
Klang and Port Swettenham during the last six
years. The population in 1901 was about 4,000, but has
largely increased since.

Deaths in Klang and Port Swettenham corrected for Deaths in
Hospital. Я

Бехег.. 259 | 368 59 46 48 45
Other Diseases 215 | 214 85 69 74 68
Total .. 474 115 122 118

582 ' M4
i

It will be noted that the remarkable improvement
in the health of the inhabitants which occurred in
1902, immediately after the anti-malarial works had
been completed, has been well maintained.

The following table shows the number of deaths
occurring in the district of Klang, excluding the town
of Klang and Port Swettenham. (Population 14,000
in 1901, since largely increased.)

Deaths in Klang District, excluding Klang Town and Port
Swettenham,

1905

І |
227 | 230 : 286

Fever.. s 266 351
Other Diseases 150 176 | 198 : 204 271
Total .. 416 408 | 498 |490 | 612

These figures are especially valuable as a proof that
the marked improvement in the health of the inhabi-
tants of the town of Klang and Port Swettenham is
due to the anti-malarial measures carried out, and not
to a general improvement in the health of the district.

In Klang and Port Swettenham we have 368 deaths
due to fever in 1901, and 45 only in 1905; whereas in
the rest of the district, which has not been dealt with
by any special anti-malarial works, we have 266 deaths
due to fever in 1901, and 351 in 1905.

It may here be mentioned that Klang is a large
planting district about 380 square miles in extent, that
it is mainly low-lying flat land utilised for the cultiva-
tion of rubber, and that it would be almost impossible
to protect the scattered population from malaria by

198

drainage and filling in swamps. А great deal is now
being done on most of the estates by regular admin-
-istration of quinine, and. also -by protection - from
mosquitoes. ' с
Malaria in children as evidenced by Examination of
blood.—No better indication of the presence or absence
of malaria in any given district can be obtained than by
a systematic examination of the blood of children. ~ :
Тһе following details of the results of examinations
.carried out by Dr. Watson in 1904 and 1905 are of
considerable interest :— ;

Results of Examination of Blood of Children in Klang and
Port Swettenham (specially Drained Areas). А

l Nov. AND Dec., 1904 Nov. AND Dec., 1905

= t "Ч.
ae аны
Z = 25 Е 2 | #3
E g | 55 3 & | 8
А ым = Еч ш = МЕ
6 - шт б с EU

К 7
Klang.. Vs .. | 178 1 0:57 | 119 0-84
Port Swettenham ..| 87 | 1 1:14 16 0 0:00
` Total .. 200 2 | 0:76 |195 ' 1 | 0:51

Results of Blood Examinations in other Parts of District not
. especially Drained.
А
Nov. AND Dec., 1004 Nov. anp Пес., 1905

d :
No. | Percentage No. Percentage
Examined | Infected , Infected |Examined Infected Infected
--------|---- асары Қашыр
298 101 | 33:89 |. 247 59 93:8

Improvement in Health of Government Employées.—
The remarkable way in which the health of the
Government employées residing at Klang and Port
-Swettenham has been affected is well shown by the
following figures. It may be mentioned that іп 1901
the number of persons residing at Port Swettenham,
.employed by Government, was 176, and in 1904, 281.

Table showing Number of Sick Certificatessand Number of Days’
Leave Granted оп account of Malaria,
қ ! | to i
: .. 3901 ' 1902 , 1008 ! 1904 | 1905
^ ' ` т ы i

SUE E ЕРЕСЕН E LER alise ls

ECT матка аласа атка
936 40 | 95 Mi 4
01026198 , 73 , T1 | 30
| і i |

A f f APR ESTERS лед беен SE

Certificates .
Days of Leave

The conclusions to be arrived at from the figures
given in this report are very evident :—
(1) Measures taken systematically to destroy the
breeding place of mosquitoes in the towns, the inhabi-
. tants of which suffered terribly from malaria, were
followed almost immediately by a general improvement
in health and decrease in death-rate.
(2) That this was due directly to the works carried

THE JOURNAL OF TROPICAL MEDICINE.

.. uniformly narrow tube down to the rectum..

[July 2, 1906.

out, and not to a general dying out of malaria in the
district, is clearly shown by figures pointing out that
while malaria has practically ceased to exist in the
areas treated, it has actually increased to a consider- .
able extent in other parts of the district where anti-
malarial measures have not been undertaken. ., .
..The fact that the statistics for 1905 are even more
favourable than those for.1902 is very strong evidence
in favour of the permanent nature of the improvement
carried out.

If, as it is hoped, malaria has beén permanently
stamped out from Klang and Port Swettenham by
works undertaken in 1901, our experience in the Malay
States should be of value to those responsible for the
health of communities similarly situated in many other
parts of the world. е

THE ANATOMY OF THE BITING FLIES OF
THE GENERA STOMOXYS AND GLOSSINA.

By Lieut.-Colonel G. M. Gites, 1.М.8. (Rtd.).
(Continued from p. 185.)

Тне abdomen is а good deal shorter than the wings,

. and, seen from above, appears to be composed of only

four segments, the juncture between the first two being
hidden and the remaining four concealed by being
curled under in the male or hidden in the telescoped
ovipositor of the female. In the gorged insect, the
whole of the ventro-anterior portion of the cavity is
taken up with the enormous crop, which in males,
when distended, occupies almost the entire space,
leaving the other viscera crowded into a comparatively
small space behind and above it. When empty of
food it contains a certain amount of air, and Lieut.
Tulloch’s account, transcribed below, must be taken
as referring to it in this condition: As his admirable
account, which entirely agrees with my own observa-
tions, is very brief and to the purpose, I cannot do
better than transcribe it, altering the nomenclature,
where necessary, to that hitherto employed. He
says -—. 52

T The midgut runs down into the abdomen of the fly as a
narrow tube of uniform diameter until it reaches nearly to
the posterior border of the crop. At this point it dilates to

"several times its former diameter, its wall at the same time
_ becoming thinner.

' and more distensible than in ‘Glossina, being about three

It is proportionately shorter, less coiled,

times as long as the fly itself. This dilated portion has
three simple coils, which lie superposed in the middle.of the
abdomen, and it then gradually narrows, continuing as a
The narrow
lower intestine has variable bends, but is not coiled, The
rectum is а dilated cone-shaped cavity, with its apex towards
the anus. Its walls are transparent, and through them are
seen the four trumpet-shaped rectal papille, the narrow
ends of which are pointed towards the anus, a single trachea
entering the base of each. Below the dilatation, the rectum
is continued to the anus as a short, narrow tube. In the
female the distal part of the rectum runs within the ovi-
positor, the anus opening between the last segment of the
ovipositor and the terminal plate. In the male the ejacu-
latory duct passes over it dorsally from left to right and
runs anteriorly to enter the penis. The appendages of the
alimentary canal are the Malpighian tubes, the crop and
the salivary glands. The Malpighian tubes arise from a

JOURNAL ОЕ TROPICAL MEDICINE, JULY 2, 1906.

б5

PLATE I.—1, Epithelium of chyle stomach, x 750; 2, vertical section, upper part of proximal intestine, х 750; 3, vertical section,
Icwer thin part of proximal intestine, x 270; /, lumen of intestine; 4, the same, x 750; 5, vertical section, upper part of
netenteron, х 270; 6, vertical section, lower part of metenteron, x 270; 7, drawing in perspective of rectal papilie as seen in a
d ssection of the rectum which is laid open, x 37; 8, vertical section of a rectal papilla, x 270; 9, transverse section of heart of
Stcmoxys, x 270; 10, tranverse section of heart of Glossina, x 270; 11,semi-diagrammatic representation of valves of heart of
Stomoxys, x 270; 12, pavement endothelium of pericardial septum, x 270; 13, portion of fat-body, x 550; 14, *' pericardial celi"
fat-body type, x 750; 15, pericardial cell, Lowne’s muscular type, x 750; 16, transverse section, thoracic aorta, х 1,200.

To illustrate article by Lieut.-Col. G. M. Gries, I.M.S., “Тһе Anatomy of the Biting Flies of the Genera Stomoxys and Glossina.’

July 9, 1906.)

THE JOURNAL ОҒ TROPICAL MEDICINE.

199

shallow constriction which marks the point of junction
between the midgut and metenteron, and it, together with
the true proctodeum, comprises in length about one fifth of
the abdominal intestinal canal. Two of the tubules arise
on either side from a short, common tube, all four being
about the same length. The two arising from one side have
thickened terminations, some four times greater than а

қ 1. 4.

Ета. 29.—Dissections of the abdomen of Stomorys, after Lieut. Tulloch, seen from
above :—(1) with the parts almost in situ; (2) with the alimentary canal unravelled ; ср,
common seminal duct; р, seminal duct; psc, duct of salivary gland; pss, crop duct;
н, dorsal vessel; мт, malphigian tubes; o, junction of distal intestine and meten-
teron ; P, proven riculus ; R, rectum; RP, rectal papillæ ; ва, salivary glands ; ss, crop;

ті, chyle

salivary gland, and lie in the pericardial sinus ; those of the
other are of uniform thickness, and end amid the fat body
of the lower abdomen. The salivary glands in the abdomen
are ventral to the crop, and seen from above only a knuckle of
each projects beyond it, and then turned forwards to end close
to the waist in slightly bulbous ends. Except for this
angular bend the glands are straight, and even if extended,
would not reach to the end of the fly. 2
Throughout its length the mucosa of the intestinal
canal is composed of a single layer of epithelial cells.
The wide thoracic portion of the midgut of the blow-
fly, called by Lowne the chyle stomach, is in Stomozys
& quite narrow tube, though it has the same structure
as in the former insect. Both it and the wide proximal
intestine is composed of a layer of cells whose compo-
nents vary & good deal in size and form, according to
the stage of secretory activity in which they have been
fixed. In the thoracic portion the muscular coat is
fairly distinct, and both the longitudinal and circular
fibres are arranged at intervals, leaving spaces where
there is only epithelium ; but the pouching out of the
lining into these spaces is by no means as marked as
in the blow-fly, so that eveu in proportion to its size
this part of the gut has not as strongly granular an
appearance when viewed with a dissecting lens. The
dilated part of the proximal intestine has an epithelial
lining (plate i., fig. 1) of much the same character, and
both in it and the narrow transparent part that
follows it the muscular coat is very ill marked, and
often appears quite absent in sections; though where
the transition to the structure of the narrow part occurs,
‘the. circular coat becomes very distinct (fig. 2). The
narrow partis lined with cubical cells of regular form

uct; tt, dilated ends of left malphigian tubes; vs, vesicular seminalis.

(figs. 3 and 4), and has a very distinct limiting mem-
brane towards the lumen of the tube. -

' The metenteron, on the other hand, is strongly
muscular, and is structurally divisible into two dis-
tinct portions. For the first and greater part of its
length itis lined with a distinct cuticular lining, the
epithelial elements of which are
scarcely discernible. In the ordin-
ary contracted condition of the
tube, this is wrinkled into deep
folds, in the interior of which
are strong longitudinal muscular
bands (pl. i., fig. 5), and outside
these is an equally strong coat of
circular muscular fibres. The last
short portion before the rectal
valve is of similar structure, but
here (fig. 6) the cuticular lining
has become distinctly chitinous,
and has developed into a curious
armature of powerful spines, the
-function of which I am unable
to conjecture. There is, however,
nothing generically peculiar in
this structure, which is, I believe,
found throughout the Muscide.
The “rectal valve" between this
portion of the intestine and the
rectum is lined with similar
spines, and is surrounded by
a muscular thickening. At first
the rectum is tubular, and its
chitinous lining has a distinct
basis of cubical epithelial elements; but after pass-
ing а quasi-sphincter formed by а thickening of
the muscular coat, it expands into a large cavity
which lies on the right side just under the interior
abdominal terga. This dilated portion of the rectum
is lined by а delicate chitinous membrane, the ері-
thelial basis of which is not easily demonstrable, and
is covered with a network of muscular fibres closer
meshed, but of the same general character as that of
the crop. This dilatation contains the four rectal
papille, which are four cylindrical projections ending
in blunt conical points, lying two and two lengthwise
in the intestine. They resemble a good deal the rectal
gills of certain aquatic larvæ, but according to Lowne
subserve the renal function, as he has found in them
a substance related to uric acid. Their general form
may be seen from the dissection (plate i., fig. 7) of the two
right-hand papille (the figure being eS) and in
section (plate i., fig. 8) are seen to be formed of very
large columnarcells surrounding a core of delicate meso-
dermie tissue in which is imbedded а large trachea.
Behind the papille the rectum contracts to a mere
slit, and the absolute anus is guarded by a strong
sphincter of unstriped muscle.

The malphigian tubes which enter the bowel
at the point of junction of the proximal intestine
with the metenteron hardly differ from those
of the mosquito even in size. Their large pig-
mented cells and slit-like lumen, zig-zag longitudin-
ally, must be familiar to most students of tropical
medicine from their dissections of those insects.
Lowne advances strong reasons for believing that

900

THE JOURNAL ОЕ TROPICAL MEDICINE.

[July 2, 1906.

their function is hepatic, and not, as usually sup-
posed, renal.

The crop has an elastic pigmented chitinous mem-
brane covered with ап open and rather irregular

Fic. 30.—General view of the digestive tract of Glossina
palpalis, as seen in dorsal view without disturbing its parts.
The heart and over-lying trachea and fat-body are removed in
the abdomen, also the muscles in the thorax, and the brain
and other parts of the nervous system are omitted from the
drawing. Тһе head is turned round to the left, in order to
show the pharynx, &c., in three-quarter side view. Ph, pharynx;
(s, esophagus (the portion which passes through the brain
being represented with a dotted outline); Sf, stomach; Th, I,
thoracic intestine, pulled over to the right, in order to show
the duct of the crop lying beneath it; S, D, salivary duct;
DS, St, duct of; 5, St, the sucking stomach; S, С, salivary
gland (that on the right is drawn from а specimen in which
the gland was more developed than in the case of that drawn
on the left); 1 13, limbs of the abdominal intestine (see
fig. 31); H, rectum. (After Minchin.)

network of unstriped muscle, and its ventral side is
connected with the abdominal sterna by a number of
single obliquely-directed striped muscular fibres. Its
whole structure is such that though clearly contrac-
tile, it is obviously absolutely incapable of active dila-
tation, so the name of “sucking stomach,” which is `
sometimes applied to it, should be carefully avoided.
In Glossina the abdominal intestine is longer, larger,
and in every way more voluminous, and the secretory
area of the dilated portion has its surface enormously
increased by deep infoldings of very large epithelial

Fra. 81.—Diagram to show the various limbs (1—13) of the
abdominal intestine, and their arrangement in the abdomen.
The asterisk * denotes the point at which the Malpighian
tubules arise in the tenth limb. (After Minchin.)

elements. The two figures herewith reproduced from
Professor Minchin’s paper will, in the light of what
has been said of the allied species, give a sufficient
idea of the arrangement of the parts, and as he pro-
poses to write a paper on the histology of the genus, any
further discussion of the subject here is superfluous.

The enormous development of the intestine is some-
what surprising in a species subsisting on so nutritious
a diet as blood.

The vascular system.— What is found by the writer
the readiest plan of demonstrating the dorsal vessel of
а dipterous insect is to compress the insect between
the fingers and thumb, at the same time, as far as
possible, strengthening out the dorsal curve, and then
to snip off the mid-dorsal portion of the abdomen by

‘a single stroke of a pair of sharp scissors.

The portion removed is then placed in water, under
the dissecting microscope, and as much as possible
of the fat body picked away. The facility of this
latter operation, however, differs greatly in different
species, but is especially difficult in Stomoxys. Lieut.
Tulloch, in his paper, notices this point. He says :—

“ Though several stained preparations were made, it was
impossible, owing to the fat body, which obscured all detail,
to count the chambers and cells in the heart wall. They
seemed, from & comparison of all preparations, to be re-

July 2, 1906.)

THE JOURNAL OF TROPICAL MEDICINE.

201

duced in proportion to the smaller number (four) of abdomi-
nal segments possessed by Stomozys."

Ав compared with Glossina, І am inclined to agree
with Lieut. Tulloch as to the number of chambers, but
must confess great uncertainty on the point.

Referring to Glossina, Prof. Minchin writes as
follows :—

* The vascular system consists ef the heart, in the abdo-
men, and its continuation, the thoracic aorta, in the thorax.

“The heart occupies the five anterior segments of the
abdomen, and is situated dorsally immediately below the
plates of the terga. It is so imbedded in the fat body and
pericardial tissue that not much can be made out of its
structure by dissection alone, and examination of it mounted
as & preparation for the microscope is necessary. It can
then be seen to have five chambers, each with a pair of
ostia and a pair of alary muscles, corresponding to the seg-
ments in which itlies. The alary muscles pass out at right
angles to the axis of the heart, and can be traced through
the fat body to their attachments at the external lateral
margins of the tergal plates.

“Тһе hindermost chamber of the heart appears to end
blindly posteriorly. A little way in front of the hinder end
are attached the two large alary muscles, the largest of the
whole series; not far in front of these again are the two
ostia, on the sides of the widest part of the chamber. In
front of the ostia tbe lumen of the heart narrows rapidly,
and to the narrow portion is attached the next pair of alary
muscles, lying in the hinder part of segment 4. This
arrangement is continued in segments 2, 3, and 4, the dilated
portion of the chamber, with the ostia, occupying the
middle of the segment, while the alary muscles, attached to
the constrictions between the chambers, lie in the posterior
regions of the segments. Тһе alary muscles of these three
segments are of moderate size. In segment 2 the heart
receives a pair of tracheal tubes, right and left, which come
to it opposite the ostia, and fork at once into branches run-
ning forwards and backwards. The alary muscles corres-
ponding to the first abdominal segment are very small and

ifficult to make out, and the region of the heart to which
they are attached does not show the slightest diminution or
constriction of its lumen, as is the case in all the chambers
posterior to it. In front of the first pair of alary muscles, at
the usual interval, are the two ostia, quite similar to those
of the other chambers. In front of the first pair of ostia the
lumen of the heart narrows to form a thin-walled vessel,
which passes through the waist to become the artery which
I have termed above the thoracic aorta. This last runs
along the thoracic intestine on its dorsal side, and is con-
tinued over the stomach, remaining apparently quite in-
dependent of the digestive tract, and only loosely attached
to it, until it reaches the esophagus. Неге it is firmly
attached and becomes considerably dilated. A short
distance in front of the stomach a conspicuous cushion-like
mass of large cells lies over the aorta. At first I took this
structure for à ganglion, but it appears to be a sort of lym-
phatic gland, judging from its appearance in sections. The
thoracic aorta is apparently continued through the neck into
the head, but I have not been able to follow its course
further than the thorax.

“ The microscopic examination of the heart shows further
that its floor is composed chiefly of fusiform cells resem-
bling unstriped muscle fibres, while its sides are made up of
gigantic cells with nuclei of corresponding proportions.
These cells are arranged with perfect regularity, and in a
manner exactly similar on the two sides of the heart. Each
ostium is formed by two cells, which are of small size when
compared with the huge cells building up the wall.of the
heart, but are very large when compared with the cells of
the surrounding tissues. Two of the giant cells intervene
on each side between the hinder end of the heart and the
fifth pair of alary muscles; two more between these muscles
and the ostia next in front of them; and so on with unfail-

ing regularity all the length of the heart, each ostium being
separated from the alary muscles next in front or behind by
just two giant cells. In front of the first pair of ostia are
found two cells of the usual size on each side, then a pair of
slightly smaller cells, which pass on into the walls of the
thoracic aorta. Thus the entire wall of the heart is built
up of 23 pairs of giant cells, not counting the ten couples of
smaller cells which compose the five pairs of ostia: to wit,
four pairs to each of the five chambers, two additional pairs
behind the fifth pair of alary muscles, and one pair
anteriorly, making the transition to the thoracic aorta. In
view of the fact that the thoracic vessel is itself to be con-
sidered as a modified anterior portion of the heart, it is in-
teresting to find that its delicate wall contains very large,
flattened nuclei, arranged in pairs right and left.

“The alary muscles consist of delicate fibrils, arranged in
an irregular fan-like manner, uniting into a stout muscle-
fibre which is distinctly striated.”

The above description, in the main, applies equally
well to Stomorys, aud is in entire agreement with such
observations as I have made on Glossina, except as to
the floor of the heart being composed of: “ fusiform
cells resembling unstriped muscular fibres.” It is
believed that the statement is referable to the appear-
ances presented by dissected specimens, which always
include the pericardial septum, which, seen in optical
section, certainly conveys the impression described.
As the result of the examination of sections, the
writer believes that Lowne is correct in describing the
dorsal vessel of Diptera as a hollow muscle, composed
at the most of two cells in any single transverse
section.

n
Ето. 32.

Lowne's conception of the heart of the blow-fly, as
gathered from his book, may be diagrammatically repre-
sented as in fig. 32, each large nucleated cell being
provided with lateral expansions which meet above in
tbe middle line. In Glossina, however, my sections
appear to show tbat there are always two cells in any
individual transverse section ; and that, as Professor
Minchin states, they are symmetrically disposed in
pairs, but I can find no difference in structure in the
upper and lower walls, and so doubt the existence of &
structurally differentiated floor to the organ.

In Stomorys there are also usually two cells in any
individual transverse section, but they are placed not
opposite each other, but alternately, so that only one
of the oblong nuclei is ever visible in a single section,
and opposite the middle of each the entire circumfer-
ence of the tube is presumably formed by that cell
alone. The number of giant cells would therefore be
less than in Glossina; but, like Lieut. Tulloch, I have
been quite unable to count them, and the heart is so

202

THE JOURNAL OF TROPICAL MEDICINE.

[July 2, 1906.

frequently damaged in serial sections of the entire
insect that they throw no further light on the point
beyond the fact that the nuclei are certainly opposite
in Glossina and alternate in Stomorys.

Seen in transverse section, the entire wall of the
heart has an uniform structure but for the nuclei of
its component giant cells. On close examination the
protoplasm is seen to be broken up into masses of
irregular prismatic section which form the cross view
of the longitudinal striation, which is distinctly visible
in longitudinal optical section. Plate i., fig. 9, repre-
sents a section of the anterior part of the heart of
Stomoxys (Banded form 9 ) in which, on the right side
of the figure, one of the nuclei of that side is cut
across, while that of the opposite side is divided
beyond the nucleus, and so represented only by a
slight projection. In pl. i., fig. 10, is shown a similar
section of the back part of the heart of Glossina, in
which the nuclei of the two component cells are
divided at about a corresponding level. It is note-
worthy that in this insect the cells project much more
into the lumen of the tube than in Stomorys, so that
at their thickest part they appear connected with the
body of the cell by а comparatively narrow pedicle.
Fig. 11 is a semi-diagrammatic representation of a valve
in Glossina as seen in optical section. It will be
noticed that it differs somewhat from Prof. Minchin’s
account of the number of component smaller cells, in
that three instead of two are represented as forming
the valve, but the appearances presented by a structure
seen in this way are notoriously deceptive, and I bave
no disposition to press the point. In Stomozys І have
as yet failed to obtain any satisfactory view of the
valves. (То be continued.)

-------4»----

Correspondence.
To the Editors of the JOURNAL oF TRorrcAL MEDICINE.

Dear Sirs,--The following case may be of some interest
to younger members of the profession in the tropics. A
blacksmith, S., aged 85, from Jerusalem, well-known as one
of the strongest men in the place, consulted me three or
four months since for abdominal pain. Nothing being much
wrong with him I prescribed a purge with santoninum. Next
.day he came back much pleased with the relief he had ех-
perienced, but I could hardly understand why he was so
pleased. However, next day his symptoms recurred, it
being cold weather and no history of fever and chills being
given, the idea of malaria never occurred to me.

Two days later I received an urgent message, and later an
offer of double the usual fee if I would go at once to see him.
He was doubled up with abdominal pain and had been very
sick, but there was nothing in the abdomen to account for
it. Finding he had a temperature of 103°, I took a slide of
his blood, warning him that if the examination were negative
he must go to hospital. The matter was cleared up, greatly
io my surprise, by my finding numerous tertian parasites
and gametes, and a few doses of quinine soon ended the
attack; the spleen was not at all enlarged.

I аш, &c.,

Ramallah, Jerusalem. J. CROPPER.

June 18th, 1906.

To the Editors of the JouRNAL oF TropicaL MEDICINE.

Sins,--In the course of my work with films from yaws
lesions and glands, I have been able to confirm some at

least of the observations of Dr. MeLennan (British Medical
Journal, May 12th, 1906), connecting spir. pallida with
cytorrhyetes luis.

The enclosed sketches were taken from a smear of serum
ofa cleaned frambwæsia, stained іп Giemsa solution. They
show in the briefest way the almost certain identity of the
organisms found in syphilis and yaws. Я

The study is a difficult one, especially for а medical
officer * fed тр” with work, and I have been handicapped
by want of higher powers. The London School of Tropical
Medicine lent mea Үү, but unfortunately they required it
again before one had got well into the research.

I am now awaiting new lenses, and hope to be in a
position to report progress later.

Fic. 1. Fig. 2.
A group as actually seen. Some forms occurring on same
slide as fig. 1.

St. Vincent, D.W.I. C. W. Вваксн, М.В.

Мау 29th, 1906.

To the Editors of the JouRNAL or TnorrcAL MEDICINE.
Dear Sirs, —I enclose a slide showing a method of prè-

paring films of blood which I have found very useful in

practice. It has the following advantages:—(1) Great
simplicity. (2) The film can be made at any distance from
the edge of the slide. (3) In an emergency the ear can be
cut with the edge of the slide in the absence of knife or
needle. An ordinary ground glass slide is clipped by
scissors so that one end ік narrowed to the desired width of
the film, this varying according to the particular mechanieal
stage in use. The film is made in the ordinary way as

described by Daniels, i.e., with the end of the slide.

I am, &c.,
J. Сворркв, M.D.

Film made by slide below.

Slide cut to desired width.

July 9,:1%6.)

THE JOURNAL ОҒ TROPICAL MEDICINE.

203

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Journal of Tropical Medicine
Juny 2, 1906. |

HYGIENIC MEASURES AGAINST SYPHILIS.
pe o Harsen Lecrure No. III.

Рвоғвввон METCHNIKOFF dealt with syphilis and
its prophylaxis in manner at once practical and scien-
tific. Syphilis, like tuberculosis and influenza, is
directly contagious from man to man, requiring no
intermediary host to transmit the infection. At first
sight it would ‘seem an easy problem to check the
spread.of a.disease which is conveyed by intelligent
human beings by appealing to their intelligence, com-
pared with what would seem the unsurmountable
difficulties of preventing the spread of disease by, say,
irresponsible insects serving as intermediary hosts in
such diseases as malaria, filaria, yellow fever, and
others. Yet it is not so ; animal pests can be destroyed,
mosquitoes can be prevented breeding their kind, but
appeal to man's intelligence is well nigh useless in
conflict with the passion which determines the infec-
tion of syphilis. The disease is, as a rule, contracted
by quite young men and women at an age before
acquaintance with the world has enabled them to
grasp, or it may be to have heard spoken of, the
meaning of syphilitic infection or how it is conveyed.

. In Western Europe one sees for the most part the
individual attacked ; in Russia the whole family may
suffer. In remote villages the disease, once introduced,
not infrequently spreads from child to mother, to grand-
parents, and to brothers and sisters by kissing the

infant. After pointing out the destructive influence
syphilis has upon the body tissues and upon duration
of life, Professor Metchnikoff dealt with the prophy-
laxis of the disease. Тһе proposal that young peraons
should be told the meaning and dauger of promiscuous
intercourse and the terrible effect of acquired syphilis
was dismissed as impracticable, and as wholly ineffi-
cacious and undeterrent. Medical inspection of women
likely to spread the disease is also au inetlicient
method, as much of the infectio takes places amongst
quite young girls before they become declared public
prostitutes. Early marriages are not calculated to
diminish the evil, owing to the extreme youthfulness
of the great proportion of syphilitics, the disease bein

contracted before even the age at what may be calle

youthful marriages аге wise or usual. Professor
Metehnikoff then proceeded to show that the only
prophylaetie of practical value is the early application
of mercury. By experiments on animals, and even on
men, by several observers it has been shown that an
inunction of metallic mereury, calomel, white precipi-
tate, or salicyl-arsenite of mereury with lanolin of the
strength:of 1:3 or 1:4 gives satisfactory protective
results. Inunction should be thorough, persisted in
for four or five minutes, and applied between one and
twenty hours after inoculation. ‘The result of experi-
ments is that mercurial ointments may certainly be
useful prophylactics against syphilis in all those cases
where a contact, however little suspicious, has taken
place. Instead of blue ointment, which causes much
irritation of the skin and mucous membranes, the use

_of salves made up with non-irritating mercury salts

above mentioned, should be recommended.

Professor Metchnikoff dismisses the contention of
persons who would punish sexual delinquents by
allowing the disease to run its course as prudish, and
sums up the matter by pointing out the effect of allow-
ing the opinions of persons with such beliefs to be
heard, in these words :—'' Persons who look apon the
prophylaxis of syphilis as immoral should apply the
same reasoning to the use of antiseptics in midwifery,
because it facilitates criminal abortion." Further, he
states: ' No considerations of a moralising tendency
should be opposed to the prevention of so disastrous
a calamity as syphilis. True morality ought rather to
contribute as much as possible to the prophylaxis of
this and many other diseases.”

THE TRAINING OF THI
INDIAN SUBORDINATE MEDICAL SERVICE.

Some 250 students of the Punjab Medical College at
Lahore recently waited on the Inspector for Civil Hos-
pitals to represent certain grievances. They complain
that certain of the native professors are arbitrary and
abusive, and desire the right of direct appeal to the
Principal. .Тһеу also represent that their books and
appliances are obsolete, and begged that the lectures
should be delivered in English, as all have passed a
sufficient test in English at the Entrance Examination.

The unanimity of the students in this case makes it
probable that the above incident is no mere ebullition
of the factiousness to which the native student is some-

904

times prone, more especially as there сап be no doubt
that they bave grave and genuine grounds for their
dissatisfaction. As to the merits of their complaints
against their native lecturers we have no means of
judging, and, in any case, they affect the qualifications
of individuals only and not the general question of the
system of management of the vernacular medical
schools; but the plea of the students is really for
European governance and teaching, and is a very
remarkable instance of the genuine preference of the
Indian for English rule. The young educated Indian
is, very naturally, apt to inveigh against his rulers as
invaders and oppressors, but where his personal
interests are concerned he will generally be found to
prefer English professors and judges to his own coun-
trymen. Personally, we think this distrust is gener-
ally quite unmerited, but it is possible that the native
best knows his own business, and there can be no
doubt that in this particular case the students’ stric-
tures on the schools and their appliances are quite
justifiable, and especially in the matter of available
medical literature. The vernacular medical student is
so poor that the publication of books to meet his
requirements cannot possibly be expected to be a pay-
ing traneaction, and hence most of those available are
practically obsolete rechauffés of English text-books,
designed to mect the requirements of Huropean
students of & past generation. It must be remem-
bered that text-books intended for the use of candi-
dates for full medical qualifications are quite unsuited
for the purpose of the vernacular student, as they are
over-laden with too much detail to be fitted for the
use of men who have but a limited time at their dis-
posal ; and hence mere translations of even the best
modern text-books, however faithful, will in no way
meet the special requirements of the case. To be

really suitable, special text-books must be compiled in

в more or less ‘‘semi-popular " style, and but little
writing of the sort has, as yet, been attempted.

As already indicated in our article on ‘ The Problem
of Medical Aid in Semi-civilized Countries," we should
be the last to propose to convert our Hospital Assistant
class into fully qualified practitioners, but are, пеуег-
theless, convinced that such instruction as they are
given should be the best available, and that greater
ab lity is required of lecturers who have to teach men
less educated than themselves, than of those who have
to deal with their own intellectual equals.

Further, it can scarcely be denied that the
“ Vernacular Medical Schools" are conducted by
the Indian Government in far too niggardly a spirit.

The only even nominal European official is the
** Principal,” but as this official, as Civil surgeon of a
great city, has already a very fair job for any two
ordinary men on his shoulders, the time he can pos-
sibly devote to the school must be so small as to make
him little less than an ornamental figurehead.

Under these circumstances the Indian ''Superin-
tendents” must needs be the real rulers of the
students, and the result must be that they have power
without responsibility, while the Principal is respon-
sible, without being able, for want of time, to exercise
any real power. In view of the large number of
students attending tbe classes, and the economie
importance of the service to the Indian Empire, the

THE JOURNAL OF TROPICAL MEDICINE.

[July 2, 1906.

mere description of the present plan of management is
a sufficient condemnation. It must not be вар)

that we are advocating the entire substitution of
European for native lecturers, as these are already far
too few to deal properly with the subjects taught ;
but the teaching staff should be strengthened by the
addition of at least two European officers, who
should give their entire time to the work, and should
be men not too senior to be in recent touch with the
latest developments of medical science, and not too
junior to possess a thorough knowledge of the
vernacular ; for though many of the students are fair
English scholars, it may be doubted if the majority
have a sufficient knowledge of our language to
benefit fully by instruction conveyed through it. In
making such a recommendation we wish to convey no
idea derogatory to the native lecturers, most of whom
are able men and most capable practitioners ; but they
are necessarily rather senior men before their capabili-
ties are discovered, and through no fault of their own,
they have lacked all opportunity of post-graduate
study, so that the adoption of our suggestion could
hardly fail to revolutionise the rather obsolete methods
of teaching now in use.

To obtain suitable text-books a substantial reward
should be offered by Government for the copyright of
the best work for the purpose in each subject in Eng-
lish dress, and the selected text-books should be trans-
lated into the vernaculars by a mixed staff of English
and Indian medical men.

The schools, too, badly lack apparatus and appli-
ances for illustrating teaching, and these should be
supplied.

It can surely not be said that the reforms suggested
are either sweeping or costly, and it can hardly be
maintained that they would fail to enormously increase
the efficiency of the vernaeular schools, and the in-
valuable service which is trained therein. Meanwhile,
however, we cannot but think that the students are
perfectly justified in indulging in what our Indian
medical contemporary elegantly denominates as
“ grousing."

SERUM-THERAPY OF PLAGUE IN INDIA.

LikvT.-CoroNEL W. B. Bannerman, the Director,
Plague Research Laboratory, Bombay, in his compre-
hensive and excellent introduction to the “ Scientific
Memoirs," No. 20, new series, dealing with serum-
therapy of plague in India, states that “Іп view of
the somewhat discouraging results obtained among
hospital patients in India, it seems necessary to com-
тепсе anew the study of the serum-therapy of plague.”

Anyone who has carefully read the memoirs in ques-
tion must agree with Lieut.-Colonel Bannerman. That
there are indications that the treatment of plague by
serum is a step in the right direction there can be no
doubt; but that the various sera to hand are adminis-
tered at times or in doses sufficient to cope with the
malady is scarcely apparent.

Lustig's serum.—Haffkine, W. M., contributes a

t“ Scientific Memoirs," by Officers of the Medical and Sani-
tary Departments of the Government of India. Calcutta, 1905.
New Series, No. 20,

July 2, 1906.)

205

THE JOURNAL OF TROPICAL MEDICINE.

report on a series of 484 cases of plague treated with
Lustig’s auti-plague serum. The general result was
as follows: Among the 484 cases treated with serum
there were 55 fewer deaths than among the 484 con-
trol cases not treated with serum.

Terni's serum.—.Haffkine, W. M., and Costello, C. T.,
report оп 110 cases of plague treated with Тегпі'в
anti-plague serum. The general result was: 89
deaths among 110 cases treated with serum, compared
with 90 deaths among 110 not treated with serum.

Brazil's serum.—Haffkine, W. M., and West, W. G.,
report оп 70 cases of plague treated with Brazil’s anti-
plague serum. In the Modikhana Hospital amongst
the serum-treated there were 17 deaths out of 20 cases
(85 per cent. mortality), against 15 deaths out of
20 control cases not so treated (75 per cent. mortality).
These figures show that fewer control cases died than
when serum was given. .

At the Maratha Hospital the serum-treated num-
bered 50, died 41 (82 per cent. mortality). Control
cases numbered 50, died 45 (90 per cent. mortality).

Roux’ serum.— West, W. G., reports оп 68 cases
treated by Roux’ anti-plague serum. The serum
treated cases showed a death-rate of 66:17 per cent. ;
the control cases a death-rate of 60:29 per cent, show-
ing а difference in favour of the control cases of 5:86
per cent. The general drift of the evidence before us
is, (1) that the initial effect of the introduction of any
serum has the power in many instances of reducing
the temperature, the pulse and the respirations. (2)
That the favourable initial effect was not maintained.
(3) Life would appear to be prolonged for an average
of several hours. (4) Decided reduction of the mortality
cannot be attributed to the treatment by serum.

—— e

DISTRIBUTION OF LIEGE EXHIBITION
AWARDS.

THE awards to the British Section of the recent
Liége Exhibition were distributed on June 13th. "The
proceedings took place at the Mansion House, and the
Lord Mayor, Alderman W. Vaughan- Morgan, occupied
the chair.

Mr. Imre Kiralty, the British Commissioner-General,
read a report upon the exhibition, and the meeting was
subsequently addressed by the Belgian Minister, Count
de Ialiang, Sir Albert Rollitt, M. Edouard Seve, Sir
William Holland, апа the Lord Mayor. The diplomas
were then presented by Count de Lalaing. А notable
feature of the ceremony was the receipt by Burroughs,
Wellcome and Co. of five awards of grand prix, three
dip ome of honour, three gold medals and one silver
medal.

"ATTI DELLA SOCIETA PER GLI STUDI
DELLA MALARIA,” ROME, 1904.

In this well-known yearly publication, A. Celli gives
& masterly resume of the work on malaria accem-
plished in Italy during the year 1904. Тһе epidemic
of 1904 was, generally speaking, more serious than
those of the preceding years. Benign tertian was pre-
dominant in the north of ltaly, while in the Roman
Compagna and the south of the peninsula the sub-

tertian was the commonest form met with. According
to Celli's observation in an epidemic of malaria, cases
of relapse are more frequent than cases of primary in-
fection; relapses were extremely common in the
hospitals of Rome in 1904 during the months of July
and August, suddenly decreasing during September,
contrary to the experience of 1903, when relapses
were most frequent in September and October.
Primary infections were observed to be more common
in July and August.

The relation between climatic factors and malaria
remains obscure; in the year 1904 the end of the
epidemic coincided with the end of the hot season.
The economical conditions have a certain indirect influ-
ence on the prevalence of the disease; in the more
prosperous provinces the use of quinine, as а preventive
апа curative agent, becomes more general and the
cases of malaria decrease. The author gives the re- .
sults obtained by the method of prophylaxis by
quinine given daily in 5 to 8 grain doses. Тһе prophy-

“міс administration of quinine in such doses does

not generally give rise to any untoward symptoms. In
Celli's experience the daily administration of quinine
in the doses mentioned is of greater efficacy than
Koch's method of giving а large dose once in seven or
ten days. The quinine prophylaxis was in 1904 applied
to 52,690 persons, all of whom were much exposed to
malarial infection ; of these 4,262 got malarial
attacks, that is to say, 8:08 per cent. in the year.

For the railway employés, the mechanical prophy-
laxis by means of wire, mosquito nets, &c., was used,
with good results.

In addition to this most interesting report of Celli,
the ''Atti" contains numerous other memoirs on
various subjects relating to malaria. В. Galli Valerio
апа Jeanne Roshag de Jongh describe their experi-
ments on the biology of Culex and Anopheles.

Martinetti and Castellini publish the results they
have obtained in their endeavour to produce & quinine
compound devoid of bitter taste. Ed. and Et. Ser-
gent report on the epidemiological studies undertaken
by them in Algeria.

Other very interesting papers are by Gualdi, Casa-
grandi, Gaglio and Rossi, for which we refer the reader
to the original publication.

Prof. Celli and the “ Societa per gli studi della
malaria," are to be congratulated for the splendid
work accomplished in the fight against the disease
which is the scourge of the Roman Compagna and of
so many other parts of Italy.

LONDON SCHOOL OF TROPICAL MEDICINE.
ENTERTAINMENT TO THE Hon. Bomanst PETIT.

„Ом June 11th the Hon. Bomanji Petit, of Bombay,
to whom the London School of Tropical Medicine is
so deeply indebted for & munificent donation to the
funds of the Institution, was entertained at luncheon by
the teaching staff and students of the School. Sir
Francis Lovell the Dean of the School presided, and
amongst those present were: Sir Patrick Manson,
Dr. C. W. Daniels the Superintendent of the School,
Dr. A. T. Stanton, the Students at the School, and Mr.
P. Michelli the Secretary. A hearty welcome was

906

accorded to Mr. Petit, and the Dean, іп proposing his
health, referred to the many benefits Mr. Petit had
conferred by his philanthropy on several publie and
scientific institutions in India, and to his generous
contribution of a lac of rupees towards the funds of
the London School of Tropical Medicine. By his
generosity and timely help the School had been
largely relieved of the heavy financial burden neces-
sarily incurred at its foundation, and the example he
had set had directly benefited the School by inducing
othera to contribute to this worthy institution, and so
to promote the welfare of their fellow subjects in
many parts of the Empire. In reference to. the present
position of the School, which owed i*s inception to tlie
Right Hon. Joseph Chamberlain, Біг Francis stated
that the teaching and appliances in the School were
of the most modern character, that much remained
to be done in the way of equipment of the museum
and library, and in several other directions. Money is
wanted for the endowment of lectureships and for

research. Recently two new Chairs had been founded, :

one for the teaching of Protozoology and the other
for Helminthology. The Colonial Office had generously
helped to establish these lectureships, whereby the
ећсіепсу of the School would be greatly enhanced.
The advance of tropical pathology had rendered these
Chairs a necessity, and it was no less imperative that
the subject of Entomology should be placed’ on a,
similar footing to Protozoology and Helminthology.
When funds were available this would be done, and it
was to he hoped that a generous donor would soon
come forward to enable the School to attain this
desirable object. Since 1899, when the School was
opened, over 600 post-graduate students have passed
through a course of instruction at the School. Sir
Francis closed his remarks by stating the deep in-
debtedness of the School to. the Hon. Bomanji
Petit, and expressed the pleasure it had given the
Seamen's Hospital Society and the London School
of Tropical Medicine to be privileged to entertain Mr.
Petit and the members of his family who accompanied
him. :

- The Hon. Bomanji Petit, in his reply, testified
to the satisfaction the establishment of the London
School of Tropical Medicine had given in India.
There were many diseases that required elucidation,
but none more urgently than plague, which had caused
widespread havoc in India for many years. The
prevention of plague ought to be one of the foremost
subjects to engage the attention of the teachers con-
nected with the London School, for in India the people
looked to the science and skill of western doctors to
free them of the scourges which decimate their ranks
and materially affected the progress of the country.
Mr. Petit urged the members of the School to continue
their good work, and to rest assured that India would
not forget their labours in the cause of mankind.

Wk would direct special attention to the article by
Dr. E. А. O. Travers апа Malcolm Watson on the
measures taken to abolish malaria from Klang and
Port Swettenham. "That these measures have been
eminently successful is а matter for univeral satis-
faction, and ought to stimulate similar efforts in every

THE JOURNAL OF TROPICAL MEDICINE.

[July 2, 71906:

part of the tropics. : We are glad to mote that Major
Ronald Ross, О.В,, F.R.S.; has drawn attention to
the results this article indicates in the T'imes, so that
the valuable information may reach the ears of
governors of colonies and others interested in the
hygiene of tropical countries. > > TE
apo ;

NURSING ASSOCIATION.
ANNUAL MEETING. |

. Lord Exern, Secretary of State for the Colonies, іп
addressing the Colonial Nursing Association at the
Colonial Office on June 13th, congratulated the Asso-
ciation on the good work they had accomplished. It
is now ten years ago since Mr. Chamberlain initiated
the movement which resulted in the Association
being founded. In many despatches to the Colonial
Office the work done by the nurses sent out by the
Association has been referred to as efficient and most
helpful, and there seems a tendency on the part of the
Colonial Office to incorporate the nurses sent out by
the Association as Government employés, and to
grant them the privileges of pension attaching to
recognition of the kind. Lord Ampthill, when moving
the adoption of the report, said funds were wanting
for the advancement of the Association, and that there
were few better ways of showing interest in the
Empire than by providing means whereby the public
servants of the Crown in distant colonies could be
provided with skilled nursing when they were strack
down by illness. Sir Frederick Hodgson, in second-
ing the adoption of the report, testified to the valu-
able work done by skilled nurses in the colonies with
which he was acquainted. T X
We can add our testimony from several independent
sources as to the benefits accruing to the communities
in which the nurses of this Association have worked,
and it is to be hoped that the members of the com-
mittee of management of the Association will in course
of time associate with them in their work those who
have had practical experience of nursing in tropical
eolonies. s

COLONIAL

AN IMPROVED METHOD OF STAINING FOR
SCHÜFFNER'S DOTS, бе. Ls

Tue following method has produced results so far
better than any which I have seen described, that ^a
brief note may be worth publishing ; it has also given
most excellent results in slides of tropical malaria
taken eight months ago, the chromatin being very
well stained. . : NN

After fixing with- absolute alcohol, the slides are
dried and at once placed in slide jars containing
Gieinsa's solution 1-10 to 1-15 until they are deeply,
and in fact over-stained (one to three hours should be
enough) They are then quickly but thoroughly
washed in plenty of water—clean rain-water does not
spoil the results, and while still wet, but drained, one
or-two drops of pure methyl alcohol are dropped: on
the slide held obliquely, two to three seconds is long
enough, and they are at once washed in water, dried,
&nd mounted in the usual way. m

Staining with Giemsa on the slide id no good,
though it.is hard to say why. In a successful prepara-

July 2, 1906.)

THE JOURNAL OF TROPICAL MEDICINE

207

tion Schütfner's dots are very brilliant, and the

substance of the corpuscle is ошу faintly seen.

Washing with methyl alcohol after drying the slide is

not quite во good а method as the above, especially

with old films.
------о---

Redicws.

THE AN&STHETIC TECHNIQUE FOR OPERATIONS ON
THE Noss AND Тнволт. By A. de Prenderville.
(London: Н. Т. Glaisher, 1906, pp. 88. Шив-
trated).

Medical men called up to administer an anwsthetic
in cases of nose and throat trouble are apt to be
anxious as to their capacity to carry out the adminis-
tration in a manner satisfactory to the patient and
the surgeon. The anxiety is natural and justifiable,
as any lesion of the respiratory passages tends to
increase the difficulty and danger of anwsthesia. Іп
large cities expert anæsthetists, being at hand, should
be employed; but in the tropics, as a rule, every
medical mun has to undertake the administration of
angsthetics in cases of the kind. Dr. РгепдегуШе в
book to men so situated should prove a useful and
invaluable help, as anesthesia in nose and throat
operations is always fraught with anxiety, and
attended by a considerable element of danger. A
perusal of Dr. Prenderville’s book will enable inexpert
anssthetists to go to work with a degree of confidence
they were perhaps not previously possessed of.

----------

Hotes and Жез.

-One of the difficulties connected with the treatment
of plague in India is to convince the people of the
advantages of the evacuation of premises in which
one or more cases have occurred. They cling to their
houses, and thus a whole family may die in rapid
succession or in periods extending over weeks. The
investigations of the Advisory Committee on Plague,
which is pursuing its researches in India, prove beyond
question that while the disease is not particularly in-
fectious or contagious and man-to-man infections do
not play any important part in spreading it, that
rooms and houses in which cases have occurred among
persons or rats are very infectious during an epidemic.
Those who live or sleep in such places are liable to
contract plague, whereas close attendance on patients
in hospital or in segregation camps is seldom dan-
gerous. Further, even after houses have been
evacuated for a month or even longer, the disease
clings. to them, and their re-occupation is full of
danger. These facts cannot be too widely made
known, and they confirm opinions that were formed
some time ago. Evacuation, to be effective, must be
promptly carried out, and three months may be taken
т) ine period over which it should extend.— Pioneer
ail.

PLAGUE INSPECTION ім Burma.
A Serious Fracas.

A’ FRACAS took place іп Maymyo Bazaar the
other day on the occasion. of the first plague

inspection by Captain Simpson of certain houses
lying to the east of the town, where the garry-
walluhs' or cabmen’s quarters are situated. Cap-
tain Simpson was accompanied by Mr. Kirkpatrick,
sanitary inspector, and a gang of coolies, with two
civil policemen for protection. It was necessary to
enter a house where а suspicious case of illness bad
occurred, but on Captain Simpson attempting to do so
the owners resisted, and in a trice a large crowd had
collected, numbering two hundred men, who had
evidently been in readiness for а row. They attacked
the plague gang with sticks and stones, and Captain
Simpson was struck with a brick and Mr. Kirkpatrick
was somewhat seriously injured. ‘The two policemen
were helpless. The matter being reported, a strong
body of police started at once with Mr. Murray, D.S.P.,
and Major Townsend, D.C., to the scene, and some
twenty men were arrested and committed for trial. As
a result of this all the garrywallahs in Maymyo went
on strike. Measures are being taken which will
probably bring them to their senses, but the strike
will affect the Burman and native community chiefly,
for these are almost the only customers of ticca
garries.—Pioncer Mail.

Нохоонѕ то British RESEARCH LABORATORIES.
Although scientific research receives little” encour-
agement: іп this country, it is gratifying to find that
the labours of British scientists are recognised abroad.
The awards to the British Section of the recent
Liége Exhibition were distributed at the Mansion
House on June 13th, and the following presentations
were made:—Wellcome Chemical Research Labora-
tories, one grand prize, one diploma of honour, and
two gold medals; Wellcome Physiological Research
Laboratories, one grand prize, and two gold medals.
Medals were also awarded to the respective directors
of these institutions. -

WE: refrain from comment upon the tinned meat
scandals, although the matter is one of vital im-
portance to tropical residents and travellers. The
“ scandals". were well known to us for some years,
and avoidance of all preparations derived from “ meat”
in any form has been urged by us in the case of in-
valid dietary. Fresh beef tea, freshly made meat
jellies, freshly prepared scraped beef, have been advo-
cated by all medical men, in preference to the much
advertised tinned, canned, or bottled substitutes for the
same. It required, however, a sensational “ novel”
to bring the matter home to the public, and we cannot
be too thankful to the writer of “ The Jungle " that the
whole question of “ beef-teas’’ should have been raised.
Medical men, however, can hardly be said to be free
from blame in the matter, as they are too apt to yield
to the desires of their patients to try some over-
advertised ‘‘ meat juice” or “ beef extract," Though
less nutritious than ordinary egg albumen, bulk for
bulk, and in no sense better or more digestible, some
of these may be harmless enough, but their adoption
involves heavy and needless expense on people who
are often ill able to afford it; and the profession might
‘do much to combat the evil by resolutely refusing to
countenance the use of all preparations of the sort

208

THE JOURNAL OF TROPICAL MEDICINE.

(July 2, 1906.

except in the rare cases where the wholesome fresh
materials are absolutely unobtainable. All medical
men who desire to be ready with arguments as to the
valuelessness of these much puffed articles should
read Dr. Robert Hutchison’s excellent pamphlet оп
“Patent Foods and Patent Medicines,” and the
booklet is so plainly written that the laity might do
worse than follow their example.

Bv the death of Professor Schaudinn at the early
age of 36, science has sustained an irreparable loss.

Rat Еһвав ах» PLAGUE.—An experiment made
in Bombay seems to favour the belief that rat tleas
convey plague. Іп а room in which a rat died of
plague a number of rats in cages were placed;
some of the cages were screened, some unscreened.
The rats in the unscreened cages contracted plague,
whilst the rats in the protected cages escaped.

Dr. NurrALL, F.R.S., has been appointed Reader
in Hygiene at Cambridge University.

READERS of the Journal will regret to know that
Lieutenant-Colonel J. E. Nicholson is about to leave
England. We are thereby deprived of the valuable
assistance he has rendered to the Journal for some
time past.

Паноке Medical Students, owing to alleged harsh
and unsympathetic treatment by their native superiors,
to the number of 250, have gone “оп strike." We
hope soon to hear that the students' grievances have
been satisfactorily settled.

Examinations for entrance into the Royal Army
Medical Corps will be held on July 26th 1906. There
are forty vacancies. k

Examinations for entrance into the Indian Medical
Service are to be held on July 9th, 1906. There are
twenty vacancies.

Dr. J. L. Topp informed the African Trade Section
of the Liverpool Chamber of Commerce that in the
area of country in Africa infected with sleeping sick-
ness some half a million people died of the disease
during the last ten years. Sleeping sickness had
spread along the trade route opened up in recent years,
and as a means of combating the disease it was sug-
gested that medical posts of inspection should be
established at regular distances, so that persons
suffering from the disease should be prevented from
travelling to districts as yet uninfected.

DEPARTMENT оғ HEALTH, IsrHMIAN CaNAL.—
Colonel Gorgas reports that during the month of
April, 1906, there were no cases of yellow fever,
plague, or &inall-pox amongst those employed on the
canal; no case of plague since August, 1905, no
yellow fever since December, 1905, and no small-pox

during the preceding year. The general health of all
sections of the community in the canal zone has
much improved lately. Pneumonia was the most
serious ailment. The systematic cleansing, disinfec-
tion, and destruction of mosquito breeding-places is
being maintained.

-------Ф-

Personal Motes.
RUTHERFORD, Dr. G. J., Medical Officer of the Gold Coast
Colony, has been transferred to the Medical Department of
Southern Nigeria.

ІмімАм MEDICAL SERVICE,
Promotions :
Lieutenant-Colonel W. Gawen King, C.LE. (temporary

Colonel) is confirmed in that rank, and in the appointment of
Inspector-General Civil Hospitals, Bengal.

Retirements.
Colonel Andrew F. Dobson (Madras), Colonel Stephenson Weir
(Bombay), Lieutenant Colonel J. Anderson, I. M.S.

Leave.
Captain C. Thomson, priv. leave, 6 w.

Lieutenant-Colonel J. L. Poynder, combined leave, 6 m.
Captain V. E. H. Lindesay, combined leave, 1 y. 51 d.

Postings.

Captain W. Selby, additional Visiting Charge, Budaun.

Captain C. H. Bensely to be Superintendent, Lahore Central
District, and Female Jails.

Lieutenant-Colonel H. Hendley to be Civil Surgeon, Lahore ;
Professor Midwifery, Lahore Medical College; and Medical
Officer, Government College. .

Captain C. 8. Lawson is confirmed Superintendent Central
Jail, Ahmedabad.

Captain A. F. W. King to be Professor, Institute Medicine
and Pharmacy, Grant Medical College, and Resident Surgeon
St. George's Hospital, Bombay.

Captain E. H. G. Hutchinson to be Civil Surgeon, Ratnagiri.

The services of Captains Trafford, Pilkington, Laudder and
Dunn, and Lieutenant Gill, have been placed at disposal of
Punjab Government for plague duty.

Major А. Buchanan to be Civil Surgeon, Nagpur.

Major E. A. R, Newman officiates as Civil Surgeon, Ranchi.

Captain C. A. Lane officiates as Civil Surgeon, Bhagalpur.

Captain J. G. P. Murray acts ав second Surgeon, Presidency
General Hospital.

Captain Н. B. Steen to be Civil Surgeon, Purnea.

----<-
Geographical Pistribution of Disease.

As information arrives we publish, under this heading, the
principal diseases met with in tropical and sub- 7
countries, so that those interested in the Geographical Dis-
tribution of disease may have a means of gathering informa-
tion concerning the prevalent ailments in diferent parts of
the world.

Philippines.

Opisthorchis sinensis was discovered in a Japanese
patient by Dr. R. P. Strong, and reported by W. J.
Mallory, on March 2, 1905, at the annual meeting of
the Philippine Islands Medical Association. The para-
site inhabits the bile ducts and gall bladder of man,
dogs, and cats. It has been met with in the pancreas
and occasionally in the duodenum. The fact that the
parasite has never been previously described as occur-
ring in the Philippines does not point to infection of
the natives of the Philippines, as the patient was a
Japanese, and it is well known that the O. sinensis is
widely prevalent in Japan.

July 2, 1906.)

THE JOURNAL OF TROPICAL MEDICINE.

209

Becent and Current Kiterature.

A tabulated list of recent publications and articles bearing on
tropical diseases is given below. To readers interested in
any branch of tropical literature mentioned in these lists
the Editors of the JOURNAL оғ TnorrcAL MEDICINE will be
pleased, when possible, to send, on application, the medical
Journals in which the articles appear.

* C. К. Soc. de Biologie,” Т.:1х., p. 160.

On Some New Trypanosomes or Fresu Water Fisnes:
THEIR EVOLUTION AND METHOD OF TRANSMISSION.

Brumpt, E., describes ten new species of Trypanosoma
and four of Trypanoplasma, and states that the former
undergo an evolutionary stage іп leeches of the genus
Hemiclepsis, and the latter in either Hemiclepsis ov Pisciola,
Some species of the trypanosomes develop entirely in the
stomach, others first in the stomach afterwards іп the
intestine, and finally the parasites are found in the sheath
of the suctorial mouth; while a third category, such as
T. Danilewskyi, develop first in the stomach and then in the
mouth-sheath. The development of T. granulosum, span.,
of the eel is described in greater detail. The forms found
in the stomach are pear-shaped. with the centrosome near
or in front of the nucleus. "These multiply actively in the
stomach, but the forms met with in the intestine are very
elongated, resembling Herpetomonas, while those found in
the mouth-sheath are of the trypanosome type, and the
parasites with which the fish are inoculated by the leeches
are always of this form.

Those developing in the stomach have the peculiarity of
losing their flagella and undergoing several fissions in this
form before regaining their lashes.

“ Archiv fiir Schiffs und Tropen Hygiene,” vol. x., No. 2.
PROPHYLAXIS OF MALARIA.

Celli believes (1) that the exhibition of quinine asa means
of preventing malarial fever should be continued daily in
doses of 6 to 9 grains (40 to 60 centigrams). (2) The addi-
tion of arsenic and iron to the quinine in chronic malaria ік
probably useless. (8) The best form of administering
quinine is in the form of the bisulphate or hydrochlorate in
sugar-coated pills. (4) Cinchonism is more apt to prevail
when quinine is given at intervals of some days than when
exhibited daily. (5) The tonic effect of quinine is of value
in persons infected with malaria.

Although quinine-taking is а valuable prophylaxis, it
should never be allowed to interfere with the sanitary mea-
sures calculated to eradicate the Anopheles from the
malaria-infected area. Whilst new ground is being opened
up, and until sanitary measures are fully established, there
сап be no doubt quinine is the most efficient of all prophy-
latic measures.

“Wien Med. Wochenschrift,” October, 1905.
Tue TREATMENT OF DYsENTERY.

Kraus and Dórr have come to the conclusion that the
Bacillus dysenteria@ are not identical. From Shiga's bacillus
a soluble toxin has been isolated, and the type of dysen-
tery it causes is that of a local bowel infection where the
toxins are elaborated, resembling the action of the diphtheria
bacillus. No toxin has been isolated from the bacillus of
Flexner, so that the poison is intracellular, comparable to
the bacilli of typhoid and cholera. Kraus and Dorr have
produced an antitoxin which has proved effectual in cases
of dysentery due to the Bacillus dysenteriae of Shiga; 20 се.
of the antitoxin were injected subcutaneously, and the
signs and symptoms of dysentery speedily subsided. The
antitoxin is of no value in counteracting the intracellular
poison of Flexner. ,

* Bulletin General de Therapeutique,’ November 23, 1905.
GENTIAN IN THE TREATMENT OF MALARIA.

Tauret, Dr. George, has isolated a glucoside from the fresh
root of gentian, termed gentiopierine. This drug, in doses
(cachets) of from 7 to 46 grains, was administered in
definite cases of malaria, some two to four hours before the
probable onset of the malarial attack. As gentiopicrine in
large doses acts as a purgative, it should be given with the
food, or a little bismuth may be administered with it.

Beside gentiopicrine, another glucoside, gentiomarine, is
met with in gentian, and the combination of these two gluco-
sides may be exhibited as an alcoholic extract of fresh
gentian root in syrup. The treatment may be required to
be continued from one to three weeks.

A Case оғ TRorrcAL. ULCERATION INVOLVING THE NOSE,
PHARYNX, AND LARYNX, WITH HISTOLOGICAL FINDINGS.

Arnold, W. F., and Fordyce, J. A., in a paper read before
the American Dermatological Association in December,
1905, described a granuloma. involving the nose, pharynx
and larynx, termed “tropical ulceration” of these parts.
The microscopic findings excluded blastomycosis, actino-
mycosis, rhinoscleroma, leprosy and tubercle; syphilis and
yaws were also excluded by the fact that the usual specific
remedies for these diseases were ineflectual. Mycosis
fungoids seemed to be negatived as a cause owing to the
absence of fragmentation and the character of the infiltrate.

“Philippine Journal of Science,” January, 1906.
TROPICAL UrckERATIONS OF THE SKIN.

Strong, R. P., describes tropical ulcerations of the skin, as
met with in the Philippines, under three headings : (1) Cases
resembling Oriental sore; the lesion is single and in the
surrounding tissues Strong found “ cockle shell ? oval bodies,
in diaineter from 3 to 4 micra, resembling Leishman bodies,
and met with free and within endothelial phagocytic cells.
They are regarded by Strong as parasites and to be forms of
blastomyces. (2) Cases in which the lesion is single,
commencing as а red spot which enlarges, hardens, dis-
charges and seabs. No protozoa were found, but a bacillus
of the Staphylococcus pyogenes aureus native was met with.
(3) Cases in which the lesion is multiple, beginning as
vesicles or pustules and breaking down into ulcers.

Bacteria do not seem to aet as a eausative factor in this
group, which may be due instead to а blastomyeytie agent,
although no organisms of this nature have been observed.

“Journ. Exper. Zool," vol. ii., p. 588.
Тив EVOLUTION оғ THE HyrornycHovs INrusonia.

Woodruff, L. L. This is a sequel to Calkins’ remarkable
study of the evolution of the Paruncecia, and has been
carried out by his methods and under his direction, though
the results are hardly as definite. Тһе observations were
devoted to Oxytricha fallar, Pleurotrichia lanceolata, and
Gastrosyla steinit, the culture medium being hay infusion.
All three species multiplied solely by transverse fission
without conjugation. passing daily through periods where
the division was less frequent, but in the end all die unless
the race be rejuvenated either by conjugation or by change
of medium. Like Calkins, he found that a cultivation
that had become very languid revived at once to a consider-
able extent by substituting beef infusion for hay infusion,
but a second experiment was not so successful, and the
series died out in 204 months after the very considerable
figure of 860 asexual generations. The periods of depression
were characterised not only by feeble multiplication and the
commonness of pathological forms, but by alterations of the
protoplasm, which became more and more vacuolated, the
macronuclei broke up, while the micronuclei became more
numerous, and lastly the ciliary apparatus atrophied. This
was associated with an increase in the size of the individuals,
which become smaller as the rate of multiplication accele-

910

rates. No inclination to conjugation was ever noted іп
the eultivations, and all attempts to bring this about failed.

Numerous observations were made on the action. of
various salts. KITPO, К.О and KBr applied once accel-
lerated. whilst KLHPO, KCL NACI and MeSO, retarded
division. In daily doses К.Н PO, and KBR markedly accel-
lerated, while KIRPO, KCl and NACI strongly retarded
division.

Light appeared to have no direct influence on the rate of
division of Ovytricha fallar.

* Bulletin de L'Institut Pasteur," T. iv., p. 346.

Prof. Mesnil, in Kolle and Wasserinann's “ Handbuch
der Pathog. Mikro-organ." G. Fisher, Jena.

Nocht, B., and Mayer, Martin, on the pathogenic trypano-
somes, This chapter of the above handbook gives а clear
and definite picture of this important subject. — Passing
over the history of the subject, the authors proceed at once
to define the two genera Trypanosoma and Trypanoplasma,
and describe the methods of examination nnd the cyto-
logieal апа evolutionary characters of these organisms.
Stress is laid on Prowazek's work on T. Lewisii and on
Schaudinn’s views on the hiematozoa of birds, though they
have not been able to include the more recent investigations
of the latter authority, which have led him to considerably
modify his views as to the inter-relations of the trypano-
somes and the spirochetes.

In any case they should have noticed the views of Novy
and McNeal, which are opposed to those of Schaudinn.

The authors adopt Koch's elassitiention, and, although it
is not usually a pathogenic organism, commence with the
study of T. Leicisii, on account, no doubt, of the large
amount of attention that has been devoted to that species,

The chapters on nagana, surra, caderas, dourine, galzickte,
Gambian trypanosomiasis and sleeping sickness, are well
written, and usually uniform and well balanced, and include
weertain number of personal observations, notably on the
pathogenic action of the two races of T. Gambiense on
different animals, The analyst considers, however, that it
would be more logical to place Zousfana disease beside
Debat in the chapter on surra instead of including it with
nagana, especially as they very justly insist on the difference
between surra and nagana, based on the difference between
the insects which act as vehicles of these diseases. The
therapeutics of this subject are condensed into a separate
chapter, and it is somewhat surprising to find no mention
either of atoxyl or of the arsenic-try panroth combination,

The non-pathogenic trypanosomes of mammals and other
vertebrates are barely mentioned, nor are those which are
almost undoubtedly pathogenic іп fish, and whieh might
well have formed the subject of a separate chapter. The
tsetse fies are dismissed in a couple of pages, but an excel-
lent double plate іп contours somewhat compensates for
this brevity. The other coloured plate gives a good ideaof
Т. Lewisii, and of the various pathogenic species, and the
microphotographs are equally successful,

Proceedings Royal Society, Series B., vol. Ixxvi., p. 284. ”

Тик DEVELOPMENT OF THE HERPETOMONAS ОҒ КАГА AZAR
AND CACHEXIAL FEVER FROM LkISHMAN-DoNOVAN BODIES.

Rogers, Major Leonard, T. M.S., who claims to have dis-
covered flagellate forms of the Piroplasma Donorani, in-
vestigates the conditions most favourable to the develop-
ment of these forms. Не has already stated that these are
best met by the emplovment of citrated human blood,
slightly acidulated with citric acid, and it is further im-
portant that the medium should be free from bacteria, which
impede the development of the parasites and bring about
their degeneration. The most favourable temperature is
22 С. With Novy's medium (gelose blood) the results
were negative. Under these conditions the small piroplasma
forms, obtained by spleen- puncture. undergo rapid develop-
ment, the course of which is clearly shown in an necompany-
ing plate. After forty-eight hours the parasites have

THE JOURNAL OF TROPICAL MEDICINE.

[July 2, 1906.

attained their largest dimensions, and some flagellate forms
appear. The small nucleus or centrosome is now in relation
with an eosinophile body which is constantly found in the
subsequent flagellate forms. These latter, during subsequent
days. are alone found, and are typical Herpetomonads, The
centrosome is always infront of the nucleus and no trace of
undulating membrane ean ever be made out. Major Rogers
proposes to call this the parasite of Kala Azar, and if, as
thus seems possible, the Herpetomonoid forms of his cul-
tures represent the most evolved stage of the organisin, the
term P. Donovani should sink, and Herpetomonas Donovant
should be substituted for it.

Longitudinal division of the flagellate forms is also figured
and described. The author remarks that the fact of acidity
of the culture medium being favourable, tends to the proba-
bility that the intermediate: host of the parasite is an
insect, and he has actually obtained flagellate forms by
mixing infected spleen blood with the stomach juices of а
louse. Lastly, the fact that a temperature of 22° C. is most
favourable to the development of the parasite explains the
seasonal prevalence of the disease.

Journal of Tropical Veterinary Medicine, vol. i., р. 5.
A New TRYrPANOsOME OF Rats.

Lingard, A.—The specimens described were found in the
blood of Мия niviventer and M. decumanus, and differ
from the types of Trypanosoma Leiisii, with which they are
associated in having the hinder end so produced as to re-
semble a posterior flagellum, much longer than the true ante-
rior опе. The portion of the parasite behind the centrosome
averages 19 u., as against 6 и. іп Lewisii. In other respects,
c.g., in the forward position of the nucleus, the new species,
which he names T. longocaudense, recalls T. Lewssii.
The author proposes to facilitate the recognition of
species by recording the length from the centrosome to
the hinder extremity, that from the centrosome to the
nucleus, the length of the nueleus, that from the anterior
border of the nucleus to the anterior end of the body of the
parasite, and the length of the flagellum; the sum of the
five data giving the total length, and lastly, the greatest
breadth. He gives their measurements for his new species,
for Lewisit, FEvansi, equiperdum, and for a trypanosome
which he calls Himalayganum, found by him in the blood of
cattle in the hills. This last isa long, thin species 75 m.
long by 38:25 m. wide. :

«С. В. Soc. Biologie,” T. 1x., p. 124.

A Cask оғ SPIRILLOSIS IN THE HORSE, ORSERVED IN
FRENCH GUINEA,

Martin, Gustav, describes a spirillum 12-15 4 long, by
0°25 u wide, with 3-4 turns in the spiral. When Siete:
the horse was wasted and showed arching of the back with
paresis of the hind quarters. Inoculation of other animals
gave negative results. Two and a half months after, the
horse was in good condition and its blood free from spirilla.

*' Centralbl f. Bakter.,” I., Original, T. xl., p. 405.

MODIFICATIONS OF THE SERUM оғ INTERMEDIATE
CARRIERS OF THE CHOLERA VIBRIO.

Friedberger, Е. Ву the term intermediate carriers of
cholera. (cholerabazillenzwisehentragern) the author refers
to persons who, though to all appearance perfectly healthy,
continue for some time to eliminate cholera bacilli in their
stools. During the last epidemic in Germany he met with
three cases of persons ixoluted from infected places, who,
without even showing the least sign of cholera, nevertheless
for periods of from three to nine days produced stools con-
taining cholera vibrios. On testing the serum drawn from
these persons it was found to have a bactericidal power 100
to 500 times above the normal; while on the other
hand the agglutinating power alike for the cholera
and for other vibrios was scarcely appreciable. To explain
the presence of these peculiar properties in the serum of

THE

July 2, 1906.)

these persons, the author assumes that they must have
suffered from an infection of the intestinal mucosa, but of

-30 mild a character as to arouse no suspicion of its existence

in their minds; as in persons having normal intestinal
mucous membranes, enormous quantities of microbes
require to be introduced to produce such marked inodifi-
cation of their serum. . |

Г Тре observation is, of course, of great practical interest,

as it explains how the infection of cholera may be intro-
duced into new. localities, at great distances, by а person

. showing no sign whatever of disease.

“ Zeitschrift f. Hygiene,” T. lii., p. 263.

Taek ACTION ок “ BRILLIANT GREEN” ON THE МАСАМА
І TRYPANOSOME. 2

Wendelstadt, H., and Fellmer, T., аге continuing their re-
searches on the treatment of nagana with the colours of the
triphenylmethane series. . The authors have tested the action
of this colour (sulphate of tetraethyldiparaamido tri-

‘phenylearbinol) in the same way they have already tested

malachite green.’ ‘Like the latter colour, but in а less
degree, this green has the drawback of causing sloughing
when used hypodermically, and of producing irritation and
atrophy of the spleen when introduced into the peritoneal
cavity.

Doses of 1 ec. of a 4 per cent. aqueous solution hypo-
dermically, or of 1 to 2,000 to 2,500 into the peritoneum,
uniformly brought about the disappearance of the Тғурапо-
soma Brucei from the circulation of rats infected four
days before with nagana.. But the trypanosomes re-
appeared after six or seven days, so as to make a fresh
dose necessary. Under this treatment, they succeeded in
keeping a rat as long as seventy-two days, while control
animals died in five to six days, but in the end the animals
under treatment suecumbed to poisoning with the drug,
and in no case was а cure obtained.

The best plan of administration is in three successive
doses of 1 cc. of $ per cent. solution, on the fourth, sixth,
and ninth day after infection. Following up Laveran’s
experiment of combining arsenie with trypan-red, they tried
the effect of following up the three doses of the dye by a
daily injection of 1 mgr. of arsenic. In three series, out of
ten rats, one rat in the first series alone appears to have
been cured, doses of 8 сс. of its blood failing to infect, In
the second series the blood of four rats killed during the
course of the treatment, was not infective in doses.of 2 to
8 сс.; four others died no doubt from poisoning with the dye ;
one relapsed, and only one has been cured, being still alive
after five months. This was the only instance of cure,
other animals having been kept up to four months, but
without being cured, and the authors attribute the com-
paratively good results obtained in this series to the fact
that the treatment was commenced forty-eight hours after
infection, and not as usual after three days. It is note-
worthy that rats inoculated with the blood of some of the
animals under treatment showed after a fortnight numbers
of trypanosomes, which presented a vague outline and a
generally curious appearance, and which disappeared the
next day, but these rats showed no immunity two and a
half months after. 2

A Масағив rhesus monkey was also treated; and as the first

* treatment with the green alone did not suffice, the combina-
ion with arsenic was adopted. After about seven. months

of repeated efforts the monkey ін definitely cured, and it is

.&n interesting and probably unique fact that it has since

proved refractory to two successive inoculations with
trypanosomes. In doses of 4 cc. the serum of this monkey
causes the immediate disappearance of the trypanosomes

. from the blood of strongly infected rats, and is strongly

. has no such action.

agglutinating in vitro, while the serum of normal monkeys
А dog was also experimented on, but
without much success.: The rest of the memoir is occupied
with a description of the changes produced in the trypuno-

THE JOURNAL OF TROPICAL MEDICINE.

211

somes under the action of the dye. A large clear vacuole
appears around the centrosome, and a variety of other
involution forms, which the authors compare to the
Leishinan-Donovan bodies, are described in the spleen, but
the significance of these ehanges is uncertain.

* Transvaal Medical Journal," Мау, 1906.
ANKYLOSTOMIASIS IN TRANSVAAL MINES.

The above journal, in an editorial headed ~ Danger,"
draws attention to the prevalence of ankylostoniiasis among
the native miners on the Witwatersrand; the ova of the
ankylostomum have also been found in specimens of under-
ground soil. Although these facts are new, the journal
remarks that it seems inexplicable that a vital matter such
as the spread of ankylostomiasis should be treated with’
mysterious silence and inactivity. On this subject it may
be remarked that the reports of medical men are, as а rule,
disregarded by the community, and it requires some lay
novelist or penny-a-liner in the lay Press to conjure up an
alarming picture with an hysterical pen to bring the matter
home to the people.

Tue INcREASE оғ MEDICAL MEN IN THE TRANSVAAL.

At the recent annual dinner of the Transvaal Medical
Society the matter of the influx of medical men was spoken
of with some concern. Тһе accession to the ranks of
medical practitioners was stated to be out of all proportion
to the increase of population. The increase of contract
practice and how to stem it is the problem which at present
confronts the medical profession in the Transvaal. for there

‚сап be no doubt this sort of practice, олсе begun, is difficult

to get rid of. Whilst the total earnings of the medical pro-
fession in the Transvaal have probubly decreased since the
pre-war days, the number of practitioners has doubled.
Under these circumstances it is difficult to find a ready
solution, but were the medical papers in Britain, to make it
widely known that the Transvaal is “over-doctored” at
present, a check might be given to still further congesting
the already plethoric ranks of the profession in South
Africa.

“The Journal of Experimental Medicine,” May 25, 1906.

Tue RELATION oF Types or ІМАНКНА IN CHILDREN TO
| Strains or BACILLUS ВүвЕМТЕБІ Ж.

Knox, J. H. M., and Schorer, E. H., from their inquiry
into this subject, found that the association of the dysentery
bacillus with diarrhea in infants is now established.’ After
the study of 74 cases of diarrhoea in infants they found:
(1) The Shiga type of bacillus present to the exclusion of
other pathogenie species on aerobie plates in 4 cases. (2) The
“ Y? bacillus of Hiss was proved to be present in 14 cases.
(8) The Flexner - Manila bacillus occurred in 8 cases.
(4) Cases in whieh the dysentery bacillus was isolated, but
not determined, numbered 8. (5) A. lactose-fermenting
dysentery-like organism was obtained in 2 instances.
(6) Combined dysentery bacillus and streptococcal infection
occurred in 11 cases. (7) Streptocoeci only were encoun-
tered in the pathogenie bacterial species in 6 cases. (8) A
pathogenie colon bacillus was isolated in 2 cases. (9) No
pathogenie organism or organism agglutinating with the
patient's blood was found іп 10 cases. (10) More than one
bacillus was present in 18 савев. The combinations were as
follows :— Group 1 and 4, 2 cases; group 1 and 2, З cases ;
group 1,9 and 4, 2 cases; group 1, 2, 8, 4, and laetose,
lcase; group 2 and 4, 5 cases.

Bacilli dysenteriæ occurred in 78:1 percent. of casesstudied,
or without the lactose-fermenting organism, which is pro-
bably not a true dysentery bacillus, 70 per cent. The
charaeter of the intestinal lesions found at autopsies were
extremely various and without definite relation to the types
of infecting dysentery bacilli; and it would appear that no
distinetion, except possibly as regards degree, can be drawn

. between the lesions produced by any of the given types of

the dysentery bacillus.

212

THE JOURNAL OF TROPICAL MEDICINE.

[July 2, 1906.

The serious nature of the ailments from which the obser-
vations were taken may be gauged by the fact that 31
children of the 74 in question died. І

“Tl Policlinico," Rome, June, 1906.
Tue EFFECT OF THE X-RAYS ON MALARIAL DISEASES.

"L'azione dei raggi Röntgen nellinfezione malarica.”
By Dr. Alberto Demarchi.

For obvious reasons it was not an easy matter to study
the action of the X-rays when applied directly to the
malarial parasites; for this reason Dr. Demarchi had to
restrict his observations mainly to the region of the spleen,
but his studies were equally directed to all three species of
malarial infection, whether quartan, benign tertian, or
fstivo-autumnal.

А microscopic examination of the blood was always made
both before and after the application of the X-vays, as also
some hours after it.

Inall the cases the rays were applied daily, and at all
periods of the attaek of ague. No accidents had to be
recorded, whether local or general, with one solitary excep-
tion when a slight erythema appeared over the irradiated
region. The patients were subjected to rays with a penetra-
iion of No. 6 Benoist, and the quantity of the rays absorbed
at each sitting was equal to 2 Н units.

The results of Dr. Demarchi's researches may be summed
ав follows :—

(1) The application of X-rays over the splenic region does
not affect or in any way modify the course of the malarial
attack.

(2) These applications exercise no action whatever on the
number, the vitality, or the normal cycle of development of
the malarial parasites of whatever species they шау
belong to.

(8) They are not capable of causing or of accelerating &
relapse.

(4) The X-rays have a manifest action on the reduction
of the swelling of a spleen if chronic.

(5) These rays may possibly exercise а favourable action
in preventing relapses of the infection.—-(J. E. №.)

“Journal of the American Medical Association,”
May 12, 1906.

TREATMENT OF SNAKEBITE.

Crum, C. W. R., M.D., treats bites of the copperhead
snakes by freezing the area around the bite with ethyl
chloride spray; he then makes two parallel incisions almost
an inch in length, through the wounds made by the fangs ;
the part is then soaked for a few minutes in strong perman-
ganate of potassium solution and dressings applied wet with
this solution; the edge of the dressing is raised every half
hour or hour anda fresh permanganate solution poured on
the wounds.

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July 16, 1906.)

Original Communications.

VERRUGA PERUANA.
By M. D. Eper, M.R.C.S., L.R.C.P., B.Sc.Lonp.

Dr. Tamayo! may fairly claim to have solved this
mystery of the High Andes. Тһе disease has been
known to Europeans since the sixteenth century, and,
as Hirsch observes, its mortality for the white man
was made manifest when it caused the death of more
than one-fourth of Pizarro's small army of 700 men.
Inlater years even greater havoc has been wrought.
In 1874 a party of 40 sailors deserted from a British
ship to work upon the Trans-Andean Railway; in the
course of seven or eight months 30 were dead of
verruga.

Hirsch gives the mortality as 6 per cent. for Indians
and negroes, 12 per cent. to 16 per cent. for whites,
amongst whom in epidemic form it may reach 40 per
cent. 27922
Regarding the nomenclature, the term “ Carrion's
disease" has been applied to the pernicious febrile
form since 1885, when Daniel Carrion, a Peruvian
medical student, inoculated himself in both arms with
the blood taken from a verruga excrescence. He
developed a severe illness on the 91st or 23rd day
and died fifteen days later, without the appearance of
any eruption. It is also known ав Oroya fever, from
the narrow valley of Oroya, where the disease is
endemic.

I can find no one previously to Dr. Tamayo who has
considered the possibility that the verruga and the
severe symptoms of Carrion’s disease are independent
conditions, having a purely coincidental relationship.
Dr. Tamayo does indeed hint at the verruga being
favoured by the more serious disease, but I think this
must have been an idea thrown out to lessen shock
among his audience.

From my own experience I should say there is no
disease in South America (and I speak from know-
ledge gained in three Republics) which is so fre-
quently overlooked or wrongly diagnosed as enteric
fever. Іп recent years malaria could be excluded, of
course, by a blood examination, not always, however,
for it is a frequently co-existing condition in other
diseases. But a positive diagnosis of enteric is some-
thing quite different. The Widal reaction was not
available in the Hinterland, away from laboratories; I
should imagine that the Parke-Davis's Typhoid Agglu-
tometer might prove of immense value to the medical
man in isolated districts where laboratories and con-
sultations are unattainable.

The possibility that Carrion’s disease is enteric fever
is so engrossing in itself, and so important is the ques-
tion of enteric fever.in the tropics, that some little
attention to the current descriptions of verruga will
not be without general interest.

Tamayo himself suggests that Carrion fever is a

‘La Crónica Médica Lima, Nos. 406 and 407, 1905. Apuntes
sobre la bacteriología de la enfermedad de Carrión, por el Dr.
М.О, Tamayo.

THE JOURNAL OF TROPICAL MEDICINE.

para-typhoid disease ; I should be content to leave it
at that, but I must draw attention to a few weak points
in his paper.?

(1) The doses and strengths of the inoculation ex-
periments are vaguely given as а few drops, а strong
dose, &c. The author refers to & table which does
not, however, accompany the articles, but as the paper
was read at a medical meeting, the table may have
been exhibited there. That table possibly gives the
exact doses and strengths used.

(2) The differentiation from Eberth's bacillus or
other members of the typhoid group is incomplete,
more especially as no polysaccharide fractional
differentiation is mentioned. But Tamayo states
that he is still engaged on the complete differentiation
of Barton's bacillus, and he promises to give the re-
sults in а later paper.

(3) The most serious omission is the incomplete
description of the post mortems, both of the animals
that died after inoculation, and of the patients who
died during the course of the malady. We аге told,
indeed, that nothing particular was observed, and this
even in cases where there had been during life abund-
ant diarrhea, enlarged liver and spleen, &с. Тһе
condition of the intestines is not once alluded to. I
must авК readers not to conclude from this that по
ulcerations of Peyer's glands were present. There is
nothing to show that the intestines were examined.
Positive evidence would here strengthen the case
enormously, but the negative evidence must not be
allowed to influence us too severely. Imperfect
observations are a frequent fault of post mortems made
in tropical South America as well as elsewhere.

А study of Dr. Tamayo's paper in conjunction with
the following extracts will, I think, convince the most
sceptical that Carrion's pernicious fever, Oroya fever
—the severe fever of verruga—is nothing but enteric
fever. 5

Relationship of Verruga іо Yaws.—Manson [1]
writes : ‘ If difference there be in their clinical features
between verruga and yaws, apparently it is more one
of degree than of kind." Scheube [2] is to the same
effect. “І am, therefore, inclined to the opinion that
the two diseases (yaws and verruga) are nearly re-
lated, verruga being nothing more than a severe form
of frambosia ог yaws, modified partly by the high
altitudes of the region where it occurs and partly by
being complicated with malaria.”

On the other band, Hirsch [3] denies any relation-
sbip, whilst Dr. Plehn [4] states, “ verruga and fram-
beesia were formerly considered related diseases, but
the former has nothing but a superficial resemblance
with that skin disease." Jeanselme [5] is equally
emphatic, “ c'est à tort qu'on a voulu identifier la
verruga avec le pian.”

I will return to this question again. .

Æ tiology.—Certain waters of the endemic districts
have always been locally under suspicion (aguas de
verruga is the term). Dr. Plehn follows Hirsch, who
quotes Dounon’s experience; he and his followers
drank the waters and were not affected. Plehn further

2 Abstract, JOURNAL ОЕ TRopicaL Мерісіме, May 15th, 1906.
Page 159.

214

THE JOURNAL OF TROPICAL MEDICINE.

[July 16, 1906.

points out that people suffer from verruga who have
never drunk the suspected waters.

Both statements are, of course, consistent with the
view that the water is contaminated by typhoid
excreta. (We remember that Dr. Klein swallowed a
culture of Koch's cholera bacilli with impunity.) Some
of Dounon’s followers may have been immune to
typhoid fever from a previous attack, nor would the
water be the sole source of infection—direct contagion
is common where there is no strict hygiene.

Pathological Anatomy.—The mucous membrane of
the intestine is occasionally hyperemic. The solitary
follicles and Peyer's glands are generally enlarged.
Sometimes ulcerations are discovered in the intestine
as well as in the stomach. Scheube treats these as
ulcerated verruga, but offers no proof; are they typhoid
ulcers? All the lymphatic glands appear swollen, the
mesenteric glands more especially so. The liver and
spleen are enlarged. (Scheube and Plehn.)

Bacteriology.—In 1898 some growths were examined
by Charles Nicolle [6], who reported that he had
found a “ microbe pathogène nouveau à ranger dans
la catégorie des microorganismes dont le bacile de
Koch est le type. Ce serait un Sclerothrix." М.
Letulle and Izquierdo confirm the presence of an acid-
fast bacillus.

The presence of this organism counts for little or
nothing in the absence of inoculation experiments.

Dr. Barton's important paper referred to by Tamayo
was read in 1898 or 1899 to the Sociedad Médica Union
Fernandina of Lima. І сап trace no reference to this
paper, but Tamayo is sufficiently explicit. Barton was
the first to isolate an organism from the blood of patients
suffering from verruga.

Tamayo, working with Ugo Biffi and J. C. Gastia-
burt, confirms all Barton's work in so far as it is
morphological.

Dr. Odriozola(7] also refers to the presence of these
micro-organisms in the blood, which grow readily at
37? C. on all media.

Jeanselme (loc. cit) suggests that the fever ‘ qui est
&ujourd'hui definitivement rattachée à la verruga est
une forme aiguë septicénique.” Firth [8] thought that
Carrion's death might have been due to septic in-
fection.

Plehn, Jeanselme, and Firth (who seem tc be the
only recent European writers on the subject to have
Seen any cases), scout very properly any connection
between malaria and verruga.

Tschudi, in 1845, noted that death may sometimes
occur at the commencement of the disease with typhoid,
i.e., верісешіс symptoms (quoted by Hirsch).

Firth suggested that the disease was due to а para-
site worm, whose first stage is passed in the mud (he
thus accepts the view of water being a factor in
the causation). Plehn (loc. cit.) likewise broaches the
possibility of some trypanosome infection. (Parasit
welcher den trypanosomen vielleicht nahesteht.)

Immunity.—Jeanselme states that one attack confers
а fairly long period of immunity.

Incubation of the Disease.—Carrion’s fatal experi-
ment established this at about twenty-one to twenty-
three days (cp. enteric).

Varieties described in the Tert Books.—(1) Fulmi-
nating, in which there is no eruption, most writers

concurring in the opinion that death ensues before the
eruption has time to appear. Naturally, there can be
no proof of this.

(2) Pernicious febrile form (Fiévre grave de Carrion).
This disease lasts two to six weeks, and has a high
mortality.

(a) With eruption—which may appear at any time
during the disease—sometimes just before death, or
sometimes during convalescence.

(b) Without eruption.

In some fatal cases, however, verruga has been
found in the internal organs (see list compiled from
Tamayo, case 3. JOURNAL OF TROPICAL MEDICINE,
May 15th, 1906, p. 160).

(8) Chronic form. This may drag on for years;
and then, as Dr. Plehn [9] states with a touch of
unconscious humour, these cases may still have a
fatal issue. (Although no one has suggested that
chronic verruga would confer immortality.)

Symptoms and Course.—I give the outlines from
Plehn, with whom other writers are in general agree-
ment.

Fever, remittent or intermittent, extending over
some weeks. Hyperpyrexia has been known. In some
cases fever falls below the normal some days before
death (ср. the typhoid condition in enteric).

In favourable cases sleeplessness and other symp-
toms gradually disappear as the fever abates ; appetite
returns, and, except for the weakness, patient is well.

Headache and pains in the limbs during the first
one or two weeks. Delirium, coma, nausea, vomiting,
diarrhoea, dysenteric stools—more rarely there is con-
stipation (see Tamayo's cases). The abdomen is
tender. Liver, spleen, and mesenteric glands enlarged.
Anemia, sallow complexion, sometimes jaundice.
Hypostatic pneumonia ; cardiac failure.

Hemorrhages from different organs.

Petechial eruption, which sometimes resembles pur-
pura hemorrhagica (cp. enteric; out of Osler's 829
cases, there were 25 with purpuric spots. Osler. Fifth
edition, p. 17).

Differential Diagnosis.—It is significant that Wurtz
and Thiroux [10] do not mention enteric amongst the
difficulties. Their list of diseases with which verruga
may be confused is (1) malaria, (2) acute hepatitis,
(3) acute yellow atrophy, (4) acute miliary tuberculosis
(5) pysemia, (6) rheumatic fever. Р

Acute yellow atrophy is rare everywhere; rheu-
matic fever uncommon in tropical South America, but
enteric is ubiquitous and common. Tamayo and his
fellow workers have, I believe, proved that verruga
peruana is a benign disease, running a chronic course,
consisting essentially in the formation of granulomatous
eruptions on the skin, and in the mucous membranes
and organs.

The resemblance of these tumours to those of yaws
is unmistakeable in the photographs (see them in
Odriozola's work or Plehn's article). The main differ-
ence is that yaws is said not to occur in the internal
organs. It does occur, however, on the mucous mem-
branes of the cheeks, gums, and in the vulva (Hirsch).
According to Van Leent, quoted by Hirsch, yaws
is found in the internal organs, spleen, liver, 4с. May
not the fact of this having been doubted (see Hirsch)
be due to the fact that the outcome of yaws is “ always

July 16, 1906.)

towards а cure.” Hence post mortems must be rare;
whilst in verruga they have been relatively frequent,
owing to the fatality of the frequently associated
Carrion's fever.

Ав an objection to the identity of the latter with
enteric fever, it may be said that there is in the
clinical accounts ап absence of the usual abdominal
complications, such as perforation. This is true,
although hemorrhage from the bowels is noted, and
amongst the sequele are given nervous affections.
Possibly when the attention of Peruvian clinicians
is drawn to Tamayo’s suggestion, we may receive
further information regarding the presence or absence
of the abdominal complications.

To sum up, Carrion's pernicious fever is typhoid
fever occurring in the tropics.

Verruga Peruana is yaws occurring in а district in
Peru where typhoid is endemic. Тһе two diseases are
thus often found in the same subject.

The casual agent of verruga is unknown ; hitherto,
as was natural, research has been mainly bacteri-
ological. It would, however, seem advisable to
examine the freshly excised granulomata for spiro-
chætæ, or, as Mr. T. P. Beddoes suggests to me, for
some form of amceba.

REFERENCES.

[1] Manson. Tropical Diseases, 1900, p. 468.

[2] бснесве. The Diseases of Warm Countries.
Edition of English Translation, by P. Falcke.

[3] Нівѕсн. Handbook of Geographical and Historical
Pathology, 1888, vol. ii., Sydenham Society.

МІ Гв. A. PLEHN. Handbuch der Tropenkrankheiten Dr.
Carl Mense, 1905, Article. Die Akuten Exanthema. Verruga
Peruviana.

[5] JEANSELME. Nouveau traité de Médicine et de Thérapeu-
Бара, Brouardel et А. Gilbert. Fasc. іу. Maladies exotiques,

906. 3
(61 NıcoLLe. Note sur la bactériologie de la Verruga du
Perou. Annales de l'Institut Pasteur, Tome 12, Sept. 1898,

Second

p. 591.

[7] Орвтог2огА. La Maladie de Carrion, Paris, 1898.

[8] Fiers. Allbutt's System of Medicine, vol. ii. Art.
Verruga.

[9] Über Jahre sich hinziehenden, zum Teil zuletz freilich
ebenfalls tódlich endenden Formen (Plehn, loc. cit. p. 439).

[10] Wortz AND Тнікоох. Diagnostic et Séemeiologie des
Maladies Tropicales, p. 58. Paris, 1905.

THE HABITS OF ORNITHO.-
DOROS MOUBATA.
(Observation of Two Gravid Females.)
By Е. C. ХУешман, M.D.

Mr. В. Newsrtean in his paper “ On the Pathogenic
Ticks Concerned in the Distribution of Disease in
Man, with Special Reference to the Differential
Characters of Ornithodoros moubata" (read at the last
meeting of the British: Medical Association, held at
Leicester)! states (what is true of most ticks) in his
remarks on the family in general, that а fully engorged
tick . . after fecundation invariably falls from
its host. Egg laying takes place shortly afterwards,
and the animal subsequently dies." * Later, however,
in speaking of O. moubata he does not state the length

А NOTE ON

! Published in this JOURNAL for August 15th, 1905.:
2 The italics are mine.

THE JOURNAL OF TROPICAL MEDICINE.

215

of time between the feeding (and fecundation) of the
tick observed by him and its egg laying (although he
gives the dates on which the eggs were laid), nor how
long the parent lived after ovipositing. Now O.
moubata is (in some instances at least) an exception in
this respect to other observed ticks, and what Mr.
Newstead omits (rather than what he says) makes his
Sketch of the part of its life history discussed by him
misleading. lextract from my recent report? to the
American Society of Tropical Medicine concerning this
tick the following observations which, if read in con-
nection with Mr. Newstead's paper above mentioned,
will give any one interested a much clearer idea of the
matter. ‘ Ticks were fed on the blood of a young pig.
Copulation was seen in two instances, the ticks grasp-
ing each other with their legs and approximating the
dorsal surfaces of their bodies. Two large impreg-
nated females were placed in & covered glass dish in
which was а handful of dust from the floor, into which
the ticks immediately burrowed. They were given no
food and examined frequently. It was nearly two
months (fifty-seven days) before any eggs were laid.
Tick No. 9 did not begin to lay for a week after her
companion had finished. Both ticks have been kept to
date without food (eleven weeks since laying their eggs)
and are still alive and active." ? Тп each case the eggs
were laid in batches and protected by the parent for
several days. Their subsequent history—differentia-
tion of the egg contents in about a week, the quiescent
larves distinguishable a few days later, and the
emergence of octopod nymphs on the fifteenth day—
corresponds almost exactly with that given by the late
Dr. Dutton and Dr. Todd, and as I have elsewhere
published the same in detail from my own personal
observations I shall not repeat it here. I have only
referred to the matter in order to add important details
which are missing from Mr. Newstead’s paper as it
appears in the JourNAL. Of course, the paper in
question may be but an abstract of a fuller communi-
cation including all the data which I have here
supplied (I have not seen full reports of the meeting at
Leicester) in which ease, however, no harm will be
done by again calling attention to so interesting and
significant а point regarding the life history of an
important disease carrier.
Bailundo, West Africa.
January 1st, 1906..

` A CLINICAL PICTURE ОЕ RELAPSING
FEVER.

Ву `У. G. Dzsar, L.M.S.

Tue following history is а pen picture of five
hundred cases of relapsing fever. The description of
this fever is so vague in the text books that the
disease can hardly be made out by the bedside. A
few of the leading symptoms are not mentioned in
any book. An ordinary busy practitioner has to

tOn Ornithodoros moubata, Murray; а disease-bearing
African tick.”

? Six months have now passed since the ticks were fed, and
about four months since they deposited their eggs. One of them
(the one which laid her eggs last) died three weeks ago. Тһе
other is still alive and apparently healthy.

216

THE JOURNAL OF TROPICAL MEDICINE.

[July 16, 1906.

depend much on the signs and symptoms of & disease.
He cannot go on examining the blood of every patient
who comes to him. The writer felt the necessity of
such an accurately described clinical history, and that
is why he has taken the liberty to write the clinical
story of relapsing fever. It is mainly a tropical disease.
It 1s frequently mistaken for plague in Bombay during
the epidemics of the latter disease.

This fever is only prevalent among the poorer
classes of people; for example: butchers, clerks, &c.
Such people eat very little fresh vegetables, fruits or
fish. Christians living miserably get it. In all these
cases it was generally found that the patients were not
taking a sufficient quantity of salt with their food. Per-
sons in similar conditions of living are attacked, and so
it is thought to be contagious, but it appears not to be
so at all. It occurs among people of low vitality.
Tubercular persons of fair type are more prone to it.
Males are attacked more than females. It generally
occurs in outbreaks. Age has nothing to do with it.
It occurs in well ventilated houses.

The patient comes to the doctor for pains in the
body. The fever comes on without shivering and
reaches its maximum height on the second or third
day. The patient appears to be very much exhausted.
The facial expression indicates that the patient must
have been ill for at least two or three months. His
conjunctive are yellow or a tinge of it is usually
there. There is no sickly smell about him, as in cases
of typhoid or pyemia. The temperature depends on
the constitution of the person; it is higher in thin and
fair-skinned people. In fat and dark-skinned people
it is less marked.

The skin in many cases is coloured a light yellow,
while in some the colour is distinctly marked. A small-
pox-like eruption is occasionally seen, but has not the
shotty feel.

Respirations are increased to thirty or more. Рег-
cussion shows a little hyper-resonance. The respi-
ratory phenomena look like that of hemorrhage—
prone due to the destruction of red blood corpuscles

y the spirilla. Similar breathing is noticed in pneu-
monic plague.

The pulse is always rapid, about 100, but good.
The heart-sounds are feeble, but not so feeble nor
obscure as in plague. Percussions over the heart show
that the cardiac dull area has diminished, while in
plague it is increased from dilatation.

The appetite is poor. Vomiting is a rare symptom.
In one case it was very marked. Vomiting of blood’
occurred in one case. Constipation is usually present,
and if a purgative be given the stools do not smell ая
in typhoid. Large doses of calomel do not induce
diarrhoea. The motions are dark-coloured (iron-laden
stools), probably due to the destruction of red blood
corpuscles. Distention of abdomen is a very rare
symptom, unlike typhoid. Assimilation is very poor.
The patient becomes markedly emaciated even in one
week, in spite of careful nursing. The spleen is enlarged
and very tender, as also the liver, but not to the extent
of the spleen, and is less tender. Tenderness of spleen
is prominently marked in all cases. General glandular
enlargement is a rare symptom. The tongue shows
irritation. It is thickly furred and moves less freely,
resembling a “liver” tongue. Such a tongue is seen in

cerebro-spinal disease. The tongue at once makes one
suspicious of plague, but it is not so foul. It shows
that the patient must have been ill for two or three
months, although he may have been ill only for two or
three days. It gets worse and worse in spite of treat-
ment. By the last two days the tongue becomes small
in mass, dry and leathery. The teeth become dry and
sordes collect on them, and the look of the face is
like that of a cadaver.

Urine is very red and of high specific gravity.
Traces of bile are present, chlorides are less. |

Intelligent people complain of pain in the epigas-
trium, while dull people say they have the pain in the
abdomen. Pain in the calves is a very prominent
symptom, and present in one and all cases. Pain all
over the body is complained of, but it is more in the
muscles and tendons than in the bones. The pain is
more marked in the anterior parts of the body—with
the exception of the calves—and the flexors. There
is no severe pain in the head, as in typhoid fever, nor
is there any pain in the back-bone and neck, as in
cerebro-spinal fever. The patient does not sleep
during the period, in spite of big doses of opium.
He is neither delirious like a typhoid patient
nor dull like a plague patient. The mental power
is clear, but the calculating power of the brain is
affected.

The muscular power is reduced from the com-
mencement. He cannot even sit for any length of
time, but, unlike a plague patient, he can walk
straight.

In spite of treatment the patient gets worse and
worse, and towards the end of the fever the typhoid
state is pronounced. Suddenly, on the seventh,
eighth, or ninth day the temperature falls to subnormal,
either with profuse perspiration or with diarrhoea, or
with vomiting of blood, or epistaxis. While the tem-
perature is going down the patient asks for food.. The
jaundice remains behind for a week after the fever has
fallen to subnormal. In the interval after the fever
the patient seems well. He eats greedily and seems
to make up for the loss of food in the week previous.
He does not complain of any pain or any after effects
(except jaundice). The only symptom that remains
behind when the fever has left is jaundice, and
especially when it has been marked. Не gets good
sleep. The motions become yellow. The spleen
becomes small.

After five, six, or seven days the patient gets fever
again with all the previous symptoms. This relapse is
mild in many cases. People who develop jaundice, or
who vomit blood during the first attack get the relapse
in severe form. The jaundice is intensified, the secre-
tion of urine becomes less, and more blood is vomited.
The urine contains blood during the relapse. Even
these cases recover splendidly provided they are not
actively drugged. The people who pass blood are
‘‘bleeders” generally, or, as they say, their wounds take
a long time to heal. The relapse is short, te., it
lasts for four or five days only, and the patients bear
it better than the first attack. Rarely a third attack
is noticed. .

Out of 500 cases one case died of suppression of
urine, two from exhaustion, one from meningitis, and
two from heart failure.

July 16, 1906.)

THE JOURNAL OF TROPICAL MEDICINE.

217

eee
SSS - - ------- 1-..-.--.а.-аааТттттт-

DiaaNosts.

A poor patient comes to a doctor with pains іп the
abdomen and calves, and with jaundice. History
shows sudden accession of fever without shivering and
juo MEME of similar cases of fever in the neighbour-

ood.

This fever is not malaria, because quinine in very big
doses has no effect and patients do not shiver.

It is not plague, because almost all patients recover,
there are no buboes, and the fever is less.

It is not rheumatism, because the pain is in muscles
and tendons, and salicylate and alkalies have no effect
on its course, and there is no swelling of joints.

It is not typhoid, because the duration is only seven
days; the characteristic headache and slow pulse are
wanting; there is по diarrhea. Chlorine mixture
seems to do harm in this disease.

The diagnosis is very simple if microscopic exami-
nation of the blood is made.

TREATMENT.

The fever runs its course and defies all methods of
treatment. The less active medicinal treatment you
give these people the better.

Opium in pill form, pushed to produce pin-poiut
pupil, does some good.

Quinine in 5 gr. doses keeps a check on the peculiar
‘‘air hunger" respirations. Patients getting quinine
have better pulse than those taking diaphoretics. The
motions are less coloured under quinine. The re-
lapse is more marked in patients who take quinine
during the first attack.

All antiseptics seem to do harm in this fever.

Diaphoretic treatment is exhausting.

Cold water baths are very beneficial. Still, under
cold baths the tongue does not improve as it does in
typhoid ; but the “ air hunger ” respirations diminish.

he urine is improved by baths.

. Food consisting of fresh fruits, especially oranges
in abundance, fresh milk, fresh mutton broth with
plenty of salt, and green vegetables is the proper diet.
Alcohol seems to do harm in this fever ; even the worst
cases recover without a drop of it.

Nothing active should be done for the jaundice.
Fomenting over the liver for pain does harm Vomit-
ing is not amenable to any treatment.

To check the relapse residence must be changed at
once. Fruits, port wine and plenty of common salt
help to render the relapse less severe.

THE ANATOMY OF THE BITING FLIES OF
THE GENERA STOMOXYS AND GLOSSINA.

By Lieut.-Colonel G. M. блік, I.M.S. (Rtd.).
(Continued from p. 209.)

The heart lies almost free in the pericardial cavity ;
but is, nevertheless, firmly supported by muscular
bands, the alar muscles described by: Prof. Minchin,
but these seem to me quite distinct from the strong
antero posterior muscle which forms a part of the
pericardial septum, and which, to judge from his
late Ixv. is the structure so named by Lowne in his
k on the blow-fly.

This latter structure is well represented in both
Stomorys and Glossina, and does not appear to
me to have any direct connection with the heart
at all and is certainly not the same as the
structures referred to under that name by Prof.
Minchin, which seem to have a much better claim
to be so called. The muscle of the septum is
a very well marked structure, broad in front and
narrow behind, and is somewhat fan-shaped. The
more internal fibres soon join with those of the
opposite side under the first two chambers of the
heart, while most of the rest extend the whole leugth
of the septum, of which they form a considerable por-
tion of the substance. The septum, is, however a very
complex structure. It is lined with a distinct layer of
pavement, endothelium (vide pl. i., fig. 12) and there are
said to be pores in it, Hereby the pericardium com-
municates with the general body cavity. Besides this
there appears to me to be a delicate but perfectly
regular layer of unstriated transverse fibres. Its
lateral attachments to the terga are embedded in thick
masses of the fat-body. Тһе fat-body appears to cor-
respond to the “ cellular” tissue of vertebrates, and
forms the packing of the organs not only about the
septum but in every other waste space of the body. It
is composed of enormous cells which appear to be
usually multi-nucleate, but as & rule, it is not easy to
distinguish the limitations of the component cells. The
protoplasm (as shewn in pl. i., fig. 13), is vacuolated,
the spaces, in specimens that have not been treated
with solvent reagents, being occupied with a reserve
store of nutriment.

Besides the structures already enumerated as enter-
ing into the formation of the pericardial septum, there
are two distinct sorts of cell which have been indiffer-
ently referred to by authors as “ pericardial cells.”
One category of these (pl. i., fig. 14) are undoubtedly
nothing more than youug mononuclear fat cells, their
protoplasms having exactly the same structure as the
cells of the fat body. The others are very different and
are multipolar cells (pl. i. fig. 15), the poles of which,
according to Lowne, are muscular fibres. These
form а network over especially the lateral parts of
the septum, and look exactly like ganglion cells,
though it is not suggested that they are of that
nature. In studying the literature of the subject it
is well, however, to remeinber that either of the
above forms of cell may be referred to by & writer, as
the obvious discrepancies between their description
are otherwise very confusing.

As far as the writer can see, Lowne's theory that the
dorsal vessel is & hollow muscular fibre is & quite
accurate description of the thoracic aorta, as it seems
to consist of a single row of long cells, the sides of
which curve upwards to meet in the middle line above.
The protoplasm, with the nuclei of these cells, forms 8
continuous thread in the middle of the ventral wall of
the tube, lying in contact with the dorsal wall of the
gut, while the lateral prolongations, which form the
walls of the vessel, are extremely thin and delicate.
The lumen of the tube is triangular with the apex
dorsal and the flat base ventral, so that it fills up the
interstice between the gut below and the lowest pair of
great longitudinal thoracic muscles, and is padded on
either side by rows of fat-cells.

918

THE JOURNAL ОЕ TROPICAL MEDICINE.

[July 16, 1906.

The generative organs,—These in all Diptera, and in
both sexes, consist essentially of a Y-shaped tube, the
branches of which lead up to a tract of genera-
tive epithelium. Into the point of meeting of the
arms of the Y, there enters, in each sex, a pair
of accessory glands, so that it would be, per-
haps, more exact to describe the agygos reproduc-
tive duct as dividing into four follicles ; as morphologi-
cally it seems probable that the reproductive and their
accessory glands may be of the same value. In
the male these glands are usually spoken of as the
vesiculz seminalis, but the term is an entire misnomer,
as they secrete а milky coagulate fluid which mixes
with the semen in the common sperm duct, but never
contain spermatozoa. Structurally they closely re-
semble the parovaria, or corresponding accessory
glands of the female. In Stomorys, however, the
usual arrangement is considerably modified, as the
paragonia only exist as separate lateral organs fora
fairly short distance as a pair of diverticula and then
unite to form a single tube which, for the greater part of
its length, seems quite without convolution, and runs be-
side the ejaculatory duct to its point of union with the
common sperm duct, which immediately after divides
into three—the lateral branches or vasa differentia
(efferentia of Lowne) looping backwards to the testes,
while the median extension widens to form a rudi-
mentary ejaculatory sac, which, however, has neither
the muscular loops nor the fan-shaped sclerite which
make it such a prominent organ in the blow-fly.

The ejaculatory duct is so small in comparison with
the paragonium which lies beside it that it is very

Fic. 33.—a, diagrammatic representation of male internal generative organs; p, trans-
verse section, paragonium ; and, d, transverse section, ductus ejaculatorius, x 400 diams.

likely to be overlooked in dissecting, and the para-

onium mistaken for it, as the latter is 0:15 mm. in

iameter, while the ejaculatory duct is but 0:05. The
duct, vasa differentia and ejaculatory sac are of exactly
similar structure, being formed of a structureless in-
tima, lined with conical epithelial cells, the apices of
which project into the lumen so as to impart to it a

ragged outline. The paragonium is a peculiar struc-
ture, as the lumen of the tube is surrounded by a
trabecular structure, the interspaces of which are filled
with a granular material. The trabecule radiate to-
wards the lumen, and so have a superficial resemblance
to columnar epithelium, but though I have stained
them in various ways, and the lining of the ejacula-
tory duct lying close by has the nuclei of its epithelia
quite distinct, I have never seen any structure in the .
granular substance which could be regarded as a
nucleus, while the trabecule are distinctly nucleated,
especially at their internodes. On this account I
prefer to consider the granular substance as inter-
cellular. Тһе testes are two small bodies enclosed in
а sac formed of flat, deeply pigmented epithelium. Іп
mature insects it is almost entirely filled with sperma-
tozoa of enormous length, but in young insects trabe-
cule of father cells project into the interior, and there
may be but little ripe sperm.

The stages of the spermatogenesis seem to be quite
normal and have been described ad nauseam by many
writers. АП these structures are imbedded in а dense
mass of fat-body, and in front lie beside the rectum.
А rather complicated system of muscles come into
view in the hindmost sections of a series which actuate
the rather complicated external genitalia. For most
of their course the ejaculatory duct and paragonium
run rather above the longitudinal axis of the insect,
but as they approach the hypopygium bend sharply
down to the venter.

The female generative organs are quite of the usual
dipterous type, each insect producing in the course of
a season an immense number
of large oval eggs.

These eggs during their
development lie more or less
in rows of about four ova of
various stages, and it is usual
to speak of these rows as
‘‘ovarioles,” but the cavity
containing each ovule is just
as separate from the more
and less developed ovules
below and above it respec-
tively, as it is from those
of similar development sur-
rounding it, and the separa-
tion in both cases consists
of an open stroma of mus-
cular fibres without any-de-
finite intima ог epithelial
lining, so that fundamentally
their structure is the same
as that of the mammalian
ovary with which human
anatomists are familiar. The
general arrangement and re-
lations of the ovaries may
be gathered from the following figure, which includes
also a diagram of the ovipositor copied from Lieut.
Tulloch’s paper.

The lateral oviducts, too, cannot be said to expand
into a funnel-shaped receptacle receiving the ovarioles,
as it seems rather a portion of the general body cavity
into which the branches open, which latter receive the

Тшу 16, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE.

219

ovules after the dehiscence of the muscular alveoli in
which they lie, and to which they are guided by a
continuity of the muscular structure of the ovary with
that of the wall of the oviduct.

The smallest germ cells are multinucleate masses

Fic. 34.—A, diagram of ovipositor, after Tulloch; B, trans-
verse section of abdomen of gravid female; с, crop; /, fat-body ;
h, heart; mg, mid-gut, x 28; ov, ovules; s, pericardial septum,
x 20.

surrounded by a capsule of small cells. The next
larger form (0) has two nuclei, and spring from a small
celled mass on one side, while on the other the
capsule is lined with large columnar epithelium, from
which is developed the chorion which forms the shell
of the full grown ovule (c). In the less mature eggs
the chorion is still recognisable as a lining of flat cells
(d) within the shell, but in those ready to pass into
the oviduct it is difficult to distinguish this membrane.
In ovaries in a certain stage of development before
the chorion has changed into egg-shell, it is easy to
mistake it for an epithelial lining of the ovariole.
The eggs (c) are elongated ovoids having at their
upper end an infolding of shell and chorion which
leads to a minute canal, the microphyle, passing to the
interior of the ovum to give passage to the sperm cells
of the male. The stroma separating the ovarioles
consists of elongated spindle cells containing each a
row of nuclei. In (e) these muscle cells are repre-
sented in the inter spaces between three contiguous
ovules. Under a high power it can be made out that
the egg-shell is fibrillated, or striated vertically to its
surface. Towards the end of the common oviduct
there opens into it the two accessory glands
(parovaria), and the ducts of the three spernothece.

Prate II.—a, Young ovariole, x 270; b, ovariole further developed, x 270; c, fully developed egg in its alveolus, x 50;
d, portion of chorion or lining membrane of egg shell, x 270; е, muscular stroma separating three ovarioles, x 270;
f, portion of parovarium, x 540; g, the same and its duct, x 270; k, section of one of the vesicule seminalis, x 540.

(То be continued.)

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THE

Journal of Tropical Medicine

JuLY 16, 1906.

METEOROLOGY FOR AMATEURS.

IwsisTENCE and repetition can never be fairly
deprecated in a good cause, and hence we have no
hesitation in returning to our contention that an
immense amount of good work might be accomplished
by Europeans whose business takes them to out-of. the-
way parts of the world which, though fairly known
from the point of view of the traveller, are as yet
quite unexplored regions to the meteorologist.

The subject forms a most interesting hobby, and
can be pursued at so small в cost that the considera-
tion of expense need hardly be а bar to anyone, as a
set of thermometers, a rain gauge, and а wind-vane
are all that are really necessary to afford all the in-
formation essential to & preliminary survey.

A set of maximum and minimum thermometers, wet
and dry bulb of each, can be got for under £92, and
a rain gauge for about 15s. more, so that the whole
cost of a reliable outfit need not exceed £3.

Maximum and minimum thermometers, manu-
factured for popular use, can, however, be obtained for
a few shillings, and by comparing these with an
accurate instrument, and tabulating any errors they
m&y show, they are easily available for more exact
work, or a corrected paper scale may be pasted over
that furnished with the instruments.

A set of such instruments were supplied to the writer by
Gallenhamp and Co., for £1 18s. 8d.

[July 16, 1906.

All that is necessary is to plunge each instrument
along with a standard thermometer into water
warmed to near the highest point of their scales, and
to take simultaneous readings as the water cools.

A rain gauge may be improvised by utilising a large
glass funnel for the purpose, and mounting it on a
bracket, so that its tube discharges into a glass tube
of а conveniently smaller diameter, say about 4th,
and of sufficient length to accommodate the largest
rainfall likely to require measurement in twenty-four
hours, so that in a region where six inches of rain is a
possible experience the tube would require to be 30
inches long.

The arrangement is represented in the subjoined
figure, and is so constructed that only the bare edge of
the funnel projects above the roun
hole in the bracket that carries it, and
the remainder of the funnel is pro-
tected by a piece of tin rather deeper
than the cone of the funnel nailed to
the edge of the bracket.

This is necessary to prevent driving
rain from striking the outside of
the funnel and running down its
surface into the measuring tube,
which latter stands іп a вшаЛ hole in
a lower bracket, while its upper end
is held by a small brass spring clip,
so that it can easily be slipped out
of its supports to empty it.

Remembering the familiar formulæ
that the area of а circle is т7;, it is
easy to calculate the volume of
water corresponding to one-tenth of
an inch of rain falling on the ex-
posed mouth of the funnel, and by
pouring into the tube successive
measures of water of this amount,
and marking the level on a strip of
paper pasted to the tube, it is easy
to graduate the latter to tenths and
inches, while the cents can be put
in by means оға proportional divider.

After graduation the paper should
receive two or three coats of varnish,
and the apparatus will then be ready
for use. The writer had a gauge
constructed at home on this plan
in use for several years, and found
that it registered quite correctly when
placed beside an instrument of the
orthodox manufacturer's type. The
lower end of the piece of plank sup-
porting the brackets that carry re-

spectively the funnel and measuring P 1, — Im-
tube, is prolonged into a conical Phe plete: S ain

point which can easily be thrust into
the ground in any suitable situation.

A wind-vane is even more easy to
construct. All that is required is a
vertical rectangular loop of stout
brass wire, the arms of which are bent to form hori-
zontal eyes, through which is threaded a somewhat
stouter wire which is fixed into the end of a pole long
enough to elevate the vane above any neighbouring

that protects the
funnel from drift-
ing rain is repre-
sented as if trans-
parent.

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July 16, 1906.)

obstacles, ав іп fig.2. То the vertical piece of the loop
is sewn a small pennon or burgee, and the points of
the compass should be indicated by pegs driven into
the ground around the base of the pole. In recording,
it should be remembered that the burgee will point in
the direction opposite that from which the wind is
coming.

ty N
Fic. 2.— Improved wind vane mounted on a pole.

The thermometers should be mounted on a board
nailed at the level of the observer's eye to the middle
pole of a small mushroom-shaped thatched hut, sup-
ported on poles about 5 feet high, but quite open at
the sides; and if this be made to cover a sufficient
area, requires по ''screen," though it is desirable to
have one, especially in dusty localities, in order to pro-
tect the muslin enveloping the wet bulbs.

That no special scientific training is needed for the
pursuit is shown by the fact that excellent work is
done in India and other parts of the world by natives
boasting of but little education, and the time that need
be devoted to it is very small, as, with the system
advocated in a previous article, of a single daily obser-
vation of maximum and minimum wet and dry ther-
mometers, punctuality of observation is by no means
essential, as the observation may be taken “then or
thereabouts ” at any convenient time of the day.

We would commend these brief notes on this subject
especially to the graduates of the Livingstone College,
for no body of men penetrate further beyond the
bounds of civilisation; and being usually fairly sta-
tionary, they are better situated for work of the sort
than are Government officials, who are usually moved
too frequently from place to place to make continuous
Observation possible; but commercial men are some-
times equally well placed, and would, we venture
to think, find an interesting relaxation from the worries
of trade in wild parts of the world, by contributing to
our scientific knowledge of their places of residence on
this highly important subject.

LIVINGSTONE COLLEGE.

CoMMEMORATION day was celebrated by а meeting
in the grounds of Livingstone College, on Thursday,
Мау 31st, Mr J. A. Simon, M.P., in the chair.

The Principal, Dr. C. F. Harford, read a brief state-
ment with reference to the progress of the College.

In the course of his remarks, Mr. Simon said : We
are, unfortunately, in this country, at this moment in
а controversy about some branches of education—a

THE JOURNAL OF TROPICAL MEDICINE.

221

subject beyond all doubt controversial, and it is there-
fore a great satisfaction—I hope I may say to all of
us—to find that in coming here we meet, not only on
common ground in the sense that we are in the
spacious grounds belonging to this place, but we meet
on the common ground of а common belief in the
worthiness of the object, and the excellence of the
method by which tbat objectis being carried out in
this place. І am sure it is а satisfaction to feel that
there are still some important matters of educational
life on which we can all agree.

As I understand it, this place does not claim to turn
out medical missionaries, but it holds that no man or
woman can serve in that high and noble office unless
һе or she has a knowledge of things medical such as
make а part of a good education in those who are
determined to learn what they should know. It seems
an extraordinary thing that à man or woman, though
this institution is as yet confined to men, that a man
ог a woman who is prepared to devote his or her life
to this high calling, with no thought of drawing back
in the face of danger, should go out to places, far away
it may be from medical aid and from protections from
disease, without such protection as a place of this
kind сап afford. It strikes one as startling that, as
we have been told by the Principal just now, though
this place has been doing its work well for many years,
the great service which it could do to a large body of
men and women going to the mission field is not taken
advantage of by the great missionary societies to the
extent one would expect. As I understand it, the
people who come to this place come here primarily in
order to learn how to protect their own lives and the
lives of those nearest and dearest to them in the work
they have undertaken, and the man who does not do
tbat is as bad as the man who does not insure his life
when he is going to be married.

I feel certain I am expressing what is іп the mind
of you all when I say that work such as is done here is
work in which we may claim Livingstone's spirit is
amongst us, and in commemorating on this day the
good work of Livingstone College during the past year
we are preserving and maintaining the tradition which
that good man and that well-trained doctor, combined
with such magnificent effect and example for all time
in Africa.

Mr. James Сап е, F.R.C.S., said: It is now thirteen
years since Livingstone College was founded, and .
some 250 students have passed through its portals
during these years, and gone into the mission field
better equipped for their work than they otherwise
would have been. Alas, only 250 students in
thirteen years; апа when we consider how many
thousands of missionaries have been sent out from
this country, it is evident that only a handful have
been trained here. We all admire missionaries, we
all esteem the man who has devoted his life to the
cause of Christianity, and his efforts, it is hoped, will
go оп as long as our race retains its virility. The
missionary takes his life in his hand when he goes
forth to do his work, and comes back, perhaps, with his
health shattered, or perhaps he dies at his post. For
the missionary to die for Christianity is a noble end,
but there is still a nobler aim—he might live for
Christianity, and this College exists for the purpose of

THE JOURNAL ОЕ TROPICAL MEDICINE.

[July 16, 1906.

teaching men how to live for Christianity. The work
which is carried on at Livingstone College I think most
of you know, it is not you who have to be told, it is
the stranger without the gates. I feel rather in the
position of a clergyman lecturing his congregation to
be regular in their attendance at church and to be
liberal in their giving; it is not to them he ought to
talk about not coming to church, it is the people who
do not go to church he should upbraid and remon-
strate with for their niggardliness in giving. The
work that is being done at Livingstone College is this :
Missionaries who have gone through а course of
theology for three or four years come to this College
for nine months—they often come for а much shorter
time—but some come for nine months, and they come
to get instruction in elementary medicine, surgery,
and hygiene. It really should be called by a term
which is familiar to you all, “ first аа” in medicine,
surgery, and hygiene You are all familar, or ought
to be, with how to render first aid to the injured ;
many of you have, no doubt, been through the St.
John Ambulance first aid course. What were you
taught? You were taught elementary anatomy and
surgery. Some say you were taught a little know-
ledge, and a little knowledge is said to be a dangerous
thing, but the instruction you were given was com-
plete and exhaustive of its kind. It is a distinct branch
of surgery and medicine, and therefore do not go away
with the idea it only teaches you “а little knowledge,”
for it completely fulfils its purpose. A course of the
kind would not be of direct use to you were you
required to render first aid to persons suffering from
disease in the tropics. Here in Britain, in our fac-
tories and workshops we find accidents are part and
parcel of our daily life; street accidents occur every
day. When one goes to the tropics, one finds that
there are, in many places, no horses, no vehicles—if
you go to South China, for instance, there are no
railways, no factories, no horse vehicles, everything
is carried on men’s shoulders, so that there are no
* accidents" such as we meet with here, and there-
fore it is not sufficient to be trained in merely “ first
aid" work which we require at home; it is not the
kind of first aid that is essential there. What is
required of à missionary in warm climates is to know
how todeal with the sudden onset of diseases, which
destroy life almost as suddenly as & railway engine
may in this Country. Тһе disease comes suddenly, its
course is short, and the patient may die, it may be, ina
few hours. It is to teach men how to render first aid
in some of the terrible maladies of the tropics that is
the aim and object of Livingstone College, and it is
necessary for missionaries to know something of this
branch of medicine. Most clearly is it necessary, for
the missionary is often looked upon by the natives as
& '' medicine " man, the reason being that most of the
white men who first appeared as missionaries had a
knowledge of medicine. Livingstone is responsible
for that in Africa; his reputation as a medical man
was great, and when the people saw him they knew
he was capable and willing to administer relief to the
suffering. Now when we send out our missionary he
is looked upon as one who knows something of medi-
cine, in the first place, from the very fact that he is a
white inan ; and in the second place, seeing also that he

is a learned man and religious, he is believed to possess
the attributes all natives are accustomed to associate
with religious teachers, namely, the power of healing.

УҮНАТ 18 REQUIRED OF THE MISSIONARY.

A hundred years ago the priest or minister in this
country was sought after by people in illness, and it
was frequently part and parcel of the work of the
clergy to administer to the body as well as to the soul.
The same idea prevails throughout the length and
breadth of Asia, Africa, and many parts of America to-
дау; the missionary is looked upon as в “ medicine”
man, and therefore how very necessary it is that the
missionary should have a knowledge of the healing
art. In the earliest days of Christianity we know the
part, the vital part, the cure of disease played, and
amongst the more primitive peoples of the world to-
day the same part is expected of us. Any one familiar
with the terrible epidemics which afflict humanity in
tropical countries, with the suddeness of the attack
and the fatal nature of many of the diseases, can well
understand the desire of the natives to be saved and
protected from the virulence of their scourges. This
prayer of the natives for relief from suffering and from
the illnesses which at times almost annihilate their
tribes is a natural, a human cry, and it becomes us to
treat it humanely. To these plague-stricken peoples
we send in our charity missionaries; men and women
anxious and willing to devote their whole time and
even their lives to benefit the souls of our unen-
lightened fellow-beings. А noble object, and one
worthy of our support, but there are means by which
this excellent work can be more efticiently carried out
than it is at present, and it is to provide these means
that Livingstone College was called into being.
Health is the handmaid of religion, and the Saxon
word “ heilig,” which we translate “ healthy," might
be as correctly transcribed “ holiness.” The missionary
sent out with по medical training is not to be envied. He
may find the people around him dying of ailments
which, for lack of even elementary knowledge, he can
do nothing to alleviate. He can have, owing to want
of instruction, no confidence in himself, and therefore
cannot inspire confidence in others. The effect of
such a position upon the mind or conscience of the
missionary it is not pleasant to contemplate; in the
name of common humanity he does his best, but his
best is unskilled labour, because he is untrained, and
the situation comes home to him with heartfelt re-
grets that he was sent out, or, that he elected to come
out from home, ignorant of even the elements of
medicine or surgery. Who is to blame if the mis-
sionary is sent out thus imperfectly equipped? Not
the young man or woman who in the enthusiasm for
the teaching of Christianity volunteered for the foreign
field. The societies to whom we entrust our mission
work are willing to take advantage of the enthusiasm
of these young men and women, and all too fre-
quently send them out imperfectly equipped, send
them to their death in many cases because their
religious fervour was not tempered with practical
wisdom. The recruiting ground for missionaries is not
illimitable; we are drawing upon our population in
many directions for the sake of empire, and with the
advance of time and opportunity more and more mis-

July 16, 1906.)

ТНЕ JOURNAL OF TROPICAL MEDICINE.

223 '

sionaries will be required for mission work ; it behoves
us, therefore, to conserve our voluntary workers in the
good cause, and to see to it that their lives are not
needlessly thrown away.

“ Do THE MISSIONARY SOCIETIES FULFIL THEIR,
Duties?”

Now, all this work cannot be carried on without
money. Many millions are contributed yearly by the
people of Britain for the missionary cause, and as
Christianity spreads in heathen lands yet more will
be required. The immense sums of money we con-
tribute are greatly to the credit of the people of this
country, and more will no doubt be forthcoming as it
is required. The moneys we contribute are paid into
the exchequer of the several missionary organisations,
and to them we look to see that this money is rightly
spent. Let me say at once that the missionary
societies which send out their missionaries without
granting them the opportunities of—nay, insisting
upon—learning something of medicine; surgery and
hygiene are not fulfilling their trust. They are
juggling with the lives of men and women
in a manner which, did the people in this country
appreciate it, would lead many charitable persons
to close their purses with а snap, and to say, “І will
contribute no more until you mend your ways.” I
should like my words to reach the ears of all the
authorities of these societies, as well as those of the
public who contribute the money. It is difficult to do
that, however, by speaking or writing mere platitudes ;
it will require a “scene” of some kind before the
public can be aroused to the situation; it would re-
quire someone in church, when on the next occasion
money is being asked for missionary societies, to stand
up before the collection is made, and to say, “ Sir, are
the missionaries you intend to send out, with the
money we are willing to contribute, to be properly
equipped for their work by being trained in elementary
medicine and surgery ? because if not we will take no
part in encouraging these estimable men and women
to go to their death." Could someone be. found to
have the courage to do this the matter would be
settled for ever; no money would be forthcoming to
societies who betrayed the confidence the public place
in their work and methods. Surely this very humane
work can be done without some such vulgar appeal to
unruly sentiment. Surely it is not necessary to have
scenes in church to rouse the public conscience in
regard to the lives of missionaries. The missionary
societies are not so numerous but that they cannot be
appealed to individually; and, although we are told a
committee has no conscience, the men on these com-
mittees are sensible Christian men, and the fact that
they are dealing with the lives of men and women
must surely come home to them.

LIVINGSTONE COLLEGE THE EUROPEAN CENTRE FOR
TRAINING MISSIONARIES IN ELEMENTARY MEDICINE.

I have spoken strongly on this subject because
I feel strongly ; and had I more power to deal with
the matter I should not rest until I had made it
compulsory by law that no missionary leaves these
shores for work in the tropics until he can satisfy the
charitable public that he is properly equipped for the

task. The lives of the missionaries are as much a
national asset as the lives of the men who go into the
public services or join commercial firms; and just as
government servants and merchants are necessary for `
our imperial wants, so are missionaries necessary to
fulfil the desires of the people of this country that
religious teaching shall be given to the heathen !

Attempts at teaching some elements of hygiene are
made elsewhere than at Livingstone College, but at
this college alone is а systematic course given which
is calculated in any way to meet the objects in view.
As usual, we are slow in this country to entertain or to
act upon & new idea; not so some of our Continental
neighbours, and several of the western European
nations send their missionaries to be trained at Living-
stone College.

Do кот BE IMPATIENT WHEN THE Natives HESITATE
то ASK YOUR ADVICE.

I would like to give a word of warning to young mis-
sionaries. Do not be disappointed if you find the
natives inclined to “stand off” at first. You may
think it ungrateful of them not to trust you at once and
to be unwilling to place their lives іп your hands. Неге
in England we do the same thing, we stand off a bit,
to see what the new doctor is like, and so you cannot
blame these people if they do not throw themselves at
once into а recently-arrived doctor's hands. But when
you gain their confidence the ‘ medicine" man is to
the natives supreme. I remember in Egypt during
the cholera expedition of 1883, when I happened to be
one of the men who volunteered for service, I went to a
village where I was told there were numbers of people
dying, but I could find no cases, I searched about
for two or three days, but could not find any evidence of
cholera, and I telegraphed to the authorities in Cairo
“Tam sorry "—I should have said, I suppose, I was
glad—'* I am sorry, but there are no cholera cases
here." At last one of the Egyptian soldiers who
accompanied me in my rounds began to trust me, and
he took me toa house where he knew there was a case
ofcholera. I went with him to the door, and there
was the mother of the lad who was said to be ill with
cholera, standing at the door, and declaring there was
no case of cholera in the house. We pushed past her,
and we searched everywhere for that patient. It was
not а large house, we soon went all over it, but there
was no sign of a patient. At last under some hay in
front of the buffalo I saw something move, and
gathering up the hay I found the sick lad. The
patient recovered, and then I began to get cholera
patients in scores. Within twenty-four hours I had
200 patients. The people thought that the British
Government intended to punish them; we had been at
war with them in 1882, and they thought we were
sent out in 1883 to complete the destruction of the
country and the people. That was the light in which
the doctors were looked upon, and one can scarcely
wonder at the backwardness of the people to accept
our services.

Again, do not be too ready to come to the conclu-
sion that there is no such thing as some particular
disease in a district because you have not seen it. You
may say to yourself :—“ I cannot find any of these
diseases I was taught so much about at Livingstone

224

THE JOURNAL OF TROPICAL MEDICINE.

[July 16, 1906.

College, and I do not believe they exist in my district.”
I remember two instances with regard to myself. I
had been five years in China before I saw a case of
elephantiasis, and I was very disappointed, as I was
led to believe I should see many cases of this nature.
However, one day a man with elephantiasis came to
be operated upon; he recovered, and after that I
had many casés. In the same way, I was going to
report to the medical papers that women in China did
not suffer from internal tumours as they did in
Europe, seeing that in five years I never found a case.
After operating upon one successfully, however, I began
to think they were quite plentiful. So I advise the
young missionary not to be disappointed because the
people do not come to you at once; you must first
gain their confidence, and you can do so if you go the
right way about it. Livingstone was an example of the
power of this quality, even to the extent that when he
moved to a fresh place the people frequently went
with him.

Were the necessity, the vital and imperative neces-
sity, for all missionaries having some knowledge of
medicine and surgery and hygiene thoroughly appre-
ciated, I am sure that there should be no doubt about
the future of Livingstone College.

I have gone carefully into and considered what is
being taught here, and you will find that it has the
entire approval of the medical profession. Of course,
objections have been raised, and people have said “ you
are training men for doctors." When the St. John
Ambulance Association began its First Aid training

ople said the same thing. That dread has longsince

isappeared ; all medical men approve of First Aid in
our streets, and how much more is it necessary when
going to parts where there is no dootor, that teaching
suitable to those far distant places should be insisted
upon. I should like to see it made law, and an
embargo put upon every ship embarking & missionary
who has not been adequately trained. Unless it is
made law, I am afraid that religious fervour may
carry us away, and men and women will still be sent
out without being fully equipped; they should be
trained to look after their own lives, the lives of their
colleagues, to help the people, and not needlessly to lay
down their lives in those distant lands.

APPENDICITIS.

THE alleged causes of appendicitis multiply. Quite
recently at least three new conditions associated with
this ailment have been mentioned. (1) In the Lancet
of February 10th, 1906, E. Burfield and E. H. Shaw
found іп а patient from South Africa lumbar and
gluteal abscesses which showed ova of bilharzia in the
appendix. Their belief is that the pus from the appen-
dix pointed backwards and upwards posteriorly, and
that along the sinuses thus set up bilharzia ova found
their way into the appendix. (2) H. H. Roberts, in
the New York Medical Journal of February 7th, 1906,
mentions intestinal oxyures to be one of the chief
causes of appendicitis and colitis. (3) A. A. Gumbines,
in the same journal, mentions a case of tapeworm in
which the symptoms pointed to appendicitis, but
completely disappeared when a tapeworm was passed.

ECHINOCOCCUS MULTILOCULARIS.

W. Ramsay Smita, of Adelaide, South Australia, in
a graduation thesis published in Medicine in October,
November, and December, 1905, deals with multi-
locular hydated cyst. After discussing the modern
views of hydated disease, he proceeds to a historical
and descriptive account of the multilocular variety,
Dr. Smith states that ‘‘the total number of multi-
locular hydatids hitherto recorded throughout the
world in human beings and the lower animals is under
100. The number of specimens I have myself col-
lected is somewhat over 1,000." The specimens are
largely collected from the lungs and livers of sheep; a
few specimens are from oxen and pigs. The most
typical form of multilocular hydatid consists of a
number of “graded” loculi communicating with one
another, and varying in size from 1 to 10 millimetres
or more in diameter, with ectocyst and endocyst con-
tinuous throughout the loculi, the small loculi being
barren, the large fertile, and аге enclosed in а common
adventitious fibrous capsule.

Dr. Smith describes а multilocular hydatid from the
human liver. The tumour occurred in & patient dead
of cancer, was of minute dimensions and calcified, but
the cyst structure was evident.

In addition to the forms of multilocular hydatids
hitherto described, Dr. Smith mentions a '' tunneling "
form. The liver in this variety showed large, tunnel-
like excavations with diverticula, involving more or
less of the organ.

Dr. Ramsay Smith states that ‘‘a typical echino-
coccus multilocularis is multilocular from almost the
earliest recognisable cystic stage, and cannot, in the
present state of our knowledge, be called merely a
variety of any other form of hydatid.”

BILHARZIA DISEASE AMONGST PORTO
RICANS IN SAN FRANCISCO.

Six undoubted cases of bilharzia have been reported
up to the present in the United States of America.
All the patients were immigrants, and two of the cases
were reported by Herbert Gunn ina paper read before
the California Academy of Medicine, and published in
the Journal of the American Medical Association on
April 7th, 1906. Gunn’s cases affected the intestines ;
all the previously reported cases had their seat in the
urinary tract. The patients had left Porto Rico four
or five years ago, went to the Hawaiian Islands, and
had resided in San Francisco about twelve months.
There seems no doubt that there is a focus of bilharzia
disease in Porto Rico, but there is no evidence that
the disease is endemic anywhere else in the American
continent.

GOUNDOU AND AINHUM.

Dr. WELLMAN ON GOUNDOU AND AINHUM.
Соомров.

F. C. WELLMAN. In reviewing the causes of
goundou (Journal of American Medical Association,
Mareh 3rd, 1906), Dr. Wellman, writing from Ben-
guella, West Africa, mentions the several alleged
causes of this condition. Не notices the growths are

July 16, 1906.)

THE JOURNAL OF TROPICAL MEDICINE.

225

often considered : (1) to be a sequel of yaws (Chalmers);
(2) a disease su generis (Braddon) ; (3) an example
of atavism in the negro (Strachan); (4) а manifesta-
tion of syphilis (Fredrichsen); (5) malformation due
to non-union of the nasal and frontal bones (Kleng) ;
(6) to be due to the presence of larve of insects in the
nostrils (MacLaud). Dr. Wellman states that none of
the explanations proposed rest on anything more
definite than conjecture. Тһе tumours are doubtless
& hyperplasia, probably due to an osteoplastic peri-
ostitis due to a definite but undiscovered cause.

AINHUM.

The same author in the same communication criti-
cises the theories appertaining to the cause of ainhum.
The following etiological theories have been brought
forward :—Ainhum is stated to be (1) а lesion of
leprosy (Zambaco) ; (2) due to injury (da Silva Lima);
(8) trophoneurosis (Scheube); (4) а circumscribed
scleroderma (Corre); (5) & congenital spontaneous
amputation (Proust) ; (6) the result of self-mutilation
by ligatures, the wearing of toe-rings, &c. (Gongora
&nd others) Of these theories Dr. Wellman thinks
that of da Silva Lima is feasible. There can be no
doubt that the affection is a cicatrix, and Dr. Wellman
mentions a possible factor in establishing irritation
in this part of the foot to be the chigger (S. penetrans),
which has a predilection for the base of the little toe,
especially if, as is so often the case, the skin at that spot
be cut or torn. The true cause, however, of goundou
and ainhum have yet to be discovered.

NOTES ON GOUNDOU AND AINHUM.
JAMES Самти, M.B., F.R.C.S.

Goundou.—At the Seamen's Hospital, in connection
with the London School of Tropical Medicine, I
operated upon a case of unsymmetrical goundou in
в European from the west coast of Africa. The man
(36) had been since boyhood visiting the west coast of
Africa, and had resided there for some twelve years,
with occasional holidays. Тһе enlargement was on
the left side of the face in the neighbourhood of the
nasal process of the superior maxillary bone, and
projected sufficiently to cause a marked deformity.
No cause was assigned by the patient for the condition,
nor could any be ascertained from the history. I cut
down upon the enlargement and removed the whole of
the adventitious growth. The piece of bone consisted
of a mass of rather closely packed cancellous tissue
covered by a layer of compact tissue of normal con-
sistence and thickness. Мо periostitis was dis-
cernible, and the fact that the growth was in the
cancellous, and not in the compact, covering favours
this view. The outgrowth in goundou would seem
(1) to be due to an increase in the cancellous tissue of
the nasal process of the superior maxillary bone in the
first instance; (2) the neighbouring bones, namely,
the nasal and (perhaps) the lachrymal, become in-
volved as the condition spreads; (3) goundou may be
asymmetrical; and (4) may occur in Europeans ex-
posed at an early age to West Coast influences.

Atnhum.—The constriction which arises at the
junction of the covered and free portion of the fifth
and (occasionally and subsequently) the fourth toes of

either foot occurs not only amongst negroes, but is
common amongst the Chinese in South China, and I
have seen a case in India. The patient I saw in India
was, I believe, a Maharatta. That the disease was
of a leprous nature I at one time believed, but a care-
ful investigation of this particular point for some seven
or eight years showed the belief to be erroneous.

-------

Beport.

A RESEARCH INTO THE ErroLocy оғ BeExi-BERI—
« Together with a Report on an Outbreak in the
Po Leung Kuk.” By William Hunter, Govern-
ment Bacteriologist, and Wilfrid V. M. Koch,
Medical Officer in charge Infectious Diseases
Hospitals, Hong Kong. (Noronha & Co., 1906.)

Ім this report, dated Hong Kong, December 29th,
1905, and which has just come to hand, Drs. Hunter
and Koch, in their introductory letter, state :—

Primary gastro-duodenitis not present.—The most
interesting feature of this part of the report is the
question as to the presence of a primary lesion in beri-
beri. Medical papers at the present time are full of
beri-beri, and one of the most widely discussed ques-
tions in this connection is whether there exists in
beri-beri a primary gastro-duodenitis, the premonitory
syndrome of Hamilton Wright. According to our
results such a lesion does not exist. Gastric and
duodenal changes, and indeed occasionally changes of
variable pathological degree of the entire small gut are
often found in beri-beri cadavers. These, however,
do not appear to be primary and the seat of primary
election of the so-called virus of beri-beri. Conges-
tions, hcemorrhages, cedematous infiltrations and even
patches of necrosis have often been found in the gastro-
duodenal mucosa, but that these are due to the actual
beri-beri virus we have reason to doubt. Microscopi-
caly the changes found are difficult to class with
active inflammation as found in diphtheria. They
resemble more closely the changes consequent upon
passive hyperemia and congestion set up by precedent
nerve degeneration. Arguing, a posteriori, little
weight is to be given to the changes found in the ali-
mentary canal, and our observations in this respect are
more or less in aecord with the recent investigations
of Durham, who lately studied beri-beri in Christmas
Island and the Federated Malay States.

No neuro-organism found.—The bacteriological in-
vestigations which have been made during the
research were many, and of a varied character.
Almost every tissue and fluid of the bodies of cases
of beri-beri have been submitted to a searching exam-
ination by almost all the methods available for the
isolation of specific micro-organisms. On referring to
this part of the report in detail, it will be seen that we
found it impossible to find any micro-oryanism which
could be brought into causal relationship with the
disease. Again and again cocci, bacteria, &c., could be
obtained from beri-beri patients of fresh cadavers.
These were of the same nature as the micro-organisms

926

THE JOURNAL OF TROPICAL MEDICINE.

[July 16, 1906.

isolated by other workers. Detailed bacteriological
work and experiments proved, however, that such
micro-organisms have nothing to do with the produc-
tion of the disease, and in the light of our present
micro-biological knowledge must be regarded as extra-
neous organisms isolated and fully described by inves-
tigators using somewhat defective technique. Тһе
bacteriological examination of Wright’s so-called
primary lesion, t.e., damaged gastro-duodenal mucosa
resulted in the isolation of many rod-shaped bacteria,
the biology of which showed them to be nothing more
or less than ordinary intestinal micro-organisms. In
summing up our bacteriological results, our investiga-
tions strongly point to the conclusion that beri-beri is
not due to any micro-oryanism of the hitherto described
types. Indeed we doubt if the discase is an acute spe-
cific infectious disorder. бо far our results are against
its being so.

Animals not liable to the disease.—Coming to the
experimental part of the report, the results of our
attempts to induce the disease in any of the common
domestic animals are decidedly a failure. In по віор1е
instance, out of over fifty miscellaneous experiments
upon monkeys, pigs, calves, sheep, fowls, rabbits, &c.,
were we able to call forth even the shadow of a sym-
tom or sign of beri-beri. =

Comparing the results of these experiments with the
series carried out by Durham, who also had negative
results, it would appear that it is impossible to convey
beri-beri directly from man to animals. So far as
published records are concerned, monkeys are the
only animals which appear to have contracted the
disease, and then only under natural conditions.
These—the experiments of Hamilton Wright and pub-
lished ір a recent number of “ Brain "—however, are
isolated observations, and judging from the recent
remarks of Durham in the Journal of Hygiene some
doubt would appear to exist as to the real condition
of the monkeys described by Wright as suffering from
beri-beri.

The question as to whether any animal can contract
beri-beri direct from man, or indirectly through some
other channel, must remain open. Our own opinion
is decidedly against the сопуеуапсе from man to
animals. With the exception of Hamilton Wright's
experiments, which must be received with due caution,
there are no reliable records of beri-beri in animals.
Indeed it would be difficult to experiment along these
lines with hope of success in the absence of the
etiological factor and its point of invasion of the body.

Our experimental researches bring us further along
the line of our conclusions as to the non-micro-organ-
ismal nature of beri-beri. Up to the present time
none of our researches have guided us to form a con-
clusion that it is a specific infectious disease. Indeed
all the evidence contained in this report is against
such a conclusion.

The premises upon which we built up such a state-
ment so antegonistic to the theories of Hamilton
Wright are the following :—'

(а) There is no evidence of a primary lesion, i.e., a
point of invasion of the virus into the body. This,
however, carries with it very little weight, as many
specific infectious diseases have a somewhat crypto-
genous point of entry into the human tissues.

(b) No specific micro-organisms сап be found in any
organ or tissue of any case of beri-beri which can be
brought into close causal relationship with the disease.
The micro-organisms found in Wright’s so-called
primary gastro-duodenitis are to be regarded as
ordinary bacteria belonging to the intestinal flora.

(c) Experimental researches are negative. The
blood contains no organisms, and the transference of
large quantities of beri-beri blood to the tissues of
healthy animals never induces disease.

Similar results are obtainable with the spleen, liver,
brain, &c.

When we come to the gastro duodenal mucosa as
found in acute and rapidly fatal cases of beri-beri, and
use an emulsion of this for feeding monkeys—
&nimals said by Wright to contract beri-beri naturally
— and obtain uniformly negative results, our faith
becomes somewhat shaken in the micro-organismal
nature or the specific infectivity of beri-beri.

In conclusion, the results of our researches are
directly opposed to those of Hamilton Wright, and in
more or less harmony with those of Durham.

Of late years & considerable diversity of opinion
would appear to prevail as to the isolation of beri-
beries aud the treatment of beri-beri cadavers. From
our researches we can see no valid reason to suppose
that in beri-beri we are dealing with a highly infec-
tious disease. Indeed beyond the removal of such
patients to surroundings light and airy, with the regu-
lation of а liberal and wholesale diet, nothing more
would be required to add to the sum total of the
necessary sanitation.

As regards the burial of beri-berics, this, in our
opinion, is of no vast importance apart from the ques-
tion of the decomposition of the body. If provision
during burial is made for rapid decomposition, as now
laid down by all hygienists, no danger will accrue.

Having summed up the results of our investigations
into this interesting disease it but remains to specu-
late on & theory as to its etiology. Іп these days
everyone strives to have a theory in regard to the
etiology of & disease like beri-beri. Whether such &
course is advisable, in the absence of any definite data,
we leave open for speculation.

———9—-————

Redicws.

MEDITERRANEAN Кеуек IN Inp1A: “Scientific Me-
moirs.” By Officers of the Medical and Sani-
tary Departments of the Government of India.
* Mediterranean Fever in India: Isolation of
the Micrococcus Melitensis,” By Captain George
Lamb, M.D., I.M.S., and Assistant.Surgeon М.
Kesava Pai, M.B., C.M. (Madras). New Series.
No. 22. Price 10 annas, or 1s.

Captain Lamb and Assistant-Surgeon Pai have suc-
ceeded in establishing the fact that Mediterranean
fever is met with amongst residents or natives of
India. In eleven of the cases the M. melitensis was
isolated from the spleen durivg life. Nine of the
patients were Sepoys of the 27th Punjabis, Multan ;
one was a Sepoy of the 12th Sikhs, Ferozepore ; and

THE JOURNAL OF TROPICAL MEDICINE.

July 16, 1906.]

one was a man, also from Ferozepore, ten years
resident in India.

In six of the cases no splenic puncture was made,
the diagnosis resting solely on the clinical history and
the serum agglutination reaction. Two of the cases
were Sepoys in the 27th Punjabis, Multan; one
was а prisoner in the Ferozepore jail; two, а man
and a woman, resident in Lahore; one a native of
Murree. There was found to be a great difference in
the agglutination value of the sera in the different
cases. The M. melitensis was isolated from the spleen
at various stages of the disease, in most instances
whilst the temperature was still high and the illness
more or less acute.

Although many of the cases occurred in the same
regiment, careful investigation failed to bring forth
any evidence in support of common infection. The
men belonged to different companies, to different races,
slept in ditferent barracks, and practically never met.
The 27th Punjabis, in which regiment the majority of
cases of Mediterranean fever occurred, were stationed
at Multan since January 29th, 1905; previously the
regiment were quartered at Ferozepore, also in the
Punjab, and many cases of a kind resembling Medi-
terranean fever had occurred in the regiment before
leaving Ferozepore for Multan. The 15th Sikhs suc-
ceeded the 27th Punjabis at Ferozepore, and one man
of the former regiment developed Mediterranean fever
at Ferozepore. This, however, seems to have been
the only case, so that the infection left behind by the
27th Punjabis cannot have been severe. The ex-
planation of the 15th Sikhs escaping the disease so
markedly is believed to be due to the fact that over
two months elapsed between the arrival of one
regiment and the departure of the other.

A VocABULARY OF Maray Mzpnican Terms. Ву P.
N. Gerrard, B.A., B.Ch., M.D. (Dublin). D.T.M.H.
oe Singapore: Kelly and Walsh, 1905.

. 107.

Thie useful book is well adapted for the purpose for
which it was written. In addition to the vocabulary
one finds valuable information in the preface. In the
appendix will be found sentences for conversational
purposes applicable to obtaining the clinical histories of
such ailments as beri-beri, venereal diseases, fevers,
cases of consumption and of dysentery. Snellen’s
Vision Test types, adapted to Malay requirements,
form a useful practical addition to the vocabulary.

—— ——9——— ——

Correspondence.

To the Editors of the JougNAL oF TropicaL MEDICINE.

Srrs,—In Lieut.-Colonel Giles’ article on “ Biting Flies,"
in your issue of April 2nd, he quotes the old French saying
“les mouches d'automne pignoient” as probably referring
to members of the genus Stomorys, and not to the common
house-fly. Under certain weather conditions, however, I
have on several occasions—both in South Australia and in
Scotland—experienced a slight but irritating “bite” from
the latter. The climatic conditions under which this happens
are dull autumn days, when summer is just passing into
winter and the housewife is in doubt about laying fires.

221

The species is unquestionably the common house-fly, but
how it produces the faint sting I cannot say. Surely it is
this occasional occurrence to which the French refer.
Yours, &oc.,
Perth, W. Australia. J. BuRTON CLELAND.

June 9th, 1906.

With reference to the above it may be remarked that
although the ordinary method of taking food, іп the house-
fly and its allies, is by means of a sort of licking action
performed by the lobes of its so called “ tongue”; these
insects are nevertheless provided with a short pointed labrum
and a hypopharynx hidden above the roots of the former.
Though hardly suited for actual piercing, these would be
quite capable of giving the slight prick occasionally inflicted
by the common tly, which, however, probably only does so
accidentally in its effort to obtain as much as possible of the
perspiration of the person on which it has settled. Ad.
mitting this, however, I believe that Stomorys is far more
commonly the real culprit.

------Ф-----
Personal Motes.

Inp1aN MEDICAL SERVICE.

India Office: Arrivals of Indian Medical Officers in London. —
Captain R. E. Lloyd, Captain R. М. Dalziell, Captain R. M.
Carter, Major J. B. Smith.

Extensions of Leave.— Lieutenant-Colonel W. S. Eyres, 6 m.
Med. Cert. ; Captain R. M. Dalziell, 3 m., Med. Cert.

Permitted to Return to Duty. — Captain E. C. Maddoch, Major
J. K. Close, Lieutenant R. F. Steel.

Postings.

Captain A. G. Sargent and Captain W. H. Cagaly, services
lent to Government of Bombay.

Major Grayfoot, to be Med. Officer, Sind Rifles.

Colonel Benson officiates as Surgeon-General, Madras, with
temporary rank.

Major Anderson, Civil Surgeon, Tippera.

Assistant-Surgeon Daley acts as Civil Surgeon, Balasore.

Lieutenant-Colonel G. Н. Bull officiates as P. M.O., Bombay.

Major E. R. Parry acts in additional charge as Civil Surgeon,
Dacca.

Captain Mathew, services lent to Government of Burmah.

Major А. Б. S. Anderson, services placed at disposal of
Government, East Bengal and Assam.

Lieutenant-Colonel Dennys officiates as Agency Surgeon and
Admin. M. O., N. W. Frontier Province.

Captain Flening, I.M.S., Civil Surgeon, Peshawar.

Major Bidie, Captain Feslir, and Captain O'Neill, services
placed at disposal of Government of Madras.

Colonel D. ffrench Mullen, services temporarily placed at
disposal of Commander-in-Chief.

Leave.
Major P. P. Kilkelly, Privilege and Study, 1 y.
Lieutenant-Colonel R. М. Campbell, privilege leave, 2 m. 28 d.
Mr. Gibson, Assistant Director, Plague Research Laboratory,
Bombay ; leave, 2 y.
Captain N. Collinson, leave on Med. Cert., in anticipation of
formal sanction.

Dr. P. A. Rigby, Civil Surgeon, Balasore, combined leave,
6 m.

------о---

Hotes and Rebs.

PunsaB MEDICAL COLLEGE AFFAIR.— Over a hundred
students of the medical school at Lahore, who were
out “ on strike," have come in and made submission.
About 164 others, including the ringleaders, still stand
out.— Pioneer Mail, June 15th.

һо
bo
о

Recent and Current Literature.

A tabulated list of recent publications and articles bearing on
tropical diseases is given below. To readers interested in
any branch of tropical literature mentioned in these lists
the Editors of the JOURNAL OF TROPICAL MEDICINE will be
pleased, when possible, to send, on application, the medical
journals in which the articles appear.

* Bulletin de L'Institut Pasteur," June 15, 1906.

“Тһе Serotherapeutics of Plague " (La Sérothérapic de la
Peste), by Dr. Edward Dujardin- Beaumetz.

As soon as ever Yersin discovered the pathogenic agent of
bubonic plague in the epidemic which was raging in Hong-
kong in 1894, he sent specimens of this шісгоһе to the
Pasteur Institute, where Roux and his colleagues, Calmette
and Borel, made vaccination experiments. By using cul-
tures killed by heating to a temperature of 60? C., they suc-
ceeded in vaccinating animals, and proved that their serum
possessed preventive and curative properties in experimental
plague infection, since when horses have been immunised to
supply the necessary serum for the treatment of human
plague. The process consists in intravenous injections into
the jugular veins of the horses, first of emulsions of microbes
killed by heat, and afterwards of living microbes which have
been rendered hypervirulent by passage through guinea-pigs
and rats. The process is a somewhat lengthy one, as it
takes from five to six months, for the vaccinations have to
be repeated weekly and in progressive doses before an anti-
toxic and antimicrobic serum can be obtained which—after
due experiments on animals—can be used for human sero-
therapeusis.

The test used at the Pasteur Institute for the dosing of
the anti-plague serum consists in inoculating a mouse with
plague, and sixteen hours later injecting it with y;th of a
cubic centimetre of serum. The recovery of the mouse
testifies to the sufficiency of the activity of the serum. In
man, the efficacy of an anti-plague serum as a preventive
measure has been fully proved, but the effect is only a
transient one, and passes away after a period of about ten
days, so that a fresh injection of the serum is then again
necessary to keep up immunity. If the focus of the epi-
demic is в restricted one, these injections are of great ser-
vice ; but serotherapeusis as a preventive measure is out of
the question in a country where plague is endemic. In this
latter case recourse must be had to the injections of microbic
emulsion killed by heat, after the method recommended by
Haffkine. In this case immunity is acquired more slowly,
but, on the other hand, it lasts longer, and may even persist
for several months.

A lengthy list of the world-wide series of vaccinations
undertaken up to date is now given, with their several
results. and with their varying success. The difference is
accounted for as follows :—The anti-plague serum was given
too late; in insufficient doses; only rarely by the intra-
venous method; and lastly, the serotherapeutic treatment
was suddenly stopped as soon as the high temperature fell.

As far back as 1898, Simond noticed that among the
Hindoos treated, those who received the serum on the first
day of the disease had a mortality of 20 per cent. only, those
treated on the third day 36 per cent., on the fourth day 66
per cent, and lastly, on the fifth day, 100 per cent. of
deaths.

If, therefore. early intervention in the treatment of plague
has a favourable intluence on the prognosis of the disease,
the quantity and the method of the administration of the
serum are ulso по less important. The doses of serum in
plague must necessarily be much higher than those used in
general practice, as, for instance, in diphtheria, where there
is a well-defined lesion only to deal with; in plague, on the
contrary, the glandular affection may be general from the
beginning, and the plague germs may be present in the cir-
culation of the blood.

THE JOURNAL OF TROPICAL MEDICINE.

[July 16, 1906.

In order to successfully counteract such a severe onset, it
is necessary to inject large and repeated doses of the serum.
Duprat, at Rio-Grande do Sul, administered subcutaneously
doses of 200 to 800 cc., and even more, as a first injection,
and, according to the severity of the disease, injections of
100 to 120 cc. were repeated every twelve hours. This
method gave only a mortality of 15 per cent. Apart from
other objections, this method, however, requires one to have
enormous quantities of serum at one’s disposal, which is not
always feasible during an epidemic.

Now the intravenous method allows of the organism
becoming saturated immediately with antitoxin and in lesser
doses. Calmette and Salimbeni, at the time of the epidemic
in Oporto, showed the efficacy of this method by obtaining
unhoped for cures in severe cases, and especially in pneu-
monic plague. The quantity injected at any one time, then,
never exceeded 40 to 60 cc. of serum.

Since then Penna, of Buenos Ayres, has systematically
used the intravenous method for treating his cases in the
isolation hospital. He first injects not less than 100 cc.,
followed by a similar injection twenty-four hours later, and,
if there is then no perceptible improvement,by a third injec-
tion. His death-rate does not exceed 142 per cent.

The serum has also been administered through the peri-
toneal cavity, with a mortality of 18 per cent.; but this
method is not strongly recommended even by its authors.

The following is briefly the procedure for intravenous
injection: Тһе veins selected аге those on the back of the
hand or on the front of the wrist, or in dark-skinned races
on the anterior surface of the fore-arm. The serum must be
thoroughly limpid and slightly warmed; the needle is
plunged into the vein, and the syringe (filled with the serum
and with every air-bubble carefully removed) is then adapted
to it ; the injection is then very slowly forced оп; a drop of
collodion over the small needle wound is the only dressing
required. There is generally great reaction after an intra-
venous injection, but the symptoms afterwards improve
suddenly, almost as if by crisis; the intense glandular
pains cease, and in twenty-four hours plague germs have
disappeared from the peripheral circulation, and an exami-
nation of the glandular juice shows the absorption of the
cocco-bacilli by the polynuclear leucocytes. Тһе accidents
due to the serum, such as edema, erythema, or arthralgia,
are only such as sometimes happen with ordinary thera-
peutic sera, and bear no relation to the doses of the injec-
tions or to the methods of introducing the same, and are
merely due to the toxie properties normally found in horse
blood-serum.

Lastly, the use of large doses of anti-plague serum and
their administration by intravenous injection, cannot be too
strongly insisted upon, as serotherapeusis has hitherto
proved the only really efficacious treatment of plague, which
still claims too many victims.—(J. E. N.)

Rotices to Correspondents,

1.—Manuscripts sent іп cannot be returned.

2.—As our contributors are for the most part resident abroad,
proofs will not be submitted to those dwelling outside the United
Kingdom, unless specially desired and arranged for.

3.—To ensure accuracy in printing it is specially requested
that all communications should be written clearly.

4.—Autbors desiring reprints of their communications to the
JournaL оғ TROPICAL MEDICINE should communicate with the
Publishers.

5. — Correspondents should look for replies under the heading
“ Answers to Correspondents.”

August 1, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE.

229

Original Communications.

STUDIES ІМ PLAGUE.
By Professor Dr. CAMILLO TERNI.

Biological Laboratory, Museum of Natural History,
Milan (Italy).

TRoucR the researches of Kitasato [1], Yersin [2],
and of the different scientific commissions in India have
solved the problem of the etiology and pathology of
plague, we have advanced very little in our knowledge
of the treatment of the disease. We have regarded
plague exclusively as a septiceemic infection of so rapid
& course as to confound the local with the general
manifestations. All the specific treatment has there-
fore been exclusively based on serum therapy, regard-
ing it of value even though all evidence points to the
absence of success by this mode of treatment.

The laudable desire to obtain for plague the success
which till now serum therapy has given only for
diphtheria must not delude us into the belief that
there are no other means of treatment.

Therefore, after these years of trial during which
anti-plague serum has had a large and well-nigh
exclusive application in the treatment of plague, it
seems to me useful to state some observations made
by myself in numerous clinieal cases treated by
different methods.

Parr I.
Tae EFFICACY or PLAGUE SERA.

In a preceding study [3; I had occasion to point out
that the plague hacillus in man does not wholly behave
as а septicemic bacterium comparable to anthrax, and
that the penetration of, and the diffusion in, the
organism does not happen directly by way of the
blood. All the clinical and experimental facts show
that plague in the beginning is limited to the lymph
system, and especially to the glands, where the plague
bacillus finds the most favourable conditions of life
and development, producing in the so-called bubo а
process of inflammation and necrosis, and the forma-
tion of extremely toxic substances which, absorbed,
give rise to the gravest and most characteristic
symptoms of this infection. The presence of the
bacilli in the blood always happens at a very late
period, and is а secondary factor in the course of the
disease; whilst death usually occurs even before the
bacilli from the lymphaties appear in the blood in
consequence of the grave intoxication of the products
elaborated in the bubo acting with a paralysing effect
on the capillary circulation. Іп many cases also after
the blood is infected, we may still obtain spontaneous
recovery when the general intoxication is less grave |4).
In plague, therefore, the greatest danger to the
patient's life depends on the quantity of toxins elabo-
rated by the bacilli in the predilected focus of the
lymphatic system, or in tissues of selection, as, for
instance, happens in cases of primary plague pneumonia,
in which sudden death by capillary vaso- motor and
cardiac paralysis is the ordinary issue, whilst the local
lesions are of little consequence in determining a fatal
issue (Lutz [5], W. C. Hossack [6], L. Е. Childe [7] ).

In these conditions it is natural that to obtain a speci-
fic treatment of plague, the first requisite of the serum
must be a remarkable anti-toxic power, especially іп
the grave cases, when the inflammation at the point
where the bacili are concentrated has reached the
necrotic phase, so that phagocytic action is almost in
abeyance owing to the impenetrability of the dead
tissues, and toxins are thus allowed to run riot, with
grave danger to the patient's life.

The essential-conditions of the pathologic process of
plague, which I was the first to state, have been amply
confirmed by the English Commission in India [8],
who opportunely observe that in plague there takes
place a combined process of invasion and intoxication,
and that therefore it is evident that two different
qualities of the therapeutie substances must possibly
be applied in the treatment of plague. In the first
place, anti-bacterial substances capable of killing or
checking the growth of the bacteria; in the second
place, anti-toxic substances must be applied in order
to eliminate or alleviate the symptoms produced by the
bacterial poisons, by which is especially compromised
the natural resistance of the organism against infec-
tion.

Do the curative anti-plague sera actually in use corre-
spond to the fundamental therapeutic conditions above
stated ? Certainly not. Yersiu's first experiments
were too hasty, as proved by their want of success
during an extended trial, and they wanted the pre-
cision attending the process of animal immunisation
according to Calmette's and Borrel's and later Roux's
(9] proposals (entire and virulent cultures inoculated
into horses in gradually progressive quantities).

Yerain's preparation. The principal fact which
characterises the plague infection is that the com-
plexity of the symptoms of intoxication appears as
scon as the bacillus instals itself in the lymphatic
glands and sets up а bubo. Every observer who has
studied the serum therapeutics of plague must now be
persuaded that no animal, ordinarily at disposal for
such preparation, produces an anti-toxic serum in the
highest degree suitable for the treatment of plague;
and that it is not even possible to obtain a high anti-
bacterial power, to give sure and constant results in
the initial period of the infection, when the symptoms
of intoxication are not yet manifest.

With the method proposed by Lustig [10] it seemed
theoretically easier to obtain the vaccine with a greater
degree of solubility, and presumably more assimilable,
from the chemical treatment it underwent in the
preparation ; but we are again confronted with another
error, because it is demonstrated that the horses
destroy only to a small extent the plague nucleoproteid,
and that they do not produce in their serum efficient
curative substances. From this point of view it is
therefore still better to follow the method of inoculat-
ing entire and virulent cultures, һу which we obtain а
greater stimulating action on the phagocytes and the
production of anti-bacterial substances which, though
feeble, are yet active enough in the. fresh serum,
especially if we use for the preparation mules, asses
and oxen instead of horses. By using horses we are apt
to find that the serum has а toxic action instead of a
curative one, on account of the undestroyed bacterial
poisons which continue to be still active in the serum.

930

(August 1, 1906.

This perhaps explains the fact that in India the mor-
tality was greatest among those treated with serum,
although the “cure” began on the first day of the
illness, when the conditions are most favourable for
obtaining good resulta.

The English Commission after years of observations
and experiments came to the following conclusions
on the question of the anti-plague sera :—

(1) “Though the method of serum therapy as
applied to the plague has not yet been crowned with a
therapeutic success in any way comparable to that
obtained in the treatment of diphtheria, none the less
the method of serum therapy is in plague, as in
other infectious diseases, the only method which holds
forth a prospect of ultimate success.

(2) “Тһе serum treatment has not as yet been suffi-
ciently successful to make it desirable to extend the
treatment, under present conditions, as a general
measure over all the districts affected with plague.
Rather, it appears to us that the imperfections of the
present methods of preparation and application should
be fully recognised, and that it should be realised that
the line of progress lies, not in the direction of apply-
ing the sera at present available to the largest number
of patients, but in the direction of studying in the case
of the animals who furnish the serum the blood
changes which are associated with the incorporation of
the plague toxins, and with the elaboration of anti-
dotal and bactericidal substance. In like manner, we
think that the condition of the blood in the human
plague patient and the changes brought about by
the administration of the serum should be carefully
studied."

These principles we kept constantly before us when
working in the laboratory of Messina at the serum
therapeutics of plague.

How to prepare by various methods an anti-plague
serum of high anti-toxic power was our constant
endeavour, and I have already published the researches
and the results, which are without doubt superior
to those obtained from the sera prepared by Yersin and
by Lustig.Galeotti, both in the treatment of man and
in the experiments on animals. The difference of
method in the preparation of serum produced by
Yersin and by Lustig-Galeotti is not calculated to
determine much difference in the quality of the pro-
ducts and in the curative effects; because the former
inoculated into the horses either filtrates of cultures or
entire cultures; the latter utilised the protein extracted
chemically from the dead bodies of plague bacteria.
Neither with the one nor with the other method is it
possible to obtain а serum with marked anti-toxic
action, especially if horses are used for the preparation,
&nd the result of the treatment is merely a stimulus of
the phagocytic action, which is not always decidedly
manifest even when intravenous inoculation is em-
ployed. А slight advantage may be noted in favour of
Lustig’s serum, as we may infer from the statistics
of the Arthur Road Hospital in Bombay, which,
however, are not free from faults of method and
calculation.

Similar results in treatment of plague we may
obtain with the artificial sera of Hayem and of Fodor,
and still better by the inoculation of corrosive sub-
limate proposed by Bacelli on account of the great

stimulating power exercised by the sublimate on the
leucoeytes.

After testing by numerous experiments the toxic
action of the pathogenic plague products іп man and
in animals in contrast with those of the artificial
cultures, I proceeded to immunise the animals with
the products derived from the infected organism
(peritoneal exudate of plague-infected guinea-pigs, juice
of buboes, &c.) instead of artificial cultures. As the
horses exhibited but little resistance against the action
of similar products, we substituted mules and oxen for
horses, with very promising results ; the anti-bacterial
and anti-toxic value of the serum obtained by this
method, compared with that of the serum from horses
immunised with cultures or with Lustig's nucleo-pro-
teid, stands in the proportion of 50 to 1.

The serum prepared according to this.method has
been amply applied in Brazil side by side with the
sera of Lustig and Yersin. Тһе results, however,
though favourable to the new method, showing a total
mortality of patients treated with this serum of 25 per
cent. only, always leave some doubts on account of
the relatively limited experience, and from the fact
that epidemics often vary in intensity and virulence.
Moreover, my serum was recently prepared, whilst
the other two sera used were much older. The great
instability of the anti-bacterial and anti-toxic sub-
stances of anti-plague serum, no matter how prepared,
makes it very dithcult to have accurate comparable
statistics, when either the sera employed are not the
same age, or when the epidemics vary in virulence.

Judging from experiments upon animals, plague
often takes on a rapidly septiceemic character, showing
that the anti-bacterial substances of the anti-plague
serum are rapidly eliminated, so that the results vary
sometimes with the same sample of serum if it is first
used fresh and then after only four or five days. The
same has been stated by the English Commission
regarding Lustig's and Yersin's sera [11].

To this circumstance must I ascribe the unsuccess-
ful results obtained in Bombay with my serum, which
has been tried in a series of 300 patients under the
direct control of Mr. Haffkine, to whom I am deeply
indebted for so generously allowing so extensive a trial
of my preparation. The serum could be applied only
after a delay of nearly six months, and it was impos-
sible to substitute it in time with a fresh one.

The instability of the therapeutic substances of anti-
plague serum just related is, however, confirmation of
the slight (if any) specific action which it possesses.

By none of the known methods have the serum
therapeutics of plague been settled, and in the gravest
cases the deficiency of the curative power of the serum
on account of the feeble and inconstant anti-toxic
action is manifest. With the animals ordinarily at
disposal in the laboratories for the preparation of sera
on a large scale, it is so far impossible to obtain an anti-
plague serum which has a curative anti-toxio efficacy
in any way comparable to that of the anti-diphtheritic
serum, and to this deficiency we must ascribe the
failure of serum therapeutics in plague. Only from
man convalescent from grave forms of plague, or from
monkeys (Масасив rhesus) and from rats (Mus decu-
manus) is it possible to obtain a very active anti-toxic
and anti-bacterial serum (reducing to 20 to 30 cem. of

August 1, 1906.)

serum the normal dose of U.I.) sufficient for the treat-
ment of cases with the gravest broncho-pulmonary
complications, which till now remain intractable to
any kind of anti-plague serum. When great quantities
of material are required during an epidemic, it is
practically impossible to obtain sera of similar strength,
owing to the demand exceeding the supply.

The problem of the specific treatment of plague
remains, therefore, still in great part unsolved. The
advantages actually obtained with serum therapeutics
are very limited, and must be considered as a good
promise for the future, rather than as a completed
or final result.

Part II.
TuE SURGICAL TREATMENT OF Вовоміс PLAGUE.

Whoever has had occasion to examine a plague bubo
in the most critical period of the disease (third to fifth
day) will be persuaded that it is impossible to hope
that by serum therapeutics the necrotic mass of the
lymphatic glands can be destroyed, seeing that
phagocytosis cannot develop effectually in dead
tissue; the plague bacilli, therefore, develop rapidly
and eliminate toxins, which, in conjunction with the
other soluble poisons of the bacterial bodies in disin-
tegration, tend to infect the patient's blood and tissues.

Ву studying the natural evolution of the disease, one
arrives at à rational method of treatment.

In the cases of spontaneous recovery the fever falls
by crisis after twenty-four to forty-eight hours, and the
infection stops before the real bubo is formed, limiting
itself to the inflammation of one or two glands. In
other cases the spontaneous recovery may occur іп a
more advanced period of the disease when the bubo is
completely developed, that is, when the inflammation
affects the majority of all the glands of a given region.
In these cases the bubo begins to fluctuate after the
eritical period (third to fifth day), and the spontaneous
issue of the pus towards the tenth to the fifteenth day
follows when an incision has not been made. We
must therefore consider as of benign prognosis all
those cases in which the plague bacillus finds itself in
the buboes associated with the pyogenic staphylococcus,
not because these act by attenuating its virulency or the
toxicity of the products, as some observers thought,
but because the intervention of these bacteria in the
phase of suppuration favours more rapidly the resolu-
tion of the illness with the evacuation of the focus of
infection. When the pus is not eliminated in time,
death will surely follow either by general infection or
by slow intoxication. The benefit of the rapid evacua-
tion of the infecting and toxic products accumulated
in the bubo in consequence of the suppuration deter-
mined by the pyogenic staphylococcus is so evident
that since the most remote antiquity the treatment
of plague consisted in hastening the suppuration and
the opening of the buboes. Recently one of the
physicians of Alexandria, Egypt, thought it expedient
to inoculate the pyogenic staphylococcus into the
plague buboes as a means of cure when they do not
manifest the tendency to suppuration [19].

The contrary occurs when the plague bacillus is
associated with septicæmic bacteria (diplococcus) or
with the streptococcus, because early in the disease
a zone of cedematous infiltration round the glands,

THE JOURNAL OF TROPICAL MEDICINE.

231

constituting the bubo, is manifest, involving thereby
the surrounding tissues and the skin in the inflam-
matory process. The diffusion of the plague bacilli
becomes thereby easier and more rapid, and a general
infection is more certain.

The natural or clinical course, which we see the
spontaneous exodus of plague follows, indicates the
rational method of the treatment of the disease:
namely, either the possibility of stopping the infective
process at the beginning of the infection by serum thera-
peutics in mild cases, or surgical intervention when the
progressive development of the buboes and the gravity
of the symptoms of intoxication demonstrate that the
specific treatment by serum is not sufficient for recovery.

It is wholly unscientific to regard plague as quite
distinct from other pathological states with which we
are familiar. In other forms — lympbangitis and
lymphadenitis of a malignant character, no physician
would think of applying the serum ав an antidote
before he intervenes surgically. Theonly difference is
that in plague the local phenomena are less evident
at the commencement of the attack and are not pro-
nounced until after general infection has shown itself.
In other forms of lymphadenitis the local conditions
arrest more readily the attention of the observer, and
induce surgical iutervention before the symptoms of
general intoxication and infection are manifest.

Experience gained in the treatment of plague, especi-
ally at the Seaman's Hospital of Rio de Janeiro, allows
me to affirm without hesitation that the great mor-
tality observed in the plague hospitals results from the
want of or delay of surgical intervention, because
the infection remains, for a period of three to five days
or more, concentrated in primary buboes and adjacent
to lymphatic paths. This danger can be got rid of by
eradicating the infected part, when the treatment by
serum is evidently inefficacious.

From the results of numerous microscopic and bac-
teriologic researches made in conjunction with Drs.
Gomes and Guimares, in order to determine the
method of diffusion of the bacilli from the point of
penetration to the bubo, I was persuaded of the
benefit of immediate surgical intervention in the treat-
ment of plague by a radical operation—the extirpation
of the bubo.

In eighty-two patients who presented phlyctenules or
furuncles or other primitive cutaneous lesions, it was
not possible to find bacilli in the lymph extracted
along the course of the lymphatic vessels between the
primary lesion and the initial bubo; nor were bacilli
found in the tissues surrounding the capsule of the
glands.

From this fact we must infer that the plague
bacillus does not find favourable conditions of de-
velopment in the lymphatic vessels, and that only in
the glands is to be found the true focus of infection,
The diffusion of the bacilli proceeds gradually from
gland to gland, and successively into all the glands of
a region before it passes into another group; and the
process of infection always moves in the direction of
the lymph stream from the more superficial to the
deeper parts, and never by the way of the blood, or by
inflammation of the intermediate lymphatics, unless
there are associated with the plague bacillus other
bacteria (diplococcus, streptococcus), in which case

982

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[August 1, 1906.

more or less diffused lymphangitis, phlebitis and
cedema may be observed.

If, for instance, the primary bubo is femoral, located
at t ie apex of Scarpa s triangle, as usually occurs, the
infection extends to all the superficial inguinal glands
betore it reaches the deep glands situated near the
crural canal; subsequently the glands of the pelvic
cavity may be involved, but at the beginning of the in-
fection, by microscopic апа bacteriologic examination
we may verify (the infection of the inguino-crural
glands, whilst the pelvic ones are still healthy. If, on
the other hand, the bubo is axillary and formed by the
swelling of the gland situated at the distal part of the
axilla, tue infection extends to all the glands of the
region before it involves the subclavicular group of
glands. In the cervical buboes also, if determined by
primary plague amygdalitis, the infecting process
liinits itself tor days t» one ог two glands of the retro-
maxillar ог superior cervical region without extending
to the central aud inferior cervical group.

Іп ths tisto-pathologic examination of the tissues, it
is also easy to demonstrate that the manner of infec-
tion of the plague bacillus in the glauds, as in other
tissues, proceeds always by degrees in small foci, first
located in the lymphatic spaces, aud later becoming
confluent, causing a destruction of the tissue (Albrecht
and Ghon) [13], (Bandi and Stagnitta) [14], (Powel
White) [15]. These pathologic locaiisations, charac-
teristic of the primary bubo, distinguish it from the
secondary buboes, and correspond to those of the
primary foci in other organs (tonsils, lungs); they
represent, therefore, the first adaptation of the virus in
the new host, and are the seats where the bacilli find
the best conditions to acquire the virulence and to dis-
play the successive toxic and infecting activity. There-
fore we see that these primary lesions in the lymphatic
channels can be more easily reproduced experimentally
with cultures of attenuated virulence ; whilst when the
bacilli after several passages through the same animal
species have obtained the greatest activity, they do
not manifest themselves, because we have then an
almost immediate general diffusion. Still, the evidence
of their preseuce is at the beginning more evident in
the lymphatic system, before they pass into the blood
but without the evidence of localisation in initial foci.

From these observations the necessity of the imme-
diate extirpation of the primary bubo would seem evi-
dent, and the possibility of cure, in a disease of so
rapidly infecting and toxic & character as plague, will
be the more certain the more we practise early elimina-
tion of the part which represents the primary localisa-
tion of the bacilli in the organism and the point of
departure of the general infection. Albrecht and
Ghon [16], of the Austrian Commission for the study
of plague in India, came to the same conclusion, ex-
pressing the opinion that in the treatment of plague we
ought not to neglect the extirpation of the primary bubo,
notwithstanding the use of the serum.

Jamagiwa [17] has also demonstrated that the
prompt extirpation of the infected glands is rational
and beneficient. And Bandi [18], in some experi-
ments made according to my advice, has also obtained
good results in the same direction in animals.

In none of the more recent clinical works on plague
has the empiric practice of the past been taken suffi-

cient note of with regard to the surgical treatment of
plague. From ancient times we see the principle
affirmed that the recovery from plague depends on the
rapid evacuation of the buboes, and in order to avoid
hemorrhage they advised the use of caustics or the
actual cautery. In all the old writings on the treat-
ment of plague the provocation of suppuration is
indicated, and not to wait too long if this is retarded,
to proceed promptly with early incision, or the use of
caustics if the suppuration is not yet manifest on
the second or third day.

Our first information concerning the surgical treat-
ment of plague goes back to Hippocrates [19], to
Archigenes, referred to by Galen [20], but especially
to the Arabian physicians (Eba, Sina, Beitar, Isaac
Iudeus, Rhazes), and was made known to Western
Europe at the time of the Crusades. In the Orient to-
day plague buboes are treated by native doctors by
deep incisions and the application of caustics or the
red-hot iron.

In the epidemics which desolated France іп 1500,
the surgical treatment of plague, especially by
Ambrois Paré [21] and his school, was stated as the
only positive and eflicacious method among all the
other extravagant remedies then in vogue. Тһе same
results were obtained by Settala [22] and Tadino [23]
in the famous epidemics of plague in Milan іп 1575
and 1630. In the epidemic of Marseilles in 1720, with
the better knowledge of practice and the study of
anatomy, we see introduced, besides the incision pre-
ceding suppuration and the medication with the anti-
septics (detersives) of that time—salt water and
vinegar, also the extirpation of the buboes by the
method recommended by Manget [24].

The persistent opinion of all the ancient observers
of plague that the result of the cure depends essen-
tially on two conditions is well enunciated by
Settala: Extract in any way and as quickly as pos-
sible the matter in order that it will not а its
poison over all the body. The necessity and efficacy
of the immediate surgical intervention in plague before
suppuration occurs acquires greater force by the fact
that this method was advised exclusively for plague,
whilst for all the other inflammatory tumours (as
furuncles, anthrax and buboes of other nature) re-
course was had to emollient cataplasms, that is to say, ·
a method of expectancy or a more tardy suppuration.

As а complement of this short account of abserva-
tions of the past, it is of interest to note that the
French physicians, during the war for the conquest of
Palestine (1799) [95], established as the general
method of treatment in plague the incision of all those
buboes which did not present signs of suppuration, in
order to facilitate the crisis. Before he gave this
order, Napoleon's English physician, O’Meara, had an
equal number treated by incisions and by the usual
method (cataplasm, emollients, or revulsives). The
result was that many more recovered by the former
than by tbe latter method of treatment.

If, therefore, so favourable and constant results were
obtained in the past when the conditions were much
worse and when all the technical and scientific re-
sources of modern surgery were wanting, it seems
really strange that we should still doubt the efficacy of
surgical intervention in buhonic plague.

August 1, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE.

233

The tradition of the surgical treatment of plague
continued after the above-mentioned epidemics, as we
may gather from Proust [26] and Cabanes (27|.

The merit, however, of drawing attention in recent
years to the advantages of the surgical treatment of
plague is due to J. Cantlie |98).

The extirpation of the buboes, especially when they
are still in the initial period, does not present any
difficulty, and is also borne by the patients without
narcosis, local answsthesia being sufficient, especially
when the bubo is superficial.

The operation in the majority of cases is limited
to: (1) Incision of the skin and of the superficial
&poneurosis; (2) isolation of the bubo from the sur-
rounding tissues; (3) removal of bubo; (4) examina-
tion of the lymphatic glands in the neighbourhood,
especially if they are hemorrhagic or tumefied and
painful. Dress the wound in the ordinary way.

The operations made in the plague hospital of Rio
de Janeiro during the epidemics of 1900 and 1901
numbered 642, with а mortality of 10 to 15 per cent.,
varying according to the number of the buboes present,
their locality, and the duration of the illness before
surgical intervention.

The extirpation of the buboes even in the fatal cases
seemed to temporarily afford beneficial effects, so
much so as to induce one to entertain the idea of a
favourable prognosis. At the autopsy of cases with
inguinal-femoral buboes which had been operated
upon, the cause of death was found to be due to infil-
tration of the lymphatic glands of the pelvic cavity,
owing no doubt to delay in operation or because the
patient objected to operation. On the other hand,
we have been able to verify the death of a patient
from septic peritonitis after nearly a month's laboured
convalescence, caused by evacuation of the ichorous
matter of a pelvic gland opening into the peritoneal
cavity. This case was one of the most typical to
prove the insufficiency of the anti-plague serum, also as
regards its anti-bacterial action, for we injected more
than 300 cem., and the bacilli still remained living and
virulent in the necrotic focus of the gland.

All the operations have been practised in the gravest
cases (pestis major), in ordinarily severe cases (mul-
tiple buboes, axillary and groin buboes, double groin
and pelvic buboes, cervieal, parotid buboes), and the
results obtained leave no doubt as to the efficacy of
the method.

After duly comparing the results obtained in the
plague hospital of Rio de Janeiro from treatment by the
surgical method I feel myself justified in recommending
it, and in regarding the objection put forward in
condemnation of the surgical plan of treating plague
buboes as without foundation in fact.

And I am also persuaded that the exclusion of this
method of treatment depends upon the want of clinical
knowledge of the disease, and upon a strange objec-
tion of medical men to surgical intervention in ailments
of the lymphatic system generally and not for scientific
reasons.!

1 The surgical treatment proposed by myself has also been
applied with succesa in plague cases in Naples in 1902 and 1903,
after the serum (Yersin- Roux) treatment had proved useless.

In none of the individuals operated upon was any
inconvenience subsequently caused by extensive ex-
tirpation of the glands. The patients left the hospital
in about fifteen days after operation and ready to
recommence their occupations at an early date.

By examining the temperature charts of typical
plague cases treated by different curative methods, one
observes that in bubonic cases operated upon, the
fever falls at once by crisis, and at the same time all
the grave symptoms of intoxication (delirium, tachy-
cardia, dyspnea) cease, whilst they continue for a long
time when the treatment is limited to serum only.

In order to demonstrate yet further the eflicacy of
surgical intervention as the rational treatment of
plague, in several cases of double buboes we extirpated
the glands from only one side, applying at the same
time the serum treatment. The improvement in the
patients was at once evident after the extirpation
of only one bubo, but on the following days the
temperature rose again over 39° C., and followed the
sub-typhoid type, with tachycardia and delirium. When
the treatment was completed by the extirpation of the
second group of buboes, the symptoms of intoxication
ceased in a few hours, and the patient became conva-
lescent.

CONCLUSIONS.

(1) In the plague hospital of Rio de Janeiro, the
mortality of the patients treated with anti-plague
serum only remained between 25 to 50 per cent., accord-
ing to the cases and the quality of the sera inoculated.
But we must remember that in the statistics in favour
of serum therapy are included the mildest cases which
ordinarily recover without cure. The estimation of
the curative effect of the specific anti-plague sera is"
very uncertain also on account of extreme variableness
of the dose in identical cases. Serum is absolutely of
no efficacy in the вербісешіс type of plague (infection
by the gastro-intestinal way), and in pestis pneumonioa,
where without doubt it is more necessary to administer
a substance capable of rendering innocuous the specific
virus in the body of the patient.

(2) The ineflieacy of the anti-plague sera which are
actually used as а means of cure depends on the
deficiency of their anti-bacterial power, and on the
almost absolute want of anti toxic substances, because
the animals used for the preparation do not readily
assimilate and destroy the poisons of the plague
bacillus, and do not accumulate in their blood suffi-
cient quantities of anti-bacterial and anti-toxic sub-
stances for the cure of man.

On this account we obtain the best results for the
serum therapeutics in plague from immunising mules,
asses, or oxen, and inoculating them with the juices
of the pathogenic products of the animals infected with
plague, instead of artificial cultures.

(3) With the artiticial sera of Hayem and Fodor we
obtained also favourable results, but the inconvenience
of inoculating large quantities of liquid directly into
a vein induced us to limit the application of such a
curative method to a few cases.

(4) With the intravenous inoculations of corrosive
sublimate, proposed by Bacelli [29], the mortality
oscillated within almost the same limits as those
afforded by the specific sera—that is, between 30 to 40

234

per cent.—and, as I have already indicated, this curative
method must be recommended before any other when
we have not at our disposal freshly prepared sera, and
when it is not possible to practise surgical treatment
at a sufficiently early period in the illness. The corro-
sive sublimate acts as an efficient stimulus of the
phagocytosis (Gaglio) ,30], and offers the advantage
that it is within every physician’s reach even in
regions where we cannot always hope to have at our
disposal other medicaments difficult to prepare, such
as sera. It is known also that mercury fixes itself by
preference in the lymphocyte of the lymphatic glands
and in the plasma, and in this manner sets up an
unfavourable condition for the development of the
plague bacilli in the tissues which this infecting germ
prefers. For this reason I think the use of mercuric
chloride preferable to carbolic acid, recommended by
Mr. Seymour (31), especially in cases іп which we
can already demonstrate the presence of the bacilli in
the blood.

(5) In grave cases (pestis major) in which it is not
possible to expect a success from the serum therapeu-
tics or from other local cures, there remains as the
only rational resource the extirpation of the buboes.

I consider the extirpation of the bubo preferable to
all the other local cures.

The simple incision of the bubo, with the evacuation
of the pus has good results, but has not so rapid and
durable an effect in arresting the course of the infec-
tion as when the bubo is completely extirpated.

Compresses of tepid disinfecting solutions (mercuric
chloride, carbolie acid) are indicated locally, in order
to limit the diffusion of the process when the bubo is
removed and the injection of those solutions (mercuric
‘chloride, 1 in 1,000, carbolic acid, 1 to 2 per cent.)
around the area occupied by the bubo, especially when
from the surrounding cedema and from the adhesive
periadenitis we may infer that there is a combined
action of the plague bacillus, together with other bac-
teria (streptococcus, diplococcus). It is also useful to
have recourse to these means when the radical opera-
tion is not possible or too long delayed.

All the other local treatinents must be considered
more pernicious than useful, because they cannot
exercise any action on the bacilli located in the tissue
of the lymphatic gland, as we thereby lose precious
time.

It is an unpardonable mistake to wait for the suppu-
ration of the bubo before we decide upon surgical
intervention, because the patient succumbs either on
account of the rapid progress of the infection, or from
the effect of the toxic products which cannot be neutral-
ised by the curative action of the serum. We must not
take into serious consideration either the constitution
of the individual, nor pay too much regard to the
resistance of the patient; whilst the bubo remains the
probability of cure becomes always more remote, the
operation has to be performed under much graver
conditions, because the extension of the infiltration
destroys the anatomic relations of the region, and
complications, such as phlebitis, lymphangitis, ichorous
infiltrations along the muscular sheath, with the
danger of an effusion into the cavities, are more likely
to ensue.

If itis not possible in the patient’s house to provide

THE JOURNAL OF TROPICAL MEDICINE.

[August 1, 1906.

for the surgical treatment, we can at least give intra-
venous inoculations of specific serum (20 to 40 cem.)
or of mercuric chloride (1 to 2 centigram of the Bacelli
solution), and subsequently bring the patient under
better conditions to the hospital.

I may affirm with all confidence that if plague is
treated by the above indicated method, the mortality is
reduced to the conditions and to the limits of the other
infectious and contagious diseases generally considered
much less grave in their effects.

The opinion of Scheube [32; , who does not think the
application of the surgical treatment during ап epi-
demie to be feasible owing to the great number of
patients, is scarcely sound, especially when we con-
sider that in time of war surgical operations of much
greater severity are rapidly and extensively practised.

Surgeons should be substituted for physicians in our
plague hospitals during times of epidemics.

BIBLIOGRAPHY.

[1] Kitasato.
Century, xv., 23.

[2] Yersin. Ann. de l’Inst. Pasteur, 1894, 1897, 1899; С. R.
de ГАс. des Sciences, 1894 ; Arch. de Méd. Navale, 1897.

[3j Revista Medica de S. Paulo, 1900; JouRNAL OF TROPICAL
MEDICINE, Nos. 14, 15, 1902.

[4] Albrecht and Ghon. ‘Ueber die Beulenpest im Bom-
bay," Wien. Aus. der kais, konl. Hof. und Staatsdruckerei Theil.,
ii., B, р. 515; Gaffky, Pfeiffer, Sticker, Dieudonné, ‘ Bericht
ueber die Thatigkeit der zur Erforschung der Pest, &c.," Berlin,
Verl. von Julius Springer, 1899, p. 265; “ Report of the Indian
Plague Commission,” vol. v., p. 63.

[5] A. Lutz. Revista Medica de S. Paulo, 1900.

[6] №. C. Hossack. British Medical Journal, 1900, p. 313.

[7] L. F. Childe. British Medical Journal, 1897, p. 1215.

[8] “ Report of the Indian Plague Commission," vol. v.,
chap. v., p. 269.

(9) Yersin, Calmette, Borrel. Ann. de Р Inst. Pasteur, 1899.

[10] Lustig. 4 Sierotapia," &c., Torino, Rosemberg e
Sellier, 1899; see also Lustig, Galeotti, Deutsche Med. Wochen-
schrift, 1897; Lustig, Zardo, c.f. Allg. Pathol., viii., 1897;
Galeotti, Malenchini, c.f. Bakl., 1897; Galeotti, Polveripi,
“ Osservazioni е Note Epid.,” &c., Torino, Rosenberg e Sellier,
1898; Galeotti, Polverini, “ Su 175 casi di peste trattati col
siero antibubbouico, &c.," Firenze, 1898; Polverini, * Serum-
therapie gegen Beulenpest," Minch. Med. Woch., No. 15, 1908.

(11] ‘‘ Report of the Indian Plague Commission," vol. v.,
chap. v., p. 281.

[12] Dr. Valassopoulo.
A. Maloine, Edit., 1901.
(13] Loc. cit., p. 486.
[11] J. Bandi und Stagnitta. Zeitschrift für Hygiene, 1899.

[15] P. White. British Medical Journal, 1901, p. 829.

[16] Loc. cit., p. 823.

[17] Jamagiwa. Virchow’s Arch., cxl., supp., 1897.

[18] J. Bandi. Revista di Medicina Navale, 1901.

[19] Hippocrates. ‘‘Opera omuia et notis Annutii Foesii,"
Francofurti, 1595; “Ге morb. vulg.,” lib. iii, sec. vii.,
“ Status Pestibus."'

[20] Galenus. ‘Opera omnia," Venetiis, Valgrissus, 1562;
De comp. med., Cap. 2, ad Glauc 2.6, De locis affect, Cap. 5-2,
De оће. med., Cap. 30.

[21] А. Paré. ‘ Opera Lib.," xxi.
Jacobum Du Puys,” 1582, р. 645.

[22] Settala. “ Cura locale de’ tumori pestilengiali." Milano,
рег G. Batta Bidelli, 1629 ; “Пе Peste et pestiferis affectibus,
Mediolani," apud Jo. Bapt. Bidellium, 1622.

[23] Tadino. ‘‘ Ragguaglio, &c., della gran peste di Milano
dell'auno, 1632," Milano, per Filippo Ghisolfi, 1648.

See also: Paulus Aegineta, '*Opus de Re Medica, &c.,”
Lib. 6, Cap. 34; Coloniae, “ Opera et imprensa Jo. Loteris,"
anno, 1533.

Prosperi Alpini. “ De Medicina Aegyptiorum, Libri quatuor,"
Venetiis, 1591.

Lancet, 1894 ; Kitasato, Nakavaga, Twentieth

“Па Peste d'Alexandrie," Paris.

De Peste. *' Parisiis apud

August 1, 1906.)

THE JOURNAL OF TROPICAL MEDICINE.

235

Bassianum Laudum. ‘‘ De originis et causa pestis Patavine.”
Venetiis An., 1555, Id. “Спга della Pesto," Ven., 1557.

Th. Jordanus. ''Pestis Рһопошепа,” &c., Francofurti,
Wechelus, 1576. .
Massaria, ‘‘ De Peste," Ven., 1597.

Hier. Mercurialis.
Patavina,” Basel, 1577.

Prosper Borgantius. “4 De Peste," Ven., 1565.

Victor de Bongentibus. “ Ресет Problemata de Peste,"
Ven., 1556.

Georgius Agricola.

[24] Manget.
pp. 214, 365, 551.

[25] O'Meara. “Conquête de la Palestine," 1799.
par Napoléon (without date).

(96) Proust. “Па défense de l'Europe contre la peste,”
Paris, 1900.

[27] Cabanés. Bull деп. de thér.," November 30th, 1899.

[28] J. Cantlie. Lancet, 1897, pp. 4-85; idem, 1897, p. 349,
'"Plague: How to Recognise, Prevent and Treat Plague,”
London, 1900.

[29] 11 Policlinico, 1895, p. 441.

(80) G. Gaglio. Archivio per le scienze mediche, vol. xxi.,
р. 841; A. Baldoni, Boll. della В. Acc. Medica di Нота,
Ann. xxxi., Fasc. 1.

[31] * Report of the Indian Plague Commission," vol. v.,

“Пе peste presertim de Veneya ei

* De Peste in 1630," Mediolanum, 1641.
"Traité de la Peste, &c., Genève, 1721,"

Editée

p. 444.

[32] Scheube. *'Die Krankeiten der warmen Liinder,”
Leipzig, 1900.

[33] P. Manson. ‘ Tropical Diseases," London : Cassell and
Company, Ltd.

THE ANATOMY OF THE BITING FLIES OF
THE GENERA STOMOXYS AND GLOSSINA.

By Lieut.-Colonel G. M. Girzs, I.M.S. (Rtd.).
(Continued from p. 919.)

THE parovaria (fig. 9) are two long, somewhat con-
voluted tubes, the larger distal ends of which are
attached to the branches of the oviduct near to the
point, where they loose themselves in the stroma of the
ovaries. They then pass backwards into the ovipositor,
and then turn forwards again to their termination in
the common oviduct. They have the same trabecular
structure as the paragonia, but the trabeoulz and the
nuclei of their internodes are much larger, and a com-
parison of fig. 9, Plate I., with fig. b, Plate II., shows
that they also present resemblances in structure to
that of the younger ovarioles. They appear to secrete
& coagulable fluid similartothat ofthe paragonia. The
remaining accessory structures are the spermothece
or receptaculss seminis, of which there are three, each
of which (Plate II., fig. b.) consists of a dense chitinous
sac supported in a cellular mass like an acorn іп its cup.

The chitinous membrane is fenestrated, as will be
seen in fig. 2, and the ducts are supported by a spiral
fibre somewhat like that of а trachea, but much coarser.

Only one coitus takes place between the sexes, and
in these sacs suflicient semen is stored on that occa-
sion to last thelife of the female.

The ovipositor is quite of the usual type.
Tulloch describes it asfollows:— `:

“Тһе ovipositor consists of three cylindrical segments of
thin chitin, which usually lie telescoped inside the abdomen.
There is also a single external flap of dark chitin, which
lies folded upon the ventral surface of the fly. When the
ovipositor is extruded, by squeezing the abdomen, the recep-
tacula and uterus are pulled down with it and can be seen
through the transparent walls. The upper segment has
three longitudinal rods of chitin, two dorsal and one ventral,
The next is similar, but the last has the two dorsal plates

Lieut.

only. The external flap, which is probably the ventral rib
of the last segment, is roughly quadrilateral, and has no
divergent prong-like processes arising from its free hinder
border.”

Within the ovipositor is a complicated system of
circular and longitudinal striated muscles, which per-
form the actions of protrusion and retraction.

The male organs of Glossina, as far as their histology
is concerned, present no notable differences from those
of Stomozys, but according to Prof. Minchin, the para-
gonia are more of the usual type, being distinct from
euch other throughout. Those of the female, on the
other hand, depart entirely from the usual fly-type,
being modified to meet the peculiar plan of reproduc-
tion of these insects which give birth not to a multi-
tude of eggs but to a very limited number of larve.
Owing to this, the common oviduct or uterus is of
great size, and to expel the large full-grown larve the
ovipositor is provided with muscles, which, although on
the same plan as those of Stomorys, are во enormously
developed that a section of this part of the body on a
casual glance looks much like one of the thorax of an
ordinary fly. Prof. Minchin’s description runs as
follows :—

* The female genital organs differ considerably in appear-
ance, according as they are in the gravid or non-gravid
condition. In the course of my dissections I have only
found one female in the latter state. In the later periods of
gestation the condition of the female is obvious externally,
but females which do not appcar to be gravid are found on
dissection to have а small larva in the uterus.

“ The female organs (fig. 85) consist, like those of the male,
of paired and unpaired portions. Тһе former comprise the
ovaries, the receptacula seminis and their ducts, and the

2-46 sem

Ето. 35. — The hinder segments of the abdomen with the female

genital organs of Glossina in situ, dorsal view. тес. sem., recep-
tacula seminis ; or. r., ov. l., right and left ovarioles ; d. rec., duct
of the right receptaculum seminis; gl. ut., uterine glands (the
greater number of these have been removed); с. d. gl., their
common duct; retr. ut., retractor muscle of the uterus; Od., ovi-
duct; Ut., uterus; L., hinder extremity of the larva, causing
a bulge iu the uterus ; pro. ut., protractor uteri, attached to the
chitinous plate (Ch. 1); m. vag., muscle (dilator vagine ?
passing fróm the vagina to the tergum of the seventh abdomin
segment ; т. v., muscle passing from the paired chitinous plate
(Ch. 2) on each side of the vulva to the seventh tergum;
Vag., vagina; V., vulva, the anterior margin of which is shown
by a dotted line; An., anus; Ch. 1, Ch. 2, paired chitinous
plates. (After Tulloch.)

236

THE JOURNAL OF TROPICAL MEDICINE.

[August 1, 1906.

uterine glands; the latter are the oviduct, uterus, and vagina.
The female system of organs is considerably modified from
the condition usually found in insects, in relation to the Ну
peculiar method of reproduction,

“ The ovaries are reduced toa single pair of ovarian tubes
or ovarioles, опе on each side of the body (figs. 35 and 86,
ov. r, or. 1). Each ovariole shows only a small number of
egg-chambers, not more than four or five. Тһе lowest
chamber is very much larger than any of the others, and
contains a large ovum. When this ovum is comparatively
small, the other ege-chambers are in a line with it (tig. 6,

tor

or.
0vl ----
Ж---- drec
x (5. 775--с%9.

Ето. 36. —The ovarioles and oviduct of a non-gravid female
Glossina. a. ov., apex of right ovariole ; other letters as in the
preceding figure. The very large ovum in the right ovariole
has pushed the oviduct over towards the left side of the body.

ov. r.), but as the ovum grows larger it grows past the other
egg-chambers, so that they appear attached to the side of
the ovum (fig. 85, ov. L, 0g. 36, ov. L, ov. r.).

“The two ovarioles are always asymmetrical, owing to
the fact that the ova in the lowest egg-ehambers reach full
growth on each side alternately, so that if there is a large
ovum on the left, there will be a smaller one on the right,
and vice versd, The largest ovum I have seen was from a
non-gravid female (fig. 36, ov. r.), und was probably nearly,
if not quite, full-sized.

“Тһе two ovarioles open into the short, broad oviduet
(figs. 85 and 86, od.), which widens out at its lower end to
open into the uterus slightly behind the proximal end of the
latter.

** At its distal-expanded end the oviduct receives right and
left the two ducts (d. rec.) of the receptacula seminis. The
latter (rec. sem.) are small spherical bodies of a bright
orange-vellow colour, surrounded by a whitish, transparent
envelope. Examination of the receptacula stained and
mounted in Canada balsam shows that the clear envelope is
an epithelium of large cells, surrounding а thick chitinous
membrane which gives these organs their peculiar colour,
and whieh is too opaque for the contents to be seen except
in sections, by which method the receptacula are seen to be
filled with spermatozoa. The two receptacula are firmly
attached to one another. From each comes off the slender
white duct, slightly convoluted. The ducts are perfectly
distinct from one another, and open, as described above,
into the lower end of the oviduct. .

“Immediately below the opening of the oviduct into the
uterus, а small tube debouches into the latter by a median
dorsal aperture. This is the common duct of the uterine
glands (бов. 85 and 86, с. d. gl). After a short course it
branches right and left into tubes, which branch again re-
peatedly, forming a great number of glandular tubes, which
differ markedly in the gravid and non-gravid condition. In
the latter state the gland-tubes are relatively few and very
slender. In the gravid condition, on the other hand, the
tubes are very numerous, forming a tightly packed mass
filling up the posterior end of the abdomen, and requiring to
be pulled away to show the other parts of the generative
system; further, the individual tubes are much thicker, and
when stained and mounted, they take up the stain very
deeply and appear very opaque. There ean be no doubt
that these glands serve for the nourishment of the larva in
the uterus.

“The uterus (Uf. is a large thimble-shaped organ
attached to the body-wall by a number of muscles. Two
retraetors (retra. ut.) run forwards from the proximal end.
There are two pairs of protractors, one dorsal, the other
ventral; the former (pro. uf.) start from the sides of the
uterus and pass backwards to a pair of chitinous plates
(Ch. 1) at the posterior end of the body. The wall of the
uterus is beset by a very large number of small tracheal
tubes (not shown in the figure), and is thick in the non-
gravid condition, but becomes thinner when stretched by
the growth of the contained larva. In all gravid uteri that
I have seen, the two раріШе at the hinder end of the larva
cause a bulge in the lower end of the uterus (fig. 85, L.).
When the larva reaches a certain size, the rings of its seg-
ments become plainly visible through the wall of the uterus ;
they could not be seen in the uterus drawn in fig. 85; but
in another, slightly larger, they could be seen distinctly.”

The writer is under the impression that there are
three and not two receptacula seminis, but the opinion
is derived from series of sections and not from dissec-
tion.

Only four or five larvee are produced by each female
in а season, so that the insect is much less prolific
than even certain mammals, and it can scarcely be
doubted that this circumstance offers the best hope of
their destruction, as it is obvious that under such
conditions the destruction of an adult is a much more
serious blow to the chances of multiplication of the
race than that of many score of the ordinary ovi-
parous flies. It seems, then, that much might be
hoped for from the systematic destruction of the adult
flies, and in view of the terrible ravages of sleeping
sickness, it cannot be denied that the object is one on
which considerable expenditure of money and energy
would be more than justifiable.

———9————

* Berliner Klinische Wochenschrift,” vol. xliii., No. 7.
AFRICAN RELAPSING FEVER.

Koch finds that although quinine is useless in relapsing
fever. the trvpan-red is of some value. Seeing that im-
munity is conferred by one attack, Koch is led to hope
that some form of serum treatment will be found efficacious.
Whilst travelling in an endemic centre of the disease, Koch
found that by pitching tents on fresh ground, apart from the
old-standing shelters, relapsing fever could be avoided, as the
tick only prevails in the dry, long-built shelters on the cara-
van route.

“ Annales de l'Institut Pasteur,” Paris, vol. xx., No. 3.
THe FRENCH Report ON YELLOW FEVER.

Marchoux, E., and Simond, P. L., in the final instalment
of the Report on Yellow Fever by the French Conunission to
Brazil, go fully into the part played by infant infection in
maintaining the endemicity of yellow fever. An outbreak
of yellow fever leaves the community almost entirely
immune to the disease. Thoxe who escape at the time of the
epidemie may subsequently develop the disease in the form
of sporadic cases, but were it not for new-born infants the
non-immunes would soon be exhausted. Owing to the
mildness of the disease in children the affection may escape
notice. and because the adults are not attacked the disease
is supposed to have died out, whereas in reality it is being
continucd amongst the infants. This possibility serves to
explain how non-immune aliens contract the disease on
arrival in the vellow fever zone. Тһе apparent immunity
of the negroes to yellow fever is no doubt explainable ou the
assumption that they had а mild type of the disease in
infancy and thereby became protected against subsequent
seizure.

August 1, 1906.)

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Journal of Troptcal Medictne

AucvusT 1, 1906.

LivERPOoL Ѕсноог оғ Tropica MEDICINE— MEMOIR
XVIII.

Reports оғ THE ExrEDITION TO THE Сомао, 1903-5.
By the late J. Everett Dutton, M.B.Vict., and
John L. Todd, B.A., M.D., C.M.McGill, with
Descriptions of Two New Dermanyssid Acarids by
Robert Newstead, A.L.S., F.E.S., &c., and “Тһе
Anatomy of the Proboscis of Biting Flies," by
J. W. W. Stephens, M.D.Cantab., and Robert
Newstead, A.L.S., F.E.S., «с. March, 1906.
(London: Published for the Committee of the
Liverpool School of Tropical Medicine by Wil-
liams and Norgate, 14, Henrietta Street, Covent
Garden.) Price 7s. 64. net.

I.—Guanp PALPATION ІЧ HUMAN TRYPANOSOMIASIS.

Dr. Todd aud the late Dr. J. E. Dutton, in their
1904 report of their expedition to the Congo, drew
attention to the usefulness of examining the fluid ex-
tracted by gland puncture as а routine method of
diagnosing the presence of trypanosomes in the human
body. The prevalence of enlargement of glands in
trypanosomiasis is not only a marked feature, but its
universality апа constancy are diagnostic signs, and
in the report now before us an enquiry into the prac-
ticability and reliability of this method of demon-

THE JOURNAL OF TROPICAL MEDICINE.

237

strating the presence of trypanosomes in the human
body has been gone into fully.

Gland Puncture.

The technique of gland puncture is simplicity itself,
although requiring care and some experience before
satisfactory results are obtained with certainty. An
ordinary hypodermic syringe, after the instrument and
skin have been rendered aseptic, is plunged into the
substance of an enlarged subcutaneous gland held
steadily in place between thumb and forefinger.

To prevent scattering the tiny quantity of fluid in
the barrel of the syringe by the sudden influx of air
when the needle is withdrawn, release the plunger,
which had been drawn out to full extent, before the
needle is withdrawn from the skin. The drop of fluid
in the syringe is expelled from the syringe on to a slide,
a cover-glass superimposed, and the preparation, ringed
with vaseline, is examined at once. Examination of à
first preparation of gland fluid is frequently negative.
When glands are particularly soft the fluid obtained
is apt to be glairy and pus-like, and therefore rarely
contains trypanosomes. The glands usually selected
for the examination are those of the post-cervical
region.

Comparisons of Clinical Methods of Demonstrating
Trypanosomes.

Successful examination may be estimated from
several standpoints. When, however, the first test was
unsuccessful, further examination succeeded in
demonstrating the presence of parasites; the result
was as follows :—

Broop
і zr 8| 3
ii| F 5 53
ЕЕ | 3 з ед
22 Е; F 8 5
Ё E] 3 2 E
| a Е E e 8
22) š
& $ j
----------------- -- ------- 1 —
1 ' 1
i !
Percentage of success- 13:3 % |412 % 49:2 % 90-4 %! 59:6 %
ful examinations
OEE lamer peccet = m
Number of repeated 2 1 — 17 | No second
successful examina- ; examina-
tions ; tion was
success.
; ful

It will be seen that according to the table the ex-
amination of the cerebro-spinal fluid gave moderately
constant results only; but when a closer analysis is
made it is found that it is in advanced cases of the
illness that the examination of the cerebro-spinal fluid
gives а high percentage of positive results. Ву
* advanced " cases are meant persons obviously ill;
in “early " cases no general symptoms are presented,
and the disease is unsuspected by friends.

THE JOURNAL ОЕ TROPICAL MEDICINE,

[August 1, 1906.

238
des = EN
! Broop
= = | | * =.
ЗЕ | = | 5 ГЕ
rs = 1 = Ек
221-8105 | à іа
TE EA Sae Š
te, =F |
ERE FRIES ----|-----------
ADVANCED CASES Я
Percentage of success. 206 5,538 4, 9773,95 6, 966%,
ful examinations
EARLY Cases | |
Percentage of success- |8:6 % | 25%, 314 pea ^| 13%
ful examinations | |
i

As trypanosomiasis advances, the glands of all the
superficial groups diminish in size, so much so that it
is occasionally difficult to find a gland large enough to
puncture. As, however, it is during the early stages
of the disease that diagnosis by other than clinical
features are called for, there can be no doubt that
gland puncture is by far the most efficient method of
demonstrating the presence of trypanosomes in cases
of trypanosomiasis.

Glandular Enlargements an Indec of Trypanosoma
Infection.

As the result of extensive examinations of many
people in many villages, Drs. Todd and Dutton came to
the conclusion that in the great majority of cases
enlarged cervical glands in apparently healthy negroes
means trypanosomiasis in an area where “sleeping
sickness ” is prevalent.

The region of the body examined for gland enlarge-
ment was the posterior cervical group, just in front of
the anterior border of the trapezius. In this situation
usually three or four middle-sized glands (diameter
1 cm.) lie at the base, or one or two glands of smaller
dimensions are met with at the apex of the triangle,
where trapezius and sternomastoid muscles meet at
their occipital insertions. Occasionally, however, the
whole of the posterior triangle of the neck is literally
filled with enlarged glands.

Another clinical point of significance is that ‘ unless
the glands of apparently healthy persons were en-
larged, juices from them did not contain trypano-
somes.”

The conclusions arrived at by Drs. Todd and Dutton
are that (1) as a rule enlarged cervical glands, without
obvious cause, do not occur in districts from which
trypanosomiasis is absent; (2) every negro with
enlarged glands must be considered, until the contrary
is shown, to be a case of trypanosomiasis ; (3) early
cases of trypanosomiasis have enlarged glands, and
will therefore be detected by gland palpation; (4)
good results may be expected from the serious appli-
cation of quarantine measures dependent for their
efficiency upon cervical gland palpation.

Prevalence of Trypanosomiasis.
By a series of maps the distribution and spread of
sleeping sickness in the Congo Free State is clearly

shown, and several interesting facts are dealt with by
the same observers under this head. The distributing
factor, Glossina palpalis, is found every where along the
route followed by sleeping sickness disease, апа it is
significant to note that there are several districts in
which Glossine are found in which there is no sleeping
sickness ; in other words, the disease may be expected
to spread corresponding with Glossina prevalence.
It seems from all available evidence that sleeping
sickness has spread, and is spreading, more widely as
increased facilities of communication multiply ; yet it
is a mistake to believe that previous to 1885, when the
Congo Free State was founded, sleeping sickness was
so limited in its distribution as we are apt to imagine.
Before the inroad of Europeans in 1884 the highest
point in the Congo known to be infected by sleeping
sickness was at the town of Bumba, situated on the
northern bank of the Congo at the point where the
great bend of the river makes its most northerly
point, and about 700 miles in a straight line inland
from the mouth of the river. In all the districts
between Bumba and the mouth the natives knew and
had a name for the disease, whereas in the Upper
Congo reaches above Bumba the disease is, or was
until recently, quite unknown, and the natives either
coin a new word to describe it or.use a name borrowed
from neighbouring tribes. In 1888 the first step to-
wards suppression of the slave trade began, expedi-
tions were sent in all directions, and soldiers and
labourers from the infected districts of the Lower
Congo travelled upwards along the Kasai River, and
penetrated far to the eastward, carrying with them
sleeping sickness. In addition to the traffic from west
io the east, that is, from the infected districts near
the mouth of the river inland, labourers were brought
from the upper reaches of the river to work near the
mouth, who, when their term of engagement ended,
returned to their native places, thereby no doubt
spreading infection to many new centres.

The evidence obtainable is, however, not sufficiently
unanimous or positive to assert that sleeping sickness
did not exist in the area between the Üpper Congo
and Lake Tanganyika, but that there has been a wider
distribution of the disease in many directions since the
traffic between Central Africa and the mouth of the
Congo has been increased is certain. One point in
the investigation seems fully brought out, namely,
that when sleeping sickness has once gained & hold on
a district, there is no evidence that the disease ever
wholly disappears.

“А New Dermanyssid Acarid Found Living in the
Lungs of Monkeys (Cercopithecus schmitdi) from
the Upper Congo." Ву R. Newstead, A.L.S, and
J. L. Todd, M.D.

In the district between Lusambo, in the upper
reaches of the Kasai River, and Kasongo, in the Upper
Congo, a parasite named Pneumonyssus duttoni, n. sp.,
has been found in eleven monkeys of the C. schmitdi
species. The parasite has not been met with amongst
monkeys of other species living in the same district,
во that it would seem that the “funny type" (C.
schmitdi) of monkey is alone affected. Female
acarids only have been found in the lungs of these
monkeys, and although no eggs have yet been seen,

August 1, 1906.]

THE JOURNAL OF TROPICAL MEDICINE.

239

larve and partially matured acarids were found in the
trachea and bronchi of the monkey, from the larynx
down to the second and fourth, and even fifth branch-
ings of the bronchi. The species of acarid closely
resembles P. simicola found in the lungs of а Java-
nese monkey, but differs in the possession of an addi-
tional pair of stigmata, and a large dorsal scutum or
shield.

Mr. Newstead also describes another new Derma-
nyssid acarid, which he has named Pnewmonyssus
griffithi, n. sp., obtained from the lungs of the Rhesus
monkey (Macucus rhesus). Тһе parasite has been
named after its discoverer, Dr. C. А. Stanley Griffiths,
The new acarid was first found in a series of six adult
Indian Rhesus monkeys, belonging to the Royal Com-
mission on Tuberculosis, which were killed for exami-
nation, on account of having been in contact with a
monkey suffering from spontaneous tuberculosis.

“Тһе Anatomy of the Proboscis of Biting Flies. Ву
J.

W. W. Stephens, M.D., and R. Newstead,
A.L.S.

The species of fly examined was the tsetse-fly,
Glossina palpalis, В. D., and the description refers to
the female of that species for the most part. In this
erudite description many hitherto unsettled points in
the anatomy of the labella, labium, labrum, hypo-
pharynx, and the mechanism of the proboscis are dealt
with and apparently settled. Many excellent draw-
ings of the proboscis of the Glossina accompany the
descriptive details.

————Ф-____-

THE MEETING OF THE BRITISH MEDICAL
ASSOCIATION AT TORONTO.

THE visit of the British Medical Association to
Toronto promises to be a success, judging from the
large number of medical men who are journeying from
Britain to attend the meeting. The Association has
previously met in Montreal, but Toronto is the furthest
distant point from ** home " at which British medical
men have assembled. Situated on the shores of the
Lake Ontario, the focus of several railway lines, and
adjacent to important agricultural districts, Toronto
has increased of late years to a commercial city of
great importance. The public buildings and the wide,
handsome streets of Toronto are held in high estima-
tion by the citizens, who are justly proud of their
flourishing city. To medical men, however, the Uni-
versity buildings and the history and development of
the University are sure to prove more interesting than
either the natural beauties of the district or the muni-
cipal and commercial buildings of the city itself.

The movement which resulted in the establishment
of a Provincial University in Ontario (then Upper
Canada) dates from the closing years of the eighteenth
century. In 1797 the Governor of the Province, at
the request of the Legislative Council and House of
Assembly of Upper Canada, petitioned His Majesty

George III. to appropriate “а certain portion of the |

waste lands of the Crown as a fund for the establish-
ment and support of a respectable grammar school in
each district of the Province, and also of a college or
university." The petition was granted, and the Exe-

. cutive Council, in conjunction with the Judges and

Law Officers of the Crown in the Province, were
instructed to report on the manner and extent of the
appropriation. Their report (1798) recommended : (1)
The immediate establishment of a grammar school
at Kingston, and another at Newark (now Niagara) ;
(2) the establishment of & grammar school at Corn-
wall, and another at Sandwich as soon as funds should
permit ; (3) the establishment of a University in York
(now Toronto); (4) the appropriation of 500,000 acres
of Crown lands for the establishment and maintenance
of the four schools and University ; and (5) the reser-
vation of at least one-half the whole grant for the
purposes of a University. In 1799 the appropriation
of lands was made, consisting of 550,274 acres.

From 1799, the project made no progress whatever.
In 1819, however, & report was drawn up by the
Executive Council, looking towards a realisation of the
land endowment, recommending the obtaining of 8
Royal Charter. In 1820 provision was made by law
for the representation of the proposed University by &
member in the House of Assembly. In 1825, the ex-
change of в portion of the original grant of lands
for an equal portion of the more valuable ** Crown
Reserves" was proposed, and was carried into effect
in 1898. In 1897 the Charter was granted for the
University under the title of the ‘ University of
King's College," and the necessary authority was
given for the exchange of the original endowment
lands above referred to. Ву this Charter, the teach-
ing, examining and management were entrusted to &
corporation, consisting of the Chancellor, President,
and Professors.

By the Baldwiu Act, the name of the institution was
changed from King's College to that of “ University
of Toronto." Its secular character was made per-
fectly clear; not only were all religious tests abolished,
as regards the Faculty, students and graduates, but it
was also provided that neither the Chancellor nor any
of the Governor's representatives on the Senate should
be **& minister, ecclesiastic or teacher, under, or ac-
cording to, any form of profession of religious faith or
worship." Тһе Faculty of Divinity was abolished,
as also the right to confer degrees in Divinity.

In 1887 an Act known as the Federation Act was
passed, whereby the various denominational institu-
tutions were united with the University of Toronto.
Under this Act, Victoria University (Methodist), St.
Michael's (Roman Catholic), Knox College (Presby-
terian), Trinity and Wycliff Colleges (Anglican), have
entered into confederation with the University of
Toronto, which latter has also, under the Act, а teach-
ing Faculty of Arts and Medicine. Latin, Greek,
Ancient History, English, French, German, Oriental
Literature and Ethics are taught both by University
College and Victoria University, and the other colleges
mentioned, while St. Michael's co-operates in teaching
Modern History and Philosophy. Ву this arrange-
ment, largely one of convenience, all other subjects
in Arts and all subjects in medicine are left to the
teaching Faculty of the University of Toronto. Both
the University of Toronto and University College are
supported from а common fund derived from endow-
ments and other sources. Various institutions, such
as the School of Practical Science, the Agricultural

240

College, &c., have entered into affiliation with the
University, and enjoy representation in the Senate,
which in turn prescribes their curriculum and examines
their students.

The architectural beauties of Toronto University
are well known. The main building is a handsome
structure in the Norman style of architecture, and
its classic main entrance is without a rival on the
American continents. This building was badly gutted
by fire some years ago, but its restoration was
thorough and complete, and the building now presents
а finer appearance than it did before the contlagra-
tion. Тһе University campus is dotted with a series
of buildings, each housing 8 certain branch of the
University's work.

—————9—————

Report.

REPORTS ON THE HEALTH AND SANITARY CONDITION OF
THE Согохү оғ Нома Кома For THE Үкан 1905.
(Hong Kong: Noronha and Co., 1906.) Pp. 140.

The estimated total population of Hong Kong, in-
cluding the adjacent territories of Kowloon (old and
new) and the military and naval commands, amounts
to 377,850. Тһе birth-rate is given as 3:40 рег 1,000,
and the death-rate as 17:45 per 1,000. The dispro-
portion between the birth- and death-rates which seem
unaccountable with a rapidly increasing population is
attributable to the fact that the Chinese women in the
colony are few in number, and that the wives of the
Chinese do not, as a rule, dwell in the colony.

Malaria.—During the past three years the total
number of deaths amongst Chinese attributable to
malaria has diminished by half, compared with the re-
turns of the previous three years. Amongst Europeans
resident in Hong Kong the deaths from malaria dur-
ing 1905 fell to four, compared with 29, 33, and 32
during the three years 1900-1902.

Dr. J. Bell, the Superintendent of the Civil Hospital,
remarks: “There can be no question that the war
waged by the authorities against the mosquito has

iven as good results here as anywhere else." One
district in the outskirts of the city of Victoria, which
used to supply very bad cases of malaria both in Euro-
peans and their Chinese servants, has not supplied a
single admission for 1905. Тһе malignant variety of
malaria is much the most common variety and the
disease is more prevalent in the latter half of the year.

Dysentery.—The bacillary form of dysentery out-
numbered the amoebic variety in а proportion of about
two to one. Тһе bacillary form of dysentery would
appear to confer an immunity against further attacks,
but not against the amcebic type; one patient suffered
in January from the bacillary form, but returned to
hospital in October of the same year with dysentery
of the amoobic type.

The Superintendent of the Civil Hospital states :
«І think the amobic variety is the less prevalent and
fortunately so, as it is а much more serious complaint,
more difficult and more tedious to treat—in some cases
I doubt whether they are ever cured by anything short
of removal out of the Tropics.” In regard to the spread
of dysentery the Superintendent writes: “Тһе

THE JOURNAL OF TROPICAL MEDICINE.

. NUTRITION AND DYSENTERY.

[August 1, 1906.

mobile form of the amcbe die rapidly in the stool, but

` the eneysted form are much hardier, and must be the

means of spreading the disease. The question for the
future to solve is whether they do not undergo some
change in a suctorial insect, and so get passed on to
man in a manner similar to malaria.”

Plague.—During 1905 the plague cases numbered
304 and the deaths from the disease amounted to
987--а death-rate of 94:1 per cent. These are the
smallest figures in regard to plague since 1894, except
during the years 1892 and 1897, when the cases of
plague numbered 44 and 21 respectively. Of the cases,
73:16 were of the bubonic type, 25:0 per cent. were of
the septic type, and 1:84 of the pneumonic variety.
Dr. W. M. Koch, the officer in charge of the Infectious
Diseases Hospital, remarks: ‘‘ Of the bubonic variety
85 per cent. died ; of septic cases, 60 per cent. It will
be noticed that the bubonic variety was the more fatal."

Hat Plague.—'' The amount of rat plague," Dr.
William Hunter, the Government Bacteriologist, re-
marks, “ would appear to be increasing in the colony.
About 5 per cent. of the rats examined during 1905
were found to be plague-infected." He adds: “ Argu-
ing from the dictum no rat plague, no human plague,
our chances of freeing the colony from this exotic are
but small for some years to come.” Dr. Hunter is
more and more impressed with the part played by the
rat in the spread of plague, and experience shows that
“ Danysz's virus as an agent for the wholesale destruc-
tion of rats has been а complete failure." Experience
with Yersin's serum in plague during 1905 in Hong
Kong is not encouraging.

Helapsing Fever.—' Three сооПев, оп their way to
North China from South Africa, were found to be
suffering from relapsing fever, and the spirillum
was found in their blood. In connection with these
cases, an important fact was noted. The office boy of
the hospital, to which these cases of relapsing fever
were admitted, was attacked by the disease. The boy
saw the patients frequently, and helped to coax mos-
quitoes to fecd on them, and assisted in procuring
films, but had nothing else to do with the patients in
the way of nursing, &c., yet he passed through a
typical attack, and the spirochætæ were found in his
blood. The question of how he contracted the disease
is a difficult problem to solve, but the fact that he did
so under the circumstance is well worth further inves-
tigation. Relapsing fever is prevalent in North China,
but is not endemic in Hong Kong.

Malta fever has not been proved to be present in
Hong Kong as ап endemic infection.

The experiments &nd observations on beri-beri by
Dr. Hunter will be specially dealt with in & future issue.

This report, which will be dealt with in the Colonial
Reports, is full of interest, and contains many original
investigations and observations.

-----Ф-----

Aediews.

By Lieutenant-Colonel
U. №. Mukerji, M.D., I.M.S., Retired. (Calcutta:

S. К. Lahiri and Co.)
It is pleasant to find that this well-known native
member of tho Indian Medical Service, although retired

August 1, 1906.)

THE JOURNAL OF TROPICAL MEDICINE.

941

from the service, has no intention of retiring also from
active scientific work, and in the present little volume
we have the results of a ripe experience in dealing with
that most troublesome tropical malady, dysentery.

Dr. Mukerji's view is that dysentery is primarily a
trophic malady, the main predisposing causes of which
are dietetic errors; inother words, that the dyspepsia
of dysentery is the cause and not the consequence of
the disease in the stage in which it usually comes first
under the notice of the medical practitioner.

Nor is this view in any way incompatible with the
results of modern parasitological investigations which
have subdivided dysentery into protozoal aud bac-
terial forms, and the latter into a number of varieties
in which Shiga’s bacillus and a variety of other strains
of microbe are found in the motions, for most who have
had much to do with the clinical side of dysentery will
agree that it is almost impossible from the bedside point
of view to predicate what micro organisms will be found
by the bacteriologist, and that it is highly probable that
it is rather the disease that atfords them their oppor-
tunity than that they are the causa causans of the
disease. On this account the reader must not expect to
find more than casual mention of the microbiology of
dysentery, which has, of course, only an indirect con-
nection with the point of view dealt with by Dr.
Mukerji.

There is no better field for the study of dysentery
and the effects of diet on nutrition than an Indian jail,
as the Indian medical officer acts not only as the
physician, but also as governor of these institutions,
and is wisely given a very free hand in the manage-
ment of the dietary of the prisoners.

The service will, we feel sure, be grateful to an old
brother officer for many useful hints on the manage-
ment of prisoners, and theauthor’s intimate knowledge
of Indian habits of life, and their bearing on health,
will make the book a most interesting one to all who
practise in our great dependency. Nearly half the
book is occupied with the results of a laborious investi-
gation of the amount of urea excreted in a group of
prisoners from March to July—the monthly diet scale
being given іп а preliminary table, but we fail to find
any summing up of the conclusions the author draws
from the tabulated results,

Col. Mukerji has a very high opinion of the value
of the inunction of oil as a protection against chills,
and hence in diminishing the incidence of dysentery,
and the reviewer recalls that although in the United
Provinces it has been found that a liberal provision of
blankets is equally effectual, an issue of oil for this
purpose to the “old and infirm " prisoners was attended
with most beneficial results.

Hereand there peculiarities of diction may be noticed,
only natural to an author who writes in other than
his mother tongue, but we doubt if any European
could be mentioned who would be capable of writing
as clearly in Hindustaui or Bengali, and the construc-
tion will present no difliculties to any one who has lived
in India.

Remembering the difficulties that beset the typo-
grapher in India, the book has been turned out by the
publisher in а ereditable fashion, though occasional
misprints may be met with.

Screntiric MEMorns. Ву Officers of the Medical and
Sanitary Departments of the Government of India.
* On a Parasite found in the White Corpuscles of
the Blood of Palm Squirrels.” By Captain W. S.
Patton, M.B., I.M.S. (Calcutta: Office of the
Superintendent of Government Printing, India,
1906.)

Captain Patton's conclusions are as follows: It
will be seen that the description of this parasite
agrees in every detail with that of a heemogregarine.
The parasite is highly specialised in that it selects the
large mononuclear leucocyte for its host. Though
closely related to Leucocytozoon canis (James), it
differs in not having & cytocyst and in possessing &
tail. I therefore propose provisionally naming it
Leucocytozoon funambuli.

As in the case of Hemogregarina gerbilli (Chris-
tophers), no developmental forms were found in the
organs and the infection remains unaltered for long
periods. Тһе squirrels, though harbouring two para-
sitic worms, were to all appearances as active as the
Madras species. It is particularly interesting to note
that trypanosomes were never found in the blood of
the Kathiawar squirrel, which seems to point to а
localised distribution of the blood parasites in very
closely related mammals.

— eo

Correspondence.

То the Editors of the JouRNAL or TRoptcaL MEDICINE.

Sig, —Mrs. Scharlieb, reported in your issue of April 16th,
1906, writing about the Tropics, says : “ Milk is not attain-
able in some places, in others it is very poor in proteids and
fats."

I should be glad of some proof of the latter part of this
statement, some published analyses of milks known to be un-
adulterated, secreted by cows in the Tropics would be useful.

Yours faithfully,
J. Tertius CLARKE, L.R.C.P.Lond.,

S. D. S. М.К.С.5.Епо., D.P.H.Camb.

Batu Gajah, Perak,
June 26th, 1906.

Lp ——

Brugs anb Remedies.

Рвіскіү Heat.—The “ Cyclopedia of Medicine and
Surgery ” recommends as a prophylactic treatment for
prickly heat (miliaria) that thin, light woollen gar-
ments should be worn next the skin, the body exposed
to heat as little as possible, constipation avoided, and
the following lotion applied locally :—

E. Acidi carbolici 202 558.
Acidi boracis abs es 51.
Zinci oxidi im. 3iss
Glyeerini — ... 20% As Sil.
Aleoholis ... bue 2%) zii.
Aquæ q. в. ad. vu es Evi.

A dusting powder consisting of :—
B. Magnesii carb., acidi borici,
pulv. amyli, «е. ... 2e. 0 RA 5l.

When the entire body is involved the patient should

THE JOURNAL ОЕ TROPICAL MEDICINE.

[August 1, 1906.

have bran, starch, or alkaline baths. Hyde recom-

mends :—

B. Acidi carbolici 5iss.
Glycerini às E 5i.
Mentholis — ... E m 51.
Sp. vin. rectif. e 25 5i.
Aqui q. 8., ad. viii.

to be applied locally.

Acting upon the suggestion of Professor Metchnikoff
in his address on “ Syphilis and its Prevention," Mr.
W. Martindale, 10, New Cavendish Street, Cavendish
Square, London, W., has prepared a “ prophylatic
ointment," suitable for instant use, and in а con-
veniently portable form.

— ——9—————

Books and Papers Receided.

THE first number dated July, 1906, of the Calcutta
Medical Journal, described as the journal of the
Caleutta Medical Club, is to hand. The new journal,
of which Dr. K. Das is the editor, is to be published
monthly at the cost of 8 annas per copy. The
journal is intended for the publication of the transac-
tions of the scientific and clinical meetings of the club
and other matters of professional interest.

The following articles are among the contents :—

(1) ** Ranchi, a Health Resort." By Nareshchandra
Mitra, M.A., M.B. The town of Ranchi, sometimes
termed “ Darjeeling of the Plains," is situated оп а
tableland more than 2,000 feet above sea-level, and
lies 240 miles south-west of Calcutta. The ‘ season "
commences in October, and extends throughout the
winter. During the winter the climate is pleasant and
bracing, and the isolated position of the town serves
to prevent the occurrence of epidemic diseases.

(2) '*Trypanosomide." By Gopalchandra Chat-
terjee, M.B. The article embodies a summary of
trypanosoma met with in men and animals, nineteen
in all, and three species of trypanoplasma in animals.

(3) “ Oxalate of Lime'in Pregnancy.” By I. Mallick,
M.A., L.M.S. According to this observer oxalate of
lime diminishes during pregnancy.

(4) “А Large Intra-cervical Fibroid.” Ву К.
Das, M.D.

(5) “А Case of Cerebral Tumour, with no Symp-
toms.” By C. Chackrabarty, M.B.

(6) “ Angioma of the Liver." By M. Mitra, M.D.,
F.R.C.S.Edin.

In the journal are to be found the Transactions of
the Calcutta Medical Club for February and March,
1906; and in addition reviews of current literature.
We wish the journal success.

— eoc

Lotes and Betws.

THE SoutH-west Monsoon.—The Times of Ceylon
of May 25th, says: The south-west monsoon has
done something more than come in like a lamb. It
has crept in like a thief in the night, furtively and

unannounced. И was here all the while. The mon-
soon arrived on May 7th, Mr. Barnard, Superinten-
dent of the Trigonometrical Surveys, informed a
representative this morning. The burst, Mr. Barnard
explained, was a traditional and popular term, but was
not recognised scientifically, во he was unable to say
whether the monsoon had burst. ** I have known the
monsoon arrive where there is a perfectly clear sky,”
he remarked. ‘ It came exceptionally early this year.
Since the 7th of this month we have really been in the
true monsoon. This is indicated by the direction of
the wind, which settled down to blow in the south-
west on that date.”

Mr. Barnard, in speaking, had charts before him
showing the direction of the wind each day. He
added: ‘ Other conditions, such as wind velocity, the
temperature of the atmosphere, rainfall, &c., place it
beyond doubt that we have been experiencing the
south-west monsoon at least since the 7th inst. The
wind was variable before that. The big rains started
on the 13th inst., but the velocity of the wind was not
affected at that date. The monsoons vary as to rain-
fall. It is too soon to sav, yet, whether this is a
monsoon of exceptionally light rain. In the next few
days, or next week, we may have more than will make
up for the deficiency."

Despite this statement, the Ceylon people do not
believe that the monsoon has yet appeared. Yester-
day evening certainly was monsoonish, but the usual
signs of heavy rain and strong south-west wind are
still absent, according to popular notions.

Reports from India, dated June 22nd, state that the
south-west monsoon has set in throughout the whole
of India, including the Punjab and Himalayas.

Inpian MeEpicat SEnvicE.— The Secretary of State
has sanctioned the appointment of officers of the
Indian Medical Service to be Director of the Pasteur
Institute at Kasauli and Assistant Directors at the
Kasauli and Coonoor Institutes, оп "the scale of salary
sanctioned for officers of the Bacteriological Depart-
ment. Ап addition of three officers will be made to
the Indian Medical Service in order to provide for
these requirements.

Pestis StMULANS.—E. S. Goodhue, writing from the
Hawaiian Islands, on ** Hawaii as a Field for Scientific
Work in Tropical Medicine,” states that Dr. Sinclair
of Honolulu, suggests the term pestis simulans, instead
of pestis minor, for a climatic bubo as defined by Cantlie.
Pestis simulans is commendable “ав being non-
committal for cases that run a mild course of true
plague in districts where plague is more or less
epidemic, and where it is impossible to demonstrate
the presence of plague bacilli.”

Inpia has a staff of mounted army nurses. The
Indian Government allows these ladies of the Indian
Nursing Service thirty rupees a month for the upkeep
of their horses, and free conveyance of their animals
to and from active service. This corps of nurses are
all ladies of good social position, and have to undergo
three years’ training iu a general hospital before
qualifying.—Zndian Public Health.

August 1, 1906.)

943

бил Sickness.—<A hypodermic injection of 415 grain
of sulphate of atropia and p grain of sulphate of
strychnia is recommended (Girard) as а specific for
sea sickness. The injection to be given at the com-
mencement of voyage or when the sea commences to
be rough.

X-RAY Burns.—At the 337th regular meeting of
the New York Dermatological Society, held November
28th, 1905, the subject of X-ray burns was taken up,
and Dr. Henry G. Piffard, Emeritus Professor of
Dermatology in New York University, said (Journal of
Cutaneous Diseases) “that he had obtained the most
benefit in treating these conditions from antiphlogistine,
chloride of zinc, high frequency current and ultra-
violet rays.”

WE regret to notice the death of Lieut. Waller
H. Hills, R.A.M.C., of cholera, аб Cawnpore. Тһе
deceased officer was only 28 years of age, but was
already extremely popular, alike with his patients and
his brother officers.

——— 9 —————

Personal Aotes.

INDIAN MEDICAL SERVICES,

India Office: Arrivals of Indian Medical Officers in London. —
Lieutenant-Colonel W. A. Lee, Lieutenant-Colonel M. Collie,
Major T. D. C. Barry, Colonel H. Hamilton, C.B.

Extensions of Leave.— Captain Н. R. J. Rainier, 4 m., Med.
Cert. ; Captain T. Н. Delaney, 6 m., Med. Cert.

Leave.

Captain W. Collinson, 1 y. general leave.

Captain W. B. Turnbull, priv. leave, 3 m.

Major W. J. Buchanan, Insp. Gen. Jails,
leave, 2 m. 15 d.

Lieutenant-Colonel D. G. Crawford, priv. leave, 2 m. 27 d.

Bengal, priv.

Postings.

Colonel О. Todd, R. A.M.C., to the Poona Division, and to act
as P.M.O. Western Command during the absence of Colonel
Trevor, on leave.

Captain H. J. Walton, Civil Surgeon, Manipuri.

Captain Knapp, services placed temporarily &t disposal of
Government of Burmah for employment in Jail Department.

Captain H. Ainsworth to officiate as Medical Adviser to the
Patiala State.

Major C. H. James is deputed to accompany Sir Rangbir
Singh, K.C.S.I., of Patiala, to Europe.

Mr. E. W. Payne officiates as Insp. Gen. Jails, Bengal.

Medical Hotes.

GLANDULAR FEVER.

A good deal of interest attaches at the present time
around this loosely named illness. In a medical man
suffering from general enlargement of glands, with a
series of skin lesions resembling a syphilide, Drs.
Stengel, White and Evans, of Philadelphia, found
that syphilis was negatived, Spirocheta pallida was
not found, but a streptococcus resembling one met
with in horses and causing glandular fever and also
epidemic coryza in these animals, was detected in the
patient’s blood, glands, and tonsils

Івтнмілх CANAL COMMISSION.

In his report for May, 1906, Colonel W. G. Gorgas
states that during the month in question there was but
one case of yellow fever in the Zone. Pneumonia
continues to be by far the most common cause of death
amongst the men employed on the Canal work.
Malaria is less prevalent, beri-beri is decreasing, and
the general health is excellent in all parts of the Zone
of work.

Dr. Novy, at the meeting of the Association of
American Physicians, said he had prepared a serum
capable of immunising against relapsing fever, and
curative if given in early stages. We anxiously await
further reports on this announcement.

———9———————

Жасы and Current Literature.

A tabulated list of recent publications and articles bearing on
tropical diseases 18 given below, То readers interested in
any branch of tropical literature mentioned in these lists
the Editors of the JouBNAL OF TROPICAL MEDICINE will be
pleased, when possible, to send, on application, the medical
journals in which the articles appear.

“The Philippine Journal of Science,” May, 1906.

Tyzzer, Е. E., “Тһе Histology of the Skin Lesions іп
Varicella.”

Whifford, H. N., “Тһе Vegetation of the Lamao Forest
Reserve.”

Bacon, В. F., * The Waters of the Crater Lakes of Taal
Volcano, with a Note on some Phenomena of Radio.
activity."

Lewis, б. N., “ Concerning Silver Oxide and Silver Sub-
oxide,”

The Suppression of Malaria at Ismailia.

“ Suppression du Paludisme à Ismailia” (The Suppres-
sion of Malaria at Ismailia). Suez Canal Company, 1906.

The object of this pamphlet is to demonstrate the methods
by which Ismailia has been completely cleared of malaria.

Ismailia, which was founded by de Lesseps in 1862, on
the banks of Lake Timsah, midway between the Mediter-
ranean and the Red Sea, has now a population of 8,000
inhabitants.

Malarial fever suddenly appeared in this town in 1877 (up
to which time it was noted for its healthfulness), and spread:
to such an extent that in 1886 nearly all its inhabitants had
suffered from ague. On several occasions the Suez Canal
Company endeavoured to arrest the development of malaria
at Ismaila, but without any appreciable results. In 1901
a fresh attempt was made by Prince Auguste d’Arenberg,
the President of the Company, which was more in accord-
ance with the ideas which had just then been published on
the part played by mosquitoes in propagating malaria. This
attempt has met with complete success, for after two years’
efforts all trace of malaria has disappeared from Ismailia.

The object of these remarks is to give some general idea
as to the nature of the work undertaken and of the measures
adopted which enabled this result to be obtained.

ee natural and medical histories of malaria are now so
well known that they need not be mentioned here. |

The researches initiated by Prince d’Arenberg, in the
spring of 1901, were undertaken with a view to the possible
methodical destruction of mosquitoes at Ismailia, and pend-
ing the results of these studies the prophylactic use of
quinine was widely employed amongst the inhabitants, the
employees who suffered from malaria were medically treated
gratuitously and received full pay whilst on the sick list.

Briefly stated, the studies made during the years 1901 and
1902 were mainly directed to the four following main
points :—

944

(1) An examination of the adult perfect Anopheles.

(2) An examination of Anopheles larvie.

(3) An examination of ordinary mosquitoes.

(4) An examination of the ground levels, with a view to
the possibility of causing the stagnant waters to disappear.

The results obtained were as follows :—

(1) The dangerous season commenced about July, and one
of the first centres of production for Anopheles mosquitoes
was situated to the east of the town; at the same time no
Anopheles were to be found either in the European or in the
Arab quarters, although the whole town was afterwards in-
vaded. The specimens captured were afterwards found to
be Anopheles pharoensis and A. chaudoyei.

(2) It was definitely proved that the reproduction of the
Anopheles mosquitoes was carried out exclusively in the
pools and smaller shallow ponds which were to be found
everywhere, and that these were filled on the rising of the
Nile, although they subsequently became dried up.

(8) The ordinary mosquitoes belonged to the genera Culer
and Stegomyia, of which there were numerous species ; both
of these generic forms went on increasing their numbers
nearly all the year round, in the cesspits, ponds, garden
water-ways, and cisterns, &c., as well as in those collections
of water where Anopheles Іагуе were found. Experiments
were made as to the destructive action of petroleum spread
over the waters which contained Іагуњ, and also as to the
quantities required for each square yard of surface to ensure
efficiency of result; the effect of. salt-water and of sea-
water on larve and nymphe showed that these could at
once be killed by the water of Lake Timsah.

(4) In order to destroy the Anopheles it would be neces-
sary to do away with all stagnant collections of water in
which the larve of these mosquitoes had been found, and a
careful survey of the town and its neighbourhood showed
that this would not be a very costly undertaking.

To complete these observations, Dr. Pressat (one of the
Company’s surgeons) was sent specially to Italy to study
the latest methods of malarial research work, and Major
Ross was specially invited the following autumn to visit
Ismailia and to favour the Company with his advice, which
was to use every effort to ensure total protection for Ismailia
from malaria by the destruction of all the mosquitoes, as
this task appeared to be afeasibleone. Immediately on the
receipt of Major Ross's report, a conference was specially
held to propose definite measures and the means of apply-
ing them, and it was decided that the destruction of the
Anopheles was first of all to be carried into effect, and after-
wards that of the other mosquitoes.

Destruction of Anopheles.—The search for Anopheles
larve revealed three dangerous foci close to the town:
(1) To the east, the marsh of Abou-Rahan; (2) to the west,
the small ponds, open drains for irrigation, and pumping-
stations for the cultivated land near Nefiche; (8) to the
south, near the northern bank of Lake Timsah and close to
the bathing sheds, some collections of water which were
formed only during the rise of the Nile.

The measures adopted were briefly as follows :—

The great marsh was intersected with deep channels
which were stocked with fish, the reeds were removed, and
the soil (wherever this was possible) was levelled, all de-
pressions being filled up with sand; the sinaller ponds and
swampy spots were all filled in, the irrigation drains were
cleared and deepened, and also stocked with fish, such as
eels, mullet, and a species locally known as chaba’r (Tilapia
gallilea).

Destruction of Ordinary Mosquitoes.—The works under-
taken for the destruction of Anopheles also helped to bring
about that of Culex and Stegomyia outside the town, but
those inside the dwellings had vet to be dealt with. This
task did not offer any great difficulty, as it consisted in the
periodical emptying of all receptacles for water, wherever
this was possible. or of spreading petroleum on the water if
the receptacles could not be emptied.

The town of Ismailia was therefore divided into six dis-
tricts (one for each week-day), and every house was inspected

THE JOURNAL OF TROPICAL MEDICINE.

[August 1, 1906.

once a week, and on the same day of the week. by a squad
of three Arabs commanded by an. European, who were told
off exclusively for this purpose. During this inspection
every receptacle for water, including the ornamental garden
ponds, had to be emptied and dried in the presence of the
chief of the squad, and the inhabitants were cautioned
against immediately refilling the emptied receptacles, ая
this might revive the half dried up larve. The cesspits at
the same time were treated with a mixture consisting of one
part of heavy petroleum to three parts of lamp petroleum,
in the proportion of one glassful to every square yard of
surface, [Before eoninencing these petroleum operations,
all the vent-holes had been eovered over with metallic gauze
to prevent the escape of mosquitoes, whieh would otherwise
have been drive away by the smell of the petroleum.] The
Conipany had also previously obtained Government sanction
for the sanitary squad to enter into the Arab dwellings; but
as the inhabitants were put to no expense, and had no work
imposed upon them, they readily submitted to this weekly
inspection, and soon volunteered their help in applying the
measures adopted.

Cost. Initial Егрепзез.--Тһе filling in of the ponds and
drainage of the marsh land cost about £2,000 altogether.

Permanent E.rpenses.—The upkeep of the drains (cutting
weeds and reeds, &c.) in the neighbourhood of the town costs
£812 per annum ; the petrolage of the cesspits and blind
wells and the filling in of local puddles in the town itself
costs £420 annually, or a total yearly expenditure of £732.

Results,—Since the commencement of 1908 the common
mosquitoes have disappeared from Ismailia, and all the
inhabitants have been able to dispense with their mosquito-
nets, which are so troublesome and anti-hygienie in hot
climates. Since the autumn of 1903 not а single Anopheles
larva has been found in the protected zone, which now
extends for nearly a mile all round the town.

Since 1902 malarial fevers have shown a manifest de-
crease, and since 1908 no fresh case of malaria has been
notified in Ismailia.’

It must, however, be noted that adult Anopheles are still
oceasionally found in the autumn in Ismailia, probably
driven in from a distance by certain winds; but that they
constitute no danger is proved by the disappearance of fever
from the town.

Of all the hypotheses put forward to account for the
invasion of malaria in 1877, the most probable one is that
Anopheles have existed from all time in this region, but that
the sudden appearance of ague in 1877 was due to the
arrival of malarial patients at Ismailia. At this time the
Ismailieh Canal was dug, and many Italians were employed
on this work, and probably several of them had already
suffered from ague in their own native country.—J. E. N.

11900 .. 2,050 cases (old and new, combined).
1901 1990 ,, ў А
1902 .. 1,550 ,, » 2:
1903 .. 9395 ,, 5 M
1904 .. 90 » a »
1905 . 55 ,, (550ld, Onew).

Rotices to Correspondents,

1.— Manuscripts sent iu cannot be returned.

2.— As our contributors аге for the most part resident abroad,
proofs will not be submitted to those dwelling outside the United
Kingdom, unless specially desired and arranged for.

3.— To ensure accuracy in printing it is specially requested
that all communications should be written clearly.

4.—Authors desiring reprints of their communications to the
JOURNAL OF TROPICAL MEDICINE should communicate with the
Publishers,

5.—Correspondents should look for replies under the heading
“ Answers to Correspondents.”

August 15, 1906.)

Original Communications.

BERI-BERI—A RESTATEMENT AND REPLY
TO SOME CRITICISMS.

By Hamitton ХҮніонт, МЛ).

Berore dealing with some recent work оп beri-beri
and criticisms of my own views as to the nature,
&c., of the disease, it may be well to restate in
epitome what the latter are. This will save reference
to brochures which may not be readily available.

CLINICAL ASPECTS.

After several years of exhaustive etiological, clinical,
and pathological researches on beri-beri, together with
a review of the work of those who had preceded me in
the study of the disease, the following conclusions
were formulated as to its cause, onset, course, classifi-
cation and termination :—

That beri-beri is, in its origin, an acute infectious
disease. That it is independent of food regarded as
food, or of any micro-organism whose special habitat
is a foodstuff. That on the contrary, it is caused by a
specific bacillus which is to be found under those
general conditions which govern most specific micro-
organisms. That, generally speaking, the disease
begins in those enjoying good health by more or less
pronounced symptoms suggestive of indigestion. That
these symptoms (gastro-duodenal syndrome) consist
of oppressive feelings or pain referred to the stomach,
dilatation of the latter and of the duodenum, with con-
sequent bulging of the epigastrium, vomiting and
perhaps diarrhoea. That this syndrome precedes any
other symptom of beri-beri by a few hours or days, and
that it marks the multiplication of the specific
bacillus and the elaboration of its extra-cellular neuro-
toxin in the contents of the stomach and duodenum.
That the gastro-duodenal syndrome is constantly and
soon joined by signs of the acute poisoning of the
nervous system as the result of the absorption of
the specific virus into the circulation, i.e., there are
anesthesia, flaccid paresis of varying extent, oedema
and cardiac irritability. That this gastro-duodenal
syndrome may either subside or intensify as the
poisoning of the neurones proceeds. That the acute
poisoning of the neurones reaches a maximum about
the twentieth or thirtieth day and then begins to sub-
side and finally disappear. That during the develop-
ment and presence of the gastro-duodenal syndrome
there is probably a continuous secretion of the specific
toxin, and that the syndrome, together with the rapidly
spreading acute poisoning of the sensoro-motor and
autonomic neurones make up acute beri-beri, or beri-
beri proper.

Further, that if such cases of acute beri-beri are not
treated by strict rest of the acutely poisoned neurones,
the symptoms of nerve poisoning do not clear up on
the elimination of the causal organism and its toxin
(about the third to fourth week from the onset), but
resolve into more narrowly confined symptoms which
then more or less rapidly change from the acute
toxemic type to a chronic degenerative type. That is,
the acute flaccid palsy (to take the most obvious
symptom) insensibly resolves to chronic atrophic

THE JOURNAL OF TROPICAL MEDICINE.

245

paralysis as the result of an inertia degeneration im-
parted to the neurones by the specific neuro-toxin,
active only in the acute stage of the disease. I pointed
out that this chronic stage of the disease is not beri-
beri proper, but simply a degenerative paralysis resi-
dual to the more extensive toxwmic palsy of acute
beri-beri or beri-beri proper. I feel bound to be some-
what tautologic on this question, because what seemed
to many to have been a plain statement has neverthe-
less been misconstrued by recent critics of my views.
So much for the clinical aspect of beri-beri.

PATHOLOGICAL ASPECTS.

The pathology of beri-beri was studied with strict
regard to the clinical signs and duration of the disease.
A considerable number of new facts were elicited, and:
these, with the data of the older observers, were co-
ordinated as logically as possible. In regard to the
pathology of beri-beri the main gonclusions were as
follows :—

That nearly all cases of beri-beri, fatal in the acute
stage of the disease (first to sixth’ week), exhibit a
necrosis of the gastro-duodenal апа neighbouring
mucosa along with the signs of inflammation. That
in association with this gastro-duodenitis there was
found & rod-shaped bacillus of constant morphological
character. That, taken with the onset of the disease
by a gastro-duodenal syndrome, it seemed pretty con-
clusive that the gastro-duodenitis would have to be
regarded as the primary lesion of the disease, and that
the constant presence of the rod-shaped bacillus was
suggestive at.least that we were dealing with a specific
organism. Furthor, that the morbid anatomy of the
acute stage of the disease was distinctly different from
that of what I termed the residual stage. That in the
former classes of cases the lesions were of the nature
of an acute poisoning of the peripheral terminations of
the neurones (no signs of degeneration in them) and
that the changes in all other organs were secondary
to such an acute poisoning. That is, there is dilata-
tion of the right heart (no hypertrophy whatever), a
small amount of fatty degeneration only, and more or
less passive congestion of lungs, spleen, liver and
kidneys (no necrosis in these organs at Mie On the
other hand, that in cases of residual paralysis (from
three months’ to several years’ standing) there is not
found a gastro-duodenitis except in cases reinfected.
That the peripheral terminations of the involved
neurones now show various degrees of true inertia
degeneration, Wallerian in appearance, and that this
degeneration has migrated towards the trophic centres.
That there are found some signs of chronic derange-
ment in the body organs, namely, dilatation of the
chambers and true hypertrophy of the cardiac muscle,
coextensive with the amount of degencration in the
cardiac nervous system, and the time which has
elapsed since the degeneration set іп; chronic emphy-
sema and even slight fibrosis of the lungs, with signs
in the liver, kidneys and spleen of the effects af pro-
longed passive congestion.

CLASSIFICATION OF BERI-BERI.

Upon both clinical and pathological data there was
propounded a new classification of beri-beri which I
hoped would be regarded as scientific rather than
merely descriptive. The older classifications took note

946

of some one feature of the disease, such as oedema, or
muscular atrophy, and the disease was then written of
as wet or dry beri-beri. There follows the new
classification :—

Acute pernicious beri-beri, which is rapidly fatal
because of the impact of the specific toxin on the ter-
minations of the entire cardiac nervous system. In
this class of cases there may, of course, be other signs
of the acute disease: varying degrees of сепа,
flaccid palsy, vaso-motor disturbance, &c. But the
main features are that the onset is sudden, the cardiac
neurones bear the brunt of the poison, and the cases
are rapidly fatal.

Acute and subacute beri-beri, in which the onset is
more or less sudden and well marked, but in which,
though there are many signs of neuronal poisoning,
the virus is not specially incident on the cardiac
nervous system.

Beri-beric residual paralysis, or the chronic stage of
the disease due to an inertia degeneration of various
kinds of neurones, from the impact of the virus in the
acute stage of the disease.

These different class names, it was suggested, may be
modified so as to indicate which particular neuronal
system is involved, thus :—
cardiac,
motor,
sensoro-motor, or
vaso-motor

cardiac,
Beri-beric Шуға

residual | sensoro-motor, or

vaso-motor

Chronic beri-beri as a classifying term for cases of
residual paralysis was avoided, because it implies that
the causal agent is still at work. Post-beri-beric
paralysis was avoided, because it implies that the
atrophic paralysis of the disease followed some morbid
constitutional state, minus paralysis. I have drawn
attention to some striking analogies between beri-beri,
as I conceive it, and diphtheria, principally that beri-
beri as diphtheria appears to bo due to a bacillus
which multiplies locally in the vicinity or actually in
a mucous surface, and produces its remote effects on
the nervous system (constant in beri-beri, casual in
diphtheria, however) through the agency of an extra-
cellular neuro-toxin. Some commentators on my
views, forgetting that there is no exact analogy in
Nature, have, nevertheless, converted my analogy into
an exact parallel. In doing so they accuse me of
stating that beri-beric paralysis is always post. Above
I have restated my position in this matter, I hope
clearly and beyond further misconception. Perhaps
the following graphic illustrations will make more
clear this conception of beri-beri :—

Acute beri-beri.

r paralysis.

КЕҮ.- -АА, Health line; Bb, death line; c, prodromal stage of
more or less marked gastro-duodenal symptoms ; D, more or less

THE JOURNAL OF TROPICAL MEDICINE.

[August 15, 1906.

well-marked gastro-duodenal syndrome, suggesting multiplica-
tion, of specifie bacillus, elaboration of its toxin and absorption
of it into blood stream, with consequent poisoning of neuronal
terminations ; о, first evidence of neuronal poisoning developing
suddenly into acute pernicious beri-beri (е), which ends rapidly
iu death at (B), into acute and subacute beri-beri (ғ and в),
which end iu recovery at (P); а, combined gastro-duodenal and
acute neuronal symptoms making up beri-beri proper, or the
acute disease ; H, more or less rapid passing of the acute poison-
ing of the neurones into an inertia degeneration, which occurs
in a large number of cases, thus constituting (KK), beri-beric
residual paralysis; L, termination of the residual paralysis in
death from cardiac exhaustion or some intercurrent affection ;
M, termination of residual paralysis in recovery; N, continua-
tion of the residual paralysis indefinitely.

-Above I have spoken of this theory, pathology, and
classification of beri-beri as generally applicable.
Does it, however, apply to those cases of beri-beri
which follow parturition, surgical and other wounds,
and which occur in children at the breast of mothers
suffering from the acute disease. I have already
answered this question elsewhere, but it may be re-
stated. If the central fact of the theory is considered,
namely, that beri-beri is caused by a specific bacillus
locally confined, which produces its remote effects on
the nervous system by means of an extracellular
diffusible neuro-toxin, it will be clear that such an
organism may act in & wound as well as in a mucous
surface. Further, that acting in a parturition wound
enough toxin may be absorbed not only to cause the
acute disease in a mother, but also in her nursin
child by secondary absorption. It might be urge
that the experimental translation of human beri-beric
blood to monkeys does not produce signs of beri-
beri in them. But obviously it is one thing to
translate a small quantity of blood from a human
beri-beric to a monkey, and another, the almost
constant translation of the beri-beric virus which
would take place between an infected mother: and
her suckling infant. In the latter case the virus
would be constantly reinforcing that previously
absorbed, while in the former the small quantity of
virus contained in the amount of blood that could be
translated would be quickly diluted and neutralised.

The data on which all of these conclusions were
based were published several years ago. Naturally it
has taken time for other workers to confirm them
іт toto or in detail, or to deny them. Observations
have, however, recently accumulated rapidly, aud it
is now proposed to examine them and see if thoy
seriously impair my own and the reasoning founded
on them.

REPLIES TO CRITICISMS.

Before proceeding, some ground must be cleared
by reference to certain misstatements made by Dr.
H. E. Durham in the Journal of Hygiene.

That author, by obviously personal strictures, at-
tempted to cast doubt on the validity of certain special
observations which I had made in the Federated
Malay States. I have not before taken notice of his
remarks, for it seemed to many that he was quite un-
fair. Perhaps if I state that Durham worked in my
laboratory for nearly a year after my views on beri-
beri had been submitted, and that on publishing what
purported to be his own observations he failed to
acknowledge the fact, and that, as is well-known to

August 15, 1906.)

those competent to discuss beri-beri, he, by his
actions in the Federated Malay States, put himself
out of court as a possible critic of beri-beri work
done there, the matter may be brought to rest. I
should not essay even this defence of my work
against Durham’s attacks were it not for the fact
that some fair-minded critics have echoed him.

To turn now to more serious subjects. There has
been considerable negative criticism of my conclusions
as restated above.

Dangerfield's extensive brochure оп beri-beri, pub-
lished in Paris, 1905, is on the whole a negative
comment on my views, inasmuch as he has submitted
data on which he affirms that beri-beri is essentially &
bacteremia. Не puts forward а mierococeus as the
form of organism that exists in the blood stream and
causes the disease. In 1900-1901 I made fairly ex-
haustive research of the blood of all classes of beri-
berics, and failed to find an organism in the flowing
blood. Dr. C. W. Daniels (** Observations in the Feder-
ated Malay States on Beri-beri,” London, 1906) has
more recently made a similar research which was
wholly negative. I shall shortly record an even later
examination of the peripheral blood of acute beri-
berics by Wise, in which no organism of any kind
was found. Finally, Drs. Hunter and Koch (“А
Research into the Etiology of Beri-Beri," Hong Kong,
1906) have published a very thorough observation of
the blood of beri-berics, and have made inoculation
experiments which show conclusively that beri-beri is
not a bacteremia. On the whole, Dangerfield's con-
clusion, and with it his negative evidence against my
view that beri-beri is originally an acute toxemia,
beginning in в local primary lesion, cannot be
accepted.

Dr. C. W. Daniels has put forward some negative
criticism of my view of the nature of beri-beri. Unfor-
tunately it is founded on an entirely erroneous concep-
tion of both my working theory and classification of
the disease. Daniels credits me as follows: “ Dr.
Hamilton Wright goes so far as to propose the
limitation of the term beri-beri to the intestinal condi-
tion, and to describe what is at present known as
beri-beri ав post-beri-beric neuritis.”

I have not, of course, proposed any such limitation of
the term beri-beri, nor have I ever used the wholly
misleading term, post-beri-beric neuritis. It is not
necessary to repeat what I have restated above оп
ihis side of the beri-beri question. Having mistaken
my words, Daniels would controvert my views as to
the nature of beri-beri by evidence which, properly
interpreted, seems to me to only support the latter.
For instance, he states: ‘‘ In cases admitted with beri-
beri, loss of appetite is common, and vomiting occa-
sionally does occur ; while distension of the epigastrium
is quite a feature in the diagnosis. As these cases have
quite other definite symptoms of the disease, and had
usually been ill for several days, the symptoms were
during the early stages of ordinary beri-beri and not
during a prodromal stage.”

I have never claimed more for the early, acute stage
of beri beri. Had Daniels read me clearly, he would
have seen that the gastro-duodenal symptoms of his
cases were part of what I have termed acute beri-beri.
Had he seen his cases early enough he would probably

THE JOURNAL OF TROPICAL MEDICINE.

247

have found, as others as well as myself have pretty
constantly found, that the gastro-duodenal symptoms
were prodromal, as well as an: accompaniment of
acute beri-beri. His conclusions on this important
point would then no doubt have chimed with mine,
that beri-beri onsets with a gastro-duodenal syndrome,
indicating the probable site of action of the specific
cause. А

In a further criticism of шу view as to the primary
lesion of beri-beri, Daniels submits a singular patho-
logical conception. He states that the lesion of the
gastro-duodenal mucosa in acute beri-beri, which he
appears to have found pretty constant, is ‘‘ not of an
inflammatory nature such as we should expect to find
іп а primary lesion, but such as occur as secondary
lesions, hemorrhages, and congestions.”’

This view is not borne out by any published evi-
dence that Daniels made an acceptable examination of
the gastro-duodenal mucosa of acute or other beri-
berics. He appears to have autopsied thirty-four cases
of beri-beri, thirteen of which exhibited ecchymoses
and congestions of the gastro-duodenal mucosa (“ The
Півеавев of British Malaya,” Studies from Institute
Medical Research, F.M.S., vol. iii., рагі 1). Не does
not claim to have been informed on the clinical
histories of these cases, and there is no detailed state-
ment of the microscopical appearances of their gastro-
duodenal mucosa. Í maintain that one may be grossly
misled by the mere macroscopical observation of
any morbid organ, and that no one is competent to
generalise on such data. I may be wrong, but I am
nevertheless forced to conclude that Daniels’ criticism,
as just quoted, is based on what he has read into my
very detailed description of the macroscopical and
microscopical state of the gastro-duodenal mucosa of
many cases of acute beri-beri whose clinical history
was known and given.

I hoped that I had made it perfectly clear that the
chief lesion in the gastro-duodenal mucosa of acute
beri-berics is а necrosis. There is, besides, more or
less precipitation of fibrin, some small-celled and poly-
nuclear leucocytic invasion, and spots and rings of
brilliant congestion due to dilatation of capillary termi-
nations. Actual hwmorrhages are rare, and just as
rarely there may be extensive hemorrhagic erosions.
Mucosal erosions may, however, be common. — Uloera-
tion I have not seen.

According to the singular pathological conception
enunciated by Daniols, this lesion in acute beri-beri,
and the essentially песѓоііс lesions of diphtheria,
cholera and tetanus, cannot be primary. It does not
appear to me that Daniels’ conclusion on this point
can be accepted.

Daniels and others would attribute what I regard as
the primary lesion of beri-beri to the action of a virus
on the vagal terminations in the gut, without attempt-
ing to account for the early selective action of the
poison. By similar reasoning, did we not know
better, we might account for the primary lesion of
diptheria as due to the action of a virus on the neuronal
terminations in the palate, pharynx and larynx. It
appears to ine to be better pathology to reason that,
given a constant primary lesion caused by a neuro-
toxin-producing bacillus, it will be the neuronal ter-
minations distributed to the site of the primary lesion

948

which will in time first succumb to the effects of the
toxin.

The rest of Daniels’ views as to the etiology, &c., of
beri-beri are almost purely speculative, and so do not
call for reply. Не does not appear to have been able
to watch the disease develop in healthy subjects, and
his limited observations on morbid anatomy do not
seem to have been made with a knowledge of the
clinical history of his cases. Не, however, arrives at an
important general conclusion after examination of
ground which I had thoroughly explored, namely, that
“ beri-beri is an infectious disease. As a rule a short
period of incubation and a period of exposure of less
than three months is requisite for full development of
the disease where the ‘endemic index’ is high.”

It will shortly appear that this general conclusion to
which I was forced, to which Daniels has been forced
after an examination of much data collected by others,
and to which observers like Scheube adhere, is denied
in toto by Hunter and Koch.

Drs. Hunter AND Косн’в RESEARCHES.

The most ambitious recent attempt to add to our
knowledge of beri-beri is that made by the just referred
to authors, Drs. Hunter and Koch, іп “А Research
into the Etiology of Beri-beri," Hong Kong, 1906.

These observers have canvassed the whole issue as
laid down in my own investigations of the disease. It
will be well to continue this line in my reply to their
criticisms.

First in regard to the question of etiology. The
above authors attempt to show that beri-beri is not an
acute infectious disease. The first facts submitted are
in a description of ** An Outbreak of Beri-beri in the
Po Leung Kuk.” A mild form of the disease was not
brought under control by ‘thorough and complete
disinfection of the buildings. This was carefully done
by the staff of the Sanitary Board, and the walls were
completely lime-washed thereafter, and the floors
scrubbed with a solution of strong carbolic acid.” Be-
cause these sanitary measures were ineffective, Hunter
and Koch conclude that beri-beri is not infectious in
nature. Of course, so sweeping a conclusion is not
warranted by the facts of the case. The observers do
not appear to have disinfected the clothes or bedding
of the inmates. They make no mention of having cor-
rected the personal hygiene of the latter, an important
matter when there was, as in this instance, an over-
crowding of Orientals. The food supply does not
appear to have been examined for materies morbi, and
during the continuance of the outbreak no effort was
made to prevent new arrivals from introducing new
infection from some endemic focus outside the Po
Leung Kuk. E

In ШІ observations made in the Kuala Lumpur gaol,
which Hunter and Koch would refute, the circum-
stances just enumerated were carefully looked to. The
Kuala Lumpur observations extended over a period of
more than two years altogether. The focus of infection
(granting infection for the time being) was by a process
of rigid exclusion narrowed to the cells of the gaol, and
finally to certain of these cells alinost alone. It will
be clear, therefore, that Haunter and Koch’s observa-
tion in this instance was inadequate to exclude beri-
beri from the category of infectious diseases.

THE JOURNAL OF TROPICAL MEDICINE.

[August 15, 1906.

To clinch what Hunter and Koch regarded as a
capital fact against the infectious nature of beri-beri,
they proceeded to repeat my observation that monkeys
may contract beri-beri when placed in а focus of the
disease.

“ Description of the Experiment А, 1-11-111. The
rooms of the Po Leung Kuk, in which the majority of
cases of beri-beri had occurred, were reserved for this
test. The rooms were left in exactly the same con-
dition as when they were used by the inmates of the
Po Leung Kuk. Two monkeys were placed in each
room, and in order to facilitate the onset of the disease
the windows of the rooms were kept shut, and the
light excluded as far as possible.”

The monkeys, after a prolonged incarceration, did
not develop beri-beri. Hunter and Koch, therefore,
conclude that “Тһе incarceration for months of
monkeys in rooms presumably infected with the so-
called beri-beri virus failed to induce the occurrence
of the disease in them. We were unable to confirm
the results ой Hamilton Wright."

It must be plain to even the most casual reader
that this attempt to work along the lines of my monkey
experiment was a failure. The conditions of Hunter
aud Koch's experiment were almost indefinitely wide
of the conditions under which my own observation
was carried out in the Kuala Lumpur Gaol. Asshown
above, Hunter and Koch had by no means proved
that it was the living-rooms of the Po Leung Kuk (in
which they confined their monkeys) which contained
the virus of beri-beri, ав had been proved in regard to
the cells of the Kuala Lumpur Gaol. Further, they
were dealing with an institution in which only the
mildest type of beri-beri had been observed, while the
Kuala Lumpur Gaol had for years been a veritable
hothed of the most severe type of the disease. For
instance, in ten or twelve of the Kuala Lumpur cells
there was placed as many healthy Chinamen who had
been roving the country as gang robbers. These men
never left tho cells from the time of incarceration until
they contracted beri-beri. Inside a month eight of
the Chinamen contracted a most severe type of acute
beri-beri, while one of them died of the acute per-
nicious form. Again, Hunter and Koch incarcerated
their monkeys in rooms with a floor space ranging
from 401 to 902 square feet. The cells of the very
lethal Kuala Lumpur Gaol, in which my observation
was made, had a floor space of about 50 square feet.
This alone was a great difference in the conditions of
the two experiments, even granting that. Hunter and
Koch had proved by exclusion that the rooms of the
Po Leung Kuk were infected. АП facts considered, it
does not appear that Hunter and Koch's observation
on monkeys was well planned, or that it was adequate
to exclude any part of my own. It certainly does not
exclude beri-beri from the category of the acute
infections.

Under the heading of “ Feeding Experiments, В,
1-111," these observers make the following statement,
and then, on the contained reasoning, proceed with
certain experiments: “Ав certain observers, as
Pekelharing and Winkler, Gerrard and others, claim
to have found micrococci, ќе., in the blood stream
of beri-beri patients, feeding animals with the blood
of such cases seemed to afford the best opportunity

August 15, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE.

249

for a successful mode of conveyance of beri-beri
from man to animal. By this method the organisms
said to be present in the blood would reach that
part of the gut, namely, the gastro-duodenal mucosa,
alleged to be the site of primary beri-beri infec-
tion, and in susceptible animals set up the disease.
It seemed to us that, by resorting to such experi-
ments, the question as to the presence of а definite
primary lesion in beri-beri, and our hopes of obtaining
positive evidence of the transmission of the disease to
monkeys by this method were strengthened by the
publication of Wright dealing with natural infection
HORN incarcerated in presumably infected prison
cells."

The reasoning of this paragraph does not appear
sound to me. Іп effect, Hunter and Koch state that
A. has а theory that beri-beri is caused by а bacillus
which never extends into the blood stream, but acts
locally in а mucous membrane, and produces its
remote effects by means of an absorbable toxin ; that
is, the disease is а toxemia. B., on the contrary, has
a theory that beri-beri is caused by a micrococcus
which gains the blood stream through the skin; that
is, the disease is а bacteremia. С., however (Hunter
and Koch), propose to prove that A. is wrong in
regard to his locally acting bacillus by feeding
animals with blood supposed to contain the skin-
piercing micrococcus of B.

Comment on such reasoning is needless, and Hunter
and Koch's “ Feeding Experiments, B, 1-111," based
on it, do not call for attention.

, Hunter and Koch now proceed along more rational
lines and attempt to show that animals fed with
gastro-duodenal mucosa of fatal acute beri-berics fail
to exhibit signs of the disease.

Their feeding experiments, E, 1-11-111, were made
on monkeys by feeding one animal in each experiment
with one bolus composed of boiled rice and broken-
down gastro-duodenal mucosa. No signs of beri-beri
followed after feeding with one bolus. Yet the authors
conclude that the experiment was negative, во far as
my view is concerned that beri-beri has as its primary
lesion a gastro-duodenitis. Тһе experiment was well
conceived, but nevertheless wholly inadequate as the
basis of any conclusion, in regard to beri-beri. The
experimenters should have borne in mind the feeding
experiments made with Koch's comma.

. А further attempt was made by Hunter and Koch to
induce beri-beri in animals by feeding them with spleen
pulp, broken-down liver, medulla, cord, brain blood,
&c., of beri-beries (feeding experiments, В, 11, pigs
I. to VI. and one sheep) Тһе amount of such
materials that could be given to animals was small, of
course, and the boluses were seldom or never repeated.
No signs of beri-heri appeared. Therefore, conclude
the authors, beri-beri may not be contracted through
the gastro-duodenal mucosa. So far as I know the
organs with which these animals were fed have never
been claimed by me to contain the bacillus of beri-beri
I have always maintained that the bacillus does not
extend within the body. It must be plain, therefore,
that this attempt to induce beri-beri was illogical,
and that no fair deductions can be based on it.

. It is gratifying to turn from Hunter and Koch's
illogieal feeding experiments to some of their really

valuable inoculation work. After a repetition of obser-
vations made by the writer several years ago, more
recently by Daniels, and still later, as I shall show else-
where, by Wise, that in no stage of beri-beri is there a
bacteremia, Hunter and Koch conclude as follows:
“ The repeated sterile result after inoculating bouillon
and agar tubes with appreciable quantities of freshly
flowing (beri-beri) blood, demonstrates more or less
clearly the non-bacteremic nature of beri-beri.” This
does not, of course, prove that beri-beri is not an acute
infection, It simply proves that it is not of the bac-
teriemic type of infection.

The authors clinch this observation by a failure to
induce beri-beri in monkeys, sheep, calves, rabbits,
&c., by inoculating them with beri-beri blood and
vaccinating them with ‘rubbed up beri.beric organs.
But these experiments do not exclude beri-beri from
the category of the acute infections. They only prove
that beri-beri is not a bacteremia. They have only а
remote relation to my own view that beri-beri is an
acute toxemia. On this view the remote effects of
the locally acting bacillus are induced by an absorb-
able toxin which circulates in the blood. Hunter and
Koch might have hoped to induce some signs of beri-
beri in their animals by carrying over in blood from
beri-berics an efficient quantity of the circulating toxin.
The small amounts of blood they were forced to use,
however, would put out of consideration any attempt

* of this kind.

Where, as the result of their experimental observa-
tions, Hunter and Koch conclude that by culture no
organisms аге to be found in the blood stream of beri-
berics they are correct and corroborate older observa-
tions of the same order. They are also correct when
they conclude that beri-beri cannot be induced by the ·
translation of beri-beri blood to lower animals, pro-
vided that they hold to the idea of a bacteremia as the
cause of beri-beri. When, however, on such data
they conclude that beri-beri is not а toxsemia caused
by a locally acting organism, they go astray. They do
not appear to distinguish between the idea of а bacteri-
етіп and a toxemia, or so it would appear from
the above quotation from their work. They appear to
have forgotten, too, that any quantity of a toxin which
they might translate from the human to а lower
animal would be quickly diluted and probably neutra-
lised by the body juices of the latter. Itis quite а

` different matter in the case of a child suckling a beri-

beric mother, as mentioned above.

I do not think that any one will, after а careful
reading of Hunter and Koch's experiments, and the
reasoning on which they were largely founded, con-
clude with them as follows: ‘‘ These experimental re-
searches, negative though they be, possess, in our
opinion, great value, as they practically prove (how
may a negative experiment practically prove?), in
opposition to H. Wright and others, that in beri-beri
we are not dealing with an infectious disease, but one
with an entirely different etiology."

Turning now from Hunter and Koch's etiological
to their clinical observations, it would appear that the
latter were confined to the inextensive subacute
outbreak in the Po Leung Kuk. Even in this ex-
perience of the disease we are not furnished with
the particulars of individual cases. Only very wide

950

THE JOURNAL OF TROPICAL MEDICINE.

(August 15, 1906.

generalisations are made. There seems to have been
no attempt made to study the disease under that
prime condition, rest or comparative rest, which is
demanded by the nature of the affection. The patients
wandered at will. It isan axiom that the true features
of an acute neuritis are obscured by adding to the
original symptoms others due to use of the damaged
neurones. І have shown that in onset, courso, and
termination beri-beri presents clinically тапу
features of an acute infection. Hunter and Koch's
clinical observations do not help us to form an
opinion one way or the other on this question.

In regard to the pathology of beri-beri Hunter and
Koch state: “Тһе descriptions recently given by
Hamilton Wright, Mott, and others are sufficiently
extensive and minute to gratify even the most curious
of pathologists.”

Why, then, did they not accept that pathology and
its classification into the acute and residual categories,
& pathology which, so far as my own work was con-
cerned, was based on not only extensive post-mortem
examinations, but also on a thorough study of the
cases before death. My attempt was to put the
morbid anatomy of beri-beri оп a scientific basis, to
co-ordinate the appearance of an organ or set of
neurones with the symptoms expressed by them
during life. For years beri-beri cadavers had been
conscientiously studied by Malcommsen, Scheube,
Baelz, Ellis, and others; the only fault in their
observation was that the lesions found were not
brought into relation with the clinical signs at the
time of death. Statements were made in regard to
the heart, muscles, &c., that appeared to be positive
for any stage of the disease. The literature was full
of such general conclusions as that there is always
cardiac enlargement in beri-beri; that the somatic
muscles are greatly atrophied, &c. My own efforts
showed conclusively that the pathologic lesion of
beri-beri varied with the stage of the disease, and
that the lesion of the acute stage of the disease was
an entirely different affair from that of the residual
stage of the disease (vide supra for an outline).

It appears to me that after the frank admission of
Hunter and Koch that pathological curiosity had
been satisfied, they should have refrained from
tabulating their morbid anatomy without апу re-
lation to the clinical histories of their cases. They
state: “ It is to be regretted that in the majority of
cases -—cadavers—exatnined a history of illness was not
ascertainable. This was due to the fact that most
of the bodies sent for section were found in the streets,
in deserted houses, or on the hillsides.” Only vague
generalisations may be made from morbid anatomy
obtained under such conditions. And so we find that
Hunter and Koch have given us the pathology of
beri-beri as it may be found in any old text-book
article on the disease. It cannot be accepted on their
clinical or post-mortem work any more than on their
etiological observations that beri-beri is not an
infectious disease.

There is but one other point in Hunter and Koch’s
work that should be attended to. Writing on the
classification of beri-beri, they remark that beri-beri
exists in two forms: ‘‘ the dropsical, moist or wet form,
and the atrophic or dry form. Вегі-Бегіс residual
paralysis is a term which has been used in an analogous

manner, and with a similar ineaning to diphtheritic
paralysis. The pathology of the diseases being
different, the comparison does not hold, and any
attempt to introduce new varieties, names, %о., is to
be deprecated.”

Of course the disease does not present itself in two
varieties. It presents itself in a multiplicity of varie-
ties, depending upon the extent to which the different
kinds of neurones are poisoned in the acute form, and
the degrees of inertia degeneration which develop in
them if they do not recover on the elimination of the
virus of the disease. Тһе terms wet and dry were
tentatively used over fifty years ago, before the patho-
logy of beri-beri could be satisfactorily studied. For
Hunter and Koch to continue to use them is to confuse
the subject, just as they confuse it by stating that the
morbid anatomy is so and so without any relation to
the clinical facts and stage of the disease. Further,
the term beri-berie residual paralysis was not proposed
on the assumption stated by Hunter and Koch. It
was proposed for the exactly opposite reasons. It
ought to prevent any one confusing the residual
paralysis of beri-beri which follows a previous acute
palsy with the post-paralysis of diphtheria which is not
post to & previous different sort of paralysis, but to
certain local and constitutional symptoms which make
up the disease. The classification which was proposed
for beri-beri (vide supra) was based on clinical and

pathological data studied in close relation to one

another. Hunter and Koch may regard it obliquely ;
yet they testify to its soundness by constantly using it
in their description of experimental work, and in the
one clear statement they make on the pathology of
beri-beri.

Taking all of the above oriticisms into consideration,
they cannot be said to weaken the views which I
have expressed (be they right or wrong) as to the
nature, cause, course and termination of beri-beri.

MALIGNANT ANTHRAX СРЕМА IN
CENTRAL AFRICA.

By A. Yare Massey, R.A., M.D., C.M.(Tor.).
Medical Officer, !

On March 14th, 1906, а black, aged 18, employed
on the shed gold, carrying dirt in a bark basket,
appeared at the hospital complaining of pain in his
neck and shoulder. Examination revealed a slight
general swelling above the right clavicle, and a very
considerable swelling and cdema of the adjoining
shoulder extending almost to the elbow. There was
no abrasion of the skin. Temperature, 103° F. The
patient did not appear to be very ill, his main trouble
being that he could not use his right arm. During
the next two days cdema increased and extended to
the fingers which became very tense. The temperature
fell to 101° Е. 18th: The patient, instead of coming
for treatment, went hunting inushrooms for food, say-
ing he was all right. 19th: Proptosis of right eye
and swelling of right face. 20th: Convulsions general,
resembling epilepsy every couple of hours; breathing
heavy; temperature normal. 21st: Proptosis
marked in both eyes; left breast slightly swollen.
23nd: Unable to close the eyes completely; согпенэ
dry and anesthetic ; edema of arm and hand slightly

‘anganytka Concessions, Ltd.

August 15, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE.

251

reduced. Convulsions very frequent and always on
being disturbed. No evidence of disease in the lungs.
23rd: Death.

Autopsy. — Decomposition was rapid. Ѕегоцѕ
cavities contained small amounts of fluid. Marked
cedema of right arm, shoulder and neck. Spleen not
enlarged. Deep glands of the right side of the neck
much engorged.

Diagnosis.—The anthrax bacillus was not found in
the blood before death, after more or less careful
search. Fluid from the engorged cervical glands,
after death, showed numerous anthrax bacilli, and
mice inoculated with this fluid died in five days, their
blood showing innumerable bacilli of anthrax.

Treatment.— Symptomatic with good feeding,
stimulants and quinine. It is regretted that a supply

SES CT LEES]

саят mt
>»,

Photograph taken on March 21st, or eighth day of disease.

of Sclavo’s anti-anthrax serum,! which has been used
with such marked success in England and on the
Continent, was not available.

Conclusions.—This is the first case of anthrax that
I have diagnosed іп а six years' practice in Central
Africa. It is quite possible that some sudden deaths
of unknown cause among natives may have been due
to the Bacillus anthracis. That there should be marked
external cedema without the pustule seems to be con-
trary to the rule. Infection may have been through
the mucous membranes of the nasal foss:e, the mouth
or the pharynx, to the deep cervical glands.

А noticeable feature was that the patient never took
his illness seriously, and even when in a critical con-
dition did not appear to feel very ill.

1 Legge. Milroy Lectures.

British Medical Journal, March
18th, 1905. E қ

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THE

Journal of Tropical Medicine

Атаувт 15, 1906.

THE SIVEWRIGHT PRIZE.

THE prize given by Sir James Sivewright, K.C.M.G.,
M.A., LL.D., has been awarded to John D. Gimlette,
M.R.C.S., L.R.C.P., of the Malay Native States,
for his contribution entitled “Тһе Puru of the Malay
Peninsula," published in the JOURNAL oF TROPICAL
Мегісінк оп May 15th and June Ist, 1906.

THE BELILIOS PRIZE.

THE prize given by Raphael Belilios, Esq., has been
&warded to Joseph Herbert Ford, B.S., A.M., M.D.
(Captain, Assistant Surgeon, U.S. Army ; Professor of
Diseases of the Tropics in the Medical Department,
Columbian University, Washington, D.C.), for his con-
tribution entitled “Тһе Treatment of Dysentery," pub-
lished in the JounNAL or Tnorrcan Mepicine, July
15th, 1904, and to J. б. Berne, Captain, R.A.M.C., for
his contribution entitled “Тһе Treatment of Dysentery,"
published in the Joumwan or Ткоріса, MEDICINE,
August Ist, 1904.

THE ETIOLOGY OF BERI-BERI.

Тнк categorical reply of Dr. Hamilton Wright to
critics of his well-known theory as to the nature,
cause, course and termination of beri-beri, is interest-
ing reading. That it will carry conviction to un-
believers is another matter; but all will agree that his
formulated conceptions bear a scientific impress which
cannot be passed over slightingly or without careful
consideration. Drs. Hunter and Koch, of Hong Kong,
have given the matter their earnest attention, and
that they have approached the subject in a truly
Scientific spirit is abundantly apparent from the de-
tailed criticism of their published report which Dr.
Hamilton Wright has found it necessary to bestow
upon their work.

Hamilton Wright's contention is well set forth in
the article we publish to-day, and we refer our readers
to the opening paragraphs of his contribution for &
further enunciation of his views. Shortly, it may be
stafed, that according to Dr. Hamilton Wright beri-
beri is, in its origin, an acute infectious disease. It is
caused by a specific bacillus having its habitat in the
gastro-duodenal tract ; the bacillus induces a necrosis
of the mucosa of that part of the alimentary canal and
“a toxin is developed, and the syndrome, together
with the rapidly spreading acute poisoning of the
sensoro-motor and autonomic neurones, make up
acute beri-beri, or beri-beri proper." This is a clear,
definite and logical position, and only requires for its
establishment clinical and pathologic confirmation.
This confirmation Dr.“ Wright maintains that he -has
established, and his opinion is shared by not a few.

Drs. Hunter and Koch tested Dr. Hamilton Wright's
views on beri-beri by extensive pathological and bac-
teriological investigations, and their conclusions
are :— S

(1) There is no evidence that beri-beri is an acute
specific infectious disease. i

(2) No micro-organism, of the hitherto describe

forms, has been found in any organ or tissue of a`

beri-beri patient or cadaver which could be brought
into causal relationship with the disease.

(3) Experimentally it has been found impossible,
by any method, to call forth the disease in any animal.

(4) In our experience true beri-beri does not exist
in monkeys infected either naturally or experimentally.

(5) Beri-beri, as the result of our investigatiors,
would appear to be non-micro-organismal in nature.
We are inclined to bring some chemical poison into
causal relationship with the disease.

(6) Our results are in direct opposition to those
obtained by Dr. Hamilton Wright.

How the conclusions are answered and dealt with
by Dr. Hamilton Wright will be found in his article
published in the current issue.

That beri-beri is а serious malady in Hong Kong
there can be no doubt, for Dr. J. C. Thomson, who is
in charge of the Tung Wah Hospital, Hong Kong,
states that “ Beri-beri із a most deadly disease, and is
now (1905 report) alarmingly prevalent in the colony."

THE JOURNAL OF TROPICAL MEDICINE.

[August 15, 1906.

A STUDY оғ THE CAUSE оғ SUDDEN DEATH FOLLOW-
ING THE INJECTION OF Horse Serum. By Milton
J. Rosenau and John F. Anderson, Hygienic
Laboratory, United States Public Health and
Marine-Hospital Service.

In their introduction to this enquiry the authors
state that: “ It has long been known that the blood of
certain animals is poisonous when transfused or in-
jected into certain other species.

* Many instances might be cited showing that the
blood serum of one animal has poisonous properties
when injected into an animal of another species. But
the blood serum of the horse apparently lacks such
poisonous action. Very large quantities of the blood
serum of the horse may be injected into man, rabbits,
guinea pigs, and many other animals without serious
inconvenience, except occasionally a slight reaction at
the site of inoculation.

“Іпа certain proportion of cases the injection of
horse serum into man is followed by urticarial erup-
tions, joint pains, fever, swelling of the lymph nodes,
«edema, and albuminuria. This reaction, which ap-
pears after an incubation period of eight to thirteen
days, has been termed by Pirquet and Schick the
‘serum disease.’

“Тп exceptional instances sudden death has followed
an injection of horse serum in man.

** These studies were taken up in October, 1905, in
order to throw light upon the cause of this unfortunate
accident. We have shown that ordinarily horse
serum is a comparatively bland and harmless substance
when injected into certain animals ; but these animals
may be rendered so susceptible that an injection of
horse serum may produce sudden death or severe
symptoms. For example, large quantities of horse
serum may be injected subcutaneously or into the
peritoneal cavity of a guinea pig without apparently
causing the animal the least inconvenience. However,
if a guinea pig is injected with a small quantity, say
zio C.C., of horse serum and after the expiration of a
certain interval is again injected with the horse serum
the result will probably be fatal. Тһе first injection
of horse serum has sensitised the animal in such &
way as to render it very susceptible to a toxic principle
in horse serum. It is probable that when the guinea
pig is injected with the first, or sensitising, quantity
of serum the strange proteid contained in the horse
serum develops in the body of the guinea pig ‘anti-
bodies' which, when brought into contact with more
horse serum given аб а second injection, produce
either a union or a reaction, which causes the toxic
action.

“ A certain time is necessary to elapse between the
first and second injections of horse serum before this
toxic action is able to manifest itself. This ‘period
of incubation’ is from ten to twelve days, and corres-
ponds suggestively with the period of incubation of the
serum disease which Pirquet and Schick place at eight
to thirteen days.

“ Guinea pigs may be sensitised with exceedingly
small quantities of horse serum. In most of our work
we used quantities less than 415 cc. and we found in
one instance that r,553,555 cc. of horse serum was
sufficient to render a guinea pig susceptible.

“ It also requires very small quantities of horse

August 15, 1906.)

serum, when given іп a second injection, to produce
poisonous symptoms. One-tenth с.с. injected into the
peritoneal cavity is suflicient to cause the death of a
half-grown guinea pig. One-tenth с.с. of horse serum
injected subcutaneously is sufficient to produce serious
symptoms. The fact that this toxic action may һе
developed by such sinall quantities of serum, and the
fact that exceedingly small quantities are suflicient to
produce symptoms and death upon a second injection,
а priori places both the sensitising and the toxic
principle in the horse serum in the * haptin group ` of
substances in the sense used by Ehrlich.

“ A still further indication that the side-chain theory
in its broadest sense may be applicable is the further
fact that immunity may be produced against the toxic
action by multiple injections of the serum.

‘While at first we thought that diphtheria anti-
toxin had some relation to this action, we are now
able to state positively that it has nothing whatever to
do with the poisonous action of horse serum ; further,
that diphtheria antitoxin in itself is absolutely harm-
less. The toxic action which we have studied is
caused by a principle in normal horse serum and is
entirely independent of the antitoxic properties of the
serum."

——— 9 —————
LONDON SCHOOL OF TROPICAL MEDICINE.

CoroxEL KENNETH Macrkop, I.M.S., M.D., LL.D.,
Hon. Physician to the King, will deliver the address
at the opening of the Winter Session of the London
School of Tropical Medicine, on October 8th. His
Grace the Duke of Marlborough, the President of the
Seamen’s Hospital Society, with which the School of
Tropical Medicine is affiliated, will take the chair on
the occasion.

His Grace has also consented to preside at the
annual dinner of the staff and students on the evening
of the day of the address.

21sr Srss1on—JuLy, 1906.— Examination Result.

Capt. І. P. Stephen, І.М.8., M.B., Ch.B. (Aberd.),
D.P.H.(Lond). With distinction.

І. A. Prins, І.М. & 8. (Ceylon), L.R.C.P. & 8.
(Edin.), (Colonial Service). With distinction.

Capt. А. W. Cook Young, I.M.S. M.B., Ch.B.,
D.P.H, (Aberd.). With distinction.

Major E. Wilkinson, F.R.C.S. (Eng), L.R.C.P.,
D.P.H. (Camb.). With distinction.

W. 8. Allan, M.B., Ch.B. (Glas.).

В.Т. Booth, M.B., B.Ch. (R.U.I.)

I. McW. Bourke, M.R.C.S., L.R.C.P. (Colonial Ser-
vice).

John Cross, M.B., Ch.B. (Glas.) (Colonial Service).

В. M. Flood, L.R.C.P. & S. (Edin.) (Colonial Service).

E. N. Graham, L.R.C.P., F.R.C.S. (Edin.)

E. M. Nicholl, M.B., C.M. (Edin.)

J. Ottley, L.R.C.P. & S. (Edin.) (Staff-Surgeon В.М.
retired).

E. C. Peake, M.B., Ch.B. (Edin.)?

E. Robledo, M.D. (Columbia, S. America).

Miss L. G. Thacker, M.B., B.S. (Lond.)

Capt. L. L. G. Thorpe, R.A.M.C., L.S.A.

A. B. Tighe, M.B., B.Ch. (Dublin).

W. M. Wade, M.B., B.Ch. (Dublin).

Miss K. Wyss, M.D. (Zurich).

THE JOURNAL OF TROPICAL MEDICINE.

953

Abstract.

Human Trypanosomiasis. Ву Dr. Ayres Kopke,
Professor at the Lisbon School of Tropical Medi-
cine. Paper read before the Fifteenth Inter-
national Medical Congress, Lisbon, April, 1906.

Professor Ayres Kopke here states the results of
his researches as to the relative value of trypanosomes
and of micro-organisms as causes of the symptoms
and histo-pathological lesions peculiar to sleeping
sickness.

He first continued the verification of the constant
presence of trypanosomes in all cases of sleeping-
sickness, and the identity of the trypanosomes, which
cause the Gambia fever and sleeping sickness, and
then endeavoured to. ascertain whether the former
disease was merely the first phase of the latter, and
whether the appearance of the severe nervous
symptoms was due only to the protozoon, or if the
later infection by diplo-streptococci, aided by the
first-named parasite, was really the determining cause
of the final phase of the disease. Lastly, as the most
important desideratum in so fatal a disease would be
that of discovering a substance which would act on
the Trypanosoma qambtense precisely as quinine acts

.on the malarial parasite, it was necessary to make

therapeutic experiments on animals previously іп-
fected, on the lines of research adopted by Ehrlich,
Shiga, Laveran and Wolferstan Thomas. The total-
number of cases observed by Kopke amounted to
56, of which 3 were not diagnosed as sleeping
sickness. Of the 53 cases, trypanosomes were present
in all of them; 40 were punctured in the lumbar
region, and all showed trypanosomes in their cerebro-
spinal fluid; 38 were clinically studied up to the
time of death, and 36 were examined post mortem,
and in all of these latter cases sections of the nervous
centres showed leucocytic infiltrations round the
vessels. Bacteriological researches were also made
during life and after death; the cultivating media
included bouillon and ascitic fluid, Kiefer's medium,
Martin’s bouillon, Martin’s gelatine and simple
gelatine.

During life only one case (and that only shortly
before death) showed diplo-streptococci. After death,
these streptococci were searched for in the sub-
arachnoid exudation of the brain, the fluid in the
ventricles, the heart’s blood, and sometimes in the
fluid obtained by lumbar puncture ; they were found
in 51:4 per cent. of the cases.

'As regards treatment, up to the end of May, 1905,
the patients were given cacodylate of soda, adrenalin,
iodine and collargol, but without any favourable
result. After this date, he prescribed trypanroth,
alone or in combination with arsenite of soda or with
atoxyl. Latterly he restricted himself to the use of
the last-named method, as suggested by Thomas.
Under this treatment, those patients who were not
in an advanced stage of the disease showed great
improvement (cessation of fever, less somnolence,
increased muscular energy, more active nutrition),
and the trypanosomes disappeared from the peri-
pheral -blood and from the ganglionic juice, although
they were still present in the cerebro-spinal fluid.

The following are the conclusions arrived at :—

(1) In all the cases diagnosed as sleeping sickness
the T. gambiense was invariably found.

(2) In the 40 cases on which lumbar puncture was
performed, an examination of the cerebro-spinal fluid
invariably revealed trypanosomes.

(3) In some cases, although the patients had try-
panosomes in their cerebro-spinal fluid, marked ner-
vous symptoms were not present.

(4) The search for diplo-streptococci during life,
with one solitary exception, was negative, but after
death 51 per cent. of the cases showed positive results
in the blood and spinal fluid.

(5) None of the animals injected with the cerebro-
spinal fluid showed the perivascular infiltrations in
the nervous centres which are so constantly found in
those patients who die from sleeping sickness.

(6) Ав regards the atoxyl treatment, a weekly hypo-
dermic injection of 10 to 15 cc. of a 1 in 10 solution,
constantly repeated for several months, showed a
considerable improvement in the condition of the
patients, but it is doubtful whether a cure can be
obtained by this means alone. The number of try-
panosomes is diminished in the blood and ganglionic
juice, and the inoculation of animals may give a
negative result ; but trypanosomes still persist in the
cerebro-spinal fluid, probably owing to the imperme-
ability of the meninges to drugs, for which reason—

(7) Medicines—to be efficacious—should be simul-
taneously administered by hypodermic injection and
by injection into the subarachnoid space immediately
after lumbar puncture. Experiments are now being
made with a 1 per cent. solution of lysol. J. E.N.

———— S39 ———

301005.

ILLUSTRATIONS OF BRITISH BLOOD-SUCKING FLIES, WITH
Notes. By Ernest Edward Austen, Assistant,
Department of Zoology, British Museum (N.H.),
1906. Pp. 74, with 34 coloured plates. Printed
by order of the Trustees of the British Museum,
London, 1906. Price 25s.

This volume, which is obtainable at the British
Museum (Natural History), Cromwell Road, London,
S.W., and at several booksellers’, is one of which the
Museum authorities may be justly proud. The illus-
trations by Mr. A. J. Engel Terzi are excellent. It is
impossible to speak too highly of Mr. Terzi’s beautiful
drawings. Scientifically correct in drawing, in pro-
portion and in colour, the illustrations have been deline-
ated with Mr. Terzi's usual care and exceptional skill,
and a higher guarantee of their accuracy and complete-
певв cannot been given. The text by Mr. E. E. Austen
is written in an attractive manner and may be under-
stood by one unskilled in the technicalities of biological
nomenclature. The information collated in the volume
is wonderfully wide, considering the few, the very few,
people who do anything practically to advance this
subject. To Lieut..Col. J. W. Yerbury the Museum
and Science generally is indebted for the devotion һе
has shown to advancing our knowledge of the Diptera,
but we want many scores of persons imbued with
Lieut.-Col. Yerbury's enthusiam before we can be said

THE JOURNAL OF TROPICAL MEDICINE.

[August 15, 1906.

to have in any way perfected our knowledge of the
Subject. The volume before us should stimulate many
men and women to take an intelligent interest in а
subject which is aiding the medical profession to trace
the origin, or at least the mode of transmission, of
several of our most common ailments.

———dpe————

Correspondence.

THE TREATMENT OF “MALARIA ULCERS” BY
LOCAL APPLICATIONS OF QUININE.
To the Editors of the JovgNAL оғ TropicaAL MEDICINE.

Strs,—Replying to the enquiry of “ W. D. G.” in the
Journat for April 2nd, 1906, as to the method of applying
quinine to the so-called * Malaria Ulcers,” I may say that
the main object seems to be accomplished when the alkaloid
(soluble or in solution) is brought into contact with the
cleaned surface of the ulcer. Any soluble salt of quinine
may be used, either dissolved in water and applied by means
of a pledget of cotton wool, or dusted dry on the surface of
the sore. The latter seems to be the most satisfactory pro-
cedure, for then the quinine dissolves slowly, and its effect
is more prolonged. Ап important matter is to get the sore
clean before applying the quinine, as the effect is otherwise
"nil. Salicylic acid is often useful in this preliminary
cleaning up. Quinine should also be administered internally
during the treatment of the sores.

A majority of our local “ Malaria Ulcers " (which, by the
way, have not been proven to hold any stiological relation
to malaria) will heal rapidly under treatment similar to that
here described.

I remain, Sirs,
Yours, &e.,

Benguella, W. Africa, CREIGHTON WELLMAN.

June 2th, 1906.

-------ө----

Өуішату,

LIEUTENANT FORBES TULLOCG, R.A.M.C.

Tue rapid termination of the trypanosomiasis infec-
tion in the lamentable case of this most promising
young officer and investigator will come as an
additional shock to all interested in tropical medicine.
The duration of such cases is usually much more pro-
tracted, and though no cases of recovery can be
recalled, it cannot be denied that recent therapeutic
experiments on animals have been so promising that
one felt entitled to retain some hope as long as life
remained.

The case is a poignant illustration of the dangers
that beset the investigation of diseases in general
and of tropical diseases in particular, especially as it
chances that only good fortune has saved another
member of the Commission from а like fate. One of
them, in faot, accidentally pricked himself with a
capillary tube full of trypanosomes, but fortunately
none of the latter can have entcred the wound, as the
entry of even a single parasite would presumably
suffice to infect. While at Entebbe, Lieutenant Forbes
Tulloch contributed to the Transactions of the Royal
Society a valuable paper on “Тһе Anatomy of
Stomoxys,” which would alone suffice to demonstrate
his qualifications as a skilled investigator. The tragedy

August 15, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE.

255

of his death is, moreover, enhanced by the fact that
the deceased officer married just before proceeding to
Uganda, and hence leaves a young widow to mourn
his loss. Lieutenant Forbes Tulloch received his
medical education at St. Mary's Hospital, Paddington,
and we cannot do better than close our notice by
extracting from the pages of the Hospital Gazette the
subjoined notice from the pen of a personal friend :—

“ It is with deep regret that we note the sad death
of Lieutenant Forbes Tulloch. Не qualified in 1901
and went to South Africa as a Civil Surgeon, and іп
1903 he obtained a commission in the Royal Army
Medical Corps. Last year he went to Uganda as a
member of the Commission for th» investigation of
Sleeping Sickness, and about four months ago he
contracted this disease by wounding his hand with
an infected knife. He was invalided home and was
treated in the Queen Alexandra Military Hospital at
Millbank, but the disease ran an unusually rapid
coürse and he died on June 20th, at the early age of
twenty-seven.

* We who remember him during his student days
recall his good nature, his generosity and the geniality
of his bearing, his character being such as made him
ever one of the most popular of men amongst us. We
remember, too, the enthusiastic way іп which hé worked
at апу subject, in which he was[interested, such as
micro-photography, to which he devoted much time
and with conspicuous success.

“Та a peculiarly sad and tragic way his Ше was cut
short and his name added to the long and honourable
list of those of our profession who have met their death
at their noble calling. In him science loses a devoted
servant, lost in her own service, and St. Mary's honours
him for his life and for his death.”

MAJOR Н. W. ELPHICK, M.B., І.М.8.

WE regret to have to record the death of Major
H. W. Elphick, of the Indian Medical Service, at the
comparatively early age of forty-one.

Major Elphick entered the service on September
30th, 1898, and arrived in India the following spring.
From the first he withstood with difficulty the trying
climate of the Plains of India, and he would have prob-
ably been better advised had he decided to abandon
the attempt to cope with it.

His liking for India and his keen interest in the
work, however, led to his disregarding repeated
warnings, and struggling on where many men would
have given in, it cannot be doubted that he has
fallen a victim to the power of a will stronger than
his frame. wa

Most of his service was passed in the Civil Depart-
ment in the United Provinces, where he was well known
and greatly liked, and his death will be deeply
regretted by a large circle of friends.

For several years he was Civil Surgeon of Dehra
Doon, the cooler climate of which, it was hoped, would
enable him to continue his service. Unfortunately,
this district is close to that powder magazine of Indian
epidemics, the town of Hurdwar with its pa odon
religious fairs, so that the services of the Civil Surgeon
of Dehra are often put into requisition during times

of danger. During the desperate efforts of the authori-
ties to guard Hurdwar from tbe spread of plague by
wholesale disinfection, a riot took place in which
Major Elphick was brutally assaulted. Though not
absolutely dangerous, his injuries were so grave as to
have a most serious effect on the health of a man
never strong at the best of times, and there can be
no doubt that the final break up of his health was due
to the injuries he received. He had to take sick
leave, and failing to recover, was База on temporary
half-pay on March 6th, 1905, and died at Rugby, on
May 20th, 1906. His death will be felt as a per-
sonal loss by all his old colleagues in the United
Provinces, for he was a man of charming рег-
sonality, who never made an enemy.

THE REV. RODERICK JOHN JOHNSTONE
MACDONALD, М.р.Ерм.

Tar Rev. Roderick John Johnstone Macdonald,
M.D.Edin., of the Wesleyan Methodist Missionary
Society, was killed in China by pirates on the West
River of the Kwangtung Province. The boat on which
he was travelling was attacked by river pirates; the
captain was shot, and Dr. Macdonald, who was a
passenger by the boat, went to his assistance: whilst
attending to the captain’s wounds, Dr. Macdonald was
himself fatally wounded.

After graduating at Edinburgh, M.B., C.M., in 1881,
and M.D. in 1884, Dr. Macdonald went to China as a
missionary, and was stationed at Wuchow, in the
Kwangsi Province. The hospital under his charge
not only increased in size by his indefatigable exer-
tions, but through his tact, skill, and untiring devo-
tion attained to widespread repute throughout the
southern provinces of China. In addition to his
hospital work, Dr. Macdonald officiated at Wuchow
as medical officer to the Imperial Chinese Maritime
Customs and as surgeon to the British Consulate
and gaol. A medical missionary of Dr. Macdonald’s
stamp isa valuable national asset, and his loss under
so tragic circumstances brings home to us the risks
that missionaries run, not only from disease in un-
healthy parts of the world, but from the turbulent
spirits that are ever ready to raise their hand against
them from one cause or anothor. The sympathy for
his widow and two young sons is sincere and wide-
spread.

—e

Hotes and "Retos.

Tue Turkish Government contemplates building a
hospital of 300 beds at Mecca. A dispensary already
exists at Mecca, and it is intended to increase its
scope of usefulness, and stipply drugs gratuitously.
Amongst other schemes for the benefit of the city and
its pilgrims, an improved water supply is proposed.

------.--

Avonast the Turks, in both Europe and Asia,
spring blood-letting is extensively practised.

956

C. T. Grayson, U.S.A., has brought out a mosquito
net for use in hammocks, termed the Grayson-Graeme
hammock mosquito net.

Tiere are 120 male and 180 female medical

missionaries in India.

Tre cocaine habit is growing to an alarming extent
amongst both Hindus and Mahomedans in Delhi.
Amongst all classes of the community, rich and poor,
men and women, adults and children, the habit is said
to be prevalent.

IuniaN МЕГІСАТ, SEnvicE.—The following were the
successful candidates at the examination for admis-
sion to the Indian Medical Service held on July 24th,
and four following days :—

.J. Taylor, M.B.; A. D. Stewart, M.B.; C. H. Cross;
В.А. Chambers, M.B.; R. H. Bott, F.R.C.S.; N. N.
G. С. McVean, M.B.; J. Morison, M.B.; S. G. 8.
Haughton, M.B.; Е. W. Cragg, M.B. ; N. S. Simpson ;
S. Singh; В.Е. Hebbert, M.B.; J. F. James, М.В.;
J. Smalley, M.B. ; A. S. Leslie, М.В.; C. M. Roberts,
М.В.; А. P. G. Lorimer, М.В.; W. M. Thomson,
M.B.; H. B. Scott; and F. C. Fraser, M.D.

SunGEON-GENERAL GUBBINS is gazetted P.M.O.
in India, vice Sir Thomas Gallwey, K.C.M.G., C.D.,
appointed P.M.O., Aldershot.

Lapy Miwro's Fund for the Indian Nursing Asso-
ciation now amounts to Rs.25,000.

A TELEGRAM published elsewhere announces certain
changes in the organisation of the Indian Medical
Service. Since 1896 officers appointed to the Service
have been allotted to the military area, though borne
on one general list, and while liable in emergency to
serve anywhere, are ordinarily employed in the areas
to which they happen to һе posted. In future the
territorial allotment will be abolished, the three
Presidency and General Lists of officers being
amalgamated, but officials already in the Service
will, as far as possible, be employed in the areas
for which they are eligible under existing con-
ditions. Future recruits to the Service will be
liable to military employment in any part of India,
but for civil employment they will be allowed, accord-
ing to their position in the examination lists, to elect
for service in certain specified areas, though in
emergency they will be liable for service anywhere.
— Pioneer Mail, July 20th, 1906.

INocerATION ім RANGOON.— Since the issue of the
circular last week by the Rangoon Municipality
plague inoculation is being accepted here, over seven
hundred persons having already submitted themselves
to the operation.— Rangoon, July 12th.

THE JOURNAL OF TROPICAL MEDICINE.

[August 15, 1906.

AN account is given in the Indian Pioneer of what
promises to be an important discovery in connection
with plague prevention. This is the fact that the
crude oil left after the distillation of petroleum is a
most valuable insecticide. Hitherto, the rat flea,
now believed to be the ordinary channel of infec-
tion with plague bacillus, has defied the usual dis-
infectants, but according to Dr. Turner's report to
the Bombay Corporation it succumbs at once to
treatment with crude oil. Should Dr. Turner's results
he borne out by further trials really effective dis-
infection of houses where plague has occurred will
become possible.

Nursina ім IND1A. — The Up-country Nursing
Association is to be absorbed in the Indian Nursing
Association, which is being organised to provide
skilled nurses throughout Northern India by the
Countess of Mayo, wife of the Viceroy. The scope
of the amalgamated Association will furnish nurses
for the United Provinces, the Punjab, Rajputana,
the North West Frontier Province, Baluchistan,
Central India, Eastern Bengal, Assam and Burma,

Тик annual dinner of the Indian Medical Service
was held on June 29th in the United Service Club,
Surgeon-General Bomford presiding. There were also
present: Colonel Bate; Lieut.-Colonels Bamber,
Leslie and Dawson ; Majors Macnamara, Gee, Macnab,
Browning Smith, Seton, Heard, Birdwood, and
Sutherland; Captains Cochrane, Ainsworth, Corn-
wall, Baird, Greig, Barron, Trafford, H. Ross, J. H.
Murray, Harvey and MacGilchrist, and Lieutenant
Proctor.

AN accusation of adulteration has been brought by
the Hyderabad Government against its opium con-
tractors, which is creating great local interest. Gum,
black sand, and the husks of sangizira are, it is stated,
used to increase the bulk and weight of the opium as
retailed. The case has been adjourned to admit of
expert analysis of the opium seized in Madras.

Tne Chief Court of Rangoon has been transferred to
another building for a week, on account of dead rats,
which were found to be infected with plague, being
discovered in the record rooms.

Hyprornonia IN AssaM.—Recently, there have been
several cases of hydrophobia in Assam from dog and
jackal bites. The Indian Tea Association of that
province have accordingly asked the local Govern-
ment to issue orders for the prompt destruction of
mangy aud ownerless dogs, and to consider whether
the imposition of a dog tax would not help to rid the
bazaars and bustis, which are now swarming with
useless and dangerous animals. — Pioneer Mail,
June 29th, 1906.

August 15, 1906.)

Mataria.—A. Woldert, of Tyler, Texas, U.S.A.,
found, except in one instance, anopheles quadri-
maculata in the houses in which autochthonous
cases of malarial fever prevailed in Philadelphia and
Texas. In cold, frosty weather the male anopheles
increased in numbers, but the females gradually
disappeared.

—_—
Geographical Distribution of Disense.

As information arrives we publish, under this heading, the
principal diseases met with in tropical and sub-tropical
countries, so that those interested in the Geographical Dis-
tribution of disease may have a means of gathering informa-
tion concerning the prevalent ailments in different parts of
the world.

Cholera. —The outbreak of cholera in the Philippines
is subsiding. The use of the vaccine prepared at the
Government laboratory is giving excellent results.

Malaria.—The U.S. cruiser Columbia had 165 out
of 300 marines on board infected by malaria contracted
at Panama when she sailed recently for Boston via
Porto Rico.

PLAGUE.

PREVALENCE OF THE DISEASE.

Cases. Deaths.
May 12th 13,207 11,414
19th 13,061 11,783

India.— Week ended

” »

ys » 26th 8,684 7,660
К June 2nd 7,888 17,094
» » 9th 3,597 3,446
э; » 16th — 1,904
55 » 23rd — 952
5 » 30th — 769
- July 7th — 536
Hong Kong.— Week ended June 2nd T3 72

9th 51 48
16th o7 45

» 3

” ”

x , 93га 34 31
E » 30th 21 18
А July 7th 12 7
5 „ 14th 14 17
И ,, 91st 7 5
5 , 98th 5 6

Persta.—Plague continues in epidemic form in the
Seistan District. The trade by the Nuski route with
Eastern Persia is seriously threatened, owing to the
prevalence of plague.

Australia.—In Brisbane up to June 16th the fresh
cases of plague during the present outbreak, which
commenced on March 10th, 1906, numbered 7, and the
deaths from the disease 3. Іп Rockhampton, after
ап absence of six years, plague appeared on April 2nd,
1906; since then and up to July 7th, 1906, the fresh
cases of the plague numbered 11.

Mauritius.—One case of plague reported during the
week ended July 14th; the patient died. During the
week ended July 26th 1 case of plague reported; the

tient died. Since March 24th, 1906, Mauritius

ad been free from plague.

THE JOURNAL OF TROPICAL MEDICINE.

257

Personal Hotes.

INDIAN MEDICAL SERVICES.

India Office : Arrivals of Indian Medical Officers in London.
—Lieutenant-Colonel A. W. Alcock, C.L.E.; Major W. J.
Buchanan.

Extensions of Leave.—Captain S. H. L. Abbott, Lieutenant-
Colonel O. H. Channer, 6 m., Med. Cert. ; Captain Е. 5. Parker,
6 m., Med. Cert. ; Captain А. T. Pridham, 1 m., Med. Cert. ;
Lieutenaut-Colonel J. Sykes, 8 d. furlough ; Major Т. W. Irvine,
study leave, 1 m. ; Major R. H. Castor, study leave, 6 w. ; Major
S. Н. Henderson, study leave, 24 m.; Major G. Е. М. Ewens,
from April 24th to Juue 30th, 1906 ; Captain F. A. Smith, study
leave, February 15th to July 15th, 1906 ; Captain W. J. Wellock,
study leave, March 1st to May 3156, 1906.

Permitted о Return to Duty. — Captain E. L. Perry, Captain
W. Lapsley, Captain А. W. С. Young, Lieutenant-Colonel J. R.
Adie, Lieutenant-Colonel J. Sykes, Lieutenant-Colonel J. J.
Pratt, Colonel J. McCloghry.

Leave.

Honorary Captain M. Murphy, I.S.M., Civil Surgeon, Parlab-
garh, privilege leave, 2 m.

Postings.

Captain T. G. N. Stokes, on special duty, Pachmarhi, to
officiate as Civil Surgeon, Belaspur.

Captain J. G. P. Murray, to be 2nd Surgeon, Presidency
General Hospital. І

Lieutenant J. Catto, 16th Rajputs, to hold additional Civil
Medical Charge of the Manipur State.

Colonel Wilkins, Р.М.О., Burmah, is transferred in same
capacity to Secunderabad,

List oF I.M.S. OFFICERS IN CIVIL EMPLOY AT PRESENT
ON FURLOUGH.

Adie, Lieutenant-Colonel J. R., I. M.8., P. Med., 6 m., April
27th, 1906.

Alcock, Lieutenant Colonel A. W., C.LE., І.М.8., India
Misc., 12 m., August 20th, 1906.

Anderson, Captain Б., I.M.S., В. Med., to September 25th,
1906.

Anderson, Lieutenant-Colonel A. V., I.M.8., Во. Med., 26 m.
3 d., September 10th, 1904.

Baker, Lieutenant-Colonel R. J., І.М.б., Bo. Med., 6 m.,
August 16th, 1906.

Barry, Major T. D. C., І.М.8., Bo. Med., 21 m. 5 d., Septem-
ber 4th, 1906.

Braide, Major С. W. F., I.M.S., P. Goals, 4 m. 1 d., July 3rd,
1906.
Browne, Captain Е. D., M.B., I. M.S., C.P. Goals, 8 m. 9 d.,
May 6th, 1906.

Browning, Lieutenant-Colonel W. B., I.M.S., М, Мей., 4 m.
16 d., June 25th, 1906.

Castor, Major R. H., I.M.S., Burma Med., 12 m., May 9th,
1906.

Channer, Lieutenant-Colonel О. H., І.М.8., Bo. Med., 3 m.

6 w. 14 d., July 1st, 1906.

Charles, Lieutenant-Colonel R. H., I.M.S., B. Med., 11 m.
16 d.
Chaytor- White, Major J., I. M.8., U.P. Med., 8 m., June 80th,
1906.
Clarkson, Major Е. C., I. M.8., B. Comm., 17 m., June 16th,
1905.

Coates, Lieutenant-Colonel W., I. M.S., P. Med., 5 m. 18 d.,
May 3rd, 1906.

Collie, Lieutenant-Colonel M. A. T., I. M.S., Bo. Med., 3 m.
8 d., August 31st, 1906.

Dalzicl, Captain R. M., І.М.8., B. Goals, 6 m., May 12th,
1906.
Deas, Captain L. J. M., I.M.S., B. Med., 4 m.

Delany, Captain T. H., I. M.S., B. Med., 23 m. 9 d., April 9th,
1905

Donovan, Major C., I. M.S., M. Med., 12 m., March 8th, 1906.

Drake-Brockman, Major Н. E., LM.S., B. Med., 18 m.,
Мау 5th, 1905.

Duer, Major C., I. M.S., B. Med., 18 m., May 12, 1905.

Evans, Captain S., I.M.S., Bo. Med., 11 m. 5 d., March 19th,
1906.

ТНЕ JOURNAL OF TROPIC: AL MEDICINE.

[August 15, 1906.

Fayer, Captain F. D. S., I.M.S., M. Medl., 15
1906.

Fenton, Captain A., M.B., I.M.S., В.
29th, 1906.

Ffrench-Mullen,
August 26th, 1906.

Fullerton, Major T. W. A.
February 18th, 1906.

Gibbons, Lieutenant Colonel J. B.,
May 17th, 1906.

Gibson, Dr. Е. M.,
August 26th, 1906.

Green, Major C. R. M.,
1906.

Grein, Major C. К. M., 1.M.S., B. Med., 21 m., May 10th,
1906.

Haffkine, W. M
1904.

Henderson, Major S. Н.,
January 18th, 1906.

Hugo, Captain Н.,1.М.8., D.S
1906.

Irvine, Major T. W., 1.M.S., 13} m., September 29th, 1905.

James, Captain S. P, M.B., І.М.8., 9 m., February 22nd,
1906.

Jameson, Major J. B., I.M.S., Bo. Medl.,
15th, 1906.

Kemp, Captain D. C.,
20th, 1905.

m., March 3rd,

Goals, 15 m., August

Lieutenant-Colonel J., В. Мей, 21 m.,

ІМ.5., U. P. Мей, 12 m,

LM.S., В. Med., 17 m.

Во. Med., uncovenanted service, 21 m.,

I.M.S., B. Med., 21 m., May 10th,

a C.LE.. Bo. Mise., uncov., 27 m., July 30th,

I.M.S., U. P. Goals, 9 m. 14 d.,

5.0., B. Med., 9 m., March 6th,

21 m., September

І.М.5., M. Med., 12 m., September

Kenrick, Captain W. H., I.M.S., B. Medl., 10 m. 7 d., May
8th, 1906.

Kilkelly, Major P. P., I.M.S., B. Med., 10 m., May 25th,
1906.

Lamont, Major J. C., I.M.S,, P. Mod., 15 m. 11 d., April Ist,
1906.

Leventon, Captain A., I. M.S., B. Medl.,

1906.

Lincoln, Captain C. Н, S., I. M.S., Bo. Med.

Lindsay, Captain V. In. H., 1.M.S., В. Med.,
ber 80th, 1905.

Lloyd, Captain R. E., I.M.S., Indian Marine Survey.

Lumsden, Major J, S. S, M.B., F.ILC.S., LM.S., U. P.
Med., 11 m. 26 d., January 6th, 1906.

Lumsden, Major J. P., I.M.S., B. Med., 14 m. 13 d., Septem-
ber 10th, 1905.

Maddox, Major R. H., B. Med., 15 m. 15 d., July Ist, 1906.

Maitland, Lieutenant-Colonel I., I.M.S., M. Med., 18 m.,
March 30th, 1905.

Melville, Major Н. B., 1.M.S., U. P. Med., 20 m.,
1906

18 m. 2 d., June 9th,

12 m., Decem-

March ist,

Miller, Captain A.,
1905.

Milne, Lieutenant-Colonel A.,
July 28th, 1906.

Monk, Lieutenant-Colonel C., 1.M.S., Bo. Med.

Morwood, Major J., I.M.S., U. P. Med., 20 m. 7 d., April 7th,
1905.

Niblock, Captain W. J., I.M.S., M. Med.,

I.M.S., M. Med., 15 m., September 11th,

I.M.S., Bo. Mint., 4 m.,

12 m., March 1st,

1906.

Nott, Major А. H., I.M.S., B. Med., 14 m., August 18th,
1906.

Orr, Major W. Н.,1.М.8., U. P. Med., 15 m. 4 d., December
3rd, 1905.

Pank, Lieutcnant-Colonel P. D., I.M.8., B. Med., 5 m. 13 4.,
May 25th, 1906.

Perry, Captain E. L., 1.М.8., P. Med., 18 m., August 15th,
1905.

Pilgrim, Major H. W.,
1906.

Powell, Captain A., 1.M.S., Bo.

Poynder, Lieuteuant-Coionel J. L., I.M.S., B. Med.,
July 18th, 1906.

Prain, Lievtenant-Colonel D., 1.М.6.,
1905.

Pratt, Lieutenant-Colonel J. J., I.M.S., U. P.
12 d., July 14th, 1906.

Rainier, Captain N. R. J., LM.S.,
November 19th, 1905.

Rait, Captain T. W. F., I.M.S., B. Med., 19 m., March 21st,
1906.

I.M.S., В. Med., 6 m. 1 d., June 15th,

3m.9d.,
19 m., February Ist,
Med., 3 m.

C. P. Med., 11 m. 23 d.,

Rundle, Licutenant-Colonel C. S., 1.M.8., Burma Med., 21 m.
7 d., July 25th, 1905.

Scotland, Major D. W., LALS., U.
1905.

Shore, Lieutenant-Colonel R., M.D.,

February Ist, 1906.

P. Med., 21 m., June 26th,

I.M.S., B. Med., 15 m.,

Smith, Captain F. А,1.М.6., B. Med., 15 m., February 15th,
th, Major б. Mel. C., I.M.S., P. Mca., 16 m., June 29th,
"init, Major Н. A, LMS., U. P. Med. , 15 m. 4 d., July 23rd,
ith, Major J. B., 1.М.8., Bo. Med., 15 m., August 5th,
ee Major A., I.M.S., Bo. Med , 9 m., January 15th, 1906.

Sutherland, Major W. D., I.M.s., C. P. Мей,
15th, 1906.

Swaine, Licutenant-Colonel C. I, C. P. Med.,
January 17th, 1900.

Sykes, Lieutenant.Colonel J., IL. М.5., U.
June 21st, 1906.

Symons, Captain T. H., I.M.5., M. Med., 14 m. 22 d., August
21st, 1905.

Turner, Major R. G., I. M.S., U. P. Med.,
1906.

Wilkinson, Major E., І.М.б., P. Comm., 21 m., July 5th,
1905.

Wilson, Captain R. P., І.М.6., B. Med., 5 m. 19 d., July 2nd,
1906.

Wood, Major Н. S.,
1905.

Young, Major W., I.M.S,, U. P.
19th, 1906.

15 m., August
18 m. 6 d.,
P. Med., 3 m. 14 d.,

9 m., June 27th,

1.M.S., B. Med., 21 m., March 20th,

Med., 21 m. 21 d., January

ЕРТЕ
NOTICE,

Henry D. МсОСилосн, M.B., C.M., late Chief
Medical Officer Hyderbad State Railways Hospitals,
Deccan, after serving twenty-one years in India,
qualified further at the Liverpool School of Tropical

Medicine, and has during the last two years settled in
practice at ** Bassendeau," Bournemouth, England.

—— ——— --

есем and Current Literature,

А tabulated list of recent publications and articles bearing on
tropical diseases is given below. То readers interested in
any branch of tropical literature mentioned in these lists
the Editors of the JovnNAL oF TRoPIcAL MEDICINE will be
pleased, when possible, to send, on application, the medical
journals in which the articles appear.

“Journ. Amer. Med. Assoc.” January 2, 1906.
TaPE-WORM TREATMENT.

Ritter, John, in an article entitled “ Some Parasites In-
festing the Human Intestine.” states that it is not necessary
to fast before and after the administration of a taniafuge for
tapeworm. He advises а calomel and coloeynth capsule or
pill with cascara and jalap added after dinner, and on the
following morning, when the bowels have been well emptied,
the following emulsion :—

К. Resine podophyllini T БРА el gri
Oleoresini filicis maris 2 es Diss
Extracti tluidi Кала... sie vee Oil
Spiritus chloroformi зі
Mucilago aeacite — ... e) Si
Aqua menthe piperitie m s. ad. iii

M. Ft. emulsio. Sig.:
tervals of half an hour.

The same drugs may be given in capsules, the extract of
kumala being evaporated previously to the consistence of
syrup, and the oleoresin of male fern being udded slightly
warm.

Take in three equal ‘doses at in-

August 15, 1906.)

THE JOURNAL OF TROPICAL MEDICINE.

“Therapie der Gegenwurt,” Berlin, vol. xlvi., No. 12.
COOKED STARCH IN DIABRHOGA.

Hauffe, G., recommends cooked starch sipped in teaspoon-
fuls from tine to time іп diarrhea of any kind. Не finds it
especially beneficial in the tubercular variety. As a gargle
in sore throat it is particularly soothing.

“ Hygien Rundschau,” T. xvi., p. 405.
CULTURE MEDIA ror CHOLERA VIBRIOS.

Doebert and Johannissian tested the ећеіепсу of Hirsch-
bruch and Schwer's medium, which is composed of gelose
and Liebig’s extract, to which is added some crystals of
violet and heliotrope with the view of distinguishing choleraic
from В. coli colonies; but find that the growth is greatly
retarded. In both the above medium and Koch's, the
colonies are fewer and smaller, and this method, therefore,
fails to come up to the expectations promised for it.

“Journal of Infect. Diseases,” T. iii., р. 394.
THe TRYPANSOMES OF TSETSE-FLIES.

Novy, Fred. G., endorses the views of Minchin and his
colleagues to the effect that the flagellates found by Gray
and Tulloch in the intestinal canal of Glossina palpalis
have no connection with Tryp. gambiense. Novy had also
some preparations of the intestinal contents sent him from
Uganda, by Gray, and considers that the forms described by
Koch ав evolutionary stages of Tryp. gambiense and Brucet
are entirely different from these flagellates, for the following
reasons :—-

(1) The Tsetse forms are much longer than the blood para-
sites.

(2) Their presence in flies that had no opportunity of biting
infected animals, as e.g., іп the Tsetses of the island of
Kimmi, already instanced by Minchin.

(8) The failure to obtain evolutionary forms from Try-
panosomes ingested by flies fed on infected animals.

(4) The impossibility of systematically infecting animals
with the flagellates of these Tsetses.

(5) The analogy of the Typanosomes of Mosquitoes.

Novy then proceeds to describe the various forms met
with, the great variety of which tends to the conclusion that
they belong to several distinct species. He proposes the
name Trypanosoma Grayi for the numerous forms in one of
these flies. These extremely varied forms belong to two
types : one very long and thin with в long free lash, bacilli-
form nucleus, and large centrosome in front of the nucleus ;
and the other thicker and shorter, with rounded nucleus and
centrosome close to it, well developed undulating membrane,
and short free lash. He compares these two types with the
male and female forms of Koch. It should be remembered
that Minchin has seen similar forms in C. palpalis starting
from the T. gambiense of the blood.

Preparations of other Tsetses yielded forms mostly differ-
ing from the above, and from each other, though evidently
belonging to the same generic group, and Novy describes
three more of them. Finally he states his conviction that the
probably non-pathogenic flagellates found in insects corres-
pond with the forms met with in artificial cultures.—(F.
Mesnil )

“ Arch. Institat. Royal Bacter.,” Camara Pestana.
Bellencourt, A., and Tranca, C., describes trypanosomes
from the badger and rabbit, the latter of which proved
infective to other rabbits, but not to mice, rats or guinea-
pigs. They also describe a bat parasite from Vespertilio
kuhli, of Tunis.

“Lancet,” March 10, 1906. А

ON THE ANIMAL REACTIONS OF THE SPIROCH.ETES OF
AFRICAN Tick FEVER.

Breuil and Kinghorn.—In this preliminary note the authors
demonstrate the marked pathogenicity of the spirillum

brought by Todd from the Congo Free State. Their investi-
gations were started from a monkey infected by ticks, and
which died with large numbers of parasites in its blood.
Peritoneal injections, usually of large doses, were always
adopted. Rats were usually infected in a few hours, though
in exceptional cases the stage of incubation may extend to
twenty-one days, and they died in from one to forty-five
days. Sometimes the animal died in the first paroxysin, and
in others they survived three or four days before succumb-
ing. The principal post mortem signs were hypertrophy
of the spleen and numerous hemorrhagic infarcts. Mice
died in from twenty-four to forty-eight hours, with enlarged
spleens. Rabbits showed spirochetes in the blood after
two to three hours, their number increasing and persisting
for three days, the animal dying in three to ten days,
The temperature ranged from 38° to 40° during the first
hour, and then remained at 40°5’ to 41°5° till death.
Marked changes in the spleen, liver and bone marrow. Of
four guinea-pigs two died on the third day, the others were
infected for forty-eight hours and then recovered. А dog
and a pony showed signs of infection for three days and
then recovered. А monkey, subcutaneously inoculated,
showed parasites in the blood. Тһе infection of monkeys
by tick bites took place after five days’ incubation, and those
that succumbed showed lesions of the spleen, liver and bone
marrow in the shape of anemic infarcts and necrotic areas.
They conclude that the spirochete of tick fever differs from
8. Обегтеігі.

* Att. dela Societa per gli Studi de Malaria,” 1906, рр. 128-132.
Тнк Presence oF Нжмотхтіс BopiEs IN THE BLoop
IN Human MALARIA.

Dr. Dante de Blasi confirms the previous researches of
Celli, Casagrandi and Carducci in their results on the non-
existence of any autolytic or isolytie properties in the blood
of malaria patients. His experiments were made with an
aqueous extract of malarial blood. 1 сс. of blood clot is
emulsified with 19 cc. of sterilised distilled water, yielding в
liquid which has itself а distinct rosy tint, so that in esti-
mating his results the experimenter must gauge the degree
of hemolysis by comparisons with type dilutions of “laked ”
blood. Не finds that both (1) the extract of malarial blood
and of non-malarial, are alike isolytic, but the former is
more so than the latter. (2) The extract of malarial blood
is alone autolytic. Autohwmolysis is, however, merely
frequent but not constant, and may be present in all types
of malarial fever. Moreover, it is not due to the taking of
quinine, as one of the cases described had taken none.
Further, the author found no autoh:winolytie power in the
blood of persons whom һе had given a gramme of quinine
daily for eight days hypodermically. Тһе phenomenon,
however, cannot be referable to the malurial parasite itself,
as it was demonstrated in the blood of two convalescents.
By centrifuging the watery extract the author separated a
deposit of leucocytes and stroma of red corpuscles, that
was even more hamolytic than the liquid itself, This
property of the blood-extract resists heating to 56° for half
an hour, but is destroyed by 60° at the end of an hour, and
by 100° in half an hour, and cannot be restored by the
addition of fresh serum. The resisting power of the red
corpuscles has nothing to do with malarial hemolysis as the
author, having found that a physiological solution is hemo-
lytic if kept for sixtcen to twenty hours in contact with a
well-washed clot, demonstrated that this solution was almost
a8 effective as the red corpuscles whether malarial or non-
malarial; while in using the watery extract the malarial
corpuscles are much more active than the non-malarial.
Intracellular hemolysine is not specific, as he found it also
in cases of typhoid, rubeola, erysipelas and scarlutina, but
in a case of anchylostomiasis the watery extract was neither
auto- nor iso-lytic, while the serum possessed both powers.

Lastly, the serum of malaria and of non-malaria patients
inhibits the autohwmolysis produced by the watery extracts
of malarial blood.

260

THE JOURNAL OF TROPICAL MEDICINE.

(August 15, 1906.

“6. К. Вос. Biologie,” T. lix., p. 19.

Тнк ParuocGkENYv oF Вплосз H&#MOGLOBINURIC FEVER, AND
ITs TREATMENT BY CHLORIDE OF CALCIUM.

Vincent, H.— According to the writer this form of fever
appears іп malarial cases under the influence of various
secondary influences, one of the commonest of which is the
absorption of quinine. This drug will sometimes give rise
to hemoglobinuria even in non-malarial cases.

When due to quinine it is easy to avert the crisis by
giving four to six grammes of chloride of eaxleium daily by the
mouth, or one to two grains hypodermically, dissolved in
physiological solution. Тһе drug here acts as an anti-
hemolytic, much as tt does in the coagulation of blood, or,
as Delezenne has recently demonstrated, in the action of
pancreatic juice. M. Laveran, however. regards the con-
nection of quinine with blackwater fever with some reserve,
us the disease is unknown in many malarious regions, and,
moreover, often appears in cases that have not tuken quinine.

“Semaine Médicale,” April 11, 1906.
TropicaL HYGIENE ім BRITISH, GERMAN, AND FRENCH
COLONIES.

Gloaguen, surgeon in the French Navy. has published
notes he made whilst cruising along the eastern coast of
Africa. Не was surprised to find that the British аге behind
the Germans in the matter of making and keeping their
possessions healthy. The English fall back on their egotism
and individual hygiene; the Germans on their intlexible
militarism, and the French on their proverbial heedlessness.

English prophylaxis is based on two things : entire separa-
tion of the native and the European communities, and strict
application of the principles of private hygiene. Тһе
English lead an active life, with athletics, &c., to keep mind
and body in a healthy condition; they reside in comfortable
houses, but they make no effort to render the country
healthier, and improve the sanitary conditions of the
natives. There is no attempt at a general plan of campaign
against tropical diseases. The native quarters are left in
their filth, and fall an easy prey to disease. Plague is
installed in nearly all the British colonies on the Indian
ocean, and with a few exceptions, no satisfactory measures
have been taken even against malaria.

The Germans, on the other hand, enforce the same sanitary
measures in the native аз in the European quarters. Hos-
pitals are being organised at the main points, and the
country is divided into districts, each in charge of an agent
empowered to enforce the sanitary regulations. Medical
stations are organised along the caravan routes, and the
natives are examined, registered, and given certificates.
Laboratories are numerous. The streets in the native
quarters have been made wide and airy, and are kopt clean.
The garbage is carted away daily, instead of being allowed
io accumulate around the houses, as in the English and
other colonies. Standing waters are drained or oiled.
Quinine prophylaxis has been introduced by the Germans
on an extensive scale. Wherever he went in the French
colonies he constantly heard the complaint: “ If only this
country belonged to England, it would have been made
healthy long ago." Тһе French are now trying to introduce
some semblance of the German measures into their colonies,
and with some success.

* Lancet," August &, 1906.

(1) *A Note on the Treatment of Catarrhal and Gan-
grenous Dysentery."

Amos, C. B. Sheldon, M.B., writing from the Hospital at
El Tor, Sinai, describes his experiences during four seasons
of observation. Не states that (1) for slight and recent
form of dysentery supervening on diarrhwa, he finds good
results from sodium sulphate in drachm doses, given hourly
until a fæcal stool is passed. The treatment is repeated on
successive days until tenesmus is no longer complained of,
and neither blood nor mucus is passed. (2) in the gangrenous
form of dysentery ipecacuanha given in the usual way

(30 to 60 grains ipecacuanha, half an hour after exhibiting
20 drops laudanum), is applicable and efficient in young and
robust men suddenly seized with dysentery. Іп old and
feeble patients, calomel in 44 grains thrice daily, a treat-
ment previously advocated, is productive of harm; calomel
in minute doses of à grain, in three successive doses, is less
objectionable; but calomel in апу form is pernicious in
dysentery. (3) Opium, by giving complete rest, is advocated
by Dr. Amos in enthusiastic terms, especially in old chronic
cases, Morphine, administered hypodermically, every four
hours or every eight hours, as expedient, combined with
sparteine or caffeine injections to combat cardiac exhaus-
tion, is the form of administration advocated.

Rectal injections have been occasionally useful, according
to Dr. Amos ; sulphate of copper. 1 in 1,000, being perhaps the
best. but rectal injections, when the intestine is gangrenous,
are not without danger. `

As regards diet, Dr. Amos states that Africans, Turks, and
all Asiatics almost invariably evince a great repugnance to
milk. When they can be persuaded to take it the régime
followed is as follows: They receive half a pint of milk at
7 a.m., when those without hemorrhage also have a small
piece of bread; at 11 a.m. a plate of finely mashed rice,
potatoes, lentils, macaroni, or beans, over which a little meat
soup has been poured, is served round. Convalescents also
have a small piece of bread. At 5.30 p.m. they have a
similar meal. During the night they have a pint of milk
diluted with water to the patient’s liking. Those who are
very weak have in addition each duy the whites of four eggs
beaten up with brandy or water. The yelks of eggs they
cannot digest. No pure water is given, but a 1 in 8000 solu-
tion of lactic acid is placed at the bedside for them to sip at
will With this dietary blackened tongues become moist
and clean in one or two days, thirst disappears, no undigested
food appears in the stools, and no difficulty is found in in-
ducing the patients to take nourishment.

(2) * A New Subspecies of Glossina palpalis on the Upper
Congo."

Massey, A. Yale, writing from Ruwe, Corgo Free State,
states that at the junction of the Lufupa and the Lualaba,
10° S. lat., specimens of the subspecies Glosgina palpalis
wellmanit have been found. Isolated cases of sleeping
sickness have been found in the locality, but it is unknown
where the patients contracted the disease.

(8) “А Case of Plague with Unusual Eye Symptoms.”

Rees, Phillip, M.B.Lond., at the Fatshan Hospital, near
Canton, China, has recently observed some unusual signs and
symptoms of plague. In one case the submaxillary region
was swollen and infiltrated to an inordinate extent; іп
other cases no glandular enlargement could be detected; a
blood-stained discharge from the nose is recorded in one or
two fatal cases. A female patient, with enlarged glands in
arm and groin, and in whom abortion occurred on the sixth
day of the illness, developed conjunctival hyperemia, the
pupil of the left eye became occluded with lymph, and there
was slight hypopyon. In the right eye there were three
patches of lymph on the posterior surface of the cornea.
Atropine instillation gradually dilated the pupil, the woman,
however, refused further treatment, and died whilst under
the care of a native doctor.

RMotices to Correspondents,

1.—Manuscripts sent iu cannot be returned.

2.—As our contributors are for the most part resident abroad,
proofs will not be submitted to those dwelling outside the United
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8.— To ensure accuracy in printing it is specially requested
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4.—Authors desiring reprints of their communications to the
JOURNAL OF TROPICAL MEDICINE should communicate with the
Publishers.

5.—Correspondents should look for replies under the beading
“ Answers to Correspondents.”

September 1,-1906.]

THE JOURNAL OF TROPICAL MEDICINE.

Original Communications.

THE BACILLUS OF HAMILTON WRIGHT,
OBTAINED FROM TWO CASES OF ACUTE
BERI-BERI.

Ву Lronarp S. DupGron, M.R.C.P.Lond.

Bacteriologist to St. Thomas's Hospital; Lecturer on Pathology
in the Medical School, and Director of the Hospital Laboratories.

(From the Pathological Department, St. Thomas's Hospital).

A SHORT account will be given here of the bacillus
which Dr. Hamilton Wright isolated from the

duodenum and from the feces in two acute cases of

beri-beri, and which he sent to me for investigation.
It will be most convenient to refer firstly to the
morphological and cultural characters of the above
mentioned organism, and then to refer to the experi-
ments which were made as to the pathogenicity of this
bacillus.

MORPHOLOGICAL CHARACTERS OF THE BACILLUS
IsOLATED FROM THE DUODENUM.

This organism varied from 0:5 to 5 » in length,
some very long forms occurring in chains were also
met with ; no constant or typical arrangement was
observed. It was Gram positive and stained well with
basic Fuchsin and Loeffler's methylene blue. Тһе
organism did not take the stain with the same
intensity throughout, some portions being much paler
than others.

MORPHOLOGICAL CHARACTERS OF THE BACILLUS
ISOLATED FROM THE FÆOES.

This bacillus showed no tendency to form chains,
was a stouter bacillus, often found in clumps, the
staining was more irregular, with a tendency to
darkening at the poles, while a few of the bacilli
showed definite club-shaped ends; in other respects
this bacillus resembled that isolated from the
duodenum.

CULTURAL CHARACTERS.

It may be stated at the outset that the organism
which Dr. Hamilton Wright has isolated from these
cases of beri-beri, was an obligatory anwrobe. It was
found to be а matter of considerable difficulty to cul-
tivate this organism in liquid media, even under
anvrobic conditions. Most satisfactory results were
obtained by growing it in the depths of solid media.

It will be most convenient if the cultural characters
of the bacillus isolated from the duodenum and from
the feces are given in в tabulated form under the
respective headings. The points of resemblance will
then be very readily seen. In all instances, except
shake cultures, the organism was grown at 37° C
either in Buchner's tubes or Bulloch's anerobic jars.

Гоореком.

Agar slopes. — Delicate and
slightly opaque colonies appeared
in twenty-four hours; they only
slightly increased in size as time
advanced. The full sized colonies
were about the same diameter as
thoge of a virulent streptococcus.

Е жсев.
Ditto

DUODENUN. F2cks.

Litmus milk. —No change in
fourteen days.

Glucose gelatine shake. — (99 С.).
Small opaque white colonies oc-
curred iu the depth of the medium
in twenty-four hours; as time
advanced, the colonies slightly
increased in size, were opaque
and showed no tendency to pro-
duce liquefaction of the medium,
even at the end of several weeks.
The growth was very much more
abundant in the depth of the
medium than at the surface. In
many instances a typical stalac-
tite arrangement was noticed.
No gas formation occurred.

Glucose gelatine stabs, —(22° O.).
A delicate growth occurred along
the course of the needle and
gradually became more marked as
time advanced. At the end of a
month the colonies were thick,
opaque, white and muoh larger
sized towards the depth of the
jelly than towards the surface.

Glucose agar slabs..— (87° C.).
Similar results to the glucose
gelatine slabs.

Neutral red broth, —No altera-
tion in colour at the end of one
month's incubation.

Drigalski and Conradi's me-
dium.—Stab cultivations were
made, but no alteration in the
colour of the medium occurred
after one month's incubation at
87? C., and no definite colonies
were detected. .

Litmus maltose shake.—Acid,
but no gas at the end of seven

Ditto

Ditto

Ditto

Ditto

Ditto

Ditto

Acid, but no gas at the
end of seven days’ incuba-

days’ incubation. tion.

Litmus lactose shake.—Acid, ^ Мо change.
but no gas at the end of seven ^
days’ incubation.

Litmus raffinose | shake. —No No change.
change.

Litmus mannite shake.—No No change.
change. :

Litmus cane sugar. —Acid, but Ditto
no gas in seven days' incubation.

PATHOGENICITY.

Saline emulsions were made from & forty-eight

hours' culture on agar of the bacillus from the

duodenum and also from the fæces.

Experiment A.—Two cc. of each culture were
injected into the peritoneal cavity of two guinea-pigs,
but neither animal was in the least way affected, and
when killed at the expiration of one month, appeared
to be perfeotly healthy. The heart muscle was
stained with Scharlach В, but failed to show the
slightest evidence of any fatty change. |

Experiments В and C.—Two cc. of saline emulsions
from gelatine cultures were injected into the peritoneal
cavity of mice &nd subcutaneously into guinea-pigs,
but in no instance was any effect produced.

Experiment D.—A guinea-pig was fed on 2 cc. of
a saline emulsion of the bacillus isolated from the
duodenum, but at the end of one month the animal
was apparently well.

AGGLUTINATION TESTS.
Owing to the courtesy of Dr. Stanton, of the

262

Seamen’s Hospital, I obtained the blood from three
cases of beri-beri. A forty-eight hours’ culture of the
bacillus isolated from the duodenum was used for the
agglutination reactions.

Period of Disease Result

Native of Bombay
Norwegian sailor...
Native of Calcutta

Early stage
6th month
Six weeks. (Se-
veral cardiac
attacks dur-
ing the past
few weeks.) '

. Dilation 1:20, no reaction
ж М

” »

CONCLUSIONS.

(1) From the investigations which I bave made it
seems probable that the bacillus isolated from the
duodenum and that isolated from the fæces are one
and the same organism. Тһе only points of difference
are slight variations in their morphology, and that one
of them acidifies lactose, the other not.

(2) There was nothing in this investigation to show
that the organism of Hamilton Wright is related to
beri-beri. It has been found to be non-pathogenic to
mice and guinea-pigs, and the serum obtained from
three cases of beri-beri during various stages of
disease, failed to produce any agglutinative reaction
on this bacillus.

Of course, one must be fully alive to the fact that,
although this bacillus is non-pathogenic to mice and
guinea-pigs, and did not agglutinate when tested with
the serum of three cases of beri-beri, i& may, yet, be
the cause of the disease, but this seems to me im-
probable.

BERI-BERI; MOULDY RICE: THE OCCUR-
RENCE OF BERI-BERI IN THE SOKOR
DISTRICT.

By Joun D. біміктте, M.R.C.S.Eng., L.R.C.P.Lond.

Tue inference that beri-beri, as it occurs in British
Malaya, is due to mouldy rice was taken some years
ago as the basis of an argument by Mr. Leonard
Braddon, F.R.C.S., State Surgeon of Negri Sembilan,
in the Federated Malay States [1]. It excited a good
deal of local discussion at the time, and the mouldy
rice theory was again lately revived by Dr. 8. Lucy,
Colonial Surgeon, Penang [2], and still more recently
urged by Charles Hose, Esq., D.Sc., Divisional Resi-
dent of Sarawak, in North Borneo [3].

It is a theory, and there are many who are not
satisfied with the circumstantial evidence which has
been brought forward to support it, while there are
others, notably, Dr. E. A. O. Travers, State Surgeon
of Selangor, who have decidedly disagreed with
Mr. Braddon's original contention that the probable
cause of beri-beri is a toxin conveyed in certain forms
of rice [4].!

! Many others who have spent years in exhaustive research
work on Beri-beri have entirely rejected the rice theory. The
cause of beri-beri, however, has not yet been definitely proved
by them to Science, and for this reason I think that any new
evidence wbich appears to support the rice theory is worthy of
their attention. А

THE JOURNAL ОЕ TROPICAL MEDICINE.

[September 1, 1906.

The following notes were taken in the interior of
Kelantan, a distant State in the Malay Peninsula,
about 350 miles north of Singapore. Three years ago
mining operations were commenced in Kelantan by a
British Syndicate which was soon formed into a large
Company, to which I was appointed the first resident
medical adviser. The native state of Kelantan had
not hitherto been explored by any European miners.
It was therefore a typically new country, with new
mines, and, beri-beri being such a well-known local
scourge among Chinese, some anxiety was felt in the
early days of the Company as to the health of the
newly imported gangs of coolies that were necessary
to carry on the work of underground mining.

Chinese labour is universally employed for this
purpose in the Malay Peninsula, but, curiously enough,
this mining district in Kelantan (afterwards referred
to as the Sokor district), remained at first remarkably
free from beri-beri. Nocases were diagnosed in 1903.

Mining operations were commenced in the interior
of Kelantan, in a valley some seven miles distant from
a small station on the river Sokor ; the general welfare
of the Company's coolies was quite as well, if not
better, cared for as compared to that in similar mining
districts; the meteorological conditions—all very
favourable to the formation of moulds—were found
to be more or less the same as those in other parts of
the Malay Peninsula; the coolies were fed upon im-
ported Rangoon rice, as is customary in other mining
camps in this part of the world.

Rangoon rice is more liable to be attacked by
moulds and weevils than any other kinds of importe
rice [3] ; it is also more difficult to clean for cooking,
as it soon becomes broken in the necessary process of
kneading and washing, but it is cheap and is in
common use. The supply was mainly obtained by
the Company from Singapore, because the conservative
Chinese do not care to purchase rice which is grown
locally and only roughly husked by indolent Malays
for retail; moreover, the Company had endeavoured
to store Kelantan rice, but found that this was im-
practicable, as it very quickly deteriorated after it had
been husked by hand and stored.

As there was no market in the Sokor district it was
necessary to stock a comparatively large amount of
rice for the Chinese miners ; this was all kept, at first,
in а small store at the river station in bags, each of
which generally contained from 1 to 14 pikuls of rice.
The pikul is a Malay measure of weight in everyday
use; it is approximately equal to 133} lbs. avoir- .
dupois, and is divided into 100 catties, each catty
roughly corresponding to 14 lbs. avoirdupois.

Way Rice DETERIORATES.

These large bags were all ‘piled in а small space,
one on top of another to a height, and being fairly
heavy were difficult to interchange. When a large
supply of rice came in, the new bags were invariably
placed on the top of the old pile. This was un-
fortunate, as was afterwards proved, because, long
before the delivery of the rice on the bank of the river
Sokor it was exposed, as rice in the husk, to deteriora-
tion through damp. Тһе writer of an article on А
Trip to Burma," recently published in the local press,
says, when describing the railway journey from Ran-

September 1, 1906.)

goon to Mandalay: “А resident of the country told
us that the paddy owners often had to wait a month
before the railway could take their grain. We saw
stacks and stacks of it—in bags—lying out in the
open alongside the line near railway stations" [5].
The rice is shipped from Rangoon to Penang, and
from there to Singapore.

Dr. Lucy also mentions that when large consign-
ments of this rice to the Straits Settlements coincide
with an interval between the crops in Rangoon, the
only supply at these times is of an inferior quality left
over from the last crop. Such an interval occurs in
October. Ав regards Kelantan, delays occur in ship-
ping from Singapore, as well as delays and boating
accidents on the Kelantan rivers, especially during
the violent weather of the North East monsoon season,
which is mostly felt during the months of November,
December and January.

Local means of communieation with the Sokor
district, again, are very slow ; under ordinary circum-
stances six or seven days are taken in transporting
cargo by river boats to the headquarters of the
Company, located about fifty miles inland from the
coast; from there it has to be transhipped into much
smaller boats for transport up the river Sokor, which
is а small stream іп the adjoining Sokor district.
Another four days would be taken before it was finally
distributed in the mining camp, making a fortnight
from Singapore even in good weather.

Some idea of the bad weather during the North
East monsoon season may be gathered from the
records of rainfall in Kelantan. The rainfall in the
Sokor distrie& was 27:99 inches in December, 1904 ;
17:42 inches for the month of November, 1905; 10:97
inches іп December, 1905, and 28:48 inches for
January, 1906.

Mining coolies or their contractors obtained rice,
from time to time, in small quantities by means of an
order in writing on the clerk in charge of the river
Store and carried it through the jungle to the mine.
There was a tendency on the part of the contractors
to apply for large quantities of rice at the beginning
of the month, but it could not always be delivered to
them then, on account of occasional difficulties with
the jungle transport. Their applications varied ac-
cording to circumstances, and their only means of
supply was through the river store. The main rivers
in Kelantan may rise to a height above 30 feet during
the wet weather, and there are then corresponding
floods in the smaller streams, such as the Sokor river
and other small rivers in the district. (Good judg-
ment was therefore essential in order to keep a fair
balance between the supply and demand for rice at
the river store. Тһе native clerk in charge of the
аа an intelligent Sumatran who was appointed
in 1903.

PREVALENCE OF DERI-BERI.

Little concern was felt as regards beri-beri during
the greater part of 1904, although the number of
Chinese workmen was greatly increased. There were,
for instance, only eight cases of this disease registered,
with two deaths, a mortality which was trifling when
compared to an appalling death-rate of 79:99 per cent.
(187 deaths out of 234 cases), as I had known it

THE JOURNAL OF TROPICAL MEDICINE.

263

in one of the mining districts of a neighbouring
State [6].

Towards the close of the year, however, the general
health of the Sokor district was far from satisfactory,
malaria was very prevalent in the mining camp, which
had always been topographically unfavourable to
health. Special attention was accordingly paid to
sanitation, and some expense as well as much trouble
was incurred in trying to render the camp more
healthy, but it was, nevertheless, unsatisfactory to
report, at the end of June, 1905, that a number of
cases of beri-beri had occurred. There had been 37
cases with 7 deaths.

The coolie gangs had been increased by about 100
men as compared to 1904, bringing the whole strength
up to 400 Chinese. Among them were a number of
inexperienced new comers from Singapore, who had
been engaged by a Chinese contractor in May under
conditions similar to those of the ‘‘Singkheh” or
indentured Chinese labourer of the Straits Settle-
ments.

The bad health of the “ one year contract Singkheh ”
is notorious in the Malay Native States, and these new
arrivals in Kelantan suffered, as might bave been
expected, considerably more than older “ Lowkhehs ”
or time expired Singkhehs would have done. Twelve
of them died from various causes in a very short time,
six of them from beri-beri in July.

Many of these untrained Chinese were lodged in
some newly-erected coolie lines, and it was thought at
the time that they were being affected by reason of a
somewhat extensive disturbance of the soil which was
found necessary when erecting their buildings. As
beri-beri has been thought by some to have an
indefinite connection with disturbance of the soil in
the Tropics [7], stress was laid on this fact; greater
attention was paid to sanitation; old buildings were
destroyed ; the ventilation and hygiene of the camp
generally improved, and overcrowding prevented as far
as possible.

TABLE A,
SHOWING THE INCIDENCE OF THE DISEASE IN 1905,

| Nationality
$2 [23 |. 53
Months o 124 Ж e a | o& | % з
Bia ЕТЕ араг
Vi nu 8 8 С EU =Z
5 E = s
Eee eer eee eee ae Me ns
January — .. 6 5 2 4 ыж” e 1
February .. а% 1 ae a close Rowe d c
March a | 2 bs Ul га ie 2
April .. 1 | 1 s PP 5% 1
May .. 10 21,2 T Те 4 6
June .. 18 17 1 wis 7 11
July .. | 98 6 | 28 ete s 8 20
August е | 10 1. I0- Oe doses is 10
September .. 4 ы 4 m 24 4
October | 5 me 5 га T 5
November ..| 9 | 2 9 he Gs 1 8
December .. 12 1 7 5 1 11
Total 105 27 94 6 5 26 19

264

THE JOURNAL OF TROPICAL MEDICINE.

[September 1, 1906.

The principles of sanitation in the Tropies were now
very strictly enforced, and at the end of the year а
great diminution in the prevalence of malaria was the
result, but it was vexatious to find that there had been
68 additional cases of beri-beri with ten more deaths
from this disease. Тһе incidence of the outbreak is
shown in the attached table A.

With regard to this table it is important to note that
the total strength of the mining coolies was reduced
by more than one half during the last five months of
the year. Тһе reduction began in August, and by the
end of the year there were only about 100 Chinese
miners left at the works. Under the heading * new
cases" only different individuals are included; the
death which occurred in February was a case which
had remained over from January. It is only of passing
interest to notice that, as regards seasonal prevalence,
by far the greater number of cases occurred during the
months of the south-west monsoon, namely, from
April to September inclusive. The greater number of
coolies were employed during these months. The
influence of the north-east monsoon on the supply of
rice will be seen later.

TABLE B.
SHOWING THE CLINICAL FEATURES OF THE FATAL CASES
IN 1905.
Date, | UT Ж НЕНЫ 1 ied,
1905 | Nationality | Subjective Symptoms pien,
Тап. 1|Javanese .. : Slight previous fever, weak- Jan. 14

| ness, orthopnæa, sudden
cardiac pain and vomiting
..| Admitted for ulcer of leg, Feb. 20
swelling of legs and body |
. followed, died suddenly .
i Debility, shortness of breath, Jan. 14
swelling of legs and face
Sudden severe cardiac with
| hepatic pain and orthopnea ,
.. Previous fever, weakness, ! ,, 29
_ swelling of whole body and
! ; extremities, sudden cardiac
pain
-. Anemia, debility, dyspnea,
tenderness of legs, with
sudden cardiac and hepatic .

i
i 1 Javanese

» 13 Ch. Kheh..
» 14 Ch. Kheb.. » 44
» 18 Javanese

» 291 Javanese » 91

i

і __ pain
June 28 . Ch. Kheh.. | Previous fever, numbness and , July 8

tenderness of legs, with
i ' general cedema
July 1|Ch. Hailam | The same as above | "E
» 2'Ch.Hailam | The same as above |», 15
» 9,Ch.Kheh.. The same ав above,

1 with , 9

hepatic pain !

Ch. Hailam | The same as above ' Aug. 14

» 24 i Ch. Kheh.. | Second attack, great cardiac July 24
; pain and 4уврпов, died |

, suddenly j

Nov. 2, СЬ. Kheb.. | Previous fever, swelling of | Nov. 9
. ;. whole body and dyspnoea |

» 24 | СЬ. Найаш | The same as above, with | » 24

greater swelling

The date in the table above refers to the day on which the
patient first applied for relief.

The incidence of the outbreak was characterised as
follows: in January it occurred in the acutest form
of the disease, all the cases died. In the second week
there were three sudden deaths within twenty-four

hours. The outbreak was mainly confined to the
Javanese who were employed as timber cutters, 33 in
number, and was so unexpected as to arouse the
private suspicion that the patients had been poisoned
by their contractor for the purpose of gain. The
cause of their deaths, however, was investigated, and
all the cases were registered as due to acute beri-beri.

In May an equal number of cases occurred in each
half of the mouth; the same happened in June, but
in July, when the disease was at its height, 18 cases
out of the total occurred in the first half of the month.
The total Chineso strength was then also at its maxi-
mum. In August, 8 cases occurred in the first half of
the month, and in November again 5 in the first half of
the month. In December, it attacked the Malays for
the first time and was seriously affecting the Chinese ;
of the total number treated 9 applied again for relief
during the first half of the month. The death rate for
beri-beri in 1905 was 16:19 per cent. for cases treated,
the greatest mortality occurring in January, July and
November. In every instance the disease was of the
so-called wet variety ; the chief clinical features of the
cases which were fatal during January, July and
November are shown in table B.

AssIGNED Causes OF BERI-BERI.

It was part of my duty to visit the Sokor district
twice every quarter, and to leave a written report
before returning to headquarters. The importance of
improved sanitation as a check to beri-beri was fre-
quently referred to in my reports, but the possibility
of mouldy rice being a vital factor in connection with
the disease was, unfortunately, overlooked until the
last month of the year. In the second week of March,
however, I examined the diets of the Javanese and
reported that their rice was of good quality, but not
sufficiently cooked. The Chinese themselves in the
Sokor district do not regard mouldy rice as even а
probable cause of beri-beri ; on being questioned as to
the cause they almost invariably refer to exposure to
the very cold water in the underground workings or
to the drinking of bad water.

The Sokor district hospital is in charge of a Chinese
dresser (corresponding in rank to the Indian hospital
assistant); this dresser was specially chosen in 1904,
partly on account of his experience of beri-beri. He
had formerly been in the F.M.8. Government Service
under me, and was, at that time, stationed in the
mining district, where the death rate from beri-beri
мав as high as 79:99 per cent. of cases treated. >

Late in December he called my attention to the
diet which was then in everyday use in the camp, and
collected, on December 20th, samples of the rice
which was being prepared for the meals in the coolie
lines on that day. I examined and found that these
samples were full of the live larve of a small light
brown moth and that the grains of rice were clotted
with excrementitious matter. The worst sample was
one taken at the coolie lines occupied by some
Chinese miners under contract to a Hailam named
Ah Juan. This contained, in addition, a few small
beetles, as well as the well-known rice weevil, Calandra
oryze, L.

At the coolie lines the Chinese cooks were trying to
clean this rice by hand after drying it in the sun, and

September 1, 1906.)

THE JOURNAL OF TROPICAL MEDICINE.

265

then washing by kneading it, by means of their feet,
in perforated empty kerosine tins. As soon as it was
sufficiently clean to the naked eye it was cooked in
the usual way, that is to say, it was put into a large
iron cooking pan (a kwalli), containing boiling water,
stirred and boiled until it was cooked and then finally
allowed to steam under the cover for about half an
hour, when it was ready to be eaten either hot or cold.
Water for washing and cooking was obtained from a
small stream running through the camp.

Three of the Chinese cooks employed contracted
beri-beri, one in the month of May, one in August,
and another in October, each after about two months’
work in the coolie lines. These cooks were, as is
characteristic of their race, mixing good rice with the
bad in order to deceive the coolies. They cooked rice
twice a day in accordance with the usual Chinese
custom ; it was their staple diet, meat being seldom
eaten. 5

It is important to note here, that all the rice at the
river store had, at the close of the year, been trans-
ferred to a new store house which had lately been
built at the mine. The river store house, only 13 feet
by 18 feet and about 10 feet in height, bad become
too small. The rice was transferred from there
during the months of September, October, November
and early in December, the fresh supply of ‘rice
for December being carried direct to the mine.
As soon as the bad rice was discovered in Decem-
ber, an examination of all the rice in the new store
was held, and it was reported that a large quan-
tity of it was unfit for consumption. I saw that
most of it was infested by the same kind of worms
and insects mentioned above, but by careful winnow-
ing more than half of it could be rendered, to all intents
and purposes, similar in appearance to good rice.
There were several bags also in which the rice was
greenish, sour-smelling and distinctly mouldy ; the
sacking was caked inside with rice which had obviously
decayed owing to exposure of the bags to water.

DETERIORATED RICE AN APPARENT FACTOR IN THE
Етіоговү oF BERI-BERI.

It is now of interest to try and trace the connection,
if any, between the occurrence of beri-beri in the
Sokor district and the variation in quantity of fresh
rice supplied from the local store, and I think it will
be admitted that this particular outbreak appears to
have been coincident with the use of deteriorated rice.

In the year 1904, all the eight cases of beri-beri
occurred in the first two months of the year, one in
January and the other seven in February; they were
all Chinese, the one in January died suddenly and
another almost suddenly in February. At this time
the coolies, who were for the most part newly arrived
Hailam miners, were working on the top of a high
hill, which caused their local means of communication
to be even a little more difficult than was usual.
Five of the 8 cases occurred among the Hailam
miners ; they had all eaten deteriorated rice.

At the end of 1903, there were 119.24 pikuls of rice
in the river store, much of which must have been at
the bottom of the pile for some time, no fresh rice
was received in January, 1904, but 60.58 pikuls were
issued, leaving 58.66 of the original balance from

1903; in February, only 27 pikuls were received, and
by the end of the month 73.96 pikuls had been issued.
The greater part of the old rice was therefore used up
in the month of February. The balance in hand at
the end of the year 1904 was 104.06 pikuls of rice.
With the exception of the month of February, when
the amount of rice in store at the end -of the month
was only 12.40 pikuls, the balance of rice at the end
of each month varied between about 30 and 90 pikuls
throughout the year, but the amount was slightly
greater during the last two months, when provision
was being made for the north-east monsoon season.
There was never a great surplus of rice in stock in
1904.

The Sumatran clerk in charge of the store told me
that he always, so far as possible, endeavoured to
interchange the bags, and this would have been
feasible provided the supply of fresh rice was moderate
in amount.

It was impossible to attempt to trace the local
issues of the bags originally imported from Singapore,
because the larger bags containing 14 pikuls of rice
were made up into smaller ones at the river store in
order to facilitate their transport through the jungle
to the mine; the small bags had no distinguishing
marks, but through the courtesy of the General
Manager of the Company I am able to show the
exact amount of fresh rice that was stored during the’
year 1905.

The accuracy of the data given in the attached
tables C and E can, I know, be relied upon, they have
been prepared for me by the Chief Accountant of the
Company. The figures, although complicated, are
worthy of close attention.

In connection with table C, it is very important to
remember that there can be no doubt that the ten-
dency was to pile the bags of fresh rice on top of the
older ones, and that until the rice began to be trans-
ferred from the river store many of the oldest bags
were necessarily at the bottom of the stacks.

TABLE С.
SHOWING THE VARIATION IN QUANTITY OF FRESH RICE IN USE
In 1905.

|

Amount of fresh Total amount of Amount of fresh Total amount
rice stored rice issued rice stored ofriceissuel

Months during the during the) during the! during the
first half of first half оГ second half of, second half
the month the month | the month of the month

Pikuls Pikuls Pikuls j Pikuls

January 16.93} | 93.00 92.00 | 98.45
February 79.86 46.95 86.04 | 18.35
March .. | 16.01 57.30 54.23 24.07
April 120.36 | 40, 67 23.964 76.20
May 6.82 82.58 - 40.82
June 81.79 84.93 ! 87.83 27.12
July .. 136.95 | 15.44 100.74 | 27.30
August .. 111.60} | 64.90 25.271 | 30.32
September 86.064 95.45 163.814 | 20.70
October .. 84.764 67.11 39.94 | 51.00
November 24.30 62.97 54.13} | 24.50
December 23.88 41.70 — | 25.10
Total .. 789.34 813.00 727.36 388.93

An examination of the above table shows that a
very large quantity of fresh rice was stored throughout

266

the year but the store was very short of fresh rice іп
the first half of January. Тһе 16.934 pikuls was
delivered in two consignments, one of which (5.964
pikuls) was received as late as the 7th of the month
and the other (10.97 pikuls) not until the 9th of
January. It follows therefore that 76.064 pikuls of
the old rice left from 1904 were used, and that 27.993
pikuls of it remained in the store.

Very little fresh rice was received in May (only 6.82
on the 4th of the month), but the maximum 249.88
pikuls was received in September, as well as large
amounts (165.90 pikuls) in February, and 237.69 in
July, but only 78.434 in November, the greater part of
which came in on the 20th of that month.

A more critical examination of table C. shows that
96.634 pikuls of rice were in stock at the end of
January, and it will be remembered that of this amount
27.991 pikuls remained from the old stock of 1904;
by deduction it will be found that, disregarding this
amount of 27.99] pikuls for the present, the remaining
68.64 pikuls may have remained untouched until the
first half of June, when 3.14 pikuls of this old rice
must have been issued. At the end of May, exclusive
of the 68.64 pikuls, there would have been only 28}
catties of fresh rice in hand. In the first week of
June the greater part of the fresh rice (48.86 pikuls)
was not received until the 13th day of the month
and by far the greater quantity of rice was issued in
the first half of this month as compared to the second
half, and again, as regards the supply of the second
half, 47.35 pikuls were received as early as the 18th of
June. The Jabour force, it will be remembered, was
greatly increased in May by a number of unacclima-
tised coolies.

It is not possible to supply an accurate statement
of the days on which the rice was actually received by
the Chinese contractors and other natives, through
reason of the carelessness with which they presented
their orders for rice at the store, but it may safely be
presumed that the 68.64 pikuls with the old stock
(27.993 pikuls), was in use about this time and that
the oldest of it had greatly deteriorated. This is
corroborated by the Sumatran clerk, who tells me that
he went on leave in February and found on his return
in May that his substitute had neglected to endeavour
to interchange the bags.

At the end of June, 196.554 pikuls were in stock,
including probably much of the 27.99} pikuls left over
from 1904, and on referring again to the bills of lading
of the boat service, I found that the greater part
(97.70 ра) of the fresh rice for the first half of
July did not arrive until the 8th day of this month,
while the greater part of that received in the second
n (71.07 pikuls), came іп as early as the 17th of
July.

The Mining Accountant at the Sokor camp has
kindly given me a note of his weekly balances of the
rice in stock at the river store from May, 1905, until
December; they were lowest on June 17th (90.68
pikuls), on June 9th (90.98 pikuls), оп May 27th
(94.614 pikuls), on May 30th (126.96 pikuls), on June
24th (125.31 pikuls), and on July Ist, when there
were 140.61 pikuls.

There can be no doubt, I think, in concluding that
either stale or greatly deteriorated rice was in use at

THE JOURNAL OF TROPICAL MEDICINE.

[September 1, 1906.

the end of December, 1904, during the first half of
January, 1905, in May, at the beginning and end of
June, at the beginning of July and probably at the
end of July; it was found in use in December, 1905,
after the rice had been transferred from the river store
to the new store-house.

A brief summary of the clinical history of the
disease shows that beri-beri occurred markedly in
the beginning of January, 1905, in May, in June, very
markedly in the beginning of July, and in the begin-
ning of August, and as the rice was transferred in
September by means of а limited number of bullock
carts, in the process of removal it may, I think, be
reasonably supposed that the oldest bags of rice then
came into circulation, but this may have been delayed
owing to the very large supply of fresh rice which was
received in September, on account of the coming of the
north-east monsoon season.

In September and October the advance of the
disease was arrested, but only to again progress in
November and December. ?

The labourers in the Sokor district comprise chiefly
Chinese, and for surface work a few Javanese and
some Kelantan Malays. The Chinese are divided
into two classes, the Hailams, who, are immigrants
from Hainam, and the Khehs, who come from a district
north of Canton. Both classes form the mining
coolies and each work in separate gangs under a
contractor or contractors of their own class. Besides
Chinese miners there are a few fitters and other
Chinese who are not working under contract. The
proportion of cases and deaths from beri-beri among
the Chinese is shown below in table D.

TABLE D.

SHOWING THE PROPORTION OF CASES AND DEATHS AMONG
THE CHINESE ІМ 1905.

MaiLAMS — KHkNS | , TREATED | TRRATED

UNDER UNDER | OTHER | IN As OUT

| CONTRACT CONTRACT CHINESE | HOSPITAL | PATIENTS

Months ES Pa a -- | - -
1S) 2:9) ЕЗІ

АЕА АТА даа á

January an Mees s 9p ous cm eae pd c X
February mxiueiz eme ur epu
March.. -Һі|-(|-і--1 |0 21-
April . 1|-14-1-:- -21-|(--|1:-
Мау 241-і) 2|113--)| 5| 1| 4 —
June .. ..1(-| 61-|(|- —110|— Torc
July .. 18 2 9 3, 1 1 8 5 | 20 ; 1
August .. 9|—16/1|2 —|—|—1|10 1
September 11 —|2,—|1 —|—|— 4 —
October —|—{ 5.-1- —|—|—|5'—
November 5,1. 4 a}/—-—] 8| 1| 1, 1
December .. 6 1 Ie EDD бөк 6| 1 Apes
-----------.-----------|-----|------
Total .. 48| 4/87, B| 9 1138| 9 56; 4

! i ! i

It will be seen that the Hailams suffered most in
July—18 cases with 2 deaths, also the Khehs in July
—9 cases with 3 deaths, and that the only death which
occurred among the other Chinese was in July. On
turning to the hospital registers it was found that
out of the 18 cases reported during the first half of
July, no less than 13 occurred during the first week,

September 1, 1906.)

THE JOURNAL OF TROPICAL MEDICINE.

267

and that all the deaths, as shown in table B happened,
with the exception of one, to be in the first half of the
month. All the cases mentioned in this paper were
of the male sex; there were only three Chinese and
very few Malay women in the camp.

Reverting to the supply of rice from the store it
may be seen that the Hailams and the Khehs, as well
as the other natives, obtained very large supplies of
rice during the months of May, June and July, but
comparatively little in February. The amount pur-
chased by them and other natives is shown in table E.

TABLE Е,

SHOWING THE AMOUNT OF Rick PURCHASED BY CHINESE AND
OTHERS IN 1905.

Months ier Ont aci Chinese Javanese | Malays
———— E
і pikuls pikuls pikuls pikuls pikul»
January 44.49 15.00 5.50 1. 15.39
February 35.00 16.00 2.90 4.60 9.40
March 37.00 | 27.00 4.00 3.00 8.87
April | 46.00 26.00 3.65 6.00 5.47
ay 47.00 40.50 6.90 4.00 5.80
June | 87.19 41.00 7.10 7.00 6.02
July , 88.00 39.50 2.70 -- 3.20
August 23.00 43.00 3.90 -- 5.50
September i 23.00 38.00 8.95 5.00 8.85
October i 26.00 | 38.00 2.30 8.00 22.85
November | 21.00 28.00 1.70 -- 17.36
December 16.00 | 24.00 1.50 4.50 9.00
Total ..| 393.61 | 876.00 46.10 44.50 | 117.71

BERI-BERI AS ІТ AFFECTS MALAYS.

It is now of telling interest to refer to the outbreak
of beri-beri among the Malays and Javanese in the
Sokor district. Malays, speaking generally, have no
tendency to beri-beri, and they do not, as a rule,
eat imported rice, but prefer to eat that which they
plant and grow in their own country.

This rice is very seldom stored by them in their
houses, unless in the form of paddy or rice in the
husk; we have seen that this is very liable to go
mouldy if stored. The natural custom of the Malays
is to pound small quantities of their paddy into rice
for cooking, and use it fresh, from day to day, as may
be required for their household use. This exertion is
undertaken by the women folk, who do not, as в rule,
follow their people to the mining camps. One of the
Malay patients in the Sokor district told me that
although the Rangoon rice was very convenient, he
could not afford to buy it all the year round as it was
£0 much more expensive than the Kelantan rice, and
he remarked naively that it always smelt of the bag
even after it had been well washed and cooked.

The Malays in the Sokor district have always been
in the habit of buying most of their tice at a village
called Kusial, some fifteen miles distant, but, during
the north-east monsoon season, owing to the wild
weather and to the greater difficulty of jungle trans-
port, they always buy Rangoon rice from the com-
panys store in comparatively large amounts, as may

e seen in Table E. It is significant that these
Kelantan coolies, among whom beri-beri is unusual,
Should have escaped in June and July but should

have succumbed in December, when they were eating
the bad rice.

The weather in January, 1905, was remarkably
mild for the north-east monsoon period, the total rain-
fall for this month only being 5:22 inches, and, under
these circumstances, Malays could have obtained Ke-
lantan rice from the village of Kusial. Malays in the
Sokor district are too independent by nature to asso-
ciate intimately with the Chinese, but will fraternise
and eat rice with the Javanese. It will be noticed
that the latter also laid in а comparatively n supply
in January, February, and December, and probably for
the same reason, but their mode of buying it from the
store was quite different. The Malays invariably buy
rice from the store in small quantities of about 40 to
80 catties at a time. The Javanese, who cannot so
well afford the time to go to and from the store so
often, always take their supply in bulk ; for instance,
in January they took the whole of their rice (7.40
pikuls) on one day, and in June their 7 pikuls in two
portions on the 3rd and 15th of the month. In March,
when I examined their diets, there was a good supply
of fresh rice, namely, at the end of February, 169.24
pikuls (deducting again the 27.994 pikuls), rather less
at the end of March (158.11 pikuls), and a good
supply at the end of April, namely, 185.564 pikuls.
It is curious that there were no cases of beri-
beri among all the nationalities in February; only
two in Mareh among the Chinese, and one in April,
months in which there was a good supply of fresh
rice in use, and it may be of importance to re-
collect that rice, although mouldy or infested with
worms, may be dried and winnowed in such a way
that there is no apparent difference to the naked eye
between it and rice which is known to be good.

EXPERIMENTAL TESTS.

The only experiments which I was in a position to
make were of a simple nature. Equal quantities (two
ounces) of fresh Rangoon rice, mouldy rice and rice :
infested with worms were well washed, thoroughly
cooked and set aside in the open air for forty-eight
hours. At the end of that time- а greyish mould
appeared first on the mouldy sample and this was
quickly followed by a light brick-red mould, which in
point of time next formed on the sample. taken from
the bag infested with worms, but only appeared
slightly on the sample of fresh rice at the end of the
third day. Fresh Siamese and fresh local Kelantan
rice were treated in the same way and the pink mould
did not appear on either until the third day, and then
first in point of abundance on the Kelantan rice.
From the preceding experiments it would appear that
mould on rice is not destroyed by boiling, as it formed
sooner on the bad samples of rice than on the good
samples.

It seems not unlikely that Chinese cooking pans,
unless thoroughly cleaned daily, might become con-
taminated in this way, as well as tubs of water in
which rice bowls and spoons are washed on the con-
clusion of a meal, by reason of rice falling into the tub
and decomposing therein.

To remark, in conclusion, on the occurrence of beri-
beri in the Sokor district, a small place in the jungle
of a new country, where the means of communication

268

THE JOURNAL OF TROPICAL MEDICINE.

[September 1, 1906.

are not good and where it is necessary to store a large
quantity of imported rice, no management, however
carefully thought out, could, I think, prevent a loss
through deterioration. It is the usual experience in
all mining camps in this part of the world, where
climatic conditions are very unfavourable for the
storing of this kind of food supply. І think it would
he unfair also to brand Rangoon rice in particular as
being specially unwholesome ; most, if not all, of the
other varieties of rice for sale in the East would, I
think, sooner or later deteriorate in the same wa
under the same conditions. A solution of the diffi-
culty in fertile places where rice in the husk can be
obtained cheaply, might be to mill the local rice on
the spot in such quantities as may be required from
time to time, but other cereals, especially those which
are supplied in bags, may also become mouldy or
otherwise deteriorated. Besides these, also in local
use, are sago and tapioca, which are exported to
Europe from Singapore, as well as “dal,” a small
green pea which is imported, and three or four
varieties of beans which are used locally, especially
by the Chinese, who also favour two kinds of dried
mushrooms.

I am indebted to Mr. W. Graeme Anderson, of the
mining department of the Company, as well as to the
General Manager and the Accountants for the help
which they have given me in preparing these notes.

REFERENCES,

[1] Внаррох. “Medical Archives of the Federated Malay
States," p. 26. Kuala Lumpur, Selangor Government Printing
Office, 1901.

(21 Lucv. Journal of the Malaya Branch of the British
Medical Association, New Series, No. 2., page 41, Singapore,
1905.

3) Hose. British Medical Journal, p. 1098, vol. ii., 1905.

4| Travers. Journal of Tropical Medicine, р. 23, August,
1902.

[5] Kuara Lumpur. The Malay Mail, January 23rd, 1906,
Selangor.

(6) біміктте. Pahang Government Gazette, No. 13, vol. v.,
July, 1901.

(7) Grur.gTTE. Supplement to the Pahang Government Gazette.
June, 1898.

— x

* Lancet," July 7, 1906.

THE ACTION OF THE SERUM оғ VARIOUS MAMMALS ON THE
А PuaaurE BaciLLus.

Lamb, С. and Forster, W. H., from experimental research
in the serum of man, monkeys, horses, oxen, sheep, goats,
rabbits, guinea pigs, and rats, conclude that no bactericidal
action against the bacillus pestis is resident in the serum
of any of these animals. In fact, the serum of all the
animals mentioned proved to be an excellent medium of
cultivation. To whatever, therefore, the immunity of some
animals against plague is due, it would not seem to be
resident in the serum.

** Il Policlinico," June, 1906.
RoNTGEN Rays IN MALARIA.

Demarchi, A., concludes from experiments that X-rays
have no effect on the course of malarial fever, either as
regards relapses or on the development of the parasites.
The reduction of the size of the spleen noted after treat.
ment by X-rays only sets in when the parasites have
disappeared from the blood by medicinal treatment.

Business Rotices.

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THE

of Tropical Medictne

SEPTEMBER 1, 1906.

BRITISH SPAS SUITABLE FOR TROPICAL
RESIDENTS.

HARROGATE.

Every one knows about Harrogate, although they
may never have been there, and we are reminded of
its existence from time to time by elegant pamphlets
detailing its virtues. Perhaps more than any other
Spa in Britain is Harrogate visited by patients from
warm climates in summer; they are sent thither by
their doctors for the most part, but as often as not
the doctor is asked, “ Do you think Harrogate would
suit me for a change?" Patients from the tropics
suffering from the common Tropical ailments of liver
or malaria do well at Harrogate during Summer. For
such patients the seaside is useless, and worse than
useless, it is harmful.

During the months of July and August those who
have come home with malaria, anemia, and enlarged
spleen are almost certain, if resident in a town in the
South of England, to get fever, probably of a remittent
type, for two or three years after settling at home.
Nor does the trouble cease there, for as the hot
weather of July returns during several, it may be
many, subsequent years, ailments such as neuritis,
gastric catarrh and hepatic congestion, lumbago and
several minor but annoying and depressing conditions

Journal

September 1, 1906.)

seem to assert themselves. What is to be done with
patients suffering from their summer relapses of old
malarial infection? Send them to a seaside town on
the South Coast, because it is the nearest approach
obtainable without going abroad to the climate from
which they came? No, the sea level favours hepatic
congestion, and the malarial parasite or toxin thrives
in the warmth. Send the patient to a Continental
Spa? People who have been abroad for many years
do not want to be sent away as soon as they reach
home ; if they are ill they do not care to be amongst
strangers, and if they are suffering from any form of
tropical ailment they would be well to keep away
from Continental Spa doctors, whose practice consists
of “ curing ” the congested livers of over. fed European
residents, and not the run-down tropical-marked and
bleached specimens of humanity one is wont to meet
with amongst old Tropical residents. A Continental
Spa? No! Where, then, are there any principles to
guide us in choosing a place of “cure?” High
ground, bracing air and a fairly cool atmospheric
temperature are the three requisites for a place suit-
able for ‘‘ delicate ” tropical residents in the months
of July, August and September, for at least five years
after their return from the Tropics. In England we
must go northwards for these requisites, and at
Harrogate, Buxton and Matlock we find for the most
part what we require.

The Harrogate urban authorities are evidently
quite alive to the commercial value of an impressive
and pleasant environment to enhance the attractions of
their valuable possession—the mineral springs. The
Stray, ap open space really of some 200 acres, runs
through the centre of the town; its well-kept paths
and plots testify to the attention bestowed upon them.
The Royal Baths building in Harrogate is acknow-
ledged to be the finest in Europe, and yet few English
people have ever even heard of them. Continental
spas and their doctors’ names they know intimately,
and can tell off-hand the nature of the waters at each
and the ailments they are good for; but British Spas,
their waters and their doctors are unknown to the
majority, and, as usual, the Briton’s ignorance of
what he has in his own favoured isle is supreme.
What is it that is wanted? А kursaal, beautiful walks,
interesting surroundings, or is it medicinal waters,
baths and treatment. In Harrogate there are all
these, and there is the cool bracing air of Yorkshire,
which is perhaps the greatest attraction of all. The
advice to be given to tropical patients resident in
England as to where to go in summer, is simple
enough. Harrogate or Buxton in England; Moray-
shire, Nairnshire or the east of Ross-shire (Strath-
peffer) in Scotland; or inland in Norway. At other
seasons of the year there are British spas further south,
where the invalid from the tropics will find himself or
herself in congenial surroundings. Each place has its
season, and, by judicious selection, the resident
abroad can spend his leave or choose his holiday at
places within his native shores—at home, in fact, for
any part of Britain is home to those who have been
long resident abroad.

The mineral waters of Harrogate are, however,
after all, the essence of the “cure.” This fact is apt
to be forgotten, not only through the attractions and

THE JOURNAL OF TROPICAL MEDICINE.

269

environment of the town, but the varieties of treat-
ment at the baths are so numerous and so elaborate
that the medicinal properties of the waters run a
chance of being relegated to a position of but little
importance. This should not be so; at any place we
can have douches, needle baths, liver packs, massage
with all its infinite and detailed varieties; but the
Harrogate waters are Nature's gifts, and it is for
these we seek after the place. Harrogate is doubly
gifted in this respect, for it has а sulphur water, and
в chalybeate and iron water. We cannot sup-
plant natural waters by any artificial laboratory produo-
tion. The chemist/s analyses шау be perfect, and his
synthetical combinations may be exact; yet he cannot
give us what Nature supplies to us. So it is with the
mineral waters, we must go to them; they cannot
be brought to us, nor made for us. Were we to
attempt to imitate the sulphur waters of Harrogate
by prescription, it would extend to a length which
even the physician fond of drugs would scarcely dare
to imitate. The constituents of these waters consist
of: Sodium .sulphydrate, sodium sulphide, barium
chloride, strontium chloride, caleiunt chloride, magne-
sium chloride, potassium chloride, lithium chloride,
ammonium chloride, ammonium carbonate, sodium
chloride, sodium silicate, magnesium bromide, mag-
nesium iodide, calcium carbonate, magnesium carbo-
nate, ferrous carbonate, potassium carbonate, sodium
carbonate, sodium iodide, barium sulphate, barium
carbonate, strontium sulphate, strontium carbonate,
calcium sulphate, sodium nitrate, silica, sulphuretted
hydrogen, carbon dioxide, carburetted hydrogen,
nitrogen.

The effect of the combination of these salis and
gases upon each other, who will venture to elucidate ?
and the physiological chemist may well stand aghast
when asked to state what their combined effect may
be when introduced into the human alimentary canal.
Yet such is Nature's plan of prescribing, and we are
left in wonderment, wholly incapable of imitating or
understanding her methods of combination to effect
& cure.

(See also Cheltenham, p. 274).

THE DEPRECIATION OF THE ATTRACTIONS
OF THE INDIAN MEDICAL SERVICE.

In previous articles we have already drawn atten-
tion to some of the causes that tend to mar the
efficiency of the Indian Medical Service and to lessen
its attractiveness as a field for professional enterprise,
but һауе hitherto confined ourselves to points of a
public character rather than to those that concern the
prosperity of the individual officer. On the present
occasion, however, we propose to consider a point of
the latter sort. Е

There can be no doubt that the privilege of engaging
in private practice has contributed enormously to the
efficiency of the Indian Medical Service and to its
popularity as а career; and, во far as we are aware, it
has never been pretended that it has been abused to
the detriment of the public sarvice.

Anglo-Indians outside the medical service have
always held most exaggerated ideas as to the emolu-

970

ments obtainable from the service, but still, twenty
years ago, any civil surgeon might fairly expect to
supplement his рау by £100 to £200 a vear from this
source, and in the larger stations his income might
even equal that of a covenanted civilian of his own
standing. All this, however, is a thing of the past,
as far as the smaller stations are concerned, and is
woefully diminished in the larger.

In each province there are some few stations which
still retain some attractions from this point of view,
but these are very properly the reward of prolonged
good service, and, practically speaking, up to fifteen
years’ service or thereabouts, the less an officer
expects to gain from this source the less will he be
disappointed. There are various causes for this. In
the first place, we have trained in our Indian univer-
sities large numbers of highly qualified native practi-
tioners, whose habits of life enable them to charge
fees much smaller than it would be either remunera-
tive or fitting for an European officer to accept, and
to this may be added the unavoidable unpopularity
of all medical men trained on the European system, as
the outcome of the efforts of the Indian Government
to cope with plague. Owing to this a large proportion
of patients who in old times would have consulted
the civil surgeon or his assistants, according to their
means, now resort to ће unani haqim or Hindu baid,
and it is only when these have failed and the sick
man is past all human aid, that the European ргаси-
tioner is called in, and when he is so, it is obvious can
expect but scanty emolument or credit from the con-
tingency.

All these adverse conditions might, however, be
expected to yield to the personal influence of a really
skilful and energetic officer, were it not for the needless
way in which medical officers are harassed by constant
changes of station. A remunerative private practice
can no more be built up in a day or a month in India
than in any other country, but an individual officer's
tenure of any station rarely exceeds a year, and is
often a matter of a few months only. An amiable
desire on the part of the powers that be to treat their
servants fairly is no doubt largely responsible for this,
but to the victims of this misplaced affection the
results are little short of ruinous. To account for how
this comes about it is necessary to explaiu the plan
on which the Civil Surgeon's official emoluments are
caleulated. Тһе Government first docks fifty rupees
from his military pay, and then compensates him by
certain additional charges, the value of which varies
in different stations. Thus the superintendentship of
& district jail is paid from 50 to 150 rupees a month.
and in the majority of stations this is the only addi-
tional charge, but in other places there may be the
medical charge of a railway, of a lunatic asylum,
coolie department, remount establishment, &c. To
give an example: in the Punjab, the Civil Surgeons of
Simla and Murree draw 50 rupees per mensem less
than their military pay, while those at Heshiapur and
Gujrut find their position unaltered. Ludiana and
Hirsar draw 25, Gujranwalla, Ferozepur and Delhi 50,
and Multan 100 rupees more than their military pay.
Now, in order to give all their share of these good
things, it is customary when a senior goes on furlough
or retires to institute'a sort of game of general post, each

THE JOURNAL OF TROPICAL MEDICINE.

{September 1, 1906.

officer stepping up into the next best place ; but as the
expenses of the move, for which he is allowed a fare,
two first class fares swallow up one or two months
of his entire pay, he is far from being a gainer by
the change, and we would plead that greater con-
sideration should be exercised in this respect, and that
all unnecessary changes should be avoided, the more
a8 they are even more uudesirable from the official
point of view than they are on private grounds, for
local knowledge is of the first importance to the
efficient conduct of a civil surgeon's duties.

Hitherto we have been considering the position of
the ordinary civil surgeon, but in the political branch
of the service the conditions are far worse, and are the
outcome of deliberate efforts on the part of Govern-
ment to reduce this source of income.

Indian noblemen are accustomed to regard it as
only consonant with their position to reward hand-
somely their professional advisers, and generally the
amount of the fee was left to the patient, though
usually the sum tendered was only about what would
be expected by a leading practitioner in England from
a wealthy client. Some years ago, however, a native
chief, choosing to consider that he owed his life to the
exceptional skill of his medical attendant, presented
the latter with the handsome fee of a lakh of rupees,
or about £7,000. The gift, though princely, was, it
must be remembered, entirely spontaneous, and
astonished no one, probably, more than the recipient.
The Indian Government, however, which had hitherto
made no regulations on the subject, ordered the officer
to refund the entire sum, but he preferred to send in
his papers, and has since, by his talents and origin-
ality, attained a far better position in England than
he could have ever expected to gain in India. There-
upon were instituted a series of orders on the sub-
ject, which have gradually been made much more
stringent, till they are now so inquisitorial and
humiliating that some officers prefer to refuse all
remuneration rather than be subjected to the indignity
involved in claiming a fairly earned reward.

Charges which would be regarded as reasonable
in any part of England, and which have been passed
as moderate by the medical administration are returned
to the latter, it is said, with some insulting endorse-
ment such as “ perfectly monstrous,” and officers have
been left without any payment whatever, and punished
for making charges based on the ordinary scale of fees
customary in India. For example, the heir оҒа reign-
ing chief was affected with a chronic tubercular bone
affection. For over a year the Agency surgeon was
in daily attendance, and often called up at night. He
kept an account of his visits and charged the ordinary
Indian fees, but the claim was rejected as excessive,
and he was further punished by removal, not receiving
a penny for his long and anxious attendance. The
indignant chief, naturally considering himself dis-
honoured by the transaction, refused to call in the
new Agency surgeon and resorted to a native haqim,
who, of course, had no medical training whatever in
the European sense, and this worthy really did charge
in a style that might fairly be called monstrous—but
as the haqim was a free agent the chief had to pay.
Тһе net result was gross injustice to the unfortunate
medical officer, deprivation of proper medical treat-

September 1, 1906.)

ment to the patient, and an extortionate bill to his
father, the chief. Asa matter of fact it is practically
most desirable that Agency surgeons should act as
medical attendants to the chief when the latter desires
it, for the friendly relations that necessarily result
between him.and a member of the Agency staff, are
frequently of the greatest value in smoothing over
difficulties, and everyone “іп the know” is aware
that it is quite common for the wholesome influence so
gained by medical officers to “ save a situation.”

There is no good reason whatever why these humili-
ating regulations should not be entirely abrogated.
No regulations could possibly prevent a really unscru-
pulous man from quietly accepting what he would be
perfectly right in considering was honestly his due,
and the mere fact that they suffice to prevent this is
enough to show that the service is not made up of
men of the sort, and that the rules are therefore quite
needless. Further, they are resented by the chiefs
even more acutely than by the medical officere, for
they naturally argue that if they may not choose their
own doctor, and honestly pay his bill, they are far less
free agents than persons who have not the misfortune
to be “ruling” chiefs.

Asa rule no other qualified medical man is avail-
able, and the outcome is that they must either do
without proper medical attendance, or be placed in a
most disagreeable position of obligation to a man
whose income is a mere bagatelle compared with their
own.

Enough, however, has been said to show that
the interference with private practice of this class is
useless and needless, and that it is vexatious and
humiliating to. all concerned, and to none more than
to the persons it is ostensibly designed to protect.

We should be the last to deny that the Indian
Government has not only the right but the duty of
maintaining the highest possible standard of profes-
sional honour in all branches of the service, and with
human nature what it is, it is inevitable that cases
should occur which call for the strictest disciplinary
action. |

Far from regarding such severity with disapproval
the members of the service would be the first to
applaud the prompt dismissal of an extortioner or
blackmailer, but perhaps not the least extraordinary
feature of the case is the reprehensible levity with
which one or two such cases that have happened in
the last twenty-five years have been dealt with. That
such men should be given ‘ another chance ” is simply
regarded as a blot to the fair pages of the nominal roll,
in which the Indian Medical Officer justly feels the
greatest pride.

No one denies that such’ cases will occur; and must
be dealt with, but this is no defence for legislating for
an honourable service, as if its members were a den of
thieves, and as long as these rules are retained it is
impossible for the Indian Medical Officer to feel that
he is being treated not only as an officer, but also as a
gentleman.

THE JOURNAL OF TROPICAL MEDICINE.

271

TUMOUR AND CANCER AMONG THE
NATIVES OF ANGOLA.

Dr. Е. CreiagHton-WELLMAN, Benguella, West
Africa, in a communication to the American Society of
Tropical Medicine, states that malignant tumours are
uncommon amongst the natives of the district in
which he is quartered. Of non-malignant tumours
keloidal fibromata are by far the most numerous. The
actual figures are :—Sarcoma, 2 cases in young women;
multiple fibromata, 1 case; keloidal fibromata nume-
rous; myxoma 1 case of nasal polypus; chondroma,
1 case; papilloma, warts, cutaneous horns, and bil-
harzial papillomata, rare; lipoma, several; hydrocele,
not uncommon.

Dr. Wellman's experience extends over several
years, and he has had the opportunity of examining
many natives.

THE BIRTH-RATE IN THE PUNJAB.
ErrkcT oF PLAGUE AND MALARIA.

THE sanitary authorities in the Punjab state that
the influerce of plague on the birth-rate is of ап indi-
rect and general nature only ; and that in spite of the
fact that there were 334,807 deaths from plague іп
1905, the birth-rate in the Punjab rose from 41:5 to
44:4 per thousand of the population. It is noticeable
that more.women than men die of plague in the
Punjab, a fact probably owing to women being secluded
indoors and therefore more in contact with the sources
of infection. The birth-rate would seem to be lessened
more markedly by the prevalence of malaria than of
plague. A severe malarial outbreak in the autumn is
reported to affect the birth-rate in the following year
more than any other form of disease. For four years
in succession the death-rate in the Punjab has been
higher than the birth-rate; and the Punjab has
recently had the highest death-rate of any district of
India, amounting to no less than 47:55 per thousand.

PRIZES OFFERED FOR DISCOVERY OF THE
TYPHUS FEVER GERM.

Tu Mexican Government have offered three prizes
of $20,000 each for (1) the actual discovery of the
typhus germ; (2) its mode of transmission to man;
(3) and of a successful preventive or curative serum or
effectual remedy. Communications to be addressed to
the Secretary of the Academy, Dr. D. I. G. Cosio,
Ortega 9, Mexico.

The reason for this liberal offer is that typhus is
prevalent in а part of Mexico at the present time
where, under the name of “tabardillo,” the disease
has attacked some 860 persons, of whom 185 have
died. Dr. Terres, of Mexico, has published several
facts in connection with the prevalence of typhus in
Mexico. He states that the disease is not transmitted
by direct contact; that it is seldom met with below an
altitude of about 2,000 feet, whilst it is endemic in
nearly every town above this altitude; the disease is
especially prevalent during dry seasons.

. Dr. Ignacio Prieto, of the National Pathologie Insti-

272 THE JOURNAL

tute, Mexico, states he has isolated a streptococcus
from the cerebro-spinal fluid of typhus patients, which
he thinks may be the causal germ. It frequently
appears as a diplococcus. Inoculation of animals has
proved positive, the time of death varying according
to the strength of the injection. There is said to be
some difference in the clinical signs between the
Mexican and the European type of typhus, in as much
as the Mexican variety does not reach its maximum
temperature for three or four duys. Moreover, the
temperature is first intermittent, then remittent, and
finally becomes continuous in the Mexican variety.

D a

Hotes anb ets.

Mosquito Brres.—Schill, in the Schweizer .Woch.
fur Chemie und Pharmacie, advises applying a paste
or saturated solution of bicarbonate of sodium to the
bitten part. Thymol, 50 per cent. alcoholic solution,
applied to hands, neck and face, is effective in keeping
off mosquitoes. І

EUROPEAN AND. AMERICAN AILMENTS.—At опе time
gout, glycosuria and multiple sclerosis, were regarded
as rare diseases in the United States of America, and
in text-books the rarity was insisted upon. Whether
the people of the United States were really less seldom
afllicted with any one of these troubles than were the
European parent stock, is a matter of opinion. At the
present time, however, the several ailments mentioned
are as prevalent in one Continent as in the other.

An INeENIoUS Mosquito DresTROYER.— Professor
Blanchard showed at & recent meeting of the Aca-
démie de Médecine, Paris, an inveution by M. Chaulin,
devised to destroy mosquitoes. The apparatus con-
sists of a small metal cage within which is an electric
light. The cage is connected with a battery whereby
an alternating current is made to traverse the wires
of the cage. The mosquito is attracted by the light to
settle on the wires and is promptly electrocuted.

Miss В. A. Berry, Senior Lady Superintendent
of Queen Alexandra’s Nursing Service for India, has
been decorated by His Majesty King Edward with
the Royal Red Cross, in recognition of her services in
India.

Sr. HELENA.—According to the official report for
1905, measles appeared in March, 1905, and up to
August 28th, 1905, when the last case occurred, no
fewer than 500 persons were attacked. Seeing that
the total population of the island amounts to only
3,761, it would appear that almost one-seventh of the
inhabitants contracted the disease. No one died of
the disease except one person, aged 52, who was also
the subject of malignant disease. It is sixteen years
since measles visited St. Helena, so that the low death-
rate is rather remarkable.

Enteric ім InpiaA. — STANDING COMMITTEE AP-
POINTED.—The Government of India have sanctioned

OF TROPICAL MEDICINE.

[September 1, 1906.

the formation of a Standing Committee for the pur-
pose of investigating and advising on enteric fever in
India and its prophylaxis. The first meeting was
held at Simla on July 3ist in the United Service
Institute. я ент

The undermentioned officers, nominated by the
Commander-in-Chief, have heen appointed on the
Committee :—President: Surgeon-General Gubbins,
P.M.O., His Majesty's Forces in India; Vice-Presi-
dent: Surgeon General Scott Reid, P.M.O., Northern
Command; Members: Colonel Forman, P.M.O.,
Bombay Brigade; Lieutenant-Colouel T. P. Wood-
house, Captains L. W. Harrison, E. B. Knox
(secretary), A. B. Smallman and Lieutenant Lux-
moore, Royal Army Medical Corps.:. Nominated by
the Home Department — Members: Lieutenant-
Colonel Leslie, Sanitary Commissioner with the
Government; Lieutenant-Colonel Semple, Director
of the Central Research Institute; Major G. Lamb
and Captain Greig, I.M.S.

A smart shock of earthquake was felt at Simla and
at Naggar (Kangra District) on July 21st, and slighter
shocks at Lahore and Dalhousie.

Inrectious Diseases Hospital АТ COLOMBO,
CEvLoN.— News has been received that a lady
travelling home with her children from Calcutta had
a most unhappy experience at Colombo recently.
One of the children developed small-pox at sea, and
on arrival at Colombo, the family were taken to the
infectious diseases hospital. Instead of finding a
properly equipped hospital, Mrs. Craig and her
children found а shanty with а couple of untrained
Cingalese in attendance. The isolation rules pre-
vented the mother from seeing her sick child, and
the attendants were altogether unfitted to look after
an European child of three years. The child died,
and when the whole of the facts of the case were
made known by Mr. W. J. Craig, who had been
summoned to Colombo by his wife, the indignation
aroused was general. Sir Henry Blake, the Governor,
made a private surprise visit to the infectious diseases
hospital and declared it to be a disgrace to the Colony.
A site for a new hospital has since been decided on.
—Times of India, July 28th, 1906.

Tae annual (1905) report on vaccination in Burma
states that: “Ош of a population of 10,500,000 the
total number vaccinated were 500,000. Two hundred
vaccinators were employed; the cost of the work
amounted to 114,000 rupees.”

We have to hand the current ‘Special Plague
Number” of the Indian Medical Gazette, which
should be obtained by all interested in the subject, as,
for the most part, the papers included in it are of
a high standard of excellence and are, moreover, of a
most practical character. Perhaps the most note-
worthy point is the fact that almost without excep-
tion, Captain Glen Liston’s rat-flea theory of the
etiology of plague is accepted as substantially proved ;
and such being the case we are obviously within
measurable distance of a really practical and p
cable plague policy for India. There are many Hindu

September 1, 1906.)

sects that would have some objection to the killing of
rats, and who might, at any rate, refuse to assist in
such operations, but except the Jains, who, like
Gilbert's Koko in the Mikado, ‘can’t kill anything,”
few would have any scruples as to the slaughter of
fleas, so that the use of insecticides is not likely to
rouse opposition. That the contributions should not
be of uniform merit is only natural, and in one case it
is certainly difficult to understand how the author
persuaded himself that he had anything original to
communicate. This paper is rendered all the more
irritating by its slipshod English.

Here, no doubt, we have the keynote to the title sclected
for this paper, and it is one which cannot fail to be of very
great interest to all medical officers in this country, and in
particular to those engaged in efforts to subdue it.

This is a complete paragraph, and if anyone can say
to what substantive the final “it” stands pronoun
their powers of analysis must far exceed the average.
Does the “it” refer to the “ keynote,” the paper, or
the country ? In view of such a gem of construction,
one is left in doubt whether mere carelessness or
ignorance has led the author to speak of Pulex
cheopis, Rothschild, as “the " rat-tlea. Ав rats com-
monly harbour several species of Pulicidz no one of
them can fairly be called *'the"' rat-flea; but if any
flea has a right to the title, it is Ceratophyllus fasci-
atus, which is found on rats all over the world,
whereas P. cheopis has only once been recorded in
temperate climates, and—if so spoken of at all—
would probably be better called ** the jerboa flea." Ав,
however, most fleas will attack a variety of hosts, it is
misleading to speak of any of them as appertaining to
any particular animal. After all this, it is not sur-
prising to find that the writer regards the de moro
origin of bacteria as possible, albeit not proven. Not
the least valuable portion of this excellent number are
the able series of editorial comments which together
form a most handy commentary of our present know-
ledge of this most difficult subject.

Mayor J. Снаутов Wuite, I.M.S., at present on
leave in England, has been deputed by the Govern-
ment of India to visit а number of Municipalities in
England, with the view of studying the working of
recent sanitary improvements.

CarTAIN James, I.M.S., іп an interesting report,
discusses the old idea that Kala-azar has any relation-
ship with malarial fever, and appears extremely
sceptical as to the so-called disease having any con-
nection with the Leishman-Donovan parasite. It is
interesting to note that the Government entomologist
has found in Assam a “near ally of the tsetse fly,"
and suggests that it may have some connection with
the disease. The Indian Pioneer very pertinently re-
marks: “If the scientific authorities do not hurry
up the disease may have died out before its origin is
discovered, for it is certainly decreasing steadily in
virulence. In 1897 some 18,597 deaths were reported
in Assam as due to Kala-azar; last year there were
only 3,030." And in favour of Captain James’ views
it muy be noted that there is no evidence of any
coincident decrease, either of malaria or of the
Leishman-Donovan parasitic disease, though iu the

THE JOURNAL OF TROPICAL MEDICINE.

273

latter case too little is known as to the diffusion of
the malady to render any conclusions practicable.

Txt death rate from cholera in Eastern Bengal and
Assam was last year more than double that of the
preceding decade. In Dacca city the Civil Surgeon
effectually stamped out the disease by prompt treat-
ment of all tanks and wells with permanganate of
potash. One is tempted to ask why this measure was
not employed elsewhere; but we are aware that it
is not always possible to carry out sanitary measures
as could be wished in India; and the reason, in the
present instance, is probably to be found in the
political unrest which has attended the establishment
of the new province. Dacca, however, is a great
Mahomedan centre, and it is noteworthy that the
members of this community, though sometimes
accused of backwardness, are often less difficult
to deal with in sanitary matters than their Hindu
fellow-countrymen.

—————»9—————

Personal Hotes.

INDIAN MEDICAL SERVICES.

Arrivals Reported in London. --Мафог W. J. Buchanan, Major
J. В. Jameson, Col. H. K. McKay, Captain J. С. A. Kunhardt.

Extensions of Leave.— Lieutenant-Colonel P. D. Pank, 2 4.
furlough ; б. Е. T. Harkness, З m., medical certificate.

Permitted to Return to Duty. — Lieutenant-Colonel P. D.
Pauk, Captain T. Н. Symons, Surgeon-Genvral W. К. Browne,
C.I.E.

Postings.

Lieutenant Steel ofticiates ав Assistant-Director, Bacterio-
logical Laboratory, Bombay.

Captain R. F. Baird ofticiates as Civil Surgeon, Farrukhabad.

Dr. H. A. Macleod, Civil Surgeon (uncovenanted service) from
Saharanpur to Mugaffanagar.

Captain U. S. J. Shaw officiates as Superintendent Royal
Lunatic Asylum.

Lieutenant-Colonel Harrington оћсіафеѕ as Chief Medical
Officer, Rajputana. .

Major P. Haig, Residency Surgeon, West Rajputana States, to
the additional charge of the Agency, Jodhpur.

Captain H. Mackenzie, services temporarily lent to Govern-
ment, Punjab.

Lieutenant C. Henderson, 29th Lancers, to Burmah Military
Police.

Major W. Vost to be Civil Surgeon, Gorakhpur.

Leave.
Major W. R. Clark, Civil Surgeon, Umballa, combined
leave, 2 y.
Retirements.

Lieutenant-Colonel J. Maitland, Madras.
Senior Assistant Surgeon Captain Staggs, I.S. M.D.

List or I.M. Orricers IN MILITARY EMPLOY, ON FURLOUGH.

Abbot, Captain S. H. L., 12 m., May 4th, 1906.

Anderson, Captain D.N.

Babington, Lieutenant 7. W. H., 1 y., September 27th, 1905.
Baker, Captain D. G. R. S., 8 m., May 16th, 1906.

Bradley, Captain R. J., 8 m., April 2nd, 1906.

Brown, Captain Н. R., 18 m., April 15th, 1905.

Buchauan, Major W. J.

Collinson, Captain М. J., Ly, June 9th, 1906.

Cruddas. Captain H. M., 1 v., March 13th, 1906.

Earle, Major H. M., 1 y., April 29th, 1906.

Eyre, Lieutenant-Colonel, M.S., 18 m., September 23rd, 1905.
Fooks, Lieutenant-Colonel H., 19 m., March 28th, 1905.

974

Gilbert, Major С. Е, L.

Graham, Captain J. D., 1y., April 16th. 1906.

Groube, Captain С. P. T., 1 y., April 1th, 1906.

Hagger, Captain R. L., 8 m., February 16th, 1906.

Hamilton, Captain W. G., 17 m., October 5th, 1905.

Hamilton, Colonel H., C.B., 6 m. 18 d., April 28th, 1906.

Harkness, Lieutenant G. Е. L., 9 m., February 15th, 1906.

Harriss, Major 5. A., 6 m., May 6th, 1906.

Illius, Captain Н. W., 1 y., March 19th, 1906.

Johnson, Major C. A.

Kirkpatrick, Captain H.

Kunbardt, Captain J. G. G.

Lee, Lieutenant.Colonel W. А.

Lister, Captain А. E. J., 21 m., February 1 2th, 1905.

MacKelvie, Captain M., 12 m., October 15th, 1905.

MacRae, Colonel R., 7 m., May 4th, 1906.

Maidment, Major F. G., 1 y., March 21st, 1906.

Marr, Captain C. F., 1y., April 24th, 1906.

Mason, Captain W. G., LS. M.D.

Meakin, Captain H. B., 18 m., March 23rd, 1905.

Murphy, Captain A., 8 m., June 6th, 1906.

Parker, Captain C. S., 18 m., August 28th, 1905.

Pinchard, Captain M. B., 18 m., August 12th. 1905.

Pratt, Lieutenant-Colonel H. J.

Pridham, Captain A. T., 7 m., March 15th, 1906.

Reynolds, Captain L., 9 m., March 4th, 1906.

Rodgers, Lieutenant-Colonel J. W., 52nd Sikhs, 1 y., January
26th, 1906.

Russell, Major A. R. P.

Sarkies, Lieutenant.Colonel C. J., 290 d., April 19th, 199.

Stephen, Captain J. P., 1 y., June 24th, 1905.

Swaine, Lieutenant-Colonel С. L.

Tate, Captain G., 1 y., October 3rd, 1905.

Thompson, Captain F. T., 54th Sikhs.

Tuke, Captain A. W., 9 m., May Ist, 1906.

Turner, Major R. G.

Whale, Captain H., 8 m., June 5th, 1906.

Wilcocks, Captain R. D., 17 m., May 27th, 1905.

Younan, Lieutenant-Colonel A. C., 1 y., March 1st, 1906.
in Lieutenant-Colonel E. P., 1 y., March 2nd,

4

—À M MÀ

INSPECTION OF ALLEN AND HANBURY'S
WORKS AT WARE, HERTFORDSHIRE.

THE admirable way in which the arrangements for
the representatives of the press on their recent visit
to Messrs. Allen and Hanbury's factories at Ware,
Herts, were carried out convinced the visitors, even
before they left by special train from Liverpool Street,
that a capable and enterprising spirit must be at the
head of affairs, and that something out of the ordinary
was in store for them. Those anticipations were
more than realised, and a thorough inspection of the
works and minute examination of the many ingre-
dients employed in the manufacture of the firm's
numerous capsules, lozenges, &c., and the celebrated
Infants’ Food, could leave no doubt that everything
was of the finest and purest quality, and the processes
of transforming the raw materials into the desired
results were carried out under the best of sanitary
conditions. The factories stand in their own grounds,
comprising some acres of grazing land, occupied by a
large herd of cows whose milk is used in a variety
of Messrs. Allen and Hanbury’s products. In these
days of scares by potted and tinned foods it is always
as well to do what опе can to remove biassed impres.
sions, and so far as Messrs. Allen and Hanbury’s
packing and the supervision exercised in hermetically
sealing and keeping air-tight their delicacies and pre-
ventatives of, and remedies for sundry, ills are con-

THE JOURNAL OF TROPICAL MEDICINE.

[September 1, 1906.

cerned, it is only right to say they could not be
surpassed, and consequently a minimum of damage
is likely to be caused to them by climatic influences.

CHELTENHAM.
THE OPENING OF THE NEw Spa.

Fox those who have spent the active part of their
lives in warm countries, and ав а place of education
for their families there is no more desirable and
popular town to reside in than Cheltenham. Тһе
education for children is excellent, both for boys and
girls, and within the means of all. In former times
Cheltenham was famous for its mineral waters, but of
late years the reputation of the town as a place of
“ eure " has heen unaccountably and most unjustifiably
neglected. It is satisfactory, however, to know that
as а place of “сите” the Cheltenham authorities have
taken a step in advance, and the opening of the new
Spa cannot fail to prove an attraction to many. Just
now “Garden Cities” are much talked about in
England as if they were something new, but we have
in Cheltenham one of the finest garden cities, not only
in England, but in Europe. Being an old-established
resort, it is without the drawback of the much vaunted
modern imitations. The Journal of the Royal Institute
of Public Health remarks :—** It would be difficult to
exaggerate the advantages of the place from the point
of view of residence. It is well situated, the shops are
admirable, and the means of amusement greater than
аб most English health resorts. The climate of
Cheltenham is of а distinctly sedative type. The
humidity is considerable, making the conditions
particularly equable. It is, like most of our western
and south-western stations, admirably, or rather pre-
eminently, suited to the very old and the very young.
For those who have done their life’s work, especially
in some tropical climate, such as India, there is no
better place in Europe than Cheltenham. All this has
been long recognised, and one has only to go to
Cheltenham and make acquaintance with its inhabi-
tants, to realise that the population is largely made up
of people who have been abroad and those who have
children to educate.

“From the spa point of view, the waters are com-
parable to thoge of Brides-les-Bains, St. Gervais,
Homburg, Kissingen, and others, which contain
chiefly the chloride of sodium and the sulpbate either
of sodium or magnesium, or both. Inasmuch as it
constitutes the only drinking-water spa of this type in
England, and, judging by the spirit which now seems
to animate its authorities, it certainly ought to have a
great future before it.

* Of the New Central Spa, which the Corporation
of Cheltenham has recently established in the Town
Hall, we may say at once that any town which is
capable of building а Town Hall such as that which
now graces Cheltenham, ought to be capable of any-
thing in the way of enterprise to render the town
successful and attractive from the health resort point
of view. It would be difficult to imagine anything,
even at Continental stations, more suited to the
requirements of a health resort than the magnificent

September 1, 1906.)

building in which the Central Spa is now situated.
It is, in fact, а casino of splendid dimensions, admirably
designed and tastefully decorated.

“ Cheltenham has this peculiarity, that its climate
is essentially a winter climate, and there is no health
resort presenting the same type of waters to which
patients can be sent in the winter. This is an advan-
tage of which the authorities would do well to make
full use.”

_ Se

Recent and Current Witerature.

A tabulated list of recent publications and articles bearing on
tropical diseases is given below. То readers interested in
any branch of tropical literature mentioned in these lists
the Editors of the JouRNAL oF TRoPICAL MEDICINE will be
pleased, when possible, to send, on application, the medical
Journals in which the articles appear.

The “Indian Medicine Gazette,” Special Plague Number,

July, 1906.
(1) Tue SPREAD оғ PLAGUE.

Browning-Smith, S., Major I.M.S., from experiences gained
in the Punjab, is of opinion that in the spread of plague
(1) the rat is the principal disseminator; (2) that the rat is
a necessary factor for epidemic bubonic plague; (3) tlen
prevalence is also necessary; (4) a plague epidemic will end
with the disappearance of either the rat or the flea; (5)
seasonal variations of plague depend on flea prevalence, the
habits of man and the breeding of fresh generations of rats.

(2) THE NaruRAL History оғ PLAGUE.

Stevens, A. F., Capt. I.M.S., draws special attention to
the disseminating agencies of plague and classifies them
info: (1) Universal or territorial dissemination, mostly by
travellers, merchandise, parcels and correspondence and by
animals; (2) regional dissemination by contiguous (urban)
and local (rural) dissemination; rats and rat-destruction
sums up the whole subject of the spread of plague and the
means we have of combating the disease.

(8) How PLAGUE 18 SPREAD.

Gordon Tucker, E. F., Capt. I.M.S., suggests practical
palliative measures for municipal authorities to carry out
when brought face to face with an epidemic of plague.
They are chiefly erection of temporary dwellings in opeu
spaces near evacuated houses for the poor, and outside the
city for the richer classes. Disinfection of infected houses
where a family accepts inoculation. Special laws to ensure
good rat-proof dwellings for stables and granaries. Destruc-
tion of rats.

(4) PLAGUE ік THE City оғ Mapras.

Ross, T. S., Capt.. LM.S., states that until January 20,
1906, indigenous plague was unknown. A few sporadic
cases developed in different parts of the city, but although
rats were found infected the disease never became generally
prevalent. Some attribute the extraordinary exemption of
anything like an epidemic of plague in Madras during all the
ten years the disease has prevailed in India, to the absence

. of the Mus decumanus. The Mus Rattus and the Nescocia
bandicota are met with, but the former is a non-burrowing
animal and therefore does not pass from house to house freely
for fear of being caught by the Bandicoot; in this way the
Bandicoot has come to be regarded by some people as the
means by which plague has been kept out of the city.

(5) How poss PLAGUE SPREAD ?

Elliott, Alex. M., M.B., mentions, amongst the several
known means of spread, that cats are probable carriers of
infection, and that from fleas taken off plague-infected cats,

THE JOURNAL OF TROPICAL MEDICINE.

275

plague bacilli may be obtained. Ап interesting case is the
probable infection of a man іп India whozpicked up a dead
rat dropped by a vulture; the fact that the buboes proved
to be axillary in this patient is also suggestive and
instructive.

(6) Тнк ErrFEcTsS or RaT EXTERMINATION ON THE ІКСІ-
DENCE OF PLAGUE IN A SELECTED AREA IN ÁZAMGARH CITY.

Walker, J. W., Capt. I.M.S., draws special attention to
the fact that plague epidemics, in smaller towns at all
events, seem to be particularly severe in alternate years.
The experiment of killing rats and mice by baits consisting
of bread sprinkled with the “ Common Sense Rat Exter-
minator" was carried ouf, in the south-eastern district of
Azamgarh. The result when the epidemic of plague visited
the city was satisfactory, іп ая much as thirty-two cases
were recorded against 133 in the north-eastern quarter,
where no steps against rats had been taken and where the
people lived under much the same conditions. А point
observed in the rat-free area was that cases imported thither
do not give rise to the series of infection to be seen in
places where rats abound. The investigation was carefully
and scientifically carried out.

(7) How PLAGUE Is SPREAD.

Allchen Gill, C., Lieutenant I.M.S., is of opinion that the
part played by man in the spread of plague is of equal
importance to the róle of the rat. А plague epidemic in
any place is usually preceded or accompanied by a
mortality among rats, but if this is inquired into, in most
cases it will be clear that the rat infection has taken place
from man. The rat-flea Puler cheopis, ің evidently the
chief intermediary host between rat and man, but whether
as a mere transmitter or as an animal in which the bacillus
of plague passes through an evolutionary stage, is unknown.

(8) AN EXPERIMENTAL INVESTIGATION AS TO THE POTENCY OF
Various DISINFECTANTS AGAINST RAT-FLEAS.

Hossack, W. М. С., M.D., of the Plague Department.
Calcutta, contributes a very interesting paper on the sub-
ject of rat-fleas and their destruction. He draws attention
to the difficulty of being certain that the fleas have com-
pletely disappeared from the rat fur. even after careful search.
He also shows that fleas, after being immersed for a time in
fluid disinfectants, may promptly recover when allowed to
escape from the liquid, even after many minutes of immer-
sion. He finds phenyl 1-500 (roughly two tablespoonfuls to
a bucket of water) is an excellent pulicide, paralysing the
flea in & few seconds and killing it in about one minute.
Izal, суп and crude phenyl are equally efficacious, but the
perchloride of mercury, even in strong solution, 1-250, was
disappointing. He advises giving up perchloride of mercury
solution, which is in common use in India, in favour of one of
the others mentioned. It must be remembered, however,
that phenyl, izal, &e., has little power as a germicide against
plague, and as Dr. Hossack remarks the substance that will
give the best results as a pulicide and germicide has yet to
be determined.

(9) RAT-KILLING FOR PREVENTION OF PLAGCE.

King, G., Captain, I.M.S., mentions several varieties of
rats met with in Bihar and adjacent districts of India.

(a) Field Hats.—(1) Gerbillus Indicus, locally named
* Нота” (the Indian antelope or Jerboa rat), a field rat;
(2) Mus Mettada, locally named “ Kuroch,” probably a large
northern variety of the soft-furred field rat of S. India; (3)
а field таб resembling the **Kuroch" rat, termed locally
* Churhowa," but which Captain King cannot classify; (4)
the Nesokia Bengalensis (the Indian mole rat); (5) the
Nesokia Bundicota (the Bandicoot), termed locally
“Ghous.” the pig-rat. Of these field rats, 1, 2 and 8 do
not burrow in outhouses; 4 and 5 are rare in Bihar and do
not burrow in outhouses.

(b) The House Rats,— (1) Mus Rufescens, termed locally.

276

“Gach Kachuha,” lives in trees, roofs of houses and holes in
mud, walls, &c.; (2) Mus Alexandrinus. These rats are
closely related in habits and in the fact that the tails of
both are distinctly black, distinguishing them from all other
rats. The importance of this feature is apparent when it
is known that these two species are the transmitters of
plague, and that when the extermination of rats is deter-
mined upon, it is the tails of the black rats that should
alone be paid for, as rats with yellowish tails or black with
yellowish fur over joints are innocuous, so far ав plague is
concerned. It would appear that the © Mus Alexandrinus
is really the eastern variety of the European black rat,
Mus rattus, which was abundant in Europe from 1347 to
1680, but is rare now, having been ousted by the brown
(drain and cellar) rat, and by better housing and sanitation
since the great plague epidemics in Europe between the
above dates.”

“ Centralbl, f. Bakten," I. Orig., T. xl., p. 630.

THE ACTION oF Aspergillus niger AND glaucus ON CULICID
Павуж.

Galli-Valerio, Bruno, and Rochazdi Jongh, J. Тһе larve
were placed in crystalising glasses, tlasks, and casks of water,
and sporulating cultures of the above species added. Inthe
smaller vessels, the greater part of the culicids failed to
survive the larval stage and only half the pupe reached the
adult condition. In the larger vessels the mortality was
less severe, and the authors conclude that though in the
natural state the larve may become infected, the method
cannot be recommended as a practical measure, as the des-
truction dealt by either petrol or saprol is much more rapid
and certain.

* Thomson Yates and Johnston Laboratory Reports,"
T. vi, Part 2, p. 139.

Тне Навітз or THE Marine Mosquito (Acartomyia
Zammitii).

Theobald, F. V., premises that there is little doubt that
Malta fever is conveyed either by the above inosquito or by
the biting fly Stomo.ys calcitrans.

This mosquito is found throughout the Mediterranean
littoral and is exceptional in passing its larval and pupal
Stages in salt marshes of a concentration of 48 to 87 grammes
per litre. Should the salt commence to crystalise out the
larve must either emigrate or die. Interesting details are
afforded of the larval and adult life history of the insect.
It may be remembered that Sergent has described from
Algeria Grubhamia maria, a closely allied form, which also
passes its larval stage in strongly saline salt marshes.

“C.R. Acad. Sciences,” T. cxlii., p. 260.
Tue ANATOMY AND HISTOLOGY OF THE IXODES.

Bonet, A.—A short study of the eye and poison glands of
these arthropods. The poison glands consist of large
pyriform cells, placed among the alveoli of the salivary
glands, and distinguishable by their staining in acid solutions.
They are more numerous in Argas than in Ixodes, which
explains the greater irritation produced by the bites of the
former genus. "Their secretory activity is associated with
nuclear emissions of the same character as the venin
granules of other arthropods and of the ophidia.

It may be noted that the poison glands of mosquitoes
also consist of similar voluminous pyriform cells.

“ Scientific Memoirs of the Med. and Sanitary Departments
of the Government of India.”
Тнк ANATOMY AND HisToLoGy оғ Ticks.

Christophers, Captain 5. R., concerns himself principally
with Rhipicephalus annulatus and Ornithodorus savignyi,
the latter being probably the camel tick, which Palton
noted as also attacking man at Aden. А very complete
account is given, with ample indications as to methods of

THE JOURNAL OF TROPICAL MEDICINE.

[September 1, 1906.

examination, and in the last chapter some information is
given on the structure of the egg and the embryology of the
group. It is important to note that it is stated that the
larve of Ornithodorus do not bite, whereas those of the
Trodide do. :

“C.R. Acad. Sciences,” T. oxlil., p. 1225.

THE EVOLUTION ОЕ THE GYMNOSPOROUS GREGARINES OF
CRUSTACEANS.

Leger. L. and Dubosq, O., revive Frenzel's hypothesis that
certain gregarines parasitic in crustaceans, for which the
latter instituted the genus Aggregata, have а double life
history, and that the alternative host should be looked for
among animals that prey largely on crustaceans, such as
the cephalopods, and have submitted the question to experi-
mental demonstration. They have never found the spores
of Eucoccidium, from the intestines of cephalopods, ореп

y

_ in the intestines of these molluscs, although they do so re

in the intestines of a variety of species of crabs, and the
sporozoites when set free are actively mobile, and penetrate
the epithelial cells of the crabs very readily. The greater
part of them are stopped by the basal membrane, and
undergo degeneration, but those that succeed in passing
through it reach the peri-intestinal lymphoid tissue and
grow into large young gregarines with a spherical nucleus
and large karyosome, though many are in the meantime
destroyed by the phagocytes. These stages agree with those
already described by the authors in crabs naturally infected
with Aggregata vagans, and they are led to believe that
these intestinal gregarines of crabs have no connection with
the cclomie Aggregata, but there is reason to believe that
they require an alternate host.

They further believe that Aggregata is the schizogonic
and Eucoccidium the sporozonic stage of the same gregarine.

“Journal of Mental Science,” April, 1906.

Knobel, W. B., Dr., discussing asylum dysentery in
England, points out (1) that between acute inflammatory
conditions of the colon and lesions of nerve cells and
fibres of spinal cord, ganglia and atrophy of cerebral gyri,
there is a distinct association. (2) Trophic influence is
evidently impaired in insanity, hence the special suscepti-
bility of the insane to dysentery. (8) The‘ privy atmosphere’
with which we are familiar in asylum wards may be due to
this trophic impairment, and the air in the ward may be a
factor in the spread of the complaint. (4) Many microbes,
either singly or in mixed infection, may produce dysentery
under certain circumstances. (5) It may be that dysentery
is produced by some microbe normally present in the intes-
tine becoming pathogenic, when the normal nerve stimulus
is withheld. (6) It is significant that disturbance of the
subsoil in the immediate vicinity of an insane asylum is apt
to be followed by an outbreak of dysentery.

Hotices to Correspondents,

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9.--Ав our contributors are for the most part resident abroad,
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JOURNAL оғ TROPICAL MEDICINE should communicate with the
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September 15, 1906.)

THE JOURNAL OF TROPICAL MEDICINE.

Original Communications.

SPRUE AND CHRONIC INTESTINAL LESIONS.

I—THE DIET IN SPRUE — MEAT—MILK — FAST
DAYS—WHY FAST DAYS ARE NECESSARY—
SEA WATER FOR RECTAL INJECTIONS.

II. — SIGMOIDO-RECTAL STRICTURE A CAUSE OF
CHRONIC INTESTINAL FLUX — А SIGMOIDO-
RECTAL PYLORUS—THE USE OF THE SIG-
MOIDOSCOPE.

By James CaxTLIE, M.B., F.R.C.S.
I.

Orinions concerning the milk versus the meat diet
of sprue, and of other lesions associated with intes-
tinal flux, still afford material for debate. The
majority favour the treatment consisting of milk only,
а few favour a rigid régime of meat or of meat
juices, whilst a third group temporise with a moditica-
tion of the two extremes, and give a hesitating ad-
herence to each. The writer has for years advocated
and practised a rigid “meat” diet in sprue, and ex-
ponenee has tended to confirm the efficacy of the
plan.

Mear Drier.

Whilst still adhering to the meat treatment as the
means of curing sprue rapidly and efficiently, an ex-
tended experience has served to modify the sweeping
assertion that by this means alone sprue is always
permanently cured. The reasons for this belief are
stated below. That a patient in what under ordinary
circumstances appears the last stages of the illness,
that is, when, in addition to emaciation, anemia,
dropsical effusion, &с, there is a decided rise in
temperature, can be saved by putting the patient on
home-made beef tea, raw meat juice and beef jelly,
administered in teaspoonful doses every ten minutes
if need be, the writer has proved again and again. A
rise in temperature takes place in most cases of sprue
some two to four weeks before what seems inevitable
death, in sprue. Milk in such cases means death,
and by meat juices alone can a patient, in what seems
'the last stages of the illness, be saved.

The further treatment in such serious cases will be
found to be that as the patient's strength improves,
which it will do, the time of feeding may, after the
first twenty-four hours, be lengthened to every twenty
minutes on the second day, and to half hourly or
hourly feeds by the third or fourth days. By the
fifth day, pounded beef (from top of round) will be
tolerated and enjoyed, and the diet intervals may be
increased to two-hourly feeds; pounded beef, meat
juice, beef tea, and beef jelly being taken seriatim at
the intervals mentioned. In a week or a fortnight, if
the cure advances satisfactorily, vegetables, bread
and stewed fruit may be added with benefit. At this
stage, or it may be later, a relapse usually occurs, and
meat seems to have failed and the doctor and patient
are disappointed. This contingency is almost inevitable,
and the doctor reverts to milk, or the patient seeks

other advice. This is the critical period of the treat-
ment, and one that causes anxiety and trouble. The
solution of this difficulty is the object of this com-
munication.

MILK TREATMENT.

This is so well known that it is unnecessary to
describe it. It is the least troublesome to administer,
it brings about, except in late stages of sprue, solid
stools, and, the diarrhoea being in abeyance, the patient
is satisfied with the result. Withal, however, it does
not, as a rule, cure. A sprue patient can only be
said to be cured when he can revert to а mixed diet,
and it is at tbe period when other substances are
added to the diet, be they starchy or nitrogenous, that
a relapse is apt to occur and the patient and doctor
are disheartened and disappointed. The solid stool
produced by a rigid milk diet is not fecal; it consists
of a mass of agglutinated milk curd from which the
whey has been extracted, and on the whey alone the
patient has lived, and, it may be, improved.

Can the milk and meat diets be combined? In the
ordinary sense, No! Meat cannot be digested when
milk or milky substances such as milk puddings are
given at the same meal. In ordinary day life it is the
éustom to take a milk pudding after consuming fish,
fowl, or butcher’s meat, and on the other hand milk
is often drunk at meals along with meat in place of
beer, or wine, or water. Such a combination is phy-
siologically wrong. The old Jewish law that milk is
not to be taken until at least two hours after eating
flesh holds good for all time, and cannot be contra-
vened with impunity by healthy people, and therefore
far less so in patients with gastro-intestinal disturb-
ances. How then can a milk and meat diet be com-
bined if both are useful in sprue. Not by taking the
two together; not even by taking the two at separate
meals but on separate days.

Fast Days.

The patient on a meat diet should, say, every third
or fourth day, fast from meat of every kind, and
take milk, and milk only, for twenty-four hours.
The writer has found this to be the secret of success
in the prolonged treatment of sprue. Meat diet is
almost certain to be attended by relapses; milk diet
when modified is almost assuredly attended by re-
currences of diarrhoea, and the ordinary attempts at
a combined diet are equally productive of failure ;
but a rigid milk diet alternating with a varied diet on
separate duys will seldom fail.

Way Fast Days ARE NECESSARY.
The writer has practised the “fast from meat” plan

with success for some time, but could not frame an

explanation until he read a paper by Sir Lauder
Brunton on the effects of & rigid diet. In the paper
and in conversations with Sir Lauder Brunton оп
the subject, the writer has come to firmly believe in
his explanation of the good effects produced by meat
fasts in cases of intestinal flux. Sir Lauder puts it
shortly thus: The bacteria of the intestine can accom.
modate themselves to almost any food; if a milk diet
has been persisted in, the sudden change to a purely
meat diet places the bacteria, accustomed to deal with

THE JOURNAL OF TROPICAL MEDICINE.

{September 15, 1906.

milk only, at a disadvantage, they cease to be active
and largely die out, and their pathogenic properties are
annulled. If, again, the meat diet is persisted in the
bacteria recover, and again multiplying become
virulent, and show their pathogenic effects as pro-
nouncedly as before. Change this suddenly and
completely by again reverting to, say, milk, and the
bacteria are once again hampered or largely killed ;
in time they become accustomed to the altered media
of their environment and again become pathogenic.
Whether this be the true explanation or not it fits in
with clinical facts, and the writer has adopted it with
success as a rational basis of treatment. Be the
nature and cause of sprue what it may, a bacterial
infection, a fermentation, or a mere physiological per-
version, the explanation offered is justified, both scien-
tifically and clinically. A change of diet, as of air,
or of water, seems necessary to human welfare. In
Britain we go for a change of air, in China it is said
to be for & change of water that the invalid goes,
and it is held by many that a “city” dinner is ап
excellent hygienic factor in the digestive economy.
Change of “air” is not confined to man's require-
ments; animals, and more especially birds, find it
necessary, although it may be for different reasons.
and all animals in a natural state change their lairs
or environment from time to time. The scientific ex-
planation of this is probably based on hygienic
factors, and would bear closer investigation with
benefit. Sameness of diet is apt to lead to “ stale-
ness" of body and mind, a fact which it would be
well also to probe more deeply. Advocacy of “ fast
days" from the stereotyped diet in sprue, therefore,
is no heterodox innovation, but one which but fulfils
natural and therefore normal bodily requirements.
Several sprue cases, by the advice of the writer,
have returned to the Tropies and follow the fast day
régime. One day in the week the usual diet of meat,
vegetables, fruit, &c., is given up, and the patient
takes nothing but milk for twenty-four hours. In
this way several persons for whom life іп а warm
climate would have been otherwise impossible, are
to-day enjoying good health. One usually allots
Sunday as the milk day, but there is no reason why
the “ fast ” day from meat should not be Friday, as it
used to be with us, and is still in Catholic countries.
Whichever day is chosen, however, is a matter of
domestic convenience, but the omission, in cases of
sprue, is apt to lead to recurrence of the ailment.

SEA-WATER FOR RECTAL INJECTIONS.

The writer finds that of all forms of lavage for the
bowel sea-water is the best. In chronic dysentery,
in mucous colitis, in ulcerative colitis and even in
sprue injections of sea water—a couple of pints filtered,
warmed, but not diluted—are highly beneficial. The
injections may be given daily for three days, but
afterwards every third day or once a week, until
all mucous or fermentation is removed. The same
good is not obtainable by ‘‘sea-salt’’ dissolved in
water, although sea salt thus used is perhaps better
than any other of the vegetable decoctions or mineral
solutions in common use.

II. — Siemoipo - RECTAL STRICTURE — А SIGMOIDO-
Rectan Ругоксѕ—Тне Usk or THE SIGMOIDO-
SCOPE.

The writer has during recent years made it а rule
to examine the rectum of all cases of intestinal flux.
To merely call it rectal examination is misleading,
for, as a rule, the rectum by digital examination or by
the ordinary rectal speculum will be found normal.
The trouble in three-fourths of cases of chronic
diarrhoea, dysentery, mucous colitis will be found at
the junction of the sigmoid flexure and rectum six
to eight inches up, that is, cight inches from the
anus anatomically owing to rectal curves, but only
six inches when straightened by the sigmoidoscope. At
this point, there is naturally a narrowing of the
bowel, even a pylorus with some of the functions of
the gastro-duodenal pylorus. We are accustomed to
think of the pylorus as if in some way the name
meant an anatomical attribute of the stomach, but
the word pylorus has no such signification. Pylorus
is derived from the Greek words толу — gate and ovpos
: > guard—a guard of the gate; the gate шау be at
the stomach, or sigmoid, or anywhere else. There-
fore, to term the narrow junction of the sigmoid
and rectum the sigmoido-rectal pylorus is по
misnomer. The anatomy and physiology of this
sigmoido-rectal pylorus, moreover, resembles in many
ways the gastro-duodenal pylorus, a point which the
writer will deal with more fully in the near future.
It is no mere narrowing, but a true guard of the gate-
way from the sigmoid to the rectum. Іп chronic
dysentery and in cases of colitis, this point will be
found tender to palpation from the surface of the
abdomen, at a point on the left side almost corre-
sponding with McBurney’s point on the right side in
cases of appendicitis. Examination of the bowel at
this point by the sigmoidoscope will elicit tenderness, at
times exquisite; the mere touching of the point with
& piece of cotton wool in а holder introduced through
the sigmoidoscope will, as a rule, cause the cotton
wool to be blood-stained, and the introduction of &
long tube, say an cesophageal tube, through the bowel
at this part introduced along the sigmoidoscope, will
show that it is painful, that there is initial resistance
to the tube of a spasmodic character, and that the
tube is firmly grasped when it has been passed through
and away up to the upper end of the sigmoid flexure
or lower part of descending colon.

Stricture at this part is а common lesion in chronic
rectal troubles, and without going into the matter
further in the present paper, it is а condition which
the writer has come to recognise and to deal with in
the treatment of many forms of intestinal flux. The
treatment consists of dilatation of the stricture, prac-
tised with the same intent as in cases of stricture of
the urethra, and followed by ав beneficial results in
the rectal as in the urethral lesions. Тһе nature of
the stricture and the attendant clinical features of
these two mucous tracts resemble each other closely,
and their cure is effected by similar manipulations.
To attempt to cure & sigmoido-rectal stricture by the
introduction of a long tube without the sigmoidoscope,
is to ensure failure. The sigmoidoscope must be in-
troduced as far as possible, that is until mechanical

September 15, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE.

279

resistance and pain prevent its further introduction,
and with the instrument held in position the
cesophageal tube is passed along the tube of the in-
strument and held firmly against the sigmoido-rectal
pylorus until the initial spasm is overcome, when it
will slide up in the higher part of the bowel, with
some pain, perhaps, but with the knowledge that the
first step has been made in the cure of a rectal trouble
which may have been of long duration and of a serious
nature.

oh Be ene

“ Archiv. für Schiffs und Trop. Hyg.,” vol. x. No. 2.
MALARIAL IMMUNITY.

Plehn, A., from clinical experience gained in Cameroon,
concludes that personal immunity in a malarial district
can only be relative and never complete. Old European
residents in malarial countries seemingly attain ап
immunity. which ін not a true immunity, but а mere
tolerance which is not absolute. Апу condition which
tends to lower resistance, such as fatigue. sudden
change in temperature, chills, accidents, or illness from any
cause is apt to be attended by a suddenly increased virulence
of the parasite or the toxins it produces. Malaria would
seem to be latent in most, if not all, residents in malarial
districts, and any departure from the even tenour of climate
or the daily routine of life would seem to render the latent
malaria active.

Natives of the Cameroon district who have never had
febrile attacks, who have no enlargement of spleen, nor any
signs of illness, may have malarial parasites in their blood ;
others, again, have enlarged spleens and some anemia, and
vet are free from fever. Neither of these states, however,
betoken immunity, for were these persons subjected to
depressing influence such as confinement iu. prison, attacks
of fever are almost certain to result. Тһе relative immu-
nity of many natives seems to be inborn, that is to say, the
child acquired immunity during fatal life by being exposed
to the endotoxins in the maternal blood: and after birth,
although attacked by malarial parasites, which find their
way into the blood through mosquito bites. уеб is the child
provided to some degree by the parasite poison present in
its blood at birth.

Dr. Plehn is of opinion that Europeans arriving in a
malarial district of the tropics сап be also rendered relatively
immune by the exhibition of quinine as a prophylactic.
The quantity should be not less than seven grains, and the
dose should be taken every fifth day. or if a large dose is
preferred seven grains on consecutive days, either the fourth
and fifth or the fifth and sixth. Quinine should be taken
during the whole period of residence in a malarial district,
and continued for at least six months after arrival іп a non-
malarial country.

When a large dose of quinine, say fifteen grains every
fifth day, fails to prevent fever, the patient should be sent for
change to а healthy (non-malarial) climate. and quinine
administered every fifth day in seven grain doses for six
months.

“ Comptes Rendus de la Société de Biologie,” November, 1905.

* Anopheles algeriensis et Myzomyia hispaniola convoient
le paludisme." By Edmond and Etienne Sergent.

Messrs. Sergent have discovered the presence of sporozoit
forms of the malarial parasite in the salivary glands of
specimens of Anopheles algeriensis әлі Myzomyia hispa-
niola. These two mosquitoes have therefore to be added to
the list of species capable of conveying malaria in Algeria ;
they are, however. both * wild," and are rarely found in
dwelling-houses.—J. E. N.

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Journal of Tropical Medicine

SEPTEMBER 15, 1906.

THE BRITISH MEDICAL ASSOCIATION MEET-
ING AT TORONTO, CANADA, AUGUST 21
TO 24, 1906.

Some 2,000 medical men attended the meeting of
the British Medical Association, which was held in
the buildings of the University of Toronto.

The meeting was a success in every way, the papers
and discussion were scientifically valuable, the social
arrangements were quite perfect, and the excursions
to neighbouring and distant places of interest were
carefully planned and conducted.

The retiring President, Mr. George Cooper Franklin,
of Leicester, England, gave an account of the work of
the Association during his year of office, and intro-
duced the new President, Dr. R. A. Reeve, Dean of
the University of Toronto. The Mayor of Toronto,
Prof. J. Н. Cameron, Prof. Alexander McPhedran
and Dr. G. A. Bingham, delivered addresses of wel-
come .on behalf of the city of Toronto, the local
reception Committee, and of the Canadian and
Ontario Medical Associations respectively.

The President, Dr. Reeve, after pointing out the
cosmopolitan character of medical study, reviewed the
early history and development of the British Medical
Association, and referred to the advancement of
medicine during the last ten years. Amongst the
important subjects dealt with and advanced during

THE JOURNAL OF TROPICAL MEDICINE.

[September 15, 1906.

that period, he mentioned: (1) The new ideas brought
forward in regard to the mechanical and chemical
processes accompanying digestion, especially in the
stomach ; (2) the necessity for pure milk in the rearing
of infants; (3) the researches in physiology by Sir
Victor Horsley; (4) the discovery that pneumonia was а
septic disease; (5) the introduction of “vaccine” for
diphtheria and typhoid fever; (6) the discovery of &
specific microbe in cerebrospinal meningitis; (7) the
full recognition of the fact that yellow fever and
malaria were carried by mosquitoes ; (8) the extraor-
dinary advances in preventive medicine.

The address in medicine was delivered by Sir
James Ватт, M.D., F.R.C.P. He chose for his subject
‘The Circulation Viewed from the Periphery.”

Of the many interesting items in this erudite paper
the following are noticeable: (1) As under normal
circumstances & sufficient quantity of blood cannot
get through the arterioles to keep the enormous
capillary bed full, the lateral pressure and the velocity
in the capillaries are ever-varying quantities; the
pressure variations ranged from 50 to 2,000 mm. of
water. (2) The variations of velocity of the blood
in the capillaries amounted to from about 0:5 to
25 mm. per second. (8) The effects of gravity in the
capillary pressure is an increase usually less than
one-half of the hydrostatic effect, nor is the increase
uniform, varying enormously in different individuals,
and in the same individual under different conditions.
(4) The viscosity of the blood is normally about five
times that of distilled water, and in many diseases
it amounts to nine or ten times that of distilled water.
In Asiatic cholera the viscosity is often so great that
it will not pass through the capillaries. А rise in
temperature lessens the viscosity; the presence of
carbonic acid gas in the blood is associated with
diminished velocity and increases the viscosity, and
Watson and Denning state that the chief resistance
to the flow is due to the viscosity, and occurs in the
capillaries. There seems, however, no doubt that the
resistance to the arterial flow, and consequently to
the heart, is situated in the first instance in the
arteriole and small arteries and governed by vasomotor
nerves. Were there not some such “ first line of
defence,” the blood would gravitate into the more
dependent parts, the cooling surface would be enor-
mous, the capillary velocity would be diminished, the
blood would become surcharged with carbonic acid
gas, and we would become cold-blooded animals. By
vasomotor mechanism a large amount of the cardiac
energy is stored up in the arteries as potential, and is
converted into kinetic energy in the arterioles and
capillaries. Sir James Barr further discussed: The
interchange of material through the capillary walls;
the arterioles and capillaries of the skin ; the arterioles
and capillaries of the splanchnic area; the capillaries
of the liver, the arterioles and capillaries of the
kidneys and of the muscles; the cerebral vessels ;
the coronary vessels; the pulmonary circulation ; the
veins; the pressure in the veins; the velocity in the
veins; the arteries, arterial blood pressure, and the
heart.

Sir Victor Horsley, F.R.C.S., F.R.S., in his address
in Surgery, dealt with “Тһе Technique of Operations
on the Nervous System.” Surgical treatment of brain

affections are undertaken for palliative or curative
purposes. Ав а palliative measure against optic
neuritis, whieh is so common a symptom of intra-
cranial disease, it would seem that blindness may
be averted with something like certainty by opening
the subdural space early, and preferably in the basal
temporal region of the right side, assuming that no
attempt is made to attack the disease itself. Curative
surgical procedures depend (1) On the nature of the
intracranial disease; (2) the loss or aberration of
nerve function it eauses; (3) whether if the lesion
be wholly extirpated there will be a recovery from
the disorder of function; (4) whether any loss which
may have been present before operation will be made
permanent by the necessary extirpation of particular
regions of the brain.

On points like the last it is evident that we cannot
give a satisfactory opinion until we know precisely,
first, what parts of the central nervous system alone
contain the representation of movements or the record
of sensation, and consequently of what parts does
destruction entail permanent loss of function. In
other words, we require to learn from the cerebral
physiologist under what circumstances and to what
extent can we get compensation of function when
various parts of the cerebrum and cerebellum are
destroyed.

(1) As regards the Cerebrum.— Apparently from
the clinical records we can generalise thus far, that
special motor functions cannot be restored if the
whole of their cortical representation be removed.
The same thing is probably also true of the special
senses, and certainly is true of the hemianopic repre-
sentation of sight. Succinctly stated, this amounts
to the generalisation that compensation is not possible
after the destructiun of middle leval centres. The
higher sensory representation and a fortióri the
intellectual functions are, on the contrary, not per-
manently abrogated by the destruction of any one
part of the cerebral hemisphere. The net conclusion,
however, must be that as little injury as possible
should be done, and no more removed than is abso-
lutely necessary.

(2) As regards the Cerebellum.—This question of
compensatory power is of notable scientific interest
when studied in the cerebrum, which is so clearly an
assemblage of different nerve centres (in fact we
might almost say organs), but it is no less interesting
in the study of a homogenous structure like the
cerebellum, and has assumed а particular impor-
tance in the present subject because of Professor
Frazier’s proposal to extirpate the lateral lobe of the
cerebellum in preference to pushing it aside by dis-
placement for the purpose of reaching deep-seated
tumours. My own experience is against such extir-
pations for convenience. In fact, I regard them as
an unnecessary mutilation, though quite admitting
that in the process of removing a large tumour in
that region the cerebellum is considerably bruised
when so pushed aside. I ought to add that although
J have removed a considerable number of lateral re-
cess cerebellar growths, I have never found it neces-
sary to do more than compress the cerebellum
aside.

Sir Victor Horsley then proceeded to describe ** Con-

September 15, 1906.) THE JOURNAL OF TROPICAL MEDICINE.

281

sideration of the Details of Operative Procedure,” and
referred to (a) Previous Preparation ; (b) Anesthesia;
(c) Maintenance of the Body Temperature; (а)
Hemorrhage from arteries, arterioles and capillaries,
and from veins. The address was illustrated by many
excellent drawings.

The address in obstetrics was delivered by W. S. A.
Griffith, M.D., F.R.C.P., F.R.C.S., who chose for his
subject, ** The Teaching of Obstetrics.”

SECTION or MEDICINE.
President: Sir THomas Bartow, Bart.

Dr. Perey M. Dawson (Baltimore) opened a discus-
sion on “ Blood Pressure in Relation to Disease.” Не
stated that the pulse pressure might be taken as an
index of the systolic output of the heart.

Dr. G. A. Gibson (Edinburgh) dealt with “ Clinical
Methods of Investigating Blood Pressure.” The
various factors concerned in keeping up the blood
pressure are: the initial pressure or energy of the
heart, the peripheral resistance, especially that of the
splanchnic area, the elasticity of the vessel, the
amount of blood in circulation and the viscosity of the
blood. Estimating blood pressure by so-called tactus
eruditus was condemned, and could only be gauged
by modern instruments of precision. Observations
should always be made with the patient in the hori-
zontal position, owing to the variations due to various
positions; and the variability noticeable according to
the time of day the observations were made, and the
influence of food and occupation were also insisted
upon.

Sir William H. Broadbent, Bart., (London) dis-
cussed “Тһе Clinical and Therapeutical Indications
of Morbid Blood Pressure,” and stated that (actus
eruditus was the ultimate means of investigation, and
that the real place of the instrumental investigation
was the education of the finger.

Professor T. Clifford Allbutt (Cambridge) read a
paper оп “Тһе Relation of Blood Pressure to Arterial
Sclerosis.” Arterial sclerosis may be apportioned under
three headings: (1) The toxic, in some of which it is
increased, as in lead poisoning; in some diminished, as
in syphilis: (2) Hyperpietie (prolonged high pressure),
in which there is considerable arterial stress, the
majority being subjects of granular kidney ; (3) In-
volutionarily, met with in senile degradation, and
associated with trophic or mechanical causes. These
various groups of causes might be combined.

Dr. J. Mackenzie (Burnley), Dr. J. Lindsay Steven
(Glasgow), Professor Alexander McPhedran (Toronto),
and Dr. G. W. McCaskey joined in the discussion.

Dr. A. Stengel (Philadelphia) read а paper entitled
“ Some Clinical Manifestations, Visceral and general,
of Arterio-sclerosis.” He stated he had found con-
tinuous fever, lasting over considerable periods of
time, in arterio-sclerosis without any local lesion to
account for it, such as myelitis or other infection, and
regarded the fever as possibly due to the active dis-
organisation of the tissues of the vessel wall, on the
analogy of ferment fever.

Prof. Russell H. Chittenden (Yale) opened the dis-
cussion on *' Over-nutrition and Under-nutrition, with
Special Reference to Proteid Metabolism." Five men
were fed for periods of from six to nine months on an

average daily metabolism of from 5:4 to 8:99 grammes
of nitrogen, t.e., 34 to 56 grammes of proteid per day.
In three cases, individuals of different weight, the
amount of nitrogen required was 0:1 0:93 and 0:102
grammes respectively per kilogramme of body weight,
amounted to not more than half of the Voit standard.
Prof. Chittenden was of opinion that 0:1 gramme of
proteid capable of metabolism per kilogramme repre-
sented the minimum proteid requirement, but it would
probably be advisable to adopt a standard somewhat
&bove this figure, and to give from 50 to 60 grammes
of absorbable proteid to & man of from 60 to 70 kilo-
grammes weight, ie. а reduction of about 50 per
cent.

Prof. Halliburton (London) was of opinion that if
we reduced the amount of proteid to the minimum
necessary to subserve the repair of waste of the tissues
we should be dangerously near the margin, and little
would be left ав а source of energy. Dr. Otto Folin
(Mass) said, at present there were no data where-
by to determine the amount of proteid necessary.

Dr. Robert Hutchison (London) remarked that it
would be interesting to ascertain the opsonic index in
persons taking a lessened nitrogenous diet, in regard
to various diseases producing organisms, and the way in
which such individuals passed through an acute illness.

Prof. L. Lapicque (Paris), Dr. C. B. Ramarao
(Madras), Sir James Grant (Ottawa), and Sir Thomas
Barlow (London), took part in the discussion.

Dr. L. F. Barker (Baltimore) read & paper on
* Amino-acids and Metabolism," the study of these
acids present in foods showed that & human being
took about the same quantity of these bodies, whether
fish, white meats, or butcher's meat were taken, and
the chemist was by synthesis now preparing from
these & series of substances called peptides, viz.,
dipeptides, tripeptides, and polypeptides.

Dr. W. B. Thistle (Toronto) read а paper on ‘ The
Treatment of Typhoid Fever." Purgatives were sug-
gested being given throughout the illness, so as to
insure increased elimination of the typhoid organisms
and their toxins. Calomel and salol were advocated
ав being at once purgative and antiseptic in the treat-
ment of the disease. Dr. W. Caldwell (Belfast) said
that the mortality of cases of typhoid fever which
suffered from constipation during the curse of the
fever was less than those in cases in which diarrhoea
was the rule, and therefore he avoided purgatives.
Dr. F. M‘Crae (Baltimore) said that typhoid was a
blood or general infection, not a local intestinal
affection, and therefore he withheld purgatives as
unscientific, and intestinal antiseptics as useless. Dr.
W. Н. Neilson (Wisconsin), Prof. McPhedran, Dr.
Barker, and Dr. J. H. Hamilton (Ontario) also
joined in the discussion. .

Dr. F. J. Smith (London), in a paper entitled ** The
Treatment of Typhoid," favoured a more varied diet
than the milk and beef tea treatment ordinarily
followed. The dread of perforation from food was
exaggerated; perforation and hemorrhage in typhoid
had other causes than dietary. Any digestible food
that was neither hard nor sharp-edged might be given
in place of milk, which favoured fermentation at
times, and was apt to cause distention and tym-
panites. The height of the temperature did not

282

negative departure from the milk regime. In cases
in which the patient was disinclined for food, water
and fruit; juice might be given freely.

Dr. McCallum (Ontario) pointed out that it was
difficult to state what a solid diet meant, for what
was solid in the mouth might be fluid in the intestine,
and vice versa.

Dr. R. Hutchinson (London) believed that to the
lactic acid contained in it was probably due the
beneficial action of milk; the question of diet, there-
fore, was not altogether a mechanical one.

Dr. McCaskey regarded milk as an unsafe diet in
typhoid, considering the large masses of casein one
found in the intestine in consequence of taking milk.

Sir Thomas Barlow remarked on the craving for
food many typhoid patients developed, and it was &
question whether it was always wise to deny them
a suitably varied diet. Scraped beef or meat or fish
passed through a seive, were often well tolerated іп
typhoid, and seemed to cause no special intestinal
trouble.

Dr. D. G. Spiller (Philadelphia) described a case
of syringomyelia, reaching from the sacral region of
the cord upwards along the medulla oblongata, the
right side of the pons, the right cerebral peduncle,
and as far as the right internal capsule (syringo-
bulbia).

In reply to Dr. C. Meyers, Dr. Spiller stated that
he believed the sensation of pain (which was present
in this case) was conduoted by Gowers' tract, and not
by the lateral columns.

Dr. S. Flexner (New York) read a paper on ‘‘ The
Serum "Treatment of Cerebro-spinal Meningitis," in
which he stated that he had succeeded in isolating
&n organism showing constant features, to which
was assigned the name Піріососсив intracellularis.
Against this he had prepared an antitoxin, made
from monkeys, and 1 c.cm. of this substance injected
into the spinal canal of a monkey which had previ-
ously received a lethal dose of the organism, prevented
death. The signs and symptoms of the disease could
be produced in monkeys by repeated doses of the
toxin. Dr. L. Steven (Glasgow) said an outbreak of
cerebro-spinal meningitis prevailed in Glasgow in
March, 1906, and it was now included among the
notifiable infectious diseases. Dr. MacFarlane (Al-
bany) believed the best form of treatment in cerebro-
spinal meningitis to be repeated tapping of the spinal
canal. He was of opinion that the disease gained
access to human beings by way of the pharynx.
Seeing that it was impossible to inject fluid into the
spinal canal in sufficient quantity to find its way
to the cerebral cavity, the limitation of experimental
meningitis to the spinal canal was probably explained.
Dr. J. J. Putnam (Boston) compared “ certain modern
philosophic doctrines with regard to their relation-
ship to the therapeutics of psychasthenia.”

Dr. G. Doch (Ann Arbour) dealt with “ Para-
centesis of the Pericardium,” stating that the operation
was always attended by danger, be the precautions
what they may. Posture seemed to have to do with
the success of the operation, as, by altering the posture
could fluid be drawn off. Тһе angle between the
xiphoid cartilage and the seventh left costal cartilage
seemed the spot best suited for tapping the peri-

THE JOURNAL OF TROPICAL MEDICINE.

[September 15, 1906.

cardium. Dr. T. B. McConnell (Montreal) mentioned
a case of accumulation of fluid in the pericardium, suc-
cessfully treated by tapping, and subsequent incision
and drainage. Sir Thomas Barlow stated that he
favoured incision in preference to aspiration in peri-
cardial effusion, and said that fluid and fibrin collected
behind the heart.

Dr. Н. A. M‘Callum (London, Ontario) introduced
the subject of Gastric Neurasthenia, which was dis-
cussed by Drs. Putnam, McPhedran, Walsh and
Caldwell.

Dr. Campbell Myers (Toronto) advocated spinal
treatment for cases of acute mental disease during
the preinsane stage. In this contention he was sup-
ported by Dr. Putnam (Boston).

SuRGERY.
President ; Sir HECTOR CAMERON.

Mr. Sinclair White (Sheftield) opened the discussion
on “Тһе Surgical Treatment of Ascites Secondary
to Vascular Cirrhosis of the Liver.” He proceeded
to show the advantage of this operation, and stated
that absolute proof has been obtained that epiplopexy
leads, in suitable cases, to a remarkable development
of anastomosing vessels between omentum and liver.

Mr. G. Guy Turner (Newcastle-on-Tyne) took part
in the discussion.

Mr. John Lynn Thomas (Cardiff) read a paper on
" Enuocleation of the Prostate." Не stated that
enucleation of the prostate should be undertaken as
soon as the patient was compelled to face the risks
of “ catheter life." Не stated that there were no
pronounced advantages of the suprapubic over
the perineal method of enucleation so far as the
incidence of mortality was concerned, but that the
suprapubic operation showed slight advantage in
regard to more complete removal of the organ. In
the discussion which followed, a decided preference
was shown, on the part of American surgeons, for
the perineal route.

Dr. С. E. Armstrong (Montreal) reported а case
of “ Successful Removal of the Spleen in a Case
of Banti’s Disease.”

Dr. Dow (Regina, Sark) showed a case of plastic
surgery of the hip joint (arthroplasty), which had
been successfully performed by introducing a layer of
fascia and fat between the end of the divided
femur. :

Dr. Ingersoll Olmsted (Hamilton, Canada) in a
paper on “Тһе Surgical Treatment of Ulcerative
Colitis,” referred to the advantages of appendicostomy
and irrigation of the intestine through a catheter,
introduced into the appendix, after the manner origi-
nated and practised by Dr. Weir, of New York.

In а discussion on “Тһе Surgical Treatment of
Duodenal Ulcer,” Dr. W. J. Mayo (Rochester, Minn.)
recommended gastrojejunostomy as the most advan-
tageous operation in chronic cases. In acute cases
with perforation, transverse suture of the ulcerated and
perforated area with pelvic drainage is indicated, with
gastrojejunostomy subsequently. The results of this
operation are eininently successful; of 175 reported
cases of chronic duodenal ulcer operated on, two deaths
only occurred; of ten cases operated upon for acute

September 15, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE.

283

perforation, four died; and of three cases operated
upon for repeated hamorrhage one died.

Mr. G. C. Franklin (Leicester) joined in the dis-
cussion, and mentioned that when a duodenal ulcer
perforated the signs and symptoms were intense
agonising pain in the upper part of abdomen, with
locally rigid muscles.

Dr. В. E. McKenzie (Toronto) stated that in ** The
Treatment of Congenital Club-Foot,” tenotomy and
simple mechanical appliances were preferable to the
more heroic measures in fashion. The tenotomy ought
to be performed not earlier than the twelfth month
of infant life.

Mr. Harold Stiles (Edinburgh) stated that he prac-
tised tarsectomy extensively in cases of club-foot,
and claimed that by this means better and more
speedy results were attainable than by tenotomy and
mechanical appliances.

Prof. W. G. McCallum (Baltimore) in a paper en-
titled ‘‘The Surgical Relations of the Parathyroid
Glands,” stated that the acute tetany which occasion-
ally followed removal of the thyroid gland, was owing
to the fact that the parathyroid bodies were removed
at the same time. The bodies referred to were met
_ with, as a rule, along the course of the inferior thyroid
arteries, but their number and position varied. "That
their removal was apt to cause tetany had been proved
in both animals and man, and their preservation ought
to be looked to during the steps of the operation for
removal of the thyroid, when possible. Sir Victor
Horsley discussed the paper.

Mr. С. J. Bond (Leicester) read a paper on “ The
Treatment of Acute Septic Peritonitis,” in which he
stated: (1) It is most important to avoid all unneces-
sary injury to the endothelium. (2) The diaphrag-
matic portion of the peritoneum is of great importance
in the absorption of fluids and in phagocytosis. (3)
Phagocytosis and the protection afforded by the
endothelial cells lining the peritoneum constituted the
first line of defence in injuries and diseases of the
&bdominal cavity. (4) Destruction of the cells opens
the way for infection to be diffused by vascular or
lymph channels. (5). Perforation of gastric or duodenal
ulcers, followed by extravasation of the visceral con-
tents into the peritoneal cavity was not followed by &
virulent infection, and if early operation was practised
curative results might be confidently anticipated. (6)
Irrigation should be freely practised after laparotomy
when gastric or duodenal contents, feces, pus, bile
or urine were found in the peritoneal cavity. (7)
Irrigation should be withheld when the exudation into
the peritoneal cavity was of a (a) sticky fibrinous
nature; (b) when phagocytosis was likely to be dis-
turbed ; (c) and when the flushing of the cavity was
likely to cause ditfusion of the infective material. 18)
In cases of gangrene of the intestine, and in local
abscesses free drainage is а necessity. Dr. W. Howitt
(Guelph), Dr. Murphy (Chicago), Dr. W. J. Mayo
(Rochester) and others, joined in the discussion.

Mr. Jenkins (London) read a paper on “Тһе
Causation of Congenital Dislocation of the Hip.”
He ascribed the condition to be due to arrest in
the bony development of the superior portion of the
acetabulum.

Мг. С. С. Turner (МемсавИе-оп-Гупе) read а com-

munication on “ Intestinal.Obstruction in Association
with the Vermiform Appendix."

Dr. Parkins (Toronto) showed а case of multiple
tumours in both breasts of a female patient.

Mr. C. H. Whiteford (Plymouth) showed а method
of retaining & rubber catheter after external urethro-
tomy by means of what he termed a perineal stop.

A SIMPLE PREVENTIVE AGAINST
MALARIA.

A CIRCULAR, published in English, Singalese and
Tamil, is being circulated by the Ceylon Agricultural
Society in Ceylon, drawing attention to the use of a
composite oil for anointing the body to prevent mos-
quito bites. The suggestion is made by E. E. Green,
К.Е.8., and M. Kelway Bamber, F.C.S.

The constituents of the fluid suggested are citronella,
kerosine, and cocoanut oils, with & certain proporticn
of carbolic acid. Ав an alternative for cocoanut oil,
vaseline can be employed, but is more expensive.

Citronella oil aione is too dear for general use, and
its effect is evanescent. Kerosine oil is similarly
fugitive, and has the additional objection of an un-
pleasant smell.

It was found by experiment that a mixture of the
above ingredients in certain proportions completely
disguised the objectionable odours of kerosine and
cocoanut oils, and produced a limpid liquid, smelling
only of citronella, with a far more lasting effect. Тһе
mixture of the more inexpensive oils so reduces the
cost that it can be freely einployed on a large scale,
and such a mixture could be easily produced locally
on a commercial scale at а reasonable cost. The
great difliculty with coolies is to induce them to take
any precautions ; but we know that they are always
ready to anoint themselves either with cocoanut oil or
with citronella if they can get it; but the latter is
generally beyond their means.

АШ employers of labour іп feverish localities
should insist upon their coolies taking the simple
precautions here suggested.

Every evening, at dusk, small quantities of the
mixture should be rubbed over the legs and arms, and
any other exposed parts, including the face; the oil
is quite free from ány harmful or unpleasant effect on
skin.

—————49— ————

Report.
THE HEALTH OF THE BRITISH NAVY—
REPORT FOR THE YEAR 1904.

Тне recently issued statistical report of the health
of the Navy for the year 1904 extends to 197 pages.

The invaliding ratio of the total force amounted to
99:7 per 1,000, a decrease of 7:28 in comparison with
the average for the last seven years.

The death-rate was 4:45 per 1,000, а decrease of
1:01 per 1,000 on the average of seven years.

The death-rate from disease alone was 3:14 per
1,000.

THE JOURNAL OF TROPICAL MEDICINE.

{September 15, 1906.

GENERAL DISEASES AND NUMBER OF CASES.

H.= Home; E.I. = East Indies; M. = Mediterranean ; S.A. =
South Atlantic; C. = China ; N.A. = North America: IF. = Irre-
gular Fores; А. = Australia; DP... Pacific; C.G.H. = Саре of
Good Hope.

Cases | Deaths Stations
— ——— ———— ——— ———
Small.pox .. is pes 12 0 H.1;El.2;C.9
Cow pox .. E 0 218 O0
Chicken-pox іш io 99 0 |Н.11;5.А.10
Measles 9 | ais! 0 (Н; 293; EL 8: C. 3;
І M. 2; I.F. 12
Rubella .. T PE 47 0 |Н.30;ЕЛ.1;Х.А/7;
M.T; LF. 2
Scarlet Fever — .. ЕТ 179 4 |H. 169; М.А. 3; ТЕ.
Dengue .. 22 жесі 26 0 1С. 25; МА. 1
Typhus Fever... 5s 1 — 16.1.
Influenza .. ee -», 1,586 1 ІН. 1083; М. 311;
| S.A. 16; N.A. 11;
! P. 4; С. 37; A. 3L;
I.F. 93
Mumps .. ds -) M3 20 |Н, 53; C. 27; A. 48
Diphtheria E ss 29 1 |H.23; M. 5; LF. 1
Plague... 2% a 1 — [ЕТ
Cerebro-Spinal Fever .. | 2 2 |H.1;C.1
Simple Continued Fever | 1,035 0 |H. 54; ЕІ. 310;
N.A. 11; S.A. 14;
! Р.5; M. 401; А. 8;
C.G.H. 27; I.F. 84
Enteric Fever .. | 276 39 | H.51;E.1.6;N.A. 25;
i P.3; M. 61; C. 49;
C.G.H. 5; LF. 17
Mediterranean Fever 130 9 |H.59;E..1; N.A.1;
M. 333; С. 12;
C.G.H. 1; LF. 22
Dysentery.. із zs 113 29 |H.10;E.I. 40; $.4.4;
P. 3; М. 16;
! C.G.H. 1; C. 36;
I.F. 23
Yellow Fever .. at 1 1 |ІЕ. (Jamaica) 1
Malarial Fevers .. zs 693 5 ІН. 167; КІ. 122;
М.А. 27; S.A. 115;
P. 3; M. 45;
C.G.H. 62; C. 105;
! I.F. 29
Septic Diseases .. Шы 34 12
Tubercle .. a A 456 64 ІН. 972; ЕЛІ. 1;
| N.A.9;S.A. 8; P. 4;
M. 75; C.G.H. 10;
| 4 C. 39; H. 17; I.F. 21
Venereal Diseases :12,258, 10 |
Rheumatism $e e, 2,36 ігі
Gout Us = Re 150
Malignant Growths x 9 R
Non-malignant Growths | 153 —
Diabetes .. - ee 8 2
Beri-beri .. 5% ққ 4 0 |E.I.3;C.G.H. 1

THE PROPORTIONS OF SICKNESS AND DEATHS IN THE SEVERAL

STATIONS.
Sickness J E
Station Strength pe ЕҚ "000 Pen
самым -— e Ó— Eos
Home .. ve 2% 59,470 121397 | 4:27
Mediterranean ЕЗ 19,590 68657 4:38
North America and 2,910 914-77 | 3:78
West Indies |
South Atlautic 1,780 990 44 3:37
Pacific .. 2s ue 1,990 704 :65 8:87
Cape of Good Hope .. 2,270 904°4 27 628
East Indies V 1,930 1,22279 10:36
China .. 10,180 779-56 4:91
Australia i 2,970 794-94 7:07
Irregular Force 8,180 9:42

86222 |

The following papers appear in the report :—

І.-боме FurtHer Points IN THE Етіоговү or MEDI-
TERRANEAN FEVER, WITH PARTICULAR REFERENCE
то THE GROWTH OF THE SPECIFIC ORGANISM
OUTSIDE THE Bopy.

By Fleet-Surgeon P. W. Вазяктт-5мітн, R.N.
Royal Naval Hospital, Haslar.

Major Horrocks, R. A. M.C., proved conclusively that
the Micrococcus melitensis escapes by means of the
urine from patients suffering from the disease. The
urine thus containing the m.m. might then convey the
disease by fresh or sea water, clothing or soil.

A few observations on similar lines were carried out
and incorporated in the Report on the Etiology of
Mediterranean Fever in the Health of the Navy,
1901, but the organism employed was derived from
artificially infected human urine, or had grown for
some period in urine, which did not appear in any
way to reduce its vitality.

The most noticeable facts were that in even moder-
ately alkaline urine the growth seemed to thrive for
a time, not dying out until it gave a very considerable
alkalinity (in one, that of standard decinormal soda
solution), and that the larger the quantity of urine
in the test tube infected, the longer the growth re-
tained its vitality, and, of course, the grosser the
original infection the more abundant the growth.

Fleet-Surgeon Bassett Smith by a series of experi-
ments investigated the viability of the M. melitensis
in sterilised urine, in sea water, in tap water, in
fabric which had been infected and slowly dried, and
in artificially infected dust.

The results of vitality of the m.m. outside the body
shows that the m.m. can retain its vitality for a long
period :—

(1) In urine which has become markedly alkaline.

(2) In fabries which have become contaminated by
urine containing the m.m.

(3) In sea and tap water infected by urine.

(4) In soil that has been infected by urine, and
that has dried naturally.

From the experiments one may gather that in any
endemic region where the sanitation is bad, it is easy
for the dispersion of the organism and possible in-
fection of the healthy to take place, quite apart from
any agency of insects as secondary hosts.

II.—FunTHER Notes ом THE DISTRIBUTION оғ MEDI-
TERRANEAN FEVER IN THE FLEET, WITH REFER-
ENCE TO ITS ETIOLOGY.

By Fleet-Surgeon P. W. Ваѕзетт-Ѕмітн. К.Х.
Haslar Hospital.

"In continuation of the statistical reports of the
occurrence of Mediterranean fever, made in the years
1901. 1902, and 1903, I have again for 1904 made an
abstract of the results from the special forms which
have been filled in, details of which are given below.
The total number of cases thus furnished is 260, ая
against 302 for 1903.”

“ Of these 260 cases 19 were relapses, giving a total
of 241 fresh ones; some instances of the fever which
occurred on the station have undoubtedly not been

September 15, 1906.)

included, none of these, probably, having been admitted
into the Malta bospital.”

“Тіс diagnosis was confirmed in every case by the
“serum reaction” test, either at Malta by Statt-
Surgeon Gilmour, or by myself at Haslar."

“ The observations of this year tend more conclusively
than before to indicate that though sporadie cases
of Mediterranean Fever do probably oceur at other
ports of the Mediterranean, by far the most prolific
centre of infection is Malta itself."

III.—ON THE AGGLUTINATION REACTION IN
MEDITERRANEAN FEVER.

By Staff-Surgeon E. A. Suaw, R.N.

Time of its Appearance.—Agglutination reaction is
manifest in blood taken from cases quite early in the
disease, viz., from two to five days.

Amount of Dilution in which it is Obtainable.—In a
dilution of 1 in 2, the blood of healthy people and
of patients suffering from other diseases will nearly
always give it, and a large proportion of them will
show traces of it in a dilution of 1 in 10.

Duration of Ayglutinating Power after Appearance. —

Birt and Lamb found it in all cases examined up to
two years after the attack. After two years it was,
in 8 out of 14 cases examined, no more marked than
in people who had not had this fever; they record
one case in which, seven and a-half years after
recovery, there was still a complete reaction in a 1 in
20 dilution.

The phenomenon of agglutination in Mediterranean
Fever is, as a rule, very marked and unmistakeable.
The appearance of little white clumps, aggregations of
micrococci, іп the mixed drop of the specific serum
&nd emulsion is frequently visible to the naked eye,
especially on comparison with the control, and for
the mere determination of the presence of agglutina-
tion in a 1 in 30 dilution, often a good pocket lens is

sufficient after а certain amount of experience has `

been gained. It is advisable, however, especially at
first, to commence with the low power of the micro-
scope, the 2-inch objective, arranging a feeble illumina-
tion ; if a strong illumination be used, the micrococci,
which, it must be remembered are not stained, will
he practically invisible in the glare. Without dis-
turbing the relative positions of the Abbé condenser
and the plane mirror as used with the j,-inch
objective, the desired reduction of illumination can
be obtained by racking down the two from near the
stage till the upper surface of the Abbé condenser is
very nearly an inch away from the upper surface of
the stage on which the slide rests. Then, first wiping
off all moisture from the under surface of the slide, and
examining firs& the control—this, if properly made,
will be found to present a very fiue, faintly granular,
appearance, without any indication of clumps then
proceeding to the lowest dilution of specific (Malta
fever) serum and micrococci, the latter, if agglutina-
tion has taken place, will һе found aggregated into big
clumps, or into a fine network spreading throughout
the drop, usually both appearances will be present
in the drop; then the higher dilutions should be
examined, and the highest one in which agglutination
has taken place, noted. No cover slips are necessary

THE JOURNAL OF TROPICAL MEDICINE.

985

. for the examination with the ž-inch objective, but if,

at the end of & couple of hours, no sign of agglutina-
tion can be detected with the 3-inch objective, a
small cover slip should be placed on the control and
on the lowest dilution, and comparison made with
the 2-inch objective; this will necessitate the
approaching of the Abbé condenser to within about
-inch of the surface of the stage, more light being
required with the higher power, but, as before, a
feeble illumination is best. If now no trace of
agglutination can be detected, the result of the
examination should be recorded as negative. It is
highly desirable that, for the purpose of comparing
the results obtained by different observers, some
common standard should be agreed to. As regards
density of emulsion used, this ideal is very difficult
of attainment, but as regards length of time allowed
for agglutination to appear and power of microscope
used, there should be no difficulty. In the last
hundred cases I have examined, I have invariably
found agglutination, if present, to manifest itself in
less than one hour, and to be visible under the 3-inch
objective. This reaction is much more marked and
definite than the corresponding one in typhoid fever.

IV.—NorEs ON THE TREATMENT AND SYMPTOMS OF
MEDITERRANEAN FEVER.

By Fleet-Surgeon D. J. МсХавв, R.N. |

Forty-two cases are brought under notice and dis-
cussed in these notes.

In the general management of these cases it was
found that they assimilated ordinary solid food with
benefit to themselves, irrespective of high tempera-
ture. ;

Numerous drugs were tried without any appreciable
result, the only one appearing to be of benefit being
cyllin.

Vm his drug is & preparation of the Jeyes' Sanitary
Compounds Company, and appears to be а coal tar
derivative.

The preparation used was pure cyllin in palatinoids,
each palatinoid containing 3 minims of the drug.

The course of treatment by cyllin was inaugurated
by a purgative such as calomel, and the drug was
given at the rate of two palatinoids thrice daily.

It is non-poisonous, and its administration was
followed by no unpleasant results.

Of the 49 cases under consideration 10 had neither
pyrexia nor symptoms. These were dismissed from
the list, and the remaining 32 dealt with.

These 32 cases are divided into 24 which were not
treated with cyllin, and 8 cases in which the drug was
tried.

The average duration of the cases not treated
worked out at 70°6 days, while that of the cases where
the drug was used was 38:5 days.

V.—Tue Year's Work АТ THE LABoRATORY, RoyaL
Navar Hospitat, MALTA, FoR 1904.

By Staff-Surgeon R. Т. Gremour, R.N.

The Agglutination Test in Mediterranean Fever and
Enteric. —Eighteen hundred and ninety-eight speci-
mens of blood were tested for these diseases. The
reaction is of great aid to diagnosis, but not infallible.

286

The agglutination reaction may be present as early
as the first day of the disease in Mediterranean
fever; can usually be obtained in the first week;
but may be delayed indefinitely. Cases with the
symptoms of this fever are met with which never
react,

The reaction rarely appears before the middle of
the second week in enteric; in this disease also it
it may be delaved, or never present.

The following deductions may be drawn :—

(1) At the commencement of convalescence there
is usually а considerable drop in the reaction.

(2) In cases which relapse the agglutination test
remains high.

(3) The reaction usually intermits before its final
disappearance.

(4) Cases may have a negative reaction for several

months, then react again.

(5) Cases may react up to eighteen months.

(6) Cases тау only react for a few months.

(7) The agglutination reaction usually ceases during
the second year of convalescence. ,

VI.—CowPRESSED AIR ILLNESS AND ITS TREATMENT
BY THE INHALATION OF OXYGEN.

Пу Fleet-Surgeon Epwarp Pars Mourityan, M.B., R.N.

The symptoms with which workers in compressed
air, men employed in caissons and divers, are affected
vary much in severity, and may һе divided into two
groups :—

(1) Those due to mechanical pressure, such as pains
in ears, frontal and maxillary sinuses, and in carious
teeth, headache, rupture of membrana tympani.
These supervene on exit from compressed air and
usually subside in a short time.

(2) Those, much graver, which are due to the actual
presence of gas in the blood-vessels and to gas-
embolism—z.e., pains in limbs (the so-called “ Bends ")
and joiuts, headache and vertigo, and other cerebral
symptoms, deafness, dyspnoea, circulatory distur-
bances and paralvsis. Тһе paralvses do not supervene
directly upon exit from pressure, but occur after а
latent period of varving duration.

Oxygen is ап important remedy in the prophylaxis
and treatment of gas-emboliam. By its use—its in-
halation under stationary pressure—decompression
can be rendered innocuous.

Symptoms of illness having set in, it promotes the
separation of the gas in the right heart and assists
the circulation. Combined with recompression, its
therapeutical action is effected in the highest degree.

ҮП.-“ Caisson” Disease (Diver's Patsy.)

By Fleet-Surgeon J. L. Ваввіхстом, К.Х.
Royal Naral Hospital, Haulbowline,

Remarks.—The explanation of the condition in
Caisson disease, like many other diseases of the
nervous system, is still very obscure, and though the
interest of the disease is centred in its pathology, the
most that can be said for the various theories brought
forward is that they are very indefinite and incon-
clusive. Іп one case reported by Levdens, death
taking place on the fifteenth дау, toci of bemorrhages

THE JOURNAL OF TROPICAL MEDICINE.

[September 15, 1906.

. and signs of acute myelitis were found in the thoracic

cord. In a case of Schultze, death occurring іп twe
and a-half months, a disseminated myelitis was found
in the thoracie region. In these cases slight fissures
and lacerations were also found, as also in a third
fatal case examined on the third day. One theory
put forward is that the effects are due to liberated
bubbles of nitrogen which have been absorbed into
the blood during the high pressure. А second
is that the symptoms are due to the pressure
driving the blood from the surface into the great
vertcbral area of veins, followed by a revulsive
anemia, which, if true, would explain the tem-
porary nature of the lesion in a case recorded by
Fleet-Surgeon Barrington. In a second case, re-
corded by the same observer, the rise of temperature
and temporary leucocytosis rather points, on the other
hand, to a secondary inflammatory condition, the
suddenness of the symptoms excluding inflammation
as a primary cause. The paralysis was purely motor;
there was no alteration in the sensation of touch,
pain, heat or cold; the only sensory phenomena were
shooting pains in the extremities. Now, since the
sensory tract lies more towards the centre of the cord,
and seeing that the reflex arcs were intact, one might
hazard that minute sparsely scattered hemorrhages
in some of the motor tracts were the explanation of
the symptoms.

ҮШІ.-Котев оғ А Cask ОҒ SPLENIC ANEMIA.
Ву Staff-Surgeon Oswatp Rees, M.D., R.N.

Shortly, the symptoms of this rare disease are :--
Insidious onset and a fatal termination. In the blood,
diminished hemoglobia, a moderate erythrocyte
anzmia (3,000,000 to 4,000,000), deformities of shape
and polychromatophilia in severe and late cases, rare
erythroblasts, marked leucopenic апетіа —(1,500-
4,000), constituent leucocytes not much altered, but
myelocytes in advanced stages—the spleen епог-
mously enlarged, whilst the other lymphatics are not
involved—pressure symptoms due to the enlarged
spleen, dyspncea, palpitation, dyspepsia, hematemesis,
and epistaxis.

As regards the position of this disease in the official
“Nomenclature of Disease,” it would seem to fall
most naturally between idiopathic anwmia апа
leuchemia.

ІХ.-Кіхоро VARNISH DISEASE.
By Staff-Surgeon P. Намптох Boypen, M.D., R.N.

This disease is an affection of the skin, chiefly of
those parts exposed to the air, of an erythematous
or eczematous character, caused by contact-with or
from sitting in а confined space recently painted with
Ningpo varnish.

There are two kinds of varnishes :—

(1) Fat or oil varnishes.

(2) Spirit varnishes.

Their manufacture requires much skill and know-
ledge of the proper mixing of the ingredients, and in
knowing how long they should be kept to mature
before use.

In ап oil varnish, to which variety Ningpo varnish

September 15, 1906.)

helongs, linseed oil is generally used as a vehicle ;
but in Ningpo varnish wood oil obtained from the
Tung tree, growing plentifully in Mid-China, is made
use of. The first process in the manufacture is to
take a quantity of copal, which is a gum exuding
spontaneously from the stems of various trees belong-
ing to the genera, Hymenda, Guibourtia, and Trachy-
lobium, found growing іп the East and West Indies,
and other parts of the world. Тһе сора! is melted
ша pot, with a quantity of boiled linseed oil, by the
aid of heat, until the mixture is perfectly clear ; more
oil is added in small quantities, and the mixture
further boiled until it becomes stringy. The pot is
then taken off the fire, and. when cooled down suffi-
ciently turpentine is gradually added, stirring all the
while until the whole is thoroughly mixed; it is then
strained and put aside until ready for use.

A quantity of Ningpo varnish was analysed and
found to contain fat, an oleo-resin, a variety of copal,
and a volatile acid, whieh were separated in the follow-
ing manner:—The varnish was first of all treated
with hot absolute alcohol, and so extracted the fat;
the residue was treated with ether, which extracted
the oleo-resin, leaving behind the very insoluble
copal. Я

The volatile acid distilled over with the oleo-resin,
and was separated by shaking up with water and
evaporating the ether. The acid was in very small
quantity, colourless, and had an irritating effect upon
the unbroken skin. !

The question now came to һе as to the source of the
oleo-resin and the irritative volatile acid, and one’s
thoughts naturally turned to the order, Anacardiane,
to which the genus Rhus belongs.

Rhus toxicodendron is a well-known irritant vesi-
cant, and has a place in the United States Pharma-
copeia.

In parts of China and Japan, Rhus vernicifero
flourishes, and is used in Japan for making the cele-
brated lacquer. :

I have found this tree growing plentifully іп the
higher parts of the Yang-tze valley, and think there is
very little doubt that the oleo-resin from this tree is
the basis of Ningpo varnish.

The varnish tree is a small, dicecious tree, 10 to
15 feet high, with smooth branches and leaves, the
latter being pinnate, and consisting of from 11 to 15
shiny green leaflets, from 2 to 3 inches long, and of an
oblong form, with a long taper point. The fruit con-
sists of racemes of small round berries, from the seeds
of which Japan wax is expressed.

The manner of collecting the resin is as follows :—
Incisions are made in the stem, and are repeated every
fourth day at successively higher parts of the tree.

The inspissated juice is scraped off with a flat iron
tool, and when the tree has been thus tapped to the
topmost branches it is felled. The log is cut into
lengths, which are tied into faggots and steeped in
water for two or three weeks, after which the bark is
pierced, and the oozing resin collected in the same
way as from the stem. The juice thus obtained is a
tenacious fluid ofa greyish brown colour. Itis allowed
to stand and settle, when a kind of skin forms on the
surface, the better quality rising to the top, and the
impurities falling to the bottom. This fluid is highly

THE JOURNAL OF TROPICAL MEDICINE. 287

corrosive, causing vesication and even ulceration of
the skin, without actual contact, although it should be
noted that, as in the case of other vegetable poisons—
e.g., primula obconica, also indigenous іп China—
many people are quite insusceptible to its action. As
a rule, women and children are the greatest sufferers.
In my own person, I have tried inhalation and also
painting the varnish on the thin skin of the forearm,
without any irritative effect being produced.

The volatile acid mentioned above has been investi-
gated by several Japanese scientists. It is named
* Urushie acid," derived from ''Urushu," the
Japanese word for the lacquer tree. This acid
under the action of a ferment (a nitrogenous body),
which is present in the fresh juice, rapidly becomes
converted into oxy-urushie acid, of which І made
mention before when noting the darkening in colour
on exposure to the air.

A peculiar feature in reference to the application of
the varnish is that it is always put on in damp
weather, as it sets much better, and gets a harder and
smoother surface.

The symptoms of varnish poisoning rival those
imputed to the upas tree (Antiaris) of Java. The
hands, arms, face, and in some cases the whole body,
become greatly swollen from simply carrying a branch
of the tree, or handling the varnish, the swelling
being accompanied by intolerable pain and inflamma-
tion, and sometimes ending in ulceration. The treat-
ment consists in the repeated application of a solution
of plumbi acetas, which seems to have an almost
specific effect in subduing the inflammation. The
distribution of the disease is no doubt a very limited
one, but 1 think it is of some importance for Medical
Officers of His Majesty's Fleet to recognise that such
an affection, which may at times assume a severe type,
exists.

The varnish, being such an excellent one, is largely
used Бу inerchant ships trading in the Far East, and
it is quite within the bounds of probability that com-
manding officera might make use of it, for varnishing
the woodwork of His Majesty's ships, without know-
ledge of its dangerous properties; and if such cases
did occur, a medical officer might be much exercised
as to the cause of the outbreak if he were not
acquainted with the symptoms of the disease.

X.—CasES RESEMBLING A CASE OF DERMATITIS
REPENS.

By Fleet-Surgeon P. В. Нахрүзірв, R.N.

ХІ.-Тне Rapicat Cure or Inaurnat HERNIA.
Ву Fleet-Surgeon VipAL G. THORPE, R.N.

-----о-

Correspondence.

To the Editors of the JouRNAL OF Tropical MEDICINE.

S1r,—In reference to Dr. Hamilton Wright's article
in your issue of August 15th, entitled, “ Beri-beri: A
Restatement and Reply to Some Criticisms,” I beg to
state that I do not consider I have misunderstood

283

THE JOURNAL OF TROPICAL MEDICINE.

{September 15, 1906.

his working hypothesis of the disease. My impres-
sion was that, his “acute beri-beri” included the
whole period marked “d ” in his graphic illustration,
namely, that during which the poison was formed,
and a slight further period during which this poison
continued to act, the whole corresponding to “g” in
his diagram.

The lesions in the stomach and duodenum I found
in thirteen out of thirty-four cases up to August, 1904,
&nd in other cases in 1904 and 1905, but though
common they cannot be said to have been ‘ pretty
constant." These lesions were found in persons dead
in various stages of the disease, but in others they
were &bsent both in early stages and in late stages.
The nature of superficial lesions of the gastric mucosa
is always difficult to determine, and when, as in beri-
beri, there are also present nerve and vascular changes
due to nerve poisoning, these difficulties are much
increased. Оп macroscopic and microscopic examina-
tion I found nothing incompatible with the hypothesis
that these changes were themselves secondary.

At no time have I ‘enunciated the pathological
conception that this lesion cannot be primary." 1 did
consider that it was necessary to test Wright's hypo-
thesis by showing whether the condition was primary
on other than histological grounds, and I therefore
paid particular attention to the period assumed by
Wright to exist, namely, that during which a gastro-
duodenitis existed and no nerve lesions had developed —
the period marked “с” in his diagram. Dr. Wright
gives no instances of his own observation in support
of his view. Не gives histories which at most show
that the patients complained of epigastric distress
before they noticed any symptoms referable to nerve
changes. Histories from natives and through native
interpreters are not sufficient verification.

It was to this period “с,” the only one in which the
evidence could be conclusive, that most of my en-
quiries were directed, and I fully recognised that it
was not the whole of the period during which Dr.
Wright considered that the poison was being formed.
In my own observations I did not find any cases in
which the symptoms described by Wright were
present without evidence of co-existent nerve lesions.

My use of the term “ neuritis” is allowed by Dr.
Wright as an alternative for “ residual paralysis ” in
the Table of Contents and on page 1 of the “ Studies
of the Institute of Medical Research,” vol. ii., Part II.

The subject is an important one, and it is well to
clear up misunderstandings. Dr. Wright thinks I
should have included clinical histories in my observa-
tions, but I venture to suggest that it would have been
better if he had placed less reliance on such histories.
With many of Dr. Wright's views I am in complete
accord, and I recognise fully the admirable work he
has done towards the clear enunciation of the pro-
blems presented by this disease, but I failed to find
any satisfactory confirmation of the primary nature of
the lesions he describes.

Yours, &c.,
C. W. DANIELS

Hew Anstruments.

Evans AND. WonRMULL, 31, Stamford Street, B.E.,
Surgical Instrument Makers, have sent us a copy of
their comprehensive catalogue, which is well worth
the perusal of any medical man who is about to
make any purchases.

WE understand that Mr. Henry Gowlland, optician, of
Selsey, Chichester, has perfected a new т; in. object
glass, oil immersion, which he guarantees to be entirely
of British manufacture, but what is of more import-
ance to our readers, is that no soft glass is used in the
objective, and that it will stand any climate. The
objective is beautifully finished, and the price is only
55s., which compares very favourably with the objec-
tives of foreign manufacture of the same power,
which are retailed in this country at £5 and upwards.
Intending purchasers would Яо well to write for
further particulars before purchasing elsewhere.

—— —»9—————

Hotes and Betws.

Tae Report in the United Provinces Gazette of
Major Chaytor White, I.M.S., as Chief Plague Officer
of the United Provinces for 1905, is replete with
practical interest. During the year 1905, plague
existed in more or less epidemic form throughout the
provinces. In many districts it was very severe, par-
ticularly in Muttra, where 45,644 deaths were regis-
tered, almost all occurring in the earlier months of
the year under review. Only one district returned
no seizures or deaths, viz., Almora. The total number
of seizures reported in 1905 were 334,679, while the
deaths totalled 305,737. It will be observed from
the following figures that the deaths have progres-
sively doubled in each of the last three years: (1903),
80,729 ; (1904), 166,620 ; (1905), 305,737. Іп the first
five months of the year the mortality was most
serious, but а marked change for the better has
occurred during the plague season of 1905-6, so that
there is hope that the disease is slowly dying out.
The mortality for the first six months of the year was
300,039, while only 5,698 deaths occurred from July 1,
to December 31. The disease has been uniformly
more severe in rural areas.

Every inducement is offered to the people to
evacuate infected sites, but they have not availed
themselves of the facilities of the “health camps”
established by Government to the extent that might
be desired, and on this account reliance has still to be
placed on disinfection. Disinfection by acid perchlo-
ride of mercury is still carried out. Izal, which was
under trial in 1904, has not proved itself more effica-
cious than acid perchloride of mercury, moreover, the
extra cost is against its use. Since December “сеуіп”
is being tried under the orders of the Government,
and from the reports since received on its efficacy it
is expected that it will prove a more effective dis-
infectant than the acid perchloride of mercury. The

September 15, 1906.)

same objection is present that is urged by natives
against the use of phenyl—its smell—to which they
strongly object. Phenyl is also used to a considerable
extent. i

Six thousand four hundred and eleven inoculations
were performed throughout the provinces during the
year 1905. Of these in Bareilly alone there were per-
formed 5,194, against 3,010 in the previous year;
this heads the list for inoculations in the provinces.

Phenyl, though a comparatively weak bactericide, it
must be noted is a much better insecticide than the
other agents mentioned, and it is probably owing to
this that it has so often been found useful, to an
extent that was inexplicable before the rat-flea
hypothesis was accepted.

The details as to the results of rat-killing are most
instructive, and it is satisfactory to find that it has
been found possible to carry out this procedure
without exciting undue opposition. This year rat
killing was carried out on a large scale throughout
the provinces. Only seven districts viz., Almora,
Debra Dun, Garhwal Saharanpur, Etab, Farruk-
habad, and Mainpuri did no rat-killing. In Dehra
Dun one rat only was killed. In all 851,167 rats
were killed in 41 out of 48 districts.

Bareilly heads the lists in the year under report, and
in it alone were killed 215,106 in five months. АПа-
habad comes next to Bareilly, and killed 77,345, Badaun
and Agra killed 66,241 and 57,711 rats respectively,
and ran third and fourth in the provinces. Badaun is
only a small town of 39,031 inhabitants, but Mr. U.
P. Allen, the collector, undertook the experiment of
killing wholesale the rats in the town. This he did
most effectively, letting out the work to contractors.
The sum of Rs. 2,750 was spent on this work in
Badaun, and not a single case of plague has occurred
since the work was begun last monsoon up to now
(March, 1906). Mr. Campbell, Collector of Bareilly,
was also most energetic, and destroyed more rats than
any other district officer. Out of the Rs. 100,000 at
the disposal of the Inspector-General of Civil Hos-
pitals, a sum of Re. 24,850 was allotted for rat killing
&nd general plague preventive measures. It may be
mentioned that the above figures practically only
refer to the last four or five months of the year, so
that the efforts of the district officers were very real.
From the plague returns, which have been received
up to and during March, 1906 (usually the worst
month in the year), it appears that the measures
adopted have done much good in reducing the mor-
tality, and the people undoubtedly believe that the
measures adopted against rats have effected this.
' Wonder" rat traps were used in almost all the
municipalities and are much better than any other
kind. They were distributed free to the public.
Rewards are given to catchers for each rat caught,
at different rates—generally two pice a rat and one
pice a mouse. The rat poison called ‘Common
Sense ” is used by some municipalities and is well
reported upon, no accident having occurred by its use.
Opinions were obtained from the heads of the Medical
Departments of various provinces as to the efficacy of
the “ Common Sense Poison " and all agreed that this
poison is by far the best. Danyz' virus was tried in
many places, but the results were not satisfactory.

THE JOURNAL OF TROPICAL MEDICINE.

289

Special tubes were got out from England and dis-
tributed, but the opinion generally expressed was
adverse. It is rather depressing, however, to find
that Major Chaytor White considers that in villages
rat-killing to & practical extent is almost impossible.

LORD KITCHENER wants the Army to have its jam
without the Gregory's powder. In а speech at the
first meeting of the Standing Committee on enteric
fever, his lordship suggested that the labours of the
members should be directed to making antityphoid
inoculation less unpleasant to the subject of the opera-
tion, even if the period of immunity were thereby
curtailed.

The speech gives evidence of personal study of
the question, but whether obtained through the action
of spontaneous disease, or by the artificial process
of inoculation, it is to be feared that immunity can
only be gained at the cost of more or less personal
discomfort.

Tue Inpian PraGue returns for the week ending
July 28th show 562 deaths, a considerable drop as com-
pared with the previous week's figures, after allowing
for belated returns which swelled that week's total.
Nearly half the mortality, viz., 262 deaths, occurred
in Bombay. Madras reports only 6, and Bengal only
15; the United Provinces, 16; the Punjab, 11;
Eastern Bengal, 4; Central Provinces, 1; Central
India, 2; and Mysore, 37. Burma runs Bombay
elose with 208 deaths.

The total number of plague cases in Rangoon, how-
ever, for July, has been the heaviest since the out-
break of the epidemic in February, 1906. "There were
during the month 706 cases and 650 deaths.

THE INDIAN COMMITTEE ON ENTERIC.—On conclusion .
of the Commander-in-Chief's address, the Enteric Com-
mittee proceeded with their deliberations. They have
since carefully considered the question of enteric fever
with reference to its prevalence amongst various
classes of individuals and communities in India.
Statistics and evidence from the Army Medical Re-
ports, the Annual Reports of the Sanitary Com-
missioner and others from the year 1856 were placed
before them. The various sources of infection—
excreta, fabrics, food, drink, &c., were discussed, and
lines of present prophylaxis and a campaign for future
prevention laid down. In the matter of cantonment
sanitation the Committee had the advantage of the
presence of the Inspecting Officer of cantonments
(Lieutenant-Colonel Thornhill), whose views on this
matter were of great assistance. The subject of anti-
typhoid inoculation was fully dealt with. It is hoped
the decisions arrived at and the line of action laid
down will have marked beneficial results, not only
on the health of the Army, but also to the community
at large. The Committee, after four full days’ sitting,
have adjourned till the middle of October, when
reports on the practical working of the various reso-
lutions will be examined, and the recommendations,
if necessary, added to.— Pioneer Mail, August 10th.

A аоор deal of disappointment is felt in Rangoon
at the action of the Special Committee on Waterworks

THE JOURNAL ОЕ TROPICAL MEDICINE.

[September 15, 1906.

in accepting the “ Hlawga Scheme” in its present
form. Instead of 40 gallons per head for a population
of 650,000, at a total cost of about a quarter of a
million sterling, the work actually accomplished can
provide only 95 gallons per head for 207,000, and has
cost over a third more than that sum; while, to pro-
vide for a population of 340,000 would cost twice as
much as the original estimate, for nearly double the
population. It is satisfactory, however, to find that
all shades of public opinion &ppear to agree that
a good and sufficient water supply is an absolute
necessity to the town.

WE reproduce from the August number of Zhe
Indian Medical Gazette, a letter to its Editor from
Dr. E. S. Goodhue, which is of interest to all students
of tropical medicine :—

THE BACILLUS LEPRE IN THE GNAT AND Bep-Buc.
To the Editor of The Indian Medical Gazette.

Dear SiR.--You will be glad to learn that Dr. W. J.
Goodhue, Medical Superintendent of the Leper Settlement
аф Molokai, after several years of investigation there, has
been able to demonstrate the B. lepre of Hansen in the
mosquito and in the bed-bug.

I will quote from Dr. Goodhue's officinl (but ах vet
private) report to the Hawaian Board of Health :- -

“ February 10th, 1906: We have since been
sectioning mosquitoes taken from various leper houses. but
until last June without any apparent success. At that time
it appeared that we had isolated bacilli in these series of
experiments, but, owing to the technique employed, it was
impossible to contirm this А This method оғ
research was abandoned. After repeated failures
and the constant re-examination of fresh specimens, success
has come as far as demonstrating the В. lepre in the
female mosquito (Cules pungens; 2...

“ February 20th 1906 : Since writing you I have discovered
the bacillus of Hansen in the bed-bug (Cimer lectularia).

I believe that the Cimer is more of a factor in the
spread of leprosy among the natives than the gnat? (here
follow reasons).

Full reports of the work, with microphotographs of slides,
Кес. will be given publicity in May. You will kindly keep
the matter confidential until May 8th, when vou will be
free to use it. We should be glad to have your Journal
containing notices of the discovery.

Yours very truly,
E. S. GOODHUE,
Government Physician.

. Hawaii.
April 9th, 1906.

That the agency of parasites should explain the
niystery of the method of transmission of leprosy
becomes increasingly probable, as parallel cases con-
tinue to be proven in etiology of other diseases. Our
knowledge of the facility of accidental and intentional
inoculation in the case of many diseases, makes it
almost inconceivable that biting parasites should not,
at least occasionally, act as inoculators; but in the
case of leprosy, the failure of all attempts to produce
direct infection makes it probable that some special
parasite must be concerned, within which the virulence
of the bacillus, as found in the human tissues, is
enhanced.

In ап Editorial our contemporary ably discusses
Mr. Jonathan Hutchinson's recent book on “ Leprosy
and Fish-Éating." That the fish causation theory
should be rejected by anyone with an extended ac-
quaintance of Indian facts relating to leprosy is a

foregone conclusion, as it is impossible to practice
long in the country without meeting with lepers who,
it is morally certain, would die at the stake rather
than touch fish in any form, whether salted or fresh,
newly caught, or in any stage of decomposition. In
India, as elsewhere, leprosy is specially a disease of
the verminous poor, but it is certainly no respecter
of caste; though the peculiar dietetic limitations that
are imposed by the caste system, and the rigidity with
which they are carried out, should make India the
best of all fields for the investigation of any food
causation theory. Many castes will not touch fisb,
while others consume it largely; and the fact that
leprosy is not practically confined to, or even specially
common in the latter, is а sufficient demonstration
that the theory in question is no better than an
improbable fad.

On the other hand, the writer evidently considers
that the last bas not been heard of Capt. Rost's
scarcity of salt theory, as he concludes his remarks
with the following paragraph :—

We have no intention of bringing forward, without proof,
u salt hypothesis, as opposed to a fish hypothesis, and as
being the last word on the leprosy question. It is, of
course, as readers of The Indian Medical Gazette are
aware, not a new one, and we hope shortly to be able to
test it in certain directions which we believe have never
been attempted—a matter which is of some interest, as we
understand that it is quite impossible to consider the
Kasauli tests as final.

———*Fr———— ——

Personal Hotes.

INDIAN MEDICAL SERVICES.

Arrivals Reported іп London.—Major B. С. Oldham, Major
H. St. J. Fraser.

Ertensions of Leave.--Captain Н. Hugo, D.S.O., furlough to
December 12th, 1906; Major J. Chaytor White, 6 w., medical
certificate ; Major J. К. Close, study leave, May 1st to July 3186,
1906; Captain E. IL. Perry, study leave, February 1st to
March 31st, and May 1st to June 26th, 1906; Lieutenant-
Colonel W. B. Browning. C.I.E., 1 m. 14 d., medical certifi-
cate; Major А. Б. О. Russell, 6 m., medical certificate ; Captain
A. E. J. Lister, 1 m., medical certificate ; Lieutenant J. W. H.
Babington, 14 d.

Permitted to Return to Duty.— Major H. E. Drake-Brockman,
Lieutenant J. W. H. Babington, Major L. F. Childe, Captain
J. B. Christian, Captain R. L. Hagger, Captain R. D. Will-
cocks, Lieutenant-Colonel W. Coates, Major S. H. Henderson,
Lieutenant-Colonel H. Fooks, Captain A. В. Fry.

Retirements.

Lieutenant-Colonel D. Prain and Lieutenant-Colonel Mawson
are permitted to retire.

Promotion.

Captain Ross Pearce, M.B.. to be Major.

Postings.

Captains F. A, Barnado and L. Cook, services lent to Govern-
ment of Bengal.

Captains H. B. Steen, O. Moses and H. A. J. Gidney, services
lent to the Government, East Bengal and Assam.

Captain W. S. Patton, services temporarily lent to Govern-
ment, Madras; and of Captain Stewart and Lieutenant Proctor,
for service on a Drainage Committee.

Captain M. Dick acts as Health Officer, Rangoon.

Lieutenant-Colonel J. Carmichael, R.A.M.C., to the Com.
mand of the Station Hospital, Jullundur.

Captain D. S. A. O'Keefe, to Medical Charge, 26th Punjabis.

September 15, 1906.) THE JOURNAL OF TROPICAL MEDICINE.

Captain R. С. Easton, to Medical Charge, 22nd Punjabis.

Captain N. W. Jeendine, to Medical Charge, 27th Punjabis.

Captain T. C. McC. Young, to Medical Charge, 34th Sikh
Pioneers.

Captain E. A. Walker, to Medical Charge, 36th Sikhs.

Captain J. Woods, to Medical Charge, 53rd Sikhs.

The undermentioned officers of the Indian Medical Service
are appointed specialists in the subjects noted :- Fevers: Major
Wimberley, 3rd (Lahore) Division. Prevention of Disease:
Lieutenants Proctor, Umballa, and Ingram Aden. Captain
Kevs is appointed specialist іп Midwifery and Diseases of
Women and Children in the Western Command.

The undermentioned ofticers of the Royal Army Medical
Corps are permitted to continue in their appointments of
specialists іп the subjects noted:--Fevers: Major Clark, 1st
(Peshawar) Division; Captain Huddleston, 5th (Mhow) Divi-
sion : and Captain Hopkins, 6th (Poona) Division. Skiagraphy :
Major Boyle, Burma Division : and Captain Grech, 7th (Meerut)
Division. Dentistry : Lieutenant Bowle, 5th (Mhow) Division.
Ophthalmology: Major McDermott, Eastern Command; and
Captain Kiddle, Western Command.

The undermentioned ofticers of the Royal Army Medical
Corps, on return from leave, are appointed specialists in the
subjects noted: — Operative Surgery: Major Cameron, 3rd
(Lahore) Division. Midwifery and Diseases of Women and
Children: Captain Maurice, Eastern Command. Laryngology :
Captain Profeit, Northern Command. Otology: Captain Berne.
Western Command,

Military Assistant-Surgeon C. А.
ofliciates as Civil Surgeon, Shahpur.

Captain J. Stephenson, to be Civil Surgeon, Umballa.

Captain C. A. Lane, to be Civil Surgeon, Purnea,

Major Brend. to be Inspector-General, Prisons, Punjab. in
succession to Major Macnamara, who is transferred to Madras,
in the same capacity.

Captain W. C. H. Forster is placed on special duty under the
Sanitary Commissioner with Government of India.

Major O'Kinealy acts as Professor of Ophthalmic Surgery,
Calcutta.

Captain S. L. Marjoribanks, to be Deputy Sanitary Com-
missioner, Western Registration District.

Captain F. H. б. Hutchinson, to be Deputy Sanitary Com-
missioner, Southern Registration "District.

Captain R. W. Antony, to be Civil Surgeon, Ratnagiri.

Major L. Rogers, Major D. M. Moir and Dr. Annandale are
appointed Fellows of the Calcutta University.

Captain E. Bisset assumes charge of civil medical duties of
the Kohat District.

LL jieutenant W. Tarr assumes Civil Medical Charge of Sheih
udin. `

Captain W. H. Cazaly, to be Civil Surgeon, Satara.

Captain A. G. Sargent, to be Civil Surgeon, Panch Mahals.

Owen, M.D., LS.M.D..

Leare. z

Major B. Oldham, combined leave, 15 m.

Major Maynard, Professor of Ophthalmology,
privilege leave, 3 m.

Captain W. C. Ross, Deputy Sanitary Commissioner, Oussa
Carch, privilege leave, 2 m, 23 d.

Captain C. J. Robertson Milne, services replaced at disposal,
Government of Bengal.

Captain W. S. J. Shaw, services temporarily lent to Govern-
ment of Punjab.

Captain C. A. Gourlay, services placed permanently at
disposal, Government, East Bengal and Assam, in Sanitary
Department.

Captain Е. Wall, 62nd Punjabis, to additional civil charge of
Fyzabad District.

Calcutta,

COLONIAL CIVIL SERVICE.

Dr. A. Morrison has retired from the office of Government
Botanist of Western Australia.

The Hon. Dr. Е. Watts, C.M.G., Government Chemist and
Superintendent of Agriculture, Leeward Island, has left the
Colony on leave for four months, during which Mr. H.
Tempany will perform his duties.

991
PLAGUE.
PREVALENCE OF THE DISEASE.
Cases Deaths.
India.—Week ended August 4th — — 738
$i » lith — 936
Mauritius 55 » Sth 1 1
a ж 15th 3 2
» » 22nd 6 4
» 4 29th ( 5 “
September 6th | iy 13
Hong Kong. — Week ended Aug. 19th 3 9

Clean Bills of Health issued for Hong Kong on
August 29th.

Australia.—During the week ended July 21st, 1
case of plague at Cairus, Queensland. No other cases
of plague reported from July 7th to August 4th in any
part of Australia.

South Africa.—No cases of plague from July 7th to
August 18th.

— eo

THE SLEEPING SICKNESS.

Kina LEOPOLD AND THE LIVERvOOL SCHOOL or
TrorIcaL MEDICINE.

In view of the alarming nature of the recent reports
with regard to the spread of sleeping sickness in Africa,
and of the fact that an expedition organised by the
Liverpool School of Tropical Medicine has been study-
ing this disease for three years in the Congo, Sir
Alfred Jones, president of the school, requested an
audience of the King of the Belgians in order to
confer with him upon the subject. In a recent letter
to the secretaries of the reform committee King
Leopold referred to his deep interest in this matter,
and, besides offering a prize of 200,000f. (£8,000) for
the person who should discover а remedy, he has
placed a credit of 300,000f. (£12,000) in the Congo
estimates for the purpose of prophylactic research.

The committee of the School were received at the
Palace, on August 23rd, at noon. The representatives
present included the president, Sir Alfred Jones, Pro-
fessor Ronald Ross, C.B., F.R.5., Professor Boyce,
F.R.S., Dr. J. W. W. Stephens, Dr. J. L. Todd, Mr. R.
Newstead, Dr. Evans, and Mr. A. H. Milne. The
King gave a most attentive hearing to the views of
the experts of the school on the necessity of preventivg
the further spread of sleeping sickness. He agreed
with Sir A. Jones that the question was one of inter-
national importance, and said that, as far as he was

. concerned, he was prepared to do all in bis power to

relieve both the white and black population from the
terrible dread of this scourge. His Majesty asked the
Liverpool School to submit to him a scheme for the
prevention of the disease, and this request will be
acted upon as soon as possible. He has promised his
co-operation if it is in апу wav feasible or practical.
Тһе King expressed in high terms his appreciation of
the energetic work now being carried on by the school
and of the thorough manner in which its expeditions
are worked. Іп conclusion, to show the value he
placed upon that work, he bestowed the Order of

999

THE JOURNAL OF TROPICAL MEDICINE.

[September 15, 1906.

Leopold upon Professor Ross, Professor Boyce, and
Dr. J. L. Todd, the last-named of whom worked on
trypanosomiasis in the Congo Free State for three
years.

The conference was followed by a luncheon at the
Palace to the representatives of the Liverpool School.
Among those present were Baron Wahis, Governor-
General of the Congo, Commandant Liebrechts,
Secretary - General of the Home Department, and
other leading representatives of the Brussels Adminis-
tration.— Times, August 24th, 1906.

UNIVERSITY OF CAMBRIDGE.

Dirtoma oF TropicaL MEDICINE AND HYGIENE.
D.T.M. anp Н. (Самв.)

The following candidates qualified for the Diploma
during the year, 1906:—February, 1906—J. Booth-
Clarkson, J. C. S. McDowell, R. Small; August, 1906 —
Samuel Anderson, Robert Thomas Booth, Charles
Walter Holden, Thomas Campion Lauder, Harry
Strickland McGill, Edward McKillop Nicholl, Ambrose
Thomas Stanton, Lessel Philip Stephen, Edmund
Wilkinson, Andrew Watson Cook Young.

(George Н. Е. Nuttall.
Examiners +Ronald Ross.
lc. W. Daniels.

--------Ф

Recent and Current Literature.

A tabulated list of recent publications and articles bearing on
tropical diseases is given below. To readers interested in
any branch of tropical literature mentioned in these lists
the Editors of the JoURNAL OF TROPICAL MEDICINE will be
pleased, when possible, to send, on application, the medical
journals in which the articles appear.

“ Proceedings of the Royal Society,” vol. lxxviii., No. B. 522.

“The Microscopic Changes in the Nervous System in a
case of Chronic Dourine. Comparison with those found in
Sleeping Sickness.”

Mott, Е. W., M.D., F.R S, states the result of an investi-
gation іп the nervous tissues of ап Arub stallion which
acquired Dourine or mal de сой, by infective coitus. The
tissues were forwarded by Dr. Lingard of the Imperial
Bacteriologist Laboratory of India. The result of the
investigation demonstrated that іп Dourine, іп animals
inoculated with Trypanosoma gambiense and in human
sleeping sickness. chronic trypanosome infection scts up a
lymphadenitis and a chronic inflammation of the lymphatics
of the central nervous system. Ав the result of these infam-
matory states, a chronic interstitial condition of the lym-
phaties of the soft membranes, the subpial septa and the
perivascular spaces. without any pronounced destruction of
the neural elements. Of this chronic interstitial change the
cell proliferation of the neuroglia is the primary evidence:
and it is surmised, from the knowledge attained by observing
chronic trypanosomiasis іп animals, that the lymphocyte
accumulation and proliferation is of a secondary character
and in part the result of the changes referred to in the
neuroglia. Я

In view of the fact that Dourine is caused by a specific
form of trypanosome conveyed during coitus in the horse.
Schaudinn’s demonstration of the spirochwtie pallida іп
syphilis is daily acquiring increased significance and interest.
Dourine may be shortly described in the light of recent
knowledge as * Horse Syphilis.”

* Indian Medical Gazette," June, 1906.
(1) SrLENIC. Apscess IN MALARIAL Fever.

Anderson, А. R. S.. Major I. M. Sọ, describes two cases
of splenic abscess in Hindu male prisoners in Port Blair
Gaol, Andaman Islands. [n both cases there had been a
long previous history of malarial fever and enlarged spleen.
In one case no mahwial parasites. were found, probably
owing to quinine administration: in the other case malig-
nant tertian parasites were found. A slough was found in
one ease ; in the other no pouderable slough, but a quantity
of broken-down splenic tissue. Of 77.949 patients suffering
from malarial fever, seen by Major Anderson during the past
five years, these are the only two cases in which splenic
abscesses were dingnosed. Di three other spleens, out of a
total of 178 fatal cases reported upon, splenic abscesses, or
the condition possibly precedent to such abscesses, were
found. In one spleen were several hiemorrhagie infarcts ;
in a second numerous miliary abscesses; and in the third
several small abscesses. .

Of the two cases operated upon by Major Anderson, one
recovered and was well five vears afterwards, the other
survived the operation nine months, subsequently dying
from pyiemia.

(2) ** CysricERCUS ÜELLULos € OF TONGUE, WITH A NOTE ON
THE HELMINTHOLOGY OF ONE OF THE Mapras ЈАП."

Williams, С. I, Major, І.М.5., found a cystic swelling
about the size ора hazel nut in the uuder-surfuce of the
left side of the tip of the tongue of a convict in the jail at
Coimbatore, Madras Presidency, India. From the swelling
when cut down upon, the head of a Twnia Solium was
enucleated. The district of Coimbatore seems to be in distinct
contrast to the reported prevalent infection of the alimen-
tary canal of the natives of India generally. for, ака rule,
the natives of Coimbatore are wonderfully free from “ worms.”

“Апп. de l'Inst. Pasteur," May, 1906.
ANTIDYSENTERIC SERUM.

Vaillard and Dopter found that the serum from horses
which have been immunised against the dysentery bacillus
is applienble and useful in dysentery іп man. The prepared
horse serum has anti-bacterial and anti-toxic properties, and
when injected in doses proportionate to the severity of the
dysenterie attack remedial effects speedily result. The
injection should be given early in the disease, but even as
late as the sixteenth day in acute dysentery the treatment is
efficient.

“ Riv. Crit. di Clin. Med.," 1906.
SPLENOCLEISIs,

Schiassi, B., in a case of enlarged spleen and marked
anaemia, cut down on the spleen, scraped the surface with
a sharp spoon, enveloped the spleen in five layers of gauze
and sewed the wound up, leaving, however, the ends of the
strips of gauze protruding from the upper and lower ends of
the wound. The strips were removed one by one from the
fifth to the ninth day after operation. The patient did well,
the blood count rose in six months (that is from before until
after operation) from 81 to 53 million red cells, hemoglobin
from 24 per cent. to 92, and white cells from 1,600 to 6,200.
In true splenic amemia the only signs and symptoms are
enlargement of the spleen and anwmia, both of which tend
to increase. The success of this operation is encouraging.

Hotices to Correspondents,

1.—-Manuscripts sent іп cannot be returned.

2.—As our contributors are for the most part resident abroad,
proofs will not be submitted to those dwelling outside the United
Kingdom, unless specially desired and arranged for.

3.—To ensure accuracy in printing it is specially requested
that all communications should be written clearly.

4.—Authors desiring reprints of their communications to the
JOURNAL OF TROPICAL MEDICINE shonld communicate with the
Publishers.

5.— Correspondents should look for replies under the heading
“ Answers to Correspondents.”

October 1, 1906.)

THE JOURNAL OF

Original Communications.

NILE BOILS.
By Frank Cote Mappen, M.D.Melb., F.R.C.S. Eng.

Professor of Surgery, Egyptian Government School of Medicine ;
Senior Surgeon, Kasr-el-Ainy Hospital, Cairo.

Durna the hot months, and particularly in the
damp weather towards the end of the summer, and
also at the changes of season, residents of Egypt fre-
quently suffer from & peculiarly painful boil (or boils),
which has so many distinctive features as to justify a
more detailed description than has hitherto, so far as
I am aware, been devoted to it.

The European residents are probably more often
attacked than the native Egyptians, though the latter
are not by any means exempt. In their case, how-
ever, the condition &bout to be described is included
with many other pustular lesions, due to the heat and
excessive sweating, in the all-embracing title of
* Hamm en-Nil," which, to the native mind, is suffi-
ciently comprehensive to connote any skin eruption
froin a prickly heat to a general furunculosis. Though
thus almost lost sight of among its many distant rela-
tives, true Nile boil does occasionally occur.

A form of boil, the so called “ Bouton de Nil," next
of kin to the Delhi boil, the Aleppo boil, and the
Biskra button, as described by Manson, Briault, and
other observers, is essentially a chronic process, and in
my eight years’ experience in Egypt I have never met
with such a condition, either in hospital or private
practice. The boil we are accustomed to call the Nile
boil is an acute inflammatory and exceedingly painful
condition, which does not last more than fourteen days
from beginning to end.

As has already been mentioned, the boil is particu-
larly frequent at the end of the summer, when the
Nile is rising or is in flood, and the weather is very
damp, and also in the early spring, that is to say, at
the end of the cold season. In certain cases it occurs
when the patient is much “run down,” or after one
of the infectious fevers, but is just as frequently met
with when he is in the rudest health. Food, drink,
or water do not seem to influence its occurrence, and
no régime or diet appears to prevent it. One is liable
to have attacks of boils at long intervals, sometimes
every summer, or to have a series of boils one after
the other, which persist for a long time. The boils
also have an unfortunate habit of developing in par-
ticularly tender places, some of their favourite seats
being the perineum, especially all round the anus, the
buttocks, the arms, the hands and the fingers, and the
face. They are not so common on the neck or on the
lower extremities below the buttocks, though they are
to be found on any part of the skin surface, and even
within the external auditory meatus. They are more
common in men than in women, but are no respecters
of age or sex, though, fortunately, they do not often
occur in young children.

Having been myself the subject of Nile boils on no
less than four occasions, I can speak with some
authority on the matter, and cannot do better than
describe my feelings in detail, reinforcing my own

TROPICAL MEDICINE.

293

personal reminiscences with certain additional facts I
have observed in other fellow-sufferers.

On accidentally rubbing my forearm with my cuff,.
I felt a distinctly painful point which, on close exami-
nation, I found to be a minute red spot at the base of
a hair, in the hair follicle. In a few hours’ time the
redness was more evident and the spot was slightly
raised around the base of the hair; the tenderness,
even at this stage, was altogether out of all propor-
tion to the naked eye appearances, the least friction
of the shirt sleeves being quite painful. During the
night I was conscious of a transient throbbing in the
spot and found myself taking unusual care to place the
arm in a comfortable position.

In the morning there was a red swelling the size of
a sixpence, not unlike an ordinary blind boil, which
was very painful, throbbed horribly, and was acutely
tender to the least touch. The skin around the hair
was dusky and was surrounded by a zone of dark red
inflammation, fading off to a hyperemic redness
beyond. The central portion of the swollen lump was
very hard and indurated, the indurated piece feeling
as though it were let into the deeper parts of the skin.
Ву mid-day the lump had increased in size and was
even more tender than before. The surrounding in-
flammation had also increased in proportion. Thin,
tender, red lines of inflamed lymphatics could now be
seen, and there was pain above the elbow and in the
axilla. A tiny blister had formed in the centre of the
boil and this burst on extracting the hair and exposed
beneath it the top of a pea-green-coloured slough,
which was firmly attached all round to the surround-
ing inflamed tissues. The colour and the characters
of this slough is very typical and its appearance con-
firms the diagnosis.

From this time onwards the swelling generally in-
creased until it reached the size of the palm of the
hand, and it exhibited all degrees of acute inflammation
with the green chamois leather-like slough in the centre.
The hard induration was now the size of a florin and
the whole of the inflamed area was cedematous and
pitted on pressure. The point of acutest pain was
immediately around the slough.

On the fourth day a drop of thick pus was squeezed
out from beside the now much enlarged slough, but
without any relief whatever. The slough was still
firm all round, except just at the skin surface, and
gave me the idea of being screwed into the bone in
the depths of the boil. The lymphangitis and the
pain in the axilla increased and the lymphatic glands
were enlarged and tender. The arm was absolutely
useless, felt as heavy as lead, throbbed violently on
any sudden movement, and could not find a comfort-
able place for itself anywhere.

On the fifth day, by dint of hot fomentations, the
slough, which was now more yellow in colour, looked
looser, and a vigorous squeeze caused the greater part
of it to pop out. It looked like a partially macerated
bean, and was coated with thick pus. The remains of
the slough still holding on tight to the depths of the
boil, had to be picked out with dissecting forceps, and
a small quantity of thick, slimy-looking pus was finally
squeezed out. There was then left a crater-like cavity
with sharply cut though rather eaten-out edges, in the
midst of a still much inflamed and induratcd area cf

904

THE JOURNAL OF TROPICAL MEDICINE.

[October 1, 1906.

skin; but from the moment of the loosening and sub-
sequent removal of the slough, the pain vanished as if
by magic, and the part, though still hard and in-
Папе, was quite painless and could be handled and
squeezed with impunity. Indeed, save for the red-
ness and the crater it was difficult to believe that a
short time before one was in such severe pain.

The next morning the cavity had filled in a great
deal and a little sero-pus could be squeezed out; by
evening it had nearly all filled with granulation tissue
and was coated with a thin layer of coagulated
serum.

In two days’ time the sore had quite healed, the red-
ness had markedly diminished, and a small hard lump
was all that remained of the induration. A permanent
scar, covered thinly with skin, remains, or a small
mass of keloid forms in the scar. Throughout the
whole period, up to the time of the expulsion of the
slough, a very small quantity of serous discharge was
found on the dressings. 1 have had two boils in
adjoining follicles, which, starting on different days,
made the whole course of the disease longer; but,
though there is а larger scar from the fusion of the
two craters, the symptoms were substantially as just
described. Infection of neighbouring follicles natur-
ally frequently results. When crops of boils occur, as
is sometimes the case in the perinaum, on the loins or
on the face, during the time of their acuteness, the
local as well as the general symptoms may be so
severe as to give rise to some anxiety. I felt perfectly
well іп myself when the boils broke out, but by the
third day I felt distinctly “ seedy,” with all the usual
accompaniments of fever, including a general malaise,
loss of appetite, headache, sleeplessness, &c. Іп
some cases when а large number of boils develop one
after the other, the constitutional symptoms may be
severe.

Professor Symmers made a culture directly from
the slough, on the third day of the disease, and grew а
pure culture of Staphylococcus pyogenes aureus. In
severe cases a spreading cellulitis may supervene, or,
more usually, an abscess form just bevond the limits
of the boil, and, rarely, all the more serious septic
consequenees may ensue.

Treatment is most unsatisfactory. Іп the very early
stage an attempt, which it must be admitted is very
rarely successful, may be made to abort the boil by ex-
tracting the hair and injecting a drop or two of pure
earbolic into the reddened follicle.

Once the boil has got beyond the initial stage the
hair should be extracted ard hot sublimate or lysol
fomentations, or antiseptic linseed poultices, applied
and changed as often as possible. These hot applica-
tions in my experience are the only measures that
afford any relief. Each time they are changed the
part should be soaked in water, as hot as can be borne,
for ten minutes before the fomentation is re-applied.

It is not the least use trying to squeeze out the
slough until it is loose. It will not come out and the
squeezing only increases the pain and the throbbing.
Sometimes it comes out of itself on the fomentations
on the fifth day. Even after its removal the fomenta-
tions are best continued for another twelve hours, after
which the part may be dressed with vaseline or
boracie ointment. Splints and other appliances to im-

mobilise the inflamed parts must be used as necessary,
and all complications treated as they arise.

Little is usually required in the way of general
treatment, except an eflicient aperient in the earlier
stages, a low diet, and rest. І have tried calcium
sulphide, sulphur, sulphate of magnesia, and many
other drugs without any good result, nor have I seen
any efiect from yeast in any form.

Once а boil bas developed it is a good plan to pull
out the surrounding hairs to prevent infection, but I
know of no remedy of any service as a prophylactic.

I would, with all respect, venture to affirm that the
condition, hitherto described as the Nile boil, or
* Bouton de Nil," does not now exist in Egypt; but
there is a particular form of boil peculiar to the
country, characterised by the intensity of its inflam-
mation, its extraordinary and early: tenderness and
pain, out of all proportion to its naked eye appear-
ances, its characteristic slough and very scanty
serous discharge, its rounded button of hard indura-
tion, and its resistance to treatmeut, until it has run
its own course, which is a distinct pathological entity
and a worthy successor to the title so long borne by
its better-known predecessor.

THREE CASES OF INFECTION WITH SCHIS-
TOSOMA JAPONICUM IN CHINESE SUB-
JECTS.

Ву О. T. Logan, M.D. `
Medical Missionary, Changteh, Hunan, China.

I am led to contribute this paper for three reasons :
(1) To help detine the geographical distribution of the
fluke. (2) To give an idea of the form of the egg and
embryo as it is seen in the stool. It seems very un-
fortunate that none of the current numbers of this
Journal nor the latest, and one might safely say the.
only, book in English on the subject of animal parasites
in man, should have failed to give drawings of the
ova or embryo that would enable one to recognise the
presence of this fluke. (3) To show the effect of
treatment.

Our first case has been reported in full, at my
request, by Dr. Beyer,! who, with Drs. Stiles and
Lovering, identified and measured the eggs in the
specimen of fxcal matter sent by the writer. They
found the average measurement of nine eggs to be
72 microns in length and 48 microns in width. Thus
it will be seen that the egg is only a little larger than
that of the Ascaris lumbricoides—a very important
matter for the novice in fiecal examination to note.

Our second case is especially instructive in that it
shows the good effects of treatment, and offers hope
that some of these patieuts may outlive the parasite
and eventually be cured. The notes on this case are
as follows :—

Tsen, male, aged 13. Born and reared in Hunan
Province; Changteh Prefecture. Occupation, farmer.
It should be stated that one of the duties of farmers, `

! & А Second Case of Infection with the Asiatic Blood Fluke
(Schistosoma Japonicum)," by Н. G. Beyer, Medical Inspector,
United States Navy. American Medicine, vol. x., No. 14, pp.
578-579, September 30th, 1905.

October 1, 1906.)

in this district at least, is to fish in the ponds that are
always near the houses of the farmers. This means
that there must be a good deal of wading, as the small
seine is one of the commonest implements used in
catching fish in these ponds, the banks of which are
always strewn with snail shells, the former occupants
of which, no doubt, are the intermediate host of the
parasite. Patient also admitted that he often drank
this waterjwithout boiling. pm

Schistosoma japonicum infection.

~

The boy gave a history of swelling of the legs and
face about two years previous to admission to the
hospital, and found that he could not do any con-
siderable amount of work without great inconvenience
on account of shortness of breath. Along with this he
had bloody stools. At the time of admission he had,
on an average, six of these stools in twenty-four hours,
accompanied by prolapse of the rectum of some one

THE JOURNAL OF TROPICAL MEDICINE.

295

and a half inches. His legs and face were swollen,
and presented the appearance of a patient suffering from
hook-worm infection. Spleen and liver not enlarged,
as in our first case. The heart dulness was enlarged
and the sounds muffled, except over the base, where
there was a loud anemic murmur. Conjunctiva and
finger-nails were colourless.

The blood examination showed only 10 per cent.

hemoglobin. Differential count of the leucocytes
showed :—
Polymorphonuclears ... 71 per cent.
Eosinophils ... ^s sse 0 3
Lymphocytes, small ... as 9) »
3 large ... 8 M

Number counted, 112.
Poikilocytes and mierocytes were numerous, with a
fair number of megalocytes. No nucleated red cells
were found.

Ға. 1.

Schistosoma japonicum. Fic. 1.—Appearance of egg as

passed in feces. Embryo inside. Cilia do not show on sharp
focus. Fig. 2.—Embryo outside of egg, at rest. Fig. 3.—
Shapes assumed by free embryo in recently voided fæces.

Patient entered hospital April 26th, 1906, and was
at once given full doses of iron preparations, combined
with strychnine and quinine, the latter in small doses.
He improved rapidly, and on May 12th his conjunctiva
was pink, and the hemoglobin had increased to 35 per
cent. The oedema of the legs and scrotum was still
present, but the stools were only three a day, and the
prolapse of the rectum was almost gone. There was
no blood nor mucus apparent in the stool. Micro-
scopic examination of the stool showed a few eggs of
Ankylostomum duodenale, Tricocephalus dispar, and
many of the ova of Ascaris lumbricoides ; no eggs of
the fluke under discussion were seen at this examina-
tion, although they had been found in previous exami-
nations, and were also found subsequently. This fact
is mentioned to show the necessity of repeated exami-
nations in suspected cases, for if there is no point in.
the bowel that is ulcerating at the time, it is probable
that no eggs will be present. It seems to be a well- .
established fact that the fluke does not thrust the eggs
directly into the bowel but into the submucous tissue,

996

and that they act as a foreign body and eventually
ulcerate out into the bowel.

June 8th. Patient was given 45 grains thymol in
three doses and expelled eight hook-worms. Subse-
quent examinations showed none of the eggs of this
worm present in the fæces.

June 16th. The patient left hospital. All edema
was gone, and there was no dyspnoea when patient
walked about. Prolapse of rectum and dysentery had
also disappeared, and patient declared that he was
suffering no inconvenience whatever.

The microscope showed under a single cover-glass
several eggs of Schistosoma japonicum and half a dozen
embryos outside the shell moving their bodies vigor-
ously, assuming all sorts of shapes, but making very
little progression. The pressure on the cover-glass
had been very moderate, and I am inclined to think
that they had hatched out of the eggs after the stool
was passed, about four hours previously, the weather
being very warm. The movement of the cilia was
very active, and the sac connected with the pro-
tuberance more clearly outlined. This was the first
time I had ever seen movement in the embryo, but
other examinations had been made in cool weather.

The third case is one seen by Dr. H. B. Taylor, of
Ngankin, Anhuei Province, and I am indebted to him
for the notes on the case, which has just been reported
to the China Medical Missionary Journal. His case
is interesting because there was no infection with the
hook-worm, as was the case in all previous infections
found іп China, including Catto’s, and it is of further
interest because the patient was not cedematous, but
on the contrary was much emaciated. The notes on
the case are as follows :— t

“The patient, a Chinese boy, aged 11, was a native
of Wang Chiang Fu, about forty miles from Ngankin,
near the Kiangsi border. He gave a history of chronic
diarrhoea of many years’ standing. The stools were
bloody at times. Accompanying the diarrhea there
had been gradual enlargement of the abdomen and
progressive weakness and emaciation. No history of
cedema at any time.

“The boy was extremely emaciated, face, body, and
extremities. Liver much enlarged, and three or four
finger-breadths below the costal margin very tender,
with rough nodular feeling on palpation through thin
abdominal walls. Spleen also much enlarged, tender,
but without nodular feeling. Intestines distended
with gas.

“Тһе first time the patient came to our dispensary
the stools were formed and contained no blood micro-
scopically. On examination, the ova of Schistosoma
japonicum were found in small numbers, along with
many of Ascaris lumbricoides. ^ Subsequently the
patient returned with dysentery. The ova were again
found. This diagnosis was kindly confirmed by Dr.
Logan, of Changteh, to whom I sent a specimen, and

whose cases of schistosoma infection were reported in

the China Medical Missionary Journal last year.
“Аб this time the boy was weaker, and more ema-
ciated than at the previous visit. His abdominal
symptoms remained as before. He remained three
weeks in the hospital on iron and tonic treatment
without material benefit.”
It would thus appear that the disease under con-

THE JOURNAL OF TROPICAL MEDICINE.

[October 1, 1906.

sideration is widely distributed in China, as it is now
definitely settled that the three provinces, Fukien,
Anhuei, and Hunan, each being separated from the
other some hundreds of miles, furnish cases of the
disease. І

THE HAMOGREGARINE OF MAMMALS
(Н. BALFOURI), AND SOME NOTES ON
RATS.

By J. Burton CrELAND, M.D. Ch.M.Syd..

Government Bacteriologist and Pathologist, Perth,
W. Australia.
(From the Pathological Laboratory, Department of Public
Health, Perth, W.A.)

It may be of interest to record, for Western Aus-
tralia, the occurrence in a specimen of Mus decumanus,
the “ Norway” rat, оға hwmogregarine apparently
identical with that referred to by Dr. Balfour in his
article on the “ Hemogregarine of the Jerboa,” in the
JOURNAL OF TrRopPIcAL MEDICINE for March 15th,
1906. In speaking of H. balfouri of the Jerboa, he
says: “ І have recently discovered what seems to be
the same parasite in the mononuclear leucocyte of the
Norway rat (Mus decumanus) in Khartoum. 1% is
probable that it exists as a leucocytozoon in the
rodents, but further observations are required.”

The rat in which the leucocytozoon was found was
one of many received and examined in this Laboratory
in connection with plague work. Many of these were
dead when received, but some were alive, and films of
blood and smears from the organs were examined in
a number of instances, and always when pathological
conditions were present. In all the many prepara-
tions examined in this way. this was the only instance
in which the leucocytozoon was met with. Trypano-
вотев were frequently seen, but it is interesting to state
that they were only encountered in those rats which
were examined immediately after death. It is a
remarkable coincidence that it was on the day after
reading Dr. Balfour’s article that the protozoon was
discovered, and that neither before nor after that date
have I again encountered it, though it could hardly
have escaped notice had it been present. This par-
ticular rat, which had been kept alive in the Labora-
tory for about a fortnight, was given chloroform, and
examined, when the only point noticed was a some-
what enlarged spleen. Only two blood smears were
unfortunately obtained, both of which show fairly
numerous beautiful examples of a leucocytozoon in
the protoplasm of the mononuclear leucocytes. This
parasite agrees perfectly with the figures and desorip-
tion in Dr. Balfour’s article, and is, I think, un-
doubtedly the same. Sections were made of the liver
and spleen, but no parasites were found in the fixed
cells of these parts, though one was seen in a leuco-
cyte in a capillary of the liver.

In the smears from the organs of this rat, made
immediately after death, cocci and bacilli of several
species were seen. It happened that at this time we
lost a number of rats which we were keeping for
experimental purposes. In those of them which were
chloroformed while sick we found in smears quite a

October 1, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE.

297

number of organisms, though of course in these there
could have been no post-mortem increase. Some of
these were even bipolar, and suggested at first infec-
tion with plague. I could not account for some time
for this apparent epizootic, in which were present
during life so many diverse organisms. However, we
found that in many instances the hind-legs were
cedematous, and on examining the soles of the feet,
uleers of varying size were almost always found,
swarming, of course, with bacteria. This condition
was undoubtedly due to damp cages, and ceased when
this defect was rectified. It suggests that even in
their natural haunts this species of rat must suffer
severely from the dampness accompanying floods and
heavy rains, which possibly may have a checking
effect on their numbers, and drive others to drier
localities.

---------

“C. R. Soc. Biologie,” Т. 1x., pp. 349-350.
GLOBULAR RESISTANCE IN BrLiovs HgMoGLOBINURIC FEVER.

Vincent, H., and Dopler, C., state that & chronic malarial
subject cannot absorb quinine without provoking a crisis of
hemolysis.

His red corpuscles are constantly less resistant to quinine
than those of healthy Тере, and become even less so during
such a crisis. Treated with hypotonic solutions of sea-salt
the corpuscles, constantly less resistant than those of the
healthy, are even less so from the access of a crisis initiated
by quinine.

After some days their resistance returns to the normal,
and this enhanced resistance may be explained from the
formation of new bodies in the blood as a sequel to the
auto-hemolysis. It may be noted that nine days after the
crisis the serum of such a subject becomes less agglutinatory
for its own corpuscles.

Searching for some explanation of the diminished resist-
ance to quinine, the authors examine and reject the
following hypothesis: That there are an insufficiency of
“ antisensibilisatrice," or an excess of cytase, or a lack of
anticytase. We are left to suppose that the corpuscles are
more fragile either from an insufficiency of the lepoid sub-
stances described by Overton or by a want of salts. In
support of the latter supposition, they remark that, on the
one hand, preventive injections of artificial serum in the
patients may initiate a crisis of hemoglobinuria, while on
the other, the red corpuscles taken at the full crisis when
their resistance to hypertonic solutions is at its least, may
be rendered more resistant by prolonged contact with a less
concentrated solution (1 to 100, about,) of chloride of calcium.

“Lancet,” August 16, 1906, p. 438.
(Әрікоснжта DuTTONI.)

Stephens, Dr. J. W. W. The note concerns itself with
methods of staining, especially with the demonstration of
the flagelle. The nitrate of silver method failed in the
author’s hands owing to the difficulty of cleansing the
spirochetes from the albumucous blood plasma, even after
repeated centrifuging and washing. He, however, obtained
beautiful results by the following methods: The material
was centrifuged and washed three or four times in normal
salt solution. Films of the deposit were then made,
and after mordanting, stained with gentian violet. The
following forms were observed: (1) With terminal flagella
no bipolar or peritrichous flagella were ci served; (2) linked
forms; (8) eviscerated forms, probably due to mechanical
or chemical action. In many cases а sort of sheath was
observed.

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THE

Journal of Tropical Medicine

Остовев 1, 1906.

KITASATO'S SUGGESTION OF АМ INTER-
NATIONAL CONFERENCE TO FIGHT
PLAGUE.

Proressor S. KrrasATO suggests that a national con-
ference be formed to fight plague in India aud South
China. This opinion is the result of close observation
of the epidemiology of plague ever since 1894, when
Kitasato first discovered the plague bacillus in Hong

* Kong. Не is of opinion that it is useless to fight

plague by the present means, each nation individually
enforcing quarantine laws, passing special regulations,
disinfecting cargoes and people, and applying locally
aud generally all the paraphernalia attaching to
modern hygienic measures. Kitasato is of opinion
that the foci of the disease must be dealt with, and as
at present India and South China are the chief seats
of plague the battle has to be fought at these cradles
of the disease. There can be no doubt that the
Japanese and several nations in Europe blame British
laxity of action for the present state of the world in
regard to plague, and we have already, in this Journal,

' A paper read at the third annual meeting of the Philippine
Islands Medical Association, March 8rd, 1906, and published in
the Philippine Journal of Science, June, 1906. Ву Professor
S. Kitasato, of the Institute for Infectious Diseases, Tokyo,

Japan.

998

broached the question of interference of other countries
in a matter which, as regards India at any rate, is
wholly a British question. That interference has
entered many minds there can be no doubt, and it
coines to this: Are we to muddle through and allow
things to drift on as they are doing, or wait for a
request from other nations to take the matter in hand ?

No doubt regard for British sensitiveness has re-
strained other Governments forwarding a request of
the kind, but if plague recurs in India during the
coming winter, to the extent it did during the winter
of 1904-5, there are indications that a combined
request may be forthcoming. Kitasato has publicly
voiced the matter, and in his speech he asks the
President of the United States of America to.take up
the matter. His words are as follows: “ Му sug-
gestion only lacks а leader, and I see that the United
States, one of the greatest nations of the earth, has
such a leader in the person of its President, Theodore
Roosevelt, who has already done so much forhumanity
and whose noble works are being admitted by the
whole world." А better leader іп а movement of the
kind than the President of the United States it would
be difficult to find; but surely, with the warning of
what may be impending before us, it is possible to find
a man or men of British nationality to forestall the
interference and to rise to the occasion. What is to
be done is another matter, and what is not being done
in India is not perhaps so apparent; but that what
we are doing is not satisfactory to people of other
countries is becoming evident. Interference in Indian
matters, military, political and medical, by the home
Government, or by Parliament, has been, and is, a deli-
cate question ; and it is the desire to spare the feelings
of Indian public servants generally that has deferred the
enforcement, and not only the enforcement but even
the direct suggestion, of many public questions which
those outside India regard as requiring amendment.
In the public press, in the meantime, the subject of
“ Our Failure in India" is being discussed. We have
not failed in India, we have brought peace, order and
security of tenure to some 300,000,000 of people where
there would have been strife, bloodshed and chaos.
Were Britain to have done nothing else, her rule in
India has entitled her to the highest pinnacle of fame,
and the men who have gained for her an unequalled
place in history by their work in India are entitled
to all the honour, fame, and consideration that can
possibly be bestowed upon them. Still, according to
other people, in regard to this question of plague
epidemics, allis not as it should be, and we are sub-
mitted to the mortification of a Japanese scientist ask-
ing the President of the United States to undertake
work which, in publie opinion, we are not equal to.
Kitasato states that plague, “however obstinate its
ravages, could be fought and vanquished by the per-
sistent efforts of man." The expenditure of “ efforts,
however laborious, the money, however vast, can be
of no value unless they be accompanied by the appli-
cation of scientific knowledge." According to Kitasato
we are evidently lacking in the scientific knowledge
necessary, and by allowing matters to drift we are in-
viting interference, which, when it comes, we will

‘sent, and the sensitive occupants of the field in India
vill regard as an insult to their service.

THE JOURNAL OF TROPICAL MEDICINE.

(October 1, 1906.

Are we doing nothing? Ву no means; we have
sent out commissions to investigate, but it seems to
most people that the day for investigation is over, that
the bacteriologist and the microscopist have done their
work, and the rigime of the practical sanitarian is
required, not merely detailing for plague duty several
already overworked men of the Indian Medical Service,
but the temporary creation of an army of workers, not
in hundreds but in thousands, to deal with plague.
As Kitasato says, the money spent for this temporary
work would be less than the plague expenditure in-
curred by the world at the present moment from
quarantine hindrances, disinfection, expenses, loss of
trade and loss of life. Unless a step of the kind is
taken, and that speedily, we will have to bear the
chagrin of the interference, justifiably or unjustifiably,
of other nations coming forward and requesting us
either to mend our ways and eliminate plague, or to
allow them to do the work we are avowedly incap-
able of. J.C.

BRITISH MEDICAL ASSOCIATION MEETING
AT TORONTO, AUGUST, 1906—ABSTRACT
OF PROCEEDINGS.

OBSTETRICS AND GYNECOLOGY.
President: Dr. W. 8. A. GRIFFITH (London.)

Proressor А. Н. Монт (Toronto) introduced the
subject of “ Concealed Accidental Hemorrhage in the
Latter Part of Pregnancy, before the Effacement or Dil-
ation of the Cervix." He pointed out that the patient
in such cases suffered more from shock than from
actual loss of blood. The treatment recommended was
morphia to the extent of 1 grain in one hour if severe
shock threatened. Dr. W. S. A. Griffith stated that
dangerous hæmorrhage, of the nature referred to by
Prof. Wright, was very rare; when, however, such
occurred, in cases in which the cervix was tough
and undilatable section of the uterus (vaginal) should
be done; in multipare, when the os and cervix were
capable of dilatation this should be done along with bi-
polar version. Dr. Temple (Toronto) and Dr. Murdoch
Cameron (Glasgow) condemned Cresarean section for
an ailment of this nature, nor was vaginal section of
the cervix necessary according to Dr. Temple. Dr.
Cameron stated that he had never seen a death from
concealed accidental hemorrhage in the latter part of
pregnancy.

Chronie metritis and arterio-sclerosis of the uterus
were discussed by Drs. Gardner and Goodall (Mon-
treal) Іп uterine arterio-sclerosis, Dr. Barker said
that nothing short of hysterectomy was of any use.

Dr. A. E. Giles (London) described the results of
146 consecutive cases of ventri-fixation of the uterus ;
the benefits in many instances were stated to be most
marked. This subject was discussed by Drs. Bovée
(Washington), Dudley (Chicago), Gardner (Montreal),
Gilliam (Ohio), Temple (Toronto.)

“ Changes in Uterine Fibroids, after the Menopause,
with Reference to Operation,” was dealt with by Dr.
C. A. L. Reed (Cincinnati). He advocated removal of
uterine fibroids occurring about the time of the meno-
pause. This conclusion was refuted by Dr. J. T. W.

October 1, 1906.)

Ross (Toronto), who stated that a fibroid was merely
an outgrowth of the muscular tissue of the uterus, and
cancerous development in tumours of the kind was
rare. Even in young married women small uterine
fibroids might exist without causing trouble, and that
their removal could not be undertaken without serious
danger to the patient. The comparative harmlessness
of fibroids, in proportion to the number of actual cases,
was insisted upon by Dr. Byford.

Dr. H. L. Reddy (Montreal) brought forward the
indications for Cesarean section, other than in pelvic
deformities and tumours.

“Тһе Appendix Vermiformis in Relation to Pelvic
Inflammation ” formed the subject of a paper by Dr.
Helme (Manchester). He discussed the association
of inflammation of the appendix and pelvic organs,
believing that contiguity rather than continuity of
structure was the explanation of the association.
Appendicitis, according to Dr. Helme, is a frequent
source of dysmenorrhea and its associated mucous
colitis, but the association of appendicitis with pelvic
disease is the exception and not the rule. The
appendix, Dr. Helme regards, not as a vestigial struc-
ture but as a differentiated part of the intestinal tract
which plays a high and important part in digestion.
He condemns the removal of the healthy appendix
during operations for pelvic disease. Dr. Lockyer
(London) dealt with the relationship of appendicitis
to pregnancy, and the treatment of the conditions
when the two are combined.

Prof. Murdoch Cameron (Glasgow), іп а paper en-
titled “ Antistreptococcus Serum in Puerperal Septi-
cæmia,” advocated its use in puerperal fever in which
there is but little laceration of the soft parts, but соп-
demned its application as useless when the fever was
due to traumatism.

The subject of “ Eclampsia ” was introduced by Dr.
Evans (Montreal); he referred to Edebohls' treatment
for eclamptic anuria by renaldecapsulation. Lumbar
puneture, introduced by Helme, had not proved suc-
cessful. Dr. Temple (Toronto) favours blood-letting,
the use of morphia, and where the cervix is dilatable
the induction of labour in the treatment of eclampsia,

SECTION or DERMATOLOGY.
President: Dr. NoRMAN WALKER (Edinburgh).

“Тһе Influence of Light-hunger in the Production
`of Psoriasis" was introduced by Dr. J. N. Hyde

(Chicago). He said that one statement was that psori-

asis never affects the lower animals because their skins
are exposed to light. Another, that were psoriasis in
man due to light exclusion the number of persons
attacked would be few : the parts of the body attacked
coincide with those least exposed to daylight; the
disease should be localised in light-excluded parts ; the
rational treatment would seem to be that by illumina-
tion. Dr. Dühring did not agree with Dr. Hyde as to
the etiology of psoriasis; it is certainly not parasitic,
and the treatment by local measures are well-nigh
useless, internal treatment presenting the only hope
of relief. Dr. L. D. Buckley (New York) said local
treatment was inadequate, and that the altered condi-
tion of the system permitted the growth of organisms.
Drs. G. H. Fox (New York) and W. T. Corbett

THE JOURNAL OF TROPICAL MEDICINE.

299

(Cleveland) remarked on the apparent immunity of
the Negro Race. Dr. Gilchrist (Baltimore) believed
psoriasis to be of parasitic origin, and advocated the
use of X-rays in the treatment of the disease.

“ Bullous Eruption ” was discussed by Dr. J. C.
Johnston. He contended that bullous eruptions were
autotoxic in origin, and required treatment by diet,
laxatives, diuretics, exercise, hot-air baths and pilo-
carpin.

Dr. Graham Chambers gave & clinical demonstra-
tion of the treatment of ringworm by means of & pre-
liminary X-ray epilation before applying the usual
remedies.

“ Errors in the Treatment of Cutaneous Cancer"
were discussed by Dr. А. В. Robinson. He said no
fixed rule could be applied to the treatment of these
ailments; excision is unsuited for cancer on the skin
of the face; X.ray treatment is of no value where the
deeper structures are involved, and ought to be соп-
fined to certain specific forms; when X-rays are
employed the superficial cutaneous layers and nodules
ought to be removed by applying X-rays. Dr. R. W.
Taylor (New York) maintained that coincidently
with primary local syphilis the whole system becomes
affected by way of the blood rather than by way of
the lymphatics.

“Тһе Wrong and the Right Use of Milk in Certain
Skin Diseases" was the subject of a paper by Dr.
L. D. Bulkley. Іп cases of acne, eczema, and
urticaria he found milk, given one hour before meals,

. when the contents of the stomach were alkaline, was

absorbed without previous caseation, and proved
beneficial ; a vegetable diet should be combined with
the milk treatment.

MALARIA IN GREECE.
LIVERPOOL Ѕсноогр or Tropical MEDICINE.

SIR ALFRED Jones, K.C.M.G., gave а lunch yester-
day, at the University Club, to Dr. Savas, of the
University of Athens, Physician to H.M. the King
of Greece. Owing to ill-health Sir Alfred was unable
to attend, and in his place the Lord Mayor of Liver-
pool (Alderman J. Ball) presided. Among those
present were: Lord Mountmorres, Professor Boyce,
Professor Ross, Professor Carter, Professor Bosanquet,
Dr. Caton, Dr. Hope, Dr. Utting, Dr. Todd, the Rev.
Arch. Gabriel, the Hon. J. L. Griffith (U.S. Consul),
Mr. T. H. Barker (Secretary, Liverpool Chamber of
Commerce), and others. A telegram was read from
Sir Alfred Jones thanking the Lord Mayor for taking
the chair. А letter was received from Mr. Mataxas,
Minister for Greece in London, thanking the Liver-
pool School for their help in the movement for
suppressing malaria in Greece.

On the proposition of the Lord Mayor, the loyal
toast and the health of the King of Greece were
honoured. The Lord Mayor then proposed the health
of Professor Savas.

Professor Savas, in responding, said that he was
sorry he could not speak the English language sufti-
ciently well to express all he wished, but he desired

300

to say how he thanked H.R.H. Princess Christian for
her assistance to the cause he represented, Sir Alfred
L. Jones for the great help he had given the Liver-
pool School of ‘Tropical Medicine, and Professor
Ronald Ross. The interest shown in this country
in the movement for the abolition of malaria in Greece
was one of many instances of the kindness that Great
Britain had always shown to his country.

Dr. Ronald Ross then gave an address dealing with
malaria in Greece. He explained that on the invita-
tion of the Lake Copias Company, Limited, he was
sent out to Greece at the instance of the Liverpool
School of Tropical Medicine to investigate malaria in
that country. He went to Greece last May, and
found such a condition of affairs as decided him to
report to the Liverpool Tropical School and to the
city generally. The way to investigate malaria was
to examine the condition of the school children, and
in the course of this work he found in one village 38
children out of 80 affected; in another 13 out of 40;
in another 25 out of 50, and in a mountain town 16
out of 100, In the city of Thebes the proportion was
only one in 50. The general statistics applying to
the whole country showed that out of a population of
two and a half millions roughly there were about a
quarter of a million cases a year. There were 250,000
cases of malaria per year, and the deaths were about
1,760. Last year there was a bad epidemic, and the cases
amounted to 960,000, the deaths numbering 5,916.
On the average there had been, roughly speaking,
two attacks of malarial fever for every five persons in
the country last year. Of such a state of things they
could have no conception in this country, for it was
not a case of having the disease once, like measles or
scarlatina, but the trouble came week by week and
month by month. It was evident that the ancient
civilisation of Greece was checked by some cause, and
he was of opinion that the cause was the spread of
malaria. The disease was probably introduced or
reinforced by the natives of Asia, introduced by their
Greek conquerors. They had a modern instance of
the same sort of thing in the Mauritius in 1866, when
the disease swept round the coast avd ruined the
place. Probably the event took place about the time
of Pericles, and it must have done a great amount of
harm. In considering the causes of the rise and fall
of nations they were apt to overlook the influence
of disease. The movement for the suppression of
malaria was supported in influential quarters, and
they hoped to obtain the support of the Liverpool
people.

Mr. W. Watson Rutherford, M.P., said that Liver-
pool, with its associations all over the world, should
take cognisance of a proposition laid so influentially
before them. Very valuable work had been given in
the direction of checking malarial disease by Dr.
Ross, Prof. Boyce, and Dr. Todd.

Mr. Daniel Steele, General Manager of the Lake
Copias Company, Limited, expressed his appreciation
of the help extended to Greece in that matter, and
his conviction that satisfactory progress would be made.

The Hon. J. L. Griflith, U.S. Consul, also spoke,
and said that Liverpool had now the opportunity of
paving part of the debt which all civilisation owed to
Greece.

THE JOURNAL OF TROPICAL MEDICINE.

(October 1, 1906.

On the proposition of Lord Mountmorres the health
of the Lord Mayor was drunk and the proceedings
ended.—Liverpool Courier, September 18th, 1906.

NOTES ON PLAGUE IN INDIA.
Rat DESTRUCTION.

THE difficulties connected with rat destruction are

many. One is the religious difficulty, as amongst
several communities taking of life of any living thing
is a strict tenet to be observed. Another, however, is
more quaint; it seems that some people object to the
rats being destroyed because they cannot then be
warned when plague threatens; death amongst rats
being a sure sign that plague will attack human
beings. So far has this curious form of prophylax is
seized upon the minds of natives that the British
resident in Mysore finds it necessary to “ dissipate
the idea that it is useful to have rats in order that
their dead bodies may give warning of the presence
of the disease."
. In the Punjab the decrease of mortality from plague
was less by 300,000 during the first six months of
1906, compared with the corresponding period of
1905. То the destruction of rats is this fortunate
result chiefly attributed.

Poona is suffering from & severe recurrence of
plague. On September 11th and 12th, 268 persons
in the city died of the disease. ;

Monkeys and cats are reported to be suffering from
plague in some districts of the United Provinces. |

Clemesha, W. W., Captain I.M.S., in an article in
the Indian Medical Gazette of September, 1906, on “Ап
Account of Plague in Bengal," states: “ That for the
spread of plague the presence of large numbers of
rats is the chief factor; insanitary houses are also an
element in the spread, but chiefly from the fact that
such houses are obviously an abode for rats.” People
engaged at certain trades seem to be especially liable
to plague, but when these come to be looked into it is
found that it is not the trade itself that is the cause,
but the environment in which the trade is carried on,
that determines the presence of the disease. It is
almost always the village shopkeepers who are first
attacked by plague, and these men conduct their work
in dark, rat-infested godowns, sheds, and grain-
stores. So strong is Captain Clemesha's belief in the
infecting power of the rat that he states: “А house
so constructed as not to be suitable for rats to live in
and not containing апу food to attract rodents, would
probably remain non-infected unless a case of pneu-
monie plague was placed in it." In Eastern Bengal
plague does not now prevail, nor has this province at any
time during the past ten years suffered severely from
plague; the reason may be, that in this part of Bengal
the villages are long, straggling lines of houses ; each
house usually is buried in a thicket of bamboos and
rank vegetation in its own compound and at some
distance from the neighbouring houses. Rats are not
so plentiful in houses of this type as in the closely
packed mud-houses met with in such districts as
Bihar, where plague is rife.

October 1, 1906.)

THE JOURNAL OF TROPICAL MEDICINE.

IMMEDIATE INCISION INTO PLAGUE GLANDS.

Nesfield, V. B., Captain I.M.S., in the Indian Medical
Gazette of September, 1906, argues in favour of early
incision, in cases of bubonic plague, with the object
of preventing toxin absorption. He states that in
plague, as in other вербісетіс infection, the specific
organisms in the lymphatic gland are engaged in
rapidly elaborating toxins which are readily taken up
by the lymphatic and vascular systems and so produce
a condition of poisoning. Within the gland, in time,
however, the organisms themselves, owing to their
numbers, cannot be accommodated in the space, and
gaining the lymph and blood streams cause septi-
cemic lesions. The presence of the toxins in the
blood tend to lessen the power of the resistance of the
blood to the organisms, so that the longer the toxins
are being absorbed the greater the ease with which the
organisms gain access to and ascendancy in the blood.
To prevent the further absorption of toxins, and sub-
sequently of organisms, Captain Nesfield recommends
that, where possible, every superficial gland should
be opened with as little delay as possible. The gland
should not оп any account be excised ; a simple incision
should be made deeply into the substance of the gland,
во that the toxic serum and plague organisms may һауе
free exit, but the cellular tissues and periglandular
lymphatics should not be disturbed. After opening
the gland Captain Nesfield pours strong tincture of
iodine lotion, about 24 per cent., into the cut surface,
and foments the part by lint soaked in the same fluid.

--------«о---

% 00008.

Tar EXTRA PHARMACOP@IA: MARTINDALE AND WEST-
сотт. Twelfth Edition. London: H. K. Lewis,
186, Gower Street, London, W.C., 1906.

A revised edition of this useful publication is to
band. It is not, surely, necessary to dwell upon the
excellence of this well-known book. Every medical
man must have it аф his elbow if he hopes to be cogni-
sant of all that is most recent in therapeutics and the
rational treatment of disease. The present volume
extends to 1045 pages, and there is not a page too many,
nor a line tbat can be spared. The labour, the care,
ihe precision and the literary efforts involved in
the production of the “ Extra Pharmacopoia'' have
always excited our admiration, and the additions to
this, the twelfth edition, still further bear out the
reputation of its predecessors. "We have frequently,
when new drugs are forwarded to us from tropical
countries, especially those in use by the natives, con-
sulted Dr. H. Harrison Martindale concerning them,
and in almost every instance he has been able to point
out to us that the ' new " plant or drug is dealt with
in the “Extra Pharmacopeia.” The chapters on
Organotherapy, on Analytical Memoranda, and the
Therapeutic Index of Diseases and Symptoms are
special features of the twelfth edition, and we cordi-
ally acknowledge the debt we owe to the authors,
W. Harrison Martindale, Ph.D., and W. Wynn West-
cott, M.B., D.P.H., for the services they have rendered
to British medicing by their arduous labours.

301

Correspondence.

THE TRUTH ABOUT BERI-BERI.
To the Editors of the JouRNAL oF TRoPICAL MEDICINE.

Srrs,—You will perhaps allow me a small amount of your
valuable space to acknowledge the whole-hearted accept-
ance by Dr. H. Wright in your Journal of August 15th
(vol. ix., p. 246, 1906) of the truth of the observations I have
set forth (Journal of Hygiene, vol. iv., p. 112, 1904, and
British Medical Journal, vol. i., 1904).

Whilst he substantiates my observations so strongly as
actually to claim them as his own, there will be many who
will regret with me that he did not give public renunciation
of the statements he had made (“ Studies from the Institute
of Medical Research," vol. ii., 1902) some time during the
two years or so that elapsed between our several publica-
tions. This would have saved me from the unpleasant task
of correcting some of his errors of fact and inference in
detail, a task which two well-known men of science strongly
urged upon me as a “ matter of public duty."

I remain, Sirs, yours, &c., :

Hereford, HERBERT E. DURHAM.

September, 1906.

———9———

Bugs amb Remedies.

Dr. PnENDERGAST's diarrhoea pill :—

Б Bismuth salicylat grain 1
Salol a - » Ф
Calomel 2 is » 45
Camphorat. tinct. of opium mins. 2
Aromat. chalk powder 4.8.
Cinnamon oil 4.8.

For one pill.

Foramint (Medizinische Klinik, No. 16, 1906).—
Daus, Dr. S., of Berlin, speaks highly of the dis-
infectant action of formic aldehyde on mucous mem-
branes. Hitherto the use of even very dilute solutions
of formic aldehyde, owing to its extreme irritability,
has prohibited its use, but by combining it with
milk sugar this difficulty has been partly overcome.
It is as a disinfectant for the mouth, fauces, tonsils
and pharynx that this combination, named foramint,
in the form of lozenges, has come into use. In acute
follicular tonsillitis, mumps, quinsy, diphtheria, middle
ear disease, foul tongue and breath, and as an oral
disinfectant generally, foramint would seem to be more
efficient and more practically useful than attempts at
gargling or swabbing out the throat, which are often
well-nigh impossible and always imperfect. We have
tried foramint, and find the remedy to be both pleasant
and efficient in mouth and throat affections.

res ЕБС
Hotes and "etos.

THANKFUL FOR SMALL Mercies.—Trom a recent
circular: Church Missionary Society, Medical Mission,
Yezd, Persia r The hospitals are now,
thanks to God’s blessing on our work, so crowded ав
to be very insanitary, aud the Women’s Hospital is
totally unsuitable for its purpose.

802

THE JOURNAL OF TROPICAL MEDICINE.

{October 1, 1906.

--

Dr. S. С. каве, Surgeon of the D. I. steamer
“ Jelunga," has died in the General Hospital, Cal-
cutta, of acute pleurisy, at the early age of 35 years.

How мот то Do Ir.—At a recent meeting of the
Bombay Corporation, during а diseussion on the
campaign against rats, Mr. Todd said he was assured
by his Hindu friends that they perfectly realised the
necessity of getting rid of rats. Тһеу set traps for
them and caught them, but as they could not kill
them, they let them loose in drains aud open spaces.

А CORRESPONDENT of the Indian Pioneer, signing
himself “ Medico," complains of the absence of all
ра teaching of Midwifery іп the University of

&hore. It must be confessed, however, that the
peculiar social system of India renders attendance
of students in actual cases of labour almost imprac-
ticable. It is only as a last resource, in desperate
cases, that a male practitioner is ever called in, and
it is practically certain that even such cases would
be left without competent assistance altogether, if
students were allowed to accompany the practitioner
called in. During twenty years’ practice in India,
though often called upon to perform craniotomy and
other obstetric operations, the writer never had the
opportunity of attending a normal labour in a native,
and under such circumstances it is difficult to see
how practice in this department can be arranged for
students. This may be unfortunate, but, it is to be
feared, is unavoidable.

Tas HEALTH оғ Bompay.—A Bombay message to
a contemporary says: The condition of public health
in Bombay continues to be unsatisfactory. The mor-
tality last week was only a hundred short of double
that of the corresponding week of last year. The
main cause of this exceptional unhealthiness is the
prevalence of cholera and choleraic diseases. There
were 119 deaths from cholera — the highest total
reported during this epidemic—and 99 from diarrhea.
But although the figures are higher. than before, there
are signs that the epidemic is about to wane, and
unless abnormal conditions supervene the presence
of the disease in our midst should not be protracted
much longer. The unusual continuance of cholera in

the city at this season has brought the water supply.

under suspicion, but these apprehensions are not
founded on fact. The disease is spread all over the
city, and local outbreaks have shown themselves
amenable to preventive measures; so that although
the water supply may in parts be liable to pollution,
this cannot be the source of infection. Undoubtedly
the food and milk supply of the people at this time
of year has a good Neal io do with the prevalence
of diarrhoea, and that predisposes to cholera when
the latter disease is about. The carelessness of the
mass of the population in exposing their food and
milk to flies and dust is also notorious, and this is
a serious factor in the spread of infection.—Pioncer
Mail, August 10th.

Mazor Ernest RonEnTS, I.M.8., has just brought
out an extensive work on enteric fever in India, pub-
lished by Thacker, Spink and Co., Calcutta. As yet

we have only before us a highly eulogistic review in
the Indian Pioneer, a lay paper, which, however, fre-
quently notices scientific works on subjects which,
like the present, are of high publie importance.

As Secretary to the Sanitary Commissioner and
Statistical Oflicer to the Government of India, Major
Roberts has had exceptional opportunities of studying
the incidence of typhoid, so that the work can hardly
fail to be of great practical value.

Major Roberts shows that typhoid for many years
has been, and is still increasing, and this in spite of
almost every cantonment having been supplied with
excellent water. Added to this, enormous improve-
ments have been accomplished in the care and cook-
ing of milk and other artieles of food, and in the hous-
ing and well-being of the soldier, in numberless
ways, and all, as far as enteric is concerned, absolutely
to no purpose. One thing alone has remained un-
changed, and that is the official system of conserv-
ancy, which is still on the “ trenching system." It is
refreshing to find this pernicious military medical
fetish attacked by one of the Inner Simla Circle, and
it is a healthy sign of the times that such an one
should be able to venture to attack it; for certainly,
until lately, the heretic who dared to attack the
sacred trenching system would have been hardly likely
to stay long at Simla.

We trust that the Indian Government will see its
way to adopt Major Roberts’ suggestion of water
carriage to septic tanks, as the present plan of dis-
tributing typhoid dust, by spreading the infected night-
soil out in the sun, with a thin layer of dust over it,
із so against rhyme and reason that it is marvel-
lous that it should have been so long supported by
the medical authorities in India.

Prague ім CarcurTA. — Dr. Pearse's report оп
plague in Calcutta during the year ended June,
1905, was submitted in August last. Dr. Pearse
establishes & number of striking conclusions con-
cerning plague ав it operated in this city. Не
shows that the alleged comparative immunity of
"omen is а delusion. Тһе proportions of men
and women attacked are precisely the same as the
proportion of men and women in the total population.

{ fewer women are attacked this is because there are
fewer women than men. Another lesson from the
experience of Calcutta is that the danger of infection
by personal contact with plague patients is much less
than has been generally supposed. The great
majority of plague cases occurred in separate houses,
that is, plague patients did not infect other inmates of
the dwelling. The result of Dr. Pearse’s direction of
the anti-plague campaign has been a flood of light
thrown on the causes of death in Calcutta. In many
cases, at ordinary times, no medical man is in attend-
ance and the cause of death is not ascertained. The
special arrangements in connection with plague have
dispelled this ignorance, and revealed an unsuspected
prevalence of phthisis, tetanus, and a number of
obscure diseases.—Pioneer Mail, September 7th, 1906.

An APPEAL FROM WESTERN CHINA.—Bishop Cassels
has written from Tao-ning, Western China, a letter
on behalf of missionary work in China, in which he

October 1, 1906.)

THE JOURNAL OF TROPICAL MEDICINE.

303

says: ''It is many years since we have been so
destitute of any medical help in tbis station and
district as we are just now. Even though we had
no doctor, we nearly always had some qualified nurse
&nd someone who could undertake dispensary work ;
but now we are absolutely without any help of this
kind, and the workers are so busily occupied that in
case of any sickness requiring nursing we should be
in a very difficult position.” Those who would like
to hear further on this matter should apply to Miss
E. Van Sommes, Cuffnels, Weybridge. — The
Hospital.

Tae Nuwara ErrvA's District MEDICAL OFFICER.
—Dr. Frank Grenier's selection as Ceylon’s first re-
presentative to the London School of Tropical Medi-
cine may be regarded as a compliment to the District
Medical Officer of Nuwara Eliya, who has the reputa-
tion at the sanatorium of having proved a worthy
successor to the late Dr. W. С. Woutersz. Dr.
Grenier does not leave for Europe till next year.

Венвіно"в REMEDY FOR CONSUMPTION : TULASE.—
The material produced by Professor Behring for the
cure of consumption, ''tulase," consists of a clear
liquid prepared by treating tubercle bacilli with
chloral. A toxin, differing from Koch’s, has been
obtained from the tubercle bacillus, which is
stated to continue the process of immunisation where
Koch’s tuberculin leaves off. Although tolerance to
tuberculin may be established, persons so treated
are not immune against the tuberculosis caused by
Koch’s tubercle bacillus, and it is to continue the
beneficial effects of Koch’s tuberculin that Behring
has been striving after. Tulase contains the
bodily substance (somatic) of Koch’s bacillus. It may
be introduced intravenously, subcutaneously, or by
way of the stomach. The best result is obtained
when tulase is given in the form of an immunising
milk by the stomach. Tulase is not on the market,
and will not be во, until the exact dosage and methods
of exhibition are positively determined.

--т--

Personal Hotes.

INDIAN MEDIOAL SERVICES.

Arrivals Reported in London.—Captain Е. Wall.

Extensions of Leave.—Major Т. W. Irvine, study leave, July
1st to 7th, 1906; Captain V. E. H. Lindesay, 6 m. furlough ;
Captain D. C. Kemp, 9 d. extraordinary leave; Major A. Street,
study leave, May 16th to August 15th, 1906; Captain Н.
Meakin, 6 m. medical certificate; Colonel R. Macrae, 3 4.;
Captain L. Reynolds, 6 m. medical certificate; Lieutenant
J. W. H. Babington, 8 4.

Permitted to Return to Duty. ошоп Golonel A. Milne,
Major T. C. Clarkson, Major H. Austen Smith, Captain A. T.
Pridham, Colonel R. Macrae, Lieutenant-Colonel O. H.
Channer, Captain G. Tate, Captain R. Bradley, Nursing Sister
Miss M. E. Gray.

Postings.

- Captain Hunter, services placed at disposal of Government,
United Provinces,

On return to India from lesve, Lieutenant-Colonel Cunning-
ham becomes Civil Surgeon of Umballa, while Lieutenant-

Colonol Adie returns in the same capacity to Ferozepur, and
Lieutenant-Colonel Coates to Lahore.

Lieutenant R. T. Collins, R.A.M.C., to hold additional civil
medical charge of Roorki.

Surgeon-General Trevor is confirmed as P.M.O., Western
Command, and Surgeon-General Slaughter to be Р.М.О.,
Eastern Command, vice General Gubbins, appointed P.M.O. in
India.

Home Department..—The services of Major Macrae and Cap-
tains O'Neill, Scroggie, and Rogers are temporarily placed at
the disposal of the Madras Government.

Tho services of Captain Justice are lent permanently to
Madras. >

The services of Captain Roberts are lent temporarily to the
Punjab, and the services of Captain Bamfield are replaced at
the disposal of the Commander-in- Chief.

Civil Assistant Surgeon Rai Sriput Sahai to be Civil Surgeon,
Hamurpur.

Promotion.
Captain Vivian Boare Bennett, M.B., F.R.C.S., to be Major.

COLONIAL MEDICAL SERVICE.

Dr. W. B. Thain, Medical Officer of Ashanti, Gold Coast
Colony, becomes Acting Cantonment Magistrate at Kumasi in
place of Major T. A. Pamplin Green, who has arrived in
England on six months’ leave. :

-------о--

PLAGUE.

PREVALENCE OF THE DISEASE.

Cases. Deaths.

India.—Week ended August 18th — 1,451
m » 25th 3,037 2,113

3 September 1st 3,503 2,522

" » 15th 4,304 3,134

Mauritius 5 37 18th 11 7
» » 20th 13 7

б » 978 16 10

Hong Kong.—One case of plague during week ended

August 26th. Clean Bill of Health issued.
Australia.—No cases of plague since June 30th.
Rodents found infected in Brisbane in August.
South Africa.—No plague since November, 1905
Rodents occasionally found infected in East London.

pees s ДЕНЕ

Prescriptions.

MALARIA—ADMINISTRATION OF QUININE
H YPODERMICALLY.

T. С. Wilson, in his “ Text-book of Applied Thera-
peutics," gives the following preparations for hypo-
dermic injection in malaria : —

R Quin. hydrochlorat grains 74
Aque destil. mins. 15
For one injection.
E (Kóbner's formula).
Quin. hydrochlorat grains 8 to 15
Glycerini "us ay mins. 30
Aqua destil. mins. 30

For one injection ; administered lukewarm.

304

THE JOURNAL OF TROPICAL MEDICINE.

{October 1, 1906.

R (When given combined with antipyrin).

Antipyrin aes 554 .. grains 6
Quin. hydrochlorat ... .. grains 15
Aqua destil. s mins. 30

For one injection.

R (Chlorhydrosulphate of quinine is recom-
mended hy Wilson).
Quin. chlorhydrosulphat
Aquee destil. 5%
For one injection.

grains 74

mins. 15

R Sulphate of quinine may be administered
when combined with tartaric acid.

Quin. sulphat. ET grains 15

Acidi tartarici... 12 -— - 8

Aqui destil. ... ix .. mins. 150
--------

Recent and Current Literature.

A tabulated list of recent publications and articles bearing on
tropical diseases is given below. , To readers interested in
any branch of tropical literature mentioned in these lists
the Editors of the JOURNAL OF TROPICAL MEDICINE will be
pleased, when possible, to send, on application, the medical
journals in which the articles appear.

** Ann. 416. Sper.,” T. xvi., p. 199.

ON THE EFFECT оғ PASSAGE THROUGH THE INTESTINES OF
EARTH-WORMS OR боп, GERMS.

Guargena, G. With rather unimportant exceptions, the
author finds that the intestinal flora of the worms is the
same as that of the soil, and that bacilli, whether found
naturally, or artificially added to the soil, are but little
affected by passage through the intestine of the worm. A
strain of В. prodigtiosus, however, increased іп virulence
while Staphylococcus citreus attenuated rapidly. The author,
however, demonstrates the important fact that worms can
carry germs to considerable distances and infect the soil of
their new resting place.

“Malaria in Tonkin and Northern Assam,” pamphlet,
11 pages, with Titles and Charts.

Salanoire, M., undertook an extended enquiry to clear
up certain points in the etiology of malaria in these regions.

His results are combined into a table giving (1) for each
station the proportion of anophclime to 100 culicime for
each month of the year; (2) two curves showing the average
annual proportion of the two sub-families and the incidence
of primary malarial attacks; and (3) a curve showing the
monthly proportion of Anopheline and Culicine for all posts
taken together.

Admitting, as indeed the author does, that curves of this
sort cannot be taken as having an absolute value, it is
obvious that except in two posts, there is a definite relation-
ship between the commonness of Anopheline and the
incidence of malaria. At Ha Gian, one of these exceptions,
Anopheline ave very scarce, though it is the most malaria-
stricken place in Tonkin. The surrounding country, however,
swarms with АпорЛейіте, and Salanoire therefore concludes
that the disease is contracted not at the post itself, but on
the way to it. The other exception, Quang Yen, on the
other hand, is regarded as a healthy station, so much ко,
indeed, that it has been chosen as the site of a convalescent
depot, but nevertheless the proportion of Anopheline is
enormous.

Salanoire would explain this by the fact that most of the
malaria enses are under treatment and so would rarely
infect the insects, but it is obviously possible that it may be

а matter of the species of anopheline which is common
there. Anopheles rossi, for example, is rarely if ever a
carrier of malaria. The author then gives some details of
the forms of parasite observed, and clearly holds the theory
of the specitie unity of malarial parasites, and finally deals
with the subject of bilious h:iemoglobinuric fever, which he
considers quite distinct from the paroxysmal hemoglobinuria
of Europe.

* Annales del Circulo Medico Argentino," 1908, p. 375.
STREPTOTHRIX MADURÆ. `

Greco, Nicolas. From the excellent clinical account
given by the author of a case originating in an inhabitant
of the Province of Santa Fé, in the Argentine Republic, it
appears fairly certain that * Madura foot” occurs in that
country. The patient had an inflamed lymphatie gland
in the corresponding thigh, and Senor Greco isolated from
the pus eultures of an organism, which he believes to be iden-
tical with Vincent’s Streptothriz (Discomyces) madura.

“ Ann. d'Ig. Sper.,” T. xyi., p. 251.
A Слѕе or HÆMOGREGARINA Bovis.

Martoglio and Carpano. Working at the production of &
serum for cattle plague, the authors found in a slide left over
night some peculiar bodies which exhibited certain staining
reactions.

Nothing similar could be found in the blood of the calf
that had yielded the blood from which the slide was made,
and the blood injected into a sheep produced no infection.
But the structures are, nevertheless, described under the
above name. Under the circumstances the authors would
have been better advised had they refrained from naming
these problematical appearances. It is very possible that a
species of Hiemogregarine may be found at some future
period in the blood of cattle, and as the identification of any
such find with this should be called H«emogregarine bovis is
clearly out of the question; a very eligible name has been
occupied to no better purpose than the gratification of the
passion for species-making.

“ Ergeln. d. allgem. Path. und Pathol. Anal. des Menschen
und der Tiere," T. x., p. 305.

Tue TRYPANOSOMIASES FROM THE STANDPOINT OF GENERAL
PATHOLOGY.

Sauerbeck, Ernst, whose recent work on the pathological
anatomy of this disease specially fits him for the task,
here follows out his subject in a sound and competent
manner.

After a brief account of the morphology and phylogeny
of the trypanosomes, the author first considers the non-
pathogenic members of the group, such as the Tryp.
lewisi of rats and T. padde, Laveran and Mesnil,
and then proceeds to the consideration of the pathogenic
species. Most space is devoted to T. brucei as in all respects
the best known member of the group, and includes an able
criticism of the views of Bradford and Plimmer (plasmodial
апа amceboid forms, &c.), and of Prowazek's sexual forms.
Convenient tables are given of the liability to, and duration of
the malady in different animals, as well as a good résumé of
his own researches.

Surra, Caderas, and Dourine are treated in a few pages, and
human trypanosomiasis occupies but three; Indian fevers
and the Leishman-Donovan bodies are treated with greater
minuteness, and he shows how Leishman’s original theory
has had to be moditied by the work of Major L. Rogers,
though he does not consider that the latter has demon-
strated the presence of true trypanosomes in his cultures.
He compares the examples of Piroplasma donovani with
that Halteridium or Hemoproteus noctue of Schaudinn.

He points out that the trypanosomes at present include
n great variety of types, the extremes of which are the true
trypanosomata, which are exclusively extracellular parasites,
and the P. donovani, which is always intracellular, and pre-

October 1, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE.

305

dicts that subdivision of the group will be necessary. A
short appendix on methods of staining is included.

“Zeit. chir. f. Hyg.,” T. Ivii., p. 812.

The same author gives an account of some work supple-
mentary to his recent study of experimental trypanosomi-
asis, in which he demonstrated the capital importance of
the macrophages in the destruction of trypanosomes. He
now describes the appearances in the bone-marrow of a
moribund guinea-pig infected with nagana, and of a rat with
caderas, and confirms Prowazek's discovery of the presence
of trypanosomes in the interior of typical polynuclear

leucocytes.
* Lancet,” September 22, 1906.
BLACKWATER FEVER DUE TO QUININE.

The journal comments on a case of the sort reported by
Dr. A. D. Ketchen in the South African Medical Record.

The patient had suffered from malaria in East Africa,
and recovered under quinine. Six months later, at Cape
Town, he fell into ill-health and suffered from dysentery.
Under these circumstances the malarial symptoms occurred,
and on quinine being again exhibited he developed hemo-
globinuria, and frequent subsequent attempts to Administer
the drug—intentional and accidental—showed that the urine
blackened within & very short time, even after such small
doses as $ grain.

The Lancet appears to regard this as ‘conclusive’; but
though no one questions that quinine may cause hmmo-
globinuria in susceptible persons, as such cases are not very
rare, it is quite a different matter to assume that toxic
symptoms of this sort are identical with blackwater fever,
and the readiness and rapidity with which the patient re-
covered from repeated attacks as soon as quinine was with-
held appear to point to quite an opposite conclusion.

“Lancet,” September 15, 1906, р. 718.

ANKYLOSTOME PARASITISM AMONG THE NATIVK WORKERS IN
pr THE TRANSVAAL. .

Posnet, W. G., records that as far back ан 1904 he met
with a case of ankylostomiasis in a native prisoner in tho
Johannesburg Gaol. He has since, as pathologist to the
Johannesburg Hospital, investigated the prevalence of the
disease amongst native African miners on the Rand, and
found the ova of the parasites in the stools of 82 per cent.
of the cases examined. Although not commonly a direct
cause of mortality, he regards the disease as a potent cause
of disability and diminished resisting power, and points out
the danger to white miners, suggesting, indeed, that the
outbreak in our Cornish mines investigated by Haldane and
Boycott іп 1902 was imported from South Africa, by Cornish
miners who were driven to seek work at home by the late war.
He has found the parasite in African miners coming from
so many parts of British and Portuguese South Africa that
he believes the disease to be very widely spread among the
native tribes, and points out the danger to those engaged in
the mining industry, white and black alike, unless suitable
measures be taken to cope with the spread of the disease.

“ Ann. Вос. de Мёд. de Gaud.," T. xxxv., p. 231, and “ Arch.
Parasitologie,” T. x., p. 150.
CONTRIBUTION то THE STUDY oF TRvPANOosoMIAsIS: THE
PROLIFERATION OF TRYPANOSOMES IN THE ORGANS.
These observations were carried out on rabbits infected
with Tryp. brucei, in which animals the disease runs а
rather protracted course, and but few parasites are to be
found in the circulation, so that the estimation of the
numbers found in the various organs is easy. The experi-
mented animals were killed at various stages of the disease,
and the blood and organs examined in the fresh state. In
the case of the latter the tissue was triturated in physio-
logical solution.
The results are given in a table, and the author concludes :
- That the parasite multiplies first аф the seat of inoculation,

the peritoneum—e.g., showing this up to the tenth day after
inoculation in this situation. Тһе infection then extends to
the blood, and it is at this stage that the parasites are most
numerous. Soon the trypanosomes settle themselves in the
testicles, orchitis being commonly observed. The lymphatic
glands are invaded in their turn, and afterwards the cellular
tissue, the skin, in odematous patches, and the nasal
mucous membrane.

In all these organs the parasites multiply progressively
with the well-known organic troubles common in the
disease, and correspond exactly with its clinical history ;
but the secretions, such as the semen, conjunctival pus, &c.,
remain free from parasites.

In the spleen, sulivary glands, liver, kidneys, suprarenals,
lungs, brain, spinal cord, lachrymal glands, thyroid, thymus,
bone-marrow, and ovary examination give uniformly nega-
tive results, save on a single occasion in the two first
mentioned organs.

In short, in the rabbit, Tryp. brucei may be more abun-
dant in certain organs than in the blood, and these organs
are precisely those which suffer from functional troubles and
coarse lesions.

VARIATIONS IN THE ELEMENTS OF THE BLOOD IN NAGANA.

Goebel, Oswald, and Demoor, Albert, in the following
issue of the ваше periodical, р. 187, confirm Van Durme’s
work on the rabbit by observations on the guinea-pig, in
which death takes place in fourteen to twenty-five days.

The parasites make their appearance in the blood in three
to six days, and at first the trypanosomes multiply rapidly,
but this is followed by a diminution, succeeded by a second
multiplication during the last two or three days before
death. ў

During the remission the parasites are fairly numerous іп
the lymphatic glands and very abundant in the testicles,
while none are to be found in the other organs.

This growth of the parasites is associated with a fall in
the number of red corpuscles, which may be reduced to a
third of their normal number, though there may be a slight
increase for a few days before death.

The onset of the disease is marked by marked hypo-
leucocytosis, but at the end there may be a return to the
normal, or even slight hyper-leucocytosis. The number of
polynuclear corpuscles is directly proportional to that of
the trypanosomes, while the lymphocytes are inversely pro-
portional. The large mononuclear corpuscles become in-
creasingly numerous to nearly the end of the case, and often
contain inclusions, which are probably the remains of try-
panosomes. There is no increase of eosinophil leucocytes.

“ Boll. В. Acad. Med. de Genova," 1906, p. 15.

Тнк Lesions PRODUCED By TRYPANOSOMA BRUCEI IN THE
EXPERIMENTAL INFECTION OF Dogs.

Massaglia, Alda, on “ Sundry Observations on Experimental
Ty panveominsis, and on the Biology of the Trypanosomes,”
ibid., p. 6.

The autlior continues his last year's study of the lesions
caused by Tryp. evansi in mice, rats, and guinea-pigs by
some researches on the infection of dogs with Tryp. бтисет,
and obtained similar results.

The most gravely affected organs are the kidneys, which
show hemorrhages into the cortical substance, albuminoid
and vascular degeneration of the epithelium of the tubuli
contorti, and Henle’s loops, nuclear chromatolysis, and
caryolysis. Іп short, subacute hemorrhagic nephritis.
The cortex of the suprarenals show indications of functional
hyperactivity, the liver of subacute hepatitis with fatty
degeneration. The adenoid tissue of the spleen is thickened,
the splenic pulp shows abundant hwimorrhages, with infil-
tration of polynuclear leucocytes, while in the Malpighian
bodies there ig an increase of lymphocytes and large mono-
nuclear white corpuscles.

Glandular enlargement of the Iymphatic glands, with
hemorrhages and infiltration of lymphocytes.

THE JOURNAL OF TROPICAL MEDICINE.

[October 1, 1906.

The bone-marrow is deep red to the naked схе, and is in
a state of marked hematopoietic hyperactivity, and con-
tains all the elements of the blood. Leucocytic counts were
made in two of the dogs, as well as in some of the guinea-
pigs, rats and mice infected with Tryp. evansi.

During the course of the disease there is marked hyper-
leucocytosis at first of all classes of leucocyte, but later on
the polynuclear cells decrease in number, while the lympho-
cytes become more numerous. Figures given for a dog and
a guinea-pig: the lymphocytes formed three-fourths of the
total, while the polynuclear cells were reduced to 3 per cent.
The red corpuscles are reduced to one-third, but maintained
a normal appearance. Іп the earlier period of an infection
the trypanosomes stain easily, but are rather smaller than
those of following swarms.

Transferred to cerebrospinal fluid or to dropsical or
amniotic fluid, the trypanosomes live for a short time. An
intercurrent microbie infection (¢.g., by streptococci) causes
the trypanosomes to disappear from the blood. At the
point of death the infected animals were lithemic.

«С, R. Acad. Sciences,” Т. oxlii., p. 1229.

EXPERIMENTAL INFECTION WITH TRYPANOSOMA BRUCEI.
DESTRUCTION OF THE PARASITES IN THE SPLEEN.

Rodet, A., and Vallet, G., draw attention to the enormous
destruction of trypanosomes in the spleen of dogs and rats
infected with nagana, and carefully describe the various
stages of the parasites met with in the spleen pulp.

They consider that the breaking up of the trypanosomes
is an extracellular process, whereas it may be remembered
that Sauerbech, who studied this question by sectionising
the affected tissues, shows that the destructive process takes
place in the interior of the macrophages. The spleen juice
of healthy dogs has a certain amount of destructive power
over these parasites, and the same is true of the lymphatic

lands, lymphoid tissue of the intestine, and the circulating
lood. `

M. Mesnil, commenting on his abstract in the Bulletin de
Institut Pasteur, believes that the present authors have
fallen into error, owing to their employing the defective
method of smearing, instead of that of sectionising.

“C. R. Acad. Sciences,” T. oxliii., p. 135.

THE TEMPORARY DISĄPPEARANCE OF NAGANA TRYPANOSOMES
IN INFECTED Dogs.

Roux, Gabriel, and Lacomme, Leon. Starting with Rodet
and Vallet's demonstration of the destructive effects of the
spleen on trypanosomes, the authors tried treating infected
dogs with inoculations of ox spleen extract (spleen ground up,
by means of Latapie's apparatus, with three times its bulk
of physiological solution) in doses of 20 cc.

Three dogs were experimented upon. In two injected
subcutaneously phagiedenie staphylococcus abscess resulted,
while the third, treated by intravenous injection, showed no
local ill-effects.

In all three, however, the trypanosomes disappeared from
the blood, but followed by relapse in the first dog after seven
days, while the others had not been followed long enough
at the date of publication.

While admitting the possibility of the disappearance of
the trypanosomes may be connected with the supervention
of the abscess, the authors prefer to believe it to be the
direct result of the spleen extract. The entire publication,
however, seems to be premature.

“0. R. Soc. Biologie,” T. 1x., p. 1065.
Tue SIGNIFICANCE ОҒ EXANTHEMATA IN TRYPANOSOME FEVER.

Nattan-Larrier, I.. and Tanon. An European patient,
from the Upper Congo, exhibited a vesiculo-papular rash on
the arms and thorax, and a circinate erythema on the
shoulder, hypochondria on the epigastrum, ахіШе, and
lumbar region, appearing in simultaneous crops and running
their course in ten to fifteen days.

Smears of the fluid obtained by scarifying the patches of
erythema showed numbers of trypanosomes, while none
could be found in blood from the finger. Erythematous
patches of the sort are, therefore, of importance in the
diagnosis of such cases. ; :

“0. R. Acad. Sciences,” Т. cxlii., p. 1482.

Tux IDENTIFICATION OF THE PATHOGENIC TRYPANOSOMES.
ATTEMPTS AT SERUM DIAGNOSIS.

Laveran and Mesnil. The material employed was the
serum of three goats, the first of which had been cured of
Zululand nagana; the second, first of nayana, and then of
Indian surra; and the third, first of Mauritius surra, and
then of the »/Aia-trang of Annam.

In like case, the mixture of virus which will cure a goat
with а variable quantity of the serum of that goat (ү; to 4
cc.) is harmless to mice. The authors have tried to ascer-
tain how these serums react on other forms of virus, so as,
if possible, to base on this a method of serum diagnosis for
the different trypanosomiases.

With some reserves, they conclude: (1) That the trypano-
somiasis of Annam differs from that of India. (2) That
the strong virus of the Togo of Marlini, which was un-
affected by the serums of cither of the three goats, is neither
nagana nor surra. (8) That the virus of Schilling's Togo is
not identical with nagana.

It may be noted that these serums were much less active
when injected twenty-four hours previously, or at different
parts of the body, though simultaneously, than if injected
mixed with the virus.

«0. В. Асай. Sciences,” T. oxliL, May 28, 1906. .
Тнк RELATIONSHIP OF ANKYLOSTOMIASIS TO BERI-BERI.

Noc, Е. The author found Uncinaria americana (Stiles)
in 74 out of 77 cases of beri-beri, and in 17 out of 82
Annamites residing in contaniinated localities, but never in
any one of 81 Europeans suffering from various intestinal
complaints. He believes that ankylostomiasis is ап im-
portant factor in the etiology af beri-beri, and asserts that
the administration of thymol effects a surprising improve-
ment in such cases. Our readers may no doubt remember
that the anwmia of coolies in the Assamese tea gardens
was for а long period known as “ beri-beri,” until the disease
was shown by Giles to be really ankylostomiasis. Have
these cases of M. Noc any connection whatever with true
beri-beri ?

“ Archives de Hyg. et Pathol. Exot.," T. i. 1908.
HUMAN TRYPANOSOMIASIS.

Kophe, Ayres. Тһе author has met with fifty-two cases
of sleeping sickness from the various East African Portu-
guese colonies, and has found Tryp. gambiense in all of
them. For diagnosis he prefers to puncture à lymphatic
gland.

In every one of forty lumbar punctures the parasites were

-found in the cerebro-spinal fluid, even when no nervous

symptoms were present, and the characteristic leucocytic
perivascular infiltrations of the nerve centres were found in
all of the thirty-six post-mortem examinations made by him.
Glossinæe (palpalis, longipalpis, wellmani) were found in
most localities where the disease exists. In only one out of
thirty-four cases did the cerebro-spinal fluid yield any organ-
isms when incubated on a variety of media. Іп this
instance а diplostreptococeus was found, but M. Kophe
nevertheless found this organism in half his autopsies.

No animal experimented on showed the characteristic
perivascular lesions, though dog-faced apes and other mon-
keys were tried, and no better success attended inoculations
of the diplostreptococcus, whether the animals were already
infected with trypanosomiasis or not. Twelve patients were
treated ; arseniate of soda, іп combination with trypanroth,
was tried on two, but was found useless, and afterwards
atoxyl was used exclusively, 10 to 15 ce. of a 10 per cent.

October 1, 1906.)

THE JOURNAL OF PROPICAL MEDICINE.

307

solution, every eight to ten days, being well borne. Under
this treatment there was obvious improvement, the trypano-
somes disappearing from the blood and lymphatic glands,
though they persisted in the cerebro-spinal fluid.

The author explains this by the impermeability of the
meninges, instancing the fact that he failed to find any
iodide of potassium in the cerebro-spinal tluid of patients
who were taking that drug. Sooner or later, however, all
his cases succumbed. Іп one ease atoxyl was injected into
the arachnoid, but the case was already moribund. An
inoculation of 10 per cent. lysol was well borne, and
no trypanosomes were found after in the fluid drawn by
lumbar puncture.

** Arch. Inst. Bacteriol., Camora Pestana,” T. i., p. 171.
EXPERIMENTAL TREATMENT OF TRYPANOSOMIASIS.

Magalhes, А. de. The author tried arsenious acid, fol-
lowed after forty-eight hours by trypanroth, on a number of
infected rats, but with little or no success.

“ Ann. Boc. de Méd. de Gaud,” Т. xxxvi., p. 52.

TRIALS oF RADIOTHERAPY IN EXPERIMENTAL TRYPANOSO-
MIASIS.

Nobelle, De, and Goebel.

Their results were absolutely
negative.

(The Röntgen rays were employed.)

“Deutsch. Arch. f. Klin. Medecin,” T. Ixxxvii., p. 98.

Tur TREATMENT OF PROTOZOAL DISEASES BY CONCENTRATED
Light.

Busck, G., and Tappheimer, V. It is well known that
a variety of colouring matters so modify the action of light
as to enable it to rapidly destroy living cells, and it was
hoped, by first injecting such a colouring agent and then
using concentrated light, that blood protozoa, such as trypan-
osomes, might be destroyed. With the exception, however,
of eosine and erythrosine, all the dyes used were so rapidly
decomposed in the blood as to be useless, and though trypan-
osomes and paramæcia immersed in serum so coloured were
rapidly killed in vitro, the results of the authors’ experi-
ments on living animals were not sufficiently encouraging to
lead them to hope much from this form of treatment.

"Preliminary Report of the Commission on Anemia in
Porto Rico."

Between March and November, 1905, 18,865 cases of
ankylostomiasis were observed, the great majority of which
were whites or mullatoes; but though the negroes were less
frequently attacked than the whites, and appeared to suffer
less in proportion to the degree of infection, many serious
cases were to be met with among them. The annual death-
rate from the disease is from 5,000 to 7,000.

The belief is expressed that in 99 per cent. of those har-
bouring the parasite (Uncinaria americana, Stiles) the
infection has been contracted by the skin. Ground-iteh
(magamorra) is the first symptom of infection. and anky-
lostomiasis follows. Ninety-six per cent. of the cases of
anemia, in fact, stated that they had suffered from ground-
itch, whilst among the healthy who had so suffered half had
had the skin disease so long ago that the intestinal parasites
might have been voided. The discase is specially rife in
the coffee plantations, the work on which is mainly done
during the rains. The Commission recommend treatment
with thymol, five doses of which is sutlicient to effect a
cure, and their results are already remarkably encouraging.

“Ше Caducée,” September 15, 1905.

TEMPORARY DISAPPEARANCE OF TRYPANOSOMES ІМ Docs

INFECTED WITH NAGANA.

Roux, б. and Lacomme, L. In a paper read аба meeting of
the “ Académie” on May 28th, 1906, Rodet and Vallet de-
scribed a series of experiments which showed that, in animals
infected with nagana, the spleen is an active centre of de-

struction of trypanosomes ; furthermore, in vitro, the spleen
appeared to have a trypanolytic action. This suggested to
Roux ала Lacomme the following experiments, which were
made with an emulsion of bullock's spleen :— :

Three dogs were inoculated with Trypanosoma brucei; іп
from six to eight days trypanosomes were freely present in the
circulation. The following day they were given 20 cc. of
spleen emulsion ; in from two to three days afterwards try-
panosomes could no longer be detected, but in one of the
dogs, in which a phagwdenic abscess developed, they reap-
peared after an interval of five days.

This phenomenon of the temporary disappearance of
trypanosomes in the blood of dogs infected with nagana,
after the lutter had received an injection of spleen emulsion,
is an entirely new one, but one consistent with the prior
observations of Rodet and Vallet, who had demonstrated the
trvpanolytic action of the spleen. This suggests the possi-
bility of being able, by repeated subjections of spleen
emulsion, to eause a final disappearance of trypanosomes
from the blood of infected dogs.

The spleen emulsion is thus prepared: Take a fresh
bullock spleen immediately after the death of the animal, if
possible; triturate it in a Latapie crusher, dilute the pro-
duct in a sterilised salt solution (7 in 1,000) in the following
proportions: salt solution 3 parts, spleen 1 part; centri-
fugalise the emulsion, and inject the supernatant fluid either
under the skin, or, preferably, into the saphena vein.—
J. Е.Х.

* Bull. et Мет. Вос. Centr. Vétér.," T. ІхххіН., p. 368.
Ligniéres, L., records an instance of the infection of & dog
with nagana in a fight with an infected coati.
* Journ. de Med. et de Chir. Prat."
TREATMENT OF Mosquito BITES.

Joly suggests the following mixture for allaying the irri-
tation of mosquito bites :—

Қ Lig. formaldehyd (40 per cent.) 3iv.
Xylol vei Fe es - iss.
Acetoni ... 52, T DP sv Ol.
Balsam canaden. 42% gr. Xv.

Ol. citronelle ... E "n e q.s.
Before applying, shake the mixture, and touch the bitten
part with end of the wetted cork or small piece of cotton-
wool, and then allow the fluid to dry on the skin.

* The Liverpool Medico-Chirurgical Journal," No. 50,
duly, 1906.
TROPICAL ABSCESS OF THE LIVER.

Newbolt, G. P., reports eight cases of liver abscess which
he had operated upon. Four were single abscesses, and all
recovered ; four were multiple abscesses, and all died. Тһе
operation favoured by Newbolt is incision and free opening
up of the abscess cavity, but he states that in a deep abscess,
with a good deal of liver substance intervening, a special
trocar and cannula is possibly of benefit in order to avoid
hemorrhage. In places in the Tropics also, where surgical
assistance is unobtainable and the operation has to be con-
dueted single-handed, the simpler operation by the trocar
and cannula is commendable. Ofthe many points raised by:
Mr. Newbolt, the following are the more important: (1) In
all the cases seen by him а history of dysentery has been
obtained. (2) Acute hepatitis, leading to abscess of the
liver, is due to micro-organisms entering the liver from the
intestine by way of the lymphaties, blood-vessels, or biliary
channels. (3) Ап hepatic abscess may present acute signs
and symptoms at first, passing on to a more or less chronic
form, in which the patient may get about, the presence of
pus being completely or for the most part masked. (4) Of
the many complications and sequelw, a suppurating hydatid
cyst, an empyema, primary malignant disease of the liver
with fever, syphilitic gummata, are the more prevalent, and
difficult of diagnosis. (5) The differential diagnosis between

308

the rupture of а liver abscess through the diaphragm, causing
cinpyema, and perforation of a duodenal or pyloric ulcer
attended by the formation of а sub-diaphragmatic abscess,
and similarly, after perforating the diaphragm, causes
empyema, is discussed by Mr. Newbolt, but nothing con-
clusive is established. (6) Tenderness over the appendix
may or may not indicate that a collection of pus anywhere
in right loin or right hypochondrium had its origin in the
appendix itself. In some cases the pain in appendix was
secondary to pus developed higher up the right flank, in
others the pus from appendicitis invades the hepatic region.
(4) The presence of Атеке dysenterte in hepatic pus may
or may not be an etiological factor in the disease. (8)
Stitching the liver to the abdominal wall is, as a rule,
impossible; when the liver is exposed, the area around
should be packed with gauze, and the abscess remain
unopened until four days subsequently.

“Journal of Economic Biology,” 1906, vol. i., part ii.
THE Errects OF METAZOAN PARASITES ON THEIR Hosts.
Shipley, A. E., and Fearensides, E. G., of Cambridge, have

studied the effect metazoan parasites exercise on their host
from four standpoints: (1) By the mere presence of the

parasite in some organ in which it takes up a certain amount,

of space and displaces a certain amount of tissue. (2) By
the migration of parasitic organisms from one part of the
body to another. (3) By the loss to the host, which has to
feed the parasite, either on the half-digested contents of its
alimentary canal or on its more elaborated fluids. (4) By
the presence of certain toxins said to be given off by the
body of the parasite, either as excretions or otherwise.

They found that metazoan parasites give off toxins which
profoundly affect the tissues of their hosts. The fact of an
association of a marked eosinophilia with the presence of
parasites in the body seem to be a conclusive proof that
toxins are given off in considerable quantities by all the
better known human metazoa.

* Medical Record,” August 18, 1906.
TREATMENT OF CHOLERA BY HYDROCHLORIC ACID.

Palier, E., suggests as a prophylactic against cholera
liberal doses of hydrochloric acid with the addition of
perhaps pepsin. For the treatment of the disease he re-
commends washing out the stomach with a 2 рег 1,000 of
hydrochloric acid in boiled water, and rectal irrigation by
1 per 1,000 of the same acid.

“ American Journal of Medical Sciences,” August, 1906.

А New INTESTINAL PARASITE OF Man: PARAM(EBA
EiLHAnRDIA Hominis.

Craig, C. F., of the United States Army, found in the
fie ces of six natives of the Philippines a parasite not hitherto
described. Watery stools with occasionally small amounts
of mucus and blood constitute the prominent signs. Ent-
атаеба dysenterie were present in all the cases, and Tricho-
monas intestinalis in one case. The parasite appears to
pass through an amcbic and a flagellate stage of develop-
ment.

* Philippines Baroku o of Health Report,” September, 1904,
to September, 1905.

X-RAY TREATMENT OF LEPROSY IN THE PHILIPPINES.

Wilkinson, H. B., states that of 18 cases of leprosy treated
by X-rays, 8 have been cured, 7 improved, and 8 not
improved. Dr.. Wilkinson's theory as to the reason for cure
by X-ray treatment is that the leprous bacilli are killed by
exposure to the rays, and that their dead bodies are absorbed
into the system, and render the persons thereby immune
against the living organisms, just as injection of dead bacilli
lead to immunisation in plague.

In support of this theory Wilkinson cites the following
facts :—

THE JOURNAL OF TROPICAL MEDIOINE.

{October 1, 1906.

(1) The treatment of one leprous spot on a patient pro-
duces improvement in spots at a distance from the one
actually treated.

(2) The cure in the distant spots seems to progress
parallel to, and to be just as complete аз in the one treated.

(3) The best results seem to be obtained only when treat-:
ment is pushed to the point of killing or beginning to kill
the tissues, which would also probably be to the point of
killing the organisms.

(4) Cases in which there are massive localised leprous
deposits are most rapidly improved. As in these cases we
have an abundant calture on which to operate, and thereby
produce immunity more rapidly.

(5) In diffuse general involvement of slight degree or
atrophic character where there are only & few scattered
organisms we have had little success.

(6) In two well-advanced cases, where the amount of new
leprotic tissue was excessively great, the improvement was
marked and rapid, but followed by loss of general health
and rapid physical decline. This may be an ОБИИ во
to speak.

“Journal Royal Army Medical Corps,” August, 1906.
MALARIAL FEVER CONTRACTED IN PORTSMOUTH, ENGLAND.

Copeland, Major R. T., and Smith, Major F., D.S.O.,
report a case of malarial fever in a soldier belonging to the
Royal Garrison Artillery, who developed typical tertian
ague, whose blood showed abundance of tertian parasites,
and in whom the spleen was enlarged. The fever dis-
appeared when quinine was given. The soldier had never
been out of England, and the question of infection was
diligently enquired into. Іп the first place, no mosquitoes
were found in the barracks (Clarence) in which the soldier
was quartered, nor were there any breeding places for mos-
quitoes near by. A source of infection may have been a
fellow soldier, home from abroad, suffering from tertian
fever, who was quartered іп the same room. Тһе soldier’s
father lived at Carisbrooke, in the Isle of Wight; he had
been in India twenty-four years ago, but according to his
statement, he never had fever. Eight days after visiting
his father the soldier developed malarial fever; it is un-
likely—not to say impossible—that the father could have
given the infection to his son ; infection was probably con-
veyed from the comrade in the same room in barracks. By
what means the infection was conveyed is a question.
Majors Copeland and Smith state that infection by a mos-
quito was impossible, as no mosquitoes were in the neigh-
bourhood, and suggest carriage by flea or bug.

The case is interesting, but the solution of the mode of
infection is, unfortunately, not accurately determinable.

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October 15, 1906.)

THE JOURNAL OF TROPICAL MEDICINE.

309

Original Communications.

THE PRINCIPLES OF DIET IN TROPICAL
CAMPAIGNS.

By Ачрвеум Dewncay, M.D., B.S.(Lond.), M.R.C.P., F.R.C.8.
Fellow of King's College ; Lieut.-Colonel I. M.S. (retired).

THE subject of the food to be supplied to our men
in tropical campaigns has to be considered under many
heads, amongst which may be mentioned the amount
to be given, its variation, its qualification by а hot
climate, and the causation of disease by food.

Relation of the Elements of Food to Work and Heat.
—Formerly Liebig's theory held good, namely, that
the albuminates of the food supplied the force, whilst
the non-nitrogenous elements simply served for the
production of heat. Lyon Playfair also stated that
the transformation of the nitrogenous food in the
body was sufficient to account for all the mechani-
cal force without holding that the fats and starches
had any share in it. But subsequently physiologists
showed that the amount of nitrogen excreted during
rest is nearly the same as that excreted during work.
The view now generally held is that stated by Fick and
Wislicenus, who compare a bundle of muscular fibre
to a machine consisting of albuminous material, just
as а steam engine is made of metal. Coal is burnt in
the latter to produce force, carbonaceous matter is
consumed in the muscular machine for a like pur-
pose. Again, as the iron of the engine is worn away
&nd oxidised, so is the muscle also worn away. Much
more coal would be burnt in the steam engine with
heavy than with trifling work ; all forms of energy of
the body are derived from the non-nitrogenous elements,
hence, during increased work, an increase in the non-
nitrogenous elements is required ; but as there is also,
as in the case of the steam engine, some wear and
tear of the body, so it is requisite to supply an in-
dan of nitrogenous material during this increased
work.

Amount of Food in Campaigns.—The amount of
food consumed must be estimated with regard to the
amount of work the soldier has to perform. А fair
day's work for an average man is held to equal about
800 foot tons per diem, а hard day's work about
550 foot tons. А march of 10 miles, in heavy march-
ing order, equals 250 foot tons. But on service the
soldier has much more work than his mere march;
he has his fatigue duties in camp; there are, in fact,
numerous additional occasions for more bodily and
mental waste, and very likely the quality of the food
supplied is not во good as in peace. Hence, De Chau-
mont laid down that a war diet should provide for a
minimum of 350 to 400 foot tons, and be capable of
being increased at the shortest notice to 500 foot tons.
Such an amount would be furnished by a diet supply-
ing—

Nitrogen 350 grains.
Carbon ... 5,500 ,,
Salts 450

т ”
whilst the increased number of foot tons would re-
quire—

Nitrogen 450 grains.
Carbon ... 6,5000 ,,
Salts 5000 ,,

* Bowel complaints immediately begin to be rife.
_ necessary variation may be obtained by the issue of

Climatic Qualifications.—The income of food in the
body results in an outcome of bodily movement and
of heat, + to 2 being expended as mechanical force,
and # to $ as heat. With the increase of external
heat Kering and Funke have shown that less produc-
tion of body heat takes place. Hence, inasmuch as
less heat is required to be produced in a hot climate,
it would appear that less heat-producing material is
required. Dr. Carpenter has shown that in very
active work in hot climates the necessary tempera-
ture of the body is maintained by such active work.
Again, in campaigns the first affections to appear in
the men are those of the digestive system, whilst it
is well known that in the East the more nearly the
diet of the European is assimilated to that of the
native, in the substitution of fruits and farinaceous
substances for oleaginous articles, the less will be the
liability to disordered digestion. Professor Maclean,
of Netley, in this respect, used to warn his class never
to eat meat more than once a day. Dr. Crawford
held that in the Tropics the meat should be reduced
and the vegetable increased. Mr. Stanley, the Afri-
can explorer, testified against ‘‘ gratifying the seem-
ingly uacontrollable and ever-famished lust for animal
food." Hence, in the Tropics, in peace time at any
rate, the food of the soldier should contain а large
proportion of fresh vegetable and less animal food.
But with the onset of а campaign we have the еп-
trance of the factor of excessive work. Is, then, the
regime of peace in hot climates to be followed out in
war? Speaking personally, & diminished desire for
animal food and fat in the hot weather was experienced
when stationary in any of the camps on the line of
communication, but when marching no such feeling
arose. Hence, it would appear that during active
operations in a campaign in hot climates an extra
meat ration is indicated; this was ordered in Lord
Roberts’ great Cabul-Candahar march and was fully :
enjoyed, nor did it lead to any digestive disorders.
In the resting stage of a tropical campaign let animal
food be in part substituted by vegetable, let the fats
be diminished, the carbonaceous elements being fur-
nished rather by the starches. In the marching and
fighting stages, on the contrary, let the animal food
resume its wonted proportion. :

The above general principles should be conjoined
with the following considerations: First, аф the com-
mencement of a campaign the ration must be ample.
In the Egyptian operations of war in 1882 the men
had to be fed for the first four days on preserved
rations, a proceeding fraught with danger. Secondly,
the food should be varied. Digestion is never so
likely to be upset as when there is à monotonous diet.
А good example of this was afforded during the first
four weeks of the Abyssinian War, where the food
was restricted to beef and flour with no ара
Тһе

the different tinned meats from Australia and New
Zealand, but the greatest caution must be exercised
in this particular. No tin should ever be passed
which is blown out. As regards vegetables, com-
pressed should never be used; they are tasteless
and stringy and set up diarrhma by their irritating
mechanical properties ; they have lost their albumen

810

THE JOURNAL OF TROPICAL MEDICINE.

and salts, and consist chiefly only of the cellulose
frame work. They were universally condemned in
the Chitral campaign, causing diarrhawa, and were,
moreover, scarcely eatable unless soaked for twelve
hours. It is also always preferable to drive cattle
with the force, rather than to carry meat supplies.
Lastly, never give salted and preserved rations at a
stretch, or, in fact, never, if possible, let the men
undergoing severe exertion have only tinned meat for
more than one day.

With regard to the question of alcohol, there should
be, of course, no daily ration of rum, but total absti-
nence is to be avoided. There are occasions when a
ration of alcohol has proved to be of the greatest
value, such as when the men arrive in camp drenched
with a tropical shower, tired out, and with no change
of clothes. But if possible, light red wines should be
issued twice or thrice a week; these are grateful and
refreshing in a hot climate, and greatly preservative
against bowel complaints and cholera. Mr. Stanley
recommended strongly their use. Where renewed
exertion is required after a long march, a ration of
rum is beneficial, as was shown in many campaigns,
e.g., the Ashanti, the Galeaka-Gaika, the Eastern
Soudan, &c. Lastly, alcohol, in the shape of a rum
ration, is contra-indicated in all cases where bowel
complaints, enteric, cholera aud other zymotic diseases
are likely to occur.

Preserved Foods in War.—Several varieties of these
are on the market. In the African War, Kopf's Con-
solidated Soups were used and answered admirably.
Whitehead's Variegated Soups were much liked.
The most satisfactory of all was “ Erbswurst," for it
was highly nutritious and most easily prepared. А
packet of this portable soup can be issued when it is
impracticable to supply & full meat ration; in Lord
Roberts’ march each soldier had half a tin before
starting the day's march. Maconachi’s field ration
was found to be excellent in Ashanti, in Egypt, in
the Soudan, and in the South African Wars.

Scurvy in Tropical Campaigns.—Now that this
disease has disappeared from our Mercantile Marine,
owing to the ships carrying lime juice with them,
scurvy probably is most frequently seen in India,
especially on the N.W. frontier. Lime juice should
always be part of the ration of war. I well remember
being a member of a Committee on a certain regiment
in Afghanistan, which had to be sent back on account
of the severe outbreak of scurvy attacking it, fully one
half of the men showing signs of the affection. In
the China War of 1860, in Looshai 1871, in Suakim in
1885, there were outbreaks of scurvy, no lime juice
being in the ration, whereas where this was given, as
in the New Zealand War of 1863-65, in Ashanti in
1873, in ПаШа, 1874, in Malay and Sunghi-Ujong,
1874-76, in Zulu, 1879, in Egypt, 1882, in Aka, 1883-
81, in Dongola, 1886, amongst other campaigns, no
scurvy appeared.

In recent wars, jam has been supplied to the
soldier, this also, besides its anti-prophylactie value, is
of good effect in counteracting the onset of fatigue by
reason of the sugar it contains. Vaughan Harley has
shown that 3,000 grains of sugar added to a small
diet, increased the work done in the proportion of 6 to
39 per cent., whilst 3,700 grains added to a full meal,

{October 15, 1906.

with eight hours a day labour, increased the work
accomplished by 22 to 36 per cent. Should lime
juice not be present with the force, what other means
have we? My friend, Surgeon-Major G. Griffith,
when P.M.O. of the Suakim Field Force, stopped an
outbreak by recommending the men to eat their
rations from the animal directly it was killed. The
late Professor Parkes also recommended that in lieu
of common salt, bitartrate of potassium should be
taken at meals. This was given with marked benefit
to the 21st P. I., during their return from Abyssinia,
when scurvy attacked them on board the transport.
Lastly, on the occurrence of four cases of scurvy in
the Mountain Battery to which I was attached in
Affghanistan, I reeommended a daily ration of vinegar,
as we had no lime juice, and no further cases came
into hospital.

In conclusion, to illustrate some of the above
remarks, I now give the scale of diet allowed to us in

Afghanistan :—
Fresh meat (exclusive of bone) 1 |b.
Bread ... . re 1} lb.
Biscuit 254 1 lb.
Rice or flour ... 4 oz.
Sugar ... 3 oz.
Tea .. «es zs zie 3 oz.
Salt m m T .. 4 oz.
Green vegetables when procurable... 6 oz.
Potatoes sd m es ... 12 oz.
Dhall ... 1 oz.
Rum .. І агат.
Tobacco 3-3 lb. per month.

During the march to Candahar the meat ration was

increased to 14 lb. and 1 tin Kopf given daily.

The diet gave roughly :—
Nitrogen ... ae Bos
Carbon ... xn .. 5,298 ,,
Salt sss aes 346 ,

The chief remark to be made concerning the diet is
that the amount of carbon was too small and this was
also shown in the increased diet for the Cabul Canda-
har march, for the only factor that distressed the men
and officers was fatigue, the amount of carbon being
5,702 grains instead of 6,500 grains. To ensure a
proper amount of carbon in the diet, cheese, іп which
the proportion of N. to C. is 1:7 should be added to
the diet. Bacon is also an excellent article of diet
to work on, the proportion of N. to C. being as 1 in
24, or porridge, the proportion being as 1 in 21.

498 grains.

FOOD OF THE NATIVES OF INDIA.

By Мазов G. Н. Fink, I.M.S. (Retd.), M.R.C.S.(Eng.),
L.S.A.(Lond.).

THE subject of food of the natives of India, though
а very wide one, is of interest from а physiological,
chemical and economic point of view. It is almost
imperative that medical men should study the food,
its constituents, and the elementary or proximate
principles in India if practising either in the great cities,
or the Mofussil, as the country districts are termed.

We are told that “ the enumeration and classification
of the food or aliments necessary to maintain human
life in its most perfect state have been usually based

Осіоһег 15, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE.

811

іп the deduction of Prout, that milk contains all the
necessary aliments and in the best form.”

Wherever you go in India, you will find that there
is great value set on milk and its products; also on
sweetmeats and sugar, by the Hindu population, from
the upper classes down to the labourer. The cow is
worshipped by the Hindu as sacred, because of both
food and drink which it provides for human life. The
Hindus boil their milk for a considerable time before
drinking it, and they sweeten it very largely with
quantities of either white or brown sugar, according
to the taste.

There are three principal products derived from
milk which the Hindus use, viz :—(a) Dhyé (sour milk
after lactic acid fermentation has set in) which they
take with sugar; and the poorer classes take it with
the rice left over from the previous night’s meal,
and sweeten it with sugar. This is the first meal very
often before going to their work, which is their break-
fast. (0) Malié or cream, which is also eaten with
sugar, or made into sweetmeats, which the middle
classes—who are unable to return to the midday meal
owing to business or duties in Government offices—
consume as their lunch or tiffin, together with other
sweatmeats. (c) Chhanah, or a firmly set curds re-
sembling cream cheese, which is also made into
square cakes soaked in syrup, and used as sweetmeats.
(а) Clarified butter or ghee, which is used for cooking
and frying all kinds of food. I need hardly discuss
the value of each of these articles, which are well
known to medical men, now that I have described
them. In considering the diet of the natives of India
one has to divide the diet of the Hindus and of the
Mahomedans respectively; then subdivide each of
these according to their status and wealth; and last
of all consider the various castes, and caste prejudices
of the former, since meat or flesh is allowed in the
case of some, but withheld from others, owing to caste.

It is erroneous to suppose that the whole of the
natives of India are vegetarians, in the strictest sense
of the term. This idea seems to have gained accept-
ance from the fact, that the wants of the natives,
chiefly the Hindu population, are few and simple, and
that they confine themselves to the actual necessities
of life in the matter of food. Also, because rice, pulse,
flour for bread, vegetables and fruit are largely con-
sumed. Rice and fiour are the staple articles in use
as food, because rice grows plentifully in some parts
of India, and flour in others, and according to the
one or the other being plentiful, во the people, whether
Hindus or Mahomedans, use it, because it is cheap
and meets their requirements and their purse. Pulse
or dhal is most generally used throughout India.
It is a form of lentils, and is most nourishing, sustain-
ing and fattening. There are several kinds—moong,
тивоот, arhar and cháná. Moong is considered the
best but is more expensive than the others. Itisa
most appetising diet when made properly, and is
usually served up with boiled rice or chappaties (flour
cakes of unleavened bread). The labouring classes
throughout India have this as a daily food with either
rice or chappaties, according to the district or province
. growing rice or wheat plentifully. In Bengal proper,
and Assam, rice is consumed more largely, while in
Upper India, flour. Among the better and the

wealthier classes in Bengal and Assam, in addition
to the above articles mentioned (rice and аһ), fish,
of various kinds, which is easily digested and contains
a deal of phosphorous, is cooked as a curry in oil
(the expressed mustard oil), and there is generally а
vegetable curry also served up at the midday
or the evening meal. Hilsah and Bekty fish are
the best kinds used, and the former contains a deal of
fatty matter, and in value is equivalent to mackerel,
if not higher in its proportion. of nitrogen. Some
cheaper forms of fish are used by the rich as well as
the poor, fish being very plentiful, as а rule. Mutton
is also permitted to be eaten by Hindus, but in Bengal
and Assam.fish is preferred, owing to its properties
being valuable for brain workers, and, being easily
digested, is a suitable form of diet for those who lead
a sedentary life.

Among the Mahomedan population, wherever you
see them, they consume more flesh than the Hindus,
and are permitted to eat either fish, fowl, mutton or
beef. Even the poorer class of Mahomedaus eat
more animal food than the Hindus, but in some parts
of India, Hindus are quite as strong on animal food
(mutton and fish) as Mahomedans. The strictest
vegetarians are the Jains, a sect of which a great
many of the mercantile caste of Upper India are
members. They abhor the taking of life in any form,
and many of the strictest among them will eat their
last meal before candle light, because the flame attracts
insects and destroys them. “Jainism,” we are told,
“is one of the most important of the living cults
among Hindus. It is professed by at least a million
men, and some of these are among the wealthiest and
most refined in the Hindu community."

Leaving Bengal and Upper India, we have to соп-
sider Bombay, Madras and the Central provinces. Ав
to the consumption of rice and flour, respectively, by
the inhabitants of these provinces, they follow much
the same rule in the matter of status and caste as in
Bengal and Upper India in the choice of their staple
food, and the various additional articles of flesh,
fish, vegetables and fruit, as well as pulse.

Ghi, or clarified butter, is an article of diet which
both Hindus and Mahomedans of all classes believe
strongly in as possessing valuable nutritive properties,
and cannot be dispensed with in cooking their food as
well as their sweetmeats of certain kinds, which need
frying lightly or smearing over the surface with, to give
it a flavour. The poorer classes in Bengal and Assam
who cannot afford ghi (which is about one rupee the sir
= 2 pounds), use expressed mustard oil, which is also
valuable and goes в longer way than ghi. Expressed
mustard oil is always used for cooking fish in, and as
an inunction among the Hindus, who smear their
children’s bodies with it from the day of their birth,
and later on in life use it over their hair, since it is
supposed to have the excellent property of keoping
away colds and catarrh, and this has been greatly
proved by experienced and mature doctors in the
country to be the fact.

I think, with regard to Madras, Bombay and the
Central Provinces in the matter of food, Madras,
which is adjacent to Bengal, in a large measure is
similar in the consumption of the various articles of
food in use among Hindus and Mahomedans respect-

312

ively. The Madrasis, of whom a large number are
Roman Catholics, live very similarly to the way their
masters live in the matter of food. Bombay holds
a mid position between Bengal and Upper India ; while
the Central Provinces follow much the same line of
diet as the United Provinces of Agra and Oudh,
which is practically Upper India, including the
Punjaub.

T have left the question of drink, and that of air, out
of this paper on the food of the natives of India,
although I must say that great stress is laid by the
natives of many parts of India on the various kinds
and qualities of water for drinking and cooking
purposes, since some are supposed to aid digestion as
well as easy cooking of their rice and pulse, while
others retard digestion and cooking.

If we analyse the various kinds of food in use in
India by the rich as well as the poor, we cannot help
coming to the conclusion that, on the whole, the food
is fairly well balanced in the matter of the elementary
principles of the dietof both Hindus and Mahomedans.
The Hindus, though largely vegetarians, live on food
rich in carbo-hydrates and hydro-carbons ; but they are,
at the same time, large consumers of milk and those
products of milk which are healthful and nourishing.
In Bengal and Assam, fish supplies largely the nitro-
genous element; while in other parts of Iudia, fish
and mutton are used. Тһе Mahomedans, who form
about the fifth of the total population of India, live on
very similar food to the Hindus; eat less sweetmeats ;
but more animal food (mutton, beef and goat’s flesh).
Their food, on the whole, contains a larger proportion
of the nitrogenous principle than that of the Hindus.
The poorer classes of both Hindus and Mahomedans
(except the hunting class and the wandering tribes,
as well as the sweepers, who are the lowest menials
in our household and eat the leavings of our food),
as в whole, though contented and happy with their
rice and flour with lentils, have some cause for com-
plaint in the matter of luxuries which they can barely
indulge in. In seasons of rich harvests or poor
harvests, their lot remains the same, and they are not
one bit better off nor worse off. It is only in times of
famine and great scarcity of food that they have to
fight hard against disease and death, and then their
lot is a deplorably unhappy one, until relief comes
through the Government. There is not the least
doubt that within the last twenty-five to thirty, or
more years, the price of food has risen, and the rate
of wages accordingly of domestic servants, which
naturally hits the better classes under Government
pretty hard. Moreover, milk and ghi, which the
Hindu population attach such great importance to
as articles of food, have risen in price, owing to the
supply not being up to the demand ; but these are
questions which are outsile the trend of this paper,
and therefore cannot be considered here.

In taking the question of the food of the natives of
India into full consideration, there ів not the least
doubt, that, on the whole, it is the most suitable to
the climate and their wants, and is a diet which is
economical as well as scientific, because the nitrogen-
ous and non-nitrogenous principles, and the mineral
salts and vegetable acids, are in that proportion which
suits their constitution. In Bengal proper, the carbo-

THE JOURNAL OF TROPICAL MEDICINE.

[October 15, 1906.

hydrates and hydro-carbons consumed, are, I should
say, somewhat in excess of the standard of health,
among the better classes.

І have ieft the Parsi population of Bombay out of
this paper, since their standard of living is more
Western or European.

FOOD AND DIGESTION IN WARM CLIMATES.
By James Самти, M.B., F.R.C.S.

THe Foop оғ NATIVES OF THE TROPICS.

WE are usually told, and home-dwelling British
folk believe, that the natives of the Tropics live on
rice. During the Russo-Japanese War the newspapers,
referring to the extraordinary exertions of the Japa-
nese, stated, in reference to their diet, that all the
hardships of the campaign were undergone by troops
whose sustenance consisted of a handful of rice mixed
with water. This misleading statement is in harmony
with the rooted belief that the natives of the Tropics
and sub-Tropics live on rice.

For China, the country best known to the writer, the
same statement is believed to hold good. What are
the facts? Every Chinese contractor engaged іп any
large undertaking knows that he can only get good
work out of his men if he feeds them well. Their early
morning meal consists of soft-boiled rice “ conjee," but
that is only the chota-hazra of the Indian. The fore-
noon meal, or breakfast, consists of fish, or fat pork,
vegetables, rice and tea. The midday meal may be
again soft-boiled rice, but the afternoon or evening
meal consists also of fish, pork, vegetables, rice
and tea. Тһе rice is іп no larger proportion to the
meal, perhaps not quite so large, than is bread in
the European breakfast. To say that the Chinaman
lives on rice is, perhaps, not so near the truth as were
we to state that the European lives on bread.

In almost every nation of the Eurasian continents,
except in Britain, two main meals during the day,
partaken in the forenoon and late afternoon, is the
rule, so that the hours of diet and the kind of food is
in China what is customary elsewhere. It is impos-
sible to work, or even live on rice alone; it is impos-
sible for soldiers, or for labourers, to continue for
more than а day or two on rice alone and remain fit
for duty. In British campaigns we know soldiers go
for a day or two on a few hard biscuits, but three days
of а biscuit diet, or even a bread diet, ends in collapse
from semi-starvation. It is as true that British sol-
diers went through the South African Campaign on
biscuits as it is to say the Japanese fought their
arduous battles on rice. Yet does this insane belief,
that the natives of tropical and of sub-tropical coun-
tries subsist on rice prevail, and the elimination of
such nonsense seems impossible.

А VEGETABLE Diet.

Vegetarianism is a potent cult amongst a certain
section of British town dwellers at present. It is
regarded as if it were something new and advanced,
and amongst what, for want of a better name, may be
termed “ cranks,” vegetarianism is preached as if it
were anew Gospel. ‘ New ” or “advanced " persons,
be they men or women, amongst other fads affect

October 15, 1906.)

vegetarianism and regard an all vegetable diet as
entitling them to be classed, with those types of
degeneracy known, as “advanced” people. А so-
called vegetable diet has been, and, it is hoped, will
continue to be, the food of many stalwart people; it
is nothing new; it is an all-sufficient and time-
honoured means of sustenance, and is not the creation
of modern minds. The belief that vegetarianism is а
new cult is as true as that the natives of India and
China live on rice; ignorance is the explanation of
both beliefs, but the eradication of ignorance of this
stamp'appears an impossible task. The term vege-
table diet is а misnomer for the most part, for it
includes, as a rule, milk, eggs, and not infrequently
butter and animal fats, in the form of dripping, &c., used
in cooking. That one can subsist, thrive and work
hard on this inclusive vegetable diet does not surely
want to be told; in many countries we find it used.
In the more northerly countries of Europ» a diet
similar to that consumed in the Eastern and North
Eastern counties of Scotland amongst farm servants
obtains. Таке the diet of а farm servant in Scotland,
at any rate, up to quite recently— Breakfast: oat-
meal in the form of porridge with oatcakes and milk.
Dinner: mashed potatoes or brose, i.e., oatmeal with
boiling water or hot milk poured over it and flavoured
with vegetables, oateakes and milk. Supper: cabbage,
or kail, or potatoes, with oatcakes and milk. Оп Sun-
day: Broth made from beef bones or neck of mutton
with vegetables. Beef or mutton was eaten only during
a few days in the year—Christmas Day, New Year's
Day, and perhaps on one.or two other occasions.
Theirs was а vegetable diet, and, with the exception
of milk, an all vegetable diet. Yet did these men
thrive and work hard on this diet, and were as good
specimens physically as any in the land. This is,
from some standpoints, a more meagre diet than that
of the Chinaman, who is foolishly believed to live on
tice, and it. is more simple and more thoroughly
vegetable than professed yclept vegetarians follow,
who frequently include not only all the vegetable
products of the Orient—sage, rice, tapioca, &c., but
also eggs and milk. It is therefore untrue that
vegetable eaters are found only in warm countries.

VARIETIES OF Боор.

Cow's Mik.—To home-dwelling Europeans it is
incredible that milk is not used as an article of diet
by people of every nationality. Several races, how-
ever, do not use milk in any form. Тһе Chinese, and
all other Mongolian peoples, constituting almost one-
fourth of the entire population of the universe, do not
drink milk, and several other races, especially the
Malays of the Archipelago, follow their example.
Babies in China, when weaned, are given the water
rice is beiled in (Conjee), as we give milk to the
children, and they thrive well upon it. In the districts
of Scotland mentioned above, milk is (or was until
quite recently), taken in larger quantity than by any
other adult people in the world. "The milk used is not
the milk as it comes from the cow, with ten per cent,
cream, but almost eight per cent. of the cream is
removed by skimming (not separated), and the
amount taken during the day would be between 24
and 4 pints.

THE JOURNAL OF TROPICAL MEDICINE.

It is doubtful if milk with the natural `

313

amount of cream could be taken in such quantities
without making the consumer ''liverish" ; on the other
hand, separated milk (quite different in quality to
skimmed milk), would, in all probability, be insufficient
to give the nutriment required. No other section of
the humau race consume milk to this extent, and as
the Tropics are approached, cow's milk is less and less
used. Goats milk is substituted in some parts;
8898 and mare's milk, either naturally or іп а
fermented state, is taken, and buffalo's milk is used by
some peoples. Buffalo's milk contains а much larger
proportion of cream, some seventeen to eighteen per
cent., but the skimmed buffalo’s milk is poor іп food-
giving properties compared with cow's.

Europeans in the Tropies, wherever possible, import
European or American cows for milking purposes,
owing to the native cows, in the far East, at any rate,
not yielding the same quantity or quality. Tinned
milk, especially Nestlé's, is largely used by Europeans
in warm climates. Were it possible to issue Nestlé's
milk in smaller tins, there is little fault to find with
its use in the Tropics; but owing to the size of the
tin sent out by the Company, the contents cannot be
consumed in one day, and in а tin once opened the
contents rapidly become quite hard in а dry climate,
or in a warm, moist climate they are apt to become
mouldy. Were it possible to export Nestlé's milk in
smaller tins, so that the opened tin need not be kept
from day to day, it would be a great gain hygienically ;
but it is doubtful if it could, under these circum-
stances, be exported at a sufficient profit without
largely increasing the cost to the consumer.

Sterilised milk, i.e. fluid milk sterilised before
being put in bottles, as that known as Dahl’s, is theo-
retically excellent, but the cost and the difficulty of
transport are rather prohibitive for general and con-
tinued use.

On board ship the absence of fresh milk is greatly
felt by invalids returning to temperate climates, and
sterilised milk is, perhaps, the best substitute under the
circumstances. ` ;

In England, milk as an article of food has well-nigh
disappeared in many country districts. In the neigh-
bourhood of all large towns the farmer is pledged by
contract to sell to the milk-agent from the town all
he produces. The farm is а '' tied-farm” as much as
a public-house in the hands of a brewer is a “ tied-
public-house.” Тһе country children have to get
along as best tbey can without milk, and as bringing
up children at the breast is going out of fashion
amongst even the rural population, the children are
under fed, and rickets is more common in country
villages round London than in the city itself. The
rural population of large parts of England at the
‘present moment have the poorest diet of perhaps any
peasantry in the world. Tea, bread, cabbage and
‘occasionally potatoes, is their staple food, yet do the
“ educated classes" believe that in the Tropics the
natives live on rice, whilst the ‘roast beef of Old
England" for adults and milk for young people is
the staple diet of all and sundry in the British Isles.
Two-thirds of the rural population in England now-a-
days taste beef perhaps once a month, and have milk,
if at all, only in teaspoonfuls with tea.

This is not the place to expatiate on a people thus

814

placed; I have dealt with that elsewhere. The physical
decline of a people with its rural population insufh-
ciently and inappropriately fed is not far off.

Beef and Mutton.—It many parts of the Tropics
fresh beef and mutton are unobtainable. Cattle may
not be reared in the district, and imported cattle are
usually employed as beasts of burden.

In out-of-the-way parts of the Tropics beef is wholly
unobtainable; the population may be too sinall to
consume, or too poor (ая in many rural parts of
Britain) to buy, suflicient of a freshly killed ox to
make it pay to do so; this obtains not only in the
Tropics, however, but in rural districts in Britain; so
the “ travellers’ tales " on these points, although they
amuse towns’ folk in England, are true not only
abroad but at home.

In the equatorial and the tropical zones north of
the equator the consumption of beef by the natives is
almost nil, and in the sub-tropical and northern
regions it is seldom used. Іп southern sub-tropical
countries—Australia, the Cape and South America,
cattle grow and flourish, and the consumption of fresh
meat, by Europeans especially, is as customary as
amongst the better off classes in Britain.

Sheep are distributed very irregularly over the
world, for in many parts it is impossible for sheep to
live. It is not climate so much as food that is the
determining faetor, for in Southern China and in Japan
where there are no sheep, it is the pasturage that is
wanting. Fresh mutton and beef, therefore, is difficult
to get in many parts, mainly owing to the environ-
ment being unsuited to the rearing and feeding of
eattle and sheep, and partly from the inability of the
people to buy imported meat.

Breeds of Cattle and Sheep.—It must be remembered
that cattle are utilised very largely, not only in
tropical but in some temperate countries, as beasts
of burden. There are milk cows and draught oxen in
the country it may be, but these are neither by a
breed nor on account of their age when killed of a
quality that produces wholesome and nutritious meat.
In Britain, cattle are fed and killed at about two
years of age, and from these and these only can the
best beef be obtained; iu most other European
countries the breed of cattle is оГ inferior quality aud
do not reach a profitable killing age until one or two
years later, necessitating thereby longer Кеср, that is,
more expense and a higher charge for beef were they
killed. Тһе consequence is the farmer cannot afford
to keep oxen for four years earning nothing, so he
puts them to the plough and their muscles become so
tough that their beef is leathery and affords but little
nutriment.

It comes about, therefore, that cattle are either
killed (except іп Britain) as calves or allowed to
reach the advanced age of ten or twelve or more
years before being killed.

The reason that veal is used so commonly in France
&nd Germany is attributable to this cause. Farmers
cannot afford to allow the animal to attain full growth
for market purposes as they have not the breed of
cattle, nor have they the pasturage, turnips, &c.,
necessary to produce the highest class beef. Their
animals when allowed to mature are utilised for

THE JOURNAL OF TROPICAL MEDICINE.

[October 15, 1906.

farm work, and when killed their muscles are so
tough that the beef requires all the tricks of the
culinary art to render it fit for consumption. Hence
the superiority of “ continental” cooks compared
with British cooks; the former find it necessary to
disguise the poor quality of the meat, the latter are
not ashamed to produce the beef as it is, culinary
tricks being unnecessary.

The quality of mutton depends greatly on the breed
of the sheep. In Australia the wool-producing sheep
are more sought after than are the flesh-producing
sheep grown in Britain. The quality of mutton, ob-
tainable from sheep from which wool is most profit-
ably grown, is quite inferior to the class bred and fed
for killing purposes; and as the farmer keeps the wool-
producing animal for as many years as possible, it
comes about that, not only from the quality point of
view, but also from that of the age of the animals
when killed is the mutton inferior in nutriment. It
is plain therefore, that beef and mutton may be good
enough from the inspector's point of view, but may be
tough to digest and wanting in nutritious properties.
Such flesh appeases hunger, no doubt, but is not
calculated to give bulk for bulk the same nutrition as
a food. In this way many dietary peculiarities of
tropical life may be explained. More meat has to be
eaten to get the sustenance necessary when the meat
is of inferior quality. This may be the reason for the
accusation made against Europeans dwelling in the
Tropics that they eat too much. Certain it is that most
Europeans eat more meat (when they can get it) in
the Tropics than at home. Some say it is because the
climate is exhausting and more strengthening food is
required ; but the real reason, no doubt, is that the
nutritive quality of the beef and mutton is inferior,
and that more has to be taken to supply the bodily
wants, thereby taxing the digestive organs, which in
hot climates are usually feeble, and bringing a train
of gastric, hepatic and intestinal troubles.

Frozen Meat.—Could frozen mutton be introduced
into tropical, countries, a great food problem would be
solved. In large cities on the coast cold storage would
allow of a plentiful supply of mutton, and perhaps
beef, being available for residents in the town itself,
but in up-country districts the introduction of chilled
or frozen meat is, in the present state of our know-
ledge, impossible. Not that the sheep of Australia or
New Zealand affords the highest quality of mutton,
for they are chiefly reared for the wool they produce,
and the carcass has, up to recent years, been a һуе-
product. Now, by freezing or chilling, the bye-product
has & commercial value, although it never can be, from
sheep of that breed, of the highest.

Fowls are generally distributed through the uni-
verse, and there are no parts of the world, so far as I
know, where fowls cannot be found. Тһе wide dis-
tribution of the fowl is an important factor in the
spread of civilisation, for it is a question if Europeans
could live in many of the out-of-the-way districts they
do were it not that they can have eggs or fowls to eat.
The nutritive value of chicken is relatively small, how-
ever, and is frequently difficult to digest ; moreover the
monotony of eating fowl day after day, and month after
month, let the fowl be cooked in ever so many ways,

October 15, 1906.)

THE JOUBNAL OF TROPICAL MEDICINE.

315

рав upon the appetite after a time, and digestion and
nutrition suffer. ў

Curry, so largely used іп tropical countries, is not
only the staple form of diet of many natives, but is
used also freely by the Europeans dwelling in warm
countries. Rice is the basis of the dish, and with it is
& congeries of materials, which may consist of fish,
flesh, or fowl, with vegetable additions of sorts. The
sauce (curry really means sauce, from the Tamil word
kart) is composed of condiments varying in potency ;
ginger, pepper (white, black, or cayenne), and various
spices give flavour and “ пір” to the meal. The use
of pepper is, of course, an Oriental custom, and the
stronger forms of pepper seem requisite as an article
of diet. The therapeutic use of pepper seems to be
not so much a stomachic tonic as an intestinal stimu-
lant, and chiefly as a stimulant to the large intestine.
It is the large intestine that first flags in its duty in
the case of the natives of tropical countries. Consti-
pation is one of their chief complaints, and the atonic
condition of the colon is the chief cause. Black pepper
is а stimulant to the colon and rectum, and its exten-
Sive use in warm climates is physiologically justified
by what has been proved by therapeutic investiga-
tion and the experience of centuries. Constipation
із combated by the natives of warm climates by
pepper and spices in the food, by castor oil occa-
sionally, and largely by the position assumed during
defecation—the natural or squatting position. Our
modern closet with its high seat is a great detriment
to defsecation, especially in habitual constipation, and
were people thus afllicted to resume the “natural”
position a great deal of the suffering due to piles
would be prevented. Some people overcome the
difficulty by standing on the seat—an awkward and
an indelicate proceeding. Тһе use of а high stool for
the feet in front of the closet seat will really give
a position sufliciently “ squatting’ to overcome the
difficulty. Curry, therefore, if properly made, is an
hygienic dish of value; and should not be regarded
with the suspicion it is looked upon in Britain, where
badly cooked rice, particles of tough, twice-cooked
meat left over from a three or four days’ old joint, and
made hot to blistering strength with curry powder
is the rule. The rice and meat should be served
in separate dishes and the condiments added by
the consumer himself, or herself, at table, and not
by the cook. According to the state of one’s digestion
80 may condiments be added, the people with atonic
intestines requiring a larger helping.

THe Basis or SPECIAL PREPARATIONS.

_ It is impossible to deal categorically with each
individual article issued by any particular firm. After
all, it is the firm—the people who make the articles
for consumption—to whom we have to look for protec-
tion in this matter. The show preparations of one
firm may be as good as another, but the ordinary
articles made to sell may be of quite another character.
Given a firm that “ сап afford to be honest," and we
have sufficient guarantee that the goods are what they
pretend to be. Mistakes may be made, and faulty
raw material may occasionally find its way into the
manufactory, but in a firm with a good name to main-

tain, and not to lose, the public can rely that the
materials employed are the best that can be obtained.
Lately the American canned goods scandals have

‘shaken the confidence of the public in all kinds of

preserved foods. What was going on in American
canning factories was well known to manufacturers of
food products in this country, to all medical men, and
to all who cared to listen to what was said and written.
The warnings were disregarded, and British manu-
facturers were eclipsed in the market; now, perhaps,
people will patronise the products of their own
countrymen, where the materials used can be in- -
spected, and the process of preparation watched.
That British producers of foods of this description
have taken intinite pains to ensure cleanliness of
premises and wholesomeness of materials, is well
known, and we look forward to still further improve-
ment in this important department of food supply.

The basis, the “ granulated powder," used by several
manufacturers in this country is professedly obtained
from America. This, perhaps, is commercially impera-
tive, for it is impossible at the present price of beef-
teas, essences, jellies, &c., in the market, that prime
beef can be used in their manufacture. The “ох in
& bottle" theory is all very well in the form of
an advertisement to induce the public to buy the
goods, but oxen in this couutry are not obtained for а
few shillings, nor yet for а few pounds. An “oxin a
bottle" would cost at least £25 instead of about as
many pence at which it is sold. We would urge on
manufacturers not to be afraid of price; beef is an
expensive commodity, and its issue in the form of
concentrated food will almost double its value, so that
it is, and it must ever remain, expensive. The pro-
ducts at present in the market are much too cheap to
command the serious attention of medical men, and
we can assure the manufacturers that they will gain
higher commendations from the medical profession
upon their products, when they issue them at a price
which even the most embryonic of financiers can
appreciate to be necessary if the “basis” of the
materials is obtained from the best beef.

Alcohol.—The natives of warm climates, both by
their religion and their habits, shun alcohol. It is in
no sense a food, and Europeans in the tropical coun-
tries would do well to avoid its use altogether.

Spirits and beer in hot, moist climates are positively
detrimental to health; light wines, white or red, do
least harm. Champagne, taken after excessive fatigue,
about sunset, is perhaps the safest form of alcoholic
beverage. It should not be taken with meals, but
only on reaching home after a fatiguing march, or
long exposure to wet. i

Tea.—As а stomachic tonic, and as a safe way of
introducing fluid to the system, tea would seem bene-
ficient and hygienic. It was evidently introduced by
the Chinese, owing to the calamities arising from
drinking unboiled water. Deep well water is almost
unknown in China, and the shallow wells and streams
are so apt to hecome polluted, owing to the habits of
the Chinese, that experience dictated the necessity of
boiling the water. But, boiled water being insipid,
and the object of its being hoiled not being evident
to ignorant ard thoughtless people, the water was

816

THE JOURNAL OF TROPICAL MEDICINE.

(October 15, 1906.

* flavoured ” by the leaves of the tea plant, a custom
which has become widespread. It was, no doubt, for
hygienic purposes tea was introduced, but the abuse
of tea-drinking has brought many evils in its train.
The Chinese drink tea after finishing their principal
meal, and, in fact, аз а drink at any time. They
do not drink tea during their meal, but after the meal
is finished. The pernicious system of drinking tea
during a meal is one peculiar to British folk, and
the habit is fraught with many dyspeptic troubles.
The best China tea, prepared by pouring boiling water
over the leaves and immediately pouring the water off
the leaves, is & wholesome fluid, calculated to aid
digestion, especially when taken after the meal is
finished, . Tea taken with animal food, be it eggs, fish,
flesh or fowl, is а certain means of producing
dyspepsia, for when the tea is * drawn" for a long
time, and when the tea used is of ап iuferior
quality—the method and material usual in Britain
and Australia— the tannic acid of the decoction,
uniting with the albumen of the animal tissues, pro-
duces a leathery compound which no gastric juice,
however potent, can penetrate and digest. Tea used
as the Chinese use it is a hygienic drink; as it is
usually used in Britain and by British folk throughout
the Empire it is detrimental to the public health.

Cofee.—Two or three mouthfuls of good coffee after
& meal is an aid to digestion; taken in quantity,
breakfast cupfuls, it is an impediment to digestion,
and diluted with half milk and taken with a meal
of eggs, fish, fowl, or flesh, is still more so.

Tobacco. —In moderation, and smoked soon after
a meal, the deleterious effects of tobacco are infini-
tesimal. When indulged in to excess, say six to eight
cigars, or fifteen to twenty cigarettes, or 1 oz. of pipe
tobacco a day, especially in a moist, tropical climate,
tobacco is an injurious cardiac depressant.

SPECIAL FOOD PREPARATIONS.

Beef Teas and Jellies ; Chicken Soups and Jellies ;
Calves-foot Jelly.—Home-made beef-tea made from
prime beef (top of the round) has the advantage that
* we know what is in it." "That, however, does not
prove it to have nourishing properties. In fact, except
as a stimulant from the salts it contains, it gives but a
meagre nutriment to the system. Home-made beef
essence is usually given in so concentrated & form
that it frequently causes flatulence and discomfort.
Of the many fluid beef extracts on the market, Bovril
has for some time held the foremost place in popu-
larity. It is used in the kitchen and in the sick-room ;
by the busy man of commerce and by the lounger in
the club ; by the soldier, the sailor, and the traveller,
and in many remote parts of the earth it is bighly
prized.. Whatever the nutrient value of Bovril, and
other preparations of the kind, there can be no doubt
_they have contributed to advance temperance; for at
publie bars nowadays one of them is asked for instead
of spirits or other alcoholic drinks. ‘Tropical climates

do not affect Bovril so long as it remains undiluted.
Brand’s Essence has long held a high place in public
estimation, and is a favourite preparation in the sick-
room. “ Lemco” is the name recently adopted by
the purveyors of the well-known Liebig extract for
their preparation. All the world knew the famous
extract prepared by Baron Liebig, but although the
name has changed we are bound to say the quality
of the preparation has not deteriorated. The extract
is as good to day as ever it was.

Chichester Brand preparations have been for a con-
siderable number of years on the market, and they
are not so widely known as they might and deserve to
be. Shippam, of Chichester, manufactures these pro-
ducts, and those we have tried—the beef-tea and

chicken jelly — are excellent, appetising, and easily
digested.

Maconochie's preparations are pleasant to look at,
agreeable to taste, and leave a sensation of cleanliness
of the palate, very different to the mawkishness and
burnt-beefy flavour which hangs about the mouth
after some of the similar preparations in the market.
The calves-foot jelly is specially good, and is relished
by children; it possesses the great advantage of being
ready for use. The essence of beef is a wholesome
preparation. Messrs. Maconochie have endeavoured,
and with success, to supply a compressed meat
tablet, under the name of Vitox. The tablet is
pleasant to taste, satisfying and sustaining, and con-
tains as much nourishment as it is possible to get into
во small a bulk. There are other well-known prepara-
tions of similar nature to the above, and most people
have а preference for this or that jelly, extract, or
essence. An apparent drawback to all these “ solidify-
ing" preparations is that they become fluid in warm
climates. This is not really a drawback, as the
nourishment is there all the same, and it means
sipping fluid instead of jelly, but if one prefers them
іп a solid state, they may be put on ice, if available,
or hung in a draught away from sunlight, or lowered
in baskets down a well, where it is usually sufficiently
cool to solidify most jellies.

Children’s Food.—Of the many special preparations
for infants’ food, it is impossible to deal with at length.
Several have been before the public for many years,
and there is no fault to find with the majority of such
preparations. Amongst those to be specially com-
mended are: Neaves' Food for Infants—a carefully
prepared and wholly hygienic product. The foods
prepared by Savory and Moore and by Allen and
Hanbury's firms have the guarantee of the names of
these well.known and respected firms. The fault to
be found with firms supplying food for infants is, that
the majority of them pretend that artificially prepared
infants' foods can, or do, take the place of milk, either
in natural (human) or unnatural (cow's) form. Of
special preparations for invalids and delicate people,
Plasmon and Sanatogen hold deservedly bigh places in
the public estimation. The former has been for some
time in the market; Sanatogen is а more recent pro-
duction, but one which has in cases of intestin:!
ailments such as typhoid, dysentery and sp

-become a favourite.

October 15, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE.

317

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THE

Journal of Tropical Medicine

. Остовев 15, 1906.

THE PUBLIC AND THE FOOD TRADE,

THE recent gruesome disclosures of the secrets of
the Chicago packing houses must have come as a rude
shock to most dwellers in the Tropics, as few such can
have read the articles that flooded the papers without
having forced on them the disagreeable conviction
that they had already largely overdrawn their account
on the peck of dirt which proverbial philosophy
places to the credit of every child born into the world.

In all our tropical possessions the old stager learns
to utilise the resources of his adopted home, while
the “griffin” may be known by his lavish expendi-
ture on tinned “ Europe stores," but there always
remains a point beyond which local resources fail to
meet the requirements of our European ménu, and to
meet which, even the most seasoned veteran is driven
to consume imported luxuries.

It is seldom that one can long follow the columns
of our Indian dailies without meeting with a case of
what is usually reported as ** degchi poisoning."

The batterie de cuisine of the Indian cook is made

examination of the dejecta; and it is & curious
circumstance that most of these outbreaks occur after
big dinner parties; on which occasions tinned deli-
сасіев always figure largely, forming as they do the
Anglo-Indian's fatted calf. They are, in fact, cases of
ptomaine poisoning.

In India it is quite possible to live comfortably
without ever touching preserved food, but in some of
our other tropieal dependencies this is far from being
the case. Notably, in West Africa, where from the
Europoan point of view, local resources are so scanty
as to leave the white population mainly dependent on
preserved food.

It is practically impossible for the consumer to
test the wholesomeness of articles preserved in tins,
as the really dangerous changes are often imper-
ceptible to the sense of taste, and do not result in
the production of gases, so as to make the can con-
vex at the ends, or ** blown." |

Food in an advanced stage of decomposition, such
as that contained in a blown tin, is hardly likely to be
eaten by any one, save under the compulsion of actual
starvation, but, unfortunately, the consequences of
eating the apparently sound articles may be far more
serious than those which would result from eating the
produets of ordinary decompositions. It is now toler-
ably certain that scurvy is caused, not by want of
certain vegetable acids, nor even by the lack of fresh
food, in the ordinary sense of the word; but that it
is due to the action of certain ptomaines which exist
in a large proportion of preserved comestibles, such as
salt beef, tinned goods, &c., and possibly even in stale
grain.

The great Arctic explorer, Nansen, remarked with
reference to an outbreak of scurvy among the men of
а sledging party, who escaped starvation by utilising
& store of provisions left, some years before, by some
previous explorers, and who rejected the blown tins,
that they would have been wiser to eat the obviously
decomposed than the deceptively wholesome-tasting
portions of the store, presumably under the assump-
tion that the bacteria, which cause the subtle and
dangerous changes, would be crowded out and exter-
minated, and their products destroyed, by those of
ordinary decomposition.

Every Indian jail superintendent knows how hard
it is to keep an Indian prison free from scurvy, in
spite of most liberal rations of fresh vegetables, and of
lime-juice. Now the only article of the prison diet
which is preserved is the grain, which forms the bulk
of the ration, and this is bought immediately after
the harvest and stored, often in а very primitive
manner, so that by the next harvest it is necessarily
more or less stale. It would be interesting to ascer-
tain if the ineidence of scurvy in these institutions 1s
seasonal. А :

Sponginess of the gums, such as is seen In Indian
jail seurvy, is by no means uncommon among Euro.
peans in West Afriea, and it seems possible that this
may be merely a manifestation of scurvy, the result of
^^» much tinned food, and that such a condition ma

n important factor in the low state of health so
noticed in residents of these colonies, quite apart
attacks of fever and other obvious tropical

fies.

818

THE JOURNAL OF TROPICAL MEDICINE.

[October 15, 1906.

It is therefore sufficiently clear that an efficient
Government inspection of all preserved provisions is a
desideratum of Imperial importance, which intimately
concerns ihe development of many of our tropical
possessions.

But it is not in the comparatively small item of pre-
served provisions alone tbat the public health is
threatened by the impurity of food supplies. Milk,
bread, and all foodstuffs in which adulteration is
possible, are manipulated in shameless fashion.

Nor is the country producer any better than the
town distributor, for it is notorious that the condi-
tions under which milk is collected on farms, and
cattle slaughtered in private abattoirs are often in the
last degree revolting.

The whole business of the production and handling
of food is, in fact, conducted without the least regard
to either decency or cleanliness. To give a single
example: Nothing is commoner, even in the best
parts of the West end of London, than to see vegetables
exposed for sale outside greengrocers' shops in such a
position that they are accessible to any pasaing dog,
and the baskets and their contents are actually often
deeply stained with canine urine.

If this be a matter so common as to attract the
notice of the casual passer by, it can hardly be sup-
posed that the proprietors of these highly priced estab-
lishmen:s can be ignorant of the disgusting conse-
quences of the method they adopt to attract attention
to their goods, and yet they continue to expose their
customers to the certainty of having their food pol-
luted іп a most filthy manner rather than lose the
chance of sale that would be involved in keeping their
commodities properly protected.

That commercial rectitude and the caution of the
buyer ever sufficed to protect the public against dirt
and adulteration is more than doubtful, but whatever
may have been the case in the “good old times," it is
sufficiently obvious that stringent Government regula-
tion of all branches of the food trade is an urgent
necessity of the present day.

Anotber matter which calls loudly for Governmental
interference is the abuse of advertisement.

It most emphatically is not a ** pardonable exaggera-
tion " to state a few teaspoonfuls of brown extractives,
smelling suggestively like ‘‘secotine,” represent the
nutritive constituents of a cow crammed into the
space of a cup, for though most buyers probably take
the bare statement with some grains of salt, it may
be taken as certain that they would not buy the stuff
were they not persuaded that the contents of the tiny
pot represent an amount of nourishment that could
not possibly be concentrated to & reasonable bulk by
any of the ordinary operations of domestic cookery,
and as such is not the case, it is indisputable that the
sellers obtain the purchase-money by false pretences,
against which the public have as great a right to pro-
tection as they have against the wiles of the thimble
rigger.

It must be remembered that it is especially the
poor who put the most implicit trust in these lying
advertisements and it is often pitiable to see hard-
pressed parents and their other children pinched, to
scrape together the extortionate price for some well-
nigh valueless meat extract, which they fondly hope

may rescue their sick child from the jaws of death:
a half-crown for the amount of albumen contained
in half of a penny egg !—not one whit more nutritious
and far less appetising.

Not the least part of the evil is that the unfortunate
victims of this system of fraudulent misrepresenta-
tion are so hypnotised by the emblazoned falsehoods
that force themselves on their sight from every avail-
able wall and hoarding, that it is impossible to convince
them of the uselessness of highly priced rubbish of
the sort, and they will pinch themselves and defraud
the butcher, baker and candlestick maker of their
just dues, in order to obtain the coveted talisman,
however strongly one may persuade them to the
contrary.

It is as great a fraud to state that a teaspoonful of
some or other concoction contains as much nourish-
ment as a pound of beef-steak, as it is to substitute
sand for sugar, and the public have as good a right to
be protected against the one as the other fraud.

Were wilful misstatements of the sort dealt with as
they should be by the public prosecutor, it is tolerably
certain that in a very short time the trade in food
specialities, which owe their popularity to nothing
but advertisement and the gullibility of the public,
would soon shrink to very modest dimensions, and it
is hard to see why steps should not be taken to ensure
во desirable an end.

——————— -

AN ADDRESS
Delivered: at the Opening of the Winter Session of the
London School of Tropieal Medicine, October, 1906.
By Colonel Кемметн MacrEop, І.М.8., M.D., LL.D.
Honorary Physician to H.M. The King.

NEARLY three years ago, on December 7th, 1903, ап
address was delivered in this place by Sir Patrick
Manson, whom I may without impropriety designate
as the Brahma and Visbnu—the creator and sustainer
—of the London School of Tropical Medicine. In
that address Sir Patrick Manson described the origin,
progress and prospects of the institution, and indi-
cated its objects, achievements and requirements.
The school, which was opened on October 3rd, 1899,
had then completed the fourth year of its existence.
An aggregate of 355 students had undergone instruc-
tion during thirtcen sessions, and evidence was pro-
duced of good work accomplished in the hospital and
school, and by many of its alumni who had utilised to
advantage the lessons, theoretical and practical, which
they had been taught.

During the three years which have elapsed since
that address was delivered the school has continued
to prosper. The aggregate of students who have at-
tended during twenty-one sessions has increased to
617. Of this number 235 belonged to the Colonial
Medical Service, for whose benefit and for the benefit
of the colonies in which its members were destined to
serve, the school was originally designed and organ-
ised, under the administration and personal initiative
of that great Colonial Minister, the Right Honourable
Joseph Chamberlain; 18 medical men employed by
the Foreign Office, 29 officers of the Indian Medical
Service, seven of the Royal Army Medical Corps, four

Осіоһег 15, 1906.)

THE JOURNAL OF TROPICAL MEDICINE.

319

of the Royal Naval Medical Service, one of the Indian
Civil Veterinary Department, and 33 medical officers
serving under other governments passed through the
School, making в total of 327, or 53 per cent. of the
whole; 71 medical missionaries and 219 private
students, or 290 non-oflicials (47 per cent.), availed
themselves of the opportunities of studying tropical
diseases afforded by the school. The large proportion
of non-official students fully confirms the wisdom of
the founders of the school in exteuding its benefits to
all medical men, and I may add women (for the aggre-
gate includes 40 ladies) interested in tropical diseases
апа mostly intending to practise in the Tropics.

The demand for admission into the school has been
well maintained, and the number of entries for the
present session has been, I learn, unprecedentedly large.
А specially satisfactory feature in the statistics of
attendance is that the number of students taking the
full eourse of three months is on the increase. The
status of the school has been strengthened by its
affiliation with the University of London and the
admission of tropical medicine as a sixth alternative
subject for the M.D. of that University. Тһе school
course has also been recognised as entitling students
to undergo examination for the Cambridge Diploma of
Tropical Medicine and Hygiene. Thirty-two students
of the school have succeeded in obtaining this diploma,
&nd one student has gained the London M.D., taking
tropical medicine as the optional subject. Special
arrangements have been made for instruction with
reference to the examination for the London Degree
and Cambridge diploma. The rich experience of tropical
and other diseases available in the Dreadnought Hospital
has been placed at the disposal of medical graduates by
the establishment of the London School of Clinical
Medicine, and the services of eminent physicians and
surgeons have been secured for imparting instruction
in the institution.

Of the transformation which has taken place of a
branch hospital into а well-equipped medical school, I
have had opportunities of personal knowledge. Some
twelve years ago I paid several visits to the Royal
Victoria and Albert Docks’ Branch of the Seamen’s
Hospital Society. About 20 patients were accommo-
dated in the rooms of a small building. The patients
whom I saw were seamen of many nationalities, who
had been admitted from vessels trading with the
Tropics, and suffered from diseases contracted in warm
climates. The arrangements for their comfort and
cure were excellent. The place was occasionally
visited by medical men interested in tropical pathology ;
but no means of systematic instruction existed. There
was a small room in which microscopic and bacterio-
logical observations were made and demonstrations
given of malarial and other parasites ; but the work
was necessarily limited to the clinical needs of the
Hospital. Recently, under the guidance of Sir Patrick
Manson, I visited this Institution—Hospital and School
--ав it now exists. The Hospital has been enlarged
and can accommodate 50 patients. The new wards
are spacious, clean and well ventilated, fitted with
every appliance and supplied with every requisite for
the treatment of the sick. The School building ad-
Joining the Hospital, with its large and well-stocked
laboratory, lecture room, museum, and library, is well

adapted and provided for the instruction of 40
students; and, in addition to accommodation for the
staff, provides quarters for 12 students, who are thus
enabled to devote the whole of their time to their
studies and practical work. The arrangements are
well suited to their purpose and reflect credit on all
concerned; but they are by no means complete, and
the School must be looked upon as in a state of adoles-
cence and immaturity. Ейогб and money are still
necessary to enable it to accomplish all the good which
its promoters and well-wishers desire.

It is satisfactory to know that the expenses con-
nected with construction and organisation have,
through the liberality of the Seamen’s Hospital Society
and the public, been fully defrayed. Conspicuous in
the roll of benefactors is the name of the Honourable
Bomanji Dinshaw Petit, of Bombay, who contributed
100,000 rupees to the School. Mr. Petit is evidently
endowed with the liberal disposition of his family.
His cousin, Sir Dinshaw Manakji Petit, Bart., among
other benefactions, founded a veterinary hospital in
Bombay, and contributed a large sum for a similar
purpose when the Bengal Veterinary College, in whose
creation I was deeply interested and concerned, was
established in the year 1892. It is also gratifying to
learn that the London School of Tropical Medicine is
free of debt and able to pay its way; but in order
thoroughly to fulfil its twofold object of education and
research, the School needs further extension and
development. The laboratory is not large enough for
present requirements; additions are necessary for
special purposes; with the exception of the Cragg's
Scholarship no provision has been made for promoting
and supporting research where it can most profitably
be carried out, namely, in the Tropics; adequate re-
muneration is not given to lecturers and instructors,
and the fees payable by students are high and capable
of considerable reduction.

For these and other purposes more money is wanted.
Sir Patrick Manson, in the address to which I have
referred, estimated that £100,000 were required to
place the School on a satisfactory and permanent basis.
I understand that of this sum about £40,000 has been
received. Тһе remaining £60,000 would form an en-
dowment which would expand the operations and
enhance the usefulness of the School. Surely the
wealthiest city and busiest port in the world may
reasonably be expected, when the want is known, to
contribute handsomely to the support of an institution
whose work is designed to mitigate the loss of health
and life, which interferes so greatly with the industry
and commerce of our tropical colonies and depen-
dencies, and causes such a waste of time, labour and
money. The wealth of London and of England is
largely drawn from the colonies and from the carrying
trade connected with them; and any agency or іп-
stitution which ministers to the promotion of health
and prolongation of life, and thereby cheapens pro-
duction, barter and transport, is deserving of encou-
ragement and support. So that motives of benevolence
and self interest combine to advocate the claims of the
School to such liberal endowment, as to make it worthy
of the city and country, and thoroughly competent to
carry out those objects and operations whose aim is to
benefit humanity and promote civilisation.

320

The necessity of special instruction in the diseases
of tropical countries does not require argument or
proof. As these countries have their peculiar flora
and fauna, of which no general teaching of botany
and zoology or special study of the plants and animals
of temperate regions can supply a knowledge, so there
are in the Tropics special manifestations and modifica-
tions of disease regarding which pathology and noso-
logy, as taught in the medical schools of this country,
afford very little information. The analogy is by no
means a strained one, for the pathology of the present
day is largely concerned with botany and zoology, and
includes a study of vegetable and animal life. This
fact has been widely recognised in the scheme of in-
struction arranged in this school. Through the libe-
rality of the colonies the subjects of protozoology and
helminthology have been added to the curriculum of
study—a novel and important departure which merits
commendation and imitation. The study of vegetable
microbes is included in that of the diseases with which
they are associated; but to complete the teaching of
parasitology there is one subject which ought to be
systematically developed, namely, pathological ento-
mology. Insects, more especially blood-sucking in-
sects, the mosquito and tsetse-fly for example, have
been found to fulfil an important function in the con-
veyance of infective disease, and the harbouring and
transmission of disease germs, and knowledge on this
subject imperatively claims to be imparted and ex-
tended. Recent observations indicate that leprosy is
spread by insect agency, and cholera, enteric fever,
and plague are very probably similarly transmitted :
but on these and other cognate points additional light
is required. I trust, therefore, that a pathological
entomologist will, in the early future, be added to the
staff of the school.

The trend of modern investigation and thought has
forced into the forefront the fascinating subject of
comparative pathology, which has followed naturally
but somewhat tardily on comparative anatomy and
physiology. The researches of recent years, conspicu-
ously as regards tropical diseases, have revealed a
community of suffering and a reciprocity of infection
and protection between man and the lower animal
creation which have invested medical science with
fresh interest and endowed it with larger power. In
this connection it is pleasing to note that an agree-
ment has been concluded between the London School
of Tropical Medicine and the Royal Veterinary College,
Camden Town, by which students of either institution
may attend the other; and an interchange of demon-
strations has been arranged. The inquiries and experi-
ments which have made comparative pathology what
it is, have been beneficial to both man and beast,
and are capable of becoming more so—a point which
is strangely overlooked by those who, from laudable
but short-sighted motives, decry some of the methods
by which our knowledgo of influences, disabling and
destructive, affecting animal life, is advanced. Physio-
logists and pathologists have been accused of callous
selfishness and cruelty in subjecting the lower animals
to experiment for the purpose of furthering medical
science and improving medical art ; but in investigating
tropical diseases, men have, themselves, in numerous
instances, incurred risks to health and life without

THE JOURNAL OF TROPICAL MEDICINE.

[October 15, 1906.

hesitation. The true causation of yellow fever was
discovered through the agency of volunteers who
readily subjected themselves to dangerous hazards in
disproving the old doctrine of infection by fomites, and
proving the fact of communication by mosquitoes. In
working out the problem of malaria, human experiment
has also been largely resorted to, as in the two crucial
tests which were applied by members of this School.
In 1900, Drs. Sambon and Low braved the perils of
the Roman Campagna during the fever season, and by

‘protecting themselves from mosquito bites escaped the

maladies which prostrated the unprotected inhabitants
of that malarious tract; and in the same year Patrick
Thurburn Manson and George Warren contracted
ague in London by allowing themselves to be bitten
by mesquitoes which had been fed in Rome on plas-
modium-infected blood. Similar risks, fatal in some
instances, have been run, in investigating Malta fever,
cholera and plague, and among recent, medical martyrs
the names of Lazear, Myers, Dutton and Tulloch,
deserve special and regretful record. Тһе study of
comparative pathology is peculiarly needful in the
‘Tropics where, under a different environment, life, and
conspicuously parasitic life, is more exuberant than in
temperate regions, and the struggle between the higher
and the lower life, between the things and forces that
make for development and construction, and those
that make for decadence and destruction, is more keen
and stringent.

The facts and laws of comparative pathology lead
up to the higher reaches of transcendental biology and
furnish new illustrations of the law of survival of the
fittest, which the genius of Darwin formularised, and
his industry so amply exemplified and established. It
is important to note, however, that in this struggle the
issue depends on circumstances and conditions, and is
fortunately subject to the dominance of mind. The
survival is not necessarily of the higher organism. In
a stato of uncontrolled nature the parasite is apt to
obtain the mastery, the lower life to flourish at the
expense of the higher; and this is specially true of the
Тгорісв, with their luxuriant vegetation and teeming
animal life. There the lower life is rampant, and the
higher heavily handicapped in the contest. But when
the earth is, according to the divine command, sub-
dued for the use of man, when the primeval forest is
cleared, the swamp drained, thedesert irrigated, when
crops serviceable to man are cultivated, and native
races trained to agriculture and commerce, educated
and civilised ; when ignorance, poverty and filth are
diminished or abolished, the parasite is at a disad-
vantage, physique and health are improved and life is
prolonged.

The salutary effect of drainage, cultivation and
cleansing, is well illustrated by the banishment of
‘malarial disease from England. Epidemics of dysen-
‘tery, which used to rage from time to time, are no
longer heard of; typhus and relapsing fevers are
seldom met with; plague and leprosy have receded
eastward, and cholera has latterly been held at bay.
In India there has also been a marked improvement in
public health in consequence of undertakings such as
railways, canals, waterworks and drains, which were
appreciatively referred to by the Right Hon. John
Morley, in his recent speech in the House of Commons.

October 15, 1906.)

I could, did time permit, cite numerous instances of
the abatement of the incidence and mortality of fevers
and fluxes in Indian towns by means of sanitary re-
forms, particularly vaccination, the supply of pure
water and improved drainage and conservancy. I see
no reason why health should be worse and life shorter
in tropical than in temperate latitudes, when the con-
ditions which affect vitality and longevity are properly
understood and made the subject of proper control.
In a word, what is required in the Tropics for healthy
existence is reclamation— economie and sanitary—and
these should go hand in hand. To this end the efforts
of the whole community, not of medical men and sani-
tarians only, but of every member of the population,
are required, and sanitary education should be made
universal and compulsory. As a step in this direction,
I am glad to learn that Sir Patrick Manson is prepar-
ing a catechism of tropical hygiene which he proposes
to place in the hands of persons proceeding to the
Tropics, and make the subject of examination as a con-
dition of service.

The marvellous progress which has taken place
during the last quarter of a century in our knowledge
of the nature and causation of disease, to which the
study of tropical diseases has so materially contri-
buted, has radically revolutionised our notions regard-
ing pathological processes. We have been compelled
to widen our view and to devote more attention to the
environment. Important as is the study of the host
and his environment, hardly less important is that of
the parasite and its environment. It is essential now
that the life history of both should be worked out,and
the conditions affecting both beneficially or prejudi-
cially. Disease is no longer looked upon as a malig-
nant entity, but as a mode of salutary resistance to
nox ; and such processes as fever and inflammation
are found to be protective and curative in their pur-
pose and effects rather than of themselves deleterious.
This view proclaims the supreme importance of the
study of the пох, as well as of the disturbances of
health and function to which they give rise. The
matter assumes an intenser interest when we consider
that there exist in the animal body, materials whose
office it is to destroy the noxæ—to kill the microbe
and antagonise the poison elaborated by it. The
existence of these materials and of their power, con-
stitutes a startling instance of that adapted prevision
commonly called design, which pervades nature, and
whose most subtle and conspicuous manifestation is
in the working of the human brain. To develop and
strengthen these resistive and curative elements in the
animal organisation, is one of the chief, if not the chief,
object of medical science ; and—greatest marvel of all
—we are learning to use pathogenetic micro-organisms
for this purpose, just as in the septic tank system we
are employing saprophytic microbes to hasten the
‘return of matter which has ministered to organic life,
to inorganic forms, and thus to accelerate the process
of decomposition, the intermediate products of which
are so apt to be dangerous to health. The prepara-
tion of protective and curative vaccines and sera is
engaging the attention of our most able and advanced
pathologists. Even cancer, which seems to belong to
the category of the infective granulomata, is being
diligently experimented on from this point of view,

821

THE JOURNAL OF TROPICAL MEDICINE.

with results which offer some promise of eventual
success. Тһе principle which underlies the great dis-
covery of Jenner, is, after the lapse of over a century,
obtaining new and remarkable applications; the
familiar formule, vis conservatrir nature and vis
тейісаітіх nature, are undergoing incarnation, and
the intuitions of our forefathers are being converted
into material facts.

In offering these observations I have, I fear, been
wandering among the hazy {heights of generalities ;
but on an occasion such as the present it seems fitting
to survey the field of work as a whole—its extent,
condition and capabilities—rather than examine
minutely the tilth of some particular portion of it.
Generalisation is a delightful exercise, and speculation,
or, ав Tyndall phrased it, the scientific use of the
imagination, is capable, when rightly and cautiously
employed, of guiding and aiding enquiry. If we can
find “ tongues in trees, books in the running brooks,
and sermons in stones,” we may reasonably expect to
discover philosophy in epiphytes, wisdom in worms,
and, I may add, “good in everything." But the
process of generalisation is prone to become, when
misused, both misleading and unproductive and is apt
to be beguiling. It is so much easier to tbink out
than to work out a problem. No better illustration of
this has ever been furnished than in that land of ideals
and shams—India. The genius of James Lumsdaine
Bryden, in the early sixties, sought to extract patho-
logy and etiology from arithmetical units and aggre-
gates of units; and strange doctrines concernin
pandemic waves, aerial conduction and convection, an
forces cosmic, telluric and climatic, became rampant.
It is fair, however, to Bryden’s memory, to state that
his chief achievement, the discovery of the great
prevalence of enteric fever in the European Army of
India, was based on an intelligent study and interpre-
tation of cases and post-mortem examinations, recorded
by medical officers. The reductio ad absurdum of
Bryden’s visionary views was accomplished by James
Macnab Cunningham, who, with a logical Scotch
mind, showed unwittingly how they led to scepticism
and nihilism. But, ever since the arrival of the
English in India, there have been men who investi-
gated the diseases of the country by clinical methods.

‘The names of Johnson, Twining, Annesley, Webb,

Martin, Goodeve, Morehead, Chevers, Carter,
Moore and Fayrer, merit remembrance. Their work
possesses great value, but it was too exclusively
devoted to the subject of disease and the environment
was neglected. A new era of systematic, practical
observation, was opened by the deputation of Timothy
Lewis and David Douglas Cunningham, in the year
1870, to investigate cholera by the methods which
they had learned in the Army Medical School, Netley,
which was an early pioneer in the special study of
tropical diseases, and in which, from first to last,
clinical and practical systems of study were followed.
It is education of this sort that has fitted men like
Bruce, Ronald Ross, Leslie, Roberts, Leishman, and
Donovan, to accomplish work which has revolution-
ised tropical medicine, and, under the stimulating in-
fluence of Professor (now Sir) Almroth Wright’s
instruction, numerous observers, among whom I may
specify the names of Lamb, Rogers, Liston, Douglas,

329

THE JOURNAL OF TROPICAL MEDICINE.

(October 15, 1906.

Bannerman, Buchanan, Christophers, James, and
Greig, are now engaged in fruitful researches in India.
Lewis and Cunningham did excellent work in many
directions; but the methods which have been instru-
mental in adding so materially to our knowledge,
particularly staining, pure cultivation and animal experi-
mentation, did not come into full use in their time.
The Government of India has now responded to the
demands of modern medical science, and has resolved
to establish laboratories for clinical aid and patho-
logical research throughout India. Many of these are
already in existence and active operation. The
Pasteur Institute, at Kasauli, has been converted into
a central research laboratory, under the direction of
Lieut.-Colonel Semple, another disciple of Wright's;
the King Institute at Guindy, in Madras, under
Lieut. Christophers, is fully fitted for vaccine bac-
teriological and pathological investigations ; the plague
research laboratory in Bombay, organised by Hatfkine,
and Hankin's laboratory at Agra, are available for all
kinds of inquiries, and Lingard’s laboratory at Muk-
tesar is devoted to similar studies in veterinary patho-
logy. Other institutions of the same kind are being
established, and in time every large hospital in India
will no doubt have its laboratory.

To those who are about to commence their studies
in this school I offer hearty congratulations on the
excellent opportunities they possess for fitting them-
selves for the responsible duties of their future career.
My own experience enables me to bear thankful testi-
mony to the priceless benefit which I derived during
my twenty-six years’ service in India, from the vivid
pictures of tropical disease which Maclean presented to
us at Netley, and the sound lessons conveyed to us in
the lecture-room, wards and laboratory, regarding their
prevention and treatment. Since the year 1865 our
knowledge of tropical diseases and of the means by
which they are most profitably investigated has under-
gone a startling advance. І realised this acutely when,
in 1897, I was appointed to occupy the Chair of Mili-
tary and Clinicul Medicine, which Maclean had so
ably filled ; and so rapid did this advance continue to
be that, during my eight years’ tenure of that office,
I found it necessary from term to term materially to
alter my lectures—to modify, to cancel, and to add.
You are fortunate in being inheritors of the great
accession to our knowledge of tropical pathology and
hygiene which recent years have brought. There is
hardly a subject which has not undergone illumination.
Malaria, cholera, plague, leprosy, yellow fever, Malta
fever, filariasis, ankylostomiasis, trypanosomiasis, kala-
azar,—to catalogue some brilliant examples—have been
investigated with diligence and success. Their special
causes have been demonstrated, and important indica-
tions for their prevention and treatment supplied.
But great as have been the triumphs much work still
remains to be done on these and other subjects. The
more we know the more we want to know. As the
circle of knowledge widens the horizon of ignorance
also seems to extend. The etiology of dysentery is
still, very obscure, and the relation of its different forms
to hepatic abscess ; we are still in ignorance regarding
the causation of beri-beri, sprue, dengue, epidemic
dropsy, infantile biliary cirrhosis, and many of the
infective granulomata ; and the strange terms, ponos,
goundou and ainhum, require pathogenic explanation.

Why is the native of India relatively immune to the
infection of ешегіс fever? Why do dysentery and
beri-beri break out in the lunatic asylums of temperate
regions, while the general population remains exempt ?
What is the relation between hill diarrhoa and sprue,
whose symptoms are almost identical; and between
kala-azar and Delhi boil, which appear to be caused
by the same micro-organism? Why is the embryo of
filaria nocturna absent from the blood in elephantiasis,
which appears in the great majority of cases to be caused
by filarial infection? These are a few examples of pro-
blems which still await solution. This school has
already sent forth many earnest and successful workers,
among whom Low, Daniels, Castellani, Bentley, Wise,
Balfour and Philip Ross, deserve special notice; and
the inspiration and training which you will imbibe `
and undergo here will stimulate and qualify you to
follow their footsteps. Тһе assimilation of knowledge
is very precious, but the acquisition of aptitude for
increasing knowledge is much more so. But, while
discovery and invention are objects of high and
laudable ambition, few are gifted with the power of

roductive original research, and it is very remarkable
ж meagre аге the really permanent contributions to
science of even the most gifted. Still it is open to
every one to aid in some manner and measure, how-
ever humble, in the building of the temple of medi-
cine. Permit me finally to remind you that the main
purpose of your lives, as practitioners of the art of
medicine, as it is the prime motive and glory of your
profession, is to promote the welfare of man, to pre-
vent and cure disease, to relieve suffering and prolong
life. In striving to accomplish these ends you will
earn gratification and gratitude, even if you fail to
gain fame or fortune.

A vote of thanks to Colonel Kenneth McLeod
was proposed by Mr. Edmund Owen, Е.К.С.8., and
seconded by Sir Frederick Young, K.C.M.G.

Sir George Denton and Fleet Surgeon P. W. Bas-
sett Smith, R.N., also spoke.

A large number of people were present, including
Professor Blanchard and Dr. P. Joly, from Paris.

Toe ANNUAL DINNER.

The London School of Tropical Medicine and the
London School of Clinical Medicine held their annual
dinner at the Hotel Cecil on October 8th, 1906. Sir
Win. Hood Treacher, K.C.M.G., occupied the chair.

Amongst those present were :—Prof. Blanchard,
Paris; Inspector General H. M. Ellis, K.H.P.,
Medical Director General of the Navy; Surgeon
General А. М. Branfoot, С.І.Е., President of the
Medical Board of the India Office; Col. Kenneth
McLeod, I.M.S.; Sir William Bennett, K.C.V.O. ;
Sir Patrick Manson, K.C.M.G.; Sir Dyce Duckworth;
Sir John McFadyean; Sir Francis Lovell, C.M.G.,
Dean, London School of Tropical Medicine; Com-
mander G. Hodgkinson, R.N.; Fleet Surgeon P. W.
Bassett-Smith, R.N.; Percival A. Nairne, Esq., Chair-
man of the Committee of Management, S.H.S. ; Н. J.
Read, Esq., Colonial Office; J. H. Batty, Esq.; A. E.
Aspinall, Esq.; E. R. Davson, Esq.; Prof. W. J.
Simpson, Prof. R. T. Hewlett, Dr. F. H. Anderson, Dr.
Oswald Baker, Dr. Robert Boxall, Dr. H. Burrows,
Dr. C. C. Choyce, Dr. C. W. Daniels, Dr. J. Mackenzie
Davidson, Dr. Andrew Duncan, Dr. W. Fox, Dr. J.

October 15, 1906.)

Galloway, Dr. Russell Howard, Dr. P. Joly (Ministry
of Marine, Paris), Dr. A. Ernest Jones, Dr. T. D.
Lister, Dr. G. C. Low, Dr. Stephen Mayou, Dr.
Guthrie. Rankin, Dr. L. W. Sambon, Dr. G. Е,
Waugh, Dr. Russell Wells, Mr. Malcolm Morris, Mr.
James Cantlie, Mr. L. V. Cargill, Mr. К. W. Goadby,
Mr. A. Lawrence, Mr. L. H. McGavin, Mr. P. Michelli
(Secretary).

The following telegram was read from the Duke
of Marlborough, who was to have taken the chair:
“ Much regret unable to preside at this evening's
dinner. Trust that both branches of school may re-
ceive that public support and recognition which their
untiring efforts and skill so richly deserve." .

The toast of “Тһе King " having been honoured,

The Chairman proposed the toast of ** The London
Schools of Tropical and Clinical Medicine." Не said
that during his service in the Eastern Tropies, ex-
tending over some thirty-three years, he had come
across a number of doctors who had had the advan-
tage of passing through the school, and he had always
found them to be keen officials, devoted to their im-
portant work, kindly, hospitable and charitable. For
a considerable time he had taken a keen interest in
the London School, which owed its origin, in the year
1899, to that great Colonial Minister and Imperial
statesman, Joseph Chamberlain, whose restoration to
health and return to active political life men of all
parties anxiously desired. He had done his best to
support and encourage in every way the foundation of
an institute for medical research in the Malay States,
the idea of which emanated from the fertile brain of
that distinguished Colonial administrator, Sir F.
Swettenham. The London Tropical School had now
a hospital with 50 beds, and there was accommodation
in the laboratory for 40 students. Nearly all of these
places were occupied, and it was evident that further
accommodation would be necessary in the future.
Altogether 617 students had passed through the
school. The Tropical School, although its financial
position was sound, he would remind them that it was
essential that a capital sum should be obtained to
form an endowment by which the teachers in the
school be adequately paid and full facilities afforded
for research.

The London School of Clinical Medicine, which was
а new organisation, had been established for the pur-
pose of supplying the increasing demand fòr post-
graduate teaching in London. It was the aim of the
Clinical School, with the aid of the Committee of the
Seamen’s Hospital Society, to provide in London
such teaching as might compare with that of any
other centre of education.

Sir Patrick Manson, in replying to the toast, said
that not many years ago some wise men shook their

: heads over the London School of Tropical Medicine,
and a great many unwise men spoke with contempt of
it. The result, however, had certainly not justified
the prognostication. At present the school was
recognised by the University of London and by the
Colleges of Physicians and of Surgeons as a bond fide
and valuable teaching institution. Through their
school important contributions had been’ made to the
advance of medical science, all having more or less a
bearing on human pathology and human disease. ‘

Drs. Castellani, Leiper and Wenyon, had each con-

THE JOURNAL OF TROPICAL MEDICINE.

393

tributed during the past year important original obser-
vations, and many other old students of the school had
added to our knowledge of tropical disease. Lack of
funds prevented the school undertaking all that was
desired and desirable in the elaboration of dis-
coveries and observations; laboratories, and specially
qualified men to work in them were imperative; aud
the equipment could not be considered complete until
ап entomologist was added to its strength.

Sir Dyce Duckworth responded to the toast of the
London School of Clinical Medicine. He stated that
this important post-graduate school was founded by
the energy and enterprise of the Committee of the
Seamen’s Hospital, who had already laid the country
under a deep debt of gratitude for the School of
Tropical Medicine. It is to be hoped that the
London School of Clinical Medicine will have a great
future, and that everything the medical staff and
teachers could do to develop the School would be
carried out in a whole-hearted manner.

Professor W. J. Simpson proposed the toast of the
orator of the day, “Colonel Kenneth Macleod.” He
stated that neither in India nor at Netley would
Colonel Macleod's work be forgotten. He had retired
after an honourable and distinguished career, and
amongst the great men who had illuminated the
Indian Medical Service, or who had filled the chair
of Military Medicine at Netley, Colonel Macleod's
name would occupy a foremost place:

Colonel Kenneth Macleod, in reply, said that the
London School of Tropical Medicine was a great
school, one that the country might be proud of, and
the people throughout the Empire ought to be thankful
for the beneficent work it had done and is doing.

Sir William Bennett proposed the toast of the
“ Visitors," and accorded a special welcome to Pro-
fessor Blanchard, who at all times had shown so
kindly a disposition towards the Tropical School.

Professor Blanchard (Paris), in reply, stated that the
London School of Tropical Medicine had stimulated
the teaching and investigation of tropical diseases
in the British Empire, and set an example which
was being followed by all civilised countries. In a
brilliant speech Professor Blanchard congratulated the
British Schools of Tropical Medicine upon their work.

Inspector-General Ellis, Director-General of the
Medical Department of the Royal Navy, said that they
were well aware of the enormous benefits they had
received from the teaching of the Schools of Tropical
Medicine in London and Liverpool.

Surgeon-General Branfoot, C.I.E., on behalf of the
Indian Medical Service, said he was glad to see
that officers of the Indian Service availed themselves
whenever possible of the teaching of these great
schools.

Mr. P. A. Nairne, Chairman of the Seamen’s Hos-
pital Society, proposed the toast of ** The Chairman.”
Sir Wm. Treacher Hood was one of many English-
men who had guided the destinies of the British
Colonies to success, and amongst the great governors
of our colonies the Chairman took a high place.

The Chairman, in acknowledging the toast, paid a
well-deserved tribute to Mr. P. Michelli, the Secretary
of the Seamen’s Hospital.

List of Students at London School of Tropical
Medicine, October 8th, 1906 :—

324

THE JOURNAL OF TROPICAL MEDICINE.

{October 15, 1906.

Indian Medical Service.—Major К. Н. Castor,
M.R.C.S., L.R.C.P.; Major S. A. Harriss, M.B., С.М.
(Edin.), M.R.C.S., L.R.C.P., D.P.H.(Camb.); Major
J. B. Smith, M.B., B.A., M.Ch.(R.U.I.)

Colonial Service.——1. W. Graham, M.B., C.M.
(Glasgow); Н. W. Gush, M.B., Ch.B.(Edin.) ; F. I.
M. Jupe, L.5.A.; H. McG. Newport, L.R.C.P. & S.;
W. B. Orme, М.К.С.5., L.R.C.P.; Р. Н. Pereira,
M.B.(Madras), 1905, M.R.C.S., L.R.C.P.; A. В. S.
Powell, L.R.C.P. & S.(Edin.); C. C. Robinson, M.B.
(Lond.), M.R.C.S., L.R.C.P.; R. Е. Williams, М.В.
(Camb.); W. J. Von Winckler, M.R.C.P., L.R.C.P.,
L.S.A. (Member Inner Temple, London).

United States Army.—Capt. J. M. Phalen, U.S.
Army, M.D.(Univ. of Illinois).

Missionaries. — W. Cammack, M.D.(N.W.Univ.,
Chicago), and Mrs. W. Cammack, M.A., M.D.(State
Univ., Iowa), American Board of Missions; C. F.
Fothergill, M.R.C.S., L.R.C.P., M.B., B.C.(Camb.),
B.A.(Camb.), Church Missionary Society; Hannes
Heikinheimo, L.M., Helsingfors, Finland, Missionary ;
В. Howard, M.B., B.Ch.(Oxon), M.A., University
Mission ; G. Е. Stooke, L.R.C.P. & S.(Edin.), L.F.P.S.
(Glasgow), Church of Scotland Mission.

Private.—Otto Bluhme, M.D. (Havana); E. P.
Caropoulos, M.D. (Athens); Miss B. Cunningham,
M.B., Ch.B.(Edin.), L.M.(Dublin) ; A. MacDonald
Dick, M.B., Ch.B.(Edin.) ; P. R. Egan, M.D. (Colum-
bia, New York); - T. Giordani, M.D. (Rome); J. G. F.
Hosken, M.R.C.S., L.R.C.P.; Miss Mary Kidd, М.В.
(Lond.); J. А. Knebel, M.D. (Utrecht and Amster-
dam); E. J. Maxwell B.A.(Camb), М.В. B.C.
(Camb., М.К.С.5., L.R.C.P.; Miguel Paz, M.D.
(Guatemala) ; Н.В. С. Newham, M.R.C.S., L.R.C.P.,
D.P.H.(Camb.); А. Н. Reid, M.B., C.M.(Edin); Р.
M. Rennie, M.B., Ch.B.(Edin.); F. O. Stoehr, М.В.
(Oxon); F. M. Suckling, M.B., Ch.M.(Sydney); K.
Raman Tampi, B.A. (Madras), M.B., Ch.B.(Edin.);
W. A. Trumper, M.R.C.S., L.R.C.P.; J. C. Venniker,
M.D.(Durham) F.R.C.S.E, M.B., B.S., D.P.H.
(Durham), M.R.C.S., L.R.C.P.; W. W. Woolliscroft,
M.R.C.S., L.R.C.P.

Indian Medical Service 3, Colonial Service 10, United
States Army 1, Missionaries 6, Private Students 90;
Total 40.

--------;--

@bituarp.
COLONEL ALEXANDER CROMBIE, M.D., С.В.

Іт is with the deepest sorrow and regret we
announce the death of Colonel Crombie, C.B., late
of the Indian Medical Service, and a member of the
Advisory Committee of the JOURNAL or TROPICAL
MEnicINE. Although the obscure illness from which
he suffered, and which confined him to bed for nearly
two years, prepared his many friends for the end, yet
his death came suddenly and unespectedly, at à time
when he was being taken abroad for the winter. Не
died at an hotel in Dover, on his way to the Continent.
By Colonel Alexander Crombie's death, the profession
loses one of its brightest ornaments. А clinician of
the first order, he brought to bear on his work not
only & keen intellect, ripened by & vast experienco,
but also an attractive personality, full of sympathy,
generosity and kindness, which inspired confidence
iu those who consulted him, and endeared him to all

his friends. Born in Fife some sixty-one years ago, of
& good family, his childhood was spent in the country,
where the fields and hills and heather implanted a
passion for’ poetry aud flowers, which continued
throughout his life, and made him а charming com-
panion to his most intimate friends. After a distin-
guished career at Edinburgh University, he graduated
with honours in 1867, and settled in practice near
Berwick-on-Tweed. Later, however, he gave up
practice and entered the Indian Medical Service, in
which he soon distinguished himself, and was
rewarded by being appointed successively to some
of its more important civil-surgeoncies, such as those
of Rangoon апа Басса. Оп his transference to
Calcutta he became Surgeon-Superintendent of the
European General Hospital, a position which not
only placed him at the head of the moat important
hospital in Calcutta, but also brought with it a large
consulting practice. Не retained this position until
he retired іп 1898, and was appointed а member of
the Medical Board at the India Office. It was in his
capacity as a member of this Board that he was
deputed to the Army Board to medically examine
officers starting for and returning from the South
African War, and it was for this service, which
entailed an enormous amount of work, together with
the good service he had done in India, that he was
decorated with the Order of the Companion of the
Bath. Gradually he was acquiring a large consulting
practice in London in tropical diseases, and there is
no doubt that if he had not been attacked by this
untimely illness, the pain and suffering of which he
endured with so much patience and fortitude, his
special knowledge of tropical diseases would have
given him one of the largest consulting practices in
London. Colonel Crombie was lecturer on tropical
diseases in the Middlesex Hospital, and also at the
London School of Tropical Medicine. He was an
excellent lecturer, and the loss which these schools
have sustained is very great. His contributions to
medical literature are particularly valuable, coming
as they do from a keen and experienced observer.
Among these may be mentioned his observations on
the normal temperature of Europeans and natives
in India, in which he showed that natives of India
had a higher temperature than Europeans, and
Europeans in India a higher temperature than Euro-
peans ih temperate climates. His paper on the
unclassitied fevers of the Tropics is also а memorable
one, in that it foreshadowed much that has been
since verified by microscopical research and discovery.
Colonel Crombie leaves а widow, a son and two
daughters to mourn his loss. Our deepest sympathy
is with them in their sad bereavement.

floticts to Correspondents,

1,—Manuscripts sent іп cannot be returned.

9.— As our contributors are for ihe most part resident abroad,
proofs will not be submitted to those dwelling outside the United
Kingdom, unless specially desired and arranged for.

3.—To ensure accuracy in printing it is specially requested
that all communications should be written clearly.

4.—Authors desiring reprints of their communications to the
JouRNAL OF TROPICAL MEbICINE should communicate with the
Publishers.

5. — Correspondents should look for replies under the heading
“ Answers to Correspondents.”

November 1, 1906.)

Original Communications.

NOTE ON A LEUCOCYTOZOON FOUND IN
MUS RATTUS IN THE PUNJAUB.

By Colonel J. R. Apis, І.М.8.
Ferozepore, India.

Note.—By Major Ross, C.B., F.R.S., Professor of
Tropical Medicine, University of Liverpool.

This report was handed to me by Colonel Adie,
I.M.S., last July, for publication in the forthcoming
number of the Thompson Yates and Johnston Labora-
tories’ Reports. Owing, however, to the delay іп this
publication, I have not been able to give effect to
Colonel Adie’s wishes. I have now requested the
Editor of the JournaL оғ TropicaL МЕрІСІМЕ to
publish the paper in view of the interesting article by
Dr. Cleland in that journal for October Ist.

THE JOURNAL OF TROPICAL MEDICINE.

325

stained red dots, six to twelve in number, are seen in
the neighbourhood of the nucleus, and, occasionally
also at one end of the oval. In one specimen the
entire protoplasm showed faint stippling.

The nucleus is peculiar. The shape is most often
quadrilateral, with rounded angles. It occupies the
whole, or nearly the whole, width of the cell, is
situated rather nearer one end, and what is very
striking, generally shows ‘transverse striation. These
strie are not always parallel, but may appear as
curious patterns. The above seems to be the appear-
ance as seen on the flat. At other times, the nucleus
is oval, or crescent-shaped, or obliquely pear-shaped ;
and this seems to be the side view.

The outline of the organism can be clearly made
out, even when the nucleus of the leucocyte is quadri-
lateral, or annular, or approaching the polynuclear
shape.

The length of this leucocytozoon is from 9:8 to 13
microns, and breadth from 5:2 to 6:5. The average

1, 2,3, 4, show the parasite in the leucocyte.

Last January, while engaged in examining the
peripheral blood of a series of ordinary house rats
(Mus rattus) in Ferozepore (Punjaub), I came upon а
film which showed something unusual—a parasite in
2 leucocyte.

I have not yet had an opportunity of studying this
parasite in the fresh state, and the description which
follows is derived from specimens met with in many
films from more than one rat, the films being stained
by the long Romanowsky method.

The appearance of an affected leucocyte is striking,
and an observer cannot fail to have his attention
drawn to it, even with a % obj. and No. 4 E.P. In
fact, by this combination, one can most easily recog-
nise & specimen in the film.

The parasite is not, so far, found in all varieties of |

leucocytes, but only in those which might be classified,
according to definition of terms, as transitionals and
mononuclears.

Its shape is uniformly oval, and the nucleus well-
defined. It appears to have a well-marked and well-
Stained cell wall. The protoplasm is either uncoloured,
or sometimes shows a faint pink staining, especially

5, 6, 7, 8, represent parasites with well-stained nuclei,
showing the peculiar arrangement of the chromatin.

towards the periphery. Not infrequently, faintly
dimensions are 11:7 by 5:6 microns. The nucleus,
when quadrilateral, is about 5 or 6 microns square.

No pigment has been seen either in the parasite, or
in the affected leucocyte. Only one free specimen has
been met with.

In a series of thirty-nine rats examined, the leuco-
cytozoon was met with in eight, or 20 per cent.;
&nd in the same series, trypanosomes were found in
sixteen, or 41 per cent. Тһе leucocytozoon was found
only in eases where trypanosomes were also found.
In other words, half the rats harbouring trypano-j,
somes were found to be harbouring the lencocytoroon]
Roughly speaking, the numbers of the two parasite
corresponded, that is, when trypanosomes were
numerous, leucocytozoa were numerous ; but in three
cases, trypanosomes were very numerous and no
leucocytozoa were found.

Through the kindness of Captain Liston, I.M.S , of
Bombay, I have seen some of his preparations of
spleen smears of rats, taken in the Punjaub when he
was investigating plague. He also noticed this leu-
cocytozoon. In his stained smears the parasites look

oval, and the nucleus oval too. But I could not
make out any particular nuclear structure. Nor is
one able to say if the leucocytozoon has any relation
to trypanosomes, as the latter are not common in rat
spleen smears. The different appearance of the
nucleus in Captain Liston's and my specimens may
be accounted for by the manner of spreading; his
being a spleen smear, and mine a blood film.

It has been noted that the parasite inhabits a par-
ticular kind of leucocyte—a large cell, whose nucleus
is never seen round, and never multiple, with con-
necting strands. It is an oval, or an indented oval,
or & ring, or it has an irregular shape. Тһе proto-
plasm is hyaline. It is not easy to make a count of
these films, as the greatly.varying shapes of nuclei
make it difficuit to classify the cells as polynuclear,
or transitional, or mononuclear. There is also the
difficulty of intermediate forms. It seems the rat,
normally, has a greater number of transitionals and
mononuclears, proportionally, than man; so that it
becomes necessary to separate the transitionals in
making counts.

The following table shows counts in rats’ blood (a)
without any parasites, (0) with many trypanosomes,
and (c) with many trypanosomes and many leu-
cocytozoa.

ea h с
‘Trypanosones Trypanosomes

| No parasites only and Leucocyte za
Polvuuclears | 2933 25:6 25:

* Transitionals | 17: 176 157
Mononuclears | 14:5 21:6 TT
Lymphocytes 2220444 32:6 ! 5l
Eosinophiles 16 i 23 : “6

D | 3 Н 0
1

Basophiles Зу |

Bentley and James `1, have found a leucocytozoon
in the dog in India. James states that it almost
invariably invades the polynuclears. Some of his
figures are of leucocytes, whose nuclei seem to point
to the transitional type, but the protoplasm is depicted
as granular. James's Leucocytozoon bentleyi is 10%
by 5} microns. Its shape is not quite the same as this
rat's parasite; it may be associated with filaria and
piroplasma.

Christophers [2] describes a somewhat similar
parasite, Hemoyregarina gerbilli, in the Indian field
rat. It is partly curved on itself, and enlarges the
red blood corpuscle from õ to 6} microns to 10 by 7
microns.

Balfour [3] describes а Lsmogregarine in the
desert rat, Jerboa. It may be free, or in the remains
of a red cell— size 5:6 to 7 by 1:4 to 2:8 microns. The
free form is 3 red-cell-diameters long, and 2:8 microns
wide. Не states incidentally, “ I have recently dis-
covered what seems to be the same parasite in the
mononuclears of the Norway rat (Mus decumanus) in
Khartoum. It is probable it exists asa leucocytozoon
in the rodents.” From the figure of this latter, the
parasite is seen to have a close resemblance to the
Punjaub specimen, and to inhabit a leucocyte which
inay be counted transitional or mononuclear.

THE JOURNAL OF TROPICAL MEDICINE.

{November 1, 1906.

Patton 4) has recently described a leucocytozoon in
the mononuclears of the palm squirrel, both in the
cells and free. He notes the large number of mono-
nuclears in a film, but does not speak of transitionals.
His leucocytozoon also shows a curled tail. Free
forms are common, 13 to 14 microns by 3 to 4 microns.
Intracellular forms measure 10 by 5 microns. Many
leucocytes have two parasites. It would appear that
trypanosomes are common in this specimen of squirrel,
but no particular mention is made of any relationship.

If this parasite has been hitherto undescribed, I
propose the name, Leucocytozoon ratti.

REFERENCES.
21, James. Scientific Memoirs, Government of India,
No. 14.
79) CHRISTOPHERS. Scientific Memoirs, Government of India,
No. 18.

ІЗ! BaLroumR. “ Hemogregarine іп Desert Rat,’ JOURNAL
ок TRopicaL MEDICINE. August 15th, 1905.

[4| Parrox. Scientific Memoirs, Government of India,
No. 24. À

OCCURRENCE AND HABITS OF SOME
SPECIES OF HUMAN BITING FLIES BE-
LONGING TO THE FAMILIES TABANIDÆ
AND MUSCID.E (GLOSSINA) FROM THE
WEST COAST OF AFRICA.

By С. С. Dungeon, F.E.S.

(Superintendent of Agriculture for British West African
Colonies and Protectorates.)

Havine had the exceptional opportunity of visiting
all the British West African Colonies and Protec-
torates during the present year, I think it probable
that a few notes I made in connection with the habits
of some of the biting flies found there, which attack
human beings, may be of interest.

I shall make no reference to the Culicide (Mos-
quitos) or Simulide, but confine my remarks to the
Tabanide (Horse flies) of the genera Tabanus, Chry-
sops and Hematopota, and to Glossina of the family
Muscide.

The effects of the bites of these flies upon human
beings are very different in severity, which point, I
think calls for further investigation. It is recognised
that among the Glossina the species palpalis conveys
the Trypanosoma causing sleeping sickness, and that
various other Glossina species in a like manner carry
the parasite of the “fly disease’’ among cattle. In
addition to this Mr. Austen now admits that there is
evidence of species of Tabanus transmitting a disease
among dromedaries in Algeria, which is also caused by
а Trypanosoma.

Idid not find that the natives in any part paid
particular attention to the attacks of '*tsetse" fly
(Glossina), but in places & species of Chrysops was not
so lightly regarded. Of this genus the one which is
held in the greatest dread is а bright reddish coloured
species, which had been placed, until the present,
under the name of C. dimidiatus in the British
Museum, but as my specimens included the true C.
dimidiatus (v. d. Wulp), this red one has now to be
called by a new name. Аз far as I was able to make

November 1, 1906.)

out this Chrysops n. sp. is known to the natives of the
Calabar district under the name оѓ“ O-owe," but I did
not ascertain the native name in the Warri province.
Both C. dimidiatus and this new species were found
commonly at Ologbo near Benin City. The latter
‘species was first brought to my notice by Mr. Munro,
Ex.-Engineer to S. Nigeria, when we were encamped
at the last-mentioned place. Тһе effects from а bite
of C. dimidiatus were similar to а honey-bee's sting,
eausing & good deal of pain and inflammation, but
from tbat of the red Chrysops even more severe with
dropsical-like swelling of the limb and high tempera-
ture. My carriers appeared very much afraid of this
insect and hastily dropped their loads when one came
near in order to arm.themselves with branches to
ward off its attack ; this they never troubled to do for
other biting flies. Both species mentioned are some-
what similar to Syrphide (Hover flies) in appearance
aud, as they also hover round the person they intend
to attack, their flight is not unlike that of these flies.
The following are the localities where I met with
them. - i

Chrysops dimidiatus (v. d. Wulp) Ologbo, Benin
City (S. Nigeria).

Chrysops n. sp. Ologbo, Benin City, Sapele (Warri
province); Odut, Uwet (Old Calabar province).

Hematopotas of two or three species occur com-
monly in the shaded paths throughout the West
African Colonies, the most frequently met with being
a dull black insect with mottled wings (my specimens
of this have apparently become destroyed in transit).
When travelling in a hammock this insect is often
seen crawling slowly about the undersurface of the
sun-protecting roof. The only example of the genus
which I have preserved is one which was caught after
having bitten a passenger upon a lower Niger steamer.
Miss Ricardo Һав marked this “n. sp. near Hema-
topota strigipennis, Karsch.” The bite does not appear
to be serious in consequences.

Tabanus is a genus which is represented by a large
number of well-marked species on the river Niger
and tributaries as well as the other rivers along the
coast. The approach of a Tabanus is made known by
its loud buzzing, but the attack is not usually made
by the insect at the point upon which it at first
settles. Іп one case I witnessed Tabanus testa-
ceiventris Macq. alight upon the back of a native at
the wheel of a steam launch in which I was travelling,
and, although it erawled over the man’s bare flesh
for some time, it did not attempt to bite until it bad
reached the outside of a vest which he wore, when it
tried to drive its proboscis through the material in
order todo so. The bites of all the species I met with,
and which I had personal experience of, resulted in
a painful swelling, which generally subsided in a few
hours. The species which gave most trouble upon
the creeks of S. Nigeria were Т. gabonensis, T.
thoracinus and T. nigrohirtus, while іп N. Nigeria Т.
teniola, T. fasciatus and T. testaceiventris were most
conspicuous. Т. biguttatus, of which the male is
differently marked to the female, I found upon three
or four occasions in а verandah in Lokoja, but it
never seemed inclined to bite, only crawling slowly
about flowers or verandah posts. On two occasions I
took specimens of T. obscurissimus, upon the ground,

THE JOURNAL OF TROPICAL MEDICINE. 327

having lost both wings. І can offer noexplanation for
this, although the coincidence seems rather remark-
able. Some of the species of the genus are brightly
coloured and the eyes of many in life are brilliant
coppery green or blue. Below I give a list of the
species obtained with notes concerning the colours of
the eyes of some. Iam much indebted to Mr. Austen,
of the British Museum, and to Miss Ricardo, who is
working at Zabanide, for the identifications of the
specimens I collected, which will be placed’ in the
National collection.

T. gabonensis Macq., Sapele, Odut, Ologbo (S.
Nigeria).

Т. testaceiventris, Маса., Ologbo (S. Nigeria): Niger
River to Muraji (N. Nigeria).

T. nigrohirtus, Ricardo, Warri (S. Nigeria).

T. teniola, Macq., Egga, Lokoja (N. Nigeria).
dull green.

T. subangustus n. sp. Ricardo, Odut (S. Nigeria).

T. n. sp. wear nigrohirtus, Ricardo, Lower Niger
(S. Nigeria).

Т. obscurissimus, n. sp. Ricardo, Uwet (S. Nigeria).

T. thoracinus, Pal. Beauv., Ologbo, Lower Niger

Eyes

(8. Nigeria). Eyes emerald green.

T. fasciatus, Fabr., Baro (N. Nigeria). Eyes cop-
pery green.
. T. latipes, Macq., Niger and Kaduna Rivers (N.
Nigeria). Eyes deep blue.

T. biguttatus, Wint., Lokoja (N. Nigeria).
dark brown.

T. splendidissimus, Ricardo, Ologbo (S. Nigeria).

T.n.sp. Odut (S. Nigeria).

I first met with Glossina palpalis in the Gambia,
upon the creeks in the Kommbo province. No flies
were seen until we were actually in the mangrove
belt and at the water side, when numbers appeared
and settled upon our clothes and upon the sides of
the canoe in which we travelled. The only animals
seen near here were the pack donkeys used for con-
veying the ground nuts to the creeks for water trans-
port. Although the place where G. palpalis was in
numbers was not fifty yards from where the donkeys
were unloaded, no tsetse flies were attracted to them.
After taking off their heavy loads the drivers hammered
the muscles of the legs of every animal and pulled the
joints, whereupon the donkeys rolled on the grass for
a short time and appeared much refreshed. A horse
suffering from the fly disease and showing all the
usual symptoms was seen at Bakau, where, while
examining а swamp, a tsetse fly settled upon me.
Unfortunately I did not manage to capture it. In
the direction of Brufut large herds of cattle were seen,
and, although there were swarms of flies about them,
no tsetse were seen. АП the cattle were in а healthy
State, but were never permitted to go in the direction
of the creeks, not very far distant. At York, S.
Leone, while waiting for a canoe to cross a tidal
ereek, Mr. Smythe, Curator of the Botanic Gardens,
who was with me, was bitten by G. palpalis and his
hand swelled to a considerable size. Although I was
subsequently bitten on several occasions by С. palpalis
and G. tachinoides in N. Nigeria, no such symptoms
appeared in my case. Тһе flight of the unfed insect
seems to be generally short and іп the form of an
upward curve, dropping suddenly near the settling

Eyes

398

THE JOURNAL OF TROPICAL MEDICINE.

(November 1, 1906.

point; this gives it the appearance of striking the
object heavily. I have only met with the two above-
mentioned species on, or upon the immediate banks
of, rivers and have never seen either feed, unless in
shade. Instances of places where one is likely to be
bitten by tsetse flies are: inside the trouser leg below
the knee, where the fly will creep up to from the
boot; inside the half closed hand, upon the palm;
close to the hat brim on the forehead or behind the
ear. I did not notice that Glossina were noisy, nor
could I observe any motion of wings while feeding.
The occurrence of G. palpalis was curiously alternated
with that of G. tachinoides on some parts of the Niger.
In the lower Niger, as far up as Iddah, an almost
black form of G. palpalis is found, from Lokoja to
Baro С. tachinoides occurs commonly, from Egga (a
few miles beyond Baro) to Muraji (junction of Kaduna
river) typical С. palpalis, and from Muraji up the
Kaduna to Dakoma G. tachinoides again was the only
species seen. Horses are the usual method of con-
veyance in N. Nigeria and so long as they are kept
away from the rivers do not run the risk of the fly
disease. G. morsitans was not seen by me іп М.
Nigeria, but I took it upon the Volta river аб about
half a mile distant from the water, as well as at a
place six miles north of Kumassi towards Aguna,
where there was no extent of water. I think that
G. morsitans has different habits to those of G. pal-
рай» and С. tachinoides, and may be found at some
distance from large expanses of water. Cattle are
not kept upon the Volta river, and although I met
with some near the place where G. morsitans was
taken north of Kumassi, I understand that these were
being brought into that town for killing, from outside
the forest belt in the north. Тһе species taken with
their localities are as under :—

G. palpalis, Rob. Desv., Gambia River, York (S.
Leone), Kent (S. Leone), Warri, Old Calabar, Lower
Niger as far as Iddah (S. Nigeria), Upper Niger, Egga
to Muraji (N. Nigeria).

G. tachinoides, Westw., Upper Niger, Baro-Lokoja,
Kaduna river, Muraji-Dakomba (N. Nigeria).

А. morsitans, Westw., Pesse, Volta River (Gold Coast) ;
between Kumassi and Ekona (Ashanti) ; probably also
Bakau (Gambia).

NOTES ON SOME OF THE MORE OBVIOUS
DISEASE CONDITIONS SEEN ON THE
LINE OF THE PROJECTED LOBITO-
KATANGA RAILWAY.

By Е. CnEIGHTON WkLLMaN, M.D.
Benguella, W. Africa.

Taer writer has from time to time published in these
columns notes and papers on the diseases found in
this colony, chiefly in the districts of Bihé and
Bailundo. The region referred to in the following
remarks, however, has not been inspected before, and
indeed, so far as I can learn, has never been up to
this time visited by a medical man. The most of the
observations here recorded were made among the
Chiyaka tribe, about 150 miles east of Lobito Bay;

and are of necessity concerned mainly with those
features which would strike the eye during a hasty
survey of the country. It may be possible on some
future occasion to present a more detailed study of
the region, including results of microscopical exami-
nations of the blood and excreta of series of the
natives. The diseases mentioned are placed іп
alphabetical order.

Abscess of Syleen.—One case seen in which I
opened and drained the abscess, the patient recover-
ing very rapidly.

Albinism.—Two cases of complete albinism were
noted.

Ainhum (see plate, fig. 9).—Two cases, neither of
which showed any symptoms of leprosy.

Deformities.—Supernumerary fingers and toes were
twice seen. Probably a better acquaintance with the
region would reveal more, as I have seen many such
cases in Africa. А case of “Siamese Twins" was
reported to me, but I did not see the children
personally.

Elephantiasis.—Pretty common among the blacks
in the district. However, іп my not large series of
blood examinations I did not see embryos of Filarta
bancrofti, although perstans was met several times,
the man whose leg is shown in the fig. 10 (see plate)
being a victim of the infection.

Epilepsy. — Very common. Many cases being
brought to me for treatment, some of which showed
scars from having fallen into the fire during fits.

Goitre.—Rare. Only one case seen. This region
furnishes a marked contrast to the goitre-stricken
areas in Bihé district.

Hernia.—U mbilical heroia is as amazingly common
as in other parts of the colony. Inguinal hernia not
rare. Half & dozen cases came asking for treatment.

Hypertrophy of the Breast in the Male.—A couple
of cases seen. The natives are very anxious to have
the growths removed, as these subject their possessors
to much chaff and ridicule from their companions.

Jiggers.—S. penetrans as common as in other parts
of the colony.

Keloids.—Common, as among all African blacks.

Leprosy (see plate, figs. 6, 7 and 8).— This disease
is much commoner in the region visited than in Bihé
and Bailundo districts, and severe cases of long stand-
ing were seen ; leprosy is as yet comparatively rare in
the districts just named.

Malaria and Blackwater Fever.— While I was not
able to make in this region many blood examinations,
yet both the sub-tertian and quartan parasites were
seen. In looking over natives one gets the impression
that the amount of malarial fever is about that seen
in similar altitudes to the north. Cachexia from this
cause (see plate, fig. 12) is about as common as in
Bihé and Bailundo. It is interesting to note here
that some thirty Boers died of blackwater fever last
season аб Capalla, а place formerly, I believe, con-
sidered to be quite healthy.

Myasis.— While I saw no cases of this condition
yet I took many specimens of Sarcophaga africa, S.
albofasciata and Anthomyia desjardensit, all of which
I have convicted of causing myasis in this colony ;
besides many specimens of Auchmeromyia luteola, the
habits of which are now so well known.

JOURNAL ОҒ TROPICAL MEDICINE, NOVEMBER 1, 1906.

Fig. 4. Fig. 9 Fig. 5.

To illustrate paper by F. Скктонтох WELLMAN, M.D., “ Notes on Some of the More Obvious Disease Conditions seen on the line
of the projected Lobitokatanga Railway.”

November 1, 1906.)

“ Ochimumusu.”—This is a marginal ulceration of
the gums common in this colony and in other parts of
Tropical Africa, I made the interesting discovery of
spirochetes in great numbers in the mouths of each
of the several cases seen with the disease in the
district under discussion. I failed to find the organism
in control cases. I shall deal at length with these
observations in a subsequent communication.

Sleeping Sickness and Tsetse Flies.—I am credibly
informed that “fly” exists on the Kambanga, Sapa,
and Solo rivers, east of Benguella along the proposed
line of the railway, also on the Kuvale river and yet
farther inland on the lower Cunene. The Boers state
that the flies are worst about the middle of the rains
(January to March), when buffalo are in the district.
Although I have not yet had the opportunity of
examining specimens, the fly is in all probability
Glossina palpalis wellmani Austen, as this is the only
tsetse yet found on the west coast south of the
Coanza river. At Bimbash, a few hours east of Ben-
guella, a gentleman connected with the railway
informs me that nearly all the natives have died of
sleeping sickness. I have elsewhere (Journal of
Hygiene, July, 1906) discussed the probable fact that
trypanosomiasis is rapidly spreading in the colony.

Tick Fever.— The “ Осһіһоріо " (Ornithodoros
moubata) abounds, as elsewhere, in Angola. Reports
of natives and colonists bere confirm my opinion else-
where published that tick fever is commoner in the
colony than it was a few years ago.

Tumours.— New growths of all varieties seem to be
in the district, as elsewhere in this part of the world,
fortunately rare. One striking case of tumour of the
lower jaw was seen (see plate, figs. 1 and 2).

Ulcers.—These are commoner in the district than
in any other region in West Africa known to me.
Many of the cases of what the writer has called ‘‘ sub-
acute tropical phagedena” go on until the underlying
bones are attacked and disorganised (see plate, figs. 3,
4 and 5). In localities where such mild cases of
elephantiasis as are shown in figs. 10 and 11 (see
plate) are common, there were noticed large numbers
of these subacute, deep-eating ulcers. Taken to-
gether with the apparent absence of F. bancrofti from
the district, this fact suggests that the same bacterial
infection may be responsible for both conditions.

Yaws.— Commoner than in Bibé and Bailundo.
Spirochætæ were found in two cases; but, as the
writer's investigations on this disease as it occurs in
the colony are soon to be published in an official
report, details need not be entered into at this time.

EXPLANATION OF PLATE.

Fias. 1 and 2.—Tumour of the lower jaw.

Fias. 3, 4, and 5.—Subacute Tropical Phagedena. (Fig. 3,
а case of long standing, resulting in necrosis and fracture of the
tibia. The end of the bone may be seen in the lower part of the
ulcer. Fig. 4, а typical sore on the shin, also with extensive
bone necrosis. Fig. 5, a piece of bone removed from the latter).

FiGs. 6, 7, and 8.—Leprosy. (Fig. 6, a typical case with
classical symptoms, main-en-griffe well shown in hands ; charac-
teristic lesions of feet, &c. Fig. 7, case with characteristic spots
and patches on legs aud abdomen; but these do not show well
in the photograph. Fig. 8, feet of latter).

Ето. 9.—Ainhum,

Fias. 10 and 11.—Elephantiasis of the legs; early stage.

Ето. 12. —Malaria Cachexia,

THE JOURNAL OF TROPICAL MEDICINE.

TWO CASES OF FRONTO-NASAL
CEPHALOCELE.

By Avexanper Ropertson, M.B., C.M.
Gilbert Islands Protectorate.

Тен TEkOoNAPA, male, aged 2, admitted to Tarawa
Hospital on account of tumour of the head.

Present State.—The patient is a hydrocephalic child,
and does not exhibit any signs of intelligence. In
the fronto-nasal region is a tumour about the size of
a small rock melon, containing fluid. The weight of
the tumour interferes greatly with the movements of
the head, the child requiring to support the tumour in
his hands. Lateral nystagmus is present in both
eyes. Above the right ear, in the line of the fronto-
parietal suture, is an irregular scar, an inch in length.

History.—The mother states that at birth there
were two swellings, about the size of a hen's egg, on
the child’s head: one above the right ear, where the
scar now is; the other at the root of the nose. The
former burst a few months after birth; the latter
gradually increased in size until it attained its present
dimensions.

Operation.—Under chloroform, the skin was dis-
sected from the tumour by means of an inverted
T-shaped incision. A small aspirating needle was
then introduced, and twelve ounces of clear cerebro-
spinal fluid slowly drawn off. During the escape of
the fluid there was no tendency to syncope, nor any
appearance of blood in the exudate. Digital examina-
tion showed the absence of the glabella and the
horizontal plate of the ethmoid, and marked separa-
tion of the nasal bones. The sac was then transfixed
and ligatured close to the skull, and the distal portion
removed. The skin incision was closed by interrupted
catgut sutures. The child made an excellent recovery
from the operation.

Nei Naua, female, aged 10, admitted to Tarawa
Hospital on aecount of tumour at root of nose.

Present State.—There is a cystic tumour іп the
fronto-nasal region about the size of a duck's egg. It
is covered by skin, which is adherent, and contains
some firm, elastic substance ; no cerebral pulsation is
detected in this mass.

Operation.— Under chloroform, a vertical incision
was made over the tumour and the skin reflected.
The cyst was then incised and examined. The wall
was composed of fibrous tissue 4th of an inch thick,
its inner surface being smooth and glistening. There
was no cerebro-spinal fluid present. At the bottom
of the cyst was a greyish mass, 2 ins. broad and
14 ins. thick, the outer portion firm and fibrous, the
inner soft and compressible ; deep pressure elicited a
faint pulsation. In order to reduce the deformity as
much as possible, I removed the outer portion of the
mass in successive layers till I reached a point ith
of an inch from the opening in the skull, produced by
the separation of the nasal bones and the absence of
the glabella; the horizontal plate of the ethmoid,
in this case, was also absent. The redundant sac
and skin were then ablated, and the wound closed by
catgut sutures. The wound healed by first intention,

-----<о--

THE JOURNAL OF TROPICAL MEDICINE.

[November 1, 1906.

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THE

Journal of Tropical Medicine

NOVEMBER 1, 1906.

A NEW ASPECT IN THE PATHOLOGY AND
TREATMENT OF LEPROSY.

Ковект Sincuatk Brack, M.A., M.D.Edin., D.P.H.
Aberd., Government Medical Officer, Cape Colony,
contributed a thoughtful and suggestive article on the
pathology and treatment of leprosy to the Lancet of
October 20, 1906. It is doubtful if any communica-
tion in regard to leprosy since the discovery of the
Bacillus (ерге has approached in importance the
suggestions and clinical observations advanced by
Dr. Black. Being clinical notes for the most part,
and therefore unlikely to appeal to the advanced
laboratory schools of the day, there is danger of his
observations being overlooked. Dr. Black has for
several years been attached to the Leper Asylum on
Hodden Island, Cape Colony. In 1897 Dr. Kolle, of
Berlin, commenced investigations on leprosy at
Rodden Island, and directed Dr. Black's attention to
the importauce of the nasal passages in the clinical
history and phenomena of leprosy. Working on the
lines snvegested, Dr. Black has arrived at important
conclusions, which are at once of scientific and
practical interest.

Regarding all varieties of leprosy as due to a
common canse, and belonging to a single specific
disease, Dr. Black found ditlieulty in accounting for
the pronounced difference in the course and behaviour

of the two well-marked varieties, viz., maculo-anms-
thetic and mixed or nodular leprosy. The former
seemed the more mild form of the disease, causing
less disfigurement and running a much longer course ;
the latter appears more virulent as regards disfigure-
ment, rapidity of development, and fatality.

He observed that (1) rhinitis is a prominent feature
of almost all (or probably all) cases of leprosy in the
early stages; (2) the B. lepre is met with in the
nasal secretion of lepers in almost all (or possibly all)
early cases; (3) in mixed and nodular leprosy the
nasal secretion is excessive, and the bacilli present
in numbers in the secretion; (4) in maculo-anesthetic
leprosy the nasal seeretion is slight, and the bacilli
fewer or absent; (5) in some mixed and nodular
leprotic cases, when the nose had fallen in, copious
nasal secretion lessened, and the disease became
practically of the mild form attendant upon maculo-
anesthetic leprosy. He concludes from these observa-
tions: (1) That the maculo-anesthetic is a mild form
of leprosy attended by an early manifestation of a nasal
ulcer, with some nasal secretion in which the B. lepre
is present, but from which the bacillus disappears in
time, owing to the nasal ulcer healing, and the nasal
secretion lessening or wholly drying up; (2) that
mixed or nodular leprosy is attended by extensive
ulceration, and a growth of granulation tissue in the
nasal mucous membrane extending from thence into
the naso-pharynx and to the cavities which communi-
cate with the nose, thereby leading to distortion of
the features. The nasal secretion in such cases is
copious and charged with large numbers of the B.
lepre. As regards manifestations, Dr. Black is of
opinion that mixed nodular-leprosy is simply maculo-
anzsthetic leprosy plus the infiltration and cedema of
the subcutaneous tissues in various parts of the body,
caused by the more active invasion of the B. lepra.

“Т think that there сап be hardly any doubt that
leprosy in its early stages begins as a small ulcer on
some part of the extensive nasal mucous membrane.
We know quite well from our clinical experience of
the disease that leprous ulcers in favourable circum-
stances tend to heal. There can therefore be little
doubt that a person can suffer from a leprous ulcer in
the nose that may heal and pass entirely away. This
is the explanation of the maculo-anesthetic cases.
They have had nasal ulceration which has passed away,
in some cases leaving perhaps a cicatrical shrinking of
the nasal septum, but during the time the ulcer existed
leucocytes or white connective tissue corpuscles got
detached from the ulcerating spot and along with the
bacilli which they were attempting to devour were
carried by the blood stream and lodged in various
situations in the peripheral nerves, where they got
entangled, and the bacilli then proceeded to grow,
causing pressure on the fine nerve fibrils, and conse-
quently setting up nutritive changes in the skin which
these axis-cylinders supplied, thus causing the patches
of discolouration and anesthesia.”

* In the nodular and mixed cases the progress of the
disease is quite different. Instead of the nasal ulcer
healing up it proceeds to grow apace, causing extensive
destruction of the nasal mucous membrane, causing it
to swell up and ultimately attacking the nasal bones
themselves."

November 1, 1906.1

THE JOURNAL ОҒ TROPIC

AL MEDICINE. 331

Dr. Black's l P us to understand
with something like precision the difference between
mild and severe forms of leprosy, and to draw attention

opportunity, were the bacillus found, of treating leprosy
There is no

nasal douches and by other means, so that the source

the treatment (and the phophylaxis) of leprosy on a
rational plane; he has raised it from the mere 4 treat-
ing of symptoms ав they arise,” and of empiric treat.
ment generally to a rational j i
platform ;

of other ailments arising by primary sores and other
foci of infection.

SANITARY ORGANISATION IN INDIA.

Tux Committee that met at Simla to consider the
constitution of the new service of Sanitary engineers
has completed its work, and its recommendations will
by the

parcel of the department under the direction of the
Sanitary Commissioners with the
not form a sort of imperium in imperio, responsible

———————————
or attached to the department of publie works, and
hence, though practically forming an integral part of
our sanitary administration, have been of it, but not
in it. иі

markedly from those of Europe,
the one field, however
valuable, cannot qualify а man to take up, off hand,

working along with the
medical specialists under the direction of the Sanitary

The training of a sanitary engineer,

merits of different patterns of sluice valve.

The medical sanitarian, in fact, knows best what
should be done, while his engineering colleague alone
The question of what to
do remains, however, the consideration of primary
importance, and unless this very obvious fact is kept

The relative
merits of septic tanks as compared with intermittent
erobic filtration, and their relative applicability to
local needs, are questions for the medical expert ;
their construction, when decided upon, that of the
engineer; but unless the medical element be given the
key of the position, i& may be taken as certain that

it will be Observed, in case of
а difference of opinion between the engineering and
medical elements, leaves the parties equally divided,
and hence throws the ultimate decision on the execu:

views on the proposals brought before the Committee.
A new meat market, for example, is projected for
some town, and the engineers bring before the: Com.
mittee plans, the preparation of which ‘represents

much trouble and expense, but which are obviously

ill suited to the purpose, from the public health point
of view, owing to ventilation being insufficiently pro-
vided for. The carrying out of the medical members’
modification would involve the preparation of com-

332

pletely new plans, and probably spoil the architectural
effect of the building. Assuming that the medical
members stand to their guns, an attitude which
involves much trouble and correspondence, the deci-
sion necessarily rests with the Lieutenant-Governor,
who, as likely as not, argues that a sanitary engineer
ought to know as well how to plan a meat market as
any ‘‘ doctor,” and the result is at best the concession
оға few utterly inadequate additional openings, and
a building quite unsuited for the purpose for which it
is designed, while the medical members are con-
demned as being impracticable and “ wanting in tact,”
While, therefore, welcoming the proposed accession
to the strength of our Indian sanitary forces, we trust
that Government will take care that the engineering
element shall be the helper, but not the master, of
the Medical Sanitary Authorities.

LEPROSY IN COLOMBIA.

Tue report that there were 30,000 lepers in a popu-
lation of 4,000,000 in the Republic of Colombia,
South America, is denied by the Colombian officiala.
The Consul General in London states there are but
5,000 lepers in a population of 5,000,000.

The leper settlements in Colombia are at Agua de
Dios, Cano del Loro, and Contratacion ; the last-
named is to be removed to Capitia at an early date.

The Colombian Government are taking steps to
place these three settlements in & thoroughly hygienic
state.

Miscellancons,

FIGHTING TROPICAL DISEASE.

A Намрвоме Donation TO THE LIVERPOOL SCHOOL
or TnaoPican Мерісіке From Н.М. тне Кіка
OF THE BELGIANS,

Номе Scources PREVENTABLE.

A COMPLIMENTARY luncheon to Professor Ronald
Ross, C.B., Professor R. Boyce, and Dr. J. L. Todd
(in recognition of the decoration recently conferred on
them by His Majesty the King of the Belgians for
services in research into tropical diseases at the Liver-

ool School of Tropical Medicine), was given by the
rd Mayor of Liverpool (Alderman Joseph Bail) on
October Ist, at the Town Hall, Liverpool. The follow-
ing was the list of acceptances: Lord Mountmorres,
Sir Alfred L. Jones, the Lord Provost of Edinburgh
(Sir Robert Cranston), Sir James Barr, Mr. George
Brocklehurst, Mr. W. Adamson, Alderman F. Smith,
Mr. T. F. Harrison, Professor Moore, Mr. A. R. Mar-
shall, Mr. .W. Roberts, Dr. Evans, Colonel Frank
Walker, Alderman E. Walker, Mr. Henry Jones, Dr.
Nisbet, Alderman W. Hall Jowett, Mr. W. J. Bellis
(Chairman of the Junior Reform Club), Mr. W. Muir-
head (Chairman of the Junior Conservative Club), Mr.
T. H. Barker, the Belgian Consul (Mons. E. Seve),

THE JOURNAL OF TROPICAL MEDICINE.

{November 1, 1906.

Mr. C. Livingston, Dr. Caton, Mr. F. C. Danson,
Mr. R. W. Leyland, Alderman M. Hyslop Maxwell,
Mr. A. H. Milne, Colonel Dobson, Mr. Ellis Edwards,
Alderman C. H. Giles, Mr. A. Lawrence, and Mr. J.
Gaffney. The Police Band played during the recep-
tion and repast.

After the loyal toasts had been duly honoured, the
Lord Mayor, in proposing “ Our Guests," said he had
asked these three distinguished gentlemen to accept
the hospitality of the Town Hall because he con-
sidered that honour should be paid to whom honour
was due. Under the auspices of the Liverpool School
of Tropical Medicine, Professor Ross, Professor Boyce,
and Dr. Todd had undertaken the investigation of
Sleeping sickness, towards which work the King of the
Belgians contributed a sum equal to £4,000 English.
Having been satisfied with the work which was so
effectively done and of such great value, His Majesty
conferred upon these gentlemen a decoration of a per-
sonal character. Не was sorry that Professor Boyce .
was not present. He had hoped to have attended this
complimentary luncheon, but his doctor forbade him
to travel from Harrogate. Proceeding, he remarked
that Professor Ross had just received the honorary
degree of Doctor of Law аб Aberdeen University,
while in 1902 he was awarded the Nobel prize for his
discoveries in malaria. Dr. J. L. Todd was a medical
graduate of M'Gill University, Canada. He had par-
ticipated in several very important expeditions of the
Liverpool School of Tropical Medicine, and had been
identified with the late Dr. Dutton іп carrying out the
extensive study of sleeping sickness. Professor Boyce
was the Dean of the Tropieal School, which owed ita
inception to Sir Alfred Jones' and Professor Boyce's
energy. Ав Chairman of the School of Tropical
Medicine, Sir Alfred Jones had brought to bear great
business capacity, much foresight, unbounded gene-
rosity, and an amount of enthusiasm, without which
the work would have lacked much of its force. The
Tropical School had only been in operation since 1899,
and by 1905 £48,200 had been collected. Never was
money more profitably spent than this 848,000. Six-
teen expeditions had been sent out to tropical and
sub-tropical countries. About 900 cases of various
tropical diseases had been treated at a special ward in
the Royal Southern Hospital, Liverpool, and he was
glad that they had the Chairman of that hospital
(Mr. Wm. Anderson) with them that day. Moreover,
they were honoured with (һе presence of the Belgian
Consul, and through him he begged to assure His
Majesty the King of the Belgians of Liverpool's warm
appreciation of his gracious act.

Sir Alfred Jones, in cordially seconding the toast,
read & translation of a letter from the Secretary-
General, Congo Free State, dated Brussels, Septem-
ber 28th. It stated: “You made reference to the
fact that if his Majesty Leopold II. would consent to
make an annual subscription of £1,000 for a period of
five years, the Liverpool School of Tropical Medicine
would be relieved of pecuniary difficulties. I have
the honour to inform you that his Majesty the
Sovereign King, responding to this appeal, has author-
ised me to place at your disposal a sum of 21,000.
We hope that this subscription will not be the last
which might be made to the institute.”

November 1, 1906.)

THE JOURNAL OF TROPICAL MEDICINE.

333

A letter was read from Professor Boyce, who said

the honour to himself and his colleagues was really
paid to the Liverpool School of Tropical Medicine.

Professor Ross, in response, remarked that he had
been previously honoured at the Town Hall during
the Lord Mayoralty of Mr. W. Watson Ruther-
ford, M.P. He should not only like to see all tropical
diseases banished, but likewise all preventable diseases
at home, such as measles, scarlet fever, and chicken
pox. He believed that by the discovery of the causes
such diseases could all be wiped out.

Dr. Todd, likewise acknowledging the toast, drew
attention to the proposed memorial to Dr. Dutton,
who had left a glorious example of self-sacrifice.

The Belgian Consul expressed, in the name of King
Leopold and his fellow-countrymen, their congratula-
tions on the success of the Liverpool School of
Tropical Medicine, which was known all over the
world.

The Lord Mayor, again rising, said: I should not
like to part without asking you to drink the health of
the Lord Provost of Edinburgh (Sir Robert Cranston,
K.C.V.O.) His lordship has come to Liverpool to
attend a church function in Everton, and I embraced
the opportunity of inviting him to join us at luncheon
to-day. ПІ mistake not, he will have been very much
interested in all that has passed to-day. I venture to
hope that the seed thus sown in his mind will ripen
and bear fruit. We are not using Sir Robert as a
medium for collecting money—the thought farthest
in our minds—but we should like him, when he gets
an opportunity in his own city, in which he is so
respected and has so much power, to sing the praises
of the Liverpool School, which is doing so much to
reduce the diseases brought about by malaria. The
more we can make known this fact the better it is for
the world. We are not working on our own account,
but for the good of humanity—helpless humanity.
Gentlemen, the health of the Lord Provost of
Edinburgh.

The Lord Provost, in reply, said Scotland was a
poor country, but it would appreciate what the Lord
Mayor had said. He agreed that municipalities
should try to discover the causes and to eradicate
preventable disease.

Sir James Barr gave “ The Lord Mayor,” and with
his lordship's response the pleasant proceedings were
concluded.

The Lord Mayor directed that the following tele-
gram should be sent to King Leopold: ‘ Grand
Marichal de la Gour, Brussels.—Please convey to his
Majesty the King of the Belgians the very hearty
thanks of myself and the School of Tropical Medicine
for the decorations conferred upon Professors Ross,
Boyce, and Todd, and our warm appreciation of his
Majesty's generous donation towards the noble work
of stamping out disease. Am now giving luncheon
party in honour of the three professors, and we
present our respectful thanks to his Majesty.—From
the Lord Mayor of Liverpool."— Liverpool Post,
October 2nd, 1906.

———9——————

Aebietvs.

THE PRINCIPLES OF TREATMENT AND THEIR APPLICA-
TION то PracticaL Mepicing. By J. Mitchell
Bruce, М.А, M.D., LL.D., F.R.C.P. Third
Edition. Edinburgh and London: Young J.
Pentland, 1905. (Demy 8vo, рр. 614.)

We have only had a few books in medical literature
during the past century which can be said to approach
the grade of classical literature. Symes’ Principles
of Surgery, Huxley's Physiology, . апа Watson's
Medicine, are, perhaps, the most outstanding books
of the kind, and were we to link the earlier editions of
Druitt's Surgery, апа Erichsen's Science and Art of
Surgery with these, the list may be said to be com-
pleted. Тһе Principles of Treatment, by Dr. Mitchell
Bruce, revives the hope that the writers of to-day can
&pproach these classical writers, and even surpass
several. The Principles of Treatment, by Dr. Bruce,
may legitimately be classed along with Syines' Prin-
сіріев, and higher praise cannot be bestowed upon any
medical work. It is, moreover, encouraging that the
book has reached a third edition, as it proves that
medical men, іп the multiplicity of books and periodi-
cals, have not altogether lost taste for tli» classical in
medicine. Every medical man who has a regard for
the ideal in medicine and in the treatment of disease,
has Bruce’s Principles of Treatment on his shelf.

-----т--

Correspondence.

THE IMMUNITY OF NEGROES TO VARIOUS
FORMS OF CANCERS.

To the Editors of the JouRNAL OF Ткорісат, MEDICINE.

GENTLEMEN, —Permit me to ask, through your pages,
whether any of your readers have observed epithelioma of
skin or rodent ulcer in negroes? During twelve years’ prac-
tice I have only once seen this disease in one negro, and in
this case the patient is an albino. Unfortunately, I have
not yet persuaded him to allow its removal, though he
promises to. My father, Dr. W. J. Branch, after forty years
in the West Indies, has admitted to me that he cannot recall
a single instance of this cancer in a blaek person. Cauli-
flower cancer of the cervix is the only epithelioma that in
my experience affects West Indian negroes, and I have
practised in six islands and have some acquaintance with
several others. Among the poor whites, rodent ulcer and
epithelioma of the lip are decidedly common.
~ Lf this exemption of the black skin from malignant disease
is borne out by the experience of others, it is curious that
more attention has not been directed to the phenomenon.

Yours, &c..
С. W. Вкахен, M.B., С.М.

St. Vincent, British West Indies,

September 28th, 1906.

SCHAUDINN MEMORIAL.
THe Еніт? Ѕснлоріхм MEDAL.

In memory of Fritz Schaudinn, the famous Proto-
zoologist, who enriched our knowledge by many dis-
coveries, one of which was the cause of syphilis, there

334

THE JOURNAL OF TROPICAL MEDICINE.

[November 1, 1906.

will be presented, on the anniversary of his all too early
death, a medal to the author of the most remarkable
work on Microbiology. At present it is intended that
the medal shall be given once every two years, and
the presentation will take place through the medium
of the Institut fiir Schiffs-und Tropenkrankeiten at
Hamburg, on the staff of which Schaudinn worked
before his death. It was ever his desire that proto-
zoology should be considered to be, like bacteriology,
a part of microbiology, in any department of which
work worthy of the medal may be done. The neces-
sary funds are already guaranteed, and care will be
taken to secure the co-operation of scientists of all
lands in the decision as to the worker best deserving
the medal.

[We are glad to know that Schaudinn and his
brilliant work is to be commemorated in a suitable
fashion. We are obliged to the authorities of the
Seemans Krankenhaus und Institut für Schiffs-und
Tropeukrankheiten, Hamburg, for the above notice.—
Ep. J.7.M.]

Dear SrR,—As you may perhaps be aware a movement
has recently been веб on foot in England to co-operate with
Germany in forming & Memorial Fund for the wife and
children of the late Fritz Sehaudinn, of Hamburg. Тһе list
of the achievements of this eminent investigator is a long
and distinguished one, and includes not only discoveries of
the highest theoretical importance, but also many of practi-
са! application to disease as in the case of his well-known
researches on amebic dysentery and malaria. The last, and
perhaps the chief, of his achievements, viz., the discovery of
the micro-organism of syphilis, was made just before his
death, and is still fresh in the public mind. The enclosed
circulars indicate sufficiently, I think, the need for the form-
ation of such a Memorial Fund.

Since the present state of international feeling renders it
desirable that this British tribute of admiration to a great
German should be as weighty as possible I have ventured
to send you а copy of the appeal. І need scarcely add that
the addition of your name to the Committee will be a valu-
able accession to its strength.

I am, &c.,
W. S. PERRIN.
(Hon. бес. of the Committee.)
The Museums, Cambridge.
October 12th, 1906.

——

SCHAUDINN MEMORIAL
[Translation.]

Dear бів,-Ав I already informed you our Schaudinn
was released from his sufferings on Friday morning last.
His condition from the moment he came under medical
treatment not, only gave occasion for the gravest apprehen-
sions, but was regarded as almost hopeless by the physician,
"ET For weeks we lived between hope and fear with-
out suspecting how serious matters were with him. Now
he is taken away from us. What we have lost in him you
know. Тһе distress is so much greater in that we have no
adequate substitute for him. Whether Protozoology, which
had begun under his guidance to develop so brilliantly, will
become without him what he promised to create for it, the
future will show. But the blow has struck those he has
left behind hardest of all his poor young wife, who expects
within a few weeks the birth of & third child, and his two
little children, а girl and a boy. They have all lost in their
father their only support. The state of Hamburg of course
pays а widow апа orphan pension and will assess this as

highly as the legal definitions in any way permit.

In spite
of this it can only be a modest one, since Schaudinn died so
young, little more than £100 for the widow and £25 for each
of the children. It will thus be of value to render private
assistance, i.e., to collect together some kind of memorial
fund. An appeal, which it has been decided to publish, will
address itself chiefly to the medical profession, and we are
reckoning upon the dermatologists taking a prominent
part. Among these Neisser, and others, have already
promised their assistance. In addition a special grant on
the part of the Prussian and Imperial authorities is hoped
for. I should. however, think that the interest in Schaudinn
abroad will not end with his life, but that people will gladly
give proof of their high esteem for the dead to his family,
which he has left behind in grief and necessity, by taking
part in the work of love.

I therefore approach you with the request to open among
your countrymen the matter, which now occupies all the
friends of the dead, and which we can scarcely bring to the
desired end through our power. I intend to apply to my
friend Minot in America, and Blanchard in France, with the
same request. In carrying out the plan I should much pre-
fer to personally remain completely in the background ;
naturally, however, I place myself completely at your dis-
posal with respect to any further information that may be
desired. А

Giessen,

June 28th, 1906.

Dear Бін,--Тһе enclosed letter has been received by Mr.
Sedgwick from Professor Spengel, of Giessen.

It is proposed to co-operate in the movement which has
been set on foot in Germany by forming a Committee of
scientific men interested in Dr. Schaudinn’s work. А list of
the gentlemen who have already signified their approval of
this scheme and have consented to join the Committee is
now sent vou, I have the honour to ask you if you will
allow your name to be included in their number. --

Subscriptions may be paid to Mr. Adam Sedgwick (at
the above address), Treasurer of the Fund, or direct to the
Schaudinn Memorial Fund at Messrs. Barclay and Co.'s
Bank, Cambridge.

J. W. SPENGEL.

I am, &c.,
W. S. PERRIN,
Hon. Sec. of the Committee.
New Museums, Cambridge,
July 14th, 1906.

Committee.—Professor Clifford Allbutt, F.R.S., Sir
Michael Foster, K.C.B., F.R.S., Mr. Jonathan Hutchinson,
F.R.S., Professor E. Ray Lankester, F.R.S., Sir Patrick
Manson, K.C.M.G., F.R.S., Professor William Osler, F.R.S.,
Mr. John Tweedy, President of the Royal College of Sur-
geons, Professor Sims Woodhead, F.R.S.E.

The following subscriptions have been received or
promised :—

£ s. d.

The Right Hon. Lord Lister... 20

Mr. A. Sedgwick RO ES!

Mr. J. J. Lister... re svo

Professor Sims Woodhead 5

Dr. J. Hutchinson 5

Mr. A. E. Shipley - TES

Professor W. Osler... ar DE

Professor T. Clifford Allbutt... 2

[It is to be hoped that medical men in practice in the

Tropics, in view of the great advance in our knowledge of

tropical diseases due to Schaudinn. will subscribe to the
Schaudinn fund.—Ep. J.T.M.]

әлм-елоооо
ooooceocoo

November 1, 1906.)

Books and Papers Received.

“Тни PRESCRIBER.”

WE are favoured with the first number of a new .

monthly publication devoted to the pharmacy of the
newer remedies, termed The Prescriber. The periodical
is edited by Thomas Stephenson, F.C.S., Ph.C. A
journal specially devoted to prescriptions and рге-
scribing would be popular with medical men. We
will await the development of the journal with inte-
rest, and hope that prescriptions and prescribing, as
well as pharmacology, will find a place in future num-
bers. The journal is published in Edinburgh.

----з---

Hotes and Fels.

Mr. ANDREW ECTE Taa given £10,000 to build
a library for the University of St. Andrew’ s, of which
University he is Lord Rector. Dundee University
College also benefits by the sum of £12,500 given by
the same generous donor for the purposes of a public
laboratory.

BnossELs Scnoon оғ TropicaL MzgpniciNE.— King
Leopold opened the School of Tropical Medicine at
Brussels, on October 13th. The School was founded
by King Leopold, who has for many years appreciated
the importance of the investigation of diseases in his
tropical possessions and colonies. The Director of
the School is Dr. уап Campenhout, formerly the
Superintendent of the Colonial Sanatorium at Water-
mael. Although the investigation of sleeping sickness
will take & prominent place in the immediate investi-
gations to be carried on at the School, instruction will
be provided in all departments of tropical medicine.
The links of sympathy and practical interest which
already exist between the schools of tropical medicine
in London, Liverpool, Paris, and Hamburg, will extend
to the new school in Brussels, and it is to be hoped
the several schools will still keep touch with each
other in the future as they have done in the past.

Sır FREDERICK Treves’ interesting book, “Тһе
other Side of the Lantern,” published by Cassell and
Co., London, is re-issued in a “ popular ” edition.
“The other Side of the Lantern” is а graphic and
personal account of what the writer saw and noted in
his journey round the world. It is written in the
terse and enlivening style characteristic of all Sir
Frederick Treves writes and does.

IT is probable that Major Bird, C.I.E., Professor of
Surgery in the Medical College, Calcutta, will be
appointed Medical Officer in attendance on the Amir
during His Highness's tour in India. Major Bird, it
may be remembered, was highly successful at Kabul
in treating injuries to the Amir's hand caused by an
accident while shooting: —Pioneer Mail, September
14th, 1906.

THE JOURNAL OF TROPICAL MEDICINE.

335

In spite of some inexplicable opposition from the
Rangoon Chamber of Commerce, а branch of Lady
Minto’s scheme for an Indian Nursing Association is
to be established in Burmah, and no country stands
in more urgent need of an efficient organisation of
the kind.

Tue first report of the health officer of Rangoon is
couched in a somewhat desponding vein, and it cannot
be denied that the rat-killing operations have, as yet,
not proved a particular success; but this is probably
because the business has been taken up in a very half-
hearted fashion. It stands to reason that, to be
effectual, the campaign against rats should be con-
ducted simultaneously throughout the entire town,
and this does not appear to have been as yet
attempted in Rangoon. Rats are notorious for their
sagacity, and, it is well known, migrate at once
should any considerable mortality occur among them,
whether brought about by plague, poisoning, or any
other cause. Тһе result, therefore, of partial attempt
is merely to spread the disease to quarters of a town
that have been left untouched.

A FASHIONABLE wedding took place at Rangoon on
September 6th, between Miss Linda Wilkins, daughter
of the popular P.M.O., of the Secunderabad Division,
and Lieut.-Colonel Menzies, Rangoon Port Defence
Volunteers. The ceremony was conducted by the
Right Rev. the Bishop of Rangoon.

A COURSE of not less than four lectures on the
prevention of disease will be delivered annually at all
stations where British troops are quartered. When-
ever practicable, the dates selected for the lectures
will be between April 1st and October 8186. The
lectures will be delivered by Royal Army Medical
Corps Officers, who will be selected by the General
Officers Commanding Divisions and Brigades, with
special reference to their fitness for dealing with the
subject. Attendance at the lectures will be voluntary,
but General and other Officers Commanding should
impress on those under them the importance of
acquiring some knowledge of this subject. The first
series of lectures commence this month. This is a
most excellent innovation, as there cannot be the
least doubt that a large proportion of sickness in
India, alike among Officers and men, is entirely due
to ignorance of the precautions that should be adopted
by all reasonable persons in such a climate.

X-Ray installations will shortly be introduced at ten
central stations in India for army purposes. So far
so good: as far as those quartered at these particular
stations are concerned; but what about the large
majority who are posted elsewhere? This means
that at all other than these central stations, any case
that may occur must needs await diagnosis until, in
response to a proper official requisition, with an
appropriate width of “ margin,’ the apparatus is
despatched to the outstation, a procedure that must
often involve a delay of several days at the most
critical period of a case. Although rather expensive,
an X-ray apparatus is not costly enough to warrant
so pitiable and misplaced an economy, and as many

336

THE JOURNAL OF TROPICAL

MEDICINE. [November 1, 1906.

private practitioners can provide themselves with one,
Government can surely afford these appliances to each
station, for at the present day an outfit of the sort
has become one of the necessities of surgical life.

Two successful cases of treatment of snake-bite by
the combined use of antivenene and the local applica-
tion of permanganate, are noted in the annual report
of the Sanitary Commissioner of the Central Provinces,
India. In both cases a ligature had been applied
immediately after the bite, and in one of them two
hours elapsed before any other treatment could be
adopted.

It is understood that the Government of India have
appointed a Committee, consisting of Lieut.-Colonel
Leslie, I.M.S., Sanitary Commissioner with the
Government of India, Mr. Lionel Jacob, Secretary to
Government in the Public Works Department, and
Mr. D. Aikman, to draw up a scheme for the creation
of a service of sanitary engineers as a separate branch
of the Public WorksDepartment. The Committee will
draw up the regulations and conditions of service, &c.
--Ріопеет Mail, September 14th, 1906.

THE death is announced of Captain F. A. Pilkington,
IM:S., of heart failure. The deceased officer was
well known and highly esteemed in Lahore.

On November 9th, 1906, Professor Ronald Ross,
F.R.S., C.B., will give ап address on the subject of
“ Malaria in Greece,” to the Medical Society of
Oxford.

X-ray Burys.—In a discussion on the treatment
of X-ray burns at a recent meeting of the New York
Dermatological Society, as reported in the Journal of
Cutaneous Diseases, Dr. Henry C. Piffard, Emeritus
Professor of Dermatology in New York University,
said that he had “ obtained the most benefit in treating
X-ray burns with antiphlogistine, chloride of zinc,
high frequency current, and ultra violet rays.”

Owrxa to the rapid spread of the cocaine habit in
India, the Punjab Government has issued а notifica-
tion under the Excise Act that cocaine, and every pre-
paration and admixture of cocaine, are henceforth
included in the definition of ‘intoxicating drinks."
This will give the authorities the same powers of
regulating the sale of the drug that they possess in the
case of opium, Indian hemp or alcohol. :

боме time ago it was pointed out in “ Notes and
News," that the Hindu population in India would
probably raise objections to the killing of rats, and
already one can hardly take up an Indian paper
without finding allusions to this difficulty, which con-
stitutes the greatest obstacle to the efficient carrying
out of this most practical of anti-plague measures. In
Nagpur, the capital of the Central Provinces, a Guru,
or Hindu religious leader, has been preaching against
the sin of killing rats, and on being asked by Mr.
Dewar, the Executive civil officer, what he thought of
tiger shooting, the Guru replied that that was not a

sin, but a duty. Mr. Dewar pointed out that at present
rats were destroving far more human lives than tigers
had ever done; but common-sense and reason weigh so
little with religious fanatics of any denomination that
it may be feared that his most apposite parallel had
little effect on the Guru's crusade. Accordingly, Mr.
Ram Narayan, an influential native banker, proposes
to provide а “ rat-ruksba "' or sort of pen in which the
captured rats may be confined as pensioners for the
natural term of their lives, the male and female animals
being kept apart. То the home-staying European, all
this appears too “ Gilbertian " for grave consideration,
but the proposal has been most gratefully received by
Major Buchanan, I.M.S., who is in charge of the plague
operations, and the thanks of all interested in Indian
sanitation are due to Mr. Ram Narayan for a proposal
which smooths the way over what bids fair to become
an insuperable impasse. In the Punjab, оп the other
hand, the campaign against rats progresses steadily,
and does not appear to be rousing opposition.
Already nearly sixty towns have been included in the
operations.

An instance of the dangers attendant on the storing
of grain in hot, damp climates, comes to us from Ban-
galore, where a serious outbreak of дізгтһова, which
raised suspicions of the presence of cholera in the
town, was traced to this cause. The stale corn was
disposed of by mixing with sound grain in sufficient
реро нов to mask the musty odour of the decomposed
article.

А PROFESSOR of Biology is to be added to the staff of
the Lahore Government College.

We learn thatLieutenant Е. Н. Stewart,I.M.S., who
recently applied to Government for the post of Surgeon
Naturalist, Marine Survey of India, has been posted
to Gyantze, Thibet! Thefact of the would-be deep
sea fisher being sent to sit on the top of mountains
12,000 to 15,000 feet high needs no comment.— Pioneer
Mail, October 5th.

Tae contributions to Lady Minto's endowment fund
for European-trained nurses now amounts to over
£8,000.

Tue Pioneer Mail of October 5th includes a useful
review “ by а specialist " of the measures that have

«hitherto been adopted for the suppression of plague, in

light of our more recent knowledge as to the mechanism
of its conveyance. Heshows how the failure of protec-
tive cordons was inevitable, evacuation merely a pallia-
tive, and why disinfection, in the ordinary sense of
the term,is worse than useless. Inoculation he regards
as needless, in view of the fact that plague may now
be regarded as though the most troublesome of all our
epidemics, it is the most easily preventable. While in
no way minimising the obstacles of native prejudices
against rat-killing, he believes that the opposition
will die down “ав soon as the people understand that
plague is primarily a rat disease." In one point we
would, however, wish to set our contemporary corre-
spondent right in a matter of history, when he says :—
* Men were employed to disinfect houses, and a con-

November 1, 1906.)

siderable number of those who were employed on this
work were attacked by plague. Boots and putties were
provided for these workers, and with good results, but
it probably never occurred to any one that the boots and
putties produced their good effect by preventing the
workers from being bitten by rat fleas." Now, asa
matter of fact, ammunition boots with pyjamas
tucked into them at the ankle, were ordered to be worn
by the men of the disinfecting gangs, by the Sanitary
Commissioner of the North West Province and Oudh
in 1899, because the holder of the appointment at that
date held a firm belief that some insect such as
the bed-bug or the flea would ultimately be proved
to be the actual carriers of the disease, in spite of
the discredit that then was thrown on tbe idea by
bacteriologists, and he further directed that the boots
as well as the legs and arms of the men engaged in the
work should be kept greased with carbolic oil on
account of the well-known aversion of fleas and other
insects to greasy and strongly-smelling substances.
The theory, it must be remembered, is a fairly old one,
and although the triumph of the truth is but so recent
а matter, the idea had even then already occurred to
Lieutenant (now Captain) Glen Liston, although he did
not publish any note on the subject till long afterwards.
The certainty of our knowledge, and the conviction that,
given intelligent co-operation on the part of the populace,
plague is an easily controllable disease, is, however, a
pleasant contrast to the groping in the dark of those
days ; for even those of us who most strongly held that
plague must be conveyed by the agency of biting
Insects, had nothing but analogy to goon. The sug-
gestion of using boots, &c., was, however, as а matter of
fact, based on the idea that either fleas or bed bugs
might very possibly be concerned in the matter, as it
was felt that the circumstances of the case rather put
our old friend the mosquito out of court, because were
those insects capable of conveying the disease, few
would be likely to escape.

А SPECIAL correspondent of the Times of India who
has been visiting Poona to investigate the causes of
the terrible exacerbation of plague in that city, draws a
gruesome picture of the insanitary conditions subsist-
ing in the poorer parts of the town. It is obvious that
rat-killing operations can stand but little chance of
success in such a honeycomb of dark, overcrowded cells
as he pictures the homes of the people to be.

—— —49——— ———

Personal Motes.

INDIAN MEDICAL SERVICES.

Arrivals Reported іп London.—Lieutenant-Colonel E. W.
Reilly, Captain T. G. N. Stokes, Major F. R. Ozzard, Major
W. А. White, Major C. L. Williams, Captain F. H. С.
Hutchinson.

Extensions of Leave.—Lieutenant-Colonel J. W. Poynder,
2 m. 21 d. leave, medical certificate; Major C. Duer, 3 m. fur-
lough; Captain М. Н. Rainer, study leave, May Ist to June 15th,
1906; Captain S. Anderson, study leave, April 11th to August

“ 81st, 1906; Captain A. Miller, 6 m. furlough; Major S. А.
Harris, 3 m. medical certificate; Captain S. Evans, M.B., 6 m.
medical certificate; Captain Н. R. Brown, 7 d. ; Major T. W.
Irvine, special leave commuted to furlough Р.А. and extended

THE JOURNAL OF TROPICAL MEDICINE.

337

2m.8d.; Major E. Wilkinson, study leave, May 1st to July
31st, 1906; Captain R. Brown, 14 d. ; Captain R. M. Carter, 2m.
Captain J. H. Hugo, furlough to March 6tb, 1907 ; Captain
N. R. J. Ranier, study leave, June 16th to October ist, 1906:
Major W. H. W. Elliot, D.S.O., 27 days. i

Permitted to Return to Duty.—Major J. Morwood, Major T.
W. Irvine, Captain R. M. Dalziel, Major A. Street, Colonel H.
Hamilton, C.B., M.D., Lieutenant-Colonel C. J. Starkies,
Lieutonant-Colonel M. A. T. Collie, Captain L. J. M. Deas,
Captain F. D. Browno, Lieutenant-Colonel R. H. Cama, Captain
D. G. R. S. Baker, Captain A. E. J. Lister, Major P. J.
Lumsden, Lieutenant-Colonel J. S. Daly, Major W. H. W.
Elliot.

Trooping. - The following officers of the R.A.M.C., embarked
on tho Rewa for India on the 19th ult.: Colonel P. M. Ellis,
Lieutenant-Colonel R. L. R. Macleod, Lieutenant-Colonel D. М.
O'Callaghan, Captain A. W. Hooper.

Postings.

On transfer from Ferozepore, Major E. V. Hugo, I. M.S., is
appointed to officiate as Civil Surgeon of Lahore, Professor of
Midwifery and Forensic Medicine, Lahore Medical College, and
Medical Officer in charge of the Medical College, Lahore,
relieving Lieutenant-Colonel H. Hendley, I.M.S., proceeding
on leave.

Captain Paton, services replaced under Sanitary Commissioner
with Government of India.

Captain W. M. Pearson officiates as Deputy Sanitary Com-
missioner, 2ud Circle, United Proviuces.

Captain W. H. Cazaly acts as Deputy Sanitary Commissioner,
Southern Registration District, Bombay.

Captain H. Crosbie to additional charge of current duties as
H.M. Consul, Kermanshah.

Major А. L. Duke, to additional charge of current duties as
Political Agent, Bikanir.

Major R. J. Macnamara, services placed at disposal Sail
Department, Government of Madras.

Colonel J. McCloghry is transferred as P.M.O. from Quetta,
to Abbotabad.

Colonel Н. К. МеКао, C.I.E., from the Presidency and
Assam Brigades to the Meerut Division.

Hon. Lieutenant L. J. O'Reilly, I.8.M.D., to be Civil Sur-
geon, Etah.

Major W. Vost is transferred from Gorakpur to Muttra, as
Civil Surgeon.

Major D.'M. Moir, Professor Medical College, Calcutta, is
appointed to the Managing Committee of the Zoological Gardens,
Calcutta.

Captain W. O'S. Murphy to the charge of the Observation
Camp for Pilgrims, Perim, Dr. J. H. Walsh, Uncovenanted
Medical Service, acting in his place as Special Health Officer,
Kurachi.

On return from leave, Surgeon-General W. К. Brown, I.M.S.,
will become'Surgeon-General with the Government of Madras,
and Colonel P. Benson, I. M.S., who has been officiating, will go
as Principal Medical Officer to the 6th (Poona) Division.

Captain D. Munro, to the Medical Charge, 11th Lancers.

Major F. R. Ozzard, to the Medical Charge, 7th Rajputs.

Captain A. Lister, to the Medical Charge, 19th Punjabis.

Captain N. W. Macworth, to the Medical Charge, 41st
Dogras.

Captain R. M. Barron, to the 54th Sikhs.

Captain R. Е. Bird is placed on Plague duty.

On return from leave Major S. K. Close becomes Civil Surgeon
of Shahjahanpur, relieving Major J. G. Humbert, who goes to
Farrukhabad.

Hon. Captain E. P. Clements, I.S. M.D., to be Civil Surgeon,
Hardoi.

Captain E. I. Perry, officiates as Civil Surgeon, Dera Ghazi
Khan.

Leave.

Colonel H. Barrow, R.A.M.C., for 6 m.

Lieutenant W. Brayne, 8 m. combined leave.

Captain D. N. Anderson, 6 m. combined leavo.
Captain J. C. Kuuhardt, 8 m. furlough.

Captain J. C. Robertson, 2 y. combined leave.
Captain F. H. Hutchinson, 1 y. 7 m. combined leave.
Captain F. Wall, 6 m., medical certificate.

338

Retirements.

The following Senior Assistant Surgeons, Bengal, are per-
mitted to retire: Honorary Captains Brown, Bailey, and Hogan.
Lieutenant R. Cobb is permitted to retire.
ii Captain L. Gundall is transferred to the temporary balf-pay
ist.

Promotions.

Captains to be Majors, July 28th, 1906.—Thomas Arthur
Granger, M.B., Harold Jobn Kinnahan Bamfield, John Wemyss
Grant, M.B., Arthur Henry Moorhoad, M.B., William Davey
Hayward, M.B., William Elmsley Scott-Moncrieff, M.D.

Lieutenants to be Captains, August 3lst, 1906.—Robert
Kelsall, M.B., John Hay Burgess, M.B., F.R.C.S., Charles
Hildred Brodribb, M.B., John McCallum Anderson Macmillan,
M.B., Clifford Allchin Gil, William Edward James Tuohy,
Terence Francis Owens, Richard Francis Steel, M.B., George
Francis Innes Harkness, Arthur Charles Ingram, M.D., Gordon
William Maconachie, M.B., Ernest William Charles Bradfield,
M.B., Alexander William Montgomery Harvey, M.B., Charles
Isherwood Brierley, John Brown Dalziel Hunter, М.В, Edward
Temple Harris,

Robert Joseph Macuamara, M.D., Herbert Wilson Pilgrim,
M.B., F.R.C.S., Francis Wyville-Thomson, M.B., Edwin
Harold Brown, M.D., F.R.C.S.E., Charles Norman Bensley,
Selby Herriot Henderson, M.B., Blenman Buhos Grayfoot,
M.D., David Wilson Scotland, M.B., Charles Robert Mortimer
Green, F.R.C.S., Richard Henderson Castor, Thomas Edward
Dyson, M.B., Edward Christian, Hare Frank Cecil Clarkson,
John Gregory Jordan, M.B., Herbert Mackinlay Morris, Allan
Rupert Postance Russell, James Morwood, M.D., Frederick
George Maidment, Edmund Alexander William Hall, M.B.—
September 30th, 1906. .

R.A.M.C.

On arrival from England, Colonel P. M. Ellis becomes P.M.O.
Quetta Division aud Colonel J. G. Harwood, P. M.O., Presidency
&nd Assam Brigades.

COLONIAL MEDICAL SERVICE.
Cyril E. Thwaites, L.R.C.P., M.R.C.S., has been appointed
Civil Assistant Resident in Northern Nigeria.
Dr. F. G. Hopkins, Senior Medical Ofticer of Southern
Nigeria, is acting as Principal Medical Ofticer during the
absence on leave of Dr. H. Strachan, C.M.G.

------<--
Recent and Current Piterature.

A tabulated list of recent publications and articles bearing on
tropical diseases is given below. То readers interested in
any branch of tropical literature mentioned in these lists
the Editors of the JOURNAL OF TRopicaL МЕрІСІМЕ will be
pleased, when possible, to send, on application, the medical
Journals in which the articles appear.

* Lancet," September 29, 1906.

(L) Two Cases or Hepatic ABsckss TREATED BY THE
TRANSPLEURAL OPERATION.

Taylor, H., describes two cases of tropical abscess of the
liver, treated by incision, removal of part of a rib, opening
the pleural cavity. cutting the diaphragm, and on reaching
the liver stitching the liver to the adjacent parts. In one
patient, as usual, “ very shallow, and interrupted respiration
supervened on the admission of air to the pleural sac and
patient became very cyanotic.” In the same patient,
“while the wound was being gently svringed out with
lin 40 carboli¢ lotion, the patient suddenly complained of
great pain in the epigastrium, became ра, broke out into
a profuse perspiration and vomited” Svringing liver
abscesses has been frequently condemned, and Dr. Taylor's
case adds another warning against the procedure. Dr.
Taylor advocates the transpleural operation and condemns
the use of the trocar and. cannula, indulging, as usual, in
Wholesale abuse of the method, stating that: '* I venture to
think that such stabs in the dark, or at least into an

THE JOURNAL OF TROPICAL MEDICINE.

[November 1, 1906.

obscurity, are out of place," &c., &c. It will be seen that
over-heroic operations for hepatic abscess by transthoracic
and transperitoneal methods are still in vogue.

(IL) Ехреміс HÆMATURIA.

Stock, Capt. Philip б. This is an account, from the
epidemological point of view. of an outbreak of bilharzosis
among the men of the 8th Hussars, at Pretoria, in 1902, in
which forty-three men were attacked. The author tried to
repeat Sonsino's observations as to the existence of an inter-
mediate host, in the shape of some species of mollusc, in
which the parasite passes through a redia stage, but failed
to obtain any confirmation of this view. He accordingly
strongly favours the idea that the embryos pass directly to
the human host, by the agency of water, either by drinking
or by bathing, and argues that the former is the more
probable mechanism of infection, as some cases had
occurred who had not bathed, and that a certain amount of
water always enters the mouth or nostrils when bathing.

He shows that the ‘period of incubation,” i.e., the
interval between infection and the appearance of symptoms,
varies from one to two months, the movements of the
troops giving an excellent opportunity of forming an opinion
on this point. As to treatment, he makes the interesting
suggestion of the administration of a toxin in the form of
Wright's serum, basing his proposal on the disappearance
of symptoms in two cases which contracted typhoid and in
another of dysentery.

(IIL) A Case оғ Аікнгм.

Alexander, D. M., and Donaldson, R., describe a typical
case of ainhum. Patient, 44, born in Port Antonio, Jamaica,
went to sca at 14. Developed hypertrophy of little right
toe and a subsequent narrowing behind. The part was
amputated through the narrow neck, which proved to be of
fibrous tissue and did not bleed when cut. The cause was
not deterinined. . PE

(IV.) Тнк Srupy or a Case or PLAGUE.

Cleland, Burton J., states that the lengthy incubation
noted in plague is due to the fact that living plague bacilli
probably liberate few, or no, toxic bodies: it is only when
owing to overcrowding of a gland bringing about loss of
food supply, or as the result of anti-microbie bodies when
the bacilli die, that their endocellular toxins are liberated
und local and systemic reaction follow in proportion to the
dose. In other words, the presence of living plague germ
infection belongs to the period usually named the incubation
period, and because the living bacilli are not toxic, and it
takes some days before the bacilli are killed and their toxins
are set free. Dr. Cleland sums up the argument when һе
states : “Тһе onset of signs and symptoms in plague is the
first indication of commencing recovery from the disease."
This statement bears out that which was enunciated by
Drs. Hunter and Simpson from observations made in Hong
Kong. The development of the bubo is a late phenomenon
of plague; gastro-intestinal symptoms (Hunter and Simp-
son) precede its appearance, and, in fact, all evidences of
fever. In Dr. Cleland's case also, diarrhea was one of the
first signs of infection and preceded all others by three days.
This theory, which is now being widely received, explains
why there ік so seldom any local reaction and as rarely a
Ivinphangitis in plague, compared with other infections, say,
by streptococci, and why one set of glands are, as a rule,
infected, and supports also the skin inoculation theory of
plague. ў f

“ Bulletin de l'Institut Pasteur,” T. iv., Nos. 17 and 18.
ANTI-CHOLERA INOCULATIONS IN INDIA.

Haffkine, Prof., gives an interesting résumé of his work
on this subject extending over шапу years, and comes to
the conclusion that although the ease incidence among the
vaccinated is only about a tenth of that obtaining among

November 1, 1906.)

the unvaccinated, the mortality among those actually
attacked differs but little.

The protective effect of the vaccine commences at once
and increases rapidly for the first four days after the opera-
tion, and lasts about fourteen months: after which its еЙесіз
diminish rapidly and probably disappear completely.

These facts are of great interest in forecasting the chances
of success of anti-typhoid inoculation, but can hardly be
said to retain much interest in connection with the practical
question of combating cholera, as Prof. Hunkin's, of Agra,
discovery of the use of permanganate of potassium for the
disinfection of wells, has made cholera an easily controllable
disease wherever the suspicious prejudices of the Indian
native do not prevent the proper carrying out of the measure ;
and wherever this is the case it may be taken as certain
that anti-choleraic injections will be even more stoutly
resisted.

It must be remembered that these vaccinations are no
light matter, and so much is this the case that in one
instance in the abstracter's experience, the men of the
Shropshire regiment who had had personal experience of
the operation ; through writhing in the agonies of cholera in а
terrible outbreuk at Sitapur, absolutely refused to subinit to
ordinary anodine hypodermie injections, because they
suspected that the medical officers intended to repeat the
anti-choleraie vaccinations that had been conducted in the
regiment a few months previously.

* Bull. Chambre d'Agriculture de Cochin Chine," 1906, p. 39.

DISTRIBUTION AND SvxPTOMOLOGY OF SuRRA IN COCHIN
CHINA.

Brau, St. Sernin, and Mutin Boudet confirm the existence
of surra in Saigon, already suspected by Blin and Chaptal,
but regard the occurrence as merely sporadic in mules and
horses from Annam and Cape St. Jacques. They distinguish
two forms—the *' dry " and the @dematous—of the disease,
and found that the presence of the parasites in the blood
was intermittent. Inoculated dogs died in about fourteen
days, after a three days’ incubation. They tried treatment
with mercuric methylarseniate dissolved in К. I. with en-
couraging results.

* Centralb!. f. Bakter.," I., Origin., T. х1., p. 683.

Tur New Кость or CUTANEOUS PENETRATION OF LARVAL
ANKYLOSTOMES.

Schüffner, W.— Regarding infection by penetration of the
skin as definitely established, the author attempts to detine
the importance of this route of infection as compared with
that through the intestinal canal.

Schiiflner is working in Sumatra, where ankylostomiasis
is extremely common, but he nevertheless found consider-
able difficulties in obtaining cultures of the larve, and
believes that this is due to the presence in the excrements
of other rival organisins which may crowd out tbe young
Ankylostomes. In his particular case the hostile and
victorious organisms were Strongylus stercoralis and the
larvie of a Ну, besides which he found it necessary to check
the development of infusoria by the addition of 2 to 8 drops
of a 10 per cent. solution of quinine. He specially studied
the onset of cutaneous infection and finds that а few drops
of arich culture placed on the arm, produces, in half an
hour, intense itching. and the subsequent formation of a
pustule, but his sections of skin so infected, though they
clearly demonstrated the fact of penetration, failed to соп-
firm Loos’ observations as to the huir follicles being selected
by the larve as a point of entry. The neighbouring tissues
were markedly infiltrated with eosinophyl leucocytes.

He notes that the larve disperse very rapidly in water,
and hence concludes that infection must usually be by
isolated individuals, under which circumstances the local
irritation is far less than that of a mosquito bite, and no
pustule forms, so that the occurrence would usually pass un-
noticed. He further discusses the various cutaneous lesions
that have been described, and in particulur * ground itch.”

THE JOURNAL OF TROPICAL MEDICINE.

339

and comes to the conclusion that none of them bear any
relation to the penetration of the ankylostomes.

In making these observations, Schütfner overlooks
the undoubted fact that infection by the agency of
water is probably a very rare occurrence, as the larvæ
require fecal matter for their nutrition, and die out
very quickly in water unless it be grossly foul with
excrement to such an extent that the most callous
of indigenous races would neither drink of nor bathe
in it. Note also Loos’ observation of their habit of
crawling out of water. The much fouled soil, how-
ever, in the neighbourhood of native villages usually
teeins with the larvæ, which must thus be constantly
brought in contact with the naked feet and ankles of
tke inhabitants, while his negative results in the search
for larve in these skin lesions can count for nothing as
opposed to the positive results of previous investigators.
No one pretends that larvae can constantly be found in
all stages of what is known as “ ground itch,” as the
irritation and puetulation are maintained by the
agency of scratching and of ordinary pyogenic
organisms long after the larve have passed through
the skin; which indeed must, in all probability, be
rendered unfit to serve as a site for further penetration
by the inflammatory changes set up. His explanation,
however, of the capriciousness of the results of breed-
ing experiments through tbe action of rival organisms
is, however, of great importance, and to those who
have worked practically at this question, accounts for
much that has hitherto been puzzling.

“ Scient. Memoirs of the Hod. and San. Departs. of Govt. of
n а. »

PARASITE OF THE WHITE BLoop CoRPUsCLES оғ PALM
SQUIRRKLS.

Patton, Capt. W. S5., LM.S.—In Kathiawar, some 98 per
cent. of this squirrel (Funambulus pennant’) were found to
be infested by a parasite of the mononuclear leucocytes, as
many as half the corpuscles being infected. The parasite is
of vermicular form, 18 to 15 microns long, by 8 to 4 microns
wide, with pointed ends, and has been named by the author
Leucocytozoon funambuli.

They are typical hiemogregarines, stain well with Roman-
ovsky, and possess а voluminous nucleus (sometimes double),
which is central in position, besides which there are a
number of cytoplasinic granules.

Comparing infected animals with healthy squirrels from
Madras, the former were found to present a marked excess
of mononuclears, a point which the author believes may have
a bearing on the etiology of leucocythwmia. The parasites
are very numerous in the spleen and may be readily found
in the liver and kidneys, but none of the organs showed any
developmental forms. The only external parasite harboured
by the squirrels was a louse, which proved to be a new
species of the genus Hematopinus, but no evidence could
be found of the louse acting as an intermediate host.

“ Schrift, der Physch.-okonom. Gesells.," z. Konigsberg,
T. lvii., р. 97.

Тнк PENETRATION OF THE SKIN BY NEMATODE LARVÆ.

Lühe, M.—The researches of Loos on this subject
appears to the author to afford an explanation of a point
noted by him in 1896, in the examination of the body of a
panther. The pulmonary alveola contained enormous
numbers of nematode larve, very uniformly distributed
through the organ, but without producing any obvious
lesions. The other organs were free from any similar para-
sites except the intestine, and between the villi of the latter
were young examples of Uncinaria perniciosa which had

840 THE JOURNAL OF TROPICAL MEDICINE.

{November 1, 1906.

caused sinall extravasations of blood. Не now regards
these facts as but another example of the migration of
nematodes in the manner discovered by Loos.

“ Zeitschr. fur klin. Med.," T. Iviii., p. 43.
ANKYLOSTOME INFECTION vid. THE SKIN.

Loos, Dr. A. Returning to the consideration of this sub-
ject, the author discusses replies to the objections that have
been raised against his theory of infection and the practical
considerations that result therefrom.

He first recapitulates the steps that led to his discovery --
his accidental imfection of himself under circumstances
which rendered invasion per os highly improbable; the
experiment on the leg of а patient an hour before aniputa-
tion, and those he afterwards made on young dogs
with Ankylostoum caninum and duodenale, and reealls his
conclusion that the route followed by the larvie is the
venous or lymphatic system, the right heart, the lungs,
trachea, qsophagus, «е. While passing through the
lymphatic glands, particularly those of the axilla, large
nuinbers of the larvae are destroyed by phagocytes, and the
stages of the process are followed out.

The symptoms produced depend largely on the number of
larve that gain admission simultaneously. When thisis seri-
ous they consist of diarrhea, more or less general cedema, and
multiple hemorrhages which he attributes, not to mechanical
but to toxic action. The age of the subject greatly in-
fluences the results as the skin in the voung is much
more easily penetrated, and the resulting infection propor-
tionally more serious.

Arrived in the intestine, Loos believes that the worms
feed not on blood, but on the mueosa, and considers the
hemorrhage that results as accidental.

It may, however, be pointed out that in expressing this
opinion Loos runs counter to the undoubted fact that the
greater proportion of parasites found post-mortem іп the
intestines are swelled out like leeches, and that the contents
of their intestines undoubtedly consist of blood. Moreover,
when examined still living in sifu, in a post-mortem con-
ducted sufticiently early after death, the ankylostome will
be found so firmly fixed to the mucous membrane that it is
difficult to understand how any food other than the blood
from the bite can gain access to the buccal cavity of the
worm; and itinay be further noted that Loeb and Smith
described certain organs producing a powerfully anti-coagu-
lant substance which would be quite useless, assuming
Loos’ very surprising theory on this point to be correct.

Loos does not deny infection per os as an occasional
mode of access for the parasite, but believes that it is of
very minor importance as compared with penetration of the
skin, and, further, is of opinion that when the former takes
place, drinking water is seldom if ever the vehicle, but that
raw vegetables are more frequently concerned, though the
commonest method of infection by this route is through eating
with hands soiled with earth, especially in the case of miners.

He states that the larvie die very rapidly if dried, so that
unless they penetrate the skin very shortly after deposition
on it, they necessarily perish ; but this sensitiveness to desic-
cation is quite contrary to the abstractor’s personal experi-
ence, and though the latter is aware that Loos explains
this by the presence of other species of nematode larve in
the cultivations used, he does not find the explanation
adequate, and believes that under certain circumstances the
larvie show remarkable powers of resisting dryness, short of
absolute desiccation.

А very important observation made by Loos is that
larvie that find themselves in water, crawl out of it by
climbing the moist banks of the pool, and that thev are
thus found at all heights—on the sides of mine shafts and
drivings, so that they are continually coming in contact with
the hands of the miners ах they feel their way along the
iN-ighted passages. This migration ean not, however, as
Tenholt supposes, be made in search of food, as at this

period of its existence the larve is enclosed in a capsule
formed by the integuments of its last ecdysis.

The larve develop best at a temperature of 28° to 80? C.
and stil develop slowly at 15’, but the danger to miners
from the disease is nevertheless always proportional to the
warmth of the mine. With regard to prophylaxis, Loos,
like every other praetieal observer who has studied the
subject, comes to the conclusion that no measures other
than those of an efficient conservancy can be expected to be
of any real use.

“ Anne. de l'Inst. Pasteur," May, 1906.

Nicolle finds that some monkeys, particularly Macacus
siniens, show a certain amount of susceptibility to leprous
inoculation, the subcutaneous method of inoculation is the
only one productive of results, and the best results are
obtained after successive inoculations. Inoculation accord-
ing to experimental research varies from twenty-two to
ninety-four days; the lesions produced are transitory,
although many leprous bacilli have been shown by Nicolle
within the large mononuclear leucocytes.

“ British Medical Journal,” October 20, 1906.
I.—Nore on А FILARIAL LARVÆ IN THE BLOOD OF A
BLACKBIRD.

Symmers, Wm. St. Clair, found in a dead blackbird
(Terdus merula), іп his garden at Belfast, Ireland, filaria
embryos in active movement in the heart blood. The larvæ
resembled closely Filaria perstans, being without a sheath
and having both extremities blunt. In size it is smaller
than perstens and is apparently identical with the larva
described by Manson in “ Natives of British Guiana.” The
parent worm was not found in the blackbird. Avian
filariasis is well known in several parts of the Tropics, but
the discovery of the embryo in the British Isles, by
Symuners, is of great interest, especially in regard to the
geographical distribution of this parasite.
Il.—MEMoRANDUM ON THE OBSERVATION OF SPIROCHETES

IN YAWS AND GRANULOMA PUDENDI.

MacLennan, Alex., in smear preparations from yaws sent
from $t. Vincent, West Indies, by Dr. Branch, found
spirochetes similar to those of Spirochete pallida, In
one preparation taken from a papilloma in recurrent yaws,
numerous spirochwtes were observed.

In two smear preparations from Granuloma pudendi
sent by Dr. Branch, Dr. Mackennan found spirochetes,
probably refringens. In one smear the parasites were
found much longer than the Spirochete pallida, and the
waving finer and closer; as many as forty waves being
counted in one specimen.

i III.—Langv.E IN THE INTESTINE.

Drew, Н. V, F.R.C.S., writing from Timaru, New Zea-
land, states that some two years ago he had as patients a
mother and child suffering from a nest of insects” similar
to the condition described in the British Medical Journal
of July 14, 1906. Mr. Drew states that the mother showed
him * insects with rounded, hard, hairy backs, dark brown
in colour, with blaek eyes, extremely repulsive looking,
which ran about quickly.” Santonin and purgatives brought
away large numbers of these insects. Mr. Drew suggests
they may be those of bot-tlies, and enquires what is known
concerning them.

Rotices to Correspondents,

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2. — As our contributors are for the most part resident abroad,
proofs will not be submitted to those dwelline outside tho United
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4.— Authors desiring reprints of their communications to the
JOURNAL OF TROPICAL MEbiCINE should communicate with the
Publishers.

5.—Correspondents should look for replies under the heading
* Answers to Correspondents.”

November 15, 1906. |

Original Communications.

MALARIA IN GREECE.

An address delivered to the Oxford Medical Society on
November 29, 1906.

Ву RoNarp Ross, F.R.S., С.В.
Professor of Tropical Medicine, University of Liverpool.

(Professor Osler, M.D., F.R.S., in the Chair.)

PROFESSOR OSLER AND GENTLEMEN, —I consider
myself extremely fortunate in being able to introduce
the subject of malaria in Greece to my countrymen,
through such a very appropriate avenue as the Oxford
Medical Society. I was actually considering how the
introduction might best be effected when I received
the invitation from your Secretary to address you to-
night. For where could any one who wishes to dis-
course of Greece do so much better than in Oxford—
herself the daughter of Greece, who has borne through
the ages the torch first fired in that divine country ?
And, since my subject is ZEsculapian, what audience
could I find fitter than yourselves? But my luck does
not end here; for in you, Mr. President, I have
chanced upon the fittest of all presidents, eminent
alike in science and in the humanities, to both of
which my theme appeals. Further, when I first
opened my beggar's wallet for subscriptions in aid of
the cause which I have to advocate to-night, it was
yourself who contributed the first dole—a goodly
number of solid drachmw, іп aid of Greece. The omens
are therefore propitious, and if I fail it will be the
fault of myself rather than of fortune.

First let the Muse explain (she is sorry that she
cannot do it in hexameters) how it came that so
humble an advocate as myself was selected for so great
a client. Early in the year І was asked by a British
Company, which owns certain large tracts of land in
Greece, to go there in order to advise as to the best
means of reducing the malaria which for а long time
had been persecuting the Company's employees. I
arrived in Greece towards the end of last May, and
there, sure enough, found Andromeda in tears, await-
ing the onslaught of the fell monster which was just
then preparing to arise (metaphorically speaking) from
his long winter sleep in order to devour her. After
inspecting the latter, instead of slaying him outright,
I determined, more wisely than heroically, to retire
for assistance, and I am here to-night in furtherance
of that intention.

Now let me begin by describing exactly my own
experiences in. Greece. Ав eyeryone knows, the
country consists principally of a mass of mountains
with small valleys between them, here and there, and
many straits and inlets of the sea. In fact, the con-
figuration is very like that of the Highlands of Scot-
land. The scenery does not possess the great variety
of colour caused by the light and shade of the humid
atmosphere of the Highlands; it is brightly but
uniformly coloured. On the other hand, its compara-

THE JOURNAL OF TROPICAL MEDICINE.

341

tive aridity is compensated for by a singular beauty
and variety of contour, which are not excelled in the
Alps or even іп ће Himalayas. High enough to retain
for most of the months of the year an exquisite lacing
of snow, the mountains, though barren and stony,
make a long vista of outlines against the very lovely
sky. I have never seen a sky equal to that of Greece.
In the Tropics a yellow light is reflected from the
burning ground upon the lower strata of the air, and
only the zenith is blue; but in Greece the azure ex-
tends almost down to the horizon, except for a narrow
margin of brilliant silvery or pearly light. After sun-
set the sky seemed to me to possess, not the deepnight
blue of the Tropics, but a wonderful purple tint of its
own, in which the “ new-bathed stars ” shine with a
brilliance not exceeded even in the desert. At mid-
day, the almost tropical glare of the sun on the chalky
soil is relieved by the dark shades of the plane trees
and the classical cypresses, and the bright green of the
vines. lt has been my fortune to see many beautiful
countries, but I think that Greece and Britain hold
the palm.

The particular valley which I was called upon to
visit was that of Lake Kopais, in Beeotia. After leav-
ing Athens, the comfortable train winds along between
Mount Pentelikon on the south and Mount Parnes оп
the north. Then, passing across the eastern spurs of
Parnes, in full sight of the Island of Euboia and its strait
on the right, it enters the valley of Thebes. Traversing
this it goes through the defile of the Sphingion (where
the Sphinx used to waylay travellers with her riddles)
and emerges on the Kopaik Plain. This is а large area
about six miles broad and twelve miles long, the long
axis pointing west and east. On the east the plain is
bounded by the Mountain of the Sphinx, which seems,
from certain points of view, to have the shape of &
woman's figure reclined along its crest. Along the
whole of the south side runs the beautiful range of
Helikon, the Mountain of the Muses. The birthplace
of Hesiod is in one of its valleys; and near one of the
summits there is the famous fountain of Hippokrene,
where the winged horse, Pegasus, took flight for
heaven, owing, it is said, to some annoyance from the
literary critics of the day. At the western extremity
of the plain rises the magnificent mass of Mount
Parnassus, the Mountain of Apollo, with its summits
clad in dazzling snow. But to resume. Тһе Корак
Plain itself is almost absolutely flat right up to
the feet of the hills which bound it, being, indeed,
the dried bed of a lake. In ancient days, according
to the interesting writings of Dr. J. G. Frazer,
of Cambridge, this lake was & large sheet of water
in the winter, and, in the summer, & series of
marshes overgrown with sedge, with rivers winding
through them and patehes of dry land between. Тһе
lake was drained in very remote times by the people
of Orchomenos, a town upon its banks, and the re-
mains of the drainage works are still visible. Тһе
water enters from numbera of small rivers and streams
gushing out of the surrounding mountains, and natur-
ally escapes, singularly enough, into great caverns, of
which there are many, called katavothre. Іп the
Middle Ages the drainage works appeared to have
been allowed to fall out of repair; but recently a
French company resumed the task; and, still more

THE JOURNAL OF TROPICAL MEDICINE.

recently, the work was taken up by the British Com-
pany, the Lake Kopais Company, which asked me to
study the malaria for them. The whole bed of the
ancient lake is now a great plain covered with crops
of all kinds, which repay the cost of the engineering
works. The water is at present discharged through
adjacent valleys into the sea.

It was here that the malaria was so troublesome.
The Lake Kopais Company has many hundreds of
employees and tenants, who were constantly being
attacked, although most of them were natives of
Greece. It had not been found possible to keep
accurate statistics of the annual number of cases ; so
that my first care was to make ап estimate for myself
of the amount of malaria present. This can be done
with a fair degree of accuracy, without the help of
statistics, in two ways —by ascertaining the proportion
of people which, first, have the parasites of malaria in
their blood, and, secondly, possess enlarged spleens.
The first method was much used in India by Stephens
and Christophers, who called the ratio of infected
persons to the total population the endemic index. To
obtain an absolutely correct figure by this means we
must make an exhaustive mieroscopieal examination
of the blood of every person in the area under con-
sideration ; but this would be too laborious for prac-
tical purposes; and we must consequently content
ourselves with an approximate valuation obtained by
examining only a part of the local population. Ав
shown by these observers, and by Professor Koch, 16
is especially the native children in a malarious locality
who have the parasites in detectable numbers—the
older people becoming comparatively immune. Тһе
blood of & number of unselected children is therefore
carefully searched for the parasites, aud the ratio so
obtained is recorded as the approximate endemic
index. For exact work a large number of children
must be examined, as otherwise the margin of error, as
shown by Poisson's formula, will be very considerable.
For example, if 50 children be examined, and 25 of
them be found to contain parasites, the error will be
no less than 20 per cent. ; so that the approximate
endemic index will not һе 50 per cent., as a hasty
observer may think, but anything between 30 per cent.
and 70 per ceut. This fact is worth recalling, because
it has been much overlooked in recent work on the
subject, and because it shows how laborious the
method really is. Тһе second method, that of ex-
amining children for enlargement of the spleen, a
thing which can be done in a minute, is much easier,
and fairly trustworthy, provided that no other cause
for splenomegaly is present.

With the valuable assistance of Dr. Kardamatis,
General Secretary of the Grecian Anti-malaria Society,
and of Mr. D. Steele, Manager of the Lake Kopais
Company, in Greece, I was able to use both methods.
The Company’s houses are on the southern border of
the plain, close to the site of the ancient Haliartos,
where the Spartan Lysander was defeated by the
Thebans, 395 в.с., and to the reputed grave of
Alkmene, the mother of Hercules. The houses are
built just where the slopes of Helikon begin to rise
from the plain; so that they were obviously not too
highly situated to be affected by the malaria. On
exunining 57 of the employees, most of whom were

[November 15, 1906.

Greeks, we found enlargement of the spleen in 14 and
the parasites in 9. But 5 of those that had parasites
had no enlargement оѓ. the spleen, and must be added
to the infected list, which therefore amounts to 19 out
of the 57, or one-third. The majority of these people
were adults; and many bad come from other locali-
ties, so that the figures are not useful for statistics.
Our next care was to examine the people in some of
the neighbouring villages. Out on the plain, about a
mile or more from the Company’s houses, there is the
village of Moulki, containing some 350 inhabitants. The
houses are closely clustered together, with very irre-
gular and elementary lanes between them. Going to
the village inn close to the school, we set to work and
examined 80 persons, mostly children ; first, by palpat-
ing them for enlargement of the spleen, and secondly,
by.making dried films of their blood for future micro-
scopical enquiry. The scene was most interesting.
Seated under a large tree, with the village priest as our
patron and protector, we pricked and palpated the
little ones, one by one. І never.saw pluckier children.
Scarcely one of them even winced at the vivisection.
Nearly all of them were very intelligent, and many
good looking; but, alas! most of them were far from
well, and some looked miserably ill, emaciated and
angmie. The cause was speedily revealed. Out of
62 of the children, between the ages of 5 months and
14 years, no less than 35 were found to have enlarged
spleens; and as no other cause of endemic spleno-
megaly, such as kala-azar, could be ascertained to be
present in the locality, we could attribute the enlarge-
ment in these children only to malaria. This diagnosis
has been fully confirmed by subsequent examinations
of the blood films, which showed that the parasites
existed in at least 17 of the 62 children at the time
when the films were made. Of these 5 had an appre-
ciable enlargement of the spleen, so that this number
must be added to the number of spleen cases in order
to arrive at the total yieldiog evidences of infection.
Hence, out of the total 62 children, no less than 40
were certainly infected—a ratio of them of 64:5 percent.
This is, of course, the lower limit of the ratio, because
itis quite possible, and indeed very likely, that the
parasites were overlooked in some of the films. Such
a ratio was unexpectedly high for any European
country, and is alinost equal to auy that has been
found in Indian or African children. .
I may add that in many. of the children the splenic
tumour was very great, reaching almost to the crest of
the ilium. This is important, in view of statements
recently made in India to the effect that great splenic
tumour is probably due to kala-azar, rather than to
malaria. The former disease is apparently not present
in Greece, the Leishmania donovani parasite never
having been discovered there. Moreover, the Grecian
cases were markedly different from the cases of kala-
azar studied by me in Assam, in 1898, for the purposes
of an oflicial report. In not a singie one of the former
did we note any enlargement of the liver, so commonly
seen in kala-azar; there was not the constant fever of
kala-azar, the expression of the face was the uncon-
cerned expression of malaria rather than the hopeless
look of the deadly eastern disease; and lastly, the
death-rate was far too small for the latter. Neverthe-
less, the splenie enlargement in & few of these cases of

November 15, 1906.) THE JOURNAL OF TROPICAL MEDICINE.

343

pure malaria was, I think, as great as anything I saw
in kala-azar. Of course, many of the children were
shockingly anemic and emaciated—not in any way, І
was informed, from lack of food, nor, apparently, from
the great prevalence of other diseases. The work was
clearly that of the spirit of the marsh.

The next thing to do was to find the source of the
malaria, or rather its carrying agents, the local
Anophelines. Ав I have said, the Kopaik Plain is
now drained and cultivated over its whole extent; but
numerous small streams enter it from the surround-
ing hills, traverse it, and discharge into the main
channels of drainage. These streams are swollen
torrents in the winter, but in the summer often be-
come trickles of water with occasional marshy borders
here and there. Several such streams enter the basin
near Moulki; but at that season (May to June) we
could find no Anopheline larvæ in them, though some
have been found subsequently, as we conjectured
would happen with the advance of the dry season.
But in addition to these streamlets there exists a long
series of shallow pools suitable for the larvee in the
“ borrow-pits " made by the engineers who con-
structed the railway embankment across the plain.
Sure enough, in some of these pits close to Moulki we
found the peccant insects, the larve of Myzomyia
maculipennis, » known carrier of malaria. These
gnats, rising from the pools, pour into the villaye
and into neighbouring houses, such as those of the
Company; become infected by biting the numerous
infected children ; and then infect any healthy persons
whom they may subsequently bite. Тһе old drama,
now so well known, was obviously being played out
before our eyes.

After having dealt with Moulki we examined the
conditions at another village of about 575 inhabitants,
situated several hundred feet high on the hills south
of the Company's houses, and called Mazi. Out of
40 school children, we found enlargement of the
spleen in 13, and the parasites of malaria in 16. Of
those that showed the parasite, 7 had no enlarged
spleen; so that we must add them to our total of
infected children, giving 20 infected out of & total of
40 examined, that is, one-half. This is a large pro-
portion, and we expected to find some breeding pools
of Anophelines close at hand. Іп this, however, we
failed; though we saw some lime pits which we thought
might become suitable for the larve аба later season.
But, nevertheless, there was no difficulty іп explain-
ing the malaria at Mazi, since we learnt that every
year nearly the whole population descends to the
plain for the harvesting in the month of August (the
most malarious month) and bivouacs there for days
or weeks. Doubtless the people of Mazi become in-
fected on these occasions; though I suspect that
breeding pools will be found close to the village by
more extensive search. . DEM ;

My time being very limited, we could make only-
hasty studies at other spots. Across the Plain lies
the village of Skripou, on the site of the ancient
Orchomenos. Here we found splenic enlargement
in exactly half of 40 school children examined ; but
had no time to take blood films. The village is
evidently intensely malarious. We had time to look
for mosquito larve only in one spot, the beautiful

Fountain of the Graces, which gushes out of the
mountain and spreads in a small marsh near at haud.
Here, again, we found the shameless insects desecrat-
ing the divine spot. What must have happened when
the Graces bathed there I cannot say. We saw only
washerwomen and geese.

Thus on the borders of the Kopaik Plain we had
examined 142 children and had found certain evidence
of malaria in no less than 80, or 57 per cent., a very
high malaria rate. But we soon obtained evidence
that the disease is not confined to this low-lying area.
Livadhia is a beautiful little town of 6,250 inhabitants,
situated 510 feet up the spurs of Helikon, some miles
beyond the western end of the Plain and facing Mount
Parnassus. It begins at the romantic gorge where
was the Oracle of Trophonios in former days, and
where the two springs of Lethe and Mnemosyne—
Forgetfulness and Memory—now flow out of the rock.
Notwithstanding the height of the situation and the
absence of any apparent marshes close at hand, we
found enlargement of spleen in 16 out of 100 school
children here. The infection is probably obtained in
lower areas oulside the town; but we had no time to
make any search for the Anophelines. We spent some
hours also at Thebes itself. This famous place, which
used to contain 40,000 inhabitants now contains only
4,780. Situated on a rocky eminence in the midst
of a large plain, the historic Kadmeia, it is considered
to be very fairly healthy; and indeed we found en-
largement of the spleen in only one child out of 50
examined; and failed in obtaining any larve of
Anophelines in several small pools round the base of
the renowned citadel. Such researches carried out
on the spot where lived Pindar and Epaminondas,
where Theban, Athenian, and Spartan had frequently
mingled in battle, and where angry Alexander wreaked
his vengeance, were “of the age." I am not certain
whether the little wriggler of the puddles had not
been a worse enemy to Thebes than was the great
conqueror. One remaius, the other has passed away
for ages. If Diogenes had possessed our present
knowledge he might have made a still more caustic
reply to his powerful visitor.

Thus, altogether, out of 292 unselected children
examined by us in five different places, we found
unmistakable evidence of malaria in 97, or one-third.
In addition to the children we examined 18 adults
at Moulki. Asis now well known, the adult natives
of a malarious locality become comparatively immune,
their spleens returning to the normal size, and the
parasites becoming extremely scarce in their blood.
Nevertheless, we found signs of malaria in 4 of these
adults, but, оѓ" course, such figures are not useful for
estimating the endemic index. Including all, we found
certain evidence of malaria in 120 out of 367 persons,
or 32 per cent. The figures for the children, however,
give.a reliable and high. malaria rate, especially when
it is: remembered that they were collected at the
beginning of the summer, before the annual malaria
season had commenced. Later in the year the endemic
index would certainly have been still higher. If,
moreover, we had examined the blood of the 200
children dealt with &t Orchomenos, Livadhia, aud
Thebes, we should certainly have been able to add
many other cases of infection to our list; while lastly,

344

THE JOURNAL OF TROPICAL MEDICINE.

[November 15, 1906.

we should remember that in all cases of malaria the
parasites frequently become temporarily too few for
detection by the microscope. Our total estimate of 33:2
per cent. infected children must therefore be much below
the maximum ratio, and may be looked upon as a
minimum ratio. The statistical corrections by Pois-
son's formula works out at 7:7 per cent.; so that we
have finally for the five localities, Moulki, Mazi, Orcho-
menos, Livadhia, апа Thebes, a minimum child-malaria
rate of between 25:5 per cent. and 40:9 per cent. The
truth is, probably that at Moulki and Orchomenos ail
the children are really infected in the autumn.

With regard to the number of breeding places of
Anophelines we found them only in two small pools,
one at Moulki and one at Orchomenos ; and the former
of these was immediately drained away by Mr. Steele,
of the Lake Kopais Company. . The season, however,
was early, and our search far from exhaustive. Many
more pools will, of course, be found ; but, nevertheless,
I infer that the amount of breeding surface per square
mile of country is extremely small, so that anti-propa-
gation measures ought to be correspondingly cheap.

Such were the results of my own observations; and
I will now give briefly some figures which I obtained
for the whole of Greece. Within the last year or two
there has been founded at Athens an admirable Malaria
Society for the study of such questions. It is under
the patronage of H.M. the King of Greece, and consists
of many enthusiastic members One of these is my
friend, Dr. Savas, Professor of Hygiene at the Uni-
versity of Athens, and Physician to the King of
Greece; and the General Secretary is my friend
Dr. Kardamatis, who gave me so much assistance
at Lake Kopais. І сап testify to the complete know-
ledge of the subject possessed by both of these gentle-
men—whom I mention more particularly than their
colleagues, because I was brought more especially into
contact with them; to their zeal in the cause, and to
their philosophie grasp of the importance of the ma-
laria question for their country. From them I obtained
the following approximate figures for the whole of
Greece :—

Population of Greece 2,133,806
Average annual number of cases

of malaria T 24% е7 250,000
Average annual number of deaths

from malaria = ДИ 1,760
Number of cases of malaria during

1905 an NA h 960,048
Number of deaths from malaria

during 1905 5,916

These figures are, I think, as sound as any that can
be collected from statistics. Malaria is a very difficult
disease to deal with in this way ; because it does not
consist of а single severe attack demanding immediate
medical assistance, but rather of a series of compara-
tively slight attacks extending over a period of years,
and, moreover, occurring principally in young children.
Many cases do not find their way into the returns
at all; while, on the other hand, relapses must be
frequently entered as fresh infections. Ав for the
death-rate, comparatively few cases die simply of
malaria, but many are carried. off by intercurrent
pneumonia or diarrhwa, or perish gradually from

anemia, under which headings the mortality is often
recorded. The figures given above, however, agree
entirely with my own estimate of the endemic index
round Lake Kopais; and I believe that if similar
methods could be used all over Greece—if all the
children in the country could be examined —it would
be found that an extremely large proportion of them
are constantly infected. Last year was & very bad
year, with a recorded death-rate of 2:4 per thousand
of the population. Nor is the malaria of a benign
typein Greece. Оп the contrary, I was informed by all
the gentlemen mentioned above and also by а number
of medical men whom I met at Thebes and Livadhia,
that pernicious attacks are very common, and that the
most serious form, that of blackwater fever, is ex-
tremely common. Such facts are recorded also іп the
writings of Kardamatis, Savas, and other able Greek
observers. The disease is therefore extremely, if not
shockingly, rife in the country—much more so even
than in Italy. Dr. Savas told me that from some
statistics which he had studied the number of cases
&nd deaths in Greece are half again as numerous as in
Italy for equal numbers of people. АП species of the
parasites are to be found in Greece. Іп our own
studies the mild tertian parasite occurred most fre-
quently, the so-called malignant species next com-
monly, and the quartan least of all—but not rarely.
As I have said, blackwater fever, the worst form of
malaria, has been very common in Greece. Regarding
the species of Anophelines, which carry malaria in the
country, Dr. Savas told me that out of 1,839 of these
insects, 1,778 were found to be Anopheles maculipennis,
21 to be Anopheles bifurcatus, and 20 to be Pyreto-
phorus superpictus, all well-known agents of the
disease.

Now, what must be the effect of this ubiquitous and
everlasting incubus of disease on the people of modern
Greece? Remember that the malady is essentially
one of infancy among the native population. Infect-
ing the child one or two years after birth, it perse-
cutes him until puberty with a long succession of
febrile attacks, accompanied by much splenomegaly
and anemia. Imagine the effect it would produce
upon our own children here in Britain. It is true
that our children suffer from many complaints—scar-
latina, measles, whooping-cough—but these are of
brief duration and transient. But now add to these,
in imagination, a malady which lasts for years, and
may sometimes attack every child ina village. What
would be the etfect upon our population, especially
our rural population—upon their numbers and upon
the health and vigour of the survivors? It must be
enormous in Greece. People often seem to think that
such a plague strengthens a race by killing off the

‘weaker individuals; but this view rests upon the un-

proven assumption that it is really the weaker children
which cannot survive. On the contrary, experience
seems to show that it is the stronger blood which
suffers most—the fair, northern blood which Nature
attempts constantly to pour into the southern lands.
If this be true, the effect of malaria will be constantly
to resist the invigorating influx which nature has pro-
vided; aud there are шапу facts in the history of
India, Italy, and Africa which could be brought
forward in support of this hypothesis.

November 15, 1906.)

We now come face to face with that profoundly
interesting subject, the political, economical, and his-
torical significance of this great disease. We know
that malaria must have existed in Greece ever since
the time of Hippocrates, about 400 B.c. What effect
has it had on the life of the country? Іп pre-
historic times Greece was certainly peopled by suc-
cessive waves of Aryan invaders from the north —
probably a fair-haired people—who made it what it
became, who conquered Persia and Egypt, and who
created the sciences, arts, and philosophies which we
are only developing further to-day. That race reached
its climax of development at the time of Pericles.
Those great and beautiful valleys were thickly peopled
by a civilisation which in some ways has not since
been excelled. Everywhere there were cities, temples,
oracles, arts, philosophies, and a population vigorous
and well trained in arms. Lake Kopais, now almost
deserted, was surrounded by towns whose massive
works remain to this day. Suddenly, however, a
blight fell over all. Was it due to internecine conflict
or to foreign conquest? Scarcely; for history shows
that war burns and ravages, but does not annihilate.
Thebes was thrice destroyed, but thrice rebuilt. Or
was it due to some cause, entering furtively and
gradually sapping away the energies of the race by
attacking the rural population, by slaying the new-
born infant, by seizing the rising generation, and
especially by killing out the fair-haired descendant of
the original settlers, leaving behind chiefly the more
immunised and darker children of their captives, won
by the sword from Asia and Africa ?

Those who havo read Dr. W. North's fascinating
book on “ Roman Fever” (Sampson Low, Marston
and Co., 1896) will remember the suggestion that the
depopulation of the Campagna was due to the sudden
introduction of malaria by the mercenaries of Sylla
and Marius, and so recently as 1866, as we know from
the works of Dr. Davidson, of Edinburgh, malaria
entered and devastated the islands of Mauritius and
Reunion, either the mosquito or the parasite having
been then brought in from without. Similarly, could
it not have been introduced into Greece about the
time of Hippocrates by the numerous Asiatic and
African slaves taken by the conquerors? Supposing,
as is probable, that the Anophelines were already
present, all that was required to light the conflagra-
tion was the entry of infected persons. Once started,
the disease would spread by internal intercourse from
valley to valley, would smoulder here and blaze there,
and would, I think, gradually eat out the high strain
of the northern blood.

I cannot imagine Lake Kopuis, in its present highly
malarious condition, to have been thickly peopled by
а vigorous race; nor, on looking at those wonderful
figured tombstones at Athens, can I imagine that the
healthy and powerful people represented upon them
could have ever passed through the anemic and
splenomegalous infancy (to coin a word) caused by
widespread malaria. Well, I venture only to suggest
the hypothesis, and must leave it to scholars for con-
firmation or rejection. Of one thing I am confident,
that causes such as malaria, dysentery, and intestinal
entozoa must have modified history to a much greater
extent than we conceive. Our historians and econo-

THE JOURNAL OF TROPICAL MEDICINE.

345

mists do not seem even to have considered the
matter. It is true that they speak of epidemic
diseases, but the endemic diseases are really those of
the greatest importance.

The same cause works the same evil in modern
Greece. Though the country has been freed from
the Turks for seventy years, aud enjoys what is con-
dered to be (though personally I doubt it) the best
form of government, yet its population has not in-
creased very much. Athens has about 130,000 inhabi-
tants, and Patras, the next largest city, about 40,000 ;
and the other towns are scarcely more than large
villages. The rural areas contain small and poor, but
not destitute, hamlets; but what strikes one most in
them is the absence of villas and of large hotels. Few
of the wealtbier people seem to live in the country.
A gentleman of Athens told me that he bought a
shooting-box, but that he was attacked by malaria
when he went to stay there. The inns are compara-
tively small and shabby, and not likely to be fre-
quented by many modern tourists, and the methods
of communication are primitive. This is very sur-
prising, because one would think that such a country
would be the Mecca of all the tourists of Europe and
America, who would pour their millions of pounds
into it, just as they do into Switzerland. But, of
course, the reputation of unhealthiness possessed by
many of the.rural tracts is fatal; the tourist thinks
twice about going to them, and the innkeeper hesitates
about spending his capital in a locality where he and
his children may expect to be frequently ill.

The whole life of Greece must suffer from this
weight, which crushes its rural energies. -Where the
children suffer во much, how can the country create
that fresh blood which keeps a nation young? But
for a hamlet here and there, those famous valleys are
deserted. I saw from a spur of Helikon the sun
setting upon Parnassus, Apollo sinking, as he was
wont to do, towards his own fane at Delphi, and
pouring а flood of light over the great Kopaik Plain.
But it seemed that he was the only inhabitant of it.
There was nothing there. “ Who," said a rich Greek
to me, “ would think of going to live in such a place

as that?" I doubt much whether it is the Turk
who has done all this. I think it is very iargely the
malaria.

Now, regarding the remedy. Science has, of course,
shown absolutely that the disease is carried by gnats,
and, in doing so, has indicated several methods of
prevention. First, there is the method of excluding
gnats by the careful use of mosquito nets and wire
gauze screens to the windows—useful for the houses of
the rich, but too costly and troublesome for the poor.
Then there is the method of Koch, the cinchonisation
of all the patients, by which they themselves are
benefited, while the gnats do not become infected and

* therefore do not spread the parasites ; but this implies

rigorous dosing with quinine for months—a thing
which patients and the mothers of children will not
submit to. But the method which I first suggested
and elaborated in 1899, namely, the reduction of
mosquitoes, is the one which I prefer, and the one
which, after seeing the conditions in Greece, I prefer
more than ever. It is, of course, the old Roman plan
of drainage against malaria, with this important differ-

346

THE JOURNAL OF TROPICAL MEDICINE.

[November 15, 1906.

ence, that we are now no longer compelled to drain
the whole surface of а malarious area, but only those
small pools in which the Anophelines breed. This
method has the immense advantage that it can he
carried out by local authorities without troubling the
people ; while in the end it is sure to be more econo-
mical and lasting in its effects than other methods
which, I think, are apt to cause waste both of moncy
and effort. To Greece it is most especially applicable.
There, the rainy season is the winter, when the mos-
quitoes do not breed; so that in the arid summer they
can find only very few suitable breeding pools. So
much the easier and cheaper will it be to treat these.
They can Бе rendered uninhabitable for the larva by
drainage, by filling up, by deepening. by dragging the
weeds, and in the last resort by periodic oiling. Where
earried out with intelligence and lovalty, as in Havana,
the Federated Malay States, and Ismailia, the work
has proved comparatively easy and cheap, while the
results (now so well known) have been of the most
briliant kind. I think that Greece, owing to the
scarcity of surface water suitable for the larvae in the
summer, will be easier to deal with than any of these
places— easier even than Ismailia, with its irrigation
system. It will be strange indeed if so intelligent a
nation cannot carry out such siniple measures in order

to rid itself of a plague which has oppressed it for
ages.

The Grecian Malaria Society has commenced the
work with energy. It has investigated local condi-
tions ; has issued numerous tracts to the people; has
urged railway companies to screen stations, aud
Government to undertake drainage. — Dr. Savas
suggests Government regulation of the sale of quinine
in order to improve and cheapen the drug—a most
necessary item. At Athens, where malaria exists only
along the bed of the Ilissos, the stream has been
“trained” in many places. Presently I hope we
shall see a survey made of the malaria and the local
breeding places in the whole of Greece, preparatory to
a general onslaught on the foe. When I wasin Athens
І had the pleasure of speaking to М. Theotakis, the
Premier, and Mr. Boutidis, the President of the
Chamber, and am sure that the Government will do its
best to support the campaign. But the Society will
have to fight many enemies, chief arqng which will
be the incredulity and indifference of the public. I
have therefore suggested that we in Britain may help
it by doing something to show our support of it. The
Liv erpool “School of Tt ropical Medicine has accordingly
offered its assistance, which has been accepted by the
King of Greece; and under the patronage of H.R.H.
Princess Christian, we have opened a list of sup-
porters, which now includes many eminent names,
beginning with those of the Greek Minister in London,
the British Minister in Athens, the Presidents of the
Roval Society and the British Academy, the Royal
College of Physicians, and many Greeks residing in
Britain, It often happens that a little foreign support
will do more to encourage a cause than much local
effort can до. If any of you wish to join us we shall
welcome you most heartily. You have but to write a
no'eto me or to our Secretary, A. Н. Milne, Esq., 1310,
Exchange Buildings, Liverpool.

When matters are in proper train, every year will

see the removal of a number of the little marshes
which are £o injurious to the country—every year will
see a decrease in the malaria. I venture to say with
confidence that, give us but the necessary means—and
we do not require much—there is no country in the
world from which we could not extirpate the disease.
Hitherto we have contented ourselves with diminishing
it in isolated towns. Let us now deal with whole
nations. Remember that it has actually been ban-
ished from Great Britain, almost by unconscious
agencies. We have only to imitate those agencies
consciously. What a triumph it will be for that great
science, of which all of us are the humble votaries, if
she can wipe out this miasm, this detilement, from an
entire country. I will not hésitate—such is our
ambition. And that country is Greece.

I asked a Greek friend why his countrymen did not
restore the Parthenon. Не replied it was because
they were unwilling to touch the sacred ruins without
the assent of the whole world, to whom they belonged.
So also Greece belongs to the whole world. We all
share in her troubles and should do our best to relieve
them. Many years have passed since Byron gave his
life for Greece. Не attributed her misfortunes to loss
of liberty. Perhaps so; but I think that an enemy
more inveterate than the Turk has also destroyed her.
Not least among the nations, Britain has studied to
help her against “her human enemies. Should we not
help her now against the more potent enemy which
we have discovered. That Science which, more than
two thousand years ago, she created is at our side
urging us on. We have no doubt of the result—we
need only to nerve the arm to strike.

Gentlemen, it was my good fortune to stand the
other day at a spot from which can be seen within
eyeshot the birthplaces of science, art, philosophy,
the drama—of Europe, of our modern civilisation.
lt was a great rock rising in the midst of a city built
on a plain—not a boundless uninteresting expanse,
but a plain, defined as such by a cincture of beautiful
mountains. I have known many of the loveliest
scenes of this wonderful earth, but nothing altogether
equal to the Attic plain. The rock was the Acropolis ;
and the setting sun flooded it with light. Upon it
rose those ruins which are unsurpassable, unpaint-
able and indescribable, because they were built, not
only for themselves, but for the visions which surround
them—the Propylæa, the Erechtheion, the Parthenon.
And who was the god for whom that temple was
built—which of all those gods, who are not dead as
some imagine, but who live now and will live for ever
until, as the poet says, ‘the future dares forget the
past"— who live because they are the everlasting
types of our own spirit? That goddess whose birth
and vietory were recorded on the pediments of the
Parthenon ; who sprang, not from the common zygosis
of Nature, but full-armed from the head of Zeus at the
touch of Fire and Toil; who conquered the Deep
himself. Study her attributes, perceived and recorded
in legend by the sages who lived before history was
barn, and we shall know her. Without human Weak-
ness, she Jed Ulvsses through the dangers of the
Deep, she gave Perseus the weapons with which he
slew the monster of the Deep, she destroyed the city
of the Deep, she made Athens triumph over the Deep,

November 15, 1906.)

and to-day has lifted man in a few centuries from the
Deep to heights unimagined before—Science herself.
The Parthenon was the temple of Science. The great
fizure of Science, standing before it, dominated the
whole of Greece. At its gates, even, stood the figure
of Hygeia, the Science of Health, whom we now
invoke. Science is the goddess whom we serve, as
did the ancient Athenians, because we know that she
and she alone can save us from these elements of the
Deep which oppress us. We are her servants. We
honour not the baser gods—the quack remedies, the
sham philanthropies, the false knowledges, the
mock philosophies, the whining pities, the lying
politics which keep men down in the depths, We
acknowledge only the intellect which sces the truth
and smites the evil. Let us pray Pallas Athena to
revisit the land where she was born.

———— А

OPERATION LEUCOCYTOSIS.

Dy P. N. Gerrarp, В.А. В.Сһ, В.А.О., M.D.(Dublini,
D.T. M. H.(Cantab,. :

` Federated. Malay States,

As it falls to the lot of surgeons very rarely to profit
both their patients aud themselves, by what I must
.insis& upon calling a surgical error, the case quoted
below, in which both of these happy contingencies
occurred, may be of interest to the profession.

Polgadu, aged 23, coolie, Tamil, male, was admitted
to Parit-Buntar Hospital on May 29th, 1906, com-
plaining of abdominal pain, and constipation for two

days. The abdomen was noted as being distended and’

tense. .
My absence at the time of his admission, on sick

leave, prevented ine from seeing the case until June
16th, on which date the following symptoms presented
themselves :—

The patient was emaciated and evidently suffer-
ing, his complaint being entirely referred to the lower
part of his abdomen. Ніз temperature rose at night
to 102°, and was usually 99° in the mornings.
Bowels constipated, urine regular and healthy, save
that on the day of his admission it had to be drawn
off by catheterisation ; his mouth was dry, and his
tongue was dry and somewhat furred ; his pulse was
rapid and atonic.

On examination the abdomen was hard and ex-
quisitely tender, more especially in the middle hypo-
gastrium and bladder region, where а tenseness and
an apparent tumour with ill-defined edges existed.

The patient was so ill that I decided upon an ex-
ploratory laparotomy next morning.

The diagnosis at that time lay, to my thinking, be-
tween the following :—

(1) An antero-cystic abscess; the symptoms in
the last case in which I operated having been very
similar to those presenting in this case.

(2) An abscess of the appendix, presenting in the
median line and involving the pelvic peritoneum.

By analogy I was much inclined to the former.

The patient, after proper preparation, was placed
on the table, chloroform was administered, catheterisa-

THE JOURNAL OF TROPICAL MEDICINE.

347

tion performed, and an incision about 24 ins. long
made іп the median line about 1 in. above the pubes.

Having made the preliminary incision [ cut through
the layers of what 1 believed to be greatly thickened
peritoneum (which I had expected to encounter), and
in the bottom of the wound what was apparently a
coil of intestine presented ; as the contents of this
protrusion were apparently clear, I came to the con-
clusion that it was a cyst or hydatid, superficial to the
bladder, and incised it, when I obtained clear urine.
Passing & catheter, there was no doubt left of my
error. On exploring the bladder, however, an interest-
ing eondition revealed itself.

The bladder appeared to be divided into two sacs, an
anterior and a posterior, or, as the patient lay, a supe-
rior and an inferior, the superior being practically cut
olf or delineated from the inferior by the presence of
an oval tumour, formed apparently by distended peri-
toneum pressing against the posterior surface of the
pubes. ;

The bulging peritoneum contained at least fluid, if
not pus, and nothing remained for me to do except
to suture carefully the bladder wound, to tie in а
catheter for drainage, and to proceed to the major
undertaking of opening the peritoneum just below the
umbilicus.

І had hardly completed the cystic suture when the
patient ceased to breathe, the pulse became. inter-
mittent, and all the signs of impending death occurred.
Strychnine and ether were promptly administered,
and I had already commenced artificial respiration
by thoracic pressure, but as no response was apparent
I started to respirate by the Silvester method ; this, to
my surprise, could not be carried out, as all the
patient's muscles were in a state of tonic contraction.
The dose of liq. strychnine administered was 4
minims. I continued for about ten minutes the
intermittent thoracic pressure, but as the pulse
apparently failed, respiration showed no signs of
becoming re-established, and the pupils became fixed,
I gave the case up as dead, and went to wash my
hands, full of vain regrets and disappointment.
Before thirty seconds had elapsed, however, respira-
tion recommenced, the pulse returned, and the patient
became sufliciently well to be removed to his ward,
but not, in iny opinion, sufficiently recovered to pro-
ceed to the completion of the operation.

Owing to a sudden outbreak of cholera in the dis-
trict some miles away I was unable to see iny patient
until Monday, the 18th. His temperature had fallen
to normal I found, after the operation, and had
remained normal, his abdomen was soft, and he was
free from pain, his general condition was good, and he
asked for full diet; his pulse was good, his tongue
clean, the bladder had acted normally, and he
appeared to be on the road to recovery from all his
ailments.

The case made an uneventful recovery, and primary
union of the bladder and of the superficial wound took
place. He left hospital, fat and well, about three
weeks after his operation.

I believe the symptoms to have been due to an
atonie and distended anterior portion of the bladder,
that peritonitis with effusion was present in the first
instance, aud that the case was cured by a determina-

348

THE JOURNAL OF TROPICAL MEDICINE.

[November 15, 1906.

tion of blood supply, and а concomitant local leucocy-
tosis to the pelvis.

This case might well suggest, in these days of
cleanliness, & more frequent exposure of the peri.
toneum in cases of effusion from any cause, with &
view to the absorption of the fluid by means of
stimulation of the pelvic lymphatics and blood
supply.

To the Editors of the JOURNAL or TnoricAL MEDICINE.

Dear Sirs,—I beg to forward an account of an
epidemic of dengue which attacked Port Sudan this
year—Port Sudan being a new town, and the seaport
of the Sudan.

I may say that dengue fever does every year show
itself at Suakim, although not there located in the
text-books. We have had also this year a very sharp
outbreak of quinine dengue at Halfa. I presume that
it made its way along the new Suakim- А ага Railway
to this inland town.

There are so many fevers out here, diagnosed as
simple fever, simple continued fever, sun fever, local
fever, &c., that it is а relief to get one disentangled
and nailed down and labelled, so to speak. There is
another Sudanese fever, although rather a twenty-one
days’ fever than an eight day, which may be mistaken
for typhoid (but it is without abdominal symptoms),
or Malta fever (but it is without throat or joint symp-
toms); it relapses, however, and differs from malaria,
in that it does not yield to quinine.

It might be called low tropical fever, for it requires
change of locality for its cure. It also requires nam-
ing. It is, I think, different in its temperature chart
from the typhoid type, in that the fever is rather of
the intermitting type than the remitting.

Yours faithfully,
J. B. CuristopHerson, M.D., M.R.C.P., F.R.C.S.,
Director Sudan Medical Department and
Physician to Н.Е. the Governor-
General of the Sudan.
Sudan Government,

Medical Department, Khartoum,
September 25th, 1906.

DENGUE IN PORT SUDAN—RED
PROVINCE, SUDAN.

By бешм Saron, M.D.
Medical Officer in Sudan Medical Department.

SEA

THE disease appeared this year as an epidemic in
Port Sudan, the new seaport of the Sudan. The first
case entered the hospital on May 29th, 1906. From
that time it increased rapidly, affecting one part of the
town, then the other, so that by the end of August a
very large number had been attacked.

It affected equally white and coloured people, and
both sexes, and men of every age, except young infants.
One attack did not confer immunity, many patients
having more than one attack. The incubation period
was from two to four days.

Etrology.—Probably the carrier of dengue is the
mosquito. The present epidemic affected chiefly
the houses where it was found, and the disease re-

appeared when there was an increase of mosquitoes
in tbe town.

It was especially remarkable that all people living
in the hospital escaped, though by that time the
wards were full of cases of dengue. "The hospital was
the only place free from mosquitoes: though we were
very careful to destroy the larve present in our water ;
this was the only precaution that was taken.

Onset.—The onset is very sudden, usually coming
on in the afternoon. Prodromata are rare, and when
present they consist of headache, anorexia and rheu-
matic pains. Тһе disease is rarely ushered in by а
chill. A patient describing his attack said: “ I have
been out to work all day, feeling the same as usual ;
about sunset I had headache, and feeling tired I sat
on а chair to rest; suddenly I began to have pains all
over, and half an hour later, when I had to go home,
I was so stiff that two men had to support me all the
way home" .

Such onsets are very common, and it is usually in
such а manner that the disease begins. The fever
then develops rapidly, and with it the headache, and
the pains in the neck and eyeball increase; the pains
in the loins, thighs, knees, and calves are very charac-
teristic and are almost always present; in & word, all
the body is stiff, and the least movement is painful ;
during the night the.patient is unable to sleep and
very restless.

Circulatory System. — Dengue does not affect the .
heart except by raising the pulse from 90 to 120, aud
in very severe cases to 130. Sometimes there is
profuse epistaxis, and this often relieves the headache
and brings down the fever.

Respiratory System.—The most important difference
between influenza and dengue lies in the fact that
the latter does not give rise to pulmonary symptoms.
There might in some cases be a mild laryngeal catarrh
and bronchitis. Тһе respiration during an attack of
dengue is accelerated.

Digestive System.—There is often with the first
symptom very severe pain in the stomach, with vomit-
ing, but these usually subside after the firat two or
three days. Тһе tongue is coated during the attack,
and begins to clear when the fever falls: there is a
complete loss of appetite. During the first three or
four days there is constipation, which is sometimes
followed by diarrhoea, in some cases persisting for a
time after the attack has subsided.

Spleen and Liver.—The liver and spleen are not
affected ; in two cases there was an enlarged spleen,
but this was probably due to the fact that the patient
had malaria before.

In the beginning of an attack there is often a deep
flushing of the face, but the real eruption does not
begin until the third or fourth day. It is present in
most cases, and consists of roseole of the size of a
pin’s head, dark in colour, coalescing and forming
patches of different sizes; this eruption affects the
face, neck, back, forearm, and hands, in some cases
extending to the thigh. The eruption begins to fade
when the fever goes down, and in a short time the
skin desquamates, peeling off in small flakes.

Kidney and Urine.—In the great majority of cases
the urinary system is not affected, a few patients had
albumin, and all of these had an attack of epistaxis.

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JOURNAL

November 15, 1906.)

Nervous System.—The pains in the head, neck and

eyes are the only troubles set up in the nervous
system.
: General Course of the Fever.—After the onset the
fever increases rapidly, rising as bigh as 103? or
104,° and is continuous in character, there being
not more than one degree difference between the
morning and the evening temperature. With the
increase of the fever all the symptoms augment
in severity; this goes on for five or six days, the
fever falls then by crisis, usually in the afternoon.
The pains and the rash then begin to disappear, and
the patient becomes convalescent.

In mild cases the fever falls to normal in the second
or third day, such cases have mild symptoms, but
in severe cases, especially when there are complica-
tions, the fever is protracted, falls by lysis, and
recovery is very slow.

An attack leaves the patient very weak and debili-
tated, the pains in the thigh, knees and calves may
persist for some time, rendering motion painful and
difficult, but gradually the tongue gets clean, the
appetite improves, and the patient is able to resume
his work.

Hyperpyrexia in a Case of Dengue.

Complication.—The most severe complication is
hyperpyrexia, but luckily it is а rare one, and appear-
ing in the very hottest part of the year; in these
cases the patient, after a protracted attack of dengue,
suddenly develops hyperpyrexia, the temperature
rising as bigh as 108° or 109°, this sudden attack
usually happens between 1 and 3 p.m., а comatose
condition supervenes, with a very weak pulse and
stertorous breathing; if he is able to survive the
high temperature he will probably have another rise
in the evening, but this time only to 105° or 106°.
The next day his temperature reaches 104°, falling
down very slowly by lysis. Such attacks are always
followed by severe bronchial catarrh, their duration
is very protracted, leaving the patient weak for a
long time. :

Mortality.—Only two cases died of dengue, both of
them Europeans. Both had long standing emphysema.
After a protracted attack they developed hyperpyrexia
with all its concomitant symptoms, and succumbed in
a very short time.

THE JOURNAL OF TROPICAL MEDICINE.

349

Death was caused by asphyxia, as the bronchi were
full of mucus, rendering respiration impossible. Pro-
bably hyperpyrexia, due to the fact that the disease
affects the brain and meninges. The other complica-
tions have already been mentioned. They consist of
rheumatic pains, epistaxis, and, rarely, albumin in the
urine and bronchitis.

Diagnosis. — The only disease which resembles
dengue is influenza, but the roseolar eruption, the
lack of pulmonary symptoms and the rheumatic pains
render the diagnosis easy.

Treatment.—The disease has а special course to
follow, and there are medicines to help it abort, or
cut it short. I found that the following prescription
is effective by relieving the pains.

Б, Sod. salicylate 10 grs.
Sod. bicarb. 10 gre.
Tinct. aconit. 2 mins.
Aqua. ... 5 1 02.

Liniment of belladonna and stimulants applied ex-
ternally might also relieve the pain. Ав to hyper-
pyrexia, immediate вропріп with ice till the
temperature falls to 99? or 100?, with strong doses of
strychnine; this is to be repeated if the temperature
gets higher again. Аз a tonic nux. vomic., quinine,
and iron, are necessary during convalescence when the
attack has been severe, followed by change of climate
as soon as the patient is able to move.

------о---

* Lancet,” October 20, 1906, p. 1,064.

“А New ASPECT OF THE PATHOLOGY AND TREATMENT OF
Leprosy.

Black, Dr. Robert Sinclair. In a short but extremely
suggestive and interesting paper, the author details some
conclusions he has reached during seven years’ experience of
the Cape Government establishinent for the isolation of
lepers on Robben Island.

Dr. Black entirely disbelieves in Mr. Jonathan Hutchin-
son's fish-eating theory of the disease, and appears to regard
contagion as the only possible method of conimunication. He
believes that in most cases the bacilli first attack the
nasal mucosa, causing a mild chronic rhinitis which is rarely
if ever noticed by either the patient or his medical atten-
dants as a symptom of leprosy.

It isin this condition that the disease is usually communi-
cated to others, and Dr. Black believes that the early recog-
nition and treatment of this condition would go far to limit
the spread of the disease, not only to others, but also within
the tissues of the person already attacked, believing that the
lesions are at first superficial and probably remediable by
surgical measures.

He further believes that leprous erythema is caused by a
toxemia, the toxins being, however, derived not from the
leprous bacilli, but from the abundant staphylococci and
streptococci which are always to be found in leprous ulcers.

* Münch. Med. Woch.,” July 24, 1906.

AGAR-AGAR IN CHRONIC CONSTIPATION.

What seems far-fetched physiological reasoning has been
applied to the treatment of chronic constipation. Agar-
agar in one or two tablespoonfuls with (when it is called
regulin) or without сақсага, is administered daily for a few
days until the bowels aet, when it is gradually reduced to
a teaspoonful. The idea is that the agar-agar swells in the
intestine, and promotes peristalsis by the bulky nature of
the contents it induces.

850

[November 15, 1906.

THE JOURNAL OF TROPICAL MEDICINE.

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Journal of Tropical Medicine

Моуемвев 15, 1906.

A———À

THE CASE OF THE INDIAN HOSPITAL
` ASSISTANTS.

Nor long ago we had occasion to note the dissatis-
faction of the vernacular students of the Lahore
Medical School with the conditions under which they
worked, and it was poiuted out that the agitation
could not in any sense be described as factious, as it
was undoubtedly based on legitimate causes of dis-
satisfaction.

The last received issue of the Pioneer Mail now
brings us the news that ‘‘ the Medical School Club of
Agra, acting on behalf of all medical students and Hos-
pital Assistants, has issued a number of memorials
to all the provincial heads of the medical departments
in India, praying for an amelioration in the pay and
prospects of & class of publie servants who, in the
opinion of the Club, do not enjoy that measure of
official consideration and patronage to which they are
entitled. The complaint is confirmed by the various
official reports, which agree in emphasising the neces-
sity of raising the status of Hospital Assistants. In
spite of these repeated representations, however, noth-
ing seems yet to have been done. — It 15 stated that the
demand on the services of hospital assistants has of
late grown beyond their ability to meet it. In many
cases, owing to the outbreak of plague, cholera, or

some other epidemics, their leave of absence is stopped,
while even normally their pay scarcely corresponds to
the amount of work expected from them.”

Tt will be observed that the memorialists are acting
in a perfectly moderate and constitutional manner, in
pleasant contrast with the methods usually adopted by
the Indian college youth when he thinks himself ag-
grieved ; and, apart from the traditional loyalty of the
Hospital Assistant class, this may be taken as an indi-
cation of their conviction of the goodness of their
case.

It cannot be denied that the class is wretchedly
paid in proportion to the amount and responsibility of
the work expected of it, and the scale of remuneration,
moreover, compares ill with that accorded to public
servants, drawn from a similar class of Indian society,
belonging to other departments.

The pay of civil Hospital Assistants “ with English
qualification," i.e., if capable of reading and writing
English, commences at Rs. 25 per mensem, and rises
to Rs. 55 (or from £20 to £44 per annum about.)

In the executive branch of the Civil Service, the
“ Teshildars," whose nearest European representatives
would be French maires, commence at Rs. 50 and
attain to Rs. 250 per mensem, equivalent to £40 to
£200 per annum. Іп the forest department the pay
of the corresponding subordinates, or “ Rangers,”
commences at Rs. 50, and reaches Rs. 150, with the
probability of promotion to “ Extra Assistant Conser-
vator," drawing, in the highest grade, Rs. 350, or about
8950 per annum. In the police department, the pay
of inspectors runs from Rs. 50 to Rs..200 per mensem.

Now, the Hospital Assistant class are undoubtedly
fully the equals of the members of the contrasted de-
partments in intelligence and education, and are
drawn from much the same strata of native society,
those, in fact, which most nearly correspond to our
** middle classes.” l

The teshildars, no doubt, usually belong to more in-
fluential families than those from which the otber
departments are recruited, but are in no way superior
in education and intelligence, while, on the other hand,
the inspector of police is usually promoted from the
ranks, and though selection for promotion doubtless
implies ability above the average, they are often of
humbler social origin than the medical subordinate.
Like the hospital assistants, the subordinates of the
forest department are specially trained in a Govern-
ment college, mainly at the public expense.

It is difficult to see any just reason for this extra-
ordinary difference of treatment, for it will be seen
that the medical subordinate’s pay finishes pretty much
about the scale at which the others commence, but
the depreciation of medical work runs right through
all branches of the department, the pay of assistant
surgeons, though fully qualified medical men, com-
paring almost as poorly with that of the corresponding
** Extra assistant cominissioner" of the executive Civil
Service. The excuse given would probably be the old
tale of emoluments gained in private practice, but-on
this matter the hospital assistant, in common with all
other exponents of the European system of medicine,
has been hardly hit by the wave of unpopularity and
distrust that has possessed native society against all
its professors as the outcome of plague and the

November 15, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE.

measures adopted to cope with it; and it is probably
this circumstance that has brought the service to the
stage of petitioning Government for better treatment.

Zven allowing for the cheapness of living in India,
Rs. 25 per mensem is starvation pay for a man who has
been raised by education to an entirely different
standard of civilisation from that of the ordinary
coolie, and it is no better than cruelty to take an
Indian lad, and after converting him into a civilised
and thinking man, to pay him somewhere about the
wages of a decent butler orcook. It must not be for-
gotten that practically all are married men with
families.

During the recent troublous times of famine and
plague in India, the loyalty and pluck of our medical
subordinates has been above all praise. They un-
doubtedly form the backbone of our system of medical
relief, and we trust that the powers that be will turn a
sympathetic ear to the petition alluded toin our Indian
contemporary, and will do something to alleviate the
hardships of & hardworking and estimable body of
men.

AN APOLOGY.

I REGRET to learn that the letters and notices con-
cerning the memorial to the late Professor Schaudinn
were inserted in the JOURNAL or TROPICAL MEDICINE
of November 156, under a misapprehension. It
appears that the letters I received were intended for
private circulation only, and those who have charge
of the memorial in this country are deeply concerned
that the letters were published. Seeing that the
letters were printed and not marked private or con-
fidential, it did not occur to me that they were not
publie property.

I beg to apologise for the error I made in publishing
the correspondence, but it was done with the intention
of advocating the cause so many of us have at heart,
namely, a fitting testimony to the memory of a man
all must revere. I write this in the first person as I
did not consult any of iny colleagues on the matter,
believing that it was a matter of publie duty to
publish the letters at the earliest pos-ible date. 16
falls to me personally, therefore, to make my humble
apology.

James CANTLIE.

MALARIA IN GREECE.—PROPOSALS FOR
ANTI-MALARIAL MEASURES.
(Issued by the Liverpool School of Tropical Medicine.)
PROPOSAL FOR FIGHTING MALARIA IN GREECE.

Dear бів,-Тһо Chairman and Committee of the
Liverpool School of Tropical Medicine, in publishing
the annexed appeal for subscriptions in aid of the
Grecian Anti Malaria League, wish to state :—

(1) That in reply toa telegram from the School,
Н.М. the King of Greece has signified his acceptance
of any help that the School can give to the Lougue of
which he is the Patron.

(2) That H R.H: Princess Christian, Honorary
President of the Szhool, has graciously consented to
be the Patroness of the subscription in Great Britain,

(8) That Sir Francis Elliot, G.C.V.O., K.C.M.G.,
H.B.M., Minister at Athens, has kindly promised to
receive the amount subscribed, and to hand it over to
the Grecian Anti-Malaria League.

(4) That support to the scheme has already been
promised by those whose names are printed in the
accompanying list.

(5) That subscriptions may һе paid to the Seeretary,
Liverpool School of Tropical Medicine, B10, Exchange
Buildings, Liverpool.

ALFRED JONES,
Chairman, Liverpool School of Tropical Medicine,

The Liverpool School of Tropical Medicine, B10,
Exchange Buildings, Liverpool.

July, 1906.

MALARIA IN GREECE.
By Ronatp Ross, C.B., F.R.S.
Professor of Tropical Medicine, University of Liverpool and
Liverpool School of Tropical Medicine.

A LITTLE while ago I was asked by the Lake Kopais
Company to make a study of the malaria which has
long been prevalent on their estates in that part of
Greece. Permission being granted by this University
and School, I went there last May and carried out the
required investigation. It revealed an unexpectedly
hich degree of malarial infection in most of the locali-
ties examined. Moreover, I ascertained from members
of the Grecian Anti-Malaria League that the district
of Kopais is by no means exceptional in this respect,
and that the malady is very prevalent in many rural
areas throughout the country. The League, which
has existed for some years, has been doing its best to
improve matters by modern methods, but is much
hampered by lack of funds. After consideration,
therefore, I have come to the conclusion that the case
is one in which a little assistance from this country
may do a great deal, and that we might well be justi-
fied in attempting to raise some small subscription
among Greeks and other lovers of Greece resident in
Britain, for the purpose of supporfing so deserving a
body.

Details regarding the prevalence of malaria in
Greece аге ав follows: Professor Dr. Savas, Physician
to H.M. the King of Greece and a Vice-President of the
League, informed me that, taking the statistics of the
larger towns for a basis (probably the lowest possible
basis), the averaye annual number of cases must be
something like 250,000, and deaths about 1,760. He
said also, that malaria was particularly prevalent in
Greece last year, the number of cases being perhaps
half as numerous as the population,

From Dr. Kardamatis, General Secretary of the
League, I obtained the following figures for last
year :—

Estimated population of Greece 9,433,806
Estimated number of cases of malaria 960,018
Estimated deaths from malaria 5,916

Tt is always diflicult to arrive at any exact estimate
of the amount of malaria in any country; but these
data appear to have been collected with all due care,
and are certainly serious and startling enough for a
European nation. It would appear that in а single
year, there were roughly two attacks for every five
persons in the country. Fortunately malaria, though

352

THE JOURNAL OF TROPICAL

MEDICINE. [November 15, 1906.

itisan extremely troublesome malady, is not often fatal ;
yet one in about every 410 persons seems to have died
of it last year alone. I was informed also that black-
water fever, the most fatal form of the disease, often
occurs in certain rural areas.

I will now describe my own experiences. It will be
remembered that the Kopaic Lake was a large stretch
of fresh water situated north-west of Baotian Thebes
at the feet of the slopes of Parnassus and Helikon. It
was frequently drained by the ancients, and as fre-
quently allowed to lapse again into the condition of a
large marsh (in winter). Recently it has been kept
well drained by the British Lake Kopais Company,
the surface of the large plain so formed being used for
extensive cultivation. On the margin of the plain
there are a number of villages, some of which were
examined by Dr. Kardamatis and myself, with the
valuable assistance of Mr. D. Steele, agent of the Lake
Kopais Company in Greece. The first method which
we adopted for estimating the amount of malaria
present was one which gives very reliable results when
used with proper scientific precautions—namely, an
examination of the people, chiefly the children, for en-
largement of the spleen. Our general result was as
follows: Out of 373 people examined enlargement of
the spleen was observed in 96, or 23 per cent. But,
in considering this ratio it must be remembered, first,
that enlargement of the spleen is indicative, not only
of a malarial infection, but generally of a long con-
tinued one; and, secondly, that the investigation was
carried out in May and June, that is before the com-
mencement of the annual autumnal malaria season.
There is no doubt that an autumnal investigation
would have disclosed a ratio of infection much higher
even than this.

To give further details—at the village of Moulki,
which is situated near the ancient Haliartos on the
Kopaic Plain itself, we examined 80 persons and
found enlargement of the spleen in no less than 38, or
nearly balf. At the village of Mazi, on the slopes of
Helikon, just above, Haliartos, we found it in 13 out of
40. At Skripou (the ancient Orchomenos) situated on
the edge of the plain, it occurred in 25 out of 50 school
children—exactly half. At the town of Livadhia, al-
though it is at a distance from the Kopaic Plain and
some way up the slope of Helikon, and is watered by
running streams rising near the ancient Oracle of
Trophonios, enlargement of the spleen was found in
no less than 16 out of 100 school children. On the
other hand, on the Kadmeia of Thebes, it occurred
only in one out of 50 children.

Another method of estimating the amount of malaria
present, namely, by searching preparations of the
finger blood of the people for the parasites which cause
the disease, need not be referred to here as the ex-
aminations are not yet complete; but so far as they
have been carried they fully confirm the spleen-test,
which of itself is sufficient for Greece. All the kinds
of parasites have been readily found ; and there can be
no possible doubt regarding the wide prevalence of the
disease. Many of the unfortunate little children, as
they filed past us in the schools, presented а sad spec-
tacle—pale and wizened, with enormously enlarged
spleens and frequent attacks of fever. I have seen
nothing worse in the most malarious parts of India;

and nothing so bad in Africa, where there is probably
more racial immunity. I suspect that there is a much
larger infantile mortality in Greece thau is shown by
the statistics; and also that the adults, partially im-
munised as they are, cannot but lose in health and
vigour in consequence of the uuhealthy childhood
which they must frequently pass through. -

The question as to how far malaria has influenced
the past history and the modern development of
Greece, is one of the greatest interest, and will, I hope,
receive future consideration. We must remember that
nearly the whole surface of the country is mountain-
ous, the arable tracts consisting of but a few small
valleys or plains, maintaining most of the rural popu-
lation. Yet it is precisely in these vital areas that the
disease is most prevalent. True, some of the larger
towns seem to be much less affected ; but à nation can
scarcely depend for its prosperity on its urban popula-
tion alone. Itis difficult to see how a vigorous country
life can exist under the conditions which I have at-
tempted to describe. One would expect to see many
villages, churches, inns and country oues scattered
about the landscape. Тһе villages are few and poor,
the country houses almost entirely absent. А gentle-
man in Athens told me that he bought a shooting box,
but that when be went there he was immediately
attacked by malaria. One would expect also to find
plentiful accommodation for travellers all over a
country where almost every hill, rock or stream is
sacred to literature, art and history—which should be
visited annually by thousands of tourists from all parts
of the world. In reality we now see throughout these
great valleys little more than what may almost be
called scenes of desolation—bare hills, empty plains, a
poor and scattered population.

Many years have passed since Byron gave his life
for Greece. Не attributed her misfortunes to loss of
freedom. Is it possible that an enemy more invete-
rate than the Turk, has been really the cause of them ?
Looking at those poor children in the villages I feel
inclined to think so.

Britain has done something for Greece iu the past ;
and may now help her again, and perhaps in a more
effective manner. Science has at length taught us
how to combat malaria on a large scale. Ismailia,
Havana, the Campagna, Hong Kong, Khartuin, the
Federated Malay States, give conclusive evidence of
this; and so far as my own experiences teach me,
the task in Greece will be & comparatively light one.
Owing to the dryness of the climate and to the fact
that the heavy rains fall in the winter, pools of water
suitable for the propagation of the malaria-bearing
goats seem to be so small and isolated that they could
easily, I think, be rendered uninhabitable for the in-
sects ; while the people are so intelligent that they are
likely to accept readily enough the numerous other
anti-malarial measures which may be adopted. Indeed,
I will venture to say, that if the work is undertaken
with the same degree of intelligence and persistence
a8 was shown in the places just mentioned, the disease
ought to be nearly banished from Greece in five years,
and, moreover, at comparatively little cost. Such a
result would be a most glorious victory, not of nation
against nation, but of science against one of the princi-
pal enemies of mankind.

November 15, 1906.)

Ав I have said, the Anti-Malaria League of Greece,
of which H.M. the King of Greece is Patron, has
already commenced the battle, and I can testify has
done so in a thoroughly practical and scientific manner.
Its own duties are to indicate with exactness the
sources of malaria near the principal towns and
villages, to advise the Greek Government regarding
the necessary measures, and to rouse the people to
defend themselves by the simple precautions which are
now so well known to medical men. All that we һауе
to do—citizens or lovers of Greece in this country—is
to try to help the League with funds and with sym-
pathy. The former will enable it to do the necessary
work ; the latter will stimulate the Greeks themselves
to aid in the task. With regard to the Government
of H.M. the King of Greece, I сап say confidently that
we may fully rely upon its sympathy with the cause,
and I say this, not as а mere compliment, but as the
result of impressions gained by me during interviews
with M. Theotokis, the Premier, and M. Boufidis, the
President of the Chamber.

In conclusion, I can say with confidence that every
penny spent in this cause is sure to give immediate
and lasting benefit to Greece. For every tract distri-
buted among the people, every pool of disease-breed-
ing water drained away or filled up, there Will be a
corresponding saving of health and life; and, as the
work progresses year by year, the hold of malaria on
that beautiful country will be gradually relaxed until
it is finally loosed altogether. The disease will dis-
appear from Greece as it has disappeared from
Britain.

------о-

Translation.

THE DISTRIBUTION OF BLOOD-SUCKING
INSECTS IN WEST AFRICA.

By Dr. H. ZIEMANN.

THE increase of the scientific and practical import-
ance of the blood parasites, as regards tropical patho-
logy, has also greatly augmented the interest taken in
those animals which we know to propagate diseases of
the blood. Iam especially thinking of the great zeal
shown in the collecting of Anopheles in all parts of the
Tropies. Already in the years 1899, 1900, the writer
of this paper endeavoured to collect the principal blood-
sucking insects of Kamerun, Togo, and Liberia, and to
urge further investigations in that direction.! But the
untimely death of the zoologist, Müggenberg, unavoid-
ably delayed the idea ; in the meantime Theobald and
Giles filled up the gaps in our knowledge of the Culi-
cide of Africa.

Inaddition to the Culicidce foundin 1899, 1900, we are
pleased to say that we also succeeded in demonstrat-
ing the presence of Stegomyia fasciata over wide areas ;
however, according to a letter received from Eysell,
our species appears to differ from the specimens found
in Habana, Аз is well known, Stegomyia fasciata is
the transmitter of yellow fever. So far this disease

‘Ziemann. ‘‘ Beitrag zur Anopheles-Fauna West Afrikas.,"
Arch. f. Schiffs und Tropenhyg., 1902, Bd. vi.

THE JOURNAL OF TROPICAL MEDICINE.

353

has not been found in Kamerun, but once, in 1887, it
was present on the west coast, and penetrated south-
ward as far as Old Calabar, close to Kamerun.

Dr. Grinberg was able to distinguish the following
species amongst the Culicidce collected by me :—

(1) Culex fatigans, Wiedem.

(2) Culex dissimilis, Theob.

(3) Culex masculus, Theob.

(4) Mansonia africana.

(5) Eretmapodites quinque costatus, Theob.

Of these Culer fatigans is of importance as a prob-
able transmitter of Filaria disease.! European Culices,
such as Culex pipiens (which occurs also in Algeria) ;
C. nemorosus, C. annulatus, &c., were not found.

Moreover, we succeeded in demonstrating the pre-
sence of piroplasmosis in animals? in all the domesti-
cated animals of Kamerun, in the coast regions, and
this disease may, in the case of native oxen of Kame-
run, be distinguished from real Texas fever, viz., (1)
by its comparative mildness; (2) by the lack of the
typical pear-shaped forms of real Texas fever parasite,
and (3) by the absence of hemoglobinuria. The
piroplasmosis of asses and cats, on the other hand,
took a malignant course. Later, when out in South
Africa, R. Koch also described, under the name of
coast fever, a malignant piroplasmosis of oxen which
has to be distinguished from real Texas fever. For
this reason, earnest attention was paid to the Irodide,
in fact, to all parasites of mammals, and these were
systematically collected. All stations have the duty
to continue collecting and to send the material
gathered to the State Hospital in Duala, which is the
central station, for further use. қ

The difficulty of identification is very much еп-
hanced by the fact that we may find on the same
animals various species, and even different genera of
lrodide. Thus, for instance, I found on goats in Togo
(Lome), Rhipicephalus evertsi (С. Neumann), and
Rhipicephalus simus (C. L. Koch). І also found on
oxen in Lagos, Rhipicephalus annulatus (Say) as well
as Ablyomma variegatum (Fab.), on elephants in Kribi ;
Dermacentor circumguttatus (G. Neumann), and
Amblyomma tholloni (б. Neumann). Further, in oxen
in Lagos, Hemaphysalis parmata (G. Neumann), and
Trichodectes spherocephalus оир . lt is true,

. this latter parasite does not belong to the Ixodidc, but

to the lice, but I mentioned it here for reasons of diffe-
rential diagnosis.

We may be quite sure that, as investigation goes on,
the frequency of the occurrence of different species of
blood-sucking Irodide, living on the same host, will
increase. Generally speaking, it is certain that the
species found in Upper Guinea differ slightly from
those of Lower Guinea, but Rhipicephalus annulatus
(Say) is the species which has the widest distribution.
This tick is generally supposed to be the transmitter
of the malaria of oxen (Texas fever). Next in order of
frequency in Upper Guinea, is Amblyomma variegatum

‘Ziemann: “ The Filaria Disease in Man and Animal in the
Tropics,” Deutsche Med. Wochenschr., 1905.

* Ziemann: ‘ Preliminary Report on the Occurrence of Tsetse
Disease in the Coast Regions of Kamerun ”; “Тһе Occurrence
of Texas Fever in the Oxen of Kamerun, and More Information
Concerning Tsetse Disease and Malaria of Animals," Deutsche
Med. Wochenschr., 1908, Nos. 15, 16.!

THE JOURNAL ОЕ TROPICAL MEDICINE.

"November 15, 1906.

tobe found. It is very remarkable that I was also
able to demonstrate the presence of Amblyomma varie-
gatum on oxen in Bamenda, a mountainous highland,
forming the hinterland of Kamerun. Ав a matter of
fact the fauna of the further hinterland of Kamerun
shows great similarity to that of Upper Guinea and
the Western Soudan. In Lower Guinea, at any rate,
in the coast region up to the foot of the mountains,
the widest distributed genus seems to be a tick which
has been named by Neumann, Heemophysalis parmata.
In addition to this species, Neumann found on the oxen
of Kamerun a Rhipicephalus ziemanni. Its further
zoological description 1 leave to Professor Neumann
himself.

I think that we should draw up lists of all the para-
sites found in each colony, till finally, by having com-
pared and interchanged the different lists of the
different European colonies, we shall be able to get at
the knowledge of the distribution of the principal
blood-sucking parasites. Тһе questions put to each
single colonial district for the purpose of ascertaining
the diseases of its animals, should in due time be
answered, and these answers communicated to the
other colonies.

Thus gradually we may hope to attain our purpose
and to establish a comparative pathology of the animals
in the African Tropics.

These were the reasons which prompted the writer
to make also a collection of the flies which are known
to transmit trypanosomes. Their identification has
not yet been fully carried out. I will only remark in
this connection that, according to Griinberg, Glossina
longipalpis (Wied.) and Glossina morsitans (Westw.),
transmitting, as we know, the Nagana disease, have
not yet been found in the coast regions of Kamerun,
though nevertheless the infection of the domestic
animals by trypanosomes is very widely distributed.
In Kamerun the following are known :—

(1) Glossina palpalis (Rob. Desv.), which is accused
of carrying the trypanosome of sleeping sickness.
(Found in several places, such as Victoria, Buea,
Barombi, бс.) My own investigations lead me to
believe that sleeping sickness on the coast only occurs
sporadically, and even then it is imported; but it
occurs more frequently in the hinterland. All imported
cases therefore should be carefully isolated.

(2) Glossina fusca (Walk.), seu tabaniformis, West-

wood, caught in the neighbourhood of the station
Johann Albrechts Hóhe (where there is also a try-
panosomiasis of the domesticated animals).

(8) Glossina tachinoides (Westw.), from the Lake
Tschad, which probably transmits a sort of tsetse-
disease in the hinterland. Recently I received some
blood films prepared from diseased animals, but they
reached me in a useless condition.

Stomoxys and Tabanide, however, seem to be more
widely distributed than the Glossinew. The former
constitute a veritable pest in some regions, as for in-
stance in Mungo, especially Chrysops dimidiatus (van
der Wulp) The domesticated animals in Duala
harbour trypanosomes which may be distinguished
clinically and morphologically from the Nagana para-
sites, and my observations tend to show that these Try-
panosomes may һе transmitted to the domestic animals
by Stomoxys, or as is probably the case in Suellaba

(Kamerun) by Tabanide. In the Philippines this
seems to be the case as regards surra.

According to Griuberg it is possible that new species
may be found amongst the Stomoxys and Tabanid:e
sent from Kamerun.

The further biological investigations into the life
habits and especially the breeding habits of these
insects are therefore of the greatest possible import:
ance, especially because we have to reckon on the
possibility that the trypanosomes which are sucked up
by the blood-sucking fly, together with the blood of the
attacked animal, may be transmitted to the progeny
of the insect in question. For further particulars on
these practical and important questions we refer to
Ziemann, ‘ Beitrag zur Trypanosome infrage,”
Centraiblatt fiir Bakteriologie, 1905, Heft 3, 4. a

B. R.
------“о------

сіе.

A Few HINTS ох THE CARE OF CHILDREN AT SEA. Ву

Samuel Synge, M.A., M.D., М.А.О., B.Ch.(Dub.

` Univ), L.M. . London: J. Bale, Sons and

Danielsson, Ltd., 83-91, Great Titchfield Street,
W.. Price 18. net.

This excellent little book will become popular, and
if it can be brought to the notice of passengers who
have children in their charge will be universally
sought after. Dr. Synge has really supplied what is
often jocularly referred to as a long-felt want, but in
this instance the legend is absolutely true. The ‘ few
hints," not only medicinally, but on every detail of
child-life on board ship, are eminently practical, and
show that the author has had experience of children
at sea and has thought out carefully what is necessary
in the way of preparation for the voyage and for appli-
cation during the voyage. The “few hints " ought to
be in the hands of every mother or nurse about to
proceed to seg in charge of young children, for the
instructions it contains will bring comfort to many an
anxious and perplexed mother who has to proceed on
a voyage with her infant child.

— —»———— —

Correspondence.

PNEMONIC FOR THE SOLVENTS OF THYMOL.
To the Editors of the JouRNAL ок TRopIcaL MEDICINE. `

Sins,—As the following pnemonic may prove as useful to
others as it has to my dressers, I publish it in the interests
of our tropical patients.

The solvents of thymol are of the greatest importance in
the Tropics, where ankylostomiasis and other parasitic
diseases of the intestinal tract exist in a far greater degree
than at home.

The pnemonie is the word “ Cottage (with one Т)» The
drugs represented by this word are: C, chloroform; О,
oils ; T, turpentine; А. alcohol; G, glycerine; Е, ether.

There is no necessity for me to make any long statement
on this subject, and I trust that others may profit in the
comparative certainty of the non-occurrence of mistakes by
the administration of solvents of this excellent drug to the
same extent as I believe I have.

Krian, Federated Malay States,
October 10th, 1906.

Р. Х. GERRARD.

November 15, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE.

355

Hotes and Fels.

МатлохАхт DisEAsES IN Cuina.—Dr. J. Preston
Maxwell, in practice at Eng-Chhun, Amoy, China,
in his report of hospital work at Eng-Chhun in the
China Medical Missionary Journal, May, 1906,
states: “ Опе of the features of the-year’s work has
been the number of new growths which have come
under treatment; certainly there is no lack of malignant
disease iu this region."

Union MEkpicarL CorrEcE, PrkiNG.— The Union
Medical College was opened on the 14th of February,
1906. Тһе professors and lecturers are drawn princi-
pally from the missions in the North China Educa-
tional Union and from co-operating missions. Chinese
tutors are also included in the teaching staff.

The College has been established to provide well-
educated Chinese with as thorough a knowledge as
possible of the various branches of medicine and
surgery. The degree of Doctor of Medicine will be
conferred upon those students who succeed in passing
the final examination.

The preliminary examinations are held in February
in each year in the College. Candidates desiring to
enter for the next college year should be in Peking
before February 22nd, 1907, and should communicate
with the Dean on their arrival.

The following are the members of the Faculty:
Thomas Cochrane, M.B., C.M., Dean; Nehemiah

S. Hopkins, M.D. ; James H. Ingram, M.D.; George-

D. Lowry, M.A., M.D.; Charles Lewis, M.A., М.Р. ;
Joseph Е. Griggs, M.A., M.D. ; Ernest J. Ре, M.B.,
Ch.B., F.R.C.S.(Edin.); Charles W. Young, B.S.,
M.D.; W. Н. Graham Aspland, M.D., C.M., F.R.C.8.
(Edin.), M.R.C.S., L.R.C.P.(Lond.) and thirteen
other lecturers. : ce y

The medical course covers five years of nine months
each. The year begins on or about the 20th of the
Chinese first month and continues until the 20th of
June; the autumn term begins on or about the 20th
of September and continues until the Chinese New
Year.

А OnixEsE Prescrietion.—Dr. W. Н. Jeffreys, in
an article in the China Medical Missionary Journal ot
Мау, 1906, gives the formula from а Chinese pre-
scription for a cough. The prescription gives tho
patient's name, the diagnosis of the trouble, а state-
ment of the condition of the pulse by which the
diagnosis was made. Тһе drugs are to be wrapped in
a separate white paper and then altogether іп а red
sheet. Тһе thirteen drugs are as follows: Baked
barley, sugar, mashed beans, bamboo shavings, a
root, another root, still another root, chalk, melon-
seeds, mashed and fermented melon-seeds, а mashed
pebble, some wild flowers, a broken clam shell. The
ingredients are to be boiled together in a large
quantity of water and drunk at one draught. Cicada
shells is the great nervous sedative in China. Why
the '*sounding-board " of the scissors grinder (cicada)
should be chosen is difficult to understand. Іп one
respect, however, the Chinese concoction forms a
pleasant contrast to European quack remedies, as it

contains absolutely nothing that could possibly do
any harm to the patient, and if there be any sound
basis for hydropathy, the large quantity of water
swallowed might possibly be beneficial.

Tur Bombay Sanitary report shows a very heavy
infantile mortality in the Presidency, 220 children
per mille dying in their first year, while in the cities
of Bombay and Ahmadabad the recorded figures
give an infant mortality of 800 per mille, more than
half the children born dying before they are a year
old. The figures may not be particularly accurate, as
registration in India is still very defective, but it is
unlikely that more exact information would notably
affect the proportional results.

Lupaiana, an important city in the Punjab, is to
have а modern water supply, and pipes, &е., to the
amount of nearly £7,000 have been ordered from
England.

ALTHOUGH diminishing somewhat in the native
city, plague is increasing seriously in the cantonment
of Poona, dead squirrels aud rats having been found
in nearly every house. Ап exceptional feature of the
outbreak is the number of Europeaus that have been
attacked. Тһе goods station master and his entire
family have died and an officer of the Railway Survey
Department has also fallen a victim to the disease.
The deceased, it appears, picked up a squirrel which
he erroneously thought to be dead, when the little
animal turned round and bit him, with the result that
within forty-eight hours he was removed to hospital
in & dangerous condition. Government has sanc-
tioned the expenditure of Rs. 500 on the purchase of
Roux's serum, and Mr. Jacob Sassoon has given Rs.
1,000 for the same purpose.

AT the instance of the Sanitary Commissioner the
Government of India have instituted a modified exami-
nation for promotion for native assistant surgeons
employed in the Sanitary Department, special
papers on hygiene, elementary bacteriology, &o.,
being substituted for those on surgery and midwifery.
In the case of an assistant surgeon so employed,
however, reverting to the ordinary line he will be
expected to pass subsequently in the subjects excluded
from the special examination. This may be con-
sidered the first step towards the formation of a
specialist corps of medical subordinates, and is un-
doubtedly a most useful and promising innovation.

A MAN sleeping under a tree on the Calcutta Maidan,
was attacked by hornets and so badly stung that he
had to be removed to the College Hospital, where
he died in а state of collapse half an hour after
admission.

Tue current number of the British Medical Journal
includes a memorandum by Captain R. Markham
Turner, І.М.8., of his discovery of the presence of
a tsetse-fly in Arabia. The specimen has been identi-
fied by Mr. Newstead, of the Liverpool School of
Tropical Medicine, as Glossina tachinotdes, West-

356

wood. In view of the constant intercourse between
Arabia and the African coast, the danger of the spread
of sleeping sickness to the Asiatic continent is only
too obvious, in view of this discovery.

—— —M — ————

Personal Kotes.

INDIAN MEDICAL SERVICES.

Arrivals Reported in London.—None.

Extensions of Leave, —Lieutenant-Colone]. A. Milne, 12 m.
furlough; Major W. D. Sutherland, study leave, August 6th
to October 10th, 1906; Major J. Chaylor White, 1 m. medical
certificate ; Captain F. A. Smith, study leave, September 1st to
September 30th, 1906; Captaiu L. P. Stephen, 2 days,

Permitted to Return to Duty.—-Captain N. R. J. Ranier, Major
J. Chaytor White, Captain R. E. Lloyd, Lieutenant-Colouel
A. C. Younan, Captain L. P. Stephen, Lieutenant G. F. T.
Harkness.

Postings.

Captain R. F. Baird ofħciates as Deputy Sanitary Commis-
sioner, 1st Circle, United Provinces.

Captain E. S. Morgan, on return from leave to be Civil
Surgeon, Etawabh.

Captain O. Dykes officiates as Civil Surgeon, Jaunpur.

Captain Melville to be Professor of Materia Medica, Lahore
Medical College.

Captain M. Mackelvie and E. Н.В. Stanley, services lent to
Civil Department, Bengal.

Captain J. W. Little, Civil Surgeon, Wano, is transferred to
Gwalior as Residency Surgeon, his place being taken by Captain
J. Б. Tyrrell, now on famine duty in Rajputana.

Major М.Н. W. Hayward, services placed at disposal Govern-
ment of Bengal.

Lieutenant-Colonel J. Sykes, Civil Surgeon, on return from
leave, to Bareilly.

Lieutenant-Colonel J. Jarratt, Civil Surgeon, on return from
leave, to Fyzabad.

Major H. Austen-Smith, Civil Surgeon, on return from leave,
to Bahraich.

Captain W. B. Turnbull, Officiating Civil Surgeon on return
from leave, to Banda.

Major W. Selby, Civil Surgeon, from Bareilly to Sitapur.

Major C. Milne, Civil Surgeon, from Fyzabad to Gonda.

Civil Surgeon Man Mohan Das, on being relieved, from Bah-
raich to Hamirpur.

Military Assistant Surgeon W. J. A. Hogan, Civil Surgeon, on
being relieved, from Banda to Pilibhit.

Lieutenant-Colonel J. A. Cunningham to be Civil Surgeon,
Umballa.

Leare.
Major Melville, furlough for 1 year.
Captain V. G. N. Stokes, combined leave for 1 year.

Retirements.
Honorary Captain C. Gill, I.S. M.D.

R.A.M.C.

Licutenant-Colonel А. E. Morris to Command Station Hos-
pital, Jubbulpur; Major F. R. Buswell, to that of Jubbulpur;
Captain F. Kiddle to that of Abu; Captain A. К. O'Flaherty to
that of Sangor; and Captain D. О. Hyde to that ef Khandalla ;
Lieutenant.Colonel Н. A. Haines officiates in command, Station
Hospital, Umballa; Lieutenant-Colonel T. P. Woodhouse
otliciates as P.M.O., Lahore division.

——9————
“ Medizinische Blatter,” No. 10, 1906.

ANKYLOSTOMES AN ETIOLOGICAL Factor IN MALARIA.

Sehrwald, of Brazil, states that һе finds in persons suffer-
ing from malaria and infected by Ankylostomum duodenale
that these worms contain the malarial parasite in their
intestine and in the mucous glands of the ankylostome's
mouth. Sehrwald is of opinion that these parasites may
directly reinfect man, and шау transmit malaria by means
of eggs or lurve. It is necessary in such cases to cause the
expulsion of the worms before treating the anwmia present
in all patients thus afflicted.

THE JOURNAL OF TROPICAL MEDICINE.

(November 15, 1906.

Recent and Current Witerature.

А tabulated list of recent publications and articles bearing on
tropical diseases 4s given below. To readers interested in
any branch of tropical literature mentioned in these lists
the Editors of the JouRNAL OF TROPICAL MEDICINE will be
pleased, when possible, to send, on application, the medical
journals in which the articles appear.

“ Annual Report of Government Veterinary Bacterlologist,”
Pretoria, 1906, p. 110.

* BLUETONGUE " IN SHEEP.

- Theiler, А. The disease may be met with throughout the
Transvaal іп marshy localities and along the river banks,
and is especially rife in the autumn, i.e., in the rainy season,
and it is very probable that, like ** horse sickness," it may
be conveyed by a nocturnal biting insect. Ав the blood of
the sheep that have suffered from the malady ceases to be
virulent after recovery, i& may be supposed that during the
dry season the virus is preserved either in the intermediate
host, or in the body of some vertebrate other than the
sheep, possibly aquatic.

The virus contained in the blood or serum, if well diluted
with physiological water, passes through a Berkefeld filter.
The dried blood dissolved in physiological water, and inocu-
lated, produces, after the usual period of incubation, &
characteristic febrile reaction, and it is possible that this
may be made the basis of а plan of vaccination.

The immunity conferred by a single inoculation is, how-
ever, somewhat feeble, and further inoculations of increas-
ing doses are usually followed by the symptoms of blue-
tongue and sometimes by death. Sometimes, however,
immunity is acquired after а second inoculation of blood, as
was also found by Spreull, and Theiler further confirms that
observer’s statement, that sheep which have passed through
the disease, and have afterwards been injected with 500 cc.
of virulent blood, yield a serum which possesses preventive
properties, 5 to 10 cc. of such serum suffice to protect, but
do not cause any obvious reaction. .

“ Bulletin de l'Académie d Madame: Paris, Year lxx.,
І оз. 8, 9. .

ANTI-DYSENTERIC SERUM. Ы

Vaillard, L., and Dopter, C., immunised horses by іпоси-
lation on alternate weeks with progressive doses of living
bacilli and of soluble toxin. The toxin is obtained by filter-
ing through porcelain a culture of dysenteric bacillus in
Martin bouillon kept for twenty days at a temperature of
87° C. of ninety-six patients treated by hypodermic injec-
tions, and later by injections into veins ; all recovered except
one. Of the patients thus treated, all had been subjected
to the usual dysenteric remedies unsuccessfully. As soon
as the serum trented was employed, the patients' condition
altered for the better, and recovery was established in from
two to six days, according to severity of illness. No un-
toward symptoms are reported from the serum treated.
The minimum dose employed was 20 cc. hypodermically
given and repeated once or twice in the severer cases.

Rotices to Correspondents,

1.—Manuscripts sent iu cannot be returned.

2.— As our contributors are for the most part resident abroad,
proofs will not be submitted to those dwelling outside the United
Kingdom, unless specially desired and arranged for.

3.— To ensure &ccuracy in printing 16 is specially requested
that all communications should be written clearly.

4.— Authors desiring reprints of their communications to the
JOURNAL OF TROPICAL MEDICINE should communicate with the
Publishers.

5.—Correspondents should look for replies under the heading
“ Answers to Correspondents.”

f December 1, 1906.

THE JOURNAL OF TROPICAL MEDICINE.

357

Original Communication.

HUMAN SPIRILLOSIS IN LOANDA
(ANGOLA).

Ву А. гв S. Mara Leitao, M.D. (Oporto).

Captain Portuguese Colonial Medical Service ; formerly at
London School of Tropical Medicine.

(PRELIMINARY Nore.)

(Translated by the author from the note sent to the ** Archivos
de Hygiene e Pathologia Exoticas," of Lisbon.)

Он July 24th, 1906, оп examining the blood of
a black soldier, native of Golungo, aged 24, who
has been in service in Loanda some time, I found
spirilla like those of Obermeieri [1].

The blood of the patient was examined by the writer
at the request of Clinical Assistant Dr. С. Vicira, of
the “ Hospital Maria Pia," of Loanda, who suspected
trypanosomiasis.

The blood films were stained by Leishman’s stain,
and examined by the уу oil immersion lens, when they
showed the spirilla referred to.

It is the first time, to my knowledge, that this
disease has been found in Loanda, and I therefore
hasten to communicate the fact, although I have de-
ferred making it public for some time, hoping to find
other cases of the disease and also to find the tick [2]
— Ornithodoros moubata — which is reported to Бе
present in Loanda, but I have failed to find it up to
the present.

Iam also looking for the enemy of this tick—the
reduviidius of F.C. Wellman, M.D., which was classi-
fied by E. E. Austen as Phonergates bicoloripes,
Stal [3].

When the patient entered the hospital he was in
thelast stages of the disease, so that only the first
blood examination was positive, and owing to the sub-
sequent examinations being negative I could not make
inoculations of animals.

Later the embryos of Filaria perstans were found
in the blood of the same patient. Ав soon as further
opportunity affords I will endeavour to ascertain
whether this spirillum is Spirillum | Obermeieri or
S. Duttoni, or whether it differs in any way from
these two. For this purpose I shall adopt pretty
closely the views of Frederick С. Novy and В. E.
Knapp [4].

REFERENCES.

[1] I have sent blood films to the London and Lisbon Schools
of Tropical Medicine to be verified.

[2] The Portuguese name is ‘‘ Carrapato" not **Garrapato,"
as Sir Patrick Manson has it in his ** Tropical Diseases," p. 714,
8rd edition, 1903.

[8] Journal of Tropical Medicine, 1906, р. 118.

М1 Studies on Spirillum Obermeieri and related organisms
analysed in Bulletin de l'Institut Pasteur de Paris, 1906, p. 612,
t. ix.

— eo

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THE

Journal of Tropical Medtcine

DECEMBER 1, 1906.

THE AFRICAN POISON TEST.

Dr. Е. С. WELLMAN, in an article published under
the imprimata of the American Society of Tropical
Medicine, gives an interesting account of the African
poison test as observed in the Portuguese colony of
Angola, West Africa. The test by poison is employed
as а means of settling disputes in many parts of
Africa, and from time to time we have accounts
which give so varied statements of the method, ritual,
and drugs employed that many untravelled people
regard the reports as mere travellers’ tales. >

Dr. Wellman’s account is taken from observations
amongst the Umbundu-speaking Bantus in the
province of Angola, and he describes the poison test
as it is practised amongst these people. Ombu-
lungu is the local name for the ordeal, which,
however, has different names in different parts of
Africa.

The custom of administering justice by the poison
test is of ancient origin, but has come down to the
present day with an accumulation of ritual and cere-
monial which tend to obscure the rational and elevate
the mythical phase of the proceeding. Тһе poison
test is appealed to on occasions of disputes of several
kinds, and withal so frequently that, according to
Dr. Wellman, it i8 “а custom which has nearly de-
populated whole districts, and has been responsible

858

for more deaths in Africa than have many important
diseases.”

The disputes which occasion resort to the poison
test are: Hereditary disputes—family or clan feuds
in fact; cases of murder when there is doubt as to
the culprit; cases of adultery, and cases of alleged
killing by witchcraft. In addition to these causes of
quarrel, acts of thieving, be it of stolen property,
slaves, wives, or cattle, after settlement by divination
in presence of a witch doctor is impossible, the
aggrieved party challenges his antagonist to trial
by poison. To refuse the challenge is equivalent to
& confession of guilt. When the quarrel reaches this
point a witch doctor acceptable to both parties in the
quarrel is decided upon, and with him lies the duty of
preparing the poison. To the witch doctor each party
to the quarrel, accompanied by friends and relatives,
pede and after preliminary speeches by the com-

atants, in which each loudly asserts his innocence,
the poison is given them to drink. After drinking, а
native dance takes place, and whichever man first
falls down is held to be the guilty party. His friends
then carry him away to die or recover, according to
the strength of the poison given him.

There seems a certain rude justice in this account
of the poison test, but when we come to look below
the surface we find that, the witch doctor not being
above bribery, it is usually the litigant with the
longest purse that wins. “ Refreshers"' in the form
of presents serve to bribe the judge, and to warp his
mind so that his decision is settled beforehand, and
the method and manner of administering the poison
draught is tampered with accordingly.

Dr. Wellman points out some of the tricks by which
the witch doctor adjusts the draught in accordance
with his preconceived conclusions as to which of the
litigants is to die. One plan is to fill two drinking
vessels (gourds) with apparently similar ingredients,
one for each of the disputants; but although to all
appearances identical, one of the vessels, that in-
tended for the unfortunate man whom it is meant to
condemn, contains a potent poison. . Another plan is,
however, more subtle; one gourd only is used, the
favoured individual is given the first half of the
draught to drink, his opponent the latter half. After
the former has finished his draught, however, the
contents of the vessel are stirred, whercby the actual
poison, which hitherto lay at the bottom, is mixed
with the fluid, when the second man receives the full
benefit of the lethal substance. Several other methods
of trickery are practised by the witch doctor, such as
enclosing the poison in a resinous substance placed at
the bottom of the vessel, which can be liberated when
desired by scratching the resinous enclosure with the
nail of the finger when stirring the decoction. Instead
of this, a skin bag with two compartments, one con-
taining а, poisonous, the other an innocuous, powder
of similar colour is employed, and the contents of
either bag dusted in the fluid into the gourd as
desired.

Dr. Wellman gives the plants from which the sub-
stances used in the poison test are obtained in various
parts of Africa with his customary accuracy of detail.
Of these he mentioned Strychnos icaja (Baill.) ;
Physostigma venosum (Balf.); Erythropleum judicale

THE JOURNAL OF TROPICAL MEDICINE.

(December 1, 1906.

(Proct.) ; Tanghinia venenifera (Poir.) ; Allenium soma-
lense (Poir.) ; and Menabea venenata (Baill.).

Amongst the Umbundus, however, none of the
above were used, but instead Erythropleum (Е.
guineense) (Don.), with two other poisonous plants,
namely, Securidaca longipedunculata (Fres.) — the
Utica bush, and more rarely Tephrosia vogelii
(Hook, fil).

The effect of the mixture used in the poison test
by the Umbundus is, in the first onset of symptoms,
vomiting and purging. This is followed later by loss
of power іп the limbs, and the victim falls to the
ground and dies speedily and quietly. The adminis-
tration of the test occasionally fails owing to the witch
doctor’s inefficient steps in mixing or disguising the
poison, when both disputants may die from the effects
of the draught.

THE ORGANISATION OF THE MEDICAL
SERVICE OF THE NATIVE ARMY OF INDIA.

Tae organisation of the military section of Indian
Medical Service has during the last few weeks formed the
subject of two leading articles in an influential Indian
contemporary, the Pioneer, and as that journal usually
keeps itself well in touch with the official hierarchy of
Simla, it may be taken as tolerably certain that the
subject would not receive such marked attention in its
columns unless changes of organisation were under
consideration.

The present system, it may be admitted, is some-
what archaic, being simply the old and somewhat
discredited “ regimental system," but it by no means
follows that it is therefore unsuited to the Indian
Army, ав it must be remembered that Indian civilisa-
tion is also very archaic, and although the sepoy is
armed and drilled on the most approved modern
European models, he remains in his social and
domestic life в very archaic person. Soldiers’ insti-
tutes and sergeants’ messes, athletic clubs, and so
forth, have, for example, become absolute necessities
of life for the British soldier, but they would be im-
possible and useless in the native army; and the
same differences of habits that make our European
organisation of the social side of military life unsuited
to native troops, deprives the station hospital system
of most of its advantages when applied to them.
Perhaps the most striking advantage that can be
claimed for the station hospital system is the greater
efficiency and economy of dieting arrangements, but
owing to caste prejudices nothing of the kind can be
attempted on behalf of the native, as some castes are
во exclusive as to object to take food even if prepared
-by a Brahman of the highest standing. Itis extremely
difficult to convey to the uninitiated the ditticulties
that meet the European physician at every point of
the dieting and nursing of native patients, and as our
native regiments are almost universally recruited from
men of the best and most exclusive castes, a vast
amount of tact and an intimate knowledge of caste
custom are essential to the medical officer of a native
corps to enable him to exercise “his profession with
success, Moreover, the subdivisions of caste are so

December 1, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE.

859

intricate, and the tendency to fission within the caste
is so strong, that it by no means follows that one can
prudently act in the case of the 1COth Dogras in the
same way as one might in the 101st of the same caste.
The redeeming point of the old regimental system in
the British service was the personal knowledge of his
patients acquired by the regimental medical officer, a
most valuable asset to any physician, but the import-
ance of such knowledge for him is but trivial as com-
pared with its indispensable character in the case of
native troops.

The weakness of the regimental system lies, of
course, in its inapplicability to modern conditions of
active service.

The Pioneer, it must be remembered, unlike our
European lay journals, appeals mainly to an official
public, and to a great extent may be said to be written
by experts for experts, and it may be well, therefore,
to consider seriously the line of argument taken by it,
and the proposals it has to make for improvement.

It takes as its text an excellent remark of Colonel
P. S. Maitland, in & paper on Army Re-organisation,
read before the United Service Institution of India in
1890, which runs as follows :—

** There is one condition that is universally recog-
nised in the organisation of the army of every State
which has any pretensions to rank as a military Power,
and also in some which have no pretensions atall. It
is, I think, not too much to say that this condition
exists in every army whose efficiency is of vital im-
portance to its country, and it may therefore be
regarded as an essential factor in producing that
efficiency. This condition is that the war organisa-
tion of an army.is precisely the same as the peace
organisation. What I mean to say is that the army
corps, divisions, brigades of an army with their staffs,
trains and subsidiary organisations, exist in peace as
they do in the field."

Judged by this indisputable test, it is at once seen
that the station hospital plan stands under even
deeper condemnation than the regimental system, for
while the latter serves very well for short operations
in which only small numbers of troops are employed,
such as the counter raids on the frontier that are un-
fortunately so often unavoidable in India; the station
hospital system has to be replaced on service by an
elaborate system of field hospitals, in the working of
which the officer has had no practice whatever during
peace.

With the scathing condemnation of the station hos-
pital system indulged in by cur contemporary we have
little sympathy, for while we equally regard the plan
as a bad one in principle, we know tbat the skill and
devotion of the officers of the R.A.M.C. have made it,
practically speaking, extremely efficient for all that
it is fit for—the necessities, to wit, of peace time.
What we regard as its most striking defect is the lack
of opportunities of exercising responsibility for the
junior officer, as the latter is little more than a
sort of superior clinical clerk to the senior medical
officer, and so acquires practically no experience of the
responsibilities of charge until, after long years, he
has them thrown by seniority on his quite unaccus-
tomed shoulders.

The regimental system, however, has this marked

advantage, that the habit and practice of responsible
charge is thrown on the medical officer from almost
the very outset of his service, and it is probably owing
to this, more than to avy other cause, that in spite of
its admitted defects, our Indian medical military
organisation has always “ worried through” without
an actual breakdown.

The Pioneer, therefore, proposes to retain the regi-
mental system, but to institute an addition—a system
of field and general hospitals, attached—which is most
important—not to stations but to brigades. The regi-
mental officer would attend to the sanitary necessi-
ties of his corps and provide for its military surgical
arrangements as a unit in action, and would attend to
the trivial cases in peace time, passing on the more :
serious cases to the field or general hospital just as he
would in war, but the oflicers of the latter would
form an integral part of the Brigade to which they
belonged, and so would retain the personal touch
with their patients, so essential in dealing with native
troops.

It is obvious that when the regimental work in peace
time was too light to occupy the entire time of an
officer, his services might be utilised to some extent in
the larger hospital by giving him a ward, for the medical
treatment within which he should be solely respon-
sible, and also that under such a plan all that would
be required on a Brigade taking the field would be,
as our contemporary remarks, not “ alteration, but
expansion,” by the strengthening of the field hos-
pitals by additions to their staffs, as it is obvious that
on active service the regimental surgeon, forming as
he would this first line of medical aid, could not be
made in any way available for assistance in the second
and third lines. Space forbids our entering into the
details of the plan as outlined by our contemporary,
but there is undoubtedly much to be said in its favour,
and we therefore trust that the article referred to may
really be. taken as a shadow forecast by the events
that are being worked towards by the respunsible
authorities.

It is obvious, however, that, like most changes tend-
ing to increase efficiency, the plan so ably advocated
by the Pioneer involves a considerable increased ex-
penditure. The regimental medical officer remains as
such, and aconsiderable addition must be made to the
nominal roll of the service, to afford at least the nucleus
of а personnel for the field and general hospitals. The
station hospital plan, on the other hand, though nasty,
is cheap; cheaper even, perhaps, than the regimental
system, though the latter is extremely inexpensive as
worked in the native army, where practically one com-
missioned officer and two or three subordinates (hos-
pital assistants and compounders) for each battalion,
with а few odd men thrown in for staff and detach-
ment work, form the entire personnel. This proportion
of medical aid to fighting men is, of course, far smaller
than that subsisting in the British Army under the
station hospital plan, and it is extremely doubtful if
even in the native army the latter could be worked
with a smaller personnel than that now employed,
under the regimental system.

It must be remembered that the Indian Medical
Service enjoys an advantage possessed by no other
military medical organisation in the shape of a reserve

360

of trained military surgeons much stronger in number
than those actually employed with the troops. — .

This reserve is the Civil Branch. When war breaks
out the civil surgeons hand over their duties to their
native assistant surgeons, who are fully qualified
practitioners, and at once proceed to the front, when
in practice they officer the field and general hos-
pitals, the regimental officers naturally and justly
claiming the more attractive share of the work in
accompanying the fighting line. Having all passed
through a more or less prolonged period of military
work and being habituated to constant and onerous
administrative responsibility, they fall naturally and
easily into their places, and the practical outcome of
the present system is very much the same as the
theoretically more ideal system advocated by the
Pioneer.

During the Tirah Campaign, for example, something
like a third of the civil surgeons in the United Pro-
vinces were withdrawn for service in the field. And
really all that is wanted to secure smooth working is
occasional mobilisation operations in time of peace ;
so that whenever manceuvres were conducted within
their Province, the civil surgeons might occasionally
enjoy the opportunity of mobilising their field hospitals,
the materials of which might be stored at provincial
capitals under the charge of the regimental officers
stationed there. Failing, therefore, the funds to carry
into effect the more ideal system advocated by the
Pioneer, why not leave things alone?

EXPERIMENTS IN PRACTICAL CULICIDAL
FUMIGATION.

Автнок I. KENDALL, Ph.D., of the Board of Health
Laboratory, Panama, states that one of the most
important sanitary problems associated with the
digging of the Panama Canal is the suppression of
mosquito-borne diseases. The destruction of mos-
quitoes is accomplished in several ways, but Mr.
Kendall deals only with fumigation.

METHODS oF PROCEDURE.

(1) Preparation of the house: Disturb the apart-
ments as little ая possible; stop up all openings;
have the door guarded by a canvas curtain.

(2) To fumigate: For each 1,000 cubic feet of air
space, 2 lbs. of sulphur, or 2 lbs. to 4 Ibs. pyrethrum,
are placed in a pot and set alight.

(3) After a few hours the house is opened up, the
mosquitoes swept up with a damp broom, the paper
and paste used in stopping up cracks removed. Of the
several fumigants, sulphur is the most convenient for
use. Pyrethrum, also known under the names of
* Bubach," Persian insect powder and Dalmatian
powder, is used, but the powder should be that obtained
from unexpanded flowers, and not the adulterated
varieties frequently offered for sale.

Campho-phenique, called also Mimm's mixture,
consists of a mixture of equal weights of camphor and
(95 per cent.) carbolie acid, and has proved a fairly
reliable culicide. Four ounces of the mixture is placed

THE JOURNAL OF TROPICAL MEDICINE.

(December 1, 1906.

on shallow pans for each 1,000 cubic feet of air space,
and subjected to the heat of an alcohol lamp. .

Of the three fumigants mentioned, campho-phenique
has the advantage of being cheap, efficient and non-
objectionable. Sulphur is efficient but proves іп-
jurious to fittings and fabrics. Pyrethrum is un-
reliable and causes darkening of light-coloured paint
and similar substances.

Several other fumigants have been experimented
with. Concerning these it is stated: Hydrocyanic
acid is dangerous to human beings, owing to its
poisonous fumes; chlorine gas has the disadvantage
of bleeching fabrics; carbon disulphide is dangerous
owing to its inflammability ; Jimson weed or stramo-
nium is unreliable; formaldehyde is an unsatisfactory
insecticide, although so potent a bactericide.

JUVENILE SMOKING.

Іт is said that we are without information as to the
effects of smoking upon native children in warm
climates. Our correspondents might help the enquiry
now being conducted by a Select Committee of the
House of Lords, which is at present engaged upon the
Juvenile Smoking Bill, by giving their opinions. We
do not ask for scientific proofs concerning the effects
of smoking on native children, that is well-nigh im-
possible, but although definite proofs may be wanting,
observations on the subject may be of value.

The points we suggest for enquiry and reply are :—

(1) Do the children of natives in warm climates
commence to smoke at a very early age, and, if во,
state approximately at what age?

(2) Are deleterious effects observable?

(3) What is the form in which tobacco is used ?

(4) Do parents in the Tropics discourage the use
of tobacco by their children ?

(5) Are parents of opinion that juvenile smoking is
deleterious, if so, in what way 2

(6) Is tobacco supposed to have any beneficial
action in the prevention of disease ?

Answers to these questions, forwarded to the
Editors, will be submitted to the Select Committee of
the House of Lords.

PRECISE DEFINITION OF DISEASES.

Dr. James F. Leys, Surgeon United States Navy,
in an article which appeared in the Medical Record of
June 10th, 1906, draws attention to the nature of the
definitions customary in medical text-books. He
objects, and rightly, too, to the use of a or an in
defining specific diseases, and cites as an example a
so-called definition of anthrax commencing, “ Anthrax
is an acute," &c. Leys would employ the following
formula for a disease of which the cause is known:
Anthrax is “the disease caused by an invasion of
Bacillus anthracis.” In the same way actinomycosis
is the disease caused by an invasion of Actinomyces
boris. Similarly may be defined tuberculosis, diph-

December 1, 1906.)

theria, malaria, and во on through all the diseases
the cause of which is known. It is to be hoped
Dr. Ley’s advice will be taken, and so-called defini-
tions, which are more in the nature of short descrip-
tions, at present in use be dropped.

—— €

ANTI-MALARIAL CAMPAIGN IN AUSTRIA AND
HUNGARY.

THE Austrian Government has during the past two
years been conducting an anti-malarial campaign
along the Adriatic coast with marked success. It is
from this region that the majority of sailors for the
fleet are recruited, and the prevalence of malaria
amongst the inhabitants of the coast has proved а
serious detriment to the health of the navy. Тһе
means taken to eradicate the disease is by draining
swampy grounds, oiling collections of water, and the
distribution of quinine. Тһе success of these mea-
sures has been proved by the fact that during the
past two years the number of fresh cases of malaria
eclined 62 per cent. The Governor of Dalmatia has
instituted similar prophylactic measures in his pro-
vince with encouraging success. In Hungary, the
part played by the mosquito in the spread of malaria
is being taught, and in many districts stringent
measures are being prosecuted to exterminate the
Anopheles.

——— .9——— ——

Reports.

MEDICAL OFFICERS OF MISSIONARY
SOCIETIES’ ASSOCIATION.

Ат meetings of this Society held in May and
October, Mr. McAdam Eccles introduced the subject
of “ Тһе Surgical Aspect of the Missionary Candi-
date " ; he dealt with the various systems seriatim, the
following being an epitome :— і

Respiratory System.

Allusions were made to deflected septum of the '

nose and to nasal polypi, and to adenoids and their
consequences. He said that many a missionary
candidate had poor physique owing to the results of
adenoids, and to a town life, particularly when their
occupation had been that of clerk or shop-woman. It
was important to see that there was no defect of the
larynx, as a clear voice was of much importance in
the preacher.
ALIMENTARY SYSTEM.

With regard to the question of teeth, the first fact
of importance was whether the loss of a certain
number of teeth negatived the going abroad of the
candidate. Mr. Eccles thought not, but that the
question of how the teeth met, in other words, their
usefulness, was the real issue. Artificial teeth were
essential for those who had lost & number of teeth,
but they must be good, simple, worn for some time

THE JOURNAL OF TROPICAL MEDICINE.

361

previous to leaving England, and two sets should be
taken out.

Should a hernia disqualify? Mr. Eccles answered
this in the positive. A radical operation should be
performed at least six months before going out.
Femoral hernim, and particularly those іп men, were
more dangerous than inguinal, and possibly umbilical
even more than femoral.

What should be the course adopted with regard to
appendicitis 2 He was emphatic that if there has

- been one attack of a definite nature, operation was

imperative before the candidate could be allowed to
proceed abroad.

VASCULAR SYSTEM.

Varicose veins, should they be always а bar to
service?) No, it depends upon the variety of varico-
sity. "There are really three forms of varicose veins,
one the single enlarged vein, due probably to a con-
genital defect, and one easily eured by operation ; the
second, the congestive form, in which there are а
number of small superficial veins enlarged, these give
rise to much trouble and are difficult to cure by opera-
tion, and probably it is best to reject the candidate
who is the possessor of them; the third form, due to
obstruction by pressure within the abdomen, mears,
as & rule, that there is trouble which necessitates
rejection, unless the pressure can be satisfactorily
removed, and that permanently.

Varicocele.—Here, again, each case has to be taken
on its merits. Slight enlargement of the spermatic
veins, especially if there have been no symptoms
arising therefrom, need not be dealt with surgically,

. and it is important not to draw the candidate's atten-

tion to them, if he does not complain of them. On

the other hand, if there has been trouble from these

varicose veins, it may be that this very fact is au
indication that the person is not а suitable one to
stand the wear and tear of a life in tropical climes.
Hemorrhoids.—These should always be operated
upon, on account of the increased liability to constipa-
tion on foreign service. Also returned missionaries
who have been subject to hemorrhoids should be
strongly advised to have them treated surgically.

LYMPHATIC SYSTEM.

Enlarged Glands.—These often mean that the can-
didate has bad poor physique, and scars in the neck
should always mean a careful examination. It has
been suggested that tuberculous glands in early life
tend to render the person immune to tubercle in later
years; this may be so, but there is often an inherent
weakness in persons who have been the subject of
tuberculous glands. :

Enlarged Thyroid Gland.—This is not necessarily
a bar to work in the foreign field, but great care
should be taken to exclude the candidate should the
enlargement be the indication of early exophthalmic
goitre.

Locomotory бүвтем.

There are а large number of conditions of the feet
which, although apparently small in themselves, are
of great importance from the point of view of the
missionary candidate.

362

THE JOURNAL OF TROPICAL MEDICINE.

(December 1, 1906.

Flat-foot.—Any tendency to flat feet, particularly in
women, should be looked upon with suspicion, often
indicating general want of tone.

** [n-growing Toe-nail."—1It is well to bear in mind
that this condition is very common, and that it is not
due to the “ in-growing " of the nail, but to the over-
pushing of the soft parts. The treatment of the lesion
18 not to remove the great-toe-nail, but to push back
the soft parts, and to see that a proper boot is worn.

Hammer-Toe. — Tuis condition may cause most

troublesome lameness, and should be treated surgically :

before а candidate is accepted.

Hallux Үаіјиѕ. — Тһе same applies to this de-
formity.

Diseases of Joints:—There are several lesions of
joints which naturally interfere with locomotion, and
may be of hindrance to the missionary. They may
necessitate the refusal of the candidate. Loose bodies
and loose cartilages should be treated by operation
before the possessor proceeds abroad.

Paralysis, including Infantile Paralysis.—It is prob-
ably best to refuse a candidate who 1s the subject of
p.ralysis of any kind.

Dejormities.—Any marked deformity is а contra-
indication to acceptance.

SPECIAL SENSES.

Eyes.—The importance of eye symptoms cannot
be over-rated. Headaches, mental strain, and other
conditions are often due to eye lesions, and any ten-
dency to these should lead to a careful examination of
the eyes. If it is necessary for spectacles to be worn,
they should be fitted and tested some months before

the missionary goes abroad, and а spare duplicate .

instrument sbould always be taken out.

Ears.—Otitis media, if present, should always dis-
qualify, and any great degree of deafness would also
do the same.

Discussion was adjourned till the Association's
meeting on October 30th, when, amongst others, the
following members took part: Colonel Hendley, I. M.S.,
Mrs. Scharlieb, M.D., Drs. MacDonald, Harford,
Soltau, Fox, and Price. Discussion centred chietly
round the questions whether with an indetinite history
of an attack of appendicitis an operation should be
performed? Whether the operation, having been suc-
cessful, the individual was by the nature of the disease
predisposed to enteric infection? Cases being quoted
to support such an hypothesis.

The question of enlarged glands, which had suppu-
rated earlier іп Ше, leaving behind merely scars,
proved also of interest, particularly with regard to
the problem whether in such cases there was immunity
from tubercle conferred, or whether such individual
under the stress and strain of life abroad showed an
increased incidence of tuberculous disease.

Tue coud:t on of movable kidney in the candidate
Was also brougut torward.

THE SOUTH AFRICAN MEDICAL CONGRESS.

On October Ist, 1906, the South African Medical
Congress маз opened at Bloemfontein, Orange River
Colony. Some seventy medical men from widely

separated parts of South Africa were present. The
Hon. Е. Wilson, C.M.G., acting Lieutenant Governor
of the Orange River Colony, opened the Congress, and
in the course of his speech dealt with the various
laws affecting medical men and the public health.
The President of the Congress, A. E. W. Ramsbottom,
M.D., of Bloemfontein, іп his opening address,
strongly advocated unity amongst medical men in
Soutu Africa.

The President of the Section of Medicine, H. Aylmer
Патша, M.D.Edin., F.R.C.P.Edin., delivered ап
address entitled, ** The Motive Powers of the Mind."
G. Porter Mathew, M.D., opened the discussion on
“The Treatment of Uterine Displacements.” Drs.
Klots, Murray, Mackenzie, Davies, Ashe, Gordon,
Gren’, and Knobel took part іп the discussion.

G. Ritchie Thomson, M.B., C.M.Edin, F.R.S.
Edin., read а paper entitled, “Тһе Diagnosis and
Treatment of Diseases of the Biliary Passages.”
Drs. Ashe, Davies, Knobel, Murray, and Richardson
discussed the paper.

G. E. Murray, M.B., F.R.C.S., read а paper оп
“ Fistalous Communications with the Urinary Tract."

J. B. Knobel, M.D., L.R.C.S.Edin., contributed a
paper on “А Case of Obstinate Ulceration of the
Dorsum of the Fingers and Dorsum of the Left
Hand, probably due to Unilateral Raynaud's
Disease.”

His Excellency the Acting Governor of the Orange
River Colony attended the Public Health Section of
the Congress, and took part in the work of the Section.

----жт----

Miscellancons.

PIETRO JAMES MICHELLI, C.M.G.

(Secretary Seamen’s Hospital, and London School of Tropical
Medicine. )

Tne authorities of the London School of Tropical
Medicine are well aware of their indebtedness to Mr.
Michelli, upon whom His Majesty King Edward VII.
recently bestowed the most honourable distinction of
Companion of St. Michael and St. George. It may be
safely said that the honour bas never been bestowed
upon one more worthy of the distinction. The
London School of Tropical Medicine has been built
up, launched, floated, and started upon its useful and
successful mission under Mr. Michelli’s capable and
eflicient pilotage; aud it is to be hoped he may con-
tinue for many years to shape its course and stand by
its helm.

]t was to Mr. Michelli that Sir Patrick Manson, іп
1597, first unfolded his scheme for imparting instruc-
tion in tropical medicine, and from that date until the
present moment Мг. Michelli has taken a lively and
enthusiastic interest in all that appertained to the
success of the School.

The scheme once formulated was submitted to the
Board of Manayement of the Seamen’s Hospital
Society. The members of the Board grasped the
national importance of the proposal. The then Deputy

December 1, 1906.)

THE JOURNAL OF TROPICAL MEDICINE.

$63

Chairman (now the Chairman of the Board), Mr.
Perceval A. Nairne, entered heartily into the develop-
ment of а school of the kind, and, loyally assisted by his
colleagues, they resolved to finance the effort and aid
the foundation of a School of Tropical Medicine at the
Branch Hospital of the Seamen's Hospital Society,
Albert Docks, London, E. Тһе formation of a school
for the study of tropical diseases was а peculiarly
appropriate step for the Board of Management of this
Hospital to take, for the patients in their wards were
largely composed of sailors suffering from tropical
ailments. Неге was the material for study, and it
only needed someone to initiate the idea, and to
organise and finance the scheme to bring it to a prac-
tical issue.

The Colonial Office, under the stimulating lead of
the Right Hon. Joseph Chamberlain, M.P. (at that time
the Secretary of State for the Colonies), lent willing
assistance, and contributed a sum of £3,550 towards
the scheme.

Since then many liberal contributors have furthered
the requirements of the School, and several of the
Crown Colonies have contributed towards its main-
tenance and development.

Some £40,000 have been spent upon the School, yet
it is satisfactory to know that the School is free of
debt, and likely to continue so. In all the work of
organisation Mr. Michelli has played an active and a
prominent part, and we rejoice to think that his
devoted services have been rewarded in а manner
which reflects honour upon himself, and has given
pleasure and satisfaction to all the members of the
Board of the Seamen’s Hospital Society, and to the
staff of teachers at the London School of Tropical
Medicine. We believe Mr. Michelli is the first secre-
tary to a public hospital on whom an honour of the
kind has been bestowed, and we take it that amongst
the many able men who serve their hospitals in a like
capacity, the decoration of Mr. Michelli will be
regarded as в welcome recognition of how their
efforts are regarded, not only by the King, but
by the country generally.

Achich.

ILLUSTRATED KEY то THE CESTODE PARASITES OF
Man. By C. H. Wardell Stiles. Washington,
1906, pp. 104.

Тнів small volume (Bulletin No. 25), issued by the
Hygienic Laboratory of the Treasury Department,
U.S.A., is an elaborate and carefully executed com-
panion to the “ Illustrated Key to the Trematode
Parasites of Man” (Bulletin No. 17), issued by the
tame laboratory. Both these volumes deserve а
better setting tban has been given them. Іп their
present form, however, they are eminently useful;
the illustrations, mostly in diagramatic form, are
excellent for teaching purposes, and the text will be
found to be practical and easily followed.

Correspondence.

INTERNATIONAL CONGRESS FOR HYGIENE AND
DEMOGRAPHY. 4

To the Editors of the Journau оғ ТворІсАЫ, MEDICINE.

Dear Srgs,—I shall be very much obliged to you if you
would have the kindness to publish the following notice in
your Journal.

Yours faithfully,
Dr. NEITNER,
Secretary-General.

Berlin,
November 14th, 1906.

Tue FOURTEENTH INTERNATIONAL CONGRESS FOR HYGIENE
AND DEMOGRAPHY.

Her Majesty the Empress of Germany has most graciously
accorded her high protectorship to the work of the Four-
teenth International Congress for Hygiene and Demography,
which will take place in Berlin in September of next year.

TYPHUS AND SPOTTED FEVER. |
To the Editors of the JovRNAL oF ТворісАІ, MEDICINE.

Sirs,—I see on p. 271 of your issue of September Ist,
that the Mexican Government have oftered three prizes of
£4,000 each for discoveries connected with typhus, and that
Dr. Terres, of Mexico, states that typhus is seldom met
with below an altitude of about 2,000 feet. Is not this
disease more probably the “ Spotted Fever” of the Rocky
Mountains? This fever has been known, since 1872, in
some of the four neighbouring States of Nevada, Montana,
Idaho, and Wyoming. It is often confused with typhus,
because of the eruption which usually ipee first on the
wrists, ankles, and back, about the third day, and spreads
rapidly over the rest of the body, lasting from eight to
twenty-one days, or even longer; the spots are petechial,
and sometimes coalesce, giving a mottled appearance to the
skin. Among other symptoms resembling typhus there
are injected conjunctive, photophobia, epistaxis, offensive
breath, sordes on teeth, dry, brown tongue, and weak pulse.
Hypostatic pneumonia is the most common complication;
convalescence is slow, and there are many other minor
resemblances to typhus. The American doctors who
have studied the disease, and have taught us the little we
know on the subject, are not usually very well acquainted
with typhus, but they consider that the two diseases are
distinct. Among symptoms which do not resemble typhus
we hear of desquamation, jaundice, tenderness of the right
iliac fossa, tympanitis, swollen joints, vomiting, enlarged
liver and spleen. Mr. C. W. Stiles made a zoological
investigation into the etiology of ‘ Spotted Fever,” іп 1904,
for the United States Government, and was unable to con-
firm the theories that the blood contained a piroplasma, or
that it could be communicated by ticks to rabbits or other
animals. His communication was published last year by
the Hygienic Laboratory at Washington.

; Yours truly,

Cavendish Square, Е. М. Sanpwits, M.D.

London.

-------о--

Drugs and Acmodics.

Тнв “ Taszoin" Braxp.—We congratulate Messrs.
Burroughs Wellcome and Co. on their successful
defence of what would appear to have been an
infringement of their rights to the exclusive use of

864

their designation for compressed drugs. А trading
company wished to register the word “ Tablones,” to
designate their products. This was refused by the
Board of Trade and subsequently on appeal to the
High Court of Justice. Тһе several attempts to
dethrone the magic word ‘Tabloid’ has hitherto
ended in deserved failure. There can be no doubt
that words resembling *' Tabloid,” used by companies
other than Burroughs Wellcome and Co., are only
employed for one purpose. Surely we have enough
originality left amongst us to devise catching names
for new preparations, without seeking to come in
conflict with existing terms.

The three following preparations are issued by Messrs.
Martindale, 10, New Cavendish Street, London, W. :—

TYLMARIN, а” new coumaric derivative. It has
been commended for the treatment of tubercular
glands, in conjunction with injection of the 22 per
cent. solution of sodium-orthocoumarate and the
glycerine solution of sodium cinnamate. The same
drug is suggested as a treatment in malignant
ailments.

Syrupus Iopo-Tannicus, is a palatable preparation
containing iodide in loose chemical combination,
and employed in the treatment of enlarged cervical
glands.

БЕРЕКЕ contains -suitable doses of opium, bismuth,
and digestive ferments; it is useful in digestive
derangements, especially those accompanied by vomit-
ing, and in the sickness of pregnancy.

——9—— ———

Books and Papers Peceived.

ProressorR GALLIO-VALERIO'S new work on the
Mosquito is published by Edwin Frankfurth, 12,
Grand Chene, Lausanne, Switzerland. The book is
ilfustrated. Price 4.50 francs.

-------“о---

Hotes and ets.

---

LEPER COLONY IN THE PHILIPPINES.—A permanent
‘leper colony has been established at Colion Island, in
the Philippines. Some 200 lepers are now installed
there. Four Roman Catholic Sisters have volunteered
to nurse the lepers in the colony.

Tre King of the Belgians has offered a prize of
about £7,000 to any person, of any nationality, who
shall discover a cure for sleeping sickness. A sum
of about £10,000 is also offered by His Majesty for
the purpose of making researches and experiments
towards exterminating sleeping sickness.

R. Косн is at present in Sese, Bugala, іп Africa.
The investigation of sleeping sickness is usurping the
whole of his time.

THE JOURNAL OF TROPICAL MEDICINE.

[December 1, 1906.

IsrHMiIAN Самат, Commission.—From January lst
to August 31st, 1906, only one case of yellow fever
was reported from the Canal Zone. During August,
1906, the mortality from the most prevalent diseases
was as follows: Pneumonia, 94 deaths; malaria,
78; typhoid fever, 12; dysentery, 20;. beri-beri, 5.
The population of the part of the Isthmus from which
these figures are obtained, numbers 75,000 people.

During September, 1906, pneumonia caused 86
deaths, and malaria 70. During the months of
August and September, 1906, there were no fatal
illnesses amongst the 4,800 Americans (whites) in the
Canal Zone.

ACCORDING to our last news from India, the stu-
dents of the Campbell (vernacular) Medical School of
Calcutta had been out “оп strike" for a week.
According to the version of the affair as reported in
the Pioneer, the cause of dissatisfaction in this par-
ticular case appears to be of a frivolous and personal
character; but as the vernacular medical students .
have always shown themselves in the past as a very
well-behaved set of young men, it may be taken that
these recurring evidences of friction and discontent in
these widely distant schools, are merely symptoms of
a general feeling of dissatisfaction with the conditions
prevailing in the service. It is to be hoped that the
probably ill-advised turbulence of these boys will not
prejudice Government against granting reasonable
concessions in the matter of pay and prospects to
this large and important service.

Tue Punjab Government has before it a “ Tenancy
Bill,” which includes some proposed enactments of
medical interest. Clause 28 gives power to levy a tax
to defray expenses connected with the sanitation and
general administration of village sites. This should
prove a very useful power, as apart from the theo-
retical position of the Government as the ultimate
possessor of the soil, it deals directly as landlord to
tenant in the case of the very extensive population of
farm colonists, now settled on, till recently, waste lands,
that have been reclaimed by irrigation.

Naturally enough, these chance collections of culti-
vators lack the power of cohesion and initiative of
older villages, and the Government is in & far better
position to make them models not only of cultivation,
but of sanitation.

These newly irrigated lands are, as might be ex-
pected, extremely malarious, and for other reasons
require special measures of sanitation.

Ап old village site can always be easily recognised
by its elevation above the endless surrounding plains.

The Indian peasant is а bad hand at repairs, and
often lets his mud-built homestead fall down when a
little timely personal exertion might have kept it
habitable for years to come.

The sun-dried bricks, of which the huts are built,
are fabulously cheap, and cannot generally be во соп-
veniently made on the site as on the banks of the
nearest tank, so he does not clear away the site or
utilise the old material, but roughly levels the heap
and builds on the ruins, with the result, that in the
course of the hundreds, and perhaps occasionally
thousands of years, a site has been occupied, the

December 1, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE.

365

centre of it stands perhaps 50 or 60 feet above the
general level of the ground. This elevation of the site
is, of course, a valuable sanitary asset, but has the un-
desirable corollary of the environs of the site being
honeycombed with irregular excavations holding dirty
water throughout the greater part of the year. Inthe
case of really old sites, the entire inhabited site is
more or less surrounded and intersected with a minia-
ture ‘lake district,” the intricacies of which would
puzzle an expert marine surveyor. The water they
contain is for the most part indescribably foul, and one
of the most urgent and insoluble of the problems of
Indian sanitation is that of the betterment of the state
of things that has resulted from the method of develop-
taent of village sites above described.

Now the irrigation colonies just mentioned have
only been started during the last few years, and it is
most important that the Government, in its strong
position us direct landlord, should step in and regulate
the development of these new villages before the evils
that have been touched upon have crystallised into
established facts.

It is extremely desirable that the inhabited site

hould be raised well above the general level of the
rrigated fields, and it is also most important that the
subsoil beneath it should be drained. Now both these
objects can be attained by making deep and properly
graded cuttings to the nearest practicable outfall, and
utilising the spoil to raise the site, but such operations
can only be undertaken by the Government itself, and
the power to levy а small tax to cover the interest of
the capital outlay will be а valuable one, which we
trust Government will promptly utilise, and justify by
works of sufficient magnitude to demonstrate that
irrigation is not necessarily incompatible with a good
standard of public health.

THERE is a want of uniformity in the attitude of the
various provincial governments in India in the matter
of dealing with the growing evil of the cocaine habit.
No steps, for example, have been taken in the United
Provinces of Agra and Oudh, to bring cocaine under
the provisions of the Excise Acts, and the result is, it
appears, that these provinces form centres from which
smuggling can easily be conducted into neighbouring
provinces where the authorities have acted more wisely
in the matter.

THE current (November) number of the Indian
Medical Gazette includes two useful ' Notes" by
members of the Calcutta Plague Staff.

In the first Captain V. B. Nesfield, I.M.S., strongly
advocates the use of chlorinated lime as a disinfectant.
He points out that owing to lack of penetrative and
diffusive power, the metallic germicides, such as mer-
curic perchloride, cupric sulphate, &c., though extremely
powerful when they can be brought into actual contact
_ with bacteria, fail in practice on account of the impos-
sibility of securing contact. A drop of a cultivation,
for example, of В. coli, placed on a scrap of paper, and
floated on some such disinfectant, remains quite
unaffected for a long time. The chlorine gas, how-
ever, given off by chlorinated lime diffuses itself into

chinks and crannies, and even permeates porous
materials. ‘Che main objection to the agent is the
difficulty of keeping it in good condition in a hot
climate, and he therefore recommends that it should
be sealed in glass tubes containing 24 oz. each, at
a cost of 224. each. Each of these tubes suflices to
make eighty gallons of a germicide lotion.

Chlorine is, of course, an excellent insecticide, but
we doubt if it would be given off in sullicient quantity
from such a lotion in a suiticiently concentrated form,
to secure the destruction of flies; as if it were so, its
application would obviously be dangerous to the dis-
infecting gangs; and failing the power to destroy
insects no germicide can be considered reliable in
dealing with plague.

Chlorine can, however, be easily and cheaply manu-
factured, with a suitable apparatus, by pouring slightly
diluted sulphuric acid on & mixture of common salt
апа binoxide of manganese, the whole of the chlorine
contained in the salt beiug liberated.

There would be no difficulty whatever іп contriving
a suitable apparatus to contain a charge of the salt
and dioxide, into which an appropriate charge of acid
might be tipped by pressing a button. All openings
but one having been closed in the room to be dis-
infected, all that would be necessary would be to place
the apparatus within the room, press the button, and
immediately leave the room, closing the door behind
one, as if provided with a fairly long flexible tube, the
gas would not begin to issue from it until ample time
had been given ‘to effect the small manipulation
necessary.

The second note, from the peu of Dr. W. C. Hossack,
deals with the species of rats found in Caleutta. He
finds that the rats concerned are Nesokia bengalensis,
or Indian mole rat, 60 per cent. ; Mus decumanus, the
short-tailed grey rat, 26 per cent.; M. alexandrinus,
а local race of M. rattus, the European long-tailed
“black rat," 14 per cent.; aud N. nemonrayus, the
lesser Bandicoot, which is rare.

If we remember rightly, Captain Glen Liston found
the black rat relatively much commoner in Bombay,
and, as he points out, that, owing to its habits, it 1s
much more commonly concerned in carrying plague
than the other species, its rarity in Caleutta may serve
to explain the comparatively lightness of tho incidence
of plague in Calcutta from plague.

Fever is becoming seriously prevalent in the fron-
tier cantonments. А Peshawar correspondent writes:
* The great topie of conversation at present is the
tremendous prevalence of fever, and it seems likely
that owing to it, the divisional manauvres, which were
timed to take place about November 27th, will have to
be abandoned, some 20 or 40 per cent. of the garrison
being affected. Тһе type seems to have reverted to
the Peshawar fever of some fifteen years ago, which,
happily, has been dormant for some years, aud greatly
resembles cholera."

А Rawal Pindi correspondent writes: “ Pindi is still
suffering under a veritable wave of fever of a most
virulent type, and labour of any sort is scarcely pro-
curable. Large fields of crops in the vicinity of the

. town stand uncut, long since over-ripe, bearing silent

866

THE JOURNAL ОЕ TROPICAL MEDICINE.

[December 1, 1906.

witness to the melancholy fact of the prevailing sick-
ness.” — Pioneer Mail. l

It may be taken for granted that no adequate anti-
malarial measures have been attempted in either of

these stations. WHY NOT?

——— —9—-—-—

Personal Kotes.

INDIAN MEDICAL SERVICES.

Arrivals reported in London.—Licutenant-Colonel J.' Smyth,
Lieutenant W. F. Вгаупе, Lieutenant C. H. Barber.

Extensions of Leave.— Major W. Pilgrim, furlough to Feb-
ruary 3, 1907; Lieutenant-Colonel R. H. Castor, one week
furlough ; Major J. T. Calvert, study leave, January 15th to July
14th, 1906 ; Captain D. N. Anderson, 6 m. medical certificate.

Permitted to return to Duty.—Captain A. Murphy.

Postings.

Major H. E. Drake Brockman, Residency Surgeon, Western
Rajput States.

Lieutenant.Colonel P. D. Pank, Residency Surgeon, Jaipur.

Lieutenant-Colonel W. Н. В. Robinson, Agency Surgeon,
Bikanir.

Major A. L. Duke, Residency Surgeon, Bangalore.

Major T. W. Irviue, Senior Surgeon and Sanitary Commis-
sioner, Mysore.

Lieutenant J. F. Boyd, to Civil Medical Duties, Kohat.

Lieutenant В. Е. M. Newland, to Civil Medical Duties,
Chitral.

Licutenant-Colonel A. W. Dawson, to Civil Medical Duties,
Roorkee.

Civil Assistant-Surgeon Purna Chandra Mukerji, to Civil
Medical charge, Gonda district.

Lieutenant-Colonel S. H. Henderson, to be Superintendent,
Central Jail, Agra.

Colonel H. Hendley resumes charge as Civil Surgeon, Lahore,
and Professor Midwifery and Forensic Medicine.

Major E. V. Hugo, to Civil Surgeon, Lyallpur.

Major G. Е. W. Ewens, resumes charge as Superintendent
Punjab Lunatic Asylum.

Major P. J. Lumsden, to be Agency Surgeon, Bhopawar.

Major N. Burden, to be Agency Surgeon, Gilgit.

Captain McCarrisa, to be Agency Surgeon, Alwar.

Major Scott Monterief, to be Agency Surgeon, Mewar.

Major J. Fisher, to be Agency Surgeon, Eastern Rajput
States.

Lieutenant-Colonel A. M. Crofts, C.I.E., to be Administrative
Medical Officer, N.W. Frontier Province.

Lieutenant-Colonel G. W. P. Dennys, to be Civil Surgeon,
Peshawar.

Captain Fleming, to Consulate Medical Officer, Turbat-i-
Haidari.

Captain L. J. M. Deas, to be Residency Surgeon, Gwalior.

Captain Macmillan, services at disposal Government Eastern
Bengal.

Captain Munro, services at disposal Government Bengal.

The under-mentioned officers are permitted to continue in
their appointments of specialists in prevention of disease:
Major Julian, Peshawar; Major Taylor, Kamptce; Major
Anderson, Mecrut ; Captain Spiller, Allahabad; Captain Small-
man, Secunderabad ; Captain Brunskill, Rangoon ; Licutenant
Watson, Karachi.

The services of the following officers are placed at the disposal
of the Government of India in the Home Department, with
effect from October 16th, 1905:—

Lieutenant-Coloncl R. №. Campbell M.B.; Major D. В,
Green, M.B., and Captains W. D. Hayward, S. Anderson, T. Н.
Delany, Н. Inness, M.B., W. V. Coppinger, А. C. Gilchrist,
aud T. H. Watling.

Leave.

Major E. Jennings, 2 y. combined leave.
Captain H. Ainsworth, 7 m. combined leave.

R.A.M.C.

Licutenant-Colonel T. B. Winter, to charge of Station Hos-
pital, Bareilly; Captain ХУ. Davis, to inspection of routes, іп
connection with Agra concentration; Major Mould, to Agra for
duty ; Captain J. F. Martin, from Northern Command to Poona
Division; Lientenant-Colonel G. Scott is granted six mouths’
leave out of India.

COLONIAL MEDICAL SERVICE.

A. L. Hoops, M.D., D.Ph., State Surgeon and Superintendent
of Prisons, Kedah, Malay Peninsula, has been appointed to act
as Adviser to the State of Kedah during the absence on leave in
Europe of Mr. б. C. Hart.

— e

PECULIAR ERUPTIONS OF THE SKIN IN
INDIA, DUE TO VEGETABLE AND IN-
SECT LIFE, AND THEIR TREATMENT.

By Major G. H. Fink, І.М.8., M.R.C.S., L.S.A.Lond.

Мовт people who bave lived in India will have seen
from time to time curious forms of skin eruption due
to certain vegetable and insect life. These are peculiar
to certain provinces and districts in India. Bengal
and Assam produce some which are not to be seen in
any other part of the country, and these very often are
powerful in their action and produce vesication of the
skin, burn, and create discomfort which resembles that
of a strong blister or a hot iron applied to the skin.

In parts of Assam, such as the North Lushai Hills,
one well-known leaf which is@ordate in shape, bluish-
green in colour, of the size of the hand, which grows
in the jungles, possesses this powerful property of а
vesicant if touched. :

But the effects of & certain spider lick or bite is to
be seen frequently in children in Bengal, when the
face is generally the part affected, owing to this part
of the body coming frequently into contact with spider
webs. The result is often an eruption on the lips or
chin, resembling Herpes, which, if untreated, goes on
to resemble Impetigo contagiosa, if you compare these
eruptions with it.

Treatment. — The most effectual treatment of a
spider's lick or bite is as follows :—

Take a basin of cold water and let the patient hold
his or her head over it. Now get a few lumps of mustard
oil cake (which is to be had in almost every oilman's
shop, since the cake is obtained after expressed
mustard oil is manufactured, and is used largely to
fatten cattle), burn these in а charcoal fire till of &
black colour. Drop the burning lumps into the basin
of water, and allow the smoke and fumes which rise
to come inio contact with the part of the patient's
skin which is affected, twice а day, for two or three
days. The result is a perfect cure.

On examining the surface of the basin full of water,
there will be seen a large number of transparent little
droplets of a yellowish-white colour, and about the
size of a pin’s head, which look like so many eggs of
lepidopterous insects, or like the simple follicles of the
secreting organs of the spider tribe (Arachnida.)

The study of Spiders, Scorpions and the Acarida, as
well as the parasitic Acarida (to which Demodex
folliculorum belongs) is very necessary, and it would
be therefore essential to devote attention to such

е

December 1, 1906.)

insect and parasitic life, as well ав the Lepidoptera,
which create skin eruptions of a vesicular and follicular
type, and to their proper treatment in the early stages,
otherwise the character of the affection is masked by
the lapse of time, and its origin very often lost.

MOSQUITO BRIEF PREPARED BY THE
AMERICAN MOSQUITO EXTERMINATION
SOCIETY.

(1) Тненв are over 100 species of mosquitoes in
the United States.

(2) Mosquitoes breed only in water. They may
breed in any kind of quiet water unstocked with
destroying fish.

(3) Mosquitoes generally require from one to
three weeks to develop from eggs to winged insects
in warm weather, longer in cold weather. Some
female mosquitoes three days old lay eggs, the
average is greater. Some species lay as many as
three or four hundred eggs at once, some lay them
singly. Mosquitoes may live several months (as
shown by hibernation aud otherwise), but probably
few live over a month.

(4) Mosquitoes do not breed in grass, but rank
growths of weeds or grass may conceal small breed-
ing puddles, and form a favourite harbouring place for
adults. The pitcher plant holds suflicient water to
breed a rare and small species.

(5) Ditlerent species of mosquitoes have as well-
defined habits as different kinds of birds, flies, &c.
Some are domestic, some wild, some migratory.

(6) Most domestic mosquitoes breed in fresh water,
fly short distances, and habitually enter houses.

(7) Most migratory mosquitoes breed in salt and
brackish marsh areas, and can fly long distances.
They are not conveyers of malaria.

(8) Rigid tests, both direct and eliminative, have
proved that certain species of mosquitoes are the
only known natural means of transmitting malaria
and yellow fever. Some other diseases are known
to be conveyed by mosquitoes.

(9) Of the domestic varieties, the dangerous
malarial mosquitoes (several species of the genus
Anopheles) are among the most generally distributed.
They seem never to travel far, only a few hundred
yards.

(10) A most common and dangerous domestic
mosquito in the south and the Tropics is Stegomyia
fasciata, which is the natural conveyer of yellow
fever.

(11) Mosquitoes are known to bite more than once,
as can be seen by observation, and is proved by the
transmission of disease from an infected person to а
new subject. i

(12) Mosquitoes are a needless and dangerous pest.
Their propagation can be largely prevented by such
metbods as drainage or filling of wet areas, removal,
emptying or screening of water receptacles, spraying
standing water with oil where other remedies are
impracticable. Attention should be paid to cisterns,
house-vases, cesspools, road basins, sewers, watering
troughs, roof gutters, old tin cans, holes in trees,

THE JOURNAL OF TROPICAL MEDICINE.

867

marshes, swamps and puddles. As malarial mos-
quitoes may be breed in clear springs, the edges of
such places should be kept clean, and they should be
stocked with small fish. The breeding and protection
of insectivorous birds, such as swallows and martins,
should be encouraged. Thorough screening of houses
and cisterns is necessary to prevent the spread of
malaria or yellow fever. The continued breeding of
any kind of mosquitoes, with the attendant menace
to public health and to the life and comfort of
man and beast, is therefore the result of ignorance or
neglect.

UNIVERSITY OF EDINBURGH.
CERTIFICATES IN TROPICAL MEDICINE.

In the Calendar of the University of Edinburgh the
following candidates are announced to have gained
certificates in the department of Diseases of Tropical
Climates, conducted by Dr. Andrew Davidson.

First-class Honours.

Alexander Edington, M.D.
Major Owen St. John Moses, ims}
D. Morley Mathieson, M.A., М.В.
James Sutherland Edwards.
Major Bryson, І.М.8.
а Н. Hill, M.D.
harles Chaves, M.B.
W. M. P. Henderson | Equal.
K. R. Tampi.
J. S. Manson.
Robert M. Wishart.
P. Lornie.
J. А. MacLeod
Arthur Dangerfield, M.B.
Halliday Gibson Sutherland
W. O. Sclater.
E. W. Dyer.
John Hunter, M.B.
А. M. Dick.
А. J. S. Walwyn.
Graham Robertson b 1
зача].

Equal
(Medallists).

| Equal.

John Macdonald
Harley P. Milligan.

Second-class Honours.

J. Theodore Young, M.B.
Hugh Jamieson, M.D. |ва
Т.Н. Dickson

—— —

PRELIMINARY LIST OF SUPPORTERS OF
THi COLLECTION IN AID OF THE
GREEK ANTI-MALARIA SOCIETY.

UNDER THE PaATRONAGE OF H.R.H. Princess
CHRISTIAN.

His ExcELLENCY Sır Francis Ешлот, G.C.V.O.,
K.C.M.G., British Minister at Athens.

His Excellency M. Metaxas, G.C.V.O., Greek Minister
in London.

Mr. Sp. Acratopulo, Liverpool.

868

Dr. Clifford Allbutt, F.R.S., Professor of Medicine,
University of Cambridge.

Alderman J. Ball, Lord Мауог of Liverpool.

Mr. Е. Benachi, President of the Greek Community of
Alexandria (Egy pt.)

Mr. К. C. Bosanquet, Professor of Classical Archæo-
logy, University of Liverpool, and Institute of
Archiclogy.

Sir James Creighton Browne, F.R.S., Treasurer, Royal
Institution of Great Britain.

Mr. James Cantlie, Editor JOURNAL oF TROPICAL
MEDICINE.

Professor Carter, M.D., Chairman, Professional,
Committee Liverpool School of Tropical Medicine.

Dr. ees Emeritus Professor, University of Liver-

OOL

Mr. Т. E. Colleutt, F. R.I. B.A., President of the Royal
Institute of British Architects.

Mr. M. Corgialeno, President of the Greek Community
in London.

Vice-Chancellor A. W. W. Dale, University of Liver-
pool.

Professor the ‘Rev. S. R. Driver, Regius Professor of
Hebrew, Oxford.

Sir John Evans, F.R.S., President, Royal Numisuiatic
Society.

Dr. Frazer, LL.D., Trinity College, Cambridge.

Mr. J. Garstang, Institute of Archeology.

Mr. Grifliths, United States Consul, Liverpool.

Professor Herdman, Е.К.5., President of the Linnean
Society of London.

Sir Alfred Jones, K.C.M.G., Chairman, Liverpool

г School of Tropical Medicine, and President, Liver-

* pool Chamber of Commerce.

Professor Macalister, M.D., St. John’s College, Cam-
bridge.

Dr. Mahaffy, D.D., Trinity College, Dublin.

Mr. B. A. Malandrinos, Greek Consul in Liverpool.

The Right Hon. Viscount Mountmorres.

Sir Shirley Murphy, Medical Officer of
London.

Mr. A. Natzio, Manchester.

x G. Hall Neale, President, Liverpool Academy of
Arts.

Mr. P. E. Newberry, Institute of Archeology.

Sir Christopher Nixon, LL.D., Ex-President, Royal
College of Physicians, Ireland.

Dr. G. H. F. Nuttall, Ph.D., Professor of Protozoo-
logy, Cambridge.

Dr. Osler, F.R.S., Professor of Medicine, University
of Oxford.

Mr. Alex. Pallis.

Mr. Rushton Parker, F.R.C.S., Professor of Surgery,
University of Liverpool.

Sir Richard Douglas Powell, Bart., M.D., President,
Royal College of Physicians.

Mr. б. C. Ralli, Liverpool.

Messrs. Ralli Brothers, London, Liverpool, Man-
chester, &c.

The Right Hon. Lord Rayleigh, O.M., President of
tlie Royal Society.

The Right. Hon. Lord Reay, G.C.S.I., LL.D., Presi-
dent of the British Academy.

His Excellency Sir John Rodger, K.C.M.G., Governor
of the Gold Coast.

Health,

THE JOURNAL OF TROPICAL MEDICINE.

-

[December 1, 1206.

Dr. J. Rutherford, Harrogate.

Mr. Watson Rutherford, M.P., Liverpool.

Dr. C. G. Savas, Professor of the University, Athens.

А. E. Shipley, Esq., F.R.S., Cambridge.

Mr. J. J. Stavridi, Greek Consul-General in London.

The Right. Hon. Lord Stanley, К.С.У.О., С.В.

Mr. D. Steele, Lake Kopais Company, Greece.

Dr. Traill, LL.D., Provost of Trinity College, Dublin.

Sir Frederick Treves, Bart., F.R.C.S.

Robert Wallace, Esq., F.R.S.E., Professor of Agricul-
ture, Edinburgh University.

Sir Henry Wood, Secretary, Society of Arts, London.

Mr. G. Zlatano, Manchester.

Mr. G. B. Zochonis, Manchester.

----Фз----
Geographical Distribution of Disease.

Ав information arrives we publish, under this heading, the
principal diseases met with in tropical and sub-tropical
countries, so that those interested in the Geographical Dis-
tribution of disease may have a means of gathering informa-
tion concerning the prevalent ailments in different parts of
the world.

PREVALENCE OF CANCER.
To the Editora of the JouRNAL or TRopicaL MEDICINE.

Sirs,—In reply to your correspondent, Dr. Branch, I would
mention that I can recall, during а practice here of eleven
and & half years, four cases of epithelioma in Soudanese
slave women brought to Morocco, and without any admix-
ture of Arab blood. They came under notice at a late
stage, and died with disseminated growths. I may have
had more in the dispensary, but my case books do not men-
tion the colour or race of the patients.

I think cancer of all kinds, except rodent ulcer, which I
have never seen here, is at least quite ав common as in
England. Of course, the Arabs largely predominate over
the pure blacks. My work, being confined to women and
children, excludes case of cancer special to men.

Yours faithfully,

Women's Hospital, GaBRIELLE BREEZE, М.В.

Tangier, Morocco.

India. :
Malignant Diseases.—At the London Mission Hos-
pital Tammaladugu, Southern India, the following
operations for malignant diseases were performed
during 1905 :—

Epithelioma—arm (excised) 1
loin 5 : 1
anus T 543 aus 1
penis, partial removal ... 1
total extirpation Ж 1
tongue, removal of half 1
cheek and ір ... т 8
lower jaw, half remove 4
palate s PA 1
scirrhus of breast ampu-
tation ... 2 ET 8
Sarcoma breast, amputation 1
Rodent ulcer ves 1
Myosarcoma buttock 1
Lymphadenoma... ties $$ 55; 1
Cancerous degeneration of ovarian
tumour 1

Песетһег 1, 1906.)

Recent and Current Literature.

A tabulated list of recent publications and articles bearing on
tropical diseases is given below. To readers interested in
any branch of tropical literature mentioned in these lists
the Editors of the JouRNAL оғ Tropical MEDICINE will be
pleased, when possible, to send, on application, the medical
journals in which the articles appear.

“The China Medical Missionary Journal,” September, 1906.
I. AN UNDESCRIBED FORM оғ ASCARIS AND ITS Бес.

Logan, O. T., writing from China (place not stated)
states that he has found an undescribed egg in the fæces.
The egg may be, he suggests, an abortive or partially
developed egg of a lumbricoid. He has further noticed
that the parent female worm has a constriction about one-
sixth inch wide, which encircles the body at the junction of
the middle and anterior thirds. These observations corre-
spond to those made by Dr. Crichton Wellman in South
Africa, who found a worm with а constriction similar to that
described by Dr. Logan, who asks if this is a new species.

An interesting clinical fact noted by Dr. Logan is that he
had seen a round worm passed by the urethra.

II. From Hangchow, Fokien. a communication con-
cerning the prevalence of disenses was as follows: (1)
Beri-beri: rare, а few cases in twenty-five years, not
endemic. (2) Cholera: sporadie cases only. (8) Dysen-
tery : common, mostly chronic, mortality not high. (4)
Hernia: very common. (5) Malariat fever: common and
virulent. (6) Plague: no plague. (7) Pneumonia: common
and deadly. (8) Typhoid: common, but of mild type. (9)
Urinary calculi: several cases every year operated on.

Of the diseases enumerated in this table, the most unex-
pected is the frequency of hernia. Most observers in
China hitherto have constantly remarked upon the extra-
ordinary few cases of hernia seen amongst the Chinese.

III. Surcrpes BY Ором Іх CHINA.

In the annual report of the Chinese Hospital, Shantung
Rond, Shanghai, for the year 1905, the number of attempted
suicides by opium is remarked upon. No fewer than 818
eases of this nature were brought to the Hospital, 196 bein
males and 192 females. Of this number, 25 died an
298 recovered. When one thinks of the number of cases
never brought to hospital, and that the above figures repre-
sent the cases brought to one hospital only, the extent of
attempts upon life by. this means throughout the length
and breadth of China must be appalling.

IV. MALIGNANT DISEASES IN CHINA.

Dr. Kuhne, in his report of the Tungkun Hospital, states :
“ Cancer and epitheliomata are not so frequent as in Europe ;
on the other hand, fibromata have а tendency to become

PIE and lymphadenoinata are often а cause of
death." ,

“Journal of Amer. Med. Вос.,” April 28, 1906.

I. A Review оғ CANCER IN THE UNITED STATES ОҒ
AMERICA, ACCORDING TO THE TwELFTH (THE LAST)
Census. Ву Guthrie McConnell, М.р.

Conclusions.

(1) That cancer appears to have actually increased in the
United States; 12-1 deaths per 100,000 population in the past
ten years.

(2) That the death-rate is higher in the rural districts and
small towns than in the cities. ;

© That native whites suffer much less than the foreign
whites.

(4) That the death-rate amongst the foreign whites in the
United States is only apparently greater than in their own
homes.

(5) That 63:1 per cent. of all cancer cases are in women,
and 86% per cent. іп men.

THE JOURNAL OF TROPICAL MEDICINE.

369

(6) That those employed in hard outdoor work have &
higher canecr mortality than the sedentary classes.

(7) That the areas showing the greatest mortality are
mountainous regions that are well watered and timbered.

(8) That cancer does not seem to be generally more preva-
lent along rivers.

(9) That those cities in which there are both a large
German population and large brewing interests do not show
а corresponding inerease in cancer mortality.

(10) That cancer mortality is greatest in persons of 65
years and over.

(11) That the average age at death is 58:1 years.

II. MALARIA INFECTION ім CERTAIN Native VILLAGES oF
THE CaNAL Zong. By A. I. Kendall, M.D.
Summary and Conclusions.

(1) Malaria existed in certain towns of the Canal Zone
at the time this work was done to such an extent that
over 50 per cent. of the native born and 70 per cent. of
the foreign born harboured parasites in their peripheral
circulation.

(2) This high percentage of infection does not necessarily
mean that a corresponding number present febrile symp-
toms; in fact, many do not.

(3) This high percentage of infection is а menace to the
health of those who, by reason of their work, may be
compelled to remain in such towns, particularly because of
the wide distribution of the Anopheles albipes, a mosquito
shown to be capable of transmitting malaria. Other
Anopheles to a lesser extent may also be factors in distri-
buting malaria.

(4) The wstivo-autumnal malaria is the prevalent type ;
the Chagres fever is, in all probability. a severe mstivo-
autumnal infection. Pernicious malaria is not caused by
а new parasite, but by an wstivo-autumnal organism of
exalted virulence.

(5) Natives and their descendants
descendants of those who have lived continuously on the
Isthmus of Panama for many years, at birth have, to a
certain degree, an inherited immunity ; an aetive immunity,
which is by no means absolute, is generally acquired,
becoming manifest at about the age of 16. Тһе foreign
born acquires a tolerance to the malarial organism ; this
tolerance, however, is not as great, nor does it begin as
early, as is the case with natives.

(6) Malaria is an environmental disease; occupation has
very little to do with the cause of this disease.

(7) Quinine in nioderate daily doses, while not absolutely
guarantecing freedom from malaria, or completely driving
organisins from the circulation, has an important preven-
tive and curative effect.

«С. R. Soc. Biol.,” T. 1х., р. 659.

Ѕквом REACTION DURING THE COURSE OF MEDITERRANEAN
FEVER. :

Soulie, H., and Garden, V. In thirtcen cases in which the
agglutinating power of the serum was tested daily, the
&uthors found this variable; and in the same patient the
power might disappear altogether on certain days. The
serum reaction of 122 patients, suffering from different
diseases, for the M. melitensis, was always negative up to Jy.

The agglutinin is destroyed by heating for five minutes
to 60°, а quite exceptional fact, which is duly emphasised.

A CASE or INVASION OF THE OVARY ОЕ А CRAB BY
THELOHANIA MÆNADIS.

Pérez, Ch. (ibid., p. 1091), describes an exceptional case
in which the ovary of the crustacean was infected by this
microsporid in the stage of young sporonts. The parasite
had completely invaded the ovary. forming the greater part
of the mass. There were a few healthy ovules, some foci of
germinal proliferation, eosinophile amwbocytes, and reticules
of follicular phagocytes, evidently engaged in absorbing
large vitilline patches, which were evidently the remains of
large ovules,

or, іп general, the

870

THE JOURNAL ОЕ TROPICAL MEDICINE.

{December 1, 1906.

The BACILLI оғ А DysENTERIFORM EPIDEMIC АТ TUNIS.

Nicolle, C., and Cathoire (ibid.) isolated two forms: (1) А
bacillus of a strain resembling that of Shiga and Chante-
messe, and differing from that of Flexner IT., which ferments
maltose, dextrine, saccharose, and soluble starch only, and
produces only indo] in peptonised water. The ingestion
of a few drops of the culture was sufficient to produce the
disease in a young rabbit. (2) A mobile bacillus, the cultures
of which smelt like those of B. сой, Subcutaneous innocu-
lation of an adult rabbit with 1 cc. of this culture in bouillon
failed to reproduce the malady. It produced indol in
peptonised water, but did not ferment lactose. It did not
agglutinate with dysenterie serum, and the corresponding
serum did not agglutinate the micro-organism of true
dysentery.

THE EXPERIMENTAL STUDY оғ BERI-BERI.

Salanone, Henri (/bid., p.1117). The research in question
was made in the bacteriological laboratory of Hanoi, and
consisted in inoculating the dura mater or substance of
the pectoral muscle of pigeons with an emulsion of the
pneumogastrie nerve of a beri.beri case. There resulted
& progressive paralysis of the legs and wings.

The blood and pulp of the internal viscera of the same

patient proved to be harmless when employed in the same
way.
From these pigeons M. Salanone has isolated a diplo-
coccus having many of the characters of that described by
Okata and Kokubo. It will not stain by Gram’s method,
slightly clots milk, and attacks lactose.

The cultures on bouillon and on serum have a smell like
stale fish. This microbe kills rabbits, mice, guinea-pigs,
pigeons, fowls, and monkeys when inoculations are per-
formed either vid the dura mater, the peritoneum, or the
trachea, and when the case terminates quickly, the lesions
of acute beri-beri are very obvious.

Marked vaso-motor paralysis, with congestion of the
internal organs, degeneration of the heart muscle, effusions
into the peritoneum, pleura, and pericardium. А pure cul-
tivation of the diplococcus was recovered from the heart-
blood of the mouse. In fowls and monkeys this disease
takes a chronic course, and in the monkey it recalls the
* dry" form of beri-beri, with polynephritis, tvpical para-
lysis of the extensors of the limbs, marked wasting, and, to
a certain extent, muscular atrophy.

“ Philippine Journal of Science," T. i., р. 169.
BERI-BERI IN THE JAPANESE ARMY DURING THE LATE War.

Herzog Maximilien. In August, 1905, the author pro-
ceeded to Тарап, to study beri-beri, of which some 80,000
cases had occurred in the Japanese Army, and to study a
coccus, Which was believed to be the cause of the disease by
the Japanese physicians, Okata and Kokubo. The coccus
was described by the latter in the Journ. Milit. Surg. Assoc.,
September, 1905, as follows, and was named by them
Kakkecoccus :—

“А diplococcus, seantily found in the blood of cases of
beri-beri, immobile, without capsule, and staining well with
analine colours. Ву pricking the region of the trapezius
after cleansing the skin, they found this coccus in the blood
in 65 eases, both by culture and by the examination of cover-
slips; in 11 eases by the examination of the latter only, the
cultures being negative ; іп 19 cases by culture, the micro-
scopic examunation being negative; while in 84 cases the
examination was absolutely negative. Тһе diplococcus
grows rapidly on gelose at 87°, and very slowly at 10°. In
bouillon, 977, there was a greyish deposit at the bottom of,
and adhering to the sides of the tubes, the liquid remaining
quite clear; in gelatine no liquefication; in serum а fine
grey cultivation; on potato а bright yellow deposit; does
not ferment sugar ; and does not clot milk. They isolated
the same microbe from the urine 15 times, and from the
stools in 45 cases,”

The results of inoculating animals with the blood of beri-
beri cases, with cultures of the coecus, or with the spleen of
infected mice were indecisive: 8 rabbits out of 21, and 15
mice out of 64 succumbed, while 7 guinea-pigs all survived.
Kokubo has prepared a seram by inoculating rabbits, which
in a hanging drop agglutinated the coecus in a dilution of
1 per cent. in two hours.

Following Kokubo's methods, Herzog succeeded in isolat-
ing the coccus from the urine in 8 out of 40 cases, but he
failed to isolate it from the blood of patients; and he points
out that the precautions taken by Kokubo would not prevent
the blood obtained from being contaminated by the secre-
tions of the sudorific and sebaceous glands. They were not
allowed to take blood directly from the median cephalic
vein.

In the only autopsy that could be obtained the coccus was
isolated from the kidneys and the meningeal fluid.

On returning to Manila, Herzog inoculated monkeys and
other animals with the coccus, but, as yet, with indecisive
results. He is, however, continuing his researches.

** Archiv. f. Schiff. und Tropen-Hyg.," T. x., p. 399.

PRELIMINARY NOTICE ON THE KAKKECOCCUS AS A CAUSE
oF BERI-BERI.

Truzuki obtained a diplococcus 7 to 8 u by 4 to 6 u from
the urine in 18 out of 65; and from the stools in 22
out of 30 cases of beri-beri. The organism exhibited only
the Brunonian vibration, and was a facultative anierobe
which produced no spores, and did not liquefy gelatine. 16
is stained by Gram’s method, and grows on ordinary media
at laboratory temperature, but best at 87°. Either in
culture inedia or in the intestine it produces а toxin, which
acts selectively on the nervous centres.

The author claims to have reproduced the characteristic
symptoms of beri-beri in animals, but only by intra-cerebro-
spinal inoculation, and states that his microbe agglutinates
with the serum of patients affected with the disease. He
further states that his diplococcus may be found in the
intestine of healthy persons. but regards this as n parallel case
to that of such persons acting as carriers of the cholera
vibrio. It may be noted that this organism stains by Gram's
method, whereas, as noted above, Herzog found that Kokubo's
coccus did not do so. Altogether it seems doubtful if
Truzuki is really dealing with the same organism, and it
seems more than doubtful that his can be considered the
true organism of beri-beri.

* Journ. Americ. Med. Assoc.,” April 28, 1906.

GENERAL INFECTION BY A PROTOZOON PRODUCING А
PsEUDO-TUBERCULOSIS OF THE VISCERA.

Darling, Dr. J. T. Writing from Acton, in Panama, the
author describes a curious case of what appeared to be
general miliary tuberculosis, but which on post-mortem
examination proved to be due to an invasion of the organs
by bodies which he regards as protozoa, for which he pro-
poses the name Histoplasma capsulata, The supposed
protozoa consisted of round or ovoid bodies about three mi-
crons long, provided with a sort of capsule, contents of which
are variable as regards chromatin. They present some
resemblance to the Leishman-Donovan bodies, and were
sometimes combined into irregular masses like miliary
tubercles. In the lungs these bodics occupied the interior
of the alveolar epithelial cells, and in the liver the endo-
thelial and hepatic cells. In the spleen and bone-marrow,
on the other hand, the parasites were free in the plasma,
though they were also found within the mononuclear leuco-
cytes. He has since met with a second case of the disease.

* Philippine Journ. 8c.,” 1806, p. 533.
TROPICAL SPLENOMEGALY.

Wooley, Paul G. The symptoms of seven cases observed
by the author had much in ccmmon with Kala-Azar:
Diarrhea, enlargement of the spleen, transitory cdema
ап irregular temperature, rheumatoid pains, wasting and

December 1, 1906.)

THE JOURNAL OF TROPICAL MEDICINE.

feebleness, and probably anemia. Hypertrophy of the liver
is not a constant symptom, and quinine proved useless, the
most important symptom being the hypertrophy of the
spleen. In the Philippines, at any rate in Wooley's cases,
the symptoms are not due to the Piroplasma Donovani, nor
did they appear to be referable to the effects of malaria or
syphilis; but he regards them as rather of intestinal origin,
and due to ulcerations or other inflammatory lesions. In
one of his cases, diagnosed as an instance of * Banti's "
disease, Wooley isolated, both before and after death, à
microbe in the form of а rodlet or diplococeus, staining
well by Gram's method, and yielding a characteristic cultiva-
tion; but the injection of monkeys with the microbe gave
only negative results. Не concludes, therefore, that a
variety of distinet morbid conditions are confused under the
title of febrile tropical splenomegaly.

“©. R. Вос. Biol," T., 1х.., p. 1149.
PROTOZOA OF ORIENTAL SORE.

Billet, A., found in a case originating at Ismailia, the
protozoon described by Wright, Margenovski, and Bogroff,
and gives a good description of the organisin. With respect
to the mechanism of propagation of the disease, he notes a
case in which one of these sores developed exactly on the
site of a mosquito bite. Now Ismailia, Touggourt, and
Bokia are all places where the Anopheles chaudoyet has
been found, and the distribution of this mosquito in Algeria
corresponds exactly with that of “ Biskra boil.”

Billet, А. (ibid, p. 1151), on a case of intermittent
edema associated with Filaria loa.

The author describes a case of the above such as would
be described by us as Calabar swellings. An adult specimen
of Filaria loa was extracted from the left lower eyelid.
Some time after young filaria having all the characters of
Е. diurna were found in the blood, during the day only,
associated with a marked eosinophilosis.

“ Deutsche Med. Wochenschrift,” August 16, 1906.

Meyer found in cases of dysentery the Entamæba his-
tologica of Schaudinn.

“Ша Presse Medicale,” April 28, 1906.
Bantrs DISEASE. l

Noumanbey maintains that the term Banti’s discase
should be confined to cases in which there is enlargement of
the spleen of long standing, anemia, enlargement of the
liver, and ascites. He is of opinion that malaria is the
cause of the disease. He found malaria parasites in one
сазе. It may be remarked that although malaria parasites
were found іп one case, it is mere assumption to aflirm that
they stood in the position of cause and etfect.

“ Bulletin de l'Academie de Médicin," vol. Ixx., No. 32.”
PATHOGENESIS AND PROPHYLAXIS OF MALARIA.

Kelsch accepts the mosquito theory of the malaria infec-
tion, but considers that other modes of infection exist, citing
turning up of the soil, exceptionally hot seasons, ingestion
of dust-laden food, fatigue, and general unhygienie con-
ditions. He asserts that the geographical distribution of
Anopheles and malaria do not coincide. Kelsch has never
known of a case of direct transinission of malaria from man
to man.

“Medical Record," July 28, 1908.

Moulden W. R., from observation on prisoners in
Manila, finds that copper has a selective action on dysen-
tery due to Атаба coli; copper solutions are better borne
than quinine; patients make a more rapid recovery under
its use, gaining flesh and strength more rapidly than under
any other method; and, most important of all, cases remain
cured, provided, of course, that treatment is kept up a reason-

able time after the disappearance of the ашса from the
stools.

371

“ Medizinische Blatter," March 8, 1906.
ANKYLOSTOMA AND MALARIA.

Sehewald states that in Brazil many patients with malariu
harbour ankylostomes. Anthelmintics, by getting rid of the
worms, also cause the disappearance of the malarial
symptoms without taking quinine.

The worms usually contain malarial parasites, which
enter by the alimentary canal of the ankylostome апа pass
to the salivary glands, as in Anopheles; tne parasite is not
found in the ova, but malaria may possibly be transmitted
or acquired through eggs.

When the ankylostome sucks blood, the malarial
organisms are injected into the blood-current of the host.
This may explain refractory cases of malaria, and the recur-
rence of attacks at the same time each year.

* British Medical Journal,” October 20, 1906.
SPIROCHÆTES IN Yaws AND GRANULOMA PUDENDI.

MacHennan reports that he has discovered spirochetes in
smears from a papilloma oecurring in recurrent yaws. The
spirochiete met with resembled the Sptrochete pallida. but
the staining (by Giemsa's solution and gentian violet)
proved fainter. In the granuloma tissue itself a few
organisms resembling Spirochete refringens were seen,
and a number of highly refractive very long spirochetes
with fine and close waving were found, but no organism
resembling the S. pallida.

* 2nd, 3rd, and 4th Memoires of the French Mission to Rio
de Janeiro, to Study Yellow Fever."

HEREDITARY TRANSMISSION OF YELLOW FEVER GERMS BY
SrEGOMYIA.

Marchoux, E, and Simond, P. L. Having proved
that infection of Stey. fasciata by Nosema slegomyie
is usually effected by heredity, the authors endeavoured
to ascertain if the same is the case with the yellow
fever germ, and have succeeded in infecting a healthy
subject by causing him to be bitten by a female
Stegomyia, hatched out from a batch of eggs laid by an
infected female. Epidemological facts, however, appear to
show that hereditary infection cannot persist through
several generations of mosquitocs, and that it plays but a
sniall, though by'no means negligible, part in the propagation
of the disease. It is obvious, however, that the destruction
of eggs and larvie assumes а new importance in prophylaxis.

We as yet know but little of the conditions that bring
about an increase or diminution of the virulence of the virus
within the mosquito. May it not be the case that hereditary
transmission has an attenuating action? — Should further
experimentation show that mosquitoes infected in this way
communicate only a mild form of yellow fever, it may be
important to ascertain if inflammatory bilious fever, which
is usually considered to be a form of yellow fever, may not
be simply due to this method of eommunication.

INFECTION OF бтксомуіж BY CONTACT WITH DEAD
INFECTED MOSQUITOES.

Three series of experiments were conducted by the
authors to ascertain if this is possible, and their results are
negative, and Јагуе placed in a flask containing dead
infected Stegomyie developed into adults which showed no
sign of virulence.

The authors have often observed that Stegomyiw avoid
parts of the skin fouled with the excretions of patients. If,
then, such excretions are virulent, which, however does not
appear to be the case, the mosquitoes would not become
infected in this way.

It appears that a fairly high temperature is necessary for
the development and preservation of the infection within
the mosquito after it has absorbed the virus of yellow fever,
but the exact conditions of temperature cannot, as yet, be
stated.

872 THE JOURNAL ОЕ

TROPICAL MEDICINE.

[December 1, 1906.

An orang and a chimpanzee were made to be bitten by
infected Stegomyie obtained from Brazil. and seven and
nine days after both animals showed an elevation of tem-
perature but without other svimptoms that could be
interpreted as certainly due to yellow fever,

АП attempts at infecting animals with cultures made
іп vilro having failed, efiorts were made to cultivate the
virus ім viro within mosquitoes,

Infected mosquitoes were ground up with glucose and
physiological solution and fed to Stegomyiæ, which were
subsequently made to bite aman, As a result, the subject
of the experiment developed a distinct form of yellow fever.
It follows, therefore, that infection can be conveyed from one
mosquito to another, but only by methods practicable only
within the laboratory. It affords, however, a convenient
method of producing infected mosquitoes for experimental
purposes.

Experiments on the conveyance of yellow fever by mosqui-
toes of other species than Stegomyia fusciata have proved
negative, Tt may be added that in most other species the
female dies immediately after laying a first and only batch
of eggs, and that this cireumstance hardly admits of sufficient
time for the virus to develop within her.

The authors have proved that this is the case with
Culer fatigans, С. teniorhgncehus, C. cocfirmatus, Jan-
thinosoma musica, Psorophora ciliata, and Teniorhynchus
Arribalzage. Stegomyia fasciata, on the other hand, сап
lay six or seven batches of eges, provided she obtains a feed
of blood after euch, and, in the free condition, produces on
the average two or three batches.

Researches into the life-history of S. fasciata showed
that it сап bite man either by day or by night from the first
days of its adult life. Aftera few days, however, particularly
after laying her first batch of eges. she bites only during the
night, and it therefore follows that man becomes infected
almost universally during the hours of darkness. А feed of
blood is indispensable to the mosquito for the production
of eggs.

The authors further give new ideas as to infantile yellow
fever; abortive forms of the disease—immunity, relapses,
and the endemicity of vellow fever.

For the preservation of specimens of mosquitoes they
recommend enclosing the insects in glass cells, the feet
being stuck down with Canada balsam.

The abstractor has, however, tried this plan, and
found it difficult to prevent the development of moulds
on specimens preserved in this way in а warm, damp
climate.

In the fourth memoir are given descriptions of the micro-
scopical lesions found in yellow fever, accompanied by some
fine coloured plates. They regard yellow fever as a sort of
generalised stentosis, all the organs being more or less
affected with fatty degeneration. Тһе glands of the skin
and intestine, and the epithelial investment appear, however,
to always escape. The tissues were fixed in Borrel's liquid,
and stained with magenta-picro-indigo-carmin, or fixed in
acidified perchloride und stained with hematin and orange
solution.

“ Arch. Inst. roy. de Bacter., С. P.,” 1906, p. 127.
THE TRYPANOSOMES OF AMPHIBIANS.

França, C.. and Айтан, M., found six Rana esculenta
from the neighbourhood of Lisbon infected by trypano-
somes which they identify as T. rotatorium (Mayer),
but conclude that two species аге really included under
the name: Т. concalion or costatum (Mayer), with an ovoid,
usually fairly broad body. and striated or unstriated with
centrosome near nucleus; and T. rotatorium (Mayer),
with the body more slender, the centrosome placed near the
hinder extremity, and a very well-developed undulatory
membrane extending the whole length of the body.

Commenting on the paper in the Bulletin. de UInstitut
Pasteur, September 80th, p. 756. Prof. F. Mesnil states his
opinion that had the authors examined a larger number of
infected frogs they would have met with intermediate forms

and would also find forms with the hinder extremity as
elongated ав the T. mega and micro-karyozeuton of
Dalton and Todd. In any case he regards the constitution
of new species as * a little premature."

The diagnosis of these proposed new forms is: T. undu-
lans, 30 by 6-9 microns, with broad undulatory membrane
and no free flagellum. Т. elegans, of same length but only
8 microns wide. They have also met with Sergent's 7.
?nspinatun,

Тһе authors lay great stress on the globular or retracted
forms assumed by the large trypanosomes after issuing
from the vessels, the fate of which had already been made
out by Danilewsky, and have followed the process in two
individuals from the assumption of the globular form to the
disappearance of the undulatory membrane and flagellum.
They saw one of the two undergo division into eight seg-
ments each with its own nucleus, and finally all degenerate,
but they were unable to follow the process in stained
preparations.

The same observers in the C. R. S. Soc. Biol., T. lx.,
p. 1108, describe the phenomena of the division of T.
rotatorium S. Str. from Hyla arborea. It takes а rounded
form, losing its membranes and flagellum. The blepheroplast
and nucleus divide, the former appearing to play the part of
a centrosome in the division of the nucleus. This is especi-
ally elear in the process of passing from the second to the
fourth nucleus stage, although the authors do not state
that it is effected by mitosis.

In preparations fixed &t once only the initial stages can
be found, the other stages being only obtainable in pre-
parations kept five hours between cover and slip previously
to fixation.

EXCHANGES.

Annali di Medicina Navale. Annal d'Igiene Sperimentale.
Archiv für Schiffs u. Tropen Hygiene. Archives de Médicin—
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et de Bacteriologie. Australasian Medical Gazette. Boletin
de Medicina Naval. Boston Medical and Surgical Journal.
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cal Journal. Brooklyn Medical Journal. Caducée.
Clinical Journal. Clinical Review. Giornale Medico del
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Medical Gazette. Indian Medical Record. Indian Public
Health. Interstate Medical Journal. Jahresbericht. Janus.
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Otology. Journal of the American Medical Association.
Journal of Experimental Medicine. La Grece Medicale.
Lancet. Liverpool Medico-Chirurgical Journal. London
and China Express. Medical Brief. Medical Missionary
Journal. Medical Record. Medical Review. Merck's
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Graduate. Pacific Medical Journal. Philippine Journal of
Science. Polyclinic. | Revista de Medicina Tropical.
Revista Medica de S. Paulo. Sei-i-Kwai Medical Journal.
The Hospital. The Northumberland and Durham Medical
Journal. Transactions of the American Microscopical
Society. Treatment. West India Committee Circular,

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“ Answers to Correspondents.”

C UVWOM UVIQUN ж ur 29211 Juepoy,, “A'W Graosqvg MauaNy Aq ioded әуелетті ор

‘9061 ‘ST WHgHNHOWG ‘ANGIOAH аму ANIOIGUN 'IVOIdOHL dO 'IVNHDOf

December 15, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE AND HYGIENE.

378

Original Communication.

RODENT ULCER IN A NUBIAN WOMAN.
By Anprew Batrour, M.D., «е.

Director Wellcome Rescarch Laboratories, Gordon College,
Khartoum.

GENTLEMEN,—In view of the letter from Dr. Branch,
of St. Vincent, which appeared in your issue of
November Ist, asking if any of your readers have
observed rodent ulcer in negroes, the accompanying
photographs of a Nubian woman suffering from that
condition may be of interest (see Plate).

The patient, who, at the time the photographs were
taken, was under the саго of Major Bray, 1. M.C., was
aged about 60, a native of Nubia, and had lived in
Egypt for along time as a slave. She returned to the
Sudan in 1901, and went to live at Kodok (late
Fashoda) on the White Nile. While there she deve-
loped an ulceration at the right side of the root of the
nose. This was scraped and healed. А nodule then
appeared at the inner canthus of the right eye. Тһе
growth broke down and formed a typical rodent ulcer,
which at the time the photograph was taken had
persisted for one year, and for which the patient
refused any treatment. It will be noted that she
possessed rather в leprous type of countenance,
though there was nothing to indicate that she was
suffering from leprosy,

November 21st, 1906.

А BLOOD-SUCKING HEMIPTERON.
By Hanorp Н. Kine.
Economic Entomologist to the Wellcome Research Laboratories.

As will be seen from the second report of the Well-
come Research Laboratories, the Sudan is by no means
deficient in blood-sucking diptera, and since that
report has been issued several species, hitherto

‘unrecorded from this country, have been captured.
Particulars of these will appear in due course, but in the
meantime the occurrence of a blood-sucking insect
belonging to a different natural order, viz., Hemiptera,
seems worthy of notice.

This little bug is one of the family Reduviide, sub-
order Heteroptera, and is therefore allied to the
Ochindundu (Phonergates bicoloripes, Stall.) recorded
in the JOURNAL оғ Tropica MEDICINE of April 2nd
and April 16th of this year, from Angola as feeding on
ticks and occasionally attacking man. Up to the
present I have been unable to ascertain its species
owing to the scantiness of the available literature, but
some idea of its general appearance may be gathered
from the following sketch and description.

Length, 2:25 by 2:5 microns.

Head black, with posterior margin brownish; com-
pound eyes black ; two brown ocelli above and slightly
posterior to the compound eyes.

Proboscis three jointed, of medium length, black
with a brownish tinge.

Antenne four-jointed and inserted low on the head.
First joint black and slightly swollen ; second, longer

and tinged with brown; third and fourth, slender,
brownish. АП, especially the two apical segments,
bear hairs. а

Thorax greenish black ; scutellum of moderate size,
black, tinged with brown.

Wings, front pair, basal portion yellowish, a dark
triangular patch on the costal border, apical portion
membranous, hind pair membranous,

Line | indicates natural size.

Legs, coxe and femora blackish, trochanters,
tibie and tarsi yellow; femora of fore pair swollen;
tarsi three-jointed, abdomen black, fringed with pale
hairs.

Head, thorax &nd abdomen sparsely clothed with
short, pale, backwardly-projecting hairs. .

Most of the members of the family Вейиойда are
predacious in habits, preying upon insects, and several
species have been noticed attacking man, generally
when handled or otherwise molested. I have not
seen the young forms of this Hemipteron, but the
adult was frequently taken during the evenings of the
month of October, biting the hands and wrists with-
out provocation. In captivity, if placed on the hand
during the day it would not hesitate to at once plunge
its proboscis into the skin and commence to feed,
causing a sharp, stinging pain. A small red lump was
the only after effect noticed, and this usually soon
disappeared.

DENGUE IN EGYPT.

By LrnEwELLYN PurLLIPS, M.D., B.C., M.A.Cantab.,
F.R.C.S.Eng., M.R.C.P.Lond.

Professor of Clinical Medicine, Egyptian Government School
of Medicine, Cairo,

Dorine this past summer and autumn there has
been an epidemic of dengue in Egypt, and a large
number of cases came under my observation. The
earliest cases that I saw were not at all typical, for in
several the fever lasted seven to ten days and there
was no rash, and I thought they were either influenza
or some undescribed form of simple fever ; but as time
passed they became more typical, severe pains being a
marked feature of the cases, and rashes began to
appear. In Cairo the epidemic was at its height in
September and October, large numbers of officials who
returned from leave at the beginning of October

874

THE JOURNAL ОҒ TROPICAL MEDICINE AND HYGIENE. [December 15, 1906.

falling victims. Not only did Europeans suffer, but
many Egyptians as well.

In most cases the disease ran its course in about a
week, the initial fever lasting two to five days. In some
instances there was a rigor during the course of the
initial fever; the terminal fever, however, was not
always noted. In several cases there were very severe
pains in the eyeballs,and in some, pain in the testicles.
The terminal rash took several forms; whilst many
had the typical morbilliform rash starting on the hands
and spreading to the body, in others it took the form
of an erythematous blush. In two instances I noted
typical urticaria, one patient being taken ill with pains
and slight fever on a Friday night, on Saturday night
a rigor occurred, the temperature falling to the normal
at 2 алп. on Sunday morning. On Tuesday morning,
a typical urticarial rash appeared all over the body
without a rise of temperature being noted, and lasted
about twenty-four hours. In others it took the form
of purpura. Ап Egyptian whom I saw in consultation
on the sixth day of his illness had a copious petechial
rash over his hands, arms, and chest, and also had
hemorrhages from the nose, stomach, and rectum. The
case looked somewhat like typhus, but the tempera-
ture was beginning to fall, the mental condition was
quite clear, and the patient’s appetite was returning.
The temperature was normal the next day. I met him
out at the Pyramids a few days later, quite well; he
was, however, rather weak. In the case of a little
Egyptian girl, a few days after the apparent termina-
tion of the disease there occurred profuse epistaxis and
a copious purpuric rash with vibices, and large blood-
stained blebs on the lips. In many instances the
secondary rash was absent.

On more than one occasion I saw epistaxis occur as
a sort of crisis. Н ешоггһасеѕ were a marked feature
of the epidemic in Luxor and other towns in Upper
Egypt.

In two instances I saw a second attack in the same
patient. A young Englishman was taken ill in
September with severe pains and fever. These lasted
about three days, then he was free from fever and
pain for two days, then they both recurred for a day ;
there was no rash. І saw him again in October with
similar symptoms, and this time he developed with the
secondary fever a typical morbilliform rash.

Іопіу saw one death. This patient's urine was, how-
ever, loaded with albumen, and he died with uremic
symptoms, the temperature running up to 107-2» F., in
spite of the application of cold packs.

Thus I observed great variety in the secondary half
of the disease, fever occurring without rash, and rash
without fever, unless it was so transient as to be over-
looked, and neither or both occurring. Lastly, as I
have described above, there was a great variety in the
rashes. Тһе occurrence of hemorrhagic forms of the
disease is especially noteworthy.

As regards treatment, I found aspirin or salicylate
of soda the best means of relieving pain, with, in some
cascs, local applications. Feeding I did not worry
much about, there being in many cases little or no
desire for food of any kind, and as long as they took
plenty of fluid I was quite satisfied. In some instances
there was much vomiting and abdominal pain. For
the haemorrhagic cases and for the urticarial cases I

used calcium chloride, which gave much relief in the
urticarial cases. When there was much sleeplessness
I found Dover's powder useful, but given in a large
dose. As much weakness and depression was left
behind I used to conclude treatment with strychnine
and quinine, or arsenic and iron.

VOMITING SICKNESS OF JAMAICA.
By C. W. Ввахен, M.B., С.М.

Іх the Annual Report of the Senior Medical Officer
of Jamaica for 1904-5, and again in that for 1905-6,
Dr. Errington Kerr refers at some length to a con-
dition there known as vomiting sickness. At his
suggestion the Government of Jamaiea issued a cir-
cular to the other West Indian Governments, asking
if such a disease had been observed in other places by
the medical men.

Not А SPECIFIC AILMENT.

After a careful examination of the reported cases
and the remarks of several of the Jamaica medical
officers, one comes to the conclusion that the vomit-
ing sickness is not a disease su? generis, but іп part
&kee poisoning and in part a coterie of pathological
conditions characterised in common by the clinical
features of vomiting and convulsions.

In several West Indian Islands there is some one
disease, so called, to which is popularly attributed all
the rapidly fatal cases of illness. In St. Kitts this is
the ''Jaunders," in St. Lucia ''pleurisie," with its
varieties, “ fausse pleurisie ” and *' pleurisie manquée,”’
in Tortola the “ biles." No doubt the vomiting sick-
ness enjoys а similar local reputation in Jamaica.

COURSE or ILLNESS.

Vomiting sickness usually attacks children; often
several cases happen about the same time in a village,
sometimes two in the same house at once. It occurs
most commonly about January, but also in other
months of the dry season. The typical attack has:
& sudden onset with pain in the belly and vomiting ;
after a few hours’ interval of comparative relief vomit-
ing again begins, and is followed by convulsions, coma
and death. Тһе description of the cases, however,
shows that there is considerable variation in the fea-
tures of the fatal illnesses which are instanced as
vomiting sickness. In several mention is made of
fever. Grave cases are rarely seen by a medical man,
and information can only be gathered from the
parents. Cases seen in life and diagnosed as vomiting
sickness usually recover.

The diseases which most commonly produce the
symptoms of-vomiting and convulsions in negro cbil-
dren are ascarides and malaria. The few deaths
among adults attributed to vomiting sickness are
perhaps due to one or other of several acute diseases,
as in the case of the ''pleurisie" of St. Lucia, for
example, pneumonia, bilious remittent fever, and
obstruction; some, perhaps, are even due to poison-
ing. The description of one case, together with the
post-mortem findings, suggests an epileptic or syphilitic
epileptiform seizure.

December 15, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE AND HYGIENE.

375

Post-MORTEM APPEARANCES.

The post-mortem appearances in the cases of vomiting
sickness also vary somewhat, though evidences of
convulsions seem to һе usually present--meningeal
hyperwmia, congestion of the choroid plexus, and
venous engorgement of the lungs. With regard to
the other findings, it may be said that the acute con-
gestion of liver and kidneys was no doubt produced or
enhanced by high temperature. The spleen enlarged,
firm and congested, suggests malaria. The full
bladder indicates coma. No examination of spleen
or blood has been made for malaria. One medical
officer, it is true, refers to this, with an offer to make
such examination if the Government would provide
him with a microscope. The authorities do not
appear to have availed themselves of this offer, a
neglect which is perhaps pardonable, for if the gentle-
man has waited twenty years for someone to give
him a microscope, it may be doubted what use it
could be to him now.

No attempt seems to have been made to obtain
analysis of the gastric contents, even in cases where
suspicion of poisoning might reasonably have been
entertained. In the Report for 1905-6 are the details
of two post mortems made the same day on chil-
dren of one family who had died of “vomiting
sickness." The appearances described are quite
inconclusive, and hardly even characteristic of disease,
yet the deaths were certified to be due to vomit-
ing sickness, and no effort was made to exclude
poisoning.

MonTALITY. TREATMENT.

All the observers agree that the mortality of
vomiting sickness under treatment is small. But as
the same writers profess to be entirely ignorant of
the nature of the condition, such treatment as is
applied must be empirical and symptomatic. Dr.
Tillman, however, who treated 144 cases which he
diagnosed as vomiting sickness, with only two deaths,
used a most rational treatment. He gave promptly
santonin and calomel, followed by a course of quinine.
The success of this procedure should have suggested
the true explanation of the symptoms. The rest of
his treatment is symptomatic.

ASCARIDES AND MALARIA.

The District Medical Officers of Jamaica do not
‘attend the labourers children free as part of their
official work, as we do in the Leeward and Windward
Islands, consequently they have not the opportunity of
knowing how much sickness there always is among
negro children in their natural state. It is only when
attention is attracted by the occurrence of several
deaths in rapid succession, that the medical officer
may һе called upon to investigate and to treat the
children in the locality, or supply medicines to the
police to treat them. Also the districts are larger and
much of the population is remote from a medical man.
The peasants are therefore far less accustomed, than
with us in the Lesser Antilles, to that medical aid
which is deemed a necessity of civilised life. The
children аге of small value and are readily replaced ;
to take them to a doctor costs I believe four shillings.
At this price it must be extremely rare that a labourer

will or can obtain medical advice for a child. With us,
on the contrary, the children are frequently brought at
the slightest ailment, and demands for worm powders
are constant. On the whole, we must therefore have
far fewer cases of grave infection with ascaris or
malaria. Notwithstanding, we are familiar with
“attacks of worms," and “ worm fits," as they are
called in St. Vincent, which correspond, by descrip-
tion, to much of the vomiting sickness. How much a
West Indian population can harbour worms may be
gathered from the fact that of 414 persons, mostly
adults, of the labouring class, in St. Vincent, I found
ova of ascaris in the feces of 56 per cent. Of
children it may be safely said that not one is free of
worms unless he has been recently treated.

A Dry Season DISEASE.

Vomiting sickness is said to be prevalent in the
months which constitute the dry season, especially
January. Cases of this kind are no doubt always
occurring, but they are at this period sufficiently
numerous to excite alarm. In the dry season, as
several of the observers point out, the people are apt
to drink bad water. This. means a prevalence of
enteritis, due probably to balantidium, cercomonas, or
trichomonas, all of which I have observed in St. Vin-
cent in diarrhaas.

The consequent unrest of the worms excites reflex
disturbances through the already irritated sympathetic.
The general resistance, low before, is still more
lowered by tho diarrhoa, and these nervous disturb-
ances are manifested as vomiting and convulsions.

Agnin, the dry season is the time for water-holes and.
rock puddles in the guts. In the heavy rains there is
little opportunity for mosquitoes to breed in water-
courses, but in the dry season there are occasional
rains enough to fill puddles. It must be borne in
mind that convulsions is often the first observed indi-
cation of а malarial attack in a child. Vomiting is
common in the onset of many fevers. Тһе combina-
tion of vomiting, convulsions and coma, with high tem-
perature noted by some of the observers, is strongly
suggestive of malaria.

Tue Agee Tree Fruit.

In Jamaica the presence of the akee tree forms а соп-
dition peculiar to that place among West Indian
Islands. The white, brain-like interior of the fruit can
be eaten raw and has a nutty flavour, though it is
usually cooked and makes a delicious vegetable. In
the centre, attached to the shiny black seeds and
extending into the lobes of the white ‘ meat," is a
pink placenta in which is a poisonous principle. These
placentas should be carefully picked out of the fruit.
The miserable, half-starved piccaninnies gather and eat
the fallen fruit ignorant of the fatal pink membrane.
The old planters of the island, living among the people
and knowing more of them than do the medical
oflicers, can give some account of the frequency of this
accident.

876

THE JOURNAL ОЕ TROPICAL MEDICINE AND HYGIENE. [December 15, 1906.

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THE JOURNAL OF

! Tropical Medictne and hygiene

DECEMBER 15, 1906.

THE HOUSING OF EUROPEANS ON THE
WEST COAST OF AFRICA.

In the bad old times, which ended with the last
century, the special plague spot of the West African
town of Lagos was a certain marshy tract known to
Europeans as the Kimberley swamp. Its position
was such that it was obviously the most urgent
danger to the health of the town, and its reclamation
was the first great work of anti-malarial sanitation
undertaken by that great and scientific administrator,
the then Governor, Sir William MacGregor. During
his only too short period of rule, anti-malarial sani-
tation was rigorously pushed, and the effects of his
wise and effective action are shown more and more
plainly every year in the health statistics of the
colony, the deaths from malaria having fallen from
4 per cent. for the period 1897 to 1900 to 1.5 per cent.
for the first five years of the present century. Since
1909, in fact, there has been only one fatal case of
malaria, sothat though there is undoubtedly much room
for improvement; the benefits that have resulted from
anti-malarial measures are absolutely beyond ques-
tion, for the change from a pestilential mortality of
40 per mille from malaria alone to the сошраға-
tively rnoderate present death-rate was abrupt, and
has been continuously maintained.

With such triumphant results, it might be thought

that the poliey so happily iuaugurated by Sir W.
MaeGregor would be pushed and extended by any
body of reasonable men, but this does not appear
to be the case unless the following allegations can
be called in question.

The Kimberley swamp was very properly converted
into an open pleasure ground, but it should be needless
to point out that it could never become suitable for an
inhabited site, as the level of the subsoil water must
necessarily always remain perilously near the surface,
and the sanitary objections to the occupation of sites
on made ground are so well known that such a course
would never be permitted in the most backward muni-
cipality in England, and in the tropics, the dangers
of such sites are many times multiplied. It appears,
however, to be a fact that the Local Government
have actually erected quarters for European officials
on the edge of this site, and are contemplating build-
ing more. The avoidance of such situations is so much
a matter of the A B C of sanitary science, that it is
impossible to believe that the Government can have
consulted their medical officers on the matter, as to do
so would be to assume а degree of ignorance on the
part of the latter that is quite incredible at the
present day.

Further, the bungalows in question are absolutely
unsuited for the purposes of tropical residence, being
planned with the usual toy verandahs, which render
the provision of adequate ventilation out of the
question, as to do so would involve the admission of
the direct rays of the sun to the rooms for a consider-
able portion of the day.

It may be taken as axiomatic that the verandahs
of European quarters should never be less than 12 ft.,
and the more that can be afforded over this the better.

In a climate such as that of the West Coast, the first
essential of health and comfort is a large roof area,and
provided this be sufficiently extensive, the more nearly
the house resembles a bird-cage the better. In any
case, the walls should be placed so well inside the
area of shade cast by the roof, that the sun can never
shine directly on them after it is a few degrees above the
horizon.

Given these essentials, it is easy to plan doors and
windows of sufficient size to admit a pleasant and
healthful current of air, in spite of the wire gauze
mosquito guards, which we know to be an absolute
essential of safety in a mosquito-ridden country.

An ideal residence should be protected with adequate
gauze-guarded verandahs on all sides, but in any case,
one verandah and the dining and sleeping room should
be so provided, and the verandah enclosed with wire
should be that on which the sun falls least throughout
the year, so that it can be used for living and working
in throughout the day, which is of course impossible
in the absurd apologies for verandahs that are only too
common on the “ West Coast." But even worse
remains, for, bad as malaria is, dysentery is worse,
and dysentery is undoubtedly a water-carried disease.
Asin most parts of the West African littoral, the
watcr supply is one of the most formidable dangers
and difliculties in Lagos, the residents having to
depend on surface wells. These wells are in no case
above suspicion, and it is to be feared that the best is
not made of them by adequate measures of protection ;

December 15, 1906] THE JOURNAL OF TROPICAL MEDICINE AND HYGIENE. 377

but in the case of the new quarters in question, the
wells have been sunk into the fathoms-deep organic
filth of the oid malarial marsh.

Of course, malaria cannot be conveyed in this way,
but the consumption of such water is a well-known
source of dysentery, and we shall be agreeably sur-
prised if the unfortunate officials so supplied do not
furnish a new instance of the danger of ignoring a
commouplace of tropical sanitation.

It is wrong and immoral for any corporate body to
subject its employees to needless risks, and if the local
authorities do sufliciently realise this, surely a govern-
ment which professes to concern itself so deeply with
the housing of the working classes should step in and
insist on the equally fair treatment for those who are
bearing '*the white man's burden" in our distant
colonies and dependencies, by insisting оп their
being housed so as to be able to carry on their
arduous and thankless duties under the best attainable
conditions of health and therefore of efliciency. The
reverse policy of stinting expenditure on the build-
ing of suitable and healthy quarters is, moreover,
not even defensible from the financial point of view,
as its penny wisdom inevitably results in a pound folly
of needless ineffective charges to pay the salaries of
oflicials on sick leave, who would have remained fit
for work under a more enlightened regimé.

——————

LIVERPOOL SCHOOL OF TROPICAL
MEDICINE, MEMOIR XXI., SEPTEMBER, 1906.

THE Runcorn Research LABORATORIES OF THE
LivEnPoon Scuoon оғ Tropican MEDICINE.

Turse laboratories are situated at Crofton Lodge,
Runcorn, sixteen miles from Liverpool, where stabling
and pasture for all sorts of animals is obtained. An
important function of the laboratories is to supply
living parasites for the practical instruction of students
taking the course in tropical medicine at the Johnston
Laboratories, Liverpool. At Runcorn the various
trypanosomes, spirochates, the ticks Ornithodoros
moubata, Argas miniatus, Ixodes reduvius, aud Lhipi-
cephalus annulatus are kept '* a-going"" and utilised
for teaching purposes.

AN EXPERIMENTAL STUDY ON THE PARASITE OF THE
AFRICAN Tick Fever (бріноснжта Durrosi).
By Anton Breinl and Allan Kinghorn.

The parasites experimented with were brought from
the Congo Free State in infected ticks to Liverpool,
and the strain was recovered from monkeys which
had been infected through their bites. (1) It was
soon shown that the spirochetes of tick ditfer from
the Spirocheta obermeieri of relapsing fever, and the
name 5. duttoni was given to the tick fever spirochite.
(2) The technique of the experimental methods is
given; and (3) а description of cases of African tick
fever in whites. (3«) The experiments on animals
show that the blood of patients suffering from re-
lapsing fever is infective for susceptible animals during
the periods of apyrexia. (4) A clinical comparison of
African tick fever and European relapsing fever reveals

the truth of Koch's statement that the attacks in tick
fever are shorter than in the relapsing fever of Europe,
and that the spirochetes are present in fewer num-
bers in tick fever. Тһе length of intervals and the
number of relapses in tick fever are not yet deter-
mined. (5) In experiments to determine animal
reactions of S. duttoni it was found that monkeys,
dogs, horses, goats, sheep, rabbits, guinea-pigs, rats,
and mice were capable of inoculation. Тһе most
susceptihle animals are white rats, and then monkeys.
Of the monkeys, the order of susceptibility was as
follows:—Young mona (Cercopithecus mona) and
young Callithrix (Cercopithecus callitrichus) were most
susceptible, followed by Rhesus (Macacus rhesus),
“sooty” (Cercocebus fuliginosus), ‘ Jew" (Cerco-
pithecus ?), and baboons (Papio anubis); all the
monkeys, with a single exception (a rhesus), became
infected. In some animals the parasites were found
only in the subinoculations. Cats were entirely re-
fractory to infection. (6) Chronicity. Tick fever runs
an acute or chronic course; in one case recorded the
patient became ill in February, and the last relapse took
place on April 22nd. (7) Virulence. No difference in
virulence was noted in strains which had passed
through a long series of animals, and that derived
from animals directly infected through tick bites.
The numbers of spirochetes in animals experimented
upon varied directly with the number present in the
inoculating blood. (8) Immunity. Мо satisfactory
explanation has yet been given of the disappearance
followed by a reappearance of the spirochetes in the
blood. There was shown to be a relatively active
immunity against reinfection, as animals reinocu-
lated at various intervals after recovery up to seven
and a half months did not become infected at all, or
only had а very slight attack. Treatment by horse,
monkey, and rat sera showed that hyperimmune
serum derived from any one-of these animals does not
prevent the infection, but it positively lengthens the
incubation period and mitigates the course of the
disease when given in large doses. No cure was
effected. by the immune serum. Experiments show
that there is a slight degree of inborn immunity,
which speedily disappears, however. (9) Specific
nature of S. duttoni. The spirochetes of African tick
fever is of a species differing from S. obermeieri, siuce
each confers a relatively active immunity against
itself, and not against each other. (10) Placental
transmission. Тһе S. duttont has been shown to pass
through the placenta from the circulation of the
mother to that of the foetus, and that the majority of
foetuses carried by infected mothers are themselves
infected. The parasites in the foetus are fewer in
number than in the mothers ; they show no morpho-
logical change after gaining the fcetal blood, nor does
the mother abort. Ап interestiug observation noted
was that although the infected foetuses were born and
lived, fewer reached maturity than in the case of
healthy rats. (11) T'he spleen in spirochetal infection.
(a) Experiments showed that the course of tick fever
in animals from which the spleen had been removed
does not differ from that noted in normal animals.
The spirochzetes appear in the peripheral circulation,
increase in numbers to the maximum, then decrease
and disappear from the blood. After an interval the

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THE JOURNAL ОЕ TROPICAL MEDICINE AND HYGIENE. [December 15, 1906.

cycle is repeated. (b) It was shown that the spiro-
chætes, when disappearing from the blood, do not
rest solely in the spleen. (с) Spirochsztes are pre-
sent in the peripheral circulation in an infective stage
on the first day after ticks are fed on a susceptible
animal. (d) After recovery from the disease, animals
subjected to splenectomy reacted in the same manner
to reinoculation as did the controls. (19) An infective
stage of S. duttoni is capable of passing through a
Berkefeld filter, which does not allow the passage of
Bacillus prodigiosus. (13) No definite conclusion has
ав yet been arrived at concerning the morphology of
S. duttoni. (14) In experiments concerning the
protozoal nature of spirochztes, Dutton and Todd
state that the transmission of the spirochetes by
ticks is not merely mechanical, and that some
developmental process takes place in the tick. Тһе
passage of the spirochetes from the alimentary
canal of the ticks to the ovary and eggs is interesting,
and it has not been shown to occur in the case of
апу bacterium up to the present, but is known to
occur with protozoa. (15) The animal reactions of
S. obermeieri are quite different from those of S.
duttoni, and, contrary to Novy and Knapp's state-
ments that a relapse has never been seen in rats,
Breinl and Kinghorn show that if the examination
is continued for a sufficiently long period relapses
do occur. (16) Animals which have recovered from
infection by S. obermeieri acquire a certain amount
of active immunity against reinfection, the efficiency
of which corresponds directly to the severity of
the attack.

-----т---

Abstract.

PaRaTYPHOID FEVER AND TvpHoip FEVER.
By Lieut.-Colonel D. B. Spencer, I.M.S.

_ LiEUT.-COLONEL SPENCER, in a series of articles pub-
lished in Mauritius (1906), deals with paratyphoid fever

and enteric fever in India. Не defines the ailment as
follows :—

PaRATYPHOID FEVER. DEFINITION.

Bacteriologically, judging from what I have read of
the subject, I should say it is a fever caused by one or
more members of the typho-coli group of organisms
acting either singly or collectively ; that is to say, more
than one organism of the typho-coli group probably
take part simultaneously in the causation of the disease
Бу а process known in bacteriology as symbiosis. But
it must be clearly understood that this fever is not
caused by the bacillus typhosus, the causa causans of
true typhoid fever, for the Widal reaction, with a
culture of the B. typhosus, is always negative in
paratyphoid fever, and it is this fact which has drawn
the attention of different observers in different parts
of the world to this fever. It has been observed in
America, England, Germany, France and India, so
that the disease may therefore be said to have no
geographical limits.

BACTERIOLOGY or DISEASE.

So far as I can gather from current literature on the

subject it appears to me that paratyphoid fever is

caused by the group of bacilli known as the Gaertner
group, which occupy an intermediate position between
the B. typhosus at the one end of the chain and
the B. coli communis at the other end. f

One of the most important organisms of this
Gaertner group is the B. enteriditis, which is the
bacillus usually associated, I believe, with meat poison-
ing and ptomaine fever, and it is this bacillus which is
generally credited with being the cause of paratyphoid
fever. According to Dr. Row, of Bombay, tbe B.
coli communis is not an unimportant factor in the
causation of paratyphoid fever.

INTESTINAL AND SEWAGE BACTERIA.

A large number of different kinds of bacilli have
been isolated of late years from crude sewage, of whicb
the following, I believe, are fairly well-known varie-
ties :—B. coli communis, with about 150 varieties ;
B. cloace fluorescens, B. stercoralis, B. frondosus,
B. fusiformis, B. subtilis, B. subtilissimus, B. mesen-
tericus, Proteus cloacinus, Proteus vulgaris, several
other species of Proteus, Micrococcus aurora, B. entert-
tidis sporogenes, of which, according to Klein, there
are from 500 to 600 spores per ce. ot sewage; then
there are the thermophylic bacteria, of which there
are some eight known varieties, and lastly we have
the great streptococcus and staphylococcus families
with their numerous varieties. These bacteria prob-
ably get into the human intestinal canal, for with
every drop of water that*we drink and with every
particle of food that we eat, an immense number of
bacteria enter the stomach, and although, fortunately
for us, most of them are dissolved in the acid juice of
the stomach, it is reasonable to infer that in the
struggle to escape some of these bacteria find their
way into the intestinal canal and are finally passed |
out with the feces. :

It is possible also that these same harmless
organisms, under a new environment in the human
intestinal canal, may have sometimes a share in the
causation of paratyphoid fever by a process known as
auto-infection or auto-intoxication from the intestinal
canal.

In a paper on Paratyphoid, by two French doctors,
Saquepée and Chevral, published lately in La Presse
Medicale, the following statement occurs :—

“Two types are generally recognised, A and B.
The cultures of A on gelatine, potato and agar re-
semble those of typhoid, while those of B are more
luxuriant and recall coli cultures. Type A acidifies
milk quickly and definitely (one to three days). Type
B (alkalifaciens of School Muller) causes in the same
media a transient acidity replaced later by a more
pronounced alkalinity. Both types are very patho-
genic to laboratory animals.”

It will appear from the above description that para-
typhoid bacilli, like the Gaertner group, occupy an
approximately intermediate position between the
B. typhosus and the В. coli, and they may there-
fore be said to be a branch if not а part of the
Gaertner group.

ENTERIC FEVER IN INDIA.
Why are the natives of India apparently immune
to enterica ?
In this connection, I think, the chemistry of

December 15, 1906] THE JOURNAL OF TROPICAL MEDICINE AND HYGIENE.

379

ptomaines furnishes an important light. We know
that these ptomaines are alkaloidal substances of the
aromatic series of organic compounds, and that they
are formed in the process of putrefaction of proteids or
&lbuimninoids derived from nitrogenous animal food,
such as meat of any kind. We know also that meat
is a regular article of diet for the British soldier, while
in the native army a large number (Hindoo) never
touch meat, fish, or eggs. Broadly speaking, the food
of the British soldier consists largely of animal diet,
that of the native soldier of vegetable diet (atta, vice,
dal) and ghee, a carbohydrate. Again, beer is a
common drink with British troops, and a British
soldier can drink as much canteen beer as he likes.
In the native army beer is unknown. Now beer is a
thing which is very apt to ferment, especially in hot
weather, and beer is drunk by British soldiers, in both

hot weather and cold, without any restriction.

TRUE ENTERICA.

Etiology. — Bacillus typhi,
Eberths’ associated with sew-
age contamination of food or
drink.

Widal Test. — Positive ге-
action with the Bacillus tuphi.

Mode of incidence.— Usually
in an epidemic form.

Mortality per cent.—T14 in
the last Maidstone ерідетіс
(Poole's Report).

Chart. — Often typical. First
week, gradual rise. Second
weck, high continued fever.
Third week, gradual defer-
vescence. Y

Mode of onset. — Gradual.

Rash.— Generally present 88
per cent in the last Maidstone
epidemic (Poole's Report).

Typhoid state. —Early and
pronounced.

Abdominal symptom s.—
Whether early or late they are
unmistakeable.

Post-mortem appearances.—
Typical ulceration of glandular
structures of small intestine.

Duration of fever.-—Gene-
rally three weeks.

Treatment,—The recognised
treatment has been an ex-
pectant treatment with intes-
tinal antisepsis and irrigation
(Burney Yeo).

INDIAN ENTERICA (A FEVER
WITH ENTERIC SYMPTOMS).

Etiology. — Probably the
Bacillus coli associated with
fermentation and putrefaction
of intestinal contents and
consequent auto-infection.

Widal Test, - Not known. (а)

Mode of incidence.—Usually
in a sporadic form.

Mortality per cent.--About
25 per ceut. in India.

Chart. —Generally irregular.

Mode of onset.—Sudden or
gradual.
Rash.—Generally absent.

Typhoid state.--Often vague
or altogether absent.

Abdominal symptoms—
Often absent.

Post-mortem appearances. —-
Often the ulceration of intes-
tine is irregular and extensive,
being not confined to glaudular
structures.

Duration of fever —Three to

four weeks, but it can be
aborted by а specific trent-
ment. (b)

Treatment, —The. treatment
I adopt is an eliminativetreat-
ment combined with intestinal
antisepsis and irrigation.

(a) Now known to be negative.
(b) Instead of three to four weeks I should now say from two
to eight weeks, or even longer.
Published iu April, 1900, in the Indian Medical Gazette.

We have thus, I think, in meat and beer those
elements of putrefaction and fermentation which are
essential for ptomaine formation. The fact that
enterica is-ao much more common in the hot weather
than in the cold, 1.6., аба time when bacterial activity

is greatest in the processes of decay, lends additional
colour to this theory, and much of this striking differ-
ence in the rates of incidence of the disease between
European and native troops is, I believe, due to а
difference in diet of the two races. .

Summarising the points dealt with in his paper,
Lieut..Colonel Spencer remarks in conclusion: It is,
I think, difficult to believe that defective sanitation
is the sole cause and the whole cause of enteric
fever as seen in India. For, while on the one hand we
сап, in India, but seldom prove & causal connection
between the disease and sewage contamination of food
or drink, there is, I think, on the other hand, & vast
array of positive evidence to show that a fever with
enteric symptoms, closely simulating true enterica,
(see tables) has been, and can be caused by
other factors—factors which I believe are as yet not
sufficiently recognised. Although spasmodic efforts
have been made from time to time by a minority of
original thinkers to show that they do exist, it
may reasonably be asked whether, with our advancing
knowledge of the subject, the time has not come for
medical men in India, whatever may be their past or
present convictions, to consider both individually and
collectively the various points enumerated above,
It is incumbent upon us to set to work to attempt
to decide whether the disease we call “enteric fever"
in India is always one disease arising from one cause
only, or а complex disease presenting several phases
and arising from a variety of causes; chief among
these may be mentioned climate, food, and intestinal
intoxication from fermentation and putrefaction of
intestinal contents and the consequent formation of
ptomaines and toxins therein of bacterial origin, though
quite independently of the typhoid bacillus. For it must
be obvious that, without correct premises, without a
correct conception of the disease, and without an
absolute unanimity among medical men as to what
constitutes a correct conception of the disease, the in-
ferences must be wrong and that there never can .be
any satisfactory solution of a complex and difficult
subject like the enteric question.

TROPICAL DysENTERY.—Abstract of paper in Lancet,
of December 1, 1906, by Captain R. J. Blackham,
D.P.H.R.C.P.S.Lond., Royal Army Medical
Corps.

Amongst the diseases of special interest to the
physician practising in the Tropics, the group of
morbid conditions, known by the term of “ dysentery,”
ranks only next in importance to enteric fever. Un-
fortunately, as Manson points out, our knowledge
is not in proportion to the importance of the subject,
and in the latest monographs on the disease it is -
evident that considerable doubt exists in the minds of
eminent climatologists, who have made a special study
of the malady, as to the exact boundary line between
simple diarrhoea and dysentery. 16 is, however, only
in very recent years that the difficulty of diagnosing
dysentery has become appreciated, and а few years
ago writers used to describe what is now considered to
be a group of diseases as a well-defined malady and
give its etiology, symptoms, and pathology in precise

880

THE JOURNAL ОЕ TROPICAL MEDICINE AND HYGIENE. [December 15, 1906.

terms. It would be well, therefore, to start by defin-
ing what we mean by “ dysentery,” and the definition
suggested is that ''dysentery is an inflammation of
the large bowel, associated with pain, tenesmus, some
slight pyrexia, and a large number of stools, consist-
ing of mucus or mucopus, with micro-organisms but
with or without blood." I think the last phrase is
important, in view of Dopter's work during the past
year, and the evidence which he has submitted
that simple diarrhea may be an abortive form of
dysentery, and that all cases of acute diarrhoea occur-
ring where dysentery is prevalent should be regarded
as suspicious, and, where possible, bacteriological
methods resorted to for diagnosis in preference to
the rough-and-ready test of the character of the
stools.

In the classification of the varieties of dysentery
much difficulty and confusion of ideas have arisen,
and as Firth points out, “it is doubtful whether the
literature of any disease is more encumbered with a
mass of names indicating the nature of the disorder
or the author's conception of its pathology than is
that of dysentery.” Terms founded on а patho-
logical basis such as “ catarrhal,” “ ulcerative,” and
“ gangrenous" have been passed on from text-book
to text-book and are used by Manson, Scheube, and
even such a recent text-book on pathology as Stengel's
(р. 547), and in an article just published in the
Lancet, but as was pointed out by Taylor as far
back ав 1901, the “disease is essentially the same іп
all varieties.” Such terms merely indicate clinical
conditions found in the various stages of a single
pathological process, and it would be well, therefore,
to dismiss this older classification and adopt the one
now used by Osler, namely, (1) amcebic dysentery ;
and (2) bacillary dysentery. This nomenclature was,
I think, first suggested by Davidson, but he added
to it a third variety, which does not really exist, as
his “ dysentery of war " is simply а form of bacilliary
dysentery.

Causes оў Dysentery.—In considering these we must
sub-divide the heading into (a) predisposing causes;
and (b) exciting causes. Let us first consider the
causes which predispose to the disease. We find that
these fall under four chief divisions, namely, (1) age,
(2) sex, (3) occupation, and (4) conditions of lowered
vitality.

(1) Age.—Dysentery may occur at any age, but in
my experience it has a singular predilection for the
extremes of life, children and old people being peculi-
arly liable, the former, doubtless, on account of their
well-known liability to catarrh of the intestinal mucous
membrane which is itself a predisposing cause of the
disease, according to Scheube (p. 466).

(2) Sex.—According to most authorities this does
not exert any influence, but Scheube cites ргер-
nancy as а predisposing cause, and it is within the
experience of most physicians who have lived in the
Tropics that when dysentery occurs in a pregnant
woman, or during the puerperium, the prognosis is
very grave indeed.

(3) Occupation.—Davidson asserts that agricul-
turists are attacked more frequently than persons
whose calling is carried on indoors, and according to
Lancarol persons who labour in the heat, such as

stokers, cooks, and mechanics, are peculiarly liable to
disease. E

(4) Conditions of lowered vitality.—There can be no
doubt that in conditions of health the pathogenic
organisms of dysentery, enteric fever, cholera, and
other diseases pass through the intestinal tract in
association with the luxuriant flora and fauna which
normally flourish therein, without causing any in-
convenience, and that it is only when the mucous
membrane of the bowel is the subject of some inflam-
mation, irritation, or impaired nutrition that it forms
a suitable nidus for the Атаба or Bacillus dysenterie.

Such conditions of reduced vitality may be induced
by a variety of circumstances, first and foremost among
which I would place “ chill," which Manson declares
to be a “powerful excitant of dysentery,” and
Scheube considers, above all things, to be mentioned
as a predisposing cause. Next I should place “ un-
favourable hygienic conditions,” such as overcrowd-
ing, contamination of the soil with sewage, and an
impure water supply. - Epidemics of the disease are
therefore peculiarly likely to occur in war and as an
accompaniment of famine, and Scheube says, “ In
almost every long campaign or siege the outbreak of
an epidemic of dysentery amongst the combatants,
amongst the besiegers as well as the besieged, is a
common occurrence.”

Amebic Dysentery.—This variety is essentially slow
developing in its nature, although acute attacks are
not uncommon. It is styled by Firth and others “ en-
demic dysentery,” and it appears to have little tend-
ency to break out into definite epidemics, as is the
case with the other form of dysentery. An amoba
was first described by Lambl in 1859 and subse-
quently by Lóseh in 1875, but to Schaudinn is due our
present exact knowledge of the genuine organism.
He found that many kinds of amoeboid organisms
occur in the human intestine and that some of these
are not true amcebe at all but merely amoeboid stages
in the development of the higher forms of the protozoa
such as trichonomas, lamblia, and other infusorians.
Genuine amcebe he divided into two classes: (1) those
provided with a shell, the thecamcebe ; and (2) those
that have no other covering, or gymnamoebe. “At
least one of the former and two of the latter sort
are now known to occur in the intestine." Тһе
two naked forms are genuine parasites, but one of
them is harmless and the other one of the most
dangerous of pathogenie protozoa. Schaudinn has
re-named the former, hitherto known as the Атаба
coli, Entameba, and the latter, hitherto known as
the A. dysenterie, as the Етіатаба hystolytica.
The E. coli was found in from 20 to 60 per cent.
of healthy stools by Schaudinn and is a shapeless
mass of protoplasin not showing much differentiation
into ecto- and endoplasm but possessed of a well-
marked. nucleus. It is difficult to find in healthy.
feeces, as its habitat being in the upper regions of the
colon it dies out as the intestinal fæces become firmer
on their passage down the bowel. If, however, the
downward course of the fæces is hurried by saline
purgatives the атов can be readily detected, as
Schuberg has shown. “ The әшосіне have two dis-
tinet cycles of development ; one vegetative or asexual,
taking place iu the naked state, the other displaying a

primitive but unmistakeable form of sexuality and
occurring inside of a capsule resembling an egg-shell
and termed a cyst. In the vegetative form the
amcebie either simply split in two or their nucleus
divides into eight daughter nuclei, each of which takes
a portion of the protoplasm so as to form a character-
istic brood of eight young amæbæ, which come apart.
In the other or sexual cycle the amaba rounds itself
otf, comes to rest, and contracts and surrounds itself
with a gelatinous coat which becomes the cyst wall.
The two nuclei, after undergoing reconstruction and
chrosmosomic reduction, divide into halves, which
copulate, so as to form two fresh nuclei, each contain-
ing half of the two parent nuclei. Each of these
copulation nuclei now divides twice and the divisions
form eight young amcebe which, however, cannot
leave their cyst until it has been taken in by a new
host and has had its wall softened in the stomach
and duodenum.” The pathogenic Е. hystolytica
differs materially from the foregoing. It possesses
a tough ectoplasm which enables it to force its way
between the layers of the mucous membrane and pro-
duce the undermined ulcers of tropical dysentery.
Schaudinn has actually observed the organism in
scrapings of the bowel from an experimentally infected

cat. “Тһе two sorts of amoeba differ also in their
reproduction. The pathogenic form in its vegetative

stage divides into two, or forms new individuals by
budding. Brood formation does not occur. The pro-
cess of encystment is also quite different. It comes
on when the patient is beginning to recover from his
attack of dysentery and the fæces are becoming solid.
The nucleus gives up most of its chromatin in
granular form to the plasma and its remains are ex-
pelled. The plasma now projects from its surface a
number of little knobs, each containing a particle of
chromatin and measuring from three to seven micra
in diameter. These break off after a while and each
becomes surrounded by a capsule which ultimately
becomes quite brown, hard, and opaque. These
‘spores’ are then expelled with the fæces and serve
to infect а fresh host.”

MeWeeney states that so far back as 1902 he
believed that the 4. coli, or rather, I presume,
what we now know as the E. histolytica, was
causative of one form of dysentery, and in the very
excellent paper from which I have quoted above he
holds that “опе of Schaudinn's experiments seems
quite conclusive." Іп this experiment this great in-
vestigator, whose untimely death we all deplore, dried
a small quantity of feces from a case of undoubted
dysentery in air, and satisfied himself microscopically
that it contained no cysts of Е. coli, but only the
small brown spores of E. histolytica. The cover-
glasses were then removed from the slides actually
examined, and the fæces washed off with about one
cubic centimetre of sterile water and administered in
food to a young cat whose stools had been proved to
be free from amæbæ. Three days later the cat began
to pass slimy faces streaked with blood. These were
found to be swarming with typical E. histolytica.
Next day the animal died from dysentery. The
necropsy showed characteristic ulceration of the large
intestine with crowds of amcebe in all stages of pene-
tration into the intestinal wall. Schaudinn adminis-

: December 15, 1906.) THE JOURNAL OF TROPICAL MEDICINE AND HYGIENE. 381

tered quantities of the fæces of this cat to another,
but it remained healthy. He then gave a small
quantity of the dried feces originally used, and within
six days ainwbe appeared in the fæces. This cat,
which was older and stronger than the first one, de-
veloped dysentery, and “died in about a fortnight”
From this experiment it would appear that amæbæ
taken by the mouth appear to be harmless, and
that “it is to the dried-up, cyst-containing fæces
present in dust and water that we must look for the
propagation of dysentery.”

Bacillary Dysentery.— Although it is evident from
the foregoing that the 4. dysenterie is clearly the
exciting cause of many cases of dysentery, it is
equally evident that there is a very large amount of
dysentery which is not due to amabe. In support
of this we find that Bruce, Washbourn, and Birt
failed to find amcebe at all in the large number of
cases they examined during the South African epi-
demics. Major W. W. O. Beveridge discovered
amæœæbæ in only three out of 147 cases examined in
the Army Medical Service laboratories at Pretoria.
Strong and Musgrave noted 766 cases of bacillary
to 561 of amwbic dysentery in their investigations in
Manila, while Rogers states that the bacillary is much
the most common form of the disease in Calcutta.
The credit of first recognising a definite bacillus
which was capable of producing dysentery is due
to Chantemesse and Widal, who showed by ex-
periments on animals that a bacillus closely allied
to the B. coli communis was frequently present in
the stools of epidemic dysentery, and capable of
producing the disease in cats; but the question of
the exact form of bacterium responsible for the disease
was hotly disputed until Shiga, of Tokio, isolated a
bacillus from the type of disease occurring in Japan,
and “proved its specificity by demonstrating the
agglutination of its cultures by blood serum.”

Prevention of Dysentery.—(1) General. Scheube
states that the general prophylaxis of dysentery de-
mands careful attention to general hygiene and the
personal avoidance of the predisposing causes, and
goes on to say “ The circumstance that dysentery does
not now appear in the tropics with the same frequency
and severity of thirty or forty years ago is to be
ascribed to the improvement in hygienic conditions,
especially in regard to water-supply, which has taken
place during recent years and to the more rational
method of treatment practised by the doctors of the
present day. In order to prevent the disease
spreading the intestinal evacuations should be disin-
fected, as should also night commodes, utensils,
privies, &c., as well as the soiled linen and bed-linen
used by the sick." Не further recommends that when
constipation occurs in the East only mild aperients
should be taken, and quotes, without comment, the
advice of Lancarol to take cold baths throughout
the year as a prophylactic. To prevent dysentery in
the tropics I would suggest that the followiug rules be
strictly adhered to, and that, having themselves
grasped their importance, all otlicials should be induced,
by precept and practice, to enforce obedience to this
simple code on their subordinates. (1) Drink only
boiled or preferably sterilised water, by which I mean
water not bacteriologically sterile but which has been

AL M

2

4

38

THE JOURNAL OF TROPIC

heated to 80? C., a temperature which is sufficient to
kill non-spore-bearing organisms and certainly the
bacteria of dysentery, cholera, enteric fever, and most
other communicable diseases. (2) Clothe warmly,
and wear a so-called cholera. belt to avoid chill being
communieated through the abdominal wall to the
intestine. (3) Be temperate in food and drink, and
remember that aleohol is a luxury and not a necessity
of life, especially in the tropies. 14) Seek medical
advice at once when constipated or suffering from
diarrhoea, however mild in charaeter, and avoid
drastic eatharties. (5) Isolate all cases of dysentery
rigorously, regard cases of diarrhoea occurring during
epidemics as suspicious, and disinfect with care all
diarrhacie stools and the bedding and clothing of all
persons affected with dysentery or suspicious diar-
rhea 15].

Treatment of Dysentery.—We are confronted at the
outset with a serious difficulty. We find that the
treatment of the two varieties of the disease is hope-
lessly mixed up by each and every authority, even
in the most recent articles on the subject such as that
of Dr. C. B. Sheldon Amos, and that it is almost
impossible to differentiate the remedies which are to be
recommended in the variety due to ато from those
suggested for the bacillary type of the disease. Ав,
however, i£ must frequently be impossible in practice
to decide the tvpe of disease at the outset of treatment
it will, I think, be best to discuss the therapeutical
measures available as a whole and merely to divide our
remarks under the classical headings of ** acute " and
“chronic.”

The indications which will assist us in the treatment
of dysentery are five in number: (1) To relieve the
pain and tenesmus ; (2) to avoid all irritation of the
inflamed mucous membrane; (3) to promote intestinal
antisepsis by removing foul accumulations and arrest-
ing putrefaction; (1) to counteract any morbid agency
in the blood as far as may be; and (5) To support the
patient’s strength by suitable diet. Let us consider
these indications.

Firstly, to relieve the pain and tenesmus.—As the use
of opium has been unhesitatingly condemned by the
older writers in the treatment of acute dysentery, the
evidence of Washbourn and Гаісһпіе is of value
as expressing the most recent views on the subject.
Washbourn goes so far as to say that he has seen
lives saved in South Africa by the introduction of а
morphine suppository, so there is now no doubt that the
first indication of the treatment of acute dysentery is to
give opium in some form or other, not to act as an
astringent but simply to moderate and control the
painful contraction of the intestines which produces
what is known as tenesmus.

Secondly, to avoid irritation of the inflamed mucous
membrane. In this relation I may point out that many
years ago Sir William Gull summed up the treatment of
acute dysentery in three words, viz: “ Rest, warmth,
and ipecacuanha.” This was not only smart and
epigrammatieal but it had the advantage of heing
correct, and Washbourn after his exceptional ex-
perienees in South Africa, has little to add to the
aphorism of the great Gull. To avoid irritation of the
inflamed mucous membrane we must apply the first
two of Gull's trinity of remedies. Rest is absolutely

EDICINE AND HYGIENE.

[December 15, 1906.

essential, and in all eases the patient should remain in
bed and use a bed-pan. All foods which leave a
residue prone to decomposition must be avoided,
and Manson objects even to milk in acute dysentery
if the tongue is foul, and limits the diet to weak
chicken broth, barley, and rice water, with a little
egg albumen till the tongue cleaus. Milk is, how-
ever, considered the best food in all cases by Scheube
and Yeo, while Osler recommends ‘ milk, whey, and
broths.”

The third indication for treatinent is to attempt to
produce intestinal antisepsis. This can, of course, be
merely an attempt, as the bowel may be regarded as a
forest crowded with flora and fauna of the most varied
and septic character, but although it may be useless to
try to render the inucosa aseptic, it may be possible to
place it in a position which will discourage the growth
of adelicate organism such as the bacillus of dysentery
appears to be. There are three ways in which we
тау attempt to treat this indication—namely: (1) by
saline aperients which sweep all foul accumulations
and organisms from the intestinal tract in a more or
less mechanical manner; (2) by the administration of
certain drugs said to be specific; and (3) by washing
out the bowel per anum by means of astringent and
antiseptic fluids. In the tropics the best preliminary
treatment for all kinds of diarrhaea is a dose of castor
oil with or without from 15 to 20 minims of liquor opii
sedativus, and Manson believes that slight cases of
dysentery are often checked thereby and require no
further treatment except rest and a bland non-irrita-
ting diet for a few days. Having done this the physi-
cian must elect whether he will resort to the saline,
specific, or lavage method of treatment.

“ Specific". Treatment.—Scheube says : “Тһе prin-
cipal drugs used in the treatment of dysentery are
calomel and ipeeacuanha, the effects of which do not
depend solely on their aperient and emetic qualities.
The drugs must be regarded as having a ‘ specific’
effect, a fact which does not seem as yet to have been
fully acknowledged, at least as far as German text-
books аге eoncerned." Manson says he can offer no
explanation of the action of any drug in dysentery, and
admits that we use them empirically, but thinks that
‘‘ipecac. and simaruba really seem to have some sort
of specific action on the disease or its cause, but in
what way it is impossible to say." Yeo thinks that
ipecacuanha may be microbicidal and arrest the
growth of the organism, whether amoeba or bacillus,
producing the discase, while Fayrer points out that
the mortality of all varieties of dysentery in India,
which was 11 per cent. before its use, fell to 5 per cent.
after its introduction. The method of exhibiting the
drug alinost universally adopted in military practice in
India, is to interdict food for three hours and then to
give 20 minims of liquor opii sedativus in a small
quantity of water. Half an hour after the opium
30 grains of powdered ipecacuanha are given in the
form of freshly prepared pills or asa bolus. To prevent
vomiting the patient is directed to lie perfectly still in
a darkened room and not to drink, speak or move for
three or four hours. He must be cautioned not to
swallow his saliva, and a nurse should remain by his
side with directions to wipe away any salivary secre-
tion on the slightest indication from the patient.

December 15, 1906. THE JOURNAL ОЕ TROPICAL MEDICINE AND HYGIENE.

Ipecacuanha prepared without the emetic principle
was much vaunted at one time, but its use was aban-
doned by most Indian practitioners before the South
African war, when it was extensively used and found
most unsatisfactory. I believe Day’s remarkable
experience of the failure of the drug to cure dysentery
was due to his using this preparation He reported
sixty cases, in twenty-six of which he used ipecacu-
anha sine emetina and opium, with the result that
nine died, and thirty-two in which he admiuistered
sulphate of magnesium with only one death.

The Lavage Treatment.—Osler says “ that the
treatment of dysentery by topical applications is by
far the most rational plan,” but I think this statement
requires qualification. Itis unquestionably a valuable
method of treatment, but it is only applicable in sub-
acute and chronic cases, at least in the tropics, where
the services of skilled nurses are comparatively rarely
obtainable. I merely refer to this method for the sake
of completeness, as the results of the two previous lines
of treatment are so good. For instance, Buchanan
has treated 855 consecutive cases by salines, with only
nine deaths, giving a case mortality of only 1:05, and
these, I think, are almost as good results as can be
hoped for in the treatment of an acute illness.

The fourth indication is to counteract any morbid
condition of the blood. This is a most important
indication, and one which has recently attracted much
attention. Where dysentery occurs in a malarial
subject quinine must be exhibited in full doses, aad
Maclean goes so far as to recommend that 20 grains of
quinine should always be administered before the
ipecacuanha treatment is begun. The morbid condi-
tion of the blood which has recently been shown to be
frequently associated with dysentery, especially on the
Indian frontier, is, however, diminished alkalinity,
which Wright has shown to be a frequent cause of
scurvy. It must, therefore, be borne in mind that a
condition resembling ordinary dysentery may be simply
a variety of scurvy, and it may be well, therefore, to
test the alkalinity of the blood by the method advised
by Wright in all cases of dysentery in which the origin
is obscure. Recently in Somaliland a succession of
cases of dysentery were found to be due to “ acid in-
toxication,” and were relieved by anti-scorbutic
treatment.

The fifth and last indication is to maintain the
patient’s strength. This must be done by suitable
diet, as indicated under our second heading, and the
administration of stimulants in some cases, but not
as a matter of routine. Few will agree with Yeo's
suggestion that port and burgundy may be used in
acute cases, and the custom of most physicians in the
tropics is to prescribe brandy or champagne in the
comparatively rare cases in which alcohol is neces-
sary. '' Ether and caffeine hypodermically and saline
injections have been employed with success in cases
in which life appeared to be endangered by hemorr-
hage and anemia with prostration and collapse."
Sparteine has also been used with success. After
the very acute stage is over, and when the appetite is
returning, the strength must be supported by a fairly
liberal diet. Egg-and-milk flavoured with nutmeg is
an agreeable and nutritious food. Pounded sweet-
bread, chicken or mutton may be given, with strong

383

soups, and the many varieties of bland farinaceous
food of which rice and bread are the types... - -

The Treatment of Chronic Dysentery.—W e now turn
to the treatment of chronic dysentery, a condition
all too familiar to physicians who have practised in the
East. The indications requiring treatment are here
merely three in number: (1) to promote a restoration
of the diseased mucous membrane ; (2) to counteract
any morbid tendency in the blood ; and (3) to support
the patient’s strength by proper diet.

(1) Manson’s routine in treating all cases of
chronic dysentery, a method of which I have had some
personal experience, is to give a short preliminary
course of ipecacuanha—30, 25, 20, 15, 10, and 5
grains on successive evenings, with rest in bed and
milk diet. Ho then proceeds to give a short course of
very small doses of castor oil, with or without opium,
three times daily, regulating the dose according to the
amount of action produced. If this treatment does
good he proceeds to give a mixture of simaruba and
cinnamon, with or without some intestinal antiseptic,
such as salol or B-naphthol. These measures failing,
he has to resort to direct topical applications.
Osler and Manson are agreed that these are of
the utmost value in the treatment of dysentery,
but on one important point the two great authorities
differ. The latter insists that topical remedies should
never be applied when acute symptoms are present,
whereas the former gives the technique for their use
in the acute stage of the disease. Nitrate of silver
injections are now considered by most authorities to
be the best form of local application in chronic dysen-
tery, but solutions of quinine are strongly advocated by
Osler in amoebic dysentery, this being with one
exception the sole instance in which a remedy peculiar
to one type of dysentery is advocated by any of the
authors I have consulted.

Recent Bacteriological Investigations.—For the pur-
pose of this paper I obtained the following strains of
B. dysenterie—(1) Shiga's bacillus, І.; (2) Shiga's
bacillus, П.; (3) Flexner’s bacillus; (4) Vaillard's
bacillus ; (5) Kruse's bacillus; and (6) B. dysenterie
(non-pathogenic). For the first of these cultures
І am indebted to Captain Harvey, assistant professor
of pathology, and for the remaining five to Major
Fowler, assistant professor of hygiene at the Royal
Army Medical College, London. To economise space
I have arranged the morphological and cultural
characteristics of the various bacilli in the accompany-
ing table, which shows clearly their resemblance to,
and difference from, the other members of the coli
group of micro-organisms.

Conclusions.—(1) I think that we may take it as
bacteriologically proven that notwithstanding slight
cultural differences the various strains of bacillus
dysenterig isolated by Shiga, Flexner, Vaillard, Harris,
and Firth are simply varieties of the same organism.
Bruce's “С Bacillus" resembles them, but I have not
ineluded it in my limited observations, as it was isolated
from а single case, and when it arrived іп England it
was almost dead aud had to be revivified by prolonged
recultivation. In addition to these pathogenic strains
of the organism there are several varieties of so-called
pseudo-dysentery bacillus which are non-pathogenic
and are to be distinguished from the true bacteria of

384

THE JOURN AL OF TROPICAL MEDICINE AND HYGIENE. {December 15, 1906.

TABLE SHOWING THE MORPHOLOGICAL AND CULTURAL CHARACTERISTICS OF BACILLUS DYsENTERIE AND THE ALLIED GROUP ОҒ
M1CRO-ORGANISMS.*

| i
i ! | А E Agzlutination
a Charaeter 4 Motility Flagella — : ee seat | Gelatin stab ioe 4 AA Litn us milk Sterile potato | with dysenterie
Shiga's Ij|Short rod|Motile in 2-6. Mostly Semi opaque. Similar to В. Faint Хо appre- |Becomes feebly|Transparent or ‘Usually only
dysente- | with recent terminal, Resemble | fyphosus, but, haziness| ciable dis-| acid. After 4| whitish agglutinates
rie l. rounded | cultures , Rather the growth film which jwhich | ehargeof days’ incuba- growth, which with serum
ends, No| from short and оё B. typho- spreads out [rapidly , colour tion acidity becomes ; fromanimal
spores. | stools. — ' thick. | sus, but are from punc- ‘clears. | has been esti- brownish red | immunised
Length Gradually; , More trans-| ture usually | No matedasequal, or dirty grey, | by special
1-34 loses parent absent indol to 6 per cent. | with dis- strain of B.
motility | decinormal colouration of| dysenterice
in sub- А alkaline solu- | potato at edge:
е cultures, | | i tion. No clot | in a few days |
|
Shiga's ditto ditto ditto Шав а char-;Growth not ditto ditto ditto ditto i ditto
bacillus II. acteristic | seen till 48 , i
odour called: hours, and l n
by the Ger.| then only |
mans slight white ; í
А “ Sperm- growth | !
geruch ” | І
| ! !
Vaillard’s |Shorter ditto Numerous ditto ditto ditto ! ditto ditto ditto i ditto
bacillus | than fine, reticu- !
: Shiga’s, | j lated, very і
otherwise ‘long and |
similar readily seen | |
(Birt). J
Flexner's Similar to! ditto Long, thick, ditto i ditto ditto ! ditto ditto ditto ditto
bacilus | Shiga , and i Н
; terminal |
Kruse’s : ditto ditto ‘Usually 2 ditto ditto ditto ditto ditto ditto ditto
bacillus | terminal !
1
Pseudo- Generally ditto Variable ditto ditto ditto ' ditto [Slightly acid at ditto Very variable
dyscuterial somewhat first. After-
bacillus , larger ! : wards slightly
| than true: І alkaline
' dysentery. ! i
bacillus
i i
B.typhosus Longer Sub- 8-12 More opaque Similar, but | ditto | ditto |Slight acidity |For several Nil
abdomin- | than cultures than those : surface film after some days appa-
alis either В. always of B. dysen-: usually | days rently no |
dusente- very mo- еті present. growth. Later
. rie or B. tile. | slight pellicle
, coli. А with velvety
2“ Oval i i surface. |
, ends"
; (Muirand
" Ritchie). А
| | |
Para- | ditto Not so mo./Variable | ditto : ditto ditto :А, usually (Paratyphoid A/Variable Nil
typhoid | tile as D. ' ‘nochange.| produced acid
bacilli | tuphosus : А : B, some- | like D. typho-
| , but more, | times fluo-! sus, and Para-
so than | ! rescence , typhoid B pro-
| В.сой | ! | duced alkali
B. coli Shorter — Motility ie More opaque Whiter, Indo] |Canary Marked acid |In 48 hours Nil
communis and notso ' than B. ty-| thicker, produe-| yellow and clot distinct
thicker | marked , phosus. moro tion colour : brownish film
i than B. as М. | opaque, and} marked, produced which rapidly
fyphosus — typhosus | showing gas and gas spreadsand be-
: | р | bubbles bubbles ! comes thicker

ж In dada to the culture media and other tests shown in the table the effects of Gram DN bile salt broth, mannite nutrose
broth, raflinose nutrose medium, salicine nutrose medium, caffeine medium, and agglutination with enteric fever serum were also tried.

The effects wer

eight bacilli ;
and acid”
medium:
“growth?

e as follows,

Granis stain:
“acid and gas” for the B. coli communis.
for the preudo-dysenterial bacillus; “acid ” for the last three bacilli.
“acid and growth " for the pseudo dysenterial bacillus ;

Ққ decolourise

ed"

with all nine bacilli.
Mannite nutrose broth :

Bile salt broth:
“ unchanged ” for the first five bacilli;

“ae

for the first

id,
“growth

no gas”

Rafiinose nutrose medium and also salicine nutrose

“unchanged” for the other eight bacilli.
with the B. tuphosus abdominalis and the Paratyphoid bacilli; “no growth”

with the other

Caffeine medium :

seven bacilli. On test-

ing with cnteric fever serum the agglutination result was “marked ” with the B. typhosus abdominalis and '* nil" with the other

eight bacilli.

December 15, 1906.)

dysentery by the fact that they act on carbohydrates
unaffected by Shiga’s and the other pathogenic bacilli
and they fail to produce enteritis in animals. Whether,
however, these bacilli represent degraded or transitional
forms of the true bacillus it is, as yet, impossible to say,
(2) That symptoms and intestinal lesions identical
with those found in man supervene after the subcut-
aneous inoculation of rabbits with the cultures of the
various strains of В. dysenterie. (3) That the
dysentery organsism have considerable vitality. They
will live on clothing for at least three weeks and are said
to maintain their virulence in damp soil for months.
When spread on bread crumbs, or similar articles of
food, they survive for about a week. (4) They are,
however, very readily destroyed by heat or by weak
solutions of perchloride of mercury or the higher
phenols. (5) The specific agglutination reaction with
the serum of persons suffering from acute dysentery
can generally be obtained within two weeks following
the onset of symptoms, but is often poorly marked. It
is, however, of some value, and the blood of all patients
suffering from a prolonged attack of diarrhcea should
invariably be tested with several strains of the bacillus,
and the stools subjected to a microscopical examina-
tion, as my chief desire in this paper is to call attention
to the fact that the character of the stools alone is not
to be considered as the test of the presence or absence
of dysentery.

I think the most important lesson to be drawn from
my investigation of the literature on this subject, and
my very limited bacteriological work with the organisms
of dysentery, is that the profession has only begun to
realise its ignorance of a very great subject and that
the clinical entities, which we have hitherto styled
dysentery, are not one disease but a group of maladies
of very varying degrees of severity, ranging from the
acute dysentery so familiar to those of us who have
served in India or South Africa, to the simple infective
diarrhoea which occurs in infants and adults. Simple
diarrhoea may be, and often is, an abortive form of
dysentery, as has been shown by the work of Dopter
and Jurgens during the early part of 1905. During an
epidemic of dysentery there are always а number of
cases which are in reality dysentery, but because no
blood appears in the stools are regarded as simple
diarrhoea, and it is these cases which constitute a grave
source of danger to the community, as they may infect
others and give rise to attacks of true dysentery.
Jurgens has recently examined the stools of twenty-five
cases of simple diarrhoea which occurred during an
epidemic of dysentery in а camp at Gruppe. He
failed to recover the B. dysenterie, but the serum of one
of the cases agglutinated with a strain of the organism.
Dopter examined bacteriologically the stools of
eleven cases of diarrhoea occurring during an epidemic
of dysentery last spring. Seven of these cases were
very mild; the В. dysenterie was, however, recovered
from one of them, but the serum reaction in all
of them was negative. The remaining four cases
did not yield to ordinary treatment and ran & pro-
longed course, but only symptoms of diarrhoea were
observed and no blood appeared in the stools. In one
of these cases the В. dysenteri@ was isolated, but in
all the serum reaction was positive,

In the light of this recent work I submit that all

THE JOURNAL OF TROPICAL MEDICINE AND HYGIENE.

385

cases of diarrhoea, occurring in the tropics should be
treated with the same precautions as if they were
manifest cases of dysentery, and in hospital should
invariably be isolated and their stools sterilised in
some simple form of steriliser, or by means of dis-
infectants. In the Indian hills all fecal matter
should be received on pine needles, and burnt as
suggested by me in a communication to the Journal
of the Royal Army Medical Corps, entitled “Тһе
Goux System and its Application to India”’ (vol. vi.,
p. 662). If acute diarrhoea and dysentery were
recognised in the service as infectious diseases,
promptly isolated, aud careful disinfection of clothing,
bedding, and stools carried out, I believe we should
hear less of epidemics of dysentery both in tropical
countries and on active service. The Japanese have
shown us a good example in the recent war, as they
fully recognised dysentery as a communicable disease
with, we are told, the happiest results. In conclusion,
I maintain that if we can in future warfare secure for
His Majesty's troops a pure, or at least, an innocuous,
water-supply, an intelligent conservancy, and the
prompt recognition and isolation of suspicious cases
of diarrhea, we can confidently hope for comparative
immunity from the fell disease, or rather diseases,
which have been the scourge of all armies in the field
since the day of Agincourt.

-----о---
1 010005.

А Japanese Техт-Воок on Puacus. Ву Dr. Tohiu
Ishigami, Superintendent Bacteriological Institute,
Osaka, Japan; formerly Assistant Bacteriologist
to Professor Kitasato. Revised by Professor
Shibasaburo Kitasato, Tokyo, Japan. Trans-
lated, enlarged and illustrated with Pathogenic
Horticulture by Donald MacDonald, M.B., C.M.
(Glasg.), late Consulting Bacteriologist to the
S. Australian Government. 152 illustrations.
3 plates. (Adelaide: Vardon апа Pritchard,
Gresham Street, 1905).

Part I.

This text-book is written by one who has closely
studied plague in all its bearings. Dr. Ishigami was
a member of the Japanese Commission which visited
Hong Kong when plague appeared there in 1894 under
the leadership of Professors Kitasato and Aoyama.
His training in the clinical and bacteriolovical features
of plague was thorough, and he has given us a text-
book which is characterised throughout by judical
statements, accurate details and many suggestions of
an eminently scientific nature as to the means by
which the plague is spread. The prophylaxis of the
disease is dealt with in а manner which must com-
mend itself to everyone who has studied plague. One
of the most interesting parts of the book is that
relating to the plague bacillus itself. The question
of involution forms of the bacillus, whereby much
confusion has arisen in the matter of diagnosis, is
clearly stated by Dr. Ishigami. It so often occurs
that bacteriologists hesitate to pronounce the disease
to be plague, because they meet only with involution
forms, that & careful perusal of the paragraphs dealing

386

THE JOURNAL OF TROPICAL MEDICINE AND HYGIENE. [December 15, 1906.

with the matter should prove instructive and con-
vincing. At pages 6 and 7 we find: On the first day
Professor Kitasato examined the blood of the heart,
spleen, liver, lungs, and swollen lymphatic glands of a
corpse dead from plague. Не found in them a con-
siderable number of strangely original rod-shaped
bacilli. On the same day microscopic examinations
of the blood obtained from the finger tips of a critical
patient revealed the existence in it of similar bacilli.

Subsequent bacteriological examinations of several
patients and corpses demonstrated the presence of the
same bacillus in every case. But those existing in the
hlood were regular in shape and smaller, whilst those
in buboes or swollen glands and other organs were
irregular in shape, and somewhat larger. Both were
found to exhibit bipolar staining, the middle part
refusing to retain the dye. The cultures made from
both varieties were similar in the shape and appear-
ance of their growth. Therefore, Professor Kitasato
was of the opinion that those which existed in the
glands and other organs were pleomorphic involution
forms, and, following a fundamental principle of
pathology, attached greater importance to those ex-
isting in the blood. Hence he conducted a series of
cultivations and experiments on animals, the results of
which were made public as explaining the cause of the
disease.

A few days after this discovery of Professor Kita-
sato's, Dr. Yersin, of France, sent out from the Pasteur
Institute, arrived at Hong Kong vid Saigon. Соп-
ducting his investigations independently of Professor
Kitasato, he studied the bacilli chiefly as met with in
the glands and organs, which we had considered to be
involution forms.

He reported the results of his investigations to the
Pasteur Institute as the cause of the disease. Since
then, Professor Aoyama has made a special micro-
scopic study of specimens of organs and glands from
the plague corpses which have been brought from
Hong Kong. He gave out as the result that the
bacillus which exists in the glands, and which is
decolourised by Gram's method, is an entirely different
species to that which exists in the blood, and which is
not decolourised by Gram's method.

Part II.

“Plague Pathogenic Horticulture” is contributed
by Dr. MacDonald, to which is added a lecture on
Plague and “ Two Dozen Anti-Plague Golden Rules."
The rules are as follows :—

Remember, plague is more “ Death " than disease.

Never visit suspected or plague-stricken houses.

Never alter a well-regulated diet.

Wash the hands frequently.

Avoid excesses in diet and wines.

Cook food well and preserve from insects.

Heat serving plates to a high temperature.

Cooking utensils wash with boiled water or water of
undoubted purity.

Rather drink weak tea than suspicious water.

Avoid excess in exercise and bathing.

Never handle dead rats.

Destroy your vermin.

Never neglect a trifling wound, cold, or dyspepsia.

Protect the lower limbs well.

Be vaccinated and re-vaccinated if you can.

Keep good fires in winter.

Avoid wet feet.

Preserve the head with sunshades in summer.

Use if you can the mosquito net.

Never exchange pipes.

Never kiss the plague suspect.

Avoid plague apparel unless fumigated.

Never fear, rather be cool, calm, and collected.

Remember cleanliness is next to godliness.

The text-book is fully illustrated and is a valuable
addition to plague literature. "

—— ——9—————

Personal Kotes.

INDIAN MEDICAL SERVICES.

Arrivals Reported in London.—Licutenant-Colonel J. Smyth,
Major Ұ. С. Drake Brockman, Major 2. A. Hamilton, Captain
J. H. Horton, Captain J. L. Robertson, Captain H. Ainsworth.

Extensions of Leave.—Lieutenant-Colonel В. J. Baker, study
leave, from April 23rd to June 23rd, 1906, and October 8th to
November 8th, 1906; Major T. W. A. Fullerton, furlough to
July 1st, 1907 ; Major C. E. L. Gilbert, three month's furlough ;
Captain D. S. Baker, one month's furlough.

Permitted to Return to Duty.—Licutenant-Colonel W. B.
Browning.

Postings.

Captain М. Mackelvie and Captain F. P. Connor, services
placed at disposal of Government of Bengal.

Lieutenant-Colonel H. Hendly is appointed Civil Surgeon,
Kurnal. :

Lieutenant Е. J. Baley, I.S. M.D., officiates as Civil Surgeon,
Singh Bhum.

Military Assistant Surgeon F. G. Cutler, LS.M.D., is
appointed Assistant to the Civi] Surgeon, Jubbulpore and Nupt.

Assistant Surgeon J. Robertson, I.S. M.D., olliciates as Civil
Surgeon, Yeoltmal.

Captain F. T. Thompson, to the Medical Charge 11th Lancers.

Lieutenant Colonel J. Morwood, to be Civil Surgeon,
Sultanpur.

Dr. E. J. Simpson, uncovenanted Medical Service, to be
Civil Surgeon, Jalaim.

Assistant Surgeon E.
Civil Surgeon, Hoshiarpur.

Lieutenant Colonel A. Coates, resumes charge of the duties of
Professor of Midwifery and Forensic Medicine, Medical College,
Lahore, and Medical Officer in charge of Government College.

Phillips, LS.M.D., to officiate as

Leave.
Major D. T. Lane, private and study leave 12 m.

---------Ф---

LIVERPOOL SCHOOL ОЕ TROPICAL
MEDICINE.

YELLOW Fever EXPEDITION.

Тне members of the Yellow Fever Expedition from
Liverpool, which commenced research work on yellow
fever in Brazil in 1905, still continue their investiga-
tions. It is satisfactory to know that the medical
members of the expedition who were attacked by
yellow fever have quite recovered from their illness.
A telegram was recently received in Liverpool to the
effect that the expedition had succeeded in proving
that the chimpanzee can be infected with yellow fever
by means of infected Stegomyia mosquito. This dis-
covery is likely to prove important from a scientific
and practical point of view.

December 15, 1906.)

THE JOURNAL OF TROPICAL MEDICINE AND HYGIENE.

387

Ale anstruments.

Tre Lawrence patent portable water steriliser for
travellers in the Tropies.

We have seen this apparatus at work, and can
commend it as both eflicient and portable. The price,
some £5, places the four gallon per hour steriliser
within the reach of all travellers in tropical countries.

————— »————

Hotes and Fetus.

CoMMENTING on the first report of the bacterio-
logists who have been studying the etiology of plague,
the Times of India says: “Тһе conclusions which
these facts force home with remorseless logic is that
even with our increased scientific knowledge we can-
not secure absolute results against plague, with
ordinary sanitary measures. We can reduce the
virulence of the seasonal epidemics by rat and flea
destruetion; we сап prepare particular localities to
resist the disease through the warning which is now
conveyed by the epidemic amongst rats; we can
reduce the media of infection by the use of insecti-
cides wherever dead rats are found; we can protect
a section of the population by making their dwellings
rat-proof; we can raise the resisting power of the
people and increase the facilities for sanitary work by
improving the conditions amongst which the poor live.
But none of these measures, or all of them combined,
no matter how vigorously and ably they may be
prosecuted, even promise absolute results in the con-
ditions of life of a great Indian city, unless they are
combined with the practice of inoculation. It is as
true to-day as it was before the Plague Conimission
set to work that there are only two certain methods
of combating plague—to run away from it or to
protect one's self against it."

With this somewhat despondent verdict of our lay
contemporary we can, however, by no means agree,
as Australian experience has shown that rat destruc-
tion, properly carried out, may be trusted as a
suflicient& measure of protection, and though native
prejudices may in certain localities place obstacles in
the way of the successful operation of the plan, we
believe that these difficulties are by no means in-
superable, provided that due tact and consideration be
exercised in meeting them.

Oxe of the Nobel prizes for 1906 has been divided
between Professor C. Golgi, of Pavia, and Professor
Ramon y Cajal, of Madrid.

ANKYLOsTOMIASIS has been declared to exist in
Virginia, United States of America.

Tue University of Sydney has established a diploma
in Public Health.

Mepican supervision of the Mecca pilgrims is
being devised on an elaborate scale.
There has been an outbreak of plague at Djeddah,

the disembarkation port for Mecca in the Red Sea,
and a strict quarantine and medical inspection is
being prepared before the pilgrims are allowed to
leave Djeddah for Mecca. Half way to Mecca, and
again at Mecca itself, the pilgrims are to be medi-
cally inspected. Ап isolation hospital has been
established at Месса.

YeLLow Fever iN Cuna. —Owing to the relaxation of
hygienic measures іп Havana, there is evidence that
yellow fever is again increasing in the island of Cuba.
Under the directing hand of Dr. Gorgas, yellow fever
was extinguished іп Cuba, but under the régime of the
Cubans since they were granted self-government, the
island, from a hygienic standpoint, is rapidly falling
back into the pestilential state which had existed there
until the United States Government assumed control.

During 1905 the deaths due to wild animals in
India were as follows :—Snakes caused 91,797 deaths ;
elephants, 45; leopards, 401; tigers, 756; wolves, 153.
Cattle were destroyed by wild animals to the
number of 99,977. No fewer than 16,915 wild
animals were killed.

Tue mortality of children born in Calcutta during
1905 amounted to 310 in every 1,000.

Rars лхо PrAGuE.—The Medical Ollicer óf Health
for the City of Madras believes that the freedom of
Madras from plague is due to the fact that there ave
few brown rats infesting the sewers of the city. Were
their numbers greater, the disease would in all pro-
bability have spread extensively.

Mosquito Destruction.—The introduction of a little
silvery fish, named in the Punjab the “ Chilwa,” and
in the Deccan and South India the “ Roopha,” into
pools infested with mosquito larvie, has proved
an efficient means of destroying mosquito life. "This
fish—the Checla argentea—is found all over India,
and would seem an excellent larvicide. Quicklime
thrown in stagnant pools has also been used with good
effect in the destruction of these pests.

CovNciL or MEDICAL Instruction ror TURKEY.
--Пхрен the title of the ‘Conseil d'Instruction
Médicale," a new medical council has been instituted
in Constantinople. The duty of this hody is to con-
trol the medical and sanitary departments of the
Ottoman Empire. Professor Mazhar Bey is the
president of the Council.

Мовооттокв AND МагаАКІА. — At а special meeting of
the Bangalore munieipal commissioners to consider
what steps should be taken to repress malaria, Captain
Standage, I. M.S., Residency Surgeon, addressed them
on the subject of the connection of the mosquito with
malaria. The work done by the Health Department
in using kerosine oil on tank borders and ponds justi-
fies the hope that the problem of decreasing malaria
is not beyond the capacity of the municipality. Не
therefore proposed that a pamphlet which he had
drawn up on the scheme be printed in several
languages and circulated broadcast. This contains a

388

THE JOURNAL ОЕ TROPICAL MEDICINE AND HYGIENE. [December 15, 1906.

popular exposition of the mosquito theory, and there
are hopes that tle people will take kindly to the de-
struction of mosquitoes. To popularise the theory an
experimental school of instruction is to be opened here
on December Ist, and will last for four months. It
will be open to six officers and non-commissioned
officers each from the Poona and Secunderabad Divi-
sious.—Pioneer Mail, November 23rd, 1906.

One might wish, however, that, in place of being
left to the initiative and enthusiasm of individual
officers, anti-malarial sanitation should be adopted
and enforced as & universal sanitary policy by the
Government of India. ‘Che ravages caused by malaria
in the cantonments of the Punjab, however, show that
this is far from being the case, and this mail's news
from Delhi speaks of the disease as raging there in
a fashion it certainly could not do if proper steps were
taken to limit the mischief. Surely the experience of
Havana and Panama, to say nothing of older successes,
should suffice to convince the ‘ Little tin gods on
wheels” that anti-malaria sanitation is something
more than a “ doctor's fad.”

------о----

BHecent and Current Literature.

A tabulated list of recent publications and articles bearing on
tropical diseases ts given below. To readers interested in
any branch of tropical literature mentioned in these lists
the Editors of the JOURNAL OF TROPICAL MEDICINE AND
HYGIENE will be pleased, when possible, to send, on applica-
tion, the medical journals in which the articles appear.

* Australian Medical Gazette,” October 20, 1906.

I. POLYCYTHÆMIA AND CHRONIC CYANOSIS WITHOUT SPLENIC
ENLARGEMENT.

Reissman, C., contributes an interesting article on this
subject. A girl, aged 18, became gradually cyanosed. The
‘liver increased in size as the cyanosis became more chronic.
A more or less acute illness, preceded by attacks of uncon-
sciousness, followed by vomiting, diarrhea, headaches,
giddiness, drowsiness, signs of venous obstruction in the
chest and leg, hæmoptysis, an increased number of red
cells in the blood, increased excretion of chromogen in the
urine, and increased coagulability of the blood. Liver
abscess was at first suspected, but search for pus in the
liver proved negative. A mediastinal tumour suggested itself,
but the subsequent history cancelled this belief; the absence
of leucoeytosis negatived an inflammatory origin. Тһе
patient recovered, and the assumption that the venous
obstruction was due to thrombosis seems to be rational,
especially in view of the fact that of the recorded cases,
post-mortem evidence seems to point to thrombosis and
thronibotie softening. Тһе explanation given by Osler in
cases of the kind is that there is increased viscosity of the
blood depending upon numerical increase of the red cells.

This disease is in many respects analogous to myelogenic
leukæmia, the bone-marrow іп one case affording ап excess
of white cells, but in polycythemia the red cells are in excess.

Reissinan suggests the X-ray treatment for polycythemia,
basing his opinion upon the benetits derived in myelogenic
leukemia for this agent.

II. Parotitis DURING DYsENTERY,

Bollen. P., met with a case of parotitis in a child aged 44,
during an attack of dysentery. The child fell ill on May
18th, 1900, and the dysenteric attack ran a typical course.
On May 25th a swelling over the right parotid region was

observed, which subsequently increased, but by June 8rd had
wholly disappeared. ^ There was not suppuration in the
parotid, but pain with earache and ditliculty in movement of
the jaw. The pus in the stools and the swelling in the
parotid subsided simultaneously. Parotitis is occasionally
mentioned as oceurring in dysentery, but the ailment is
usually part of a general pyæmic condition and ends іп
suppuration.

“Treatment,” November, 1906.
Tur TREATMENT OF TAPEWORM.

Jubb, G., advises for tapeworm treatment rest in bed for
two days, a dose of castor oil on going to bed, a milk diet
for two days, on evening of second day in bed а second dose
of eastor oil. On the morning of the third day, while fasting,
a capsule containing 15 minims of extract of male fern is
given every fifteen minutes till six capsules have been taken.
One hour after the last capsule. a tablespoonful of castor
oil. After the oil has acted the patient to resume ordinary
diet. Jubb finds that male fern exhibited ав recommended
is equally efficient for Tenia mediocanellata or for T.
solium. The head is best sought for by causing the stool
to be dropped in water and searched for in a shallow porce-
lain tray. `

“ Medical Record,” August 4, 1906.
SPLENIC EXTRACT IN THE TREATMENT OF MALARIA.

Carpenter recommends the fresh extract of spleen in
5 grain doses every four hours. In quartan and æstivo-
autumnal types a hæmatinic is usually required in addition,
but in the acute tertian and quotidian types the splenic extract
alone is sufħcient.

“ Semaine Medicale,” September 26, 1906.

Zanardini, G., advocates the use of creasote- enemata in
dysentery, made as follows: 1 drachm of a 10 per cent.
solution of creasote is added to the yolk of one egg and
made into ал emulsion with a litre of water.

Billet has also used creasote in the form of one-quarter
to one-half litre of an emulsion made by а 1 or 2 per
cent. solution of creasote in almond oil These enemata
are administered twice daily for as long as symptoms
continue.

* La Clinique," May 18, 1906.
Tue TREATMENT ОҒ LEPROSY.

Unna considers chaulmoogra ofl is the nearest approach to
a specific remedy for leprosy we possess. The drug can be
given by the mouth or by the rectum, but should not Бе
administered hypodermically, owing to the pain it causes.
In order to overcome the difficulties of local medication
from thickening of the tissucs and the obstruction of the
lymphatics by the lepra bacillus, Unna recommends the
application of local heat and massage. The parts may be
covered with flannel and ironed, or baths of “ ink " at a tem-
perature of 86° F., combined with massage. The applica-
tions serve to dislodge the bacilli and render them more liable
to destruction by ointments containing ichthyol, chrysarobin,
pyrogallol, or other bactericides. The ink bath consists of
a solution of sulphate of iron and tannin.

eS

Slotices to Correspondents,

1.— Manuscripts sent іп cannot be returned.

2,— Аѕ our contributors are for the most part resident abroad,
proofs will not be submitted to those dwelling outside the United
Kingdom, unless specially desired and arranged for.

3.—To ensure accuracy in printing it is specially requested
that all communications should be written clearly.

4,—Authors desiring reprints of thcir communications to the
JOURNAL OF TROPICAL MEDICINE AND HYGIENE should com-
municate with the Publishers.

5.— Correspondents should look for replies under the heading
“ Answers to Correspondents.”

Journal of Gropical Sevicine

SELECTIONS

FROM

COLONIAL MEDICAL REPORTS,

1906.

PRINTED BY JOHN BALE, SONS AND DANIELSSON, Ілмітер,
ORD HOUSE,

January 1, 1906). COLONIAL MEDICIAL REPORTS—TRINIDAD.

Colonial Medical Reports.—No. 16.—Trinidad (continued).

RETURN OF INFANTILE MORTALITY FOR THE YEAR 1904-1905.

Асе PERIODS
Diseases poc -——Q— ee -4----. = е еле Myo: бары,
Under | month. 1 to 8months | 8106 months | 6 to 9 months | 9 to 12 months

Diarrhea... Di as Ei үз "E 26. 13 44 ! 28 16
Lung Diseases 5; ds EY rs ne 1 10 16 8 4
Premature Birth — .. 22 s 2% MC 36 1 22 А vs us
Debility 35 is Js Pe jx ҚА 83 i 8 6 ! 1 d
Tetanus Neonatorum e 22 ia dl 30 je 2; 25 M
Dentition .. ve Ps s vs ate D Se » | 6 7
Malnutrition .. s: i. vs Яу s 6 7 5 4 | Е!
Tuberculosis .. s is E ae P zu 3 4 19 | z
Influenza $ $s Ж " АР е NS Ne 1 ee ae
Typhoid Fever 2% e m 2 3 1 1 4 2 t
Whooping Cough .. га " с. 2» 1 22 1 1 En
Congenital Syphilis .. s 23 za . 4 10 ; of 1:
Marssmus .. 2% 2s is UN RE 1 , 5 3 1 1
Infantile Convulsions Ja А е; сыл 4 p 1 5 9 "m
Malarial Fever 5% a es Au А 1 2 4 |
Monstrosity .. %% D = wid 2% 1 . vs e
Hydrocephalus Вр ie Не alk ел 1 e m 1
Hemorrhage from Umbilicus — .. m 2% 19 m pa ! сс
Obstruction of Bowels 52 EN m m 1 M ds і Ў 42
Meningitis .. i si 25 T T .. 1 3 ў 1 1
Peritonitis .. E ae 3: zs ie 1 2 zu р . el
Asphyxia ve 2s 2% iz ia vs 1 - vs i T 1
Congenital Lung Disease .. vs se Er 2 1 5 І s 2%

IN Heart ,, > m ste Ss 2 x us н А

% Liver ,, T 2% 25 % 3 1 of | 1
Anemia Ad А е - Р ся 2. i | 1 |

169 89 106 | 78 39

~
TWN — 2;

moto eto w

4 THE JOURNAL ОЕ TROPICAL MEDICINE.

Return or Diseases AND DEATHS IN 1904, AT THE

Colonial Hospital, San Fernando Hospital, Distriot and Yaws Hospitals.
GENERAL DISEASES.

Alcoholism
Anemia
Anthrax
Beri-beri
Bilharziosis
Blackwater Fever
Chicken-pox ...
Cholera
Choleraic Diarrhwa ..
Congenital Malformation
Debility
Delirium Tremens
Dengue
Diabetes Mellitus
Diabetes Insipidus
Diphtheria
Dysentery
Enteric Fever...
Erysipelas
Febricula
Filariasis
Gonorrhea
Gout... ЖЧ
Hydrophobia ...
Influenza
Kala-Azar
Leprosy
(a) Nodular Wes
(b) Antesthetic ...
(c) Mixed..
Malarial Fever—
(a) Intermittent—
Quotidian ..
Tertian
Quartan
Irregular ... а
Туре undiagnosed
(b) Remittent шы
(с) Pernicious .. m
(d) Malarial Cachoxia ...
Malta Fever ...
Measles
Mumps
New Grow ths— hte
Non-malignant ...
Malignant
Old Age
Other Diseases
Pellagra
Plague ved
Pywinia
Rachitis
Rheumatic Fever
Rheumatism ...
Rheumatoid Arthritis.
Scarlet Fever ...
Scurvy ... T
Septicemia 5
Sleeping Sickness
Sloughing Phagediena
Small-pox s
Syphilis—
(a) Primary
(b) Secondary
(c) Tertiary À
(4) Congenital ...
Tetanus p
Trypanosoma Fever
Tubercle —
(a) Dhthisis Pulmonalis.
(0) Tuberculosis of Glands
(c) Lupus NA
(а) Tabes Me senteric a. is
(е) Tuberculous Disease of Bones

Total
Admis- Cases
sions. Deaths. Treated.
26 ... 1»... 26
600 .. 90 .. 626
(T NES 77
Секе 9
303 .. 52... 308
E |
м 4 H
JL ana Ng
60 .. 96 .. 65
wo 3.. 12
241... — .. 94
Toe Tes 4
37... 1.. 37
145222 8/22 Wi
95 .. 1.. 25
1,004 .. 3 ..1,026
Se ts 3
125. 26 .. 127
9702 23 2 928
84... 6.. 87
MEME 1
HL od. 8
19... — 21
155 .. 55 181
64... 39 65
3.. 2.. 3
211 .. 1.. 932
"272 ee 1
paix fe 1
И xe. 2
33 —.. 83
60 -— 4 61
16 з R3
27 2. 98
332... 157 355
ae ae

Admis-
sions, Deaths.
JENERAL DISEASES- continued.

Other Tubercular Diseases Gy Ex
Varicella -- 2. —
Whooping Cough 42 c
Yaws 829 .. 3

Yellow Fever.

LOCAL DISEASES.

Diseases of the—

11,183

(January 1, 1906.

Total
Cases
Treated.

Cellular Tissue ... 256 . 6... 265
Circulatory Svstem—
(а) Valvular Disease of Heart .., 147 38 ... 161
(6) Other Diseases 54 94 55
Digestive System—
(а) Diarrbeea si .. 906 121 ... 827
(b) Hill Diarrhoea... eM Tue -.. --
(с) Hepatitis I ae 6... --. 6
Congestion of Liver ... e 10.. —.. 10
(d) Abscess of Liver oe 4 5. 4
(е) "Tropical Liver.. 17 3.. 17
(f) Jaundice, Catarrhal . - -- 2. =
(2) Cirrhosis ‘of Liver es — PE ss ME.
(h) Acute Yellow Atropuy PEE e 2
(1) Sprue 3 — s —
(J) Other Diseases.. 1,025 .. 132 ... 1,054
Ear . 23 .. 1 24
Eye ЕЕ 312 .. — .. 335
Соната Sy stem—
Male Organs 465 8 ... 452
Female Organs 1,007 ... 43 ... 1,033
Lymphatic System 140 59 .. 155
Nervous System 520 ... 104 ... 534
Nose 30 . 1. 32
Organs of Locomotion . 171 3... 185
Respiratory System 623 120 .. 658
Skin— .. = —.. --
(а) Scabies .. — —. S
(b) Ringworm : — Ea —
(c) Tinea Imbricata — -- 220 —
(4) Favus — -- --
(е) Eczema.. 2 tes се --
(f) Other Diseases 1,020 12 ...1,164
Urinary Svstem.. 458 ... 135 ... 466
Injuries, General, Local- se. -
(а) Siriasis (Heatstroke) E —.- --.. -
(b) Sunstroke (Heat Prostration) 1..--.. 1
(с) Other Injuries Р 912 ... 98 .. 959
Parasites— 18... — 19
Ascaris lumbricoides 38 .. 3. 39
Oxvuris vermicularis 1.. — 1
Dochmius duodenalis, or Ankylos-
toma duodenale 23 210 29 .. 916
Dracunculus medineusis (Guinea-
worm) ... 1.. — 1
Tape-worm - — —
Poisons—
Snake- bites 6 .. 1. 6
Corrosive Acids ... UT е; ---
Metallic Poisons РА — 2
Vegetable Alkaloids 94 .. 3. 24
Nature Unknown ES - m
Other Poisons 28 .. -- 28

Surgical Operations —
Amputations, Major
Minor
Othor Operations
Kye ... s
(а) Cataract "
(b) Iridectomy E
(c) Other Eye Operations A

January 1, 1906.:

COLONIAL MEDICAL REPORTS —BASUTOLAND. 5

Colonial Medical Reports.—No. 17..-BASUTOLAND.

Medical Report for the Year ending December 31st, 1904.

By EDWARD CHARLES LONG, М.К.С.8., L.R.C.P.

Principal Medical Officer.

PoruraTION.

Тнк census taken іп 1904 shows a remarkable in-
crease in the population. In thirteen years, the native
population has increased 60 per cent. The number of
Europeans, which of course bears an insignificant pro-
portion to the total population, now amounts to 895,
as against 578 in 1898.

Of the natives 163,916 are males and 184,515
females. The only age test applied in the census was
an under and over fifteen years age limit : 174,043 were
under 15 years, and 173,688 over 15 years of age.

There is & good deal of local overcrowding, an evil
which, I think, is increasing and unnecessary, seeing
that the population works out at 34 per square mile.
The natives are housed in huts which are usually
placed very close together, forming small villages.
The huts are, as a rule, unventilated and very little
air circulates between the huts. The ground around
them is fouled with all sorts of refuse, excreta, &c.
These eustoms undoubtedly have an unfavourable in-
fluence on the health of the community, and coupled
with the more general use of European clothing, are
partly responsible for the marked increase in tuber-
cular disease, to which subsequent reference will be
made.

Ав there is no registration of births and deaths, no
trustworthy information is available concerning the
birth and death-rate. The mortality amongst young
children is high, and speaking from general impres-
sions, I should say that the death-rate amongst
young people generally, is higher than it used to be.

GENERAL HEALTH.

The year 1904 was an exceptionally healthy опе.
The number of patients treated at the dispensuries
was less than the previous year, and there were no
epidemics.

SMALL-POX.

No cases of small-pox were recorded during the
year. This highly satisfactory state of affairs is un-
doubtedly due to the energy with which vaccination
has been prosecuted during recent years. The

majority of the inhabitants aave now been vaccinated,
and a fair proportion re-vaccinated.

24,301 vaccinations, all with calf lymph, were per-
formed during the year. The value of vaccination is
now thoroughly appreciated by the natives. Instead
of opposition, we now have frequent applications from
chiefs and headmen for vaccinators to be sent to their
districts.

Enteric FEVER.

Sporadic cases of typhoid have been recorded. The
majority of the cases admitted into hospital were
labourers who had contracted the disease in neigh-
bouring territories.

TUBERCULOSIS.

I regret to have to record a noticeable increase of
tubercular diseases throughout the territory. The in-
crease is traceable to (1) tuberculosis contracted
durivg residence at mining centres; (2) overcrowding
in the villages, and insanitary surroundings and habits ;
(3) the general adoption of European clothing; (4) to
direct infection.

A noticeable proportion of the men who have been
engaged in underground work at the mines return
suffering from miners’ phthisis. This cause cannot,
of course, be dealt with here. With a view to com-
bating the other causes and instructing the natives in
the elementary principles of sanitation and public
health, a small pamphlet on the subject has been
written, translated into Sesuto, for distribution
throughout the native schools, If the reading of this
little book is made compulsory in the schools, much
good may be looked for by the people thus receiving
some simple instruction during youth in those most
important subjects, public health and sanitation.

The figures given in the nosological return do not,

- I think, represent the real number of tubercular cases

in the country. Many cases returned as adenitis
would, I feel sure, be found to be tubercular, if they
could be followed up. Two cases of acute miliary
tuberculosis came under my notice during the year,
the diagnosis being confirmed by post-mortem exam-
ination.

6 THE JOURNAL OF TROPICAL MEDICINE.

(January 1, 1906.

SYPHILIS.

This disease is still an important factor in relation
to the health of the nation. The returns show no
diminution in the number of cases treated. The wide-
spread prevalence of the disease is having an appre-
ciable effect in lowering the physique of the people.

The identity of syphilis aud so-called yaws has been
fully discussed in a previous report. As some observers
still regard yaws as a separate disease, I would again
point out that the experience of medical officers in
this country proves that every lesion delineated in
Fasciculus ХІҮ. of the New Sydenham Society’s Atlas
finds its counterpart in syphilitic natives іп Basuto-
land.

New GROWTHS.

Benign growths are still frequently met with, and
specimens of all growths are forwarded to the Cancer
Research Fund. Malignant growths are extremely
rare.

GOITRE.

. This disease is never seen іп the Basuto, but Fingos
are very subject to it. It is fairly amenable to treat-
ment by painting with iodine, and the internal
administration of iodine of potassium and arsenic.

One case which ended fatally is worth recording.

A female Fingo, aged 20 years, was adinitted with a
large bilateral goitre. It diminished slightly in size
under treatment, but the patient, who was а fine
healthy-looking young woman, was anxious to have it
removed by operation. While waiting for operation,
and being apparently in excellent health, the tempera-
ture suddenly rose one day to 106° F., accompanied by
a very rapid pulse, muscular tremors, and cold sweats.
In spite of all treatment, the symptoms persisted, and
the patient died forty-eight hours after the first onset
of the unfavourable symptoms. Мо post-mortem
examination was obtainable.

RHEUMATISM.

This disease seems to be more prevalent in dry
years. Тһе subacute and chronic forms are the most
common. Many acute cases probably escape observa-
tion from inability to attend at the dispensary. A
considerable proportion of the more chronic cases
would appear to be gonorrhwal in origin.

We find large doses of perchloride of iron, with
saline purgatives, the most efficacious treatment.

DISEASES OF THE CIRCULATORY SYSTEM.

The increasing number of heart cases is traceable to
the prevalence of rheumatism. Syphilis, as far as my
observation goes, does not seem to affect the vascular
system in natives. Most of the patients only seek
advice when the disease is far advanced. Mitral
stenosis and incompetence are the most common forms
of valvular disease. One death occurred from peri-
carditis, in which the pericardium was universally
adherent.

RESPIRATORY SYSTEM.

Catarrhal pharyngitis and bronchial catarrh were
prevalent during the winter months. Pneumonia was
less prevalent than during the previous year.

GENERATIVE SYSTEM.

The only cases calling for notice under this heading
were one of hypertrophied prostate in a very old
native; the prostate was enucleated by the supra-
pubic operation, and weighed 8} oz. The other case
was one of extrauterine foctation, which was success-
fully treated by laparotomy.

ПівкавЕв or THE Nose.

А case of empyema of the frontal sinus, with
necrosis of the anterior wall of the sinus, was treated
hy trephining the sinus, curettiug and drainage.

DISEASES OF THE Eye.

The method of subconjunctival injections has been
given a fair trial during the year, but the expectations
of its value have not been realised.

б

METEOROLOGY.

This does not call for special notice. The year was
again unusually dry, the rainfall being about 12 inches
below the average. The crops were, however, saved,
and a suflicient food supply assured to the inhabitants.
The winter was long and exceptionally cold, but does
по мри to һауе had any ill ctfect on the general
health.

January 1, 1906.)

THE JOURNAL ОЕ TROPICAL MEDICINE. 7

'* (9) That one of these trypanosomes is prob-
ably identical with Trypanosoma brucei. The
other two differ from it, and are, provisionally,
unclassed.-

“ (10) That these varieties of trypanosomes are
conveyed from the sick to the healthy by the
Uganda tsetse-fly (G. palpalis), and not by other
biting flies (Stomozys).” .

It appears that the lymphatic glands of every
case of sleeping sickness are enlarged, and the
juice taken by puncture during life contains many
active trypanosomes, and also disintegrating forms.
In so-called “ trypanosoma fever” the same con-
ditions and findings obtain. It was also de-
termined that lymphocytosis occurs in all cases
of sleeping sickness. Тһе cells met with in the
cerebro-spinal fluid of the sleeping sickness cases
taken during life by lumbar puncture are lympho-
eytes, and these are. more numerous in the late
stages of the disease. The presence of a diplo-
streptococcus in various tissues and fluids, which
for some time has excited diseussion as to the
part it plays іп sleeping sickness, seems to have
been proved to have no etiological significance ;
but is quite a late development in the disease
when it does appear, which is not always the case.
All the evidence goes to show that the trypano-
soma derived from the blood of early cases of
sleeping sickness, and those derived from the
cerebro-spinal fluid of advanced cases of the
disease are one and the same, namely, the
T. gambiense.

The tsetse-fly, the Glossina palpalis, seems to be
the medium of transmission; and this fly, when
infected, can communicate the disease to monkeys
as well as to men. Trypanosomes occur in
animals such as oxen, ponies, camels, dogs and
mules, in the area in which the Commission was
at work; but it was impossible on morphological
grounds alone to arrive аба final conclusion as to
the identity or otherwise of the various “ strains ”
met with in different animals, but there can be
no doubt that the T. gambiense differs morphologi-
cally from the animal varieties. By inoculation
experiments, however, there would appear to be
a marked. distinction in the behaviour of the
several trypanosomes met with in animals.

Lieutenants A. C. Н. Gray and F. M. G. Tulloch
report several observations made оп tsetse-flies.
They proved that the Т. gambiense multiplies in
the alimentary canal of the G. palpalis, and that
the trypanosomes undergo morphological change
in the fly. Trypanosomes taken from the intes-
tine of the fly did not infect monkeys, but the
salivary glands of the fly were seen to be occupied
by trypanosomes from the intestines of the fly.

Of noted lesions in sleeping sickness the only
one which seems to have been recently added is
а petechial haimorrhage in the mucous membrane
of the stomach. .

As regards treatment, arsenic—as sodium
arseniate, as Fowler’s solution, or the combination
of the former with trypanroth or atoxyl; seem
the only drugs which have so far given even par-
tially beneficial resülts.

MALARIA.

Of the several forms of prophylaxis, quinine,
mosquito netting and destruction of mosquito
breeding grounds, each has its advocates. The
Italian Commission for the study of malaria
found quinine most effective in preventing
relapses of attacks of fever and in restoring the
patients to health. The members of the Com-
mission found 6 grains to adults daily, and 3 grains
to children, were efficacious in preventing new
infections and in preventing relapses of illness.

The objection to quinine taking is the difficulty
of getting patients or persons exposed to malaria
to continue using the drug, except under the
strictest supervision. The same may be said of
protection by mosquito netting; apathy on the
part of the persons exposed to malaria is the
great drawback to the complete suecess of
mechanical protection from mosquitoes; but
where supervision was possible, as in the case of
the Corsican Anti-malarial League, mosquito net-
ting proved highly, in fact completely, efficacious.
Destruction of Anopheles’ breeding grounds as a
prophylactic agent did not find favour to any great
extent in Italy, owing to the difficulty of drain-
ing the large swampy areas where mosquitocs
breed. In several parts, however, this mode of
exterminating malaria has given excellent results,

THE JOURNAL OF

TROPICAL MEDICINE.

{January 1, 1906.

one of the best, perhaps, being that obtained at
Klang and Port Swettenham, in the Malay
States, by Dr. Malcolm Watson. Іп a district
where eradication seemed at first sight well-nigh
impossible, Dr. Watson practically exterminated
malaria by systematic drainage of mosquito
breeding places, and by clearing the immediate
neighbourhood of shrubs and secondary jungle-
growth. At Port Swettenham, during the years
1901-02-03-04, the first-mentioned year being
previous to anti-malarial measures, the cases of
malaria numbered 188, 70, 21 and 4.

In both Klang and Port Swettenham, malaria,
as a fatal disease, was reduced to mil, and as
a factor in illness wholly insignificant. Major
Ross’s work at Ismailia in the same direction
gave, and continues to give, most encouraging
results. In 1901, before anti-malarial measures
were tried in Ismailia, there were 1,990 cases of
malarial fever in the town; in 1903 and 1904
the fever cases fell to’ 214 and 90 respectively.
It would seem, therefore, that by all methods of
malaria prophylaxis—quinine taking, netting and
drainage—malaria may be thwarted, and a com-
bination of two or all of these methods affords
proof that malaria is a preventible disease.

Matta FEVER.

During the year 1905 no branch of medical
scientific enquiry has borne better fruit than the
investigation of the etiology of Malta fever by the
Mediterranean Fever Commission. The Commission
was formed in the early part of 1904, and in June of
that year commenced regular investigations. The
members of the Commission were Colonel Bruce,
F.R.S., Major Horrocks, Staff-Surgeon Shaw, Dr.
Zammit of Malta, and Dr. Johnstone of the Local
Government Board.

The First Report by Major Horrocks was de-
voted to a study of the duration of life of the
Micrococcus melitensis outside the human body. His
conclusions were :—

(1) The M. melitensis is able to live for six days in
a urine which has become alkaline from the presence
of ammonia.

(2) The M. melitensis survives for sixteen days
when spread in a thin layer on a glass cover-slip.

(3) The M. melitensis survives for sixty-nine days
when planted in a dry sterilised manured soil.

(4) In dry sterilised sand the duration of life of the
M. melitensis appears to be only twenty days.

(5) In а sterilised manured soil saturated with
water the M. melitensis appears to survive for only
seven days.

(6) The M. melitensis is able to live for eighty days
on dry fabrics, such as blanket, khaki serge, and khaki
cotton.

(7) The М. melitensis appears to live for a com-
paratively short time in sterilised tap-water. It was
only recovered in pure culture six days after being
planted out, though from the result of Experiment
VIII. it appears possible that the duration of life may
extend to three weeks.

Major Horrocks’ Second Report consisted of
* Further Studies on the Saprophytic Existence of
Micrococcus melitensis," published September, 1904.
His conclusions were :-—

(1) The M. melitensis retains its vitality in sterilised
tap-water for thirty-seven days.

(2) In a Maltese soil,’ allowed to dry naturally, the
M. melitensis survives for forty-three days; and in
one thoroughly dried immediately after inoculation it
survives for twenty-one days.

(3) The М. melitensis survives for seventy-two days
in a damp soil.

(4) Exposure to the sun for a few hours kills the
М. melitensis.

(5) The M. melitensis survives for twenty-five
days in sterilised sea-water.

The Third Report, on “ The Recovery of the Micro-
coccus melitensis from the Urine, Feces, and Sweat of
Patients Suffering from Mediterranean Fever," is by
Major Horrocks, in conjunction with Captain Kennedy.
Up to September, 1904, the M. melitensis had been
isolated thirty-nine times from the urine of thirteen
different patients. Тһе microccocus was isolated not
earlier than the fifteenth day in Malta fever and not
later than the eighty-second day of the disease.
The examination of fæces for recovery of the cocous
proved negative, although as many ав 1,026 plates
were made from eighty-six stools. Major Hor-
rocks remarks that many of the streptococci
occurring in stools bear a superficial resemblance
to the M. melitensis. From the sweat the
М. melitensis had not been isolated at the time
of the Report (September, 1904); the infection
of bacteria-free sweat from Malta fever patients
did not give the characteristic agglutinins in the blood
of monkeys experimented upon; but in one experi-

Jey 15, 1906. COLONIAL MEDICAL REPORTS—BASUTOLAND.

“Colonial Medical Reports.

No. 17..-BASUTOLAND (contin ned),

Return oF DisEAsES AND DEATHS IN 1904, АТ THE
Basutoland Hospitals.

GENERAL DISEASES. Total

Айшік- Cases

sions. Deaths, Treated.

Aleoholism — ... - vi vis Wi ocu 2n 4
Anemia 2а es ET d - ) es 70
Anthrax ids ze ied E 5 1. — 5
Beri-beri 1 2% Pu bes Tr eo eem ==
Bilharziosis |... ur " M. 00-2. - --
Blackwater Fever — ... s 2d bee Te -
Chicken-pox ... sis ‘ae Pn Ws uma d pus zx:
Cholera Е i TS we oma —
Choleraic Diarrhæa E E жы SS om =
Congenital Malformation E hat Se Б
Debility ee Sat ae Sse unm | hg 211
Delirium Tremens ЖК d PELLI --
Dengue a* dus EM wx CER. m ==
Diabetes Mellitus... as зд мы ташы. 2% 6
Diabetes Insipidus ... s T We Epner ыш =
Diphtheria ... 29 ix КЕ Hs dos ib 5
Dysentery |... Er m m Br bone wb 32
Enteric Fever... oe ей 10s SM 1.2 24
Erysipelas 2% ЖИ ss "T UU EL T 9
Febricula ss E sue s ses 5.. — 127
Filariasis : сыр sire i T ee --
Gonorrhea... ды 9% m we Te -- 345
Gout... re А s As um 12
Hydrophobia ... m Es ae e e c —
Influenza m a ae 2: des 1..- 31
Kala-Azar - сха oad ik de. Of aug mm wm
Leprosy s Si kd Э iet ms
(а) Nodular Аб EM 16 ee ma 6
(b) Anesthetic ... fed b ЖРА Cem n STER 5

(c) Mixed... E i 2s De. Gaps ES 4
Malarial Fever— ... D ies nay CERES. тті e
(a) Intermittent- — XT der was (ERIS SS ds
Quotidian ... o E ue — 2. -- —

Tertian .. wae iu ақы YO eee =
Quartan ... MT ed sues Sie 5-5 ж.
Irregular... a s e — ue — —

Type undiagnosed RA Lb que ex —

(b) Remittent ... еэ АЕ bee — —

(c) Pernicious ... $e ы TL ы Ет =

(d) Malarial Cachexia ... TN tee pel сыз ze
Malta Fever ... i zh ИЕ --
Measles 70% hod e s MELLON 3
Mumps 26 52% e ise vemm EE us 173
New Growths— 022 сз 2n me mts —
Non-malignant ... is a e. 53.. 2.. 155
Malignant ET a E^ as 4.. 1. 6
Old Age а the 2: ves emu — . --
Other Diseases 2i 2% m" eo e = --
Pellagra ae и vis s Ges ee um =
Plague ... 5 Ls ue ue we 22 -- J=
Pyæmia iss e ВЕ us Da Tone. 3
Rachitis zx e - 9
Rheumatic Fever - —
Rheumatism ... 6 — 741
Rheumatoid Arthritis. - -- —
Scarlet Fever .. 22 Е --
Scurvy ... 6 -- 52
Septiciemia Е — - -
Sleeping Sickness - -- —
Sloughing FORESTA: — - ==
Small-pox ... -- Sm ы SES сы стер =
Syphilis— .. m n ie e — - m
(a) Primary Р — — 11

(b) Secondary -- - 377
(c) Tertiary M 16 — 765
(d) Congenital ... — - 969
Tetanus ie -- -- --
Trypanosoma Fever |. -- -- . —
Tubercle— -- 2.20 —
(а) Phthisis Pulmonalis АЕ ide B uus 53 75
(b) Tuberculosis of Glands... . W.. —. 58
(c) Lupus 254 52 ЕНЕ E
(d) Tabes Mesenterica . " 5 ul oS 10
(e) Tuberculous Disease of Bones `. 5.. — 19

Admis-
$ sions, Deaths,
GENERAL DrsEAsES-— continued.

Other Tubercular Diseases Е
Varicella vig mn ie ce 0 --
Whooping Cough veh nm dis IE
Хал 22 TH е5 a eme -

Yellow Fever. ie A - "i — 2...

LOCAL DISEASES.

Diseases of the—

Cellular Tissue ... M ss er BAS
Circulatory System—
(a) Valvular Disease of Heart ... б... 1
(b) Other Diseases d bes 6... 3
Digestive System— — ... ih . HM
(a) Diarrhoea si РЕ TOME
(^) Hill Diarrhoa.. i We EROR cbe
(c) Hepatitis ira ad TELS
Congestion of Liver ... ve —
(d) Abscess of Liver 50% MEN
(e) Tropical Liver.. M "Ls
(f) Jaundice, Catarrhal `.. до. EA
(9) Cirrhosis ‘of Liver... eee EI
(h) Acute Yellow Atrophy eu —
(i) Sprue ... : eee
(J) Other Diseases.. 25% Me Te as ӘХ
Ear 22 n dis 294 42. ==
Еуе ы: M uen ME uu GE
Generative Sy stem—
Male Organs E T ies O5 0
Female Organs .. ur e 500. —
Lymphatic System — ... v 1400-22 cm
Nervous System nis sss sro AG sa
Nose : ae gu: 1.
Organs of Locomotion |. Aes e 295.
Respiratory System... iet we. dba
Skin— .. E sis mo сатыл
(a) Scabies .. ves n e — --
(b) Ringworm 5% ah ee. Fabbe SH
(с) Tinea Imbricata — —
(d) Favus -- —
(e) Eczema.. k des е 9. —
(f) Other Discases ds x 4 cH
Urinary System.. ses 8 ---
Injuries, General, Local — - -
(а) Siriasis (Heatstroke) Е = -
(b) Sunstroke (Heat Prostration) — e cm
(c) Other Injuries hal sro lo
Parasites— s e wa wm --
Ascaris lumbricoides ... p e c -

Oxyuris vermicularis bse is
Dochmius duodenalis, or Ankylos-

toma duodenale 45% ad ИЕ
Dracunculus medinensis (Guinea-
worm) ... iss Pe Le eee ee --
Tape-worm ees "t i toe ет Cr
Poisons—
Snake-bites des ad e АЕ
Corrosive Acids ... 1 ve ee --
Metallic Poisons 555 an e ee
Vegetable Alkaloids — ... Do "E ee Bee
Nature Unknown oat as eM ee
Other Poisons... sent дез 1Г00--.. --
Surgical Operations—
Amputations, Major ... E ЕЕЕ
Minor .. 25 MEL
Other Operations i дра wt eee ЕЕ
Eye ... ET vis "ML
(a) Cataract ... NS "ELI
(b) Iridectomy cee ee —

(c) Other Eye Operations dort 9m ans

THE JOURNAL ОҒ TRO

PICAL MEDICINE.

[January 15, 1906.

RETURN OF THE STATISTICS OF

POPULATION FOR THE YEAR 1904.

Europeans | Mixed
and Basuto and
Whites | Coloured
Number of inhabitants in 1904 be a 895 347,731 | 222
Number of inhabitants in 1891 bil 518 218,324 | 180
Increase sad 217 129,407 49
METEOROLOGICAL RETURN FOR THE YEAR 1904.
TEMPERATURE
SST Se mem ae - SS es Rainfall, Amount
i біраз aa | in Inches
Shad nade
| Maximum Minimum Range Mean |
January 97 48 49 12 i 7:80
February 89 46 43 6T i 4:36
March "4 16 38 60 1:93
April У T kx е E ні 28 56 56 1:23
May.. ia ES wx " EN 74 24 50 19 "60
June.. "T m ds 54. we d 69 17 52 43 178
July.. 2» 7 iG. ae as | 69 20 49 44 25)
August us ! КІ 21 60 50 | --
September .. 81 І 25 56 53 | "69
October — .. 48 | 33 55 60 146
November .. | 96 38 58 67 | 2:80
December .. | 101 42 | 59 11 | “70
|

Colonial Medical Reports.—No. 18.—Northern Nigeria.

MEDICAL REPORT FOR THE YEAR 1908.

By Dr. 8. W. THOMPSTONE.

Principal Medical Officer.

ESTIMATED POPULATION FOR THE YEAR 1903.

THE average European population resident іп
Northern Nigeria during the year was 309. This in-

eludes both oflicials (civil and military) and non-
oflicials (traders, missionaries, &c.).

DEATHS.

There were 18 deaths during the year, 12 amongst
officials, and 6 amongst non-oflicials. Of the total
deaths 3 occurred in action, and 1 from ptomaine
poison, leaving altcgether 14 deaths which were at-
tributable to the effects of the climate.

DEATH-RATE PER 1,000.

This gives a total death-rate of 58:25 per 1,000
calculated on the average resident population, or, ex-

cluding the four deaths above referred to, of 45:3 per
1,000.

CoMPARISON WITH Last YEAR.

Last year the average resident population was 290,
and the number of deaths 9, a death-rate of 31:03 per
1,000. There has been an increase of population over
last year therefore of 19, and in the total death-rate of
27:2 per 1,000. Comparisons made between statistics

January 15, 1906).

of mortality based on such a relatively small popula-
tion as that of Northern Nigeria, which has been
occupied by Europeans for so short a time, are, how-
ever, obviously fallacious, and until records of а num-
ber of years are available it cannot be stated that the
death-rate of one year is above or below the normal
rate.

PREVALENCE ОР SICKNESS IN THE DIFFERENT SEASONS
OF THE YEAR, AND CHARACTER As TO MILDNESS
он Severity оғ DISEASES PREVAILING.

The months of September, October, November and
December, show the greatest amount of sickness, and
March, April, May and June, the least, the rainy
season having been the most unhealthy part of the year.

The character of the various diseases met with
has not changed, with the exception that black-
water fever has assumed а more severe form, the
cases have been more serious and the death-rate
higher.

RELATIVE MORTALITY IN THE DIFFERENT SEASONS.

The greatest number of deaths in any one month
occurred in September. There were no deaths in
February, June and August.

METEOROLOGICAL CONDITIONS OF THE SEASONS.

The rainfall during the year was 32°88 inches at
Zungeru, and 59:85 at Lokoja—the greatest recorded
having been at Lokoja in September, when it amounted
to 13:97 inches in the month. Theaverage at the two
stations at which complete records were kept was
46:36 inches for the year. The maximum shade tem-
perature in Lokoja was 101? in March, the minimum
56° in January. The highest mean temperature was
84-4? in March, and the lowest 78:4? in August. Last
year the maximum shade temperature was 102? in
June, and the minimum 51° іп December. The
highest mean temperature was 85° in April, and the
lowest 72? in November. Тһе rainfall at Lokoja in
1902 was 53:61 inches. In Zungeru the maximum
shade temperature was 107?, which was recorded in
March, and the minimum 60? in November. Тһе
highest mean temperature was 89:7? in March, and
the lowest 78:4? in August. The highest mean rela-
tive humidity was 86:6 per cent. in August, and the
lowest in December, 55:4 per cent. Hygrometrical
observations were not taken, however, until May.
The general direction of the wind was S.W. for the
greater part of the year both at Zungeru and Lokoja.
I append a chart which shows graphically the seasonal
variations of mean temperature, relative humidity,
rainfall and sickness rate.

New meteorological stations have now been estab-
lished in all provinces, and returns will be available for
the next annual report, which will give more repre-
sentative records of the different degrees of tempera-
ture, rainfall, and relative humidity met with
throughout the Protectorate.

PARTICULAR DISEASES DURING THE YEAR.

The prevalent diseases among Europeans have been
malarial fevers and dysentery. Of the former (ex-
eluding blackwater) there were 884 admissions with
2 deaths, and of the latter 41 admissions with no

COLONIAL MEDICIAL REPORTS—NORTHERN NIGERIA. 9

deaths. Sixteen cases of blackwater fever occurred
throughout the Protectorate during the year, with
6 deaths, a case mortality of 37:5 per cent. There
were 3 cases of small.pox amongst Europeans, with
no deaths.

GENERAL SANITARY CONDITION OF THE
PROTECTORATE.

The general sanitary condition of the stations oc-
cupied by Europeans is being improved gradually, but
much yet remains to be done. The Government
premises are kept clean, and are well drained, but the
water supply in most out-stations is poor, and the
houses merely temporary mud and grass structures.
The native towns, with the exception of those in the
vicinity of the European settlements, are practically
in their primitive condition.

ZUNGERU.

Sanitary State of the Principal Stations with reference
to Water Supply, Drainage, «с.

Average European population, 50.

Deaths during the year, 5.

The general sanitary condition of Zungeru is good,
the cantonment is kept clean, and is well supplied
with surface drains running down to the Dago river,
which effectually carry off all surface water. The
general health of Europeans throughout the year has
been good.

Water Supply.

The water supply is derived from the Dago river.
which flows through the cantonment; it has not
proved satisfactory during the dry season, owing to
the extreme drought, drinking water having had to be
carried a long distance from the Kaduna river. A
scheme is now in progress for damming the stream,
which is hoped will keep it runnivg in future. Tanks
are also being fitted round the bungalows to col-
lect rain-water. A pumping station on the Kaduna
would solve the problem of obtaining a good supply
the year round. :

Disposal of Refuse.

The dry earth system for the disposal of excreta is
in use, and has proved satisfactory—the contents of
pails being buried іп trenches. АП combustible refuse
is burnt, and the rest buried at some distance from the
cantonment.

Loxosa.

Average European population, 42.

Deaths during year, 2.

The sanitation of Lokoja has much improved re-
cently—the Government premises being in good con-
dition, and the lines occupied by native soldiers clean.

Water Supply.

This is derived from the Niger river, and is distilled
before being issued for drinking purposes; the
supply is ample, and the quality all vhat can be
desired.

Disposal of Refuse.
As at Zungeru and all other Government stations.

Drainage is satisfactory, by surface drains to the
river.

10 ТНЕ

JOURNAL OF TROPICAL MEDICINE.

E inicia! y] 15, 1906.

The hospital accommodation is quite inadequate
for a station of this size, through which all the invalids
in the Protectorate pass on their way to England. A
new hospital is, however, now in course of erection,
which will amply meet all requirements for some years
to come. It will probably be ready for occupation In
April next.

ILLORIN.

European population, 12.

Deaths during the year, 1

The sanitary condition of this station is good, except
as regards the position of the native barracks, which
are too near the Europeans. These are being moved.

Water Supply.

The drinking water for the I;uropeans is obtained
from & well about 30 feet in depth; its quality is fair.

Disposal of Refuse.

As in all other stations.
Drainage good.
бокото.

European population, 8.

Deaths during the year, none.

The general sanitary condition is good. There is,
however, a good deal of swamp in the wet season near
both the fort and the Residency, which requires drain-
ing. Much has been done, but much still remains.
Near the fort it is especially improved, but that near
the Residency is a much more serious matter, and
will take much time and labour to render satisfactory
from a sanitary point of view. All that can he done
is being done in this direction.

Water Supply.

This is obtained from rock springs in good positions ;
the water is of excellent quality.

Disposal of Refuse.
As elsewhere.
Drainage: Open drains have been, and are being
cut, to take off surface water.

Kano.

European population, 14.

Deaths during year, none.

The Eniropean station is situated about three-quarters
of a mile from the native town of Kano, and consists
of the Hesideney and the military lines, the latter
lying about 200 yards south-east of the former. Тһе
Residency used to be the former Emir's summer resi-
dence, and consists of blocks of houses and several
outhouses. Тһе general sanitary condition is satis-
factory, except during the rains, when drainage is
difficult, owing to the flatness of the surrounding
country.

Water. Supply.
All water is obtained. from wells, and is boiled and
filtered before use.
Disposal of Refuse.
By burning and in trenches.

ZARIA.

European population, 25.

Deaths during the year, 1.

The present site occupied by the civil population
is unsatisfactory. The military lines have been moved
four miles away to Dandua, a much better position
from a sanitary point of view; the question of moving
the civil population is under consideration.

Water Supply.

This is poor, being derived from wells, none of which
are above suspicion, the quality is inferior, and the
supply meagre.

At Dandua there is a running stream of good water.

Disposal of Itefuse.
As in other stations.

Youa.

European population, 8.

Deaths during the year, none.

The sanitary condition of this station is good. In
the early part of the year much annoyance was caused
hy mosquitoes. A ** mosquito brigade” was organised in
August,and the Medical Oflicer reports that he has
now filled all possible breeding places within 800 yards
of the Residency with sand and planted grass over
them. Mosquitoes are now rarely found in Ше vicinity
of the European dwellings.

Water Supply.

The water is obtained from the Benue, poured into
settling jars, boiled, and passed through a Berkefeld
drip filter.

Drainage.

Good, except in one place, to the west of the Resi-
dency, where a swamp formed during the wet season.
This, however, only existed for а short time when the
rains were at their heaviest.

VACCINATIONS PERFORMED DURING THE YEAR AND
THE CONDITION OF THE POPULATION IN RESPECT
OF PROTECTION FROM SMALL-POX.

Systematic vaccination in Northern Nigeria has been
commenced during the year. Arrangements have been
made for a small weekly supply of lymph to be sent to
all stations, as it is found from experience that there
is great ditlieulty in obtaining it in an active condition
if kept in this climate for more than & few weeks
at the outside.

The native population is at present (with the excep-
tion of 174 cases successfully vaccinated during the
last three mouths, and those who have already suffered
from the disease) entirely unprotected from small-pox.
On account of the enormous size of the Protectorate,
and the relatively small staff available for these duties,
it will be many years before much can be done to

vaccinate even a small proportion of the inhabitants,
but in view of the frequency of outbreaks of this
disease, it is of the utmost importance that- active
measures should be taken to protect, at any rate, those
natives who live in the vicinity of European stations.

February 1, 1905.)

Colonial Medical Reports.—No. 18.—Northern Nigeria—

(continued). à
GENERAL HEALTH.

Europeans.

The general health has not been so good as last
vear, both the death and invaliding rates having been
higher for all classes of the community. Analysis of
the statistics of mortality for the year shows that the

COLONIAL MEDICAL REPORTS—NORTHERN NIGERIA. 11

а ғғ аа Г.Т

cent.; the non-official death-rate being 18:8 per cent.
greater than the official for the year.

There have been 34 officials and 9 non-officials
invalided in the twelve months, а total invaliding rate
of 13:9 per cent.

Natives.

Тһе total number of natives treated at the Govern-
ment hospitals and dispensaries during the year was
3,983, an increase over the previous year of 876. А

serious outbreak of small-pox occurred

x
N
N
N
3

залил TY
lereeuary|
жағасы |

SICMNESS RATE зит» Ұмы Ap pr
MEAN TEMPERATURE ”

RELATIVE HUMIDITY -
RAINFALL К -

death-rate from climatic causes among Government
officials has been remarkably less than among the
non-official population. There were resident during
the year an average of 273-8 officials in the Pro-
tectorate, amongst whom there were 9 deaths from
disease, a death-rate of 3:2 per cent., the average
resident non-official population for the same period
being 35:2 with 6 deaths, a death-rate of 17:04 per

at Lokoja in June. Тһе disease was
introduced by freed slaves brought down
the Benue. Fortunately, however, by
prompt isolation and vaccination of con-
tacts it was prevented from spreading to
the native town. There were altogether
77 cases, with 8 deaths.

Steps аге being taken for the provision
of permanent enclosures for the isolation
of infectious disease both аб Lokoja and
Zungeru, in which grass huts, which can
be burnt when no longer required, will
be built as wanted. .

The amount of venereal disease met
with is still regrettably large, there
baving been 627 cases of gonorrhea
treated during the year, and 98 cases of
syphilis.

І attach the following returns :—

A. Statistics of European population.

В. Nosological Returns, Zungeru.'!

SKE SS
RATE

8

Мо. 19.—Northern Nigeria.—Medical
Report for 1904.
By Dr. S. W. THompstone, Principal Medical
Officer.
ESTIMATED POPULATION FOR THE
Year 1904.

Asin former years statistics of European
population only are given, it being im-
possible to estimate with any approach
to accuracy the number of natives in the
Protectorate.

The average number of Europeans
resident in Northern Nigeria during the
year was 322, including both officials and
non-offieiale—312 being males and 10
females.

DEATHS.

There were 13 deaths in all during the
year, 8 amongst oflicials, and 5 among
non-officials. Of these deaths 1 was due
to accident, leaving 12 attributable to
climatic causes.

DEATH-RATE PER THOUSAND.

The total death-rate for the year, calculated on
the average resident population, and including deaths
from all causes, was 40°37 per 1,000, or excluding
the one accidental death, 37:26. There is a very
noticeable difference in the relative mortality of
officials and non-officials, there having been 5 deaths

! Diagram only printed.

19 THE JOURNAL OF TROPICAL MEDICINE.

{February 1, 1906.

amongst 52 non-ofticials, as against 8 deaths (including
one from accident) amongst 270 officials, giving a
non-official death-rate of 96:15 per 1,000, and an
official one of 29:69. This difference being brought
about almost entirely by the more careful selection of
candidates for employment in Government service,
and by their shorter tour of residence—many of the
men sent out by the trading firms being obviously
physically unfit for tropical service.

CoMPARISON WITH Previous YEAR.

Last year the average resident population was 309,
and the number of deaths 18—the death-rate being
58:25 per 1,000. There has been an increase of
European population over last year of 13, and а
decrease іп the death-rate from all causes of 17:55 per
1,000.

PREVALENCE OF SICKNESS IN THE DIFFERENT SEASONS
OF THE YEAR, AND GENERAL CHARACTER AS TO
THE MILDNESS ок SEVERITY OF THE DISEASES
PREVAILING.

As in former years, the rainy season was the most
unhealthy for Europeans, July being the worst month,
and the month with the heaviest rainfall. The smallest
number of admissions was recorded in February. The
general character of the diseases prevailing showed no
change except in the case of hemoglobinuric fever,
which has become more prevalent but has assumed a
milder type. There were 31 admissions with 5 deaths
from this disease during the year—a case mortality of
16:1 per cent.—as against 16 cases with 6 deaths in
1903. An inerease in the number of cases with a
very marked reduction in the death-rate—the case
mortality last year having been 37:5 per cent.; one
case of enteric fever occurred in Bornu—the first re-
corded in Northern Nigeria.

RELATIVE MORTALITY IN THE DIFFERENT SEASONS.

There was practically no difference in the relative
mortality in the different seasons, the deaths being
pretty evenly distributed throughout the year. There
were no deaths during the months of January, March,
September, and December.

METEOROLOGICAL CONDITIONS OF THE SEASONS AND
THEIR PROBABLE EFFECT WITH REGARD TO
HEALTH.

Zungeru.—The rainfall during the year was 51-1
inches, or 18-22 inches more than іп 1908, the wettest
month being July, with 15:07 inches. Rain fell during
eight months of the year, from March to October,
inclusive—the heaviest fall recorded being 2°64 inches
in thetwenty-four hours, on August 24th. Themaximuin
shade temperature was 103° Е. in March and April,
the minimum, 56° F., which was recorded in Novem-
ber, December, and January. The highest mean
temperature was 86° іп April, and the lowest 77° in
July, August, and December, the mean temperature
for the year being 799. The mean relative humidity for
the year was 63:6 per cent., the highest mean being 82
for July, and the lowest 38 for December—calculated
from readings taken at 9 a.m. The lowest actual
relative humidity recorded was 15, from hygrometer
readings taken at 4 p.m. on December 27th.

Lokoja.—The total rainfall was 41-72 inches for

the year, or 18:13 inches less than last year—the
heaviest rainfall having been in July, 834 iuches.
The maximum shade temperature was 102? on March
llth, and the minimum 57? on December 23rd. The
highest mean temperature was 86? in March, and the
lowest 79? in July, August, September, and December.
The mean temperature for the year was 80? F.

Yola.—Total rainfall 33:77, the greatest recorded
being 10:99 inches in August; the heaviest fall oc-
curring on June 21st, 2:10 inches.

The mean temperature for the year was 80°, the
maximum being 107? F., which was recorded on
March 16th, and the minimum 609, on January 13th.

Complete statistics are not available from any other
stations, as their meteorological instruments did not
arrive until after the commencement of the year.

: The general direction of the wind throughout the
Protectorate was from the south-west from June to
November, and from the north-east during the remain-
ing months of the year; the Harmattan lasting, with
slight intermissions, from December to the end of
May; the first tornadoes oceurring in March, and the
rainy season ending in October.

With regard to the probable effect of the meteoro-
logical conditions on the health of the community, it
may be stated generally that Europeans have the best
health in the dry season, and natives in the rains.
Europeans, by taking proper precautions, avoiding in
great part the diseases that affect the native in the
dry season when water is scarce and polluted, and the
native being less affected by the great cause of the
excessive mortality among Europeans— malaria—a
disease more especially of the wet season.

PARTICULAR DISEASES THAT HAVE OCCURRED
DURING THE YEAR.

By far the greatest amount of sickness during the
year has been due, as in the past, to malaria; the
total admissions from this disease (excluding black-
water fever for the sake of convenience) having been
515, with 3 deaths, compared with 386 admissions
with 2 deaths last year. Thirty-one cases of hamo-
globinuric fever occurred with 5 deaths, and 18 of
dysentery with no deaths. Dysentery is becoming
much less prevalent, the total admissions for the year
being less than half those in 1903. There were two
cases of small-pox among Europeans, with no deaths.

GENERAL SANITARY CONDITION OF THE
PROTECTORATE.

The general sanitary condition of the European
stations is good. The principle of forming separate
locations for natives and Europeans has been carried
out in all cases as far as possible, and sites have been
chosen for permanent buildings in the headquarters of
the various provinces. The question of improving the
water supply is being solved in great measure by the
supply of small condensers.

The large native towns are stil in their original
condition as regards sanitation, and it will be probably
many years before anything сап be done to improve
them. They are kept clean as far as outward appear-
ances go, but the old system of digging wells and
privies side by side obtains everywhere, and probably
accounts for most of the intestinal diseases met with
amongst natives.

SANITARY STATE OF THE PRINCIPAL STATIONS WITH
REFERENCE TO Water SuprPLY, DhHAINAGE, С.

Zungeru.—The headquarters of the Protectorate has
an average resident population of 69:5 Europeans, 66
officials, and 8:5 non-officials. Тһе cantonment is kept
clean, and is well supplied with surface drains running
down to the Dago river, which effectually carry otf all
rain-water. Early in the year & series of dams was
constructed across the river with the object of holdiug
up the water and providing for a continuous flow
throughout the dry season. Тһе system has proved
most successful, and & condenser has been erected
which provides the European residents with a plentiful
aud pure supply of drinking water the whole year
round. In addition to this, iron tanks have been
fitted to most of the bungalows to store rain-water
during the wet season.

Disposal of Refuse.—The dry-earth system is in use
for excreta—as is the case in all Government stations
— the contents of the pails being emptied into shallow
trenches and buried. All combustible refuse is burnt
daily, and the rest buried at some distance from the
cantonment.

The general health of the official population has
been good; that of the employés of the Niger Company
extremely bad. This difference is due, as pointed out
earlier in this report, principally to the want of care
exercised in the selection of suitable men, and the
long tour of service required of them.

Lokoja had an average resident population during
the year of 65:9 Europeans, 51/7 officials, and 14-2
non-officials. The sanitary condition of the European
quarter is good, and the lines occupied by the native
soldiers are well kept and clean. The cantonment is
well supplied with surface drains running down to the
Niger, and refuse is disposed of as at all other
stations.

Drinking water is supplied by а condenser from the
river; the supply is ample, and the quality excellent.
The new hospital for Europeans, referred to in my
last report, has been completed, and has been in use
since May. Itiscool, well ventilated, and large enough
to meet all requirements for some years to come.

Zaria.—The average resident European population
during the year was 23. The site now occupied by
the civil population is most unsatisfactory, the water
supply is insuflicient and bad, and the ground unsuit-
able. A new site at Dandua, five miles away, has
been occupied by the military during the year, and
has proved to be an excellent one. It is proposed to
move the entire European population out there early
in 3605, and abandon the old situation at Zaria.

The health throughout the year has been good,
there having been no deaths. The water supply at
Dandua is obtained from & running stream, and is of
good quality and ample in amount.

Kano.—The average resident European population
during the year was 18:4; the general health was fair.

The sanitary condition of the site at present occu-
pied is as good as the nature of the ground will
allow. Drainage is unsatisfactory during the wet
season owing to the flatness of the surrounding coun-
try—no proper fall being obtainable, and the soil
becoming waterlogged in heavy rains. Тһе water

COLONIAL MEDICAL REPORTS—NOBTHERN NIGERIA. 18

supply is obtained from shallow wells, and is in-
sutticient for the needs of a large population during
the dry season. The question of moving to & more
suitable locality is under consideration, and several
alternative sites have been proposed; no particular
place has, however, yet been decided on, the local
conditions varying so much at different seasons of the
year, that it was considered inadvisable to make а
final choice until more extended observations have
been made.

VACCINATIONS PERFORMED DURING THE YEAR, AND
CONDITION OF THE POPULATION IN RESPECT OF
PROTECTION FROM SMALL-POX. .

One thousand three hundred and four successful
vaccinations have been performed during the year, all
stations being now supplied with & small weekly or
fortnightly consignment of lymph. Great difficulty is
experienced in obtaining it in an active condition at
those stations which are farthest away in the interior,
the long journey on carriers’ heads in the hot weather
rendering it in many cases inert on its arrival. The
returns received from the different stations show a
regularly decreasing scale of successful vaccinations,
according to the distance from Lokoja; Lokoja itself
heading the list, with Katagum and Bornu at the
bottom.

There have been two more cases of small-pox among
the white population during the year, again demon-
strating the fact that the disease can be acquired from
natives, and refuting the popular theory held by many
Europeans to the contrary. The natives throughout
the Protectorate, with the exception of those success-
fully vaccinated during the last two years and those
who have already suffered from the disease, are
entirely unprotected from small-pox, and all that can
be done at present is to vaccinate all Government
employés and those natives living in the immediate
vicinity of the various stations, anything like general
vaccination, though . most desirable, being quite
impracticable.

GENERAL HEALTH DURING THE YEAR.

The general health of the European community has
been fair; the death-rate has been considerably lower,
but the sickness and invaliding rates higher than last
year. More cases of illness have come under treat-
ment, but of a milder type. There have been 50
officials and 17 non-officials invalided during the year,
a total invaliding rate of 20:8 per cent., as compared
with 13:9 per cent. last year.

The health of the natives has been good through
the year, no serious epidemies have occurred, and the
death-rate, so far as can be gathered, has been normal.
The total number of natives treated at the Government
hospitals and dispensaries was 13,504, an increase over
the previous year of 9,521. This very large increase
is, however, partly accounted for by & change which
has been made in the method of keeping the records
of cases—no account having been kept in the past of
many of the patients. Dispensaries are being estab-
lished in the native towns nearest the different pro-
vincial headquarters, but they will necessarily be
only on a very limited scale at first, the expense of
equipping fifteen or twenty stations with the necessary

14 THE JOURNAL ОЕ TROPICAL MEDICINE. [February 1, 1906.
instruments, drugs, and appliances being very Venereal diseases һауе been very prevalent among

great.

During the year 483 patients have been treated as
paupers throughout the Protectorate.

With the object of providing for the isolation of
infectious diseases, such as small-pox, &c., in Zungeru
and Lokoja, permanent enclosures have now been builtin
each of these stations, one acre in extent, surrounded
by unclimbable iron fencing, and provided with lock-
up gates. It is intended when the necessity arises to
build temporary grass huts within them, which can be
put up quickly when wanted and burnt when no longer
required.

natives, syphilis being widely distributed throughout
the northern and eastern parts of the Protectorate.
Nine cases of beri-beri, eight of them at Lokoja, have
been admitted during the year, with two deaths.
This disease is not endemic so far as can be ascer-
tained, and all eases met with have occurred in the
parts of the Protectorate nearest the sea, and in direct
communication with the coast.

I attach the following returns :—

Statistics of European population.

Meteorological returns for Zungeru and Lokoja.

Nosological return for Northern Nigeria.

STATISTICS OF EUROPEAN POPULATION.

All Europeans 19009 1901 I9 L008. 1904
Average actually in the Protectorate ., 165 165 290 309 322
Number of deaths... Ты 2M 21 13 9 9 18 . 18
Number of invalids | 21 30 20 43 . 67
ANALYSIS OF 1901 STATISTICS.
| | Invaliding
Europeans Totals Deaths , Deatlerate с Tavalids | "абе к
| per 1,000 ` per 1,000
Average actually in the Protectorate 322 13 40:37 67 | 2080
Officials Gh oat he 270 s | 92902 : 50 | 1851
Non-officials 52 5 , 9015 , 17 | 326:9
ZUNGERU METEOROLOGICAL RETURN FOR 1904.
TEMPERATURE RAINFALL Winns i
= Бє » р PI | А К Remarks
ez x = 2i ae Lc |
ЕЕ EE 32 feo] fe |
ЕЕЕ i Е $ is SE 2а
"2 | а С 5з REUS Jy
January sgt - ҚЫ ..| 102 56 46 80 = 53 N.E. —
February p bat МЕ ..| 101 ; 60 41 80 | — 55 | N.E. —
March |... 100 | G1 42 84 | SA. 47 1 SW. -- |
April 103 67 36 86 9:20 55 ' SW. — ^"
May 97 68 29 81 6:14 71 S.W. --
June 92 68 24 79 7:01 17 S.W. --
July. 89 68 21 17 15:07 89 S.W. --
August ... 90 , 68 23 TT ; 1015 , 8l S.W. —
September | 90 67 23 78 | 6:58 77 S.E. — |
October... | 94 67 27 79 3:41 76 S.W. —
November 7? бае dy inl 98 56 49 "8 | -- 52 N.E. —
December oes ual Wu be 99 56 43 TT — | 88 N.E. —
E E TE, lac ce mr tion SR ЖЕТІ РРА
| ] | : І |
Total pfe em m -- i B11 — -- —

February 15, 1906.) COLONIAL MEDICAL REPORTS—NORTHERN NIGERIA. 15

Colonial Medical Reports.—No. 19.—Northern Nigeria—(continwed).
LokojA METEOROLOGICAL RETURN FOR 1904.

TEMPERATURE RAINFALL Міхгз
. z А s қ , | 23 z ғ 38 $5 Remarks
ЕЕ ЕЕ 81043103 £z £2 | fe |
$4 ae E: ж Lio Ез СІЗ £m |
А я <5 aq os | <
January i . "E 2% 97 | 69 38 80 Б -- — —
February T im E НЕ 9-1 61 85 81 -- — -- --
March .. E ba ate ee 102 65 ^. зт | 86 1:79 - -- —
April .. 4% 54 vx vy 97 66. HM 83 , 3:22 em — —
May ba is he is me 94 , 59 . 35 | 80 7:70 65 S.W. — d
June .. 2% s T oe 93 | 07 ! 96 81 > 7:81 TT S.W. — |
July ж 4% Ea m 2; 91 68 23 79 8:34 77 S.W. —
August .. 2% vi US vt 88 70 18 79 2:97 76 S.W. —
September m 5% E A 90 68 | 22 79 7:14 78 S.W. -
October .. ar és T m 92 68 . 24 , 80 275 76 S.W. Ja |
November 25 ся - “a 96 63 338 , Bl - 73 S.W. ге
December vs zs һу; 22 96 57 39 79 e 78 S.W. -
i у І
Total z 2% әз — j — - | — ' 41°72 — | |
Return OF DISEASES AND DEATHS IN NORTHERN NIGERIA IN 1904.
EUROPEANS NATIVES
ә | Yearly Total | 3 Е ә Yearly Total : T -
Diseases E = Ё Б 8 ies : i 8
€ o ж т : 5 S-
EE: £ 2 | 20 ЕБ PEL Е | p Еж ; Remarks
gc} 5 E) = sal zc 8 А X se i
aia $9 PP i 1,3 14%
гіз £i à|à 5 бел 15 pE,
Small- pox 1 2 |— 3 1 3 | 26 T 29
Chicken-pox Uus EM dete xe RES zz 7 X 7 m
Measles. . ; кек кане oe ke ЕЕ 8 = 8 RU
Enteric Fever .. eae tio T 1 — ашы» жы = -
Dysentery .. 1' 18 |—| 19 1 5 , 00 94 | 61 z
Beri-beri . CORAM Vous pr EE exer 2. 9 9 11 iy vers
Malarial Fever з 8 515 3; 523 3 6 925 8 931 | 12
Hemoglobinuric Fever -|—' 81 5| 91 3 – 1 - 1 =
Unclassified Fevers .. Ame 10 - 10 1 — 23 - 23 0]
Tubercle 2% : Ш Аа, WE — - — 4 — 4 ES
Leprosy.. Baa o ae a TN 21 - 21 1
Yaws |... жені oes d Eu 5 18 2 23
Syphilis. . Саша ee tam 9 ; 210 -- 219 i 10
Gonorrhea’... -- 2|- 2 |—; 40 | "96 836 27
Parasitic Disease -- 2|— а! — 4 967 971 15
Effects of Poisons m md Mn — RS 3 3 3 --
Rheumatism = Wit 17 — 5 687 5 1 692 12
Anemia si 1 298 | -' 29 , --} — 18 10 ' ав
Debility.. ot = з: — 3 | 1:3: 25 5 26 1 |
Undefined А 53 - 4 ,--- 4 1- 2 | 306 >: 28 308 5
No appreciable Disease і--| = 0-1 - je - 4 — 4 —
Diseases of the Nervous System —|14;— += р 291 5 291 3 !
» » Eye .. z -— 8|--: 811 9 612 - 692 17 |
» oo» Еш... —-|7!/—; 7, — | 62 — 62 1
» » Circulatory System -—L B5 peo dee 41 7 41 2
35 », Respiratory System == 15 — | 15 xe 5 | 716 33 721 26
n » Digestive System .. 11101 42 | 102 — 7 | 2,184 45 2,141 18
Е » Lymphatic System -|10--| 10 - 5 ! 192 6 197 4
ys » Genito-urinary System — | 18 |— | 18 1 4 ' 286 15 290 18
ag » Organs of Locomotion — 9 [5 R$ — 2 88 — 90 --
35 » Connective Tissue.. —| 12 ,—. 12 — 5 849 1 847 85
5 » Skin.. —! 21 22021 сы 944 1 958 26
Injuries.. 2 i Ке vs sel] 98. — 98 3 104 2,300 I8 | 2,374 53
Minor Surgical Operations .. is mE EE sae ES Dos 94 : 94 1
Accident (Drowning).. 29% 20 xem — {| — - - -- -—
Uncertified .. ES 2% os "| = L ~ =, >= -- — - |
uu occu LL dc
Totals 4% aes ec 12 | 875 13 | S87 014 148 Баш 293 Қы 204

* Hepatic Abscess.

THE JOURNAL ОЕ TROPICAL MEDICINE.

‘February 15, 1906.

Colonial Medical Reports.—No. 20.—The Gold Coast.

MEDICAL AND SANITARY REPORT
FOR THE YEAR ENDING DECEMBER, 1904.

By Dr. KENNETH F. Т. BUEE.

Acting Principal Medical Officer. `

(L) GENERAL REMARKS.

The general health of the Colony has been good.

There has been some increase in the number of cases
of small-pox, but the number of deaths has been much
lower, 1 in 62, as against 11 in 37 last year.

Measles cases were more numerous, 16 against 6,
but there were no deaths.

Dysentery was more prevalent, and shows a total of
82 with 23 deaths, against 56 with 10.

Malaria was slightly less than last year, while the
European population is nearly one-tenth greater.

The rainfall throughout was, on the whole, less, an
increase over last year being only noted at Axim and
Kwitta, and last year’s average was low; the result
was that in many places lack of water was seriously
felt, and vegetables were scarce.

(2) HEALTH OF THE

the population has been vaccinated ; for the most part
the people do not raise conscientious objections and it
is mainly due to the moving part of the population
that small-pox is kept alive, since they are not easily
vaccinated.

(4) METEOROLOGICAL REPORT.

A new station will be started at Sekondi in January.
Тһе reports from Accra, Aburi, Cape Coast, Axim,
Kwitta, Kumasi, and Gambaga are appended.

The most noticeable featureis the low rainfall, less
even than last year.

(5) GAOLS or THE COLONY.

Reports were received from Accra, Adda, Akuse,
Axim, Cape Coast, Elmina, Kumasi, Kwitta, Saltpond,
Sekondi, l'arkwa, and Winneba.

EUROPEAN COMMUNITY.

How Employed Number Deaths Invalided келінді toe 1,060 те
|
Oficials.. 202.02.020 . st 8 oF — авто | 769
Mercantile Firms, (ее 02020220220 305 0 38 — w es | T
Mining Companies .. .. .. .. .. 92800 900 9| 1009 | OT
Missions eee 17 1 ————n — сз 4| M66 —
PEDE "Ur (e 098 ———— 9) 0 1429 | 89389

The return gives at a glauce the points of the
European health.

Ав compared with last year there were more
Europeans; the deaths were fewer and the invaliding-
rate slightly higher. It seems as though the steps
taken everywhere to keep down mosquitoes are bear-
ing some fruit, but in this direction we have been dis-
tinetly helped by the dry season.

(3) Native PopruLaTmION.

The health of the native population is fair, the dry
weather has in many cases been a cause of suffering
and ill-health.

The principal diseases treated were malarial fever,
diseases of skin, ulcers, yaws, diseases of intestines
and respiratory organs.

Smuall-pox was not prevalent ; there is almost always
some present, and probably will be till the whole of

The general health was good. The number of cases
treated in hospital was 332, and of these 18 died.
The deaths were as follows :—-

Sekondi E
Elmina 2
Cape Coast :
Saltpond 2
Accra 4
Adda ... 1
Akuse ... 1
Kumasi 2

Total 18

The general sanitary condition of the different
prisons was as good as could be expected, taking into
consideration the class of building in use. Most of
prisons are old forts, and in many cases are badly

COLONIAL MEDICAL REPORTS—THE GOLD COAST. 17

adapted for the requirements of a gaol. There are
very few solitary cells, and the prisoners are confined
in associated wards; a custom to be condemned on
physical, sanitary, and moral grounds. A central
prison for long-sentence prisoners is on the Estimates
for this year. The water and food are generally good
and sufficient.

The medical officers in charge of the various gaols
report as follows ;—

Accra.— General health very good throughout the
year. Diet good ; water good, but occasionally rather
scarce. Ventilation of cells good. The prisoners are
employed at trades in the prison, and outside at road
making and repairing, street repairing, sanitary work,

с.

Adda.—Health good ; diet and drinking water good ;
ventilation poor. Prisoners employed repairing pub-
lic roads and general scavenging. .

Akuse.— Оп the whole the health of the prisoners
during the year was good. Diet and water good;
ventilation of cells and wards good.

Avim.—The general health of the prisoners during
the year was good. Food good; water good ; ventila-
tion of cells and wards fair. Prisoners employed at
road repairing, whitewashing, carrying water, «е.

Cape Coast.—Health good ; both diet and drinking-
water good. Some difficulty in obtaining a sufticient
supply of good water during the dry season; ventila-
tion of cells and wards primitive and inadequate ; the
accommodation is insufficient. Prisoners employed
at emptying latrines, cutting firewood, clearing
Government land, and carrying water.

Elmina.— Health good ; diet and water good ; venti-
lation of cells and wards quite inadequate —very bad.
Prisoners employed at cooking, grinding corn, mat
and basket making, and public works.

Kumasi.—Health good; food and water both suffi-
cient and good; ventilation fair. Prisoners employed
at road-making and cleaning, garden, and general
scavenging.

Kwitta.—On the whole the health has been good;
diet good; water fairly good; cells and wards are not
well ventilated. Prisoners employed for emptying
latrines, labour on town roads.

Saltpond.—General health has been good; diet and
drinking water good; ventilation satisfactory; em-
ployed at usual work.

Sekondi.—General health good; diet and drinking
ing water good; ventilation of cells and wards not
very good. Prisoners employed at road making and
sanitary work,

Tarkwa.—General health fairly good; diet and
drinking water good; ventilation of cells and wards
not very good. Prisoners employed at usual general
work.

Winneba.—General health fairly good; diet and
drinking water good; ventilation of cells and wards
good. Prisoners employed at usual general work.

(6) Тнк Lunatic ASYLUM.

There were 71 patients remaining under treatment
in the asylum at the end of 1903, and during the year
1904, 34 new cases were admitted, making а total of
105 cases, 83 males and 22 females. During the year
30 were discharged from the asylum, 14 died, and

1 absconded, leaving 60 patients under treatment at
the end of 1904. Of the patients who died 12 were
males and 2 females; an inquest was held in every
case. The health of the lunatics has been fairly satis-
factory, and of the 14 deaths during 1904, 12 were
in-patients who had been recently brought in from
Axim and Sekondi districts.

The food of the inmates of the asylum has been
generally of good quality. The water supply is good
and the quality excellent; it is stored in the large tank
situated in front of the asylum, and its distribution
has been carefully supervised.

The occupation of inmates consists chiefly in
gardening, emptying latrines and general household
duties. А few patients take willingly to work in the
gerens most, however, refuse absolutely to do any
work.

(7) Sanrrary Report.

During the past year great improvements in the sani-
tation of many of the principal towns in the Colony
have been carried out, more especially in the Cape
Coast and Sekondi. The resistance to sanitation on
the part of the native population of Cape Coast still
continues, but not to such an extent as during the
previous year, although it is still comparatively active.
In other towns it is of а more passive nature; the
native is satisfied with the conditions in which he has
lived for centuries, and does not wish for anything
better.

I append a short summary of the sanitary condition
of the principal towns :—

Accra.—The control of the sanitation of Accra is
vested in the Town Council. This body, in July,
1903, obtained the services of a European Inspector
of Nuisances, trusting that the employment of such
an official would tend to promote greater cleanliness
and a general improvement in the sanitation of the
municipal area. As regards the general cleanliness
of the main streets and dust-bins of the town, there
has been some improvement, but much yet remains to
be done to improve the back streets and outskirts of
the town. The water supply, the disposal of sewage,
and the removal of ruinous buildings, are all most
important, and are all receiving attention. The present
dust-bins are inadequate in size, and are being replaced,
as funds permit, by larger and better ones. A properly
erected incinerator would be of great benefit to the
town. Ап Order in Council has been issued that all
tanks, wells, &c., should be rendered mosquito-proof.
The new market has been opened at Christiansborg.

Cape Coast.—Great difficulty is experienced in deal-
ing with the drains in many parts of the town. This
is largely due to the peculiar construction of these
drains and to their being inaccessible. The difficulty
is chiefly felt in dry weather.

Owing to the latrines having to be emptied by prison
labour, this work has not at all times been satisfac-
torily performed. The Medical Officer of Health has
no authority over these men. i

This will probably be improved now that a Euro-
pean gaoler has arrived.

The water supply for domestic purposes is unreliable
both as regards quantity and quality.

The work of cleaning the town, filling up holes,

18 THE JOURNAL OF TROPICAL MEDICINE.

treatment of refuse, and general prevention of Ano-
pheles breeding, continues.

Sekondi.—The neighbourhood of Sekondi is more
or less hilly, and certainly picturesque. European
Sekondi is well segregated from Native Sekondi, and is
proportionately healthy and clean in consequence.
Many of the official bungalows are built on the sur-
rounding eminences facing the sea, and a delightful
breeze does much to mitigate the unpleasantness of the
high temperature.

The town naturally lends itself to sanitation, and its
newness, segregation, and cleanliness are factors that
will tell considerably as regards its suitabliity for
European habitation. There is no reason why Sekondi
should not be one of the healthiest towns on the West
Coast.

The small rainfall and the consequent scarcity of
drinking water, and the presence of the lagoon between
Accra and Lagos Towns are perhaps the two greatest
drawbacks to contend with, but these are not insur-
mountable difficulties nor should they be very costly
ones.

Azim.—The town of Axim is in a fairly good sanitary
state. The number of scavengers is limited, consider-
ing the area of the town, but they are assisted by
prison labour. Тһе outlying villages are not in a
satisfactory state, as most of the inhabitants are
engaged in the catching and curing of fish.

Elmina.—-The town of Elmina has been kept clean,
and as free ав could possibly be done from mosquitoes,
by supervision being strict in not allowing stagnant
water to remain in empty tins, &c. This, no doubt,
accounts for the comparative freedom from malarial
fever.

The other towns in the district when visited have
on the whole been found fairly clean.

Tarkwa.—The sanitary condition of Tarkwa is good.
Water is plentiful and fairly good.

Kwitta.—The station is at present in fairly good

order. The streets are fairly clean, the town is dry
and healthy. The Government bungalows are in
good order.

In nearly all the other towns of the Colony some
sanitary improvements have been carried out; but
there is nothing of any special interest to record.

(8) DEPARTMENTAL.

Medical Officers.—The Medical staff has been up to
its full strength.

One medical officer died during the year.

European Nursing Staff.—The staff has been up to
its full strength.

Dispensers.—The staff of dispensers is at present
below its strength, owing to resignations and dis-
missals.

Native Nursing Staff.—This is also at present short-
handed.

APPENDIX I.

REPORTS ON HOSPITALS.

Report on the Colonial Hospital, Accra, for the
Year ended December 31, 1904.

I have the honour to report that I took over charge
of the above hospital from Dr. Rutherford on

[February 15, 1906.

December 10th, 1904, Dr. Kennen being in charge of
the Dispensary.

There have been no important structural alterations
during the year. The large tank in front of the
asylum has been repaired and cleaned.

IN-PATIENTS.

The number treated during the year 1904 was 383, as
against 469 in 1903.

The 383 for 1904 were compared as follows :—

Europeans 23, as against 51 for 1903.

Native officials 28, as against 45 for 1903.

Civil Police 127, as against 118 for 1903.

Native non-officials 201, as against 255 for 1903.

Hausa W.A.F.F., 4.

Small-pox in 1904, 9.

OvuT-PATIENTS.

New cases, 1904 :— :

Males 969, as against 1,759 for 1903.

Females 629, as against 1,170 for 1903.

Civil Police 987, as against 1,164 for 1903.

Old cases trented during 1904, 3,079.

Twenty operations were performed during the year,
with two deaths.

The mortality amongst Europeans remains low,
there being but one death in hospital (non-official) ;
the same as in 1903, and against three in 1902, and
seven in 1901.

The native mortality in hospital was 33, as against
31 in 1908.

EXPENDITURE.

The total expenditure for diets in 1904 was £172
9s. 10d., as against £265 8s. 2d. for 1903. The largest
expenditure was in the month of February, £20 10s.
10d.; the lowest іп May, £9 2s. 6d. The amount
recovered from patients was £87 14s. 3d., as against
£145 5s. 7d. for 1903. i

An examination was held in July for druggists’
licences; there were three candidates, of whom one
passed.

DISPENSARY.

The dispensary has been under the charge of

Mr. Cato, assisted by Mr. Laryea.

NuRSING.

During the year the nursing has been under the
charge of Nursing Sisters Oram, Marshall and Fraser,
and а native staff.

THe Hosrrrar.

This is well kept, considering the deficient water
supply, vide Meteorological Report infra.

Native nurses and dressers are difficult to obtain ;
considering night work and the care and attention
their employment necessitates, their salaries are
inadequate for suitable persons.

METEOROLOGICAL.
Readings have been taken twice daily.
Rainfall 17-28 ins., as against 20.04 in 1903.
The largest rainfall was in May, 3:90 ins., and June,
8:97 ins.
ise highest solar radiation reading was in May,
5:88.

Shade minimum, 69:87, іп July.
(Signed) R. D'Arcy Irving,
Senior Medical Officer.

March 1, 1906.)

COLONIAL MEDICAL REPORTS—THE GOLD COAST. 19

ea

Colonial Medical Reports.—No. 20.—The Gold Coast—
(continued).

Report on the Colonial Hospital, Axrim, for the Year
ended December 31, 1904.

The hospital consists of a European ward of three
beds, and a native ward of eight beds. A store-room,
pharmacy, and two bedrooms, one of which is occupied
by the dispenser and the other by the dresser.

Both wards are large enough for ordinary require-
ments, but both have been fully occupied on two
occasions.

The hospital has been painted during the year, and
is now in a much more satisfactory state.

The number of new patients treated in the out-
patient department was 802, as compared with 740
іп 1903. The attendances of old cases were 2,555, as
compared with 4,023 in 1903.

The number of patients admitted into hospital was
162, as compared with 50 in 1903. Very many of
these cases, however, did not contract their illness in
Axim, but were sent in from outlying bush villages,
mining companies, and timber concessions on the
Ancobra River. There were several cases admitted,
practically moribund, the total number of deaths for
the year being thirteen.

(Signed) A. MACQUEEN,
Medical Officer.

Report on the Colonial Hospital, Cape Coast, for the
Year ended December 31, 1904.

The number of admissions for the year was con-
siderably lower than that of the preceding year, being
306, against 586 in 1903. This is largely accounted
for by the marked improvement in health of both
European and Native communities. It is also prob-
able that the floating population in Cape Coast has
decreased very considerably since 1903. There was
also a marked decrease in small-pox, 100 more cases
being recorded in 1903 than in 1904.

Thirty deaths were recorded for the year—a number
that cannot be regarded as large when we consider
that in many cases natives only bring a case to
hospital when they have given up any hope of treating
it successfully themselves.

(1) Remittent malarial fever.

(2) Pulmonary diseases, such as bronchitis, pneu-
monia, pleurisy.

(3) Intestinal diseases, such as dysentery, diarrhea,
colic.

(4) Small-pox, and a number of injuries of various
nature.

Amongst those cases admitted there were three
Sern aA as cerebral hemorrhage, having aphasia
without loss of consciousness in the early stage.

One case of sleeping sickness occurred in a Hausa
soldier. In deference to Mahomedan custom a post-
mortem examination was withheld.

A convict prisoner admitted with brain symptoms of
an indefinite character, accompanied by fever, died
after some days’ illness.

As I suspected cerebro-spinal meningitis, I held
& post-mortem examination with Dr. Claridge. Well-
marked meningitis was discovered, and pus was found
between the brain and the arachnoid membrane.

Amongst the injuries, one case of severe extensive
burn ended in death from shock.

One case of gunshot wound died.

A case of compound fracture of the femur led to
amputation of the thigh, the case being now nearly fit
for discharge from hospital.

In the case of the Éuropean who died in hospital,
it would appear that his sickness commenced as an
infectious influenza cold, as the two Europeans in the
factory contracted the disease at the same time. Тһе
deceased had been under treatment of a private prac-
titioner, who left the country soon after, and I was
called to see the case.

I found the patient was in a state of delirium, due
to the abuse of alcohol, and he had been wandering
about the house in the night, although in a most
serious condition, his temperature being at 106°.

He was admitted to the hospital without delay. I
found well-marked symptoms of pneumonia present.
The delirium continued until collapse and unconscious-
ness set in, the patient dying within twenty-four hours.
I am convinced that early systematic treatment in
hospital would have saved the life in this case.

The other death was that of Dr. W. A. Murray,
Deputy Principal Medical Officer, the cause being
blackwater fever. Two points are worthy of notice in
connection with this case. First, that it was the second
attack of this little understood and treacherous
climatic disease.

The first attack occurred about the middle of 1894,
more than ten years ago. :

The second point worthy of notice is that Dr.
Murray had just returned from a trying journey
through Ashanti, and I understand he was not very
fit in health on arrival in Cape Coast.

The case was not entered as an admission to hospital,
as Dr. Murray died in his quarters adjoining the
hospital. The remaining European cases admitted to
hospital presented an unusually mild type of malarial
fever, chiefly remittent, and formed a marked contrast
to the severe cases common here some years ago.

EQUIPMENT.
The equipment was fairly satisfactory.

STAFF.

The staff was adequate and efficient for the greater
part of the year. The European nurse was taken away
from this station in October. There was little work
for a nurse during the year.

DISPENSARY.

A total of 2,508 cases were attended at the dispensary,
mostly of a trivial nature. The prevalent diseases
were :—

(1) Pulmonary diseases, such as bronchial catarrh.

(2) Intestinal complaints, such as dysentery, diar-
rho and constipation. i

(3) Rheumatism.

(4) Affections of the eye.

(5) Affections of the ear.

(6) Injuries.

(Signed) P. J. GARLAND,
D.P.

20 THE JOURNAL OF TROPICAL MEDICINE.

Report on the Colonial Hospital, Sekondi, for the Year
ended December 31, 1904.

During the year the medical duties have been
carried out by Dr. Buée and myself, I acting until
March 11th, and Dr. Buée from the latter date until
September 14th, when I again relieved him, and have
continued to act until the present time.

During the year the sanitary duties have been car-
ried on by Drs. Beringer, Le Fanu, and Collier
in succession.

European HOSPITAL.

The European hospital consists of two wards. The
smaller is used for higher grade officials, and contains
four beds. The larger is used for second grade officials,
and contains eight beds.

Both wards are well ventilated and comfortable in
every respect. The whole hospital is kept clean and
in good order, and is in a good state of repair.

Native HOosPITAL.

The Native Hospital is situated at some distance
from the European, and is well ventilated, clean, and
in good repair.

The hospital is made up of three wards, which are
as follows :—

One large ward m ... 10 beds

Small ward A a Weg Ben 2 ,,

Small ward B " ves sie 9-і
Total hs 14 »

Wards “А” and “В” are set apart for native
officials, the large ward being allotted to non-official
patients.

There are store-rooms, dispensary, operation room,
bath-rooms &nd other usual offices attached to the
hospital.

The supply of instruments and drugs is fairly good.

There have been a fair number of minor operations,
and several major operations, including amputation,
&c., which I аш glad to say have been generally
successful in result.

The number of patients treated in hospital was as
follows :—

Europeans 191
Natives (males)... 121

i (females) 2

Civil Police 12

In-patients ...
Total . 896

Europeans bes 0
Natives (males)... 1,261

Out-patients „ (females) 81 New cases.
Civil Police — ... 132
Total 2. 1,474
Europeans ate 0
; Natives (males)... 2,029
Out-patients „ (females 110 Old cases.
Civil Police 201

Total ... 2,340

[March 1, 1906.

There were thirteen European officials invalided,
and two deaths; one from blackwater fever and one
from cerebral hemorrhage.

Amongst the non-officials (European) there were
five deaths, only one of these being а permanent
resident in Sekondi, the others came in sick from out-
lying districts, There were no deaths among the
native officials.

Amongst the non-oflicials (natives) the deaths were
as follows :—

Males ... E m T .. 16

Females ... А En au E" 1

Civil Police nil
Total is "T sse cm

The number of deaths, including all classes, both
Europeans and natives, being summarised as fol-
lows :—

( Officials wi
(Non-officials ... 2
( Non-officials (males)...
| Females : ae

Europeans

Natives

SIER
Ф | ось

Total

The majority of cases of illness occurring among
the Europeans have been malarial fever of the various

types.

REVENUE.

Amount recovered from officials, in-
patients (European and native) ... £228 16 6
In-patients (Civil Police) fe zx 23 6
5 (Civil non-officials) 110 13 0

Amount paid by dispensary paying
patients oes s jue ТЕ 310 0
£345 3 0

EXPENDITURE.

Expenditure for diets, provisions, fuel, &c.,

£362 7s. 11d.

The medical staff at present is as follows :—
Medical Officer—W. S. Webb.
Medical Officer of Health—J. H. Collier.
Nursing Sister—-A. Wallace.

- 5 M. Marshall.
Dispenser—F. W. C. Wulff.
Dressers—Four.

The native staff is fairly good. I have always
found Mr. Wulff a trustworthy and accurate

dispenser.
(Signed) W. 6. Wess,
Medical Officer.

Report on the Colonial Hospital, Adda, for the Year
ended December 31, 1904.

I have the honour to forward a Report on the
Colonial Hospital at this station, for the year 1904.

I took over the duties of Medical Officer from Dr.
Lunn, my predecessor, on February 6th, 1904, since
which date I have acted in that capacity.

The buildings consist of a hospital with three wards,
a male, a female, and one for Europeans. The

COLONIAL MEDICAL REPORTS—THE GOLD COAST. 21

number of beds available for natives are ten, and one
for Europeans. There are also two latrine rooms, a
dispenser's room, store- and bath-room recesses. The
building is completed by one consulting room and
dispenser's two living rooms. There are two out-
. buildings, one being a building composed of a kitchen
and three rooms. The hospital is bright, airy, and
comfortable, while this, as well as the outbuildings
and surroundings, have been kept regularly clean.

І ATTENDANCES.

New cases (including 157 paying patients) 1,151,
and old cases 1,615. There is a great decrease in the
numbers of both new and old cases, and this is the
result of the fact that the majority of patients who
could afford to pay refused treatment when they are
asked to do so.

Fees collected, paying patients during the year,
£1 13s. 10d.; average fees charged, Od. first time, and
ld. each attendance afterwards. :

IN-PATIENTS.

There have been forty-two admissions during the
year; eight deaths occurred. Two were brought into
the hospital in a moribund state, and one died in one
hour after admission of fracture of the pelvis, and one,
& consumptive, twenty-four hours after admission.
The other six died from (1) rupture of the bladder,
(2) gunshot wounds, (1) pneumonia, (1) malignant
new growth of leg, (1) injury to spine.

There were no major operations, but there were
several cases of minor types.

There has been uo small-pox, no vaccination per-
formed. One case of diphtheria occurred during the
last quarter, out-patient (a child 2 years old) died two
days after admission.

(Signed) G. CHARLES WALKER,
Medical Officer.

Report on the Colonial Hospital, Kwitta, for the Year
ended December 31, 1904.
BuirpDiNos.

The hospital building is a good one. The infectious
diseases building is set apart from the hospital, about
100 yards distant. Has not been used this year.

Drugs, &c.
Drugs and dressings have been sufficient.

IN-PATIENTS.

Sixty-one were treated in the hospital, with five
deaths. Paria medinensis caused most admissions.

Out-PATIENTS.

925 received medicine at the dispensary, mostly
paupers. A number came from the outlying villages.
Intestinal complaints, skin diseases and injuries were
most common. Cases of true tropical diseases are not
prominent.

SMALL-POX.

There has been no amall-pox, and no vaccination.
(Signed) Е. S. HARPER,
Medical Officer.

Report on the Colonial Hospital, Elmina, for the Year
ended December 31, 1904.

I have the honour to submit to you the annual
report for the medical work carried on at Elmina for
the year ending December 31st, 1904.

BuiLDINGS.

No alterations have taken place in the buildings
during the past year.

. The building, &c., is sufficient for the demands
made upon it.

WATER SUPPLY.

The supply of water in the tank in the hospital yard
is of sufficient quantity to las& out the dry season.
The quality is good.

Diet, «с.

The diet of the patients has been good both in
quality and quantity, the latter being quite liberal.

Daucs.

The drugs have always been of suflicient quantity
to meet all demands.

PATIENTS.

Very few patients have been treated in hospital, and
none of those of a dangerous condition, with the ex-
ception of а double pneumonia and strangulated
hernia.

OPERATIONS.

Since taking over there have been no serious
operations, with the exception of one strangulated
hernia mentioned in the preceding paragraph.

LATRINES.
" The latrines provided are in every way sufficient.

INCOME AND EXPENDITURE.

The income was £7 17s. 9d., and the expenditure

was £45 9s. 34.
' (Signed) W. B. TuaiN,

Medical Officer.

Report on the Colonial Hospital, Saltpond, for the Year
ended December 31, 1904.

During the past year the general health of the
Europeans, officials and non-officials has been good.
The principal diseases have been malarial fevers and
dysentery.

No deaths have occurred, but two non-officials have
been invalided, one from remittent fever, by my pre-
decessor in the early part of the year, and the other
from blackwater fever, this last December.

During the year there have been 981 new cases
апа 2,555 subsequent attendances.

Fees to the amount of £8 9s. 6d. have been
collected.

Thorough weekly inspections of the town have been
made by me since my arrival in July, and the town
has been maintained іп а good sanitary state.

The scavenging and latrine arrangements have been
well carried out under the efficient supervision of the
Inspector of Nuisances.

[March 1, 1906.

22 THE JOURNAL OF TROPICAL MEDICINE

Several water-holes and pools where mosquitoes
have been found breeding have been filled up. Many
ruined houses have been pulled down, and vacant
ground has been fenced in and so kept cleaner.

There has been no small-pox during the year.

The work of the dispensary staff has been entirely
satisfactory. I have found Mr. Sutton, the dispenser,
invariably most eflicient, very willing, and courteous
to the patients. Mr. Quansah, the dresser, has also
proved most useful, painstaking and trustworthy.

(Signed) Антнок E. Honw,
Medical Officer.

ArrENDiX II.
Medical Report on Ashanti for the Year 1904.

The health of Kumasi has shown a great improve-
ment during the year 1904, both in the number of
officials placed on the sick list and the severity of the
attacks of fever.

111 officials were placed on the sick list during the
year, and out of that number four were invalided—
three to England and one to the Canaries; this latter
officer returned and completed his tour. One case of
blackwater occurred, and no death took place.

These figures compare very favourably with 1903.

I append comparative list.

INVALIDING.

Four officials were invalided, one to Canary, three
to England; both the latter were permanently in-
valided.

MEDICAL OFFICERS.

Two medical officers have been stationed in Kumasi,
and all out-stations have each had the services of one
during the year.

SUBORDINATE STAFF.

I am glad to be able to report that Kumasi has had

a second dispenser stationed.
MEDICAL STORES.
Good and sufficient for present requirement.

INSTRUMENTS.
Kumasi is fairly well supplied with instruments.

Новвев,

I am glad to say, have shown ап improvement,
although the death-rate amongst them is still high.

WATER.

European supply good.
Native supply is abundant and good.

QUARTERS FOR EUROPEANS.

Good.
LATRINES.

Pan System.—I understand that 500 pans are on
order; this will be of great service to Kumasi in
enabling it to be kept in a good sanitary condition.

During the year six latrine houses have been erected
in different parts of the town, and are much appre-
ciated by the community.

METEOROLOGICAL CONDITION.

The most remarkable features in the meteorological
condition during the year were the heavy rains falling
in the months of June and December, as compared
with 1903, and the postponing of the Harmattan wind
until late in December. )

Owing to the short time siuce merchants have
started living here it is difficult to judge as to their
health, but so far it has been good.

Hearta оғ Native OFFICIALS

has been good throughout the year. A decided
falling off has been shown in the admissions to and
attendance at hospital of members of the West African
Frontier Force.

OuT-8TATIONS.

General Health.—The health of the out-stations in
Ashanti has been good throughout the year, with the
exception of Odumassi in the north-west of Ashanti ;
the health at this station has been decidedly bad, two
fatal cases of blackwater occurring; and one official
was unable to complete his tour of service owing to
chronic malaria. Тһе health of the other officials has
not been satisfactory.

KUMASI.
| NUMBER
Average Official | No. placed on DO: of қы ; і E
Population , Bick List, Fever Invalided ! Died
і i
ooo, =a Le PON a
| 1904. |
95 11% | 1 4” 2
! 1903. ;
25 2207150 | 1 | E 1
! |
OUT-STATIONS.
1904, !
Odumassi,3 .. 30 2 | 1 2
Mampon,3 .. 6 1 Ў 1 =
Kwissa, 3 26 9 1(mild) — =
Obuassi, 3 s 15 — zu

* Invalided to Canary, returned to Colony and completed
tour.

t Out of this number 13 suffered from ptomaine poisoning
due to bad tinned food.

1 Invalided to the Islands; died at Canary.

(Signed) Н. TwEEDY,
Sentor Medical Officer.

APPENDIX III.
Medical Report, Northern Territories, for the Year 1904.
NORTHERN TERRITORIES.

The Northern Territories are divided for adminis-
trative purposes into four districts, the White Volta
District, the Black Volta District, the Gonja District,
and the Kintampo District, and at the headquarters of
each district a medical department is maintained.
During the early part of this year the headquarters of
the Gonja District was removed from the town of
Salaga to that of Yegi.

March 15, 1906.)

Colonial Medical Reports.—No. 20.—The Gold Coast —
(continued).

Yegi lies close to the River Volta, about one day's
journey from Salaga.

In the six months for which statistics аге available
the health of all ranks at Yegi has been very inferior
to that at Salaga, but too short & period has elapsed
since the change to warrant any generalisation from
the facts collected.

The following table shows the total number of all
ranks who served in the Northern Territories in
1904 :—

European Omciats Native Officials (бом Coast Regni Station Carriers

46 29

573

375

HkALTH--EUROPEANS.
All important variations in the health of the
European officials are shown in Table A.
They suffered from the following diseases :—

Diarrhaa... irs Аты 2 cases.
Gastritis ... 254 ids 24% 3
Heemoglobinuric fever ... EN 29: 3
Intermittent malarial fever uses clus
Remittent malarial fever . 40 ,,
Renal colic 1

_ Vomiting (at Wa) (symptom only) 1 ,
Thus of a total of 64 cases of illness 59 were of
malarial origin.

INvaLIDING.

Two European officials were invalided during the
year after recovery from hemoglobinuric fever.

DEATHS.

No deaths of Europeans were recorded. А military
officer who left Gambaga, having completed over a
year's service, died of hemoglobinuric fever shortly
after landing in England.

THE Аск AVERAGE ОҒ OFFICERS.

Officers under 30 years appear to suffer more
severely from disease than those above that age.
Unfortunately the age average is decreasing. Аб the
beginning of the year, at Gambaga, 16 was between 30
and 40 years, but in the latter part of the year it fell
to between 20 and 30 years.

À similar decrease is, I believe, common to other
stations.

Tae Native OFFICIAL.

Health.—All important variations in health are

shown in Table B.

They suffered from the following diseases :—
Continued fever ...
Abscess
Bronchitis
Abscess of liver
Constipation’
Diarrhea ...
Tonsillitis ...

Injury

5 cases.

Mm ee Sy

_ prison labour.

COLONIAL MEDICAL REPORTS—THE GOLD COAST. 23

Of 29 native officials serving, 11 were admitted to
the sick list during the year.

Invalided: There was no invaliding.

Death: There was no death.

The native official is really a stranger in the Northern
Territories, where his mode of life is not that of the
Coast town he comes from.

His food also differs greatly from that he is accus-
tomed to at home, on account of the complete absence
of plantain, or Koko Yam, from the Northern Ter-
ritories dietary.

It will be observed, notwithstanding, that he enjoys
excellent health, and that his ailments are usually of
trifling importance.

Gorp Coast REGIMENT.

All important variations in the health of the Gold
Coast Regiment, 2nd Battalion, are shown in Table C.
The men suffered chiefly from the diseases arranged
below, in the order of frequency :—
Guinea-worm, continued fever, injuries, constipation,
bronchitis, gonorrhcea, syphilis, rheumatism.
Invaliding: Eight men were invalided as unfit for
military service, suffering from syphilis, gonorrhea,
cardiac disease, necrosis of bone.
Deaths: Seven deaths occurred during the year
from the causes stated below :—
Pneumonia yes ж 4
Epistaxis T - m 1
Pysmia sis im 1
Intestinal obstruction 1

STATION CARRIERS.

All important variations in the health of the station
carriers are shown in Table D.

They suffered chiefly from the following diseases
arranged below in the order of frequency :—

Constipation, guinea-worm, injuries, bronchitis,
rheumatism, diarrhoea, remittent fever, gonorrhea,
syphilis.

Invalided: Twenty men were invalided as unfit for
work from syphilis, phagedsena, hernia.

Deaths: Two deaths took place, one from cirrhosis
of the liver and one from pneumonia.

TowNSFOLKE.

А total of 1,247 persons were treated at the five
dispensaries during 1904.

These persons represented all grades of native society
from the towns and villages near the dispeusaries.
They suffered chiefly from the following diseases,
arranged in order of frequency :— .

‘Ulcers, injuries, bronchitis, constipation, ringworm,
conjunctivitis, syphilis, guinea-worm, yaws, rheuma-
tism, gonorrhea.

SANITATION.

The control of the sanitary arrangements is in the
hands of the Medical Officer.
There is one Inspector of Nuisances at Gambaya. .

LATRINES.

Pan latrines are supplied for the use of European
officials, and the pans are emptied twice a day by
Pit latrines are supplied for the use of

94

THE JOURNAL OF TROPICAL MEDICINE.

[March 15, 1906.

the native population. The latrines are dug and kept
in good order by prison labour.

Rubbish heaps are formed at suitable places chosen
by the Medical Officer, and the heaps are burned
weekly.

SLAUGHTER Houses.

All animals to be slaughtered for use as food are
daily examined by the medical officer, who has the
power to veto the slaughter of those he may consider
unfit.

INFECTIOUS DISEASE.

No epidemic of grave infectious nature has occurred
during the year.

A mild epidemic of chicken-pox occurred at Wa.

An epidemic of mumps has prevailed at Gambaga
for the past three months.

No cases of small-pox were recorded.

THE MEDICAL DEPARTMENT.

The medical establishment in the Northern Terri-
tories consisted of :—
1 Senior Medical O fficer.
4 Medical Officers.
1 Dispenser.
4 Dressers.

HosPrrALs.

аатбада.--Тһеге is an excellent hospital of ten
beds, with operation room, consulting room, dispensary,
store, mortuary, kitchen and quarters for the dispenser
апа dresser. :

There is an isolation hospital for infectious diseases.
299 cases were treated in 1904.

Kintampo.—There is a hospital of three beds, with
dispensary, store and quarters for the dresser.

Forty-five cases were treated in 1904.

Salaga.—There is a hospital of eight beds, with dis-
pensary and store.

353 case were treated in 1904.

Yegi.—The erection of a hospital will be begun next
year. A dispensary and store have been already
built.

Three cases treated (in the store) in 1904.

Wa.—There is a hospital, with dispensary, store,
kitchen and dresser’s quarters.

Ninety-one cases treated in 1904.

METEOROLOGY.

The meteorological station for the Northern Ter-
ritories is situated at Gambago.
It is supplied with the following instruments :—

Solar maximum thermometer.

Shade maximum is
Shade minimum »
Dry bulb 5$
Wet bulb »
Rain guage.

From Table E it will be seen :—

(1) That the rainfall amounted to 40:51 inches.

(2) That the rainfall occurred in seven montbs, from
April to October inclusive.

(3) That there were five rainless months.

(4) That the average humidity varied almost directly
as the rainfall.

(5) That the average minimum temperature approxi-
mately corresponded to the average dew point during
the rains only.

(6) That during the rainless months there was no
dew.

The rainfall for the last three years was :—

1902 31:59 inches.
1903 48:08 ,„
1904 4051 ,,

(Sgd.) W. M. GnanaM,
Ag. S.M.O.,
Gambago, Northern Territories.

TABLE A.

MEDICAL STATISTICS RELATING TO EUROPEAN OFFICIALS SERVING IN

THE NORTHERN TERRITORIES, 1904.

GAMBAGA KINTAMPO SALAGA Үкоі Wa
e АШЫ n - is 33 | EX
1904 БӘР 22 125 4 22| | 55
ЕРИ СИ ИИ [E9 a [52] $a 188) Р
LEE аА 1 8 | 8 |Б зв р ад |в а вее EFAA-
5% 12215 5% :5| 4а] |435) |4! |4214|714а gS |5
Zz8| | 4% 48 48 | 48
------|---|--- -| —|—— — | --|----------------
January | 120} 2; 5| 0| 0] 4 0| 0| 0| 4| 2) 41.0), 0 —}—Jr— ish 1] |07040
February 12/7] 1 4/ 0| 015 0| 0|; 0 VE da "А0 о -|--|- —1 4| 0| 0/010
March .. 11:4 1 2| 0 0 8 5 | 27 0 5 2 5 0 01 — - - | — 4 0 07010
April 116) 1| 4] 0| OF -7 110120 4/ 010|0|04- -|-|- — i 4! 0} 010/0
May 1021 01 0| 01 016 0|; 0| 0 2/ 1); 2} 0| 0 — | — | —|—f 3| 0.1.0.00
June 104| 2 8 0 0 4 0| 0 0 | 2| 0 0 0 0 2 1 4 0 0 3 2/14) 010
July 9:4] 0 0 0 0 4 0| 0 0 1 0 0| 0 0 2 2 8 0 0 3 1/10 | 0/0
August ., 93| 3 143 0 0 4 0| 01] 0 1 90| 0/00 9 1 4 0 0 3 9211 01/0
September} 92| 1| 7| 0| Of 4 1| 2] 0 1 1| 3] 01| OF 2| 1] 8] 0 014, 94:8/10]0
October .. 93| 4/29] 0 0 4 2 3 0 11.21 6y 60 0 2 2 9 1 0 6) 2/17 0/0
November 85| 2/29] 0! 0] 4 0; 0| 0| 1| 01 010 018) 2] 8| 0| OF 61" Bes 0/0
December 81| 5[18| 1] Of 46 |-0|,0) 0 11 01 0 0 0129 2/10} 0. OF 4| 4! 800
шм Ws саг ын “іс IAT, A L1 O ------І-----
Totals.. | 1221 | 92 |113 | 1| 0] 586 | 9/39] 0 7| 8198| 0| 01М4 1146| 1 51 | 14 | 77 0/0
| |

25

COLONIAL MEDICAL REPORTS—THE GOLD COAST.

March 15, 1906.)

TABLE В.
MEDICAL STATISTICS RELATING TO NATIVE OFFICIALS SERVING IN THE NORTHERN TERRITORIES, 1904.

Wa

Yea

SALAGA

KINTAMPO

GAMBAGA

рма | 090000000000 | o
popivAu] | 222000000000 |?
ЗТ 380010 | ooooocooooooao | о
жырла малон __ SOLE IES ұза
yg | ooooncooonno | e

| | | | jesessess

paprreauy | |] || 1|99о9оооо | o
ISIT HIIS 917 uo | | | | чоо чочо ea
sup Jo 1equin x | 7*8 А en

КЕЛ | | | | | 90нче | e

quang П лды. Ы

ped | oooooooooooo o

yopiteAu] | оЭэоооооооосоо | о
18/71 3215 eu uo ооозв-осоюоск- оо -
sup Jo 1oqumN | ч ө Lo | e

xotg | dde west es ре
wWsueng | ааоваонынн |е
ped | oooooocoecece о

рәрцташц | эооооооооосо | о
28171 915 911 uo ""cOOooococorooo та
sfep Jo 1equiuN —

хә | аэооссоосо-ооо | eo

muang | AD AD 1 1C iO iO NNA i i i ао |8

ped | ооороооооооо о

popiteAur | ooooooocooooo | о
18/71 AIG eu uo оочооаоооооо 125)
sAep Jo ләдшақ

xotg | оочоочоооооо | a

ooodoocoooooo | Ф

ЧуЗаәл35 DDDDONMNHMOOOS à

7-52 I E a Жағы А

P с oer PI 06 85,88 a

z Ei. sag | я

- SEROZXMu9ugsSog9g 9

ESSE PEPPERS 5 | 5
ShHAtABRRANOZA

TABLE C. 4
MEDICAL STATISTICS RELATING TO THE 2ND BATTALION GOLD Coast REGIMENT SERVING IN NORTHERN TERRITORIES, 1904.

ped Ooooonocooonuoo [4
peprreany оооооо"ооооо -
< Lm]
F^ ER | xaasateenenea |в
5 —
іо о о о H H H H oco +
wung DHAAAADDHOHS x
|
— —À———Óá—n—a ae
| peur А6262 о
| ppraug | | || | |Зәооо- a
G áo Ra ec
- Ig | | | [ 77.29. 5954%>34 | EA
ооооса
wung LE] 15855959 S
са
pad оЭээооооосососо о
peprivaug ooocooooooooo |9
; i REF
Ге]
E xolg Q с ор 01 О A 00 e со соо |8
SISSIN ARRA |E
ui3ueng <j 2 Б
ee ee БЕ ЧЕНЕ
perd oooonooooooo [f
i popitvAu] ooooooonaoooo | a
a | |
E ND
= | MS SSSRRSSS A588 | &
M &
ec Oo voa ©
| m8u0ng BLSSSSLLLEES Е
| pad оочо-"осо-оо |
| орташ | 979795979 e E |
$ | )
& | eo E^ осон т
Е 5559295596288 5
2 xotg HA = | &
j |
оока зоро ос Le
x Q AN Фо с-саса =
q13u09138 5 «m 60 65 60 60 00 60 00 CO 60 60 N
| | Y
т e 9-е-өзе RS ы “ышы .
= e зе "eze a Wu ә. .
& ре =; 5,52 2
d S. Basgeg 8
so о ре
В ырға o SS 5290 5
394Е?а85%555%5 | a |
a Ф
5выия4дь-еаоиа

96 THE JOURNAL ОЕ TROPICAL MEDICINE. [March 15, 1906.
.
TABLE D.
MEDICAL STATISTICS RELATING TO STATION CARRIERS SERVING IN THE NORTHERN TERRITORIES, 1904.
GAMBAGA KINTAMPO SALAGA Үксі Wa
2. ка еа Ја раа 3 Е ЕЕЕ 1, ТБ
= 2 ^ = ж = = t6 r =
s ТАГА EJZ ajg [sis Ela ЗЕГЕ Е |А
8 % 3 z s 2 S 2 | 8
SMELL Eie enr ----- Б 00) Ье E
January.. 24 | — | — | 56 87 |—|—] 75 71 — -- — — 8|—]—
February 30 1|— 50 49 е m 75 8,— — -- — ya 9 | dE
March 40 1| — 51 44 lere 75 9; — — — — | — 1 eee ee
April 82 12 МІ | SD рае тагт. и ет ра = j= | 8 53
May 15 |—|—y] 80 26 65 3 8|/—j|—
June 21 --|--| 50 23 |— | — | 46 2|— 50 14- | — 8|-— lc
July .. 47 | —|— | 50 | 18 |—|—| 12 | 8| — 85 | 19 |—|— 7| —|—
August .. 86 1 1 50 7 -- | ~ 12 5|— 40 | 14 -- |-- 4“|--|--
September 31 2|- 50 10 |—|- 12 2,— 7 | 34 2|— 6 | lee
October .. 8 | — 42 17 |— | — { 12 41 — 59 34 |—|— Е
November 98 |— | —| 414 A |.——|—| 12 | a)— 1|13 |—|— 11-і1|-
December . 2 |—|—]|.41 | 89 | —|mr1l18; 74— 51 | 29 | 1,1 6 em iea
Totals 352 |17| 11] 624 | 290 erum 489 |56 | — 868 |197 | 8| 1 59 |< tes
NL UNT E21 wil ! 4 М I -—
: TABLE E.
MONTHLY AVERAGES OF DAILY METEOROLOGICAL OBSERVATIONS AT GAMBAGA, NORTHERN TERRITORIES, 1904.
E Е Е | è Е b 7 =
El B Z = g
of of of ee ab Ea
E 4 ЕЕ FR as E Remarks
92 ga ga E gE g>
5 5% <g 52 = ЕЕ
2 2 & 4 4
А z зыта, pees
January 148:35 | 92-32 | 69:74 | 50°23 , 34:54 | 9290 0:00 | (1) The season of the rains is preceded
February 147:08 | 9275 | 7041 | 48:65 | 38048 | 22°34 0:00 and closed by thunderstormis accom-
March .. 154:09 | 95°41 567 | 5830 | 32°70 | 19:74 061 panied by violent gales of wind.
April . 151:50 | 98:76 8:48 | 59:08 | 46:66 ! 18:33 174 ,(2) Hail fell once in May and once in
ay ee 146:00 | 85:38 72:82 64:26 57:80 12°51 6:65 June.
June .. 158.28 | 84:73 | 69°86 | 66°66 | 71:00 | 14:86 819 | (3) Early in December the wind changed
July .. 139:96 | 79:03 | 69:90 | 70-24 | 83-67 919 | 1001 to N.E., and the so-called Harmattan
August 144:00| 79:61 | 71:38 | 70°36 | 82:77 8:22 7:25 season began,
September 153-26 | 80:50 | 70:20 | 70°80 | 79:26 | 10:30 7:97 (4) During the season a strong breeze
October 150-29 | 83:00 | 71:20 | 71:88 | 77:64 11:70 8:09 usually prevails day and night.
November 148:50 | 90-00 | 71°66 | €8°63 | 56:26 | 18°33 000 | (5) The total annual rainfall was
December 143:80 | 90°38 | 69:35 | 57°60 | 41:00 | 21:08 0-00 40:51 inches.

(9 Lupus "m
(d) Tabes Mesenterica ..

(b) Iridectomy

April 2, 1906.] COLONIAL MEDICAL REPORTS—THE GOLD COAST. 27
Colonial Medical Reports.—No. 20.--ТНЕ GOLD COAST (continued).
RETURN or DisEasES AND DEATHS IN 1904, AT THE
Government Hospitals at Accra, Cape Coast, Elmina, Axim, Kwitta, and Kumasi.
GENERAL DISEASES. Total Р Total
Admis- Cases Admis- Cases
sions. Deaths. Treated. sions, Deaths. Treated

Alcoholism yas E 5 (GENERAL DiskEASES— coni in ued.

Anemia 1. fae ge 1 Other Tubercular Diseases - -- -

Anthrax Ж E — Varicella 7 A . — - -

Beri-beri 8. 2. R Whooping Cough — — —

Bilharziosis ELS -— Yaws .. А 6 — 6

Blackwater Fever Gack, 22 -- Yellow Fever Em -- =>

Chicken-pox ... aise ee =

Cholera : — 2. -

Choleraic Diarrhwa .. -- 2. -- --

Congenital Malformation -- 220 -- =

Debility Y 21... 2 21 LOCAL DISEASES.

ee Tremens P NEM 3

Dengu Eia. — Diseases of the—

Diabetes Mellitus Es m = Cellular Tissue ... m 75. 2 TR

Diabetes Insipidus Picks. NEM = Circulatory System—

Diphtheria oo Teas М. — (а) Valvular Disease of Heart 5. 2. 5

Dyseutery " 82... 98. 82 (b) Other Diseases 14 .. 1. 14

Enteric Fever... loa S 1 Digestive System— oo =

Erysipelas 3.. 2 3 (а) Diarrhoea 4 M. 1.. 84

Febricula 10 4. = 10 (b) Hill Diarrhoa.. - —.. —

Filariasis = — (c) Hepatitis c -- 2. -- --

Gonorrhea 18: --- 19 Congestion of Liver ... 5..- 5

Gout ... ЮЙ MEME - (4) Abscess of Liver 12 .. 9 .. 14

Hydrophobia ... TEE € (e) Tropical Liver.. - nds —

Influenza Qu. um 2 (f) Jaundice, Catarrhal . 2. lx. 2

Kala-Azar ELLO go ne e 9 Cirrhosis 'of Liver , -- ts —

Leprosy Bere AE t) Acute Yellow Atropiy -- -- 1. --
(а) Nodular dno,’ phe = à Sprue .. жа, Hm a ms
(b) Anesthetic ... ER = (J) Other Diseases... 180 .. 9... 183
(c) Mixed... L5. ese Ear es . 9.. --. 2

Malarial Fever— . 5 - - Еуе 26... --.. 296
(а) Intermittent- - ae Е Generative System — 19... -. 19

Quotidian .. 1722: 17 Male Organs 30... 1... 32
Tertian --.. -- e. Female Organs d —. 4
Quartan 162 ... 162 Lymphatic System Wo а. 29
Irregular ... deno. at 3 - Nervous System 54 .. 19... 56
Type undiagnosed 55:6 c— 55 Nose 9. : 3
(b) Remittent .. 937... 6... 21 Organs of Locomotion . 38 2. — 33
(c) Pernicious ... uu 15. 9. 15 Respiratory System 158 25 162
(d) Malarial Cachexia ... —. -- Skin— .. = = Sg

Malta Fever .. es жы — (a) Scabies .. 3.. — 3

Measles 16 .. 17 (0) Ringworm ye E s

Mumps ; err - (с) Tinea Imbricata m -

New Growths | = — (d) Favus fs is e z
Non-malignant .. бы = 6 (e) Eczema.. PE SE 1
Malignant 2. 1 2 (f) Other Diseases 2. l. 137

Old Age А SAT uu Urinary System... 14 .. 2. 15

Other Diseases —— em — Injuries, General, Local— — e cmn --

Pellagra - 2.20 -- (а) Siriasis (Heatstroke) LI s --

Plague ... LASS Ac - (b) Sunstroke (Heat Prostratiou) 5.. 1. 5

Pyemia -- 2. -- -- (с) Other Injuries } 200... 5... 210

Rachitis Li Ea —— Parasites— BR —.. 89

Rheumatic Fever | -- 1 Ascaris lumbricoides -- — .. -

Rheumatism ... 060... — 63 Oxyuris vermicularis ... Y We = — 2. —

Rheumatoid Arthritis. NG TAS = Dochmius duodenalis, or Ankylos-

Scarlet Fever .. nea = ne toma duodenale E zs E - —

Scurvy ... LX E — Dracunculus medinensis (Guinea-

Septicemia 1 - 1 worm) ... 455 zd . G4 -— 64

Sleeping Sickness А os Ss Pls Tape-worm -- — —

Sloughing Phagodena RUE: — Poisons—

Smallpox ... 59... 1 62 Snake-bites 9 us н 2

Syphilis — T 22 e Corrosive Acids ... nc тж =
(a) Prima Bees 8 Metallic Poisons = - —
(9 Secondary 9... - 10 Vegetable Alkaloids m EE =
(e) Tertiary — -- — Nature Unknown kn ES Er
(d) Congenital . -- 2. — -- Other Poisons 9 2 2

Tetanus aie i 3.. 2 3 Surgical Operations—

Trypanosoma Fever .. EM = Amputations, Major 12 .. 1 12

Tubercle— ... 3. 2 Minor -- 2. = —
(a) Phthisis Pulmonalis. S us = Other Operations %6 .. 4 %6
(b) Tuberculosis of Glands et PES Eye .. із = = -

-- 2. -- (a) Cataract ... = = =

(в) Tuberculous Disease of Bones

(c) Other Eyc Operations es

28 THE JOURNAL ОҒ TROPICAL MEDICINE. [April 2, 1906.
APPENDIX V.
ACCRA.
METEOROLOGICAL RETURN FOR THE YEAR 1904.
TEMPERATURE RAINFALL |
Month Ет с жы å Remark.
% СЕЕ 8 5-8 è > 23 È | a8 ave
ЕЕ Ез РЕ EE E Е ғ: 55 SS
43 $8 zg | 2 8 х $^ FE £
January 7074 | 8751) 7141 1509 | 79-46 is 80 03
February 13:20 87-37 73°16 1817 | 80:26 21 | 80°38
March .. 74:54 8661 7441 12:12 80:51 926 | 80:87
April 72:33 87:03. 75:36 12:33 81:19 "83 13:90
May 69:08 89:06, 75:93 10:54 8249 90 71:82
June 68:70 84:40, 74:36 10:06 | 79:38 97 85:66
July... 62°87 79:88 | 72:54 6:83 15:96 “61 92:00
August .. 69°12 77°90 | 72:25 5:64 | 75:07 қ 87:93
September 66:45 | 8150! 71:43 10:06 | 16:46 T 8240
October .. 67:16 88:39 | 71:74 11:58 77:53 46 14:25
November 82:86 86:96 | 71:96 14:99 19:46 2 ! 7038
December 81:12 87:00! 71:67 15:32 79°33 2 75:00
-----------Гр---|------------ NU ажа: GERM алды
Totals 1688-72 853:03 | 1018-04 876:22 137:73 947:10 17:28 | 959:87
a аю APT WE ДИ SEP ЕСЕ. = жекені |
Mean 140-72) 71:04 84°83 | 73:01 11:47 18:92 1:44 | 79°98 gx
ABURI.
METEOROLOGICAL RETURN FOR THE YEAR 1904.
TEMPERATURE RAINFALL WiND
; Mont! l " | i Remarks
ones B Es | Е Е 2$ t$ sé
ce 38038 d$ ВІЗІЗІНІНІН
»* E = “ & E
3 3 8 Е “4 Ф a с = Lp & E 2 = Pi
January 118:38 73°77 85:25 89:09 8:16 83:67 2 89:85 | Ға
February 12117 7279 | 84-06 74:18 9:99 19:09 "55 82-27 | 5%
March 119:67 69:80 | 78°77 71:93 6:83 15:35 4:16 84:14 ж”
April 133°43 69°30 | 88:73 79°33 9:40 84:03 1:84 76:18 5%
Мау 124:48 65:19 | 82:67 73°70 9:29 78:18 6:24 80:41 Е"
June 120°80 69:04 16:02 68:00 8:18 72:01 6:47 82:20 4
July a 122:06 99:09 19:87 65°61 7:25 69:24 9:19 85:53 Vs.
August .. 125:22 7051 71:67 69:12 8:54 73°93 "65 83°79 i
September 13276 6968 18:60 67°53 11:00 | 73:06 2:97 85:83 55
October .. 136:16 71:58 19:51 69:38 10:19 74:44 290 84:40 Se
November 125°73 75:90 81:56 7163 9:63 76°59 “52 83°51 zn
December 139341 74:64 75°32 10:00 6:32 18:16 3:30 87:72 КА
--------- -------------- | millium cmt atii СҮТІНЕ! ——!) өк CENCE "SA
Totals . : 1513-27 | 881:54 |972:03 86245 99-65 912-75 31:10 | 998:33
———— Á———— JA —— e o Hn = | ЛЕСІНЕ (Мы жа ж ee
Mean 126:10 73°46 81:00 71:87 8:30 | 76:06 2:59 83:19

April 9, 1906.)

COLONIAL MEDICAL REPORTS—

AXIM.

METEOROLOGICAL RETURN FOR THE YEAR 1904.

‘TEMPERATURE

RAINFALL

THE GOLD COAST.

i | T
Month A | т g ы > сз Remarks
х ж Е - = 1 = м 5 5 Е a
73 | 585 ^а т Ax zz
тті an a тарала ЕН БЕРІ NE SC = ean Hort aoc a a a
January 13974. 54:22 | 8790 6838 | 19:45 ; 18:14 08 "
February 180:68 50:96 89:24 68:65 | 23:68 , 78:94 1:07 4
March .. 163:80 52:12 87:74 72921 1448 : 80:33 8:50 .
April 1:90 38946 8746 71:96 16:53 | 19-71 5°63 Y
May 21:58; 31:58 86:20. 71:12 15:16 78:70 14:46 з
June 12190. 31°24 8260 71:13 1146 . 76:86 32:57 :
July T 122:38 30 16 80:29. 7048 9:80 15:88 71 .
August .. 117-16 29441 18:51, 67:70 10:80 73°10 "5 д
September 19943 25:02 81:10: 69:53 11:56 ; 73°31 111
October .. 12945 24:53 82:12, 70:80 | 11:32 | 76:46 2:56
November 129:16 | 8533, 70:93 ! 14:56 18:13 2:99
December 129-64 85:80. 74:48 | 11:32 | 80:14 3:76 |
1 м i i
Totals 1551:82 306-70 | 1014°38 | 848:08 169:42 | 929:20 75°09 1094-45
Mean 129810 2567 | 8159 7007 LAL ; vida | 625 85°37
CAPE COAST.
METEOROLOGICAL RETURN FOR THE YEAR 1904.
TEMPERATURE RAINFALL Wind
Month 2 Ез g S -8 Remarks
ae | 34 4E | 3 5 ge | £P
25 Ee 93 25 8 ӨШ SE
z mS ж a од 4
January 69:90 85°70 | 70:87 14:88
February 69:82 86°55 | 72:62 18:93
March 71:32 86:61 | 72:93 13°67
April 73:00 86:66 | 73:33 18:33
Мау | 72:32 85:90 | 72:41 ` 1848
June |! 71:03 82:90! 70:80 4:19
July .. 10:29 80:93 | 70-90 10:03
August .. | 68°70 79:09 | 69:08 10:06
September 70°43 80:36 | 70:66 11:03
October .. 72:19 | 82:00| 71:88 10:22
November К 78:98 84:83 | 78:58 11:50
December . 78:88 85:88| 73-77 19:06
5-2.
Totals | 856-31 , 1007:36 | 862°68 ` 188-33

ШИЕ ИНЕ ОНАН,

71°35 83-94 | 71:89 11:52

80 THE JOURNAL ОЕ TROPICAL MEDICINE. [April 2, 1906.

KWITTA.

METEOROLOGICAL RETURN FOR THE YEAR 1904.

‘TEMPERATURE RAINFALL
Month = | а Li E > c
E i2 | $F Ei Е ті i3 жі
Ж x z 47 za ez
E rr C CI NN CHA! MEUOSIS NONSE uu
January sid us ..] 134:00 6948 9996 79:25 ]UN3 , 8510 15:33
February 2. "m ..| 13648 7472 89:62! 77:68 11:03 83°65 10 72:68
March .. 22 te ..| 14283 75:00 | 8893| 77-00 | 1183 ! 83-01 B 73-70
April .. m T ..| 14200 75:06 89:06 | "75810 10:66 43°73 9:11 10:85
Мау ace ҚУ; ы; ..| 149580 17348 89:45! 76:70 19:74 83-07 1:79 68:40
June .. 5% 22 ..| 14046 7343 ' 8906 | 15:60 13:80 82:33 8:26 71715
July Зи E s .. | 140:06 72:58 Su 77, 157 1306 | 82:323 54 74°67
August .. << ys ..| 185:22 7054 87:45 | 73:96 13°48 80:79 17 81:77
September BH Eu ..| 148:36 7178! 88:00! 75:03 12:96 81°51 52 16:11
October. . te ae ..| 14200 75°87 88:58! 76°41 19:16 82:49 14 74:00
November 55 an ..| 14700 75:06 ! 88:00! 77:40 10°53 82°70 76:91
December He d ..| 14008 75:87 | 87:38) 74-67 1274 | 81:02 1:76 19:29
Totals .. - ..|1686:33 882:82 |1065:26 | 917:89 |146 72 | 90156 1540 90146
Меап 140:52 73:56 88-77 | 76:49 12-22 82:68 1:54 15:19
KUMASI,
METEOROLOGICAL RETURN FOR THE YEAR 1904.
TEMPERATURE RAINFALL
Month = ! КЕ - ; s sz 3 в Remarks
FE | 38 $8 ғ ЕТЕ Hl
= ae 88 z5 Е =
4% ЕЕ СЕ 2 = ЕЕ EK ái
January. 184:45 ES 85:22 63:54 21:64 74:38 70 79:00
February 175:24 m 94:68 65:79 92:62 80:93 02 18:65
March . 148-03 P 90:15 70:93 18:88 80°54 3°64 78°25
April ` 140:93 vs 71:10 vs m 4:22 19:76
Мау 14522 67:45 ex 70°41 ee 22 4°78 85:54
June. 14008 70:56 . 54:36 72:63 12:66 18:49 89:80
July 199-09 6841 i 79:67 70:22 945 74:94 9:60 88:67
August .. 19774 6854 ; 79°58 69:88 10:00 7410 49 . 83:03
September 170°43 69:53 82:63 71:10 11:80 76°86 2°62 84-93
October .. әй 151:22 65:67 80:96 71:45 12°22 76°20 5:43 92-90
November 149:50. 69:86 | 86-28 71:36 14:86 78°79 1:88 86:00
December a 140:80 i 66:41 | 84:70 68:41 16:29 76:55 9:84 82°23
— —À M — өзек» IA RID EO ae сөнеді S —— = —
Totals 4% 1752°68 55048 84818 83677 150492 77108 89:75 996:25
лі L———ÓÓÀ ue — А ———— ee I
Mean .. ia ..| 14605 68-80 | 84:81 69:78 1504 17710 88:02

Аргі 16, 1906.) COLONIAL MEDICAL REPORTS—THE STRAITS SETTLEMENTS. 31

Colonial Medical Reports.—No. 20.—The Gold Coast (continued).

GAMBAGA.

METEOROLOGICAL RETURN FOR THE YEAR 1904.

қ TEMPERATURE RAINFALL WIND
| NN E
i
Month = 5 a B ом» 48
Z Eg Е 5 2 2 2
8B | 22 | $2 | $2 E = | 2 | es | ES
55 | $9 | ge | 23 3 sg | be | ЗЕ |
January.. an - ..' 143°35 | 59:29 92°32; 69-74
Fobruary a 9 ... 147703 | 51:86 92°75 | 70:41
March КА m .. 154:00 | 42:43 95:41| 75:67
April .. ii ec 0. 152501... 93°76 , 73:48
May 2. Ms ..! 146:00 РА 85°38 | 72:82
June .. Ys v ..| 15823] .. 84°73 | 69:86
July .. xs А ..1 13996 .. 79:03, 69:90
August .. 22 - e, 14400, .. 79:61| 71:38
September 5% ЕН ..' 15896 .. 80:50| 70:20
October .. 52 | 150:29 ee 83:00 | 71:29
November M 2% 1.1 148:50 Si 90:00 | 71:66
December 4% ЯК zs | 143-80 .. 4. 29038, 69°35
Totals .. T .. 1775:01|153-58 | 1046-87 | 89576 |18945 | 951-24 40:51 | 693-78 zu d
zamora асаа CER M D ee | —— |— — -|———_|—_—__-—_-
Mean .. zd 5 | 147191 5119 87°23, 74:64 15°78 | 79°27 5:06 | 57°81 e dl

Colonial Medical Reports.—No. 21.—The Straits Settlements.

MEDICAL REPORT FOR THE YEAR 1904.
By Dr. D. К. McDOWELL, C.M.G.

Principal Civil Medical Officer, Straits Settlements.

POPULATION AND HEALTH. (2) The death-rate for the whole of the Colony

was 39 in 1904 as against 39:49 in 1903 and

1) The following table shows the estimated popu- 42:96 in 1902, and judging from this there seems
lation and the birth and death-rates for the years to have been an improvement in the public health of

1908 and 1904 for the several Settlements. the Colony in 1904 over the two previous years.
l Е i Ж nma Е BE 2 А i n
жаным алгі: уалы Deaths Dg EE оше
Settlement i
1903 1904 1903 1904 1903 1 1904 i 1903 1004 1903 1904
MEER ГЕРИНГ re We ee ШЕ [cs PO ERR MADE. Pec
Singapore .. .. ae es .. | 240,833 | 246.195 | 5,089 5.435 11,505 | 10.937 91:13 22:05 47-77 44:37
Penang .. . .. fe 24 2. | 130,121 | 180,602! 2,405 | 2,493 , 4,988 5,517 | 1917 19:08 | 3833. 4294
Dinding .. .. .. .. ..| 4236 4291| 136 | 158 1 1837 198 , 3230 36491 3234 | 29-80
Province Wellesley — .. .. ..|117.078 | 117.762; 3.813 | 3.778 | 3.979 | 3,392 | 3207 | 3208 | 2801 | 28-80
Malacca .. gs m 52 ..| 96,276! 96,689 | 3,976 | 3,380 3,332 3,259 | 41:30 24:97 34:61 33°73
= i | ———
Total .. .. Уф .. 588,544 595,782] 15,509 | 15,244 | 23.941 | 23,233 26335 | 25:59 39:49 | 39-
l i | і i і

32

THE JOURNAL OF TROPICAL MEDICINE.

(April 16, 1906.

From this table it will be seen that there was &
considerable reduction in the number of births in
Malacca іп 1904 as compared with 1903. Singapore,
however, shows an increase in the birth-rate and an
appreciable reduction in the death-rate, a result which
was also obtained in 1903 as compared with 1902.

(3) Of the total number of deaths registered in
1904, 3,841 were among infants of under one year old,
against 3,865 in 1903, and 3,631 in 1902. Of the
total deaths registered in Singapore in 1904, 284 were
among persons who had resided less than one month
in the Settlement.

(5) Beri-beri.—Iwo thousand six hundred and
thirty-one cases were admitted into hospital with 879
deaths in 1904, as against 1,919 cases with 647
deaths in 1903, and 1,901 cases with 575 deaths in
1902. Тһе total number of deaths registered in 1904,
1903 and 1909 respectively, were 2,287, 1,729, and
1,607. It will be seen, therefore, that this disease
has a tendency to increase. Five cases of beri-beri
occurred in the General Hospital and 60 in the Tan
ТосЕ Seng's Hospital among patients admitted for
other diseases. There were 266 cases of beri-beri in
the Singapore Prison as against 169 in 1908, but the

PLAGUE CHOLERA | BMALL-POX
а TERME NUES IO SED SERERE А
i 1903 1904 1908 1904 1003 1904
i р. mu е же $ Й )
Cases | Deaths Cases Deaths | Cases Deaths ! Cases | Deaths Cases Deaths Cases Deaths
eo OE oe RA TA Eie NT ck SES PDT al P PER CT ылы Oe Te айылы At cel cic a ant E RN Қа ni erat Ч
! | 1
Singapore .. ari 3 з г 90 20 226 190 | 9 | 3 ^ 109 29 зз ; 1
Penang - (eer Mule up “An Gl ons ees c mS U^ os Ше d uh 227 57 8 , 2
Province Wellesley.. | 22.0! Н | А ) | е 958 | 49 6 | 2
Malacca іш өзе door | Doc | | oe j} 82600 | 40 101 7
------------------------- MEI SM ANC
| | | i
Total .. eld 3 | з. 20 20 . 226 | 190 3 , 3 860 | 175 142 : 22
1 "OPE " i ) |
(4) Тһе above table gives the number of cases of percentage of deaths was lower іп 1904. Following

zymotic diseases in the several Settlements in the
years 1903 and 1904, and deaths therefrom, not in-
cluding cases imported into the Colony.

Plague.—The 20 cases in Singapore in 1904 all
proved fatal. "They occurred in different parts of the
town among 17 Chinese and 3 Tamils. Two of the
cases were said to be among late arrivals in Singapore,
but this could not be definitely ascertained.

Cholera.— Only 3 cases, all fatal, were reported in
Singapore, one occurring in the prison. There were
none in the other Settlements.

Small-pox.—One hundred and forty-two cases with
22 deaths were reported in all the Settlements, being
a great decrease over the figures for 1903.

Enteric Fever.—This, I am afraid, is on the increase.
One hundred and seventy-nine cases with 69 deaths
were reported in Singapore, as against 148 cases and
47 deaths in the year previous. One hundred and
seventy-three cases were treated in hospitals in the
several Settlements. Of these 75 died. Three cases
occurred in the Singapore Prison.

Diphtheria.—Seventeen cases were reported in

the good result of former years 30 prisoners with beri-
beri were transferred to Malacca from Singapore, but
the result was not satisfactory.

(6) Venereal Diseases.—The admissions to all the
hospitals for 1904 numbered 1,784, with 95 deaths.
In 1903 there were 1,818 admissions, with 96 deaths,
and in 1902, 2,341 admissions, with 90 deaths. Of
those admitted in 1904, 237 were females, of whom
152 were prostitutes.

(7) Owing to the overcrowding and bad sanitation
phthisis is very much on the increase, 1,644 deaths
have been registered in Singapore alone, or 2,534 for
the Colony. i

(8) Sanitation.—With the continued overcrowding
in Singapore the sanitation cannot be said to be in а
satisfactory state. There is practically no sewerage
system. The drainage in many places is bad, and
the water supply is being constantly cut off. The
time has come, I think, when the question of
remedying these defects should be seriously con-
sidered by the authorities concerned. The want of a
good and plentiful water supply is undoubtedly one

Singapore with 9 deaths. of the chief causes of the high mortality rate. In
Bap 8 y
NUMBER OF ParikNTS TREATED NUMBER ок DxaTHs. PRRCENTAUE ee To Тотль
Europeans Asiatics Total Europeans | Asiatics | Total Europeans | Asiatics Total
еее EDT. Se ee EE ==. 2s -І- e a - 27225
(а) 1902 1,159 96,515 27.674 68 | 4.406 1 4,474 586. 61 16:16
(b) 1903 1,043 94,324 25,367 45 , 9,911 | 3,956 431 ' 16:07 15-6
(c) 1904 1,163 24,769 25,932 c9 | 3,767 3,836 593 | 15-21 14:79

(a) Includes 331 cases and 42 deaths in Lunatic Asylum. (0) Includes 400 cases and 55 deaths in Lunatic Asylum.

(с) Includes 485 cases and 59 deaths in Lunatic Asylum.

_ April 16, 1906] -

Penang and Malacca the general condition may be
considered satisfactory, but in the former Settlement
fears are also expressed of the water supply running
short. In the province improvement goes on slowly
but steadily.

(9) Hospitals and Work done.—The total number of
admissions into the hospitals during 1904, excluding
the lunatic asylum, was 23,462 against 23,150
in 1903.

(10) The preceding table shows the work done
during the last three years.

(11) The diseases responsible for the анды
number of admissions and deaths are shewn in the
subjoined Tables, compared with the corresponding
diseases and deaths in 1903.

I.— GENERAL DISEASES.

1903 | 1904
Diseases 2 eis tits, е iba
Admissions Deaths Admissions l Deaths
а ae 5 So eee
Dysentery POR 707 267 | 723 245
Malarial Fover ..| 2,005 151 ! 2,094 ; 205
Beri-beri . . 2% 1,919 647 2,631 | 879
Phagedo»na e 234 60 ` $44 67
Tubercle of Lungs 730 408 ^; 853 | 484
Venereal Diseases 1,818 96 1,784 | 95
Rheumatism 1,075 КА 823 1
Anemia .. 964 262 590 ' 93
Debility .. 907 339 157 970
П.-Шосаг, DISEASES.
; 1903 1904
DISEASES i
|
| Admissions ! Deaths | Admissions | Deaths
Diseasesof the Nervous | i
System (including | j
admissions to the i
Lunatic Asylum less ў
cases transferred | A
there from other: ) | |
hospitals) .. | 736 112 | 651 : 138
Diseases of the Res-
piratory System (not
including Phthisis) 574 108 496 , 126
Diseases of the Diges- | i
tive System (includ- )
ing Diarrhoea) E 2,028 678 1,616 524
Diseases of the Skin.. 2,626 4 2,997 4
ш. —InguRIEs.
| 1003 1904
| Admissions Deaths Admissions | Deaths
Generaland Local; 1,557 56 1,831 | 139

(12) Operations.—One hundred and twenty-four
operations, returned as such, were performed, with à
deaths. There were also 226 operations performed in
the General Hospital, Singapore, requiring the use of

. COLONIAL. MEDICAL REPORTS—THE G GOLD COAST. . 33

an anesthetic. These were included in the return
under the diseases for which they were admitted, but
а separate statement shewing the operations per-
formed is put up.

(13) Six specimens of malignant tumours and
growths were forwarded to the Superintendent of the
the Cancer Research Fund, London, from Singapore,
and seven from Penang.

(14) The recovery rate in the Lunatic Asylum in
1904 shows an improvement over that of 1903.

The Maternity Hospital return shows that good
work was done there during the year. One Proba-
tioner passed her examination and was granted the
usual certificate.

(15) Quarantine.—Two hundred and seventy-nine
thousand two hundred and ninety-seven crew and
passengers were examined on arrival in Singapore, and
4,444 pilgrims on departure. In Penang the numbers
inspected were 144,691 crew and passengers and 1,435
pilgrims. "There seems to be a great reduction in the
number of pilgrims inspected both in Singapore and
Penang in 1904 as compared with 1903.

Further needed improvements, details of which will
be found in the appendix under Quarantine, were car-
ried out on the Station at St. John's. The Port Health
Officer reports that the disinfecting steam lighter
Hygeia, fitted with a Clayton disinfector, has answered
all expectations.

(16) Out-Door Dispensaries. — Nineteen thousand
nine hundred and seventy patients attended at the
various Out-Door Dispensaries in the several Settle-
ments during 1904 as against 18,031 the year previous.

(17) Vaccination.—The total number of vaccinations
performed throughout the Colony during 1904 was
15,765 as against 15,496 in 1903. The following
table shows the number vaccinated, with the results
in the several Settlements during 1904.

Га
i 55% | RESULT
SETTLEMENT ; &8 5 |
ГОИ
a d | Perfect Modified Failed Unknown
;
(. 255: | 2,551 €. оа
Singapore 1,797 | 1,631 | 9 96! 61 (b)
| "aro | ‘a6 3a | d .. W
Penang | 3,280 | 2,200 — 633 | 177, 904
Dindings .. i 133 44 7 13: 69
Province Wellesley 8,680 2,924 ' 287 452) 17
Malacca [| 3,945 3,379 1 72 | 387| 107
тет ep сла а | ——-—--
Total 15,765 | 13,151 |100 d 458

(а) By Government Vaccinator. (b) By Liconsed Vacéinatons:

The above do not include vaccinations performed in
the prisons or at the Quarantine Stations. Saigon
Lymph was used throughout the year. The results,
although not very satisfactory, especially in Province
Wellesley, appears to be an improvement over those
of 1903.

(18) Stajf.—Dr. G. D. Freer, Colonial Surgeon Resi-
dent, Penang, returned from leave on March Sth, reliev-
ing Dr. Т. Н. Jamieson, a private medical practi-
tioner.

34 , THE JOURNAL OF TROPICAL MEDICINE.

[April 16, 1906.

Dr. R. Dane, Colonial Surgeon, Singapore, proceeded
on long leave to Europe on March 4th, his place being
taken by Dr. W. S. Sheppard, Supernumerary Colonial
Surgeon.

Dr. J. Catto resigned his appointment as Resident
Medical Officer, St. John’s, and Assistant Port Health
Officer, and was succeeded by Dr. D. M. M. Ross, from
England, on March 19th.

Dr. A. L. Hoops was appointed House Surgeon in
the General Hospital, Penang, a new appointment,
and arrived there from England on June 9th.

Assistant Surgeon H. J. Gibbs returned from long
leave on November 18th, after having successfully
passed the examinations for the L.R.C.P.Lond.,
and M.R.C.S.Eng. He also took the certificate in
psychological medicine.

Assistant Surgeons M. W. Laporte (Singapore), and
S. A. O'Keefe (Penang), retired during the year.

Dr. Edith Boomgardt was appointed Assistant
Registering Officer of deaths in Penang in place of
Assistant Surgeon O'Keefe, retired. Ап additional
Assistant Surgeonship was sanctioned for the Quaran-
tine Station at Singapore. This was temporarily filled
by the appointment of Mr. A. P. Dantes, M.R.C.S.,
L.R.C.P., whose services were also utilised at the
General Hospital as House Surgeon.

Тһе posts of matron and three nurse probationers
were added to the Lock Hospital, Singapore, and two
nurse probationers to the General Hospital, Penang.

There were several changes among the nursing stafi
tending much to disorganise good work and discipline.

With the exception of some old hands the dresser
staff does not seem to be satisfactory. Although the
scheme for salaries has been improved the class of
men applying for admission is not promising. This
branch of the medical service requires to be strength-
ened, and I hope, with the opening of the Medical
School in the Colony, to have men joining for a lower
degree, say, of hospital assistant.

(19) Two Straits Students, Messrs. Sit Peng Lok
and B. G. Samy, passed the grade of Assistant Surgeon
in Madras, returned to the Straits in 1904, and filled
up two posts vacant from the beginning of the year in
Province Wellesley and Malacca respectively. At the
end of the year there were eleven student apothecaries
of the Straits Government in the Madras Medical
College. In view of the establishment of a medical
school in Singapore no more students will be sent to
Madras in future.

(20) The Morphine Ordinance and Opium Ordinance
were amended with a view to bringing those dealing
in those articles as chemists and druggists under
more eflicient control, апа restricting all unqualified
medical men from prescribing the same.

(21) In September, 1904, the Honourable Tan Jiak
Kim, & member af the Legislative Council and an
influential member of the Chinese community,
petitioned the Government on hehalf of the Chinese
and other communities of this Colony praying for
the establishment of a medical school. The Govern-
ment, notwithstanding the difficulties hitherto ex-
perienced in the proposal to establish such an
institution, expressed its willingness to sanction
such an undertaking, provided the petitioners were
willing to pay for the initial cost of same, ie., for

the building and equipment, and raise on endow-
ment fund of $60,000 for the payment of ten
scholarships for students of native origin, the Straits
Government and the Government of the Federated
Malay States undertaking to give five Scholarships
each in addition, and paying for the staff and up-
keep of the said school. With commendable prompti-
tude Mr. Tan Лак Kim managed ќо collect
subscriptions far in excess of the amount actually
requise All preliminary steps for the establishment
of the school have been taken. А Bill constituting
the necessary Council will soon be introduced in the
Legislative Council, and in a few months hence the
school will be an accomplished fact.
May 12th, 1905.

APPENDICES.
SINGAPORE.
Report by Dr. J. Leask, Colonial Surgeon Resident.
TABLE А--1.
8 ізі: 0515.
z8| € рз ЗЕРЕН ER:
e2, = Е 5 s ££ ач! Б5
gg) 25 jE |i P 35
ie bos | 816 E° 575
23 ! е e a Е
European 20| 615| 635| 553 1142 |29, 661
Natives ..| 82 | 2,169 | 2,251 1,736 175 261 | 79 ; 11:63
Native Police.. | 12 | 377, 359. 375; 1| 1,1 0:25
Totals .. |1144 | 3,161 3,275 ; 2,664 187 |304 |120 | 9:28

The work in the wards has been heavy through-
out the year, not so much owing to the increase in the
number of admissions, which was only 57 over the
previous year, as to the large number of daily sick
(163-045, the highest on record for this Hospital) and
to the large number of Surgical cases in the Native
Wards.

Of the General Diseases causing admissions to
Hospital, the various manifestations of Malaria come
first with 333 admissions and 12 deaths. Next in
order are Venereal discases (including local affections)
298 with 5 deaths, Beri-beri 126 with 41 deaths,
Dysentery 120 with 31 deaths, Tuberculosis 108 with
4 deaths, Enteric Fever 76 with 22 deaths, Dengue
45 cases, Debility 32 and 1 death, Anemia 28 and 1
death, Febricular 20 cases, Tetanus 6 with 4 deaths,
Erysipelas 6 with 2 deaths, Pyemia 4 with 3 deaths,
Septicæmia 3 and 3 deaths. Я

Of the Nervous Diseases, Insanity in its various
forms 171, Meningitis 8 cases and 8 deaths were the
most noteworthy.

Diseases of the Eye caused 20, of the Ear 15 and
Heart diseases 15 admissions with 2 deaths.

Respiratory Diseases.—Pneumonia 42 cases апа
15 deaths, Bronchitis 40 and 1 death, Asthma 17 and
1 death and Pleurisy 11 cases were the most note-
worthy.

Diseases of the Digestive System.—Diarrhoa 34
cases and 3 deaths, Sprue 18 cases and 2 deaths,
Fistula in Ano 17, Constipation 16, Hernia 13 cases
and 2 deaths, Hepatitis 13 cases and 2 deaths, Liver
Abscess 12 cases and 8 deaths, Appendicitis 12 cases
and 2 deaths, Piles 5, and Cirrhosis of Liver 4 cases
and 1 death.

Мау 15, 1906.)

Colonial Medical Reports.—No. 21.—The Straits Settle-
ments (continued).

Urinary System.—Bright’s disease 9 cases and 1
death.

Diseases of Bone.—Periostitis 5, necrosis 5, caries 4,
are of interest.

Diseases of Connective Tissue.—Abscess 49, cellulitis
22 cases.

Skin Diseases.—The most numerous of these were :
Ulcer 79 and 1 death, and eczema 95.

Injuries. —The most numerous general injuries were:
Multiple injury 35 савев with 10 deaths, burns and
scalds 31 cases with 8 deaths, heat-stroke 5 cases and
1 death.

Of the 650 local injuries the most important were :
Wounds 480 cases with 4 deaths, compound fracture
64 cases with 14 deaths, simple fracture 45 cases with
5 deaths—these last were in cases of fracture of the
spine.

Of poisons the more important were: Alcohol 54,
zum 5 cases and 2 deaths, lead and mercury 1 case
each.

Parasites.—The most numerous were: Acarus scabiei
95 cases, mostly in Chinese Sinkehs, and others of
interest were Ascaris lumbricoides 3, Ankylostoma
duodenale 7, Filaria sanguinis hominis, 6, Tenia
solium, 4.

After twenty-one years’ experience of the Straits, I
cannot help being struck by the steady increase of
certain diseases during that period, amongst the
Asiatic population chiefly.

The first of these is tuberculosis, mostly of the lung.
This disease having once got a footing and having
found а suitable environment, has steadily spread.

Along with this I find that fistula in ano is becoming
much more common, and lately a few cases of disease
of bone, hitherto absent, are beginning to appear.

Pneumonia has been making rapid strides during the
last few years.

Enteric fever has become common amongst Euro-
peans and natives.

When in 1884 I reported a case of diphtheria my
report was received with incredulity, and I was in-
formed that the disease was not known in the Straits.
Since then there have been a number of unmistakable
cases, many of them fatal.

A warm, moist climate such as this is an ideal one
for the breeding of pathogenic micro-organisms, espe-
cially in the crowded native quarters, and it remains
a matter of quarantine to keep other infectious germs out.

It is scarcely necessary to animadvert ou venereal
diseases, which have always caused a large proportion
of admissions to hospital, except that they are prob-
ably an important factor in the causation of insanity,
yet general paralysis of the insane, as it appears in
Europe, is unknown in Asiatics, and locomotor ataxy
is rare.

The Asiatic is becoming Europeanised — too much
so—stalls for the sale of bread and butter may be seen
along the streets; the domestic servant, who would
not help himself to any European beverage but brandy
and sherry, has now taken quite kindly also to whiskey
and beer, and in fact to anything with alcobol in it,
very much to his detriment; and now, though the
admissions for alcoholism are still mostly in Europeans,

COLONIAL MEDICAL REPORTS—THE STRAITS SETTLEMENTS. 35

there are a few Asiatic admissions from this cause,
Chinese, Sikhs, and Tamils.

Three thousand one hundred and sixty-one patients
(of whom 220 were females) were admitted, as against
3,104 in 1903, and the total number treated was 3,275,
as against 3,233 in 1903.

The average dailynumber of sick was 163:045 — ће
highest on record—as against 130:22 in 1903.

Deaths.—There were 304 deaths (28 among females),
73 of which occurred within а few hours of admission.

The percentage of deaths to total treated was 9:282,
as against 9-029 in 1903.

European Wards.—There were 615 cases (of whom
70 were females) admitted to these wards. European
members of the Police Force are included in these
admissions. ; :

. The diseases for which the greatest numbers were
admitted were: Venereal diseases 71, malaria 49,
alcoholism 89, tuberculosis 31, dysentery 19, rheu-
matism 10, parasites 10, liver abscess 9, hepatitis 7,
appendicitis 6.

ocal and general injuries were the cause of 70
admissions.

Zymotic Diseases.— Small-pox 4, dengue 29, mumps
3, enteric fever 22, influenza 1. :

Transfers.—There were 11 transfers, 3 to quaran-
tine, 3 to native wards, and 5 to lunatic asylum.

Deaths.— There were 42 (6 being females).

The percentage of deaths to total treated in the
European wards was 6:614.

Native Wards (not including native police).—
There were 2,169 patients (of whom 150 were females)
admitted, as against 2,187 and 141 respectively in
1903.

The diseases for which the largest numbers were
treated were: Malaria 235, insanity 162, beri-beri
118, venereal diseases 140, dysentery 86, tuberculosis
67, ulcer 63, abscess 39, pneumonia 35, anemia 24,
diarrhoea 23, bronchitis 20, rheumatism 20, fistula
in ano 15, alcoholism 12, constipation 12, debility 21,
heart diseases 11, asthma 11, hernia and sprue, each
10, Bright's disease 7, hepatitis 6, appendicitis 5,
abscess liver 3.

Local and general injuries were responsible for
630 admissions.

Zymotic Diseases.—Enteric fever 52, dengue 12.

Five Chinese patients developed beri-beri in the
ward while under treatment for other diseases respec-
tively 14, 19, 71, 111 and 115 days after admission.

Deaths.—There were 261 deaths (22 of whom were
females) among patients treated in the native wards ;
65 died within a few hours of admission.

The percentage of deaths to total treated was 11-63.

The number of native private patients depositing
money in advance to defray hospital expenses was
662, as against 778 in 1903.

Native Police.— There were 377 admissions, as
against 353 in 1903.

The causes of admission were: Venereal diseases
79, malaria 49, malingering 40, bronchitis 16, ulcer
15, dysentery 15, tubercle 10, rheumatism 10, Бегі-
beri 6, pneumonia, asthma, varicose veins and sprue,
each 4, alcoholism 3, local and general injuries 21.

Zymotic Diseases.—Dengue 4, small-pox 1, chicken-
pox 1, enteric fever 2, and influenza 4.

(Мау 15, 1906.

36 THE JOURNAL OF TROPICAL MEDICINE.

Transfers.—One to quarantine camp.
Absconders.—There were 58, mostly Malays.
Deaths.—One Malay died of beri-heri.

Percentage of deaths to total treated, “25.

Medico-legal Work.—There were 1,242 cases sent
to hospital by the police for examination or admis-
sion, as against 914 in 1903.

There were 57 dead bodies sent for post-mortem
examination by the coroner, as against 76 in
1903.

There were 189 persons sent to hospital for ob-
servation as to sanity, as against 161 in 1903.

My observation with regard to sending these to the
General Hospital in my report for 1903 holds good
for 1904.

Operations.—There were 226 surgical operations,
requiring the administration of a general or local
anesthetic, performed during the year.

The most numerous and interesting were: On
tumours 3, abscess 31, excision of glands 23, removal
of sequestra 13, excision of shoulder 1, amputations
20, trephining skull 2, harelip 1, enucleation eye-
ball 5, suturing divided tendons 3, paracentesis thora-
cis 1, excision, of ribs for empyema 1, exploratory
puncture of liver 2, gastrostomy (Francke’s) 1, hepatic
abscess, 12, abdominal section for suturing wounded
intestine 3, strangulated hernia 9, hernia radical cure
2, typhlitic abscess 1, fistula in ano 12, circumcision
17, hydrocele radical cure 8, removal lymph scrotum
1, elephantoid labium 1, curetting uterus 3, ovari-
otomy 1, abdominal section for pelvic hamato-
cele 2.

During the last twenty-four years it has been my
practice to give from 25 to 30 minims of tincture
of belladonna a quarter of an hour or twenty minutes
before the administration of chloroform, and I have
had no case of death from chloroform in my prac-
tice during all these years. The active principle
of this drug has a paralysing action on the cardio-
inhibitory fibres of the vagus and so prevents
reflex inhibitory impulses from affecting the heart's
action.

Asan Asiatic will just as soon part with his life
as with a limb, a great deal of the surgery in this
hospital is necessarily ultra-conservative, and the
death-roll is consequently heavy, and stay in hospital
long. On the other hand, the most wonderful re-
coveries take place sometimes.

Stafi—I have been in charge throughout the
year.

House Surgeons.—Dr. Ford and Dr. Barrack have
been house surgeons, and on September lst, Mr.
A. P. Dantes, M.R.C.S., L.R.C.P.Lond., assistant
surgeon, took duty in addition as acting house sur-
geon, thus placing a great deal more time for purely
professional work at the disposal of the house
Surgeons.

It would be to the advantage of the hospital to
have three house surgeons permanently, there being
too much work for two.

In the subordinate staff I have to record numerous
changes again, militating against the efficiency of the
hospital.

PoricE Foros.

Report by Dr. W. G. Ellis, Police Surgeon.

The total number of the force attending the out-
patient room at the Central Station was 4,096, as
compared with 3,478 for 1903, and 4,305 for 1902.
More of these than is usual were malingerers, and
when it could be definitely brought home to them
they were reported and punished. Latterly I have
sent many of those whom І considered to be malinger-
ing to hospital for observation, where they were
detained for & few days and so lost their pay, and
the crime is now diminishing.

The greatest number seen on any one day was
84, the lowest 2.

The average daily number attending shows a slight
increase over the previous year; it was as follows :-—

Month 1899 1900 1901 1902 1008 1904
January — .. | 32-72 ! 17-69 | 14:19 | 1-92 | 12-08 | 11-88
February — .. 9895 18:83 | 19-55 | 11-70 | 15-90 | 11-62
March.. |. | 29-76 | 18-15 | 13°73 | 11-12 | 11-72 | 12-11
April . | 28-04 | 18:02 | 14-86 | 17:10 | 12-14 | 11-12
May 28-57 | 19-01 | 12-34 | 17-32 | 11-68 , 14-52
June . . | 25-65 | 22-64 | 19:38 | 17:70 | 18-74 | 15-61
July .. | 28-08 ' 18-72 | 11-77 | 15:00 | 19:18 | 15-07
August .. | 22-37 | 18-97 | 12-65 | 19-05 | 11-08 11:88
September .. | 28-65 | 16-04 | 13:08 | 14-00 | 10-46 | 12-69
October .. | 29-19 21-93 | 12-66 | 14:10 | 10-25 | 16:46
November |. | 26-65 : 91-50 | 18:9 | 14-10 |1068 | 18-57
December .. | 25-84 18-91 | 13-08 | 16-22 | 10-80 | 14:82

|

Of the out-patients seen, 857 were sent to hos-
pital as in-patients, compared with 556 sent to hospital
in 1899, 290 in 1900, 294 in 1901, 350 in 1902, and
317 in 1903. Others of the force have been admitted
to the General Hospital for treatment, having been
sent by inspectors as urgent cases ; of these I have no
records.

The 357 were suffering from the following disorders :
Unclassed fevers 65, intermittent fever 5, dengue 10,
enteric fever 2, dysentery 10, diarrhcea 17, beri-beri
12, phthisis 4, bronchitis 16, pneumonia 1, appendi-
citis 1, Bright's disease 2, rheumatism 11, syphilis 40,
gonorrhea 37, cellulitis 20, synovitis 5, ulcers 8,
minor injuries 9, hydrocele 3, eye and ear affections
9, skin diseases 6, tape-worm 8, alcoholism 4, debility
9, malingering 48.

During the year there have been 70 cases of beri-
beri, with 2 deaths, and necessitating the invaliding of
three men from the service. Nearly all of these cases
occurred in the Central Station in the months of June
and July. This station at the time was much over-
crowded, men using the same beds in relays, and no
proper attention was paid to cleanliness. The cessation
of the overcrowding, a thorough clean up, and the
regular use of disinfectants, quickly bore fruit, though
a few odd cases continued to occur until nearly the end
of the year. Thecases were mostly slight, and coming
under observation early soon recovered upon being
transferred to the seaside stations.

Three hundred and thirty-three candidates for the
force were examined during the year; of these 262
were passed as fit, and 71 were rejected.

Мау 15, 1906.)

The causes for rejection were as follows: Over
age 4, ill-development 24, phthisis 8, hernia 2, anemia
4, heart disease 9, enlarged spleen 7, hydrocele 1,
venereal diseases 8, and impaired vision 4.

The nationalities were: Twelve Europeans passed
and none rejected, 117 Malays passed and 35 rejected,
52 Sikhs passed and 14 rejected, 37 Indians passed and
12 rejected, 30 Chinese passed and 8 rejected, 5 Eura-
sians passed and none rejected, and 9 Sikhs passed for
re-engagement and 2 rejected.

Tne sanitary conditions of the 35 stations are fairly
satisfactory, and several minor improvements have
been completed during the year. Details of inspections,
with my suggestions, are made in a book which is
forwarded to the Chief Police Officer from me to
time.

Prison HosPrTAL.
Report by Dr. J. Leask, Colonial Surgeon in Charge.

The sanitary condition of the prison was fair, and
was further improved during the year.

I mentioned in my report for 1903 that more ventila-
tion was required for the cells and in the Middle Grade
Work Yard.

Dr. C. W. Daniels, Director of the Institute of
Medical Research, Federated Malay States, visited the
prison in February and reported on its sanitary condi-
tion, making certain recommendations.

The following additions and alterations were carried
out :—

(a) Perforated iron plates were inserted at the
bottoms of the cell doors, giving better floor ventila-
tion.

(b) Iron weather-boards were fixed over the eell
windows, and the wooden boards placed inside the
windows in wet weather were done away with. In
some instances, notably at the punishment cells, these
ре have been too much sloped, cutting off too much
ight. Y
(c) The bathing tanks were separated from the
latrines, thus doing away with a possible source of
contamination of water, as prisoners will drink from
the bathing tanks when not watched.

(d) The latrine in the kitchen, also contiguous to а
water-tank, was done away with, and а more sanitary
arrangement made outside the kitchen.

(e) А new set of water-pipes was laid throughout the
prison, away from the drains, doing away with another
possible source of water contamination.

(f) The cement work of the prison was relaid
throughout, with the exception of the interiors of the
halls. When newly laid down this work has been so
slippery that a number of accidents have occurred—
two warders slipped and broke their arms, and quite a
number of falls amongst warders and prisoners have
occurred.

(g) The flat parts of the roofs of the blocks were
sloped and extra down pipes fixed in order to carry
away storm water more rapidly.

(h) Iron gratings were substituted for honeycomb
brickwork in the arches under the blocks. These are
hinged and locked so as to give access for cleaning
purposes.

COLONIAL MEDICAL REPORTS—THE STRAITS SETTLEMENTS. 37

(2%) The flattened roof ends of the worksheds and
wheelhouse were carried out as open gable ends, and
this has produced a marked improvement in the air of
these places.

(j) An allowance of soap is now being issued to the
prisoners for body cleansing.

(k) The substitution of brick for corrugated iron
artitions between the cells is being carried on steadily,
ut not very carefully, as I notice numerous

crevices at the angles of the cells.

In spite of all improvements three cases of enteric
fever occurred, two of whom must have contracted the
disease in the prison; dysentery has been prevalent;
one case of what was clinically cholera occurred, and
beri-beri cases have increased in numbers.

The health of the prisoners during the year was not
satisfactory. Although there were fewer admissions
to hospital (1,009, as against 1,041 in 1903) the aver-
age daily sick was much higher (72:47, as against 44:96
in 1903) and the number of deaths was greater than
during the previous year.

There were 52 deaths in hospital, as against 45 in
1903 and 38 in 1902, giving & death-rate of 48:01 per
mille of total treated, as against 40:7 іп 1903 and 26-04
in 1902.

Out of 3,052 male prisoners examined on admission,
1,146 showed signs of present or past venereal disease,
as against 916 іп 3,272 admissions in 1908.

D:ets.—Bengal rice, 4.6., rice which has gone
through a process of malting, was given instead of
Siamese rice on November lst (except for congee
making, for which it was unsuitable).

Births.—A Chinese short sentence prisoner was
delivered of a child in February.

Work done in Hospitai.—There were 74 patients
remaining in hospital on December 31st, 1903 ; 1,009,
of whom 10 were females, were admitted during 1904,
giving a total treated of 1,083. Of these, 936 were
discharged, 30 transferred to Malacca, 52 died, and 65
remained on December 3186, 1904.

The diseases responsible for the greatest number of
admissions were :—

Beri-beri 266 cases, as against 169 in 1903 and
415 in 1902.

Fevers 163 cases, as against 163 in 1903 and
188 in 1902.

Dysentery ... 136 cases, as against 104 in 1908 and
156 in 1902.

Dyspepsia ... 87 cases, as against 43 іп 1903 and 66
in 1902.

Diarrhea ... 67 cases, as against 112 in 1903 and
186 in 1902.

Deaths.—There were 52 deaths, as against 45 іп
1903. The causes of death were dysentery 19, beri-
beri 17, pulmonary tuberculosis 7, heart disease 2,
cholera, enteric fever, cancer of stomach, fibroid
phthisis, enteritis, compound fracture of thigh and
cerebral hemorrhage in beri-beri patient 1 each.

Beri-beri.—Instead of exacerbating towards the end
of the year,-as it did in 1903, this disease quickly
declined from September, as shown in the subjoined
comparative table.

In the firat quarter of the year there were 63 ad-
missions and 2 deaths, in the second quarter 55
admissions and 3 deaths, in the third quarter 108

38

THE JOURNAL OF TROPICAL MEDICINE.

[May 15, 1906.

TABLE A—2.

SHOWING THE ADMISSIONS AND DEATHS MONTHLY SINCE THE BEGINNING OF THE OUTBREAK.

|

$ 1898 1599 1901 1902 1903 1904
|
F4 х т ҒА x | ! т т т

Month Bis B la| 8 z. 5 s Žig 5 'z| 8 |g] 813

21043 PEQOS ee 4 2%- 3/3 CR ee meee 63

ele eS (Sb T à & o£ alá Bo] ЕА рв Le

< < 124 < |, < | 5 < <
January | 92 5 .. 15 1 22 ıl | 2| 80 | 2
February 1 95 8 ..101.. 8 1 6 |..]| 18 7..
March " 25 T Eat Pts 92]... 6 |..| 90 ,..
April 1| 23 Б. AT) vas BC srl, 3 16 '..
May is zi Sag Van Mos 2 ,;.. 51. 1412 25 1 Bj. 1 98 2
June ae se .. 0. 0 s qe [т рас аа 97,8 79 /8| 3 1 | 1
July... a 1 7 .1 86 12, 2 , 2 861.. 1]|..|29 | 1
August .. e 2 19 в 12)! a7 i..| .. {.. | 8412
September e 6 3 | 82 | 1 10 ;. 36 8 2 |..| 45 7
October.. 22 10 5 |..| 94 ' 2: 19 | 1, 6 | 1| 7 [..| 296 , 1
November 9 78 1 8 1.., 44 Ti 41 1 395 1; 58 6| 10 ..
December 1. 22 16 | 2| 7 ar; 96 | 2 g2! 1/65 | в 411
d D
3 194 | 1/165 | 2; 224 198 219 | 9 415 | 1/169 |16| 266 |17
| l i д {

admissions and 10 deaths, and during the fourth
quarter 40 cases and 2 deaths.

The third quarter was therefore the most unhealthy
as regards beri-beri this year, and in consequence of
the large numbers overcrowding the hospital, 30 cases
of beri-beri were sent to Malacca on October 6th.

There were 266 admissions and 17 deaths, as against
169 admissions and 16 deaths in 1903, giving the per-
centage of deaths to total treated as 6:7, against 9 4
in 1903. :

Grades Affected.— One hundred and fifty-three cases
of beri-beri occurred among short sentence prisoners,
68 among middle, 21 among lower, 15 among revenue,
and 5 among upper grade prisoners : 3 cases occurred
in prisoners undergoing simple imprisonment and one
in a civil prisoner.

in the Times newspaper on the Chinese coolie question in
South Africait was stated by a medical writer that females
were immune from beri-beri. There were 6 well-marked
cases of beri-beri in female prisoners in 1904, 1 Chinese
and 5 Malays. In 1900 there were 7 female cases ; іп
1901, 1 Chinese ; in 1902, 1 Chinese ; in 1903, 1 Malay.

Length of Imprisonment of those Attacked.—Of the
266 admissions, 51 were primary attacks occurring in
prisoners under three months in prison; 87 were
primary attacks occurring in prisoners over three
months in prison; 5 were recurrences occurring in
prisoners under three months in prison ; 52 were recur-
rences occurring in prisoners over three months in
prison; 10 were admitted suffering from the disease,
and 61 had а previous history of having suffered
from beri-beri outside the prison.

TABLE A—3.

TABLE SHOWING THE INCIDENCE OF BERI-BERI IN THE DIFFERENT GRADES, SINCE THE BEGINNING OF THE OUTBREAK.

Grade 1897 i 1898 | 1899
| |» | _
Upper B 7 6
Middle a 94 | 193
Lower 84 2 8 6
Short Sentence 3 19 ^! 9
Revenue xx ee e M 3 | 6
Civil Prisoners zs is vs 2% | 1
His Majesty’s Pleasure : dx
Females zs |

Total 8 124 | 165

1900 | 1901 1902 1903 1904 Total
|
9 | аз 19 9 5 68
105 i 55 129 97 68 611
40 40 102 97 91 244
52 102 136 88 158 569
8 7 | 19 5 1010 68
9 2 10 3 ! 4 22
1 ae es ws De 1
7 19.1 1* 1* 6* 1
n кеттик ERE ee — ---
! П
994 219 ‚415 | 169 266 1,585
] l i

Nationalities attacked by Beri-beri.—Chinese 229
with 15 deaths, Malays 28 with 1 death, Indians 8
with 1 death, and Filipino 1.

Sexes attacked by Beri-bert.—In the correspondence

А * Included under Grades.

Deaths from Beri-beri.—There were 17, and one beri-
beri case died of cerebral hemorrhage and softening.
Of these, 14 were short sentence, two middle and one
lower grade prisoners.

June 1, 1906.)

COLONIAL MEDICAL REPORTS—THE STRAITS SETTLEMENTS.

39

Colonial Medical Reports.—No. 21.—The Straits Settle-
ments (continued).

. Dysentery.—There were 136 admissions and 19
deaths, as against 104 with 13 deaths in 1903. Тһе
disease continues to be of а severe type, and
ipecacuanha in large doses, with intestinal irrigation
(alkaline in the early stages, and of nitrate of silver 4
grain to one ounce in later and more chronic cases),
have given the most satisfactory results. А

Post-mortem examinations in the fatal cases have
shown the same deep necrosis of tissue mentioned last
year. :

Grades Attacked.--Short sentence 62 cases, middle
grade 33, lower grade 22, revenue grade 7, upper
grade 3, remand prisoners 4 (simple imprisonment 8),
and 2 prisoners from banishment.

Nationalities.—Europeans 2, Chinese 93 with 12
deaths, Malays 27 with 1 death, Indians 13 with 5
deaths, Anamite 1 died.

Dyspepsia.—This has been more prevalent this year,
causing 87 admissions, as against 43 in 1903. Fissured
tongues and cracked lips, and an eruption of lichen
planus are also making their appearance.

Zymotic Diseases.—One case of chicken-pox and one
case of measles occurred in short sentence prisoners.
The former case probably contracted in prison, and
the latter probably came into prison with the disease
in the period of incubation.

` Cholera.—One Chinese short sentence prisoner con-
tracted cholera after having been over three months in
prison, and died within а few hours. Clinically, it
was а typical case, but the bacteriological examination
was negative. f

Enteric Ferer.—There were 3 cases during the

year. .
The first was that of a European short sentence
prisoner who was committed to prison on July 22nd,
and admitted to hospital on August 2nd, having been
feeling unwell for eight or ten days before.

The second case was a Cbinese lower grade No. 164,
committed to prison March 1st, and admitted to hos-
pital December 13th. Тһе source of infection was
probably outside tbe prison.

The third case was a Chinese lower grade No. 175,
committed to prison March 16th, and admitted to hos-
pital December 21st.

The European and one of the Chinese (No 175) re-
covered, and the other Chinese (No. 164) died.

In the two latter cases Widal's reaction was positive.

In the fatal case the post-mortem appearances were
very well marked.

There was one case of mumps.

In none of these infectious cases could the source of
infection be traced.

Tan Tock Sena’s HosPrTAL.

Report by Dr. №. S. Shepherd, Acting Colonial
Surgeon.

Buildings.—Only such repairs as were absolutely
necessary have been executed during tbe year, owing
to the prospect of an early removal of the hospital to
& new site.

The usual whitewashing and tarring were performed

twice during the year by the Public Works Depart-
ment. |. - n

"Growwdls.—The digging of long trenches in many
places leading into the main drains has done much to
improve the drainage of the grounds.

The hospital is to be congratulated on having ob-
tained the services of Dr. Finlayson as Pathologist.
He now-conducts the autopsies in all cases except
those of medico-legal interest.

Statistics. — Тһе total number of patients treated and
the death-rate are set down in Table I., which also
gives the figures for the preceding nine years. The
death-rate —22:4 per cent.—is a little below the

average.

А certain number of admissions are readmissions, as
stated in last year's report. It is not easy to estimate
this number, as patients when seeking readmission
frequently give a new name.

The average daily number was 571.

Table II. gives the diseases for which admission was
chiefly sought in 1904 and the previous four years, also
the number of deaths from these diseases.

` Beri-beri.— One thousand one hundred and twenty-
five cases were admitted, as against 975 in 1903. Iam
inclined to attribute to this increase in our numbers
the increase in our death-rate from this disease—46
per cent., as against 36 per cent. in 1903. Our beri-
beri wards were undoubtedly too crowded, but there
seemed no option between admitting the sick and
sending them back to their houses to die. Many of
our admissions under this head were cases brought in
by the police, who could not be refused admission. A
certain number of cases about 60—appeared to have
originated in the hospital; but owing to tne difficulty
of diagnosing latent beri-beri it is not possible to esti-
mate this number with exactness.

During the year trial was made of potassium per-
managate as в remedial agent, this drug being admin-
istered in two-grain doses twice daily. No good
appeared to follow this treatment and after & few
months it was discontinued. Our experience seems
to indicate that а milk diet is best for this disease.
Blisters over the pericardium appear to relieve the
distressing cardiac dyspnoea better than any other
treatment.

Fevers.—There were 617 cases of malarial fever, 245
cases being of the benign and 372 of the malignant
variety. The prevalent benign form is tertian, not more
than a dozen cases of quartan occurring in the year.
Twenty per cent. of malignant and seven per cent. of
the benign cases proved fatal, many of the patients
being brought in іп a comatose condition by the police.

The intramuscular injection of quinine has been
practised in all cases when a rapid result was desir-
able. No ill-effects have been recorded in a single
instance.

There were 70 cases of enteric fever with 36 deaths,
as against 11 cases with 7 deaths in 1903. The high
mortality rate is due to the lack of skilled nursing and
to the fact that the patients are so often brought to
hospital in a dying condition. ;

Fourteen major operations were performed, mostly
amputations of the leg for large intractable ulcers.

General Remarks.—During the year I have found it
necessary to institute the following changes :— :

40

THE JOURNAL OF TROPICAL MEDICINE.

[June 1, 1906.

To set apart а separate staff of dressers for night
duty. Hitherto continuous night and day duty has
been expected of the dressers, an obviously impossible
expectation.

he only drawback to the present system is that it
depletes our already very insufficient day staff.

"Two senior dressers have been set apart, one for
dispensing, the other as steward.

o attempt to locate the dresser to the wards under
his particular care. То this end, a table and a chair
have been given him in one of his wards, and the
dressers' room, situated too far away from the wards
to be useful, has been converted to another purpose.

А system of diet indent book wherein the dresser
writes his indent each afternoon for the succeeding
day. This secures a permanent record, by which
expenditure can be cheoked by myself.

А daily roll-call of the attendants has, indirectly,
done much to lessen the number of those running
away after each pay day.

An attendance book has been placed in each ward
for recording the time and duration of the assistant
surgeons’ and dressers’ visits.

The large staff of ward attendants, coolies, barbers,
toties, &c., amounting to about seventy men in all,
has been struck off the list of patients. Our daily
average number of patients is thus less by this number.

TABLE I.
Tan Tock Зема’в HOSPITAL.

Percentage

Year | Remain dmit Total Died | Average s to

ed | Admitted | Daily Sick of Deaths to
1895 | 586 ! 5,583 | 6,119 | 1,465 547 29-94
1896 | 547 | 7,041 | 7,588 | 2,194 | 575 | 26-72
1897 | 652 | 7,110 | 7,762 | 1,799 598 99:89
1898 | 617 | 6,425 | 7,042 | 1,402 623 19-63
1899 | 583. | 5,887 | 6,470 | 1,994 560 | 4150
1900 | 583 | 5,941 | 6,594 | 1,459 | 574 23-36
1901, 549 | 6,556 | 7,105 | 1,694 563 | 23-84
19021 598 | 6,562 | 7,090 | 1,583 599 99:39
1903 | 550 | 6,968 | 7,518 ' 1,668 589 29-12
1904 | 502 | 6,536 | 7,098 | 1,590 | 571 | 22:40

|
TABLE II.

Тан Tock SENG's HosPiTAL.
Showing Admissions and Deaths from certain Diseases.

i -
1904 ; 1908 1902 1901 1900
|
Р a ! a! Р z | ш т
Diseases 1 521|,),8.3181|31|51|2.28(%
z z = 51% 3/8 i\i2°813
Z 2 |5034 8034
Е E S AIE åE JAE 4
ааа ера је
Beri-beri . 1,125 521 1975 | 895 152 912 тат | 405 тов 305
Uleer 679; .. 893 .. | .. 1... |743... 819| ..
Rheumatism 327) .. 674) .. .. |518 651 | ..
Anemia 280| 83 |549 167 |324 106|294| 99 301 |113
Debility 233 | 193: 480 184 | 869. 118 | 875 | 172 |150| 84
Diarrhea 219 , 115: 402 1959 | 296 176 | 398 | 279 437 | 285
Dysentery 195 95'956'197| .. 96] .. 1126! .. |158
Secondary i l i
Syphilis | 337 | 29|344| 54| .. .. |420; 35 |324 | 38
Tuberculosis 843 , 212 | 288 | 190 ! 498 . 293 | 412 | 273 | 276 | 186
Malarial Fever | 617, 95! .. i SE sete Lae doe

ША

QUARANTINE CAMP.
(1) BmaLL-POX. `

Male .. 25
Female s

Of those treated, 8 were Chinese, 6 Tamil, 6 Malays, and 6

' miscellaneous,
(2) Вовохіс PLAGUE.
| ! | |
| i ЕЕ ds Е т E ! H
iB P,5 § 3
8 < a | < &
Male .. m" ie 7 08 8 ! 8
Female 55 aon ДЕ: 8

Of these cases, 8 were Chinese, 1 Tamil, and 2 Bombay men.

(8) DIPHTHERIA.

2/2 |g $123 E
ЕЕ ёа |А ЕЕ
2 3 a < a
Male .. 2 | 8 8 1 2
Two were Chinese, and 1 Arab.
LEPER ASYLUM.
ecl $e J l ;
з | я 2) Fa Sy. ÍF
i$:318|3 Ер
. C 8 3 ё E E i i & | E
Male .. | 15 59 74 9 22 2 31 10
Female 20 6 26 25 es 53 | 6 | 20

The sanitary condition of the asylum was good.

The space allotted to the females is, however, ve
limited. The nine males discharged were hande
over to the care of their relatives by order of the
magistrate.

Lunatic ASYLUM.
Heport by Dr. W. G. Ellis, Medical Superintendent.

The average daily number of patients resident
during the year was 268 (males 213, females 55), an
increase of 53 males and 6 females as compared with
the previous year.

On December 31st, 1903, there remained 231
patients (males 179, females 52). There were admitted
in 1904, males 223, females 31, making the. total
treated 402 males and 83 females. The maximum

June 1, 1906.)

COLONIAL MEDICAL REPORTS—THE STRAITS SETTLEMENTS. 41

and minimum numbers іп the asylum оп any опе day of
the year were respectively 305 and 229.

Of the 283 patients remaining on December 31st,
1904 :— i

Males. Females. Total.
151 .. 85 . 186 came from Singapore.
80/2 LL ae 50 » » Penang.
8 .. 3» riii 1t -, . Province >
Wellesley.
15 .. 1. “е 16 » » Malacca. .
S. x» ізе 42 5 » 9, British North
Borneo.
е x lm t 1 » » Labuan.
19- 4. locus 13 » oy Negri Sem-
bilan.
] .. — .. 1 » » Johore.

There were 12 criminal lunatics and 2 lunatic
eriminals under treatment on December 31st, 1903 ;
9 criminal lunatics and 8 lunatic criminals were
admitted during the year, making а total of 31
criminals treated; of these three were discharged
recovered, 6 on expiry of sentence were transferred as
ordinary patients, 4 died, and 14 criminal lunatics and
4 lunatic criminals remain under treatment.

Evidence of past and present venereal disease in
the admissions, as in previous years, is common.
Over 24 per cent. had suffered from syphilis, a per-
centage that has gradually increased from the 13:48
per cent. of the 1896 admissions. Syphilis was the
undoubted cause of the insanity in many of the cases,
and was the cause of death in 8 cases, 3 being due to
gumma in the brain.

Beri-beri.—From October 18th, 1903, to October
13th, 1904, all patients were fed on the cured Bengal
rice, and during this period but one case of beri-beri
occurred in the asylum, a case attacked early in
November, 1903. During this same period the disease
was epidemic in the Singapore gaol, and formerly
when epidemic in the one institution it was invari-
ably epidemic in the other. On October 13th, 1904,
we returned to the uncured Siam rice, and in Decem-
ber 15 cases of beri-beri arose, coming from all parts
of the asylum, though none occurred amongst the 20
males and 8 females kept on Bengal rice as controls.
I am far from being convinced that the consumption
of the uncured rice is the cause of beri-beri, and have
yet several experiments to complete; but my experi-
ence of the past few years, since making researches
into the subject, certainly tends to make me far less
antagonistic to the theory than formerly. My work
is not yet ready for publication, but shortly I trust to
have some results to bring forward.

In the early part of the year some of the under-
ground drains in the lower levels of the asylum became
blocked, and at the same time an epidemic of dysen-
tery and diarrhea broke out. In all there were 47
cases of bowels diseases with 9 deaths. The drains,
after some delay, were dug up, substituted by surface
. drains, and the health of the asylum improved.

Towards the end of the year the asylum became
considerably overcrowded, a possible factor in the
outbreak of beri-beri, and the health of the patients
Suffered, many being attacked with dysentery and
diarrhoea. i

I am happy in being able to state that it has been
decided to construct a new asylum upon- modern and
sanitary lines as soon as possible, and an excellent
site with sufficient land for a farm has been chosen.

Admissions.—Two hundred and twenty-three males
апа 31 females have been admitted during the year;
of these, 22 males and 7 females were readmissions.

One hundred and sixty-six males and 24 females
eame from Singapore, 21 males and 2 females from
Penang, 17 males and 1 female from Malacca, 4 males
and 3 females from Province Wellesley, 11 males arid
1 female from Negri Sembilan, and 4 males fro
British North Borneo. : ай

The physical condition of those admitted was іп a
large number of cases deplorable, as із овца here: Of
the 254 admissions, 85 were chronicled as physical
condition impaired, and 47 as greatly impaired. Of
these latter, 15 died before they had been in residence
a month.

Discharges.—One hundred and four patients have
been discharged recovered, equal to a recovery rate of
40:94 on the admissions. This is a marked improve-
ment upon last year, and must be considered satis-.
factory.

Twenty-three patients were discharged relieved and
11 not improved to the care of their friends. A far
larger number of patients are fit to be discharged in
this way, but their friends and relatives are in China,
and we have no means of communicating with them.

Deaths.—Forty-eight males and 11 females died
during the year. The percentage of deaths -on- the
&verage number resident was 22:01, the lowest since
1893. ^

Forty post-mortem examinations were held and the
results recorded. І

Industries.—During the year there have been manu-
factured 3,792 yards of cloth and 33 blankets. From
the cloth there have been made 745 pairs of trousers,
656 jackets, 261 women’s jackets, 163 sarongs, and
108 dusters.

About 80 per cent. of our inmates are usefully
employed, every encouragement in the way of small
luxuries such as tobacco, fruit, &c., being given them
to this end.

Marernity HOSPITAL.

Report by Mr. М. А. Wray,
іп Charge.

The buildings are in good order. Four additional
dwelling-rooms were erected during the year for
servants.

Whitewashing, tarring and painting were carried
out during the year. __

Dr. Fowlie continued to render his valuable services
to the hospital.

Mrs. Hennessy, the matron, has done very good
work.

One probationer, Mrs. Massabini, passed her ex-
amination and received а diploma as midwife. Mrs.
White is still under training.

The number of admissions (72) shows a decrease of
18 on last year, but as the hospital was closed from
March 23rd to May 23rd owing to à case of septic-

Assistant Surgeon

42 THE JOURNAL OF TROPICAL MEDICINE.

[June 1, 1906.

өшіп occurring in the hospital, the numbers compare
favourably with previous years.

The following table shows the work done during the
year :—

| i
(aima joe Discharged |Died Remaining
à
І
i

Nationality Remaiued

!

Europeans .. | 1 98:22) 99 i
Eurasians ..| .. 4 4; 4
Tamils ел 3 95 28 . 28 52
Chinese — ..| .. 10 10! 8 2
Hebrew Sie: Dale 4 4 4 Хр
Singhalese .., .. 1 5 li ass 1
—— -c m! d I —————

276 | 73 3

Total .. 4 72

The three deaths were due to (1) septicemia, (2)
shock on dc membranes in & case of placenta
previa, and (3) from beri-beri and peritonitis, the
patient, & Chinese, having been, it was said, in labour
for nine days before seeking admission.

The average daily number in hospital was 2-02.

Of the 66 labours in hospital, 58 were natural, 4
were difficult, 8 were preternatural, and one was
complex.

There were 3 cases of placenta previa. Тһе first,
a Singhalese lady, died of septicemia, the second, a
Chinese, succumbed to shock, on rupturing the mem-
branes, and the third, а European, came in early and
made a good and rapid recovery.

There was one case of foot presentation and one of
breech. There were also one case each of partial
inversion of the uterus and premature detachment of
the placenta. Forceps were used in three instances.
There was one case of abortion in the fifth month.

Hemorrhage occurred in five cases, three unavoid-
able (placenta previa) and two accidental (partial
inversion of the uterus and premature detachment of
the placenta).

Of the 66 births, 57 children were born alive, 8 were
stillborn and 1 prematurely, the sexes being 30 males
and 36 females.

PENANG.
Report by Dr. Т. С. Mugliston, Colonial Surgeon.

The public health of Penang for 1904 has been up
to the average of previous years, and judging from the
total number of deaths registered and by the death-
rate per mille of the estimated population, though not
во good as 1903, was better than that of the year 1902.

The total number of deaths registered was 5,517, as
against 4,988 in 1903, and 5,787 in 1909; of the total
number of deaths registered, 4,222 were within muni-
cipal limits and 1,295 in country districts. On an
estimated population of 130,602, this gives a crude
mortality of 49:24 per mille. Eliminating the deaths
at Pulau Jerejak (Leper Asylum 140, quarantine sta-
tion 6, and of those dying shortly after arrival in the
colony, 309; town 279, country 30), the corrected
death-rate for the island comes to 88:75; 40:49 per
mille for the population within municipal limits, and
38-06 per mille for the country.

Zymotic disease in epidemic form was absent ;
small-pox, 3 cases only occurred in the town; 16
cases were imported and removed from vessels ; of
these 19 cases, 7 died. Chicken-pox—there were 66
cases (8 cases imported) ; measles 9 cases.

Cholera.—No cases were reported; 5 cases were
imported and treated on Pulau Jerejak.

Enteric Fever—One hundred and thirty-eight
deaths were registered. According to hospital sta-
tistics, there were 10 admissions, with 6 deaths.

Plague.—Two cases occurred among a ship's crew,
both cases were removed to the quarantine station,
Pulau Jerejak, and died ; the diagnosis was confirmed
bacteriologically. No cases occurred in the town or
country.

The infant mortality for 1904 was rather high, the
number of infants dying under one year being 704, or
12:75 per cent. of the total number of deaths regis-
tered, and 28 per cent. of the total number of births
registered. Referring back to the records for ten years,
the number of infants dying last year is the highest,
while the percentage to the total number of deaths
registered comes second to the year 1899. Tetanus
neonatorum accounts for about 19 per cent. of those
infants dying under three months.

On the retirement of Assistant Surgeon O'Keefe on
pension, Dr. Edith Boomgardt, L.R.C.P. & S.(Edin.),
&c., was appointed Deputy Registrar of Deaths.
During the first three quarters of the year 1904 the
percentage of unclassified ‘fever’ cases to the total
number of deaths registered in municipal limits ap-

‘proximated 3:84 (first quarter 1:30 per cent., second

quarter 1:26 рег cent., third quarter 1:28 per cent.) ;
in the fourth quarter, the percentage of such ‘‘ fever ”
cases to the deaths registered in municipal limits is
"78. Under the present careful investigation the vague
item of ‘fever ’’ is much curtailed, and returns are
much better and fuller than formerly, and more care
is taken in arriving at the cause of death. I have
only referred to deaths within municipal limits; the
majority of deaths (nearly 95 per cent.) registered in
country districts are returned as “fever.” If these
unclassified “ fever ” cases, which are returned by the
police, are eliminated, it will be seen that the number
of unclassified “fever” cases in the town is almost
nil.

GENERAL HOSPITAL.
Heport by Dr. G. D. Freer, Colonial Surgeon, Resident.

The total number of cases treated was 2,117, and
the number of deaths 86, as compared with 1,866 and
87 respectively for the previous year.

The average daily sick was 58:53, and the percentage
of deaths 4:66.

European Wards.—There were 208 admissions in
all, of whom 96 were females. Тһе chief diseases
ireated were malarial fever 51, venereal disease 14,
dengue 11, typhoid fever 5, diarrhoea 5, pneumonia 2,
bronchitis 2, injuries 5, alcoholism 6.

Native Wards (excluding police).—The number of
admissions was 1,171 (females 104) and deaths 72.
The chief causes of admission were: Injuries 396,
malarial fever 127, mental diseases 68, venereal
diseases 69, alcoholism 46, ulcers 44, beri-beri 30,
diarrhoea, 25, dysentery 22, bronchitis 28, pneumonia 18.

June 15, 1906.)

COLONIAL MEDICAL REPORTS—THE STRAITS SETTLEMENTS. 43

Colonial Medical Reports.—No. 21.—The Straits Bettle-
* ments (continued).

One hundred and thirty-five Indian immigrants
were sent for treatment from the Indian Immigration
Depot, and sixty-five Sinkehs from the Chinese
Protectorate.

Eighty-two cases were sent for observation as to
sanity, of whom 21 were transferred to the Lunatic
Asylum, Singapore.

Native Police (including Malay States Guides).—
The admissions numbered 686, against 495 for the
previous year, and were made up as follows: Sikhs
355, Malays 297, Hindus 28, Chinese 6 ; of the Sikh
admissions, 104 were from the detachment of Malay
States Guides.

The principal diseases among them were malarial
fever, 157 ; dengue, 45; venereal disease, 48; ulcers,
12; bronchitis, 34; dyspepsia and constipation, 31;
diarrhoea апа dysentery, 10; injuries, 19; pneumonia,
4. There were two deaths from pulmonary tuber-
culosis and malarial cachexia respectively.

Two hundred and thirty recruits were sent for
examination, 155 were passed and 75 rejected. .

Eighty men were boarded as unfit for further
service.

Dengue.—Out of a total of 71 cases admitted to the
General Hospital, 64 were in the months of June,
July, and August. Among the police stationed in the
Fort it was at one time exceedingly prevalent, hardly
a man escaping, and it is interesting to note that out
of the total (71), 45 cases were Sikh police stationed
in the Fort, while from the Malay States Guides
stationed at Sepoy Lines there were only two ad-
missions; also, out of 11 European admissions, 8 were
policemen living in the Fort. At the same time,
although these cases were not specially isolated in
hospital none of the other patients nor any members
of the hospital staff contracted the disease. The
&bove rather points to the conclusion that dengue is
not infectious in the ordinary meaning of the word,
and is in favour of Dr. Harris Graham's theory
(mentioned in Manson's “ Tropical Diseases ”) that, like
malaria and yellow fever, dengue is communicated by
а species of mosquito acting as an intermediary. No
doubt the Fort moat forms an excellent breeding
ground for many species of mosquitoes. There were
no deaths from the disease.

Malaria.— As usual both in the general and pauper
hospitals, malaria accounted for a large number of the
admissions, and in many of these the diagnosis was
confirmed by a microscopical examination. Out of а
hundred consecutive fever cases, mostly Chinese
pauper patients, I find that malarial parasites were
found in 51. In З of these crescent bodies only were
found; in 16 crescent and small signet ring parasites,
in 24 small signet ring bodies only, in 4 benign tertian
parasites, and іп 4 benign quartan parasites. Out of
the 51 patients in whom malarial parasites were
found, 16 were found to have marked enlargement of
the spleen, but in 20 of the others in whom no parasites
had been found, the spleen was also found to be
enlarged. From several of the latter specimens were
obtained by splenic puncture and stained with a view of
showing the Leishman-Donovan body, but in no case
80 far has this been discovered.

Operations. — The principal operations performed
included: Excision of hip-joint, 1; amputation of
thigh, 2; thoracotomy with excision of ribs for em-
pyema, 3 (1 died); for abscess of liver, 5 (3 died);
removal of tumour, 8; excision of lower jaw, 1;
ligature of femoral artery, 8; trephining of skull, 2
(1 died); radical cure of bernia, 1; radical cure of
hydrocele, 2; for strangulated hernia, 2 (1 died);
external urethrotomy (Wheelhouse), 6 ; partial excision
of rectum, 1; excision of eye-ball, 3; tracheotomy,
1; extraction of lens for cataract, 5; altogether 88
operations were performed uuder chloroform.

New Growths.—Seventeen cases of new growths
were admitted into the general and pauper hospitals
during the year. Specimens from seven of them were
forwarded to the Cancer Research Society, but во far
no report has been received as to their nature. The
following are the probable diagnoses with the
nationalities of the patients :—

Sarcoma of neck ... 5 all Chinese.

Sarcoma of orbit 1 Chinese.
Carcinoma of liver ... 1 Eurasian.
Carcinomaof pancreas 1 Eurasian.
Carcinoma of rectum 1 Hindu.
Epithelioma of penis 3 2 Hindus and 1 Chinese.
Epithelioma of lip 1 Malay.
Epithelioma of seba-

ceous cyst of scalp 1 Chinese.
Fibroma of breast 1 Chinese.
Fibroma of thigh 1 Sikh.
Hernia testis (probably

gummatous) .. 1 Chinese.

Medico-Legal.—One hundred and thirty-six bodies
were sent for post-mortem examination and inquest. I
am glad to say that since the completion of the new
* Morgue” in December, dead bodies are now sent
there instead of to the hospital mortuary, a most
desirable change for many reasons.

Prison HosPITAL.
Report by Dr. T. C. Mugliston, Colonial Surgeon.

During the year there were 4,705 admissions into
prison, as against 3,674 for 1903, the daily average
prison population being 421-92.

The admissions to hospital, excluding these detained
under forty-eight hours for trivial complaints or observa-
tion numbered 155, giving an average daily sick of 6:97,
and a daily sick rate of 1:65 of the prison strength.

There were 11 deaths in the prison during the year
(five in the first three quarters and six in the last
quarter) which is equivalent to a mortality of 7:09 per
cent. of those admitted to hospital and 2°34 per mille
of the admissions to prison.

The 11 deaths were due to the following causes :—

Malarial fever ... - да ES!
Phagedena H 7 us wu i
Debility ... t se 225 ES,
Tubercular phthisis x ss e. 9
Chronic diarrhoea ad d 2

Of the total admissions to the prison, 296 bore traces
of or were actually suffering from venereal disease ;
285 prisoners showed marks of a course of morphia
injections, and 76 were confirmed opium smokers.

44

THE JOURNAL ОЕ TROPICAL MEDICINE.

[June 15, 1906.

Vaccination of all prisoners who had not been
previously vaccinated or revaccinated, or who bore
no marks of a previous attack of small-pox, was per-
formed this year on 423, with a percentage of 80-77
successful cases to total vaccinated. ;

Vaccine lymph from Saigon was used in all cases.

PAUPER HOSPITAL. 4
Report by Dr. G. D. Freer, Colonial Surgeon Resident.

Duildings.—New quarters for the senior dresser
were built during the year. Тһе attap roof of Ward 3
was replaced by a tiled one, the wooden supports
replaced by brick pillars, and the floor renewed. Тһе
floors of Wards 2, 9, and 10 were reconcreted and
cemented, and the wooden flooring of ward and
verandahs in the pauper female ward replaced by
solid concrete and cement.

Staff.—l took over charge from Dr. Jamieson on
March 5th, on my return from leave. Assistant
Surgeon C. T. de Souza was transferred to Malacca
on July 23rd, being replaced by Assistant Surgeon
C. J. Bateman on August 15th, Assistant Surgeon
T. J. Scully acting in the interval.

TABLE

Work Done.—The total number of patients treated
was 4,010, of whom 400 remained from the previous
year, the average daily sick 392:02 and the percentage
of deaths to total treated 20:14, compared with 3,986,
36459 and 17.76 respectively in 1903. Forty-one
patients died within twenty-four hours and eighty
within forty-eight hours from the time of admission.

In the female ward twenty-four patients remained
in December 1903, and 121 were admitted during the
year, making a total of 145.

Table A shows the admissions and deaths from
the principal diseases for the past four years. It
will be seen that there was а very considerable in-
crease in the number of beri-beri cases, the admis-
sions and deaths being nearly twice as many as in
the previous year.

Table B shows the admissions and deaths of
different nationalities for beri-beri, together with the
rainfall for each month of the year. An inspection
of this will show that contrary to the usual rule
observed here, there was no increase in the number
of cases admitted during the wet autumn months.

. Fifty-two lepers were admitted during the year, of
whom forty-six were transferred to the Leper Asylum.

A.

Table showing Admissions and Deaths from the Principal Diseases for the past Four Years at the Pauper Hospital, Penang.

1901 1902 1903 1904
Diseases. - === = | стас |
А I ||
MM d Deaths| Percentage NOE ni Percentage quM. | Deaths | Percentage | rod 1 Deaths| Percentage
EET METRE Таке CNN ЕЕ ам КЕ енені лы саны he cor IAM OK Mme tm
| | і
Malarial Fever 440 68 15:45 418 39 , 9:33 342 | 94 7:01 | 334 36 1077
Beri-beri 424 134 81:60 382 121 | 3167 275 69 25:00 512 134 26:17
Dysentery T 138 | 56 40:57 101 56 55:44 91 40 | 43:95 в 40 46:51
Diarrhoea 431 219 50°81 480 250 51:97 408 191 | 46°81 ' 889 188 56:62
Dehility aA 246 63 25°60 168 79 47:02 | 235 | 108 | 45:95 | 265 91 34:33
Pulmonary Tubercu- | i
losis 2% А 158 95 60:19 234 110 47:00 205 115 | 56:09 | 207 132 63°76
Anemia ve 210 54 25°71 249 5 3:35 113 | 23 20:35 129 24 18:60
Venereal Disc ases.. 711 38 5:34 653 32 4:90 681 26 3:81 | 581 85 6:02
----------------------------------і | -EBEÉEL—-—ILL—--—LLLIIolIIÉZ————d— LLLI a
Total Cases Treated, | | |
with Deaths — .. 4,415 839 19:00 4,055 814 20:07 3,986 708 17:76 | 4,010 808 20-14
\
a = на —
TABLE B.
Table showing the Admissions and Deaths, Pauper Hospital, Penang, for Beri-beri for the Year 1904.
January | February | March April May June July | August [september | October | November | December Total
Nationalities | 2 | , | 2 8 | 2 S h 8 5. 8 | 2 2 2 |8 £ 3 |
$18. 19 к 5 = |е E = 2 5 & 2 2 5 “1 5 5 И. - du! 513 2
ҮЗІ ІЗДІ 313313133 2/2/53 2135121512 138/14 1 3 Е
5А 5 АЕА ЕА 5 А [ЕА АДАА ДЕА ІЗ АЕ АДА B sire
3| |3 E Е | E Е z = | E E | 3 Е 3 |
— | | A2 : joy | SS
| | | | |
Chinese 34| 2/40| 4 46] 9/34|10| 46 17 |85 9 | 51| 15 | 35| 9 | ва | 16 29 14 | 94 | 14 | 36 | 19 |435 |131
| | |
M | | | |
Klings 9 4 1 793 2| 1| 8 1 Tj d 1 2 20| 8
| | | |
— ! = | ^ a aS ee
Rainfall 9°76 2°02 9-88 | 970 7:79 4-24 9:19 26:33 | 14-64 | 21:30 10:65 3:99 123-85
|

June 15, 1906.)

COLONIAL MEDICAL ВВРОВТ8--ТНЕ STRAITS SETTLEMENTS.

PROVINCE WELLESLEY.
Report by Dr. W. Н. Fry, Colonial Surgeon.

The estimated population for Province Wellesley for
1904 is 117,762, compared with 117,078 in 1903.
This is computed to be as follows :—

Europeans 186 Malays 69,370
Eurasians 304:5 Indians 19,919
Chinese 26,889°5 Other Nations 1,093

The births numbered 3,778, compared with 3,813 in
1908, being 32-08 per mille of population, compared
with 32:58 in 1903.

The deaths were 3,392, compared with 9,279 in
1908, being 28:79 per mille of population, compared
with 28:02 in 1903.

The number of deaths among infants from worms

and convulsions continues very high, being no less -

than 741 from both causes for the entire province ; in
consequence of this a circular was in September issued
to all police-stations and Penghulas detailing the chief
symptoms and signs of worms, their causes, and treat-
ment to be adopted. It is possibly in consequence of
this that the death-rate from these parasites has in the
northern district sunk from an average of 16 to 10 per
month, and in the central district from 5 per month to
3 only. I have no doubt, however, that unless the
circular is continually brought to notice the benefit
will not be permanent.

The number of cases admitted to hospitals through-
out the whole province was 1,588, with 208 deaths,
compared with 1,469 cases and 241 deaths in 1903;
this being a death-rate of 13:09 per eent. of admis-
sion to hospital, compared with 16:40 per cent. in 1903.

Zymotic Disease. — Comparatively few cases of
small-pox осештей in the province during the year;
this was anticipated from the number of cases (258) of
this disease in 1903, it having been observed that an
unusual number in one year is usually followed by one
or two years' remission of the disease.

Some few eases of chicken-pox were reported, chiefly
in the neighbourhood of Prai and Butterworth.

Dengue fever occurred throughout the province, but
to no great extent, such few cases as sought admission
to hospital did so for the rheumatic pains and other
sequel of the disease.

Тһе cases of small-pox numbered 6 with 2 deaths,
and of chicken-pox 7 cases with no deaths.

Of the above, 9 were treated at the General Hos-
pital, Butterworth.

One саве of small-pox which afterwards proved fatal
was too ill to be removed from his house when first
seen. None of the persons affected had been revac-
cinated since infancy.

The nationalities of those affected comprised 7
Hindus and 6 Malays, 9 being males and 4 females.

GENERAL Hospital, BUTTERWORTH.
Work Done :—

Remained from 1903 ... n .. 94
Admitted... is ТЯ Ect .. 479
Discharged 586 sag .. 891
Tranferred S "M a Li 6
Absconded Me ds "d SH
Died vee 2M Js 2 .. 6
Remained at end of 1904 es 2... 44

Of the 55 deaths, 7 occurred within twenty-four
hours of admission.

Number of males admitted 426 ; died 428. Number
of females admitted 53; died 7.

Average daily number of sick, males 42:35 and
females 3:08.

Percentage of death to total treated was 10:72, or
excluding those that died within twenty-four hours,
9:81.

The chief diseases treated comprised :—

Venereal Disease 58 with two deaths.

Ulcers ... ake .. 61.

Wounds and Injuries... 42.

Diarrhea ... 85 with 15 deaths.
Intermittent Fever ... 21.

Beri-beri ... 19 with 3 deaths.

Dysentery 9 with 3 deaths.

Operations.—Forty-nine operations were performed,
chiefly of a minor nature.

Venereal Disease.—Of those admitted with venereal
disease, eighteen stated that they had contracted the
disease from Chinese or Japanese prostitutes residing
at Campbell or Cintra Streets, Penang. І shall again
refer to this subject later on.

GOVERNMENT District Hosritat, BUKIT MERTAJAM.
Work Done :—

Remained from 1903 ... Les аи 287
Admitted... е К T 605
Discharged 474
Transferred hk e ES .. 16
Absconded s. m xx e. 11
Died m Е к m .. 99
Remained at end of 1904 е 2.2249

Of the 99 deaths, 17 occurred within twenty-four
hours of admission. Average daily number of sick,
males 46:82 and females "80.

The chief diseases treated included :—

99 with one death (from
exhaustion).
79 with three deaths.

Ulcers

Venereal Disease

Beri-beri 54 with 21 deaths.
Malarial Fever 43 with 5 deaths.
Debility ... 47 with 8 deaths.
Rheumatism ... І |

. 87.
Dysentery and Diarrhcea 34 with 11 deaths.

Province WELLESLEY, SOUTHERN DIVISION.

Report by Dr. A. H. Keun, Colonial Surgeon.

The hospitals in the Southern Division of Province
Wellesley are four in number, viz., the Government
District Hospital at Sungai Вакар, and the three
Estate Hospitals of Batu Kawan, Caledonia and
Byram.

THe GovERNMENT District Hospitat, SUNGAI `
BAKAP.

During the year the general wards and outhouses
were whitewashed and damar varnished, while the
Colonial Surgaon’s quarters were re-roofed and various
petty repairs executed in all the hospital buildings.

46

THE JOURNAL OF TROPICAL MEDICINE.

[June 15, 1906.

An attempt was made at repairing the Contagious
Disease Ward, but owing to the dilapidated condition
of the building it was deemed advisable to include a
new shed in next year’s estimates.

Water supply remains as before, and is from surface
wells, the drinking water well being within the hos-
pital grounds, and the well for washing purposes in a
Malay Campong within 200 yards of the hospital.
The supply continues good and abundant.

Work Done.—On January 1st there were 23 cases
under treatment in hospital. The admissions durin
the year amounted to 504, forming a totul of 527
treated. This shows a distinct advance on the previous
year, when 342 cases in all were treated. There were
54 deaths, giving a percentage of 10:24. This com-
pares most favourably with the 56 deaths of last year,
with its percentage of 16:87 to the total treated. Of
these 54 deaths, 4 took place within twenty-four hours.
The principal diseases treated were general and local
injuries with 74 cases and 3 deaths (2 from exhaus-
tion after severe scalds and 1 from pyemia іп а com-
pound fracture of tibia case). Ulcers came next with
40 cases. Ав is usual in the province, diarrhea
accounted for a number of admissions, viz., 33, of
whom 11 died, making a percentage to total diarrhoea
treated of 33:3. This contrasted with the 66:85 per
cent. (of deaths from diarrhea to total diarrhoea
treated) of last year shows a distinct improvement.
Rheumatism of a subacute nature accounted for 28
admissions with no deaths. Malarial fever 29 (no
deaths); ansmia, 30 cases with 7 deaths ; debility,
17 cases with 3 deaths; leprosy, ll cases; acute
pneumonia caused 9 admissions with two deaths ; and
cirrhosis of liver 6 admissions with 2 deaths. From
the returns of the Government District Hospital as
well as from the retirns of the various Estate Hos-

itals in the South Province, it will be seen that while
еа continues, а factor accounting for large admis-
sions and high mortality, there is on the whole a dis-
tinct improvement everywhere. The Tamils are
атти susceptible to this disease. Тһе gastro-
intestinal canal appears .to be the most vulnerable
point of a Tamil. Various are the theories to account
for the prevalence of the disease in the estates, and
the water supply has again and again been held respon-
sible for the disease. It was with the object of remov-
ing this source of danger that the Penang Sugar
Estates erected water boilers and sterilisers to supply
boiled and sterilised water to the coolies in all their
estates in the province. In addition sterilisers were
put up in the hospitals for hospital use. Boiled water
has been in use since April, 1903. As a result this
year saw a distinct decrease in the admissions from
diarrhoea and dysentery. However, other factors be-
sides the drinking water are responsible for bowel dis-
orders. Among the most prominent I would place the
long hours many of the coolies have in the fields ex-
posed to all sorts of weather; the imperfect nutrition
which of necessity many of them have owing to their
having to cook their own dinners on their return home
after 5 p.m. or so, when too exhausted and depressed,
many prefer to feast on cakes and other innutritious
food and filth sold in the Kuchis; but above all the
very ehilly evenings and nights play a most important
part in filling our hospitals. Many of the coolies have

to sleep on the bare ground, sometimes on planks
resting directly on the ground. In the early morning
there is always a distinct fall in the temperature, and
tbe damp cold ground extracts the heat from the
bodies lying over it. This leads to a chilling of the
system, which among the Tamils manifests itself by
bowel disorders. But the predisposing causes are
equally important. In many of the batches that have
arrived, the managers state, are weak coolies who are
unable to resist intestinal disease and who succumb to
the first attack. To attempt to fix on one cause as
the chief factor in the causation of this disease is
impossible, and in the consideration of the causation
of the disease the one fact must always be borne in
mind that in the Tropics the bowels are the organs
most susceptible to disorders, and such disorders are
frequent from injudicious dietary, impure water, chills,
exposure, or excessive exhaustion.

Hospital Staf.—I was in charge during the whole
year. There was no Assistant Surgeon in the hospital
during the whole year; third grade dresser 8. Dora-
samy did very good work, while Mr. A. Moses ably
seconded him.

Batu Kawan Estate.

Under the management of Mr. Lamb, a series of
improvements was effected in the hospital buildings
and outhouses. New roofing to all the wards (except
the Chinese and Middle Wards) and new bertam
sides were fixed. Improvements were also effected in
the coolie lines. A few lines were rebuilt and an
innovation of distinct value, viz., raised platforms for
beds, &c. made. On September 18th, a gang of
scavengers was organised to attend to the scavenging
of the lines. Previous to this date the work was done
by the general body of the coolies on Sundays. The
estate employs free and indentured coolies, the latter
include Tamils, Japanese and Chinese, each living in
their own special lines at a distance from each other.

The strength of the working element is as follows:—

Indian Immigrants and Second Contract Coolies 162
Free Tamil Coolies ses n" .. 252

Javanese Coolies . 59
Tamil Kongsi Coolies 350
Chinese s 70

Total... 886

The water supply continues the same as previous
years, and was ample during the whole year. For the
convenience of field workers fresh water is conveyed in
boats daily to the fields for drinking purposes.

Hospital Staff.—Mr. Thomas continued as dresser
in eharge and his work generally was excellent. At
present he has no assistant under him.

Tamil Patients.—On January 1st there were 14
Tamil patients. There were 239 admissions, making
a total of 253 cases treated. There were only 3
deaths, one from tetanus, one from diarrhoea, and опе
from ehild-birth. Mortality, 1:18 per cent.

Chinese Patients.—On January lst there were 5
Chinese patients. There were 36 admissions, making
в total of 41. Ко deaths occurred among them in
hospital.

July 2, 1906.)

COLONIAL MEDICAL REPORTS—THE STRAITS SETTLEMENTS. 47

Colonial Medical Reports.—No. 21.—The Straits Settle-
ments (continued).

Javanese Coolies.—The year only saw 17 admissions
with no deaths. Among the Tamils ulcer was the pre-
vailing disease, 88 cases ; febricula came next, 55 cases
with no deaths; diarrhoea next, 28 cases with one
death; chicken-pox, 14 cases no deaths; gonorrhoea,
10 cases.

Among the Chinese diarrhoea came first, 6 cases with
no deaths; ulcers, 6 cases; anemia, 4 cases no
deaths; and among the Javanese coolies rheumatic

ains accounted for 4 admissions, and diarrhea
or 3.

In studying the diseases occurring among the
different nationalities, it is interesting to note that
diarrhoea is pera еқ among them all, though more so
among the Tamils. That the Chinese should suffer
shows that the water cannot be the only cause, as
Chinese scarcely ever drink cold water. Hot water
and hot weak tea are their universal drinks, even on
the estates. The decline in the mortality of diarrhea
is well shown in the following table of mortality.

| |

ae Li
e|/gic Ele = |8 18
ДИН
8,1618 81815 81804
— |} | ——|-——!—— -——|——|——
Diarrhea .. 149] .. )111 6 63 | 16 , 28 6 | 3
a Ni M tite

Death Percentage.. | 20:80 | 6:32 3:57

CanEpoNiA Estate HosPITAL.

Various repairs were executed in the hospital build-
ings, but of & petty nature. The drainage of the
hospital remains the same.

Water Supply.—Last year the boiling apparatus
erected in Caledonia was completed, and this has since
been in use during the whole year; about 9,000 gallons
of water а day are boiled, and this water is conveyed
in pipes to both the Caledonia and Victoria Kuchis,
where it is stored in iron cisterns. These cisterns are
cleaned about twice а month. Water is to be found
in them at all hours of the day and night, ample
in quantity for all the ooolie uses. А few standpipes
on the roadside gave a liberal supply. While the
water supply is ample for all purposes, one cistern and
one outlet or tap only for each Kuchi are wholly in-
adequate. Тһе hospital steriliser is also in use for
hospital purposes. There was a temporary stoppage
from October to November, owing to leakages. The
water used is obtained from the Jawi stream before
it reaches the coolie lines.

Hospital Statistics.—During the year, 1,508 cases
were treated in the hospitals, with 46 deaths, giving
в percentage of 3:05. This contrasted with the 1,433
cases treated in 1903, with 75 deaths (5-23 per cent.),
shows a distinct improvement in the mortality of the
estate. The admissions to this estate hospital are
chiefly from Victoria and Caledonia Estates, while
Krian Brick Fields have supplied three patients. It is

interesting to contrast the various admissions with
reference to nationalities, and the mortality of the
separate estates. It is at once seen that Victoria
Estate has supplied the largest number of Tamil
patients and the highest mortality. This is accounted
for by that estate receiving most of the newly arrived
indentured coolies, and it is among such men, who
arrive debilitated after their sea-voyage, and are put
at once on field duty, unaccustomed to the climate and
perhaps to the food, that gastro-intestinal diseases,
which perhaps accounted for most admissions, do most
mischief.

! і y
Deaths 1 Dysentery Deaths

; Diarrhæa
Victoria Tamils.. 145 i 61 53 6
Caledonia Tamils 44 ; 1 | 20 3
Javanese.. . 93 | ; i 4 1
Bengalis .. Ке 5 ! ; 1 |
Total 217 7 | 78 | 10

In 1908, diarrhoea and dysentery, for both estates,
accounted. for 356 admissions, with 41 deaths (11:5
рег cent.). In 1904, the total admissions for diarrhoea
and dysentery were 295, with 17 deaths, giving & per-
centage of 5'7. This speaks in itself of the distinct -
improvement in the health of the estates, and shows
that diarrhoea and dysentery are not the formidable
diseases they used to be. Of these admissions for
diarrhoea and dysentery, 118 cases came from Victoria,
with 12 deaths, and 64 from Caledonia, with 4 deaths,
the percentage of mortality being practically the same
in the two estates (a little over 6 per cent.). The other
diseases treated were local and general injuries, 263
cases; intermittent fever, 136; simple continued fever,
65; gonorrhoea, 84; ulcers, 44; bronchitis, 39.

Hospital Staf.—Dr. Ellery, the Estate Medical
Officer, was in charge during the whole year. The
staff remains the same as in the previous year, viz.,
two experienced dressers, one apprentice dresser, and
а number of attendants.

The Cook-houses, which I referred to in last
year's report, did excellent service this year. Every
indentured coolie must take his meals here during hit
first month on the estate ; afterwards he may continue
at his own pleasure. There is an average of about
ninety coolies at the tables. A cup of hot kanji is
served out to the indentured coolies every morning
before proceeding to the fields, for which a small
charge of half a cent or so is made. This is a measure |
of great value, as otherwise the coolies would have to
go out every morning into the cold, chilly air on an
empty stomach, or after partaking of cold rice left ove
from the meal of the night before. :

Byram Estate HosPiTAL.

Various petty repairs were done to the hospital
buildings. The hospital latrines were improved. A
new ward for infectious diseases was erected, and
found serviceable in the measles outbreak this year.

Water Supply.—The hospital boiling apparatus was
in constant use during the year. А new steriliser to

48 THE JOURNAL OF TROPICAL MEDICINE.

[July 2, 1906.

a a 56 рыба Ге NE ee ne ee rmm nm nen Pu rr
a

supply sterilised water to the whole estate was com-
pleted and was in use during the year with only a
stoppige of a month. . As mentioned in my last year's
report, the water is brought up in water-boats from the
Jawi Canal, near Caledonia.

Work Done.—On January 1st, 1904, there were
33 cases in hospital. During the year there were 690
Tamil admissions, making a total of 720 Tamils
treated, and 305 Javanese, 1,025 in all. There were
23 deaths among Tamils, and 5 among Javanese, 28
in all, forming a percentage of 2/73 to the total
treated. Last year there were 18 deaths out of 1,038
cases treated (or 1-78 per cent.).

The principal diseases treated were :—

И Tamil. Deaths. Javanese. Death,
Diarrhea s 98 7 24 Nil.
Dysentery 22 76 7 97 1
Intermittent Feve 141 — 34 —
Bronchitis 22% - 94 — 1 -
Colic iss nM 12 ЕЕ 7 —
Gonorrheea See 39 -- 100 --
Ulcers Me 72 == 20 —
Local and General

Injuries T 51 — 10 —
Confinement А 18 — 1 —
Chancres wie 23 — 7 —

The chief feature of the returns of the estate is the
number of admissions from venereal disease, especially
among the Javanese.

This year saw the commencement of Javanese
immigrant labour. Four hundred and three coolies
(males 222, females 181), arrived in the estate; of
these 100 were found suffering from gonorrhea and
7 from chaneres, or 26:5 per cent. of all arrivals.
Immediate steps were taken to examine all the
arrivals to isolate the infected ones. While there has
been a decrease in the admissions from diarrhea and
eee the death-rate has slightly increased,
thus :—

1903—291 cases of diarrhoea and dysentery with 16
deaths.

1904—225 cases of diarrhoea and dysentery with 15
deaths.

Krian Brick FIELDS.

The health of the coolies employed here has always
been excellent, and this year only saw three admis-
sions into hospital with no deaths.

Public Health.—This year has been practically free
of all epidemics except little outbreaks of measles
in Byram and Caledonia Estates, and in Batu
Kawan.

Small-pox.—Not a single case occurred in the south
province. It is, however, of very great importance to
consider the vaccination question of the province. At
the present time all children born in the district must
be vaccinated within three months, failing compliance
the parents are fined. But with a partial wandering
population as we have in the province, where many
natives migrate from place to place in search of work
or to turn their hands to various occupations in various
districts, children are often carried by their parents
into other districts, and so pass out of the notice of
the police and the public vaecinator. In this way

large numbers escape vaccination. Parents, while they
are becoming conscious of the prophylactie action of
vaccination and its beneficial effects in modifying
cases of small-pox, still look for the most part on
vaccination as a painful operation, and so avoid bring-
ing their children up for vaccination. With such а
rich soil for the small-pox germ, it is not surprising
that when a few cases of small-pox occur the disease
soon spreads and too often reaches epidemic propor-
tions, and the mortality is proportionally high. The
only remedy appears to me to lie in the hands of the
police. The local police should at once communicate
with the police of the district where the natives have
gone to, and the information should be sent to the
superintendent of vaccinations of that district. It
would not be a difficult matter for the police to
ascertain the districts the parents have gone to, from
friends and neighbours, and in' this way a great
irregularity could be remedied. Тһе subject of re-
vaccination is also of great importance. While out-
breaks of infectious diseases everywhere are always
serious in an estate where natives are more intimately
in contact with each other, outbreaks are of very great
importance owing to their rapid spreading and high
mortality. Compulsory revaccination is а necessity.
New immigrants should be revaccinated prior to
leaving their country or on arrival. In this way one
source of danger can be obviated. There was a little
epidemic of chicken-pox in Batu Kawan, where 14
cases were treated with no deaths. There were 26
cases of measles treated in Caledonia Estate Hospital,
all from Victoria Estate. In Byram, 31 cases of
measles were isolated and treated, as well as 12 cases
of chicken-pox.

Another subject of very great importance to the
health of the community is the prevalence of venereal
diseases among the natives. Unfortunately, hospital
statistics will not emphasise the danger, as natives do
not care to come into hospital to be treated for such
diseases, which they know are not immediately fatal,
while native treatment has apparently some beneficial
results on them. Wandering prostitution is, in my
opinion, chiefly responsible for this prevalence. Only
the Japanese and some Chinese (Macao) prostitutes
reside in recognised brothels. There are a very large
number of Tamil and Malay prostitutes who wander
from village to village, residing a few days only at each
place, and shifting from street to street, and so avoid
the complaints of their being nuisances being made
by neighbours. Most of these women suffer from
venereal diseases, and they are the means of spread of
these loathsome diseases. Apparently there is no
remedy short of special legislation.

The Sanitary Department is doing slow and steady
work in the south province with corresponding im-
provement in the sanitation of the villages.

APPENDIX D.
MALACCA.
Report by Dr. Е. В. Croucher, Colonial Surgeon.

The general health of tho Settlement during 1904
was fairly satisfactory. With an estimated population
at the end of the year of 98,878, the death-rate was

July 2, 1906.)

COLONIAL MEDICAL REPORTS—THE STRAITS SETTLEMENTS. 49

32:95 per mille against 33:81 per mille last year, and
31:19 per mille in 1902. The deaths in children under
one year of age numbered 851, nearly 25 per cent. of
the total.

The chief causes of death were returned as :—

Fever ... ms .. 1,307 against 1,405 last year.
Convulsions ... id 574, 735 n
Phthisis ; 168 , 163 5
Intestinal Diseases 901 ,, 116 5;
Beri-beri wd zu 984 ,, 184 »
Debility after Fever ... 97 —

Old Age P 974 , 959 »
Pneumonia ... E 49

Phagedena .. ted 19

The total number of births during 1904 was 3,380
(males 1,741, females 1,639), compared with an
average of 3,579 during the previous ten years. This
gives a birth-rate of 31:19 per mille for the year, against
an average rate of 38:34 “рег mille for the previous
decade. Six hundred and thirty-five births (males
344, females 291) were registered within municipal
limits.

The total number of deaths registered in the
Settlement was 3,259 (males 2,042, females 1,217),
as against 3,332 (males 2,008, females 1,324) in
1903, giving a death-rate of 32-95 per mille. Of the
deaths, 672 occurred within municipal limits with an
estimated population of 15,711, and 2,587 іп the
country districts. This gives a death-rate for the
town of 42-77 per mille, and country 31.10 per mille.

The following were given as the chief causes of
the deaths within municipal limits:—

Beri-beri 100 against 39 in 1903.
Fever ss. UB» “sy 182 ,,

Phthisis 53 y 61 ,
Convulsions ... ^ 75 ,, 150 ,
Diarrhoea 91 (chiefly in young children).

Dysentery, 45, old age 64, pneumonia 26, pre-
mature birth, 18.

The most noticeable feature in these figures is
the increase in the number of deaths from beri-
beri.

Smull-por.—One hundred cases of small-pox were
recorded in the Settlement during the year with 7
deaths. The disease was generally of а very mild
type. Fifty-nine cases occurred in persons previously
vaccinated.

Dysentery.—Two outbreaks of dysentery of a very
severe type occurred, one in Alei, about 5 miles from
town, the other at Alor Gajah. Both were due to a
shortage of drinking water, following on a period of
very dry weather. At Alei, 52 cases were reported
with 27 deaths. This mukim lies very low near the
coast, and it is said that deep wells cannot be sunk as
the water is saltish. The water for drinking is derived
chiefly from shallow surface wells which are easily
infected. Dresser Hosie was stationed at Kandang
during the outbreak and did his best to aid the people,
but I do not think they were ever convinced that the
disease was due to the defective water supply. At
Alor Gajah there were 27 cases reported with 8 deaths.

There was also a large increase in the number of
patients suffering from beri-beri, the admissions being

437, as against 251 cases іп 1903. Тһе number of
deaths from the disease was 89, against 64 last
ear.
y The other principal diseases treated were malaria,
996 with 5 deaths; rheumatism, 174 ; diarrhoea, 85
with 24 deaths ; dysentery, 74 with 31 deaths ; phthisis,
61 with 28 deaths: phagedena, 49 with 20 deaths ;
pneumonia, 26 with 15 deaths ; syphilis, 85 with 2
deaths; injuries, 99 with one death; nephritis, 24
with 6 deaths; ulcers, 737.

Eighteen prostitutes suffering from venereal disease
were admitted during the year.

Operations.—Sixty-nine operations were performed
with 4 deaths (amputation of thigh, amputation of leg,
resection of intestine for strangulated hernia, and gas-
trostomy for stricture of cesophagus).

Necropsies.—Ninety-four were made during the
year.

Gaor HOSPITAL.
The general health of the prisoners, with the excep-

tion of an outbreak of dysentery in October, was satis-
factory. Тһе average daily number of prisoners was

civil, 5:54, and criminal, 46:56.

Buildings, &c.—The wells were closed early in the
year and water from the Ayer Keroh Reservoir laid on.
Ventilators were fixed in the lower part of all the cell
doors.

Patients in Hospital :—

Remained ... Ses m .. Nil
Admitted ... m st .. 80
Discharged ... "Lm . 24
Died .. E 2% ыры 6
Transferred ... Lus i% Nu
Remaining end of the year... Nil

Thirty-seven prisoners suffering from beri-beri who
had been sent from Singapore in 1903, were still re-
maining at the beginning of the year. Of these, 3 died,
3 were discharged, and the remainder, much improved
in health, were sent back to Singapore. Twenty-nine
more were sent here in October. Of these, 2 died, 4
were discharged, and 23 remained at the end of the

ear.

i There was an outbreak of dysentery in October
affecting ten of the prisoners, the dresser in charge,
and one of the warders. The first case attacked suc-
cumbed after two days’ illness, and at the post-mortem
examination there was found extensive gangrene of the
large intestine. All the other cases did well with the
exception of the warder, who was treated at his own
home and died after about four weeks’ illness.

The origin of the outbreak remained a mystery ; it
could not with any likelihood be put down to the water
or food supply or to defective sanitary arrangements.
Dust is given as one of the means by which dysentery
was conveyed. Shortly before the outbreak, owing to the
collapse of one of the buildings, excavations were made
in the prison yard, and a large amount of sand and sub-
soil water was thrown up on to the surface. І any
dysenteric pronouncing organisms were included it is
possible that this was the way in which the disease was
produced.

50 THE JOURNAL OF TROPICAL MEDICINE. [July 2, 1906.
Colonial Medical Reports.—No. 22.—Somaliland Protectorate.
MEDICAL REPORT FOR THE YEAR 1905.

METEOROLOGICAL RETURN FOR THE YEAR 1905.

TEMPERATURE | RAINFALL Wisp
А "cx s 2: —
E 1. | А £ =» Е 5 Remark
ы А | Z Я | ieee 5 H 23 23 ES Ё £
53 ЕЕ | E E E 8% EE EE 55
"2 134 n ME 35 j ša c a DS
| ' |
January ..! 155° F. | 85°F, 62°F 23° F | 70 F.| 714 59 N.E. | Light Records taken in shade.
February .| 150 86 7 16 1 77 075 68 N.E. |Moderate. except solar maximum,
March . 160 RU: 75 14 , 80 *605 76 N.E. | Light during Jan., Feb., Mar.,
April T 93 74 19 | HM 1:05 76 М.Е. | Light , Nov., Dec.
May 140 96 80 16 88 702 73 SW. | Light ; During Мау records taken
June 140 99 84 15 ' 92 e 43 S.W. | Strong | indoors. During July and
July .. 144 113 90 13 i 97 " 52 S.W. | Strong | August taken indoors іп
August .. 140 112 85 27 97 01 85 S.W. | Strong, draught of air.
September 142 111 77 34 | 88 21 45 Variable} Light | Records from September
October .. 140 95 73 22 | B4 73 ` МЕ. | Strong taken in shade.
November 160 | 93 69 924 ; "7 10 60 N.E. | Strong |
December | 165 "6 61 25 69 41 60 N.E. | Strong |
— ————— — —(—————————M—— ——— танған
Mean of Year .. 957 75 207 | 92:1 :23 60 | N.E.
TEES TE ЕП БЕК а с = 1 р MM КА КЕЛ
RETURN OF THE DISEASES AND DEATHS IN 1905 aT THE Diseases of the— А Cases. Deaths.
FOLLOWING INSTITUTIONS: BERBERA, BULHAR AND ZEYLA Female Organs 2% АА F ME 18 ..
HOSPITALS. Organs of Locomotion vs 5 as 45
GENERAL DISEASES— Casos. Deaths. Se Tissue D NN "og 18 1
Small-pox 314 144 ius in m m m mm МЕ oe Т 1
Febricula 3 - njuries, General "m is А as 5 se
Injuries, Local Е y re zs - 418 ..
Dysentery .. 115 1 Surgi А
Malarial Fever — ну ня urgical Operations Fi СЫ; s ка 170 5%
(a) Intermittent 1,007 ine онова N^ 2 Bi ea Es 59 i %
(b) Remittent .. 117 N arasites .. .. .. o .. ..
Erysipelas К 3 m : .
Tubercle — .. 36 1 Estimated Population for the Year 1905.— The popu-
Chicken.pox .. 9 -* lation during 1905 numbered—52 Europeans, 300,000
Syphilis— .. ' Africans, 200 Indians, 100 mixed and coloured per-
(a) Primary .. 25 Ts E tf : ЗЕ h
(b) Secondàry .. 51 : sons, Except from an increase o uropeans the
Gonorthoa . Е 397 .. number of people was the same as that for 1904.
Scurvy | .- 56 ss The population аб the present time is probably
D bau ыы 255 .. nearly stationary, as the outbreak of small-pox in
New Grows — р `7 1904-5 and the emigration decrease are compensated
Non-malignant 4 .. for by the birth-rate. An estimation of the birth-rate
Malignant 1 .. ав regards the coast towns shows this to be 10 per
Anemia 34 1 cent. among the married women. No figures are
Debility, бола 8 1 obtainable for th te portions of th tr
Whooping Cough 2 .. obtainable for the more remote portions of the country
Loca DiSEASES— inland. |
Functional Nervous Disorders— T 2 Death-rate.—No records on this are available.
Paralysis e 7 1 Prevalence of the Disease at Different Seasons.—
НЕ а ' Тһе table of statistics as regards the prevalence of
Hysteria 1 `| the disease at the different seasons is apt to mislead,
. Neurasthenia .. 6 .. unless it is kept in mind that practically the entire
Diseases of the— .. p. * native population emigrates into the interior during
E S 199 * — the extreme heat of the summer, leaving only those
Noi x o ns 9 ; who are in fixed employment on the coast. Тһе popu-
Circulatory System 21 1 lation able to present themselves at the hospitals thus
Respiratory System 519 1 varies from 20 to 30,000 during the winter, to 8 to
Peu red и. à 4,000 during the summer, and of this latter number
Urinary System 10 i the patients are confined to those drawn from the
Male Organs .. 31 .. Adult and more physically strong of the population.

July 16, 1906.)

Colonial Medical Reports.—No. 22.—Somaliland Protectorate
(continued).

As regards the periods when sickness most gener-
ally prevails the spring and autumn are the more
trying to the Somali natives. This is accounted for
by the lack of provision for any variations in the
temperature as regards clothing. The native dress
remains the same at all seasons, and is of cotton only,
while a blanket for use at night is not а common
possession.

Among the Europeans resident in the country one
observes that definite organic disease is uncommon,
and except for the milder types of malarial fever and
diarrhea their diseases are entirely confined to the
neurasthenie type, predisposed to by the physical
conditions imposed on them by residence in such a hot
climate.

In character the diseases of the country generally are
not of an aggravated type, though undoubtedly the
neurasthenic class of patients require invaliding in
many cases before recovery takes place.

Relative Mortality at the Different Seasons.—Janu-
ary, February, ahd March are the months in which
most sickness prevails, closely corresponding to the
rainy season of the year as regards the coast.

Causes Affecting Public Health.—Meteorological :
The hot, violent sandstorms which continue during
the summer do undoubtedly lower the physical condi-
tion of both Europeans and natives alike. These hot
winds seem to be responsible for most of the anemic
and debility cases. As regards other causes at work
besides the meteorological, the general health is
affected by the almost absolute absence of fresh vege-
tables among almost all classes over the greater part
of the year. The natives do not cultivate, but live on
camel’s milk and meat, and occasionally on mutton.
oo milk is also the chief source of salts in their
ood.

The poor Somali lives, therefore, very much, as
regards his diet, on a par with some of the South
American tribes, whose diet is almost exclusively
animal, except for matté, a plant allied to and used as
tea. Certainly directly the Somali is deprived of
camel’s milk he very quickly develops scorbutic
symptoms. The natives as a race are total abstainers
from alcohol, a very considerable asset as regards their
physical condition.

Remarks on the Particular Diseases which have
occurred during the Year.—Dysentery: All the cases
which have come under my personal notice have been
of an exceptionally mild type.

Malarial Fever.—The hospital figures show remit-
tent fever on the coast to be exceptional. Of the
different towns, Berbera is the one most affected by in-
termittent fever, probably due directly to the suffici-
ency of fresh water allowing a surface drainage and
breeding ground for mosquitoes on the foreshore of the
harbour. Mosquitoes seem to entirely disappear during
the very hot months—that is, from May to October.
Except for imported cases the towns of Bulhar and
Zeyla are almost entirely free from malaria the whole
of the year, due to the scarcity and expense of water
leading to care and prevention of waste.

Insanity.—Cases of insanity of any of the recog-
nised types are almost unknown, and but for syphilis

COLONIAL MEDICAL REPORTS—SOMALILAND PROTECTORATE. 51

most of the predisposing causes aro absent. Cases of
monomania, of which a few exist, do not readily
become subjects for treatment at the protectorate
hospitals. І

Diseases of the Skin.—The large number of skin
diseases recorded are accounted for under ulcers
chiefly, these ulcers being on the legs and ankles of
badly nourished subjects, and are of the usual tropical
type. А

A curious dermatological phenomenon із presented
among those of the European population who are for
any length of time resident in the country ; namely,
a redness or hyperwmia, which remains constant, and
almost amounts to a staining of darkish red colour,
over the hypothenar palmar surface of both hands.
The condition was first brought to my notice by Mr.
H. E. S. Cordeaux, C.B., who has had several yeurs'
residence іп the country. No actual swelling or
other symptoms seem to be related to this condition.

Poisons.—Except in one case, where a vegetable
poison was taken by a native as a purgative, which
caused death, with symptoms of acute gastric and renal
irritation, no cases have occurred except bites or stings
of insects.

General. Sanitary Condition of the Protectorate.—
Probably few other countries have во great а natural
protection for the preservation of the publie health as
exist here. Тһе dry heat and lack of thick vegetation,
with the fierce sand storms which sweep the country,
dry and cover up any animal or vegetable refuse very
much in the same way ав occurs in the desert proper.
Drainage as such practically does not exist, nor in the
ordinary sense is it necessary where the dry earth
System exists naturally in so high a degree of perfec-
tion.

Ав regards water supply, only one town, that is, Ber-
bera, can be said to have & moderately good supply
service. . The water comes from springs at а tempera-
ture on leaving the rock of about 100? F., and contains
ап excess of chlorides, but it is not unwholesome after
standing for twenty-four hours to cool and deposit its
sediment.

The other towns of Bulhar and Zeyla are supplicd
from very indifferent brackish wells, mostly situated
at a distance from the actual vicinity of the dwellings.

Inland, water of a very fair quality is obtainable in
small qualities. .

Overcrowding.—This does not exist, as the popula-
tion is a nomadic one, travelling over its tribal area
and living under mat or grass shelters only.

Vaccinations.— The number of vaccinations per-
formed during the year was 1,650; of these, 496 were
successful, while in the case of 804 the result was
unknown, leaving 350 as unsuccessful in result. It is
probable that at the present time about 20 per cent. of
the population has been vaccinated ; about 5 per cent.
of the tribes in the more immediate vicinity to our
stations, and with whom we come more directly in
contact, have the marks of small-pox.

General Observations.—An attempt has been made
to give such demonstrations and instruction in
General Hygiene as has come within the scope of
interest of the more highly educated native teachers
and other residents. Native masons, carpenters and
artisans have been approached on matters dealing

52 THE JOURNAL OF TROPICAL MEDICINE.

[July 16, 1906.

more especially with their respective work, in its
relationship to the public health.

Ventilation and such like matters in regard to stone-
built houses, and the dangers associated with faulty
drainage and water contamination have been fully
dealt with.

There can be no question as to the fact that phthisis
does occur in the country, and I am of opinion that
this disease is slowly extending. Ап isolation hospital

is in course of being built expressly for these cases, in
the neighbourhood of Berbera.

At the present time a collection is being made of the
stinging flies throughout the area accessible to Euro-
peans; this it is hoped may prove a practically com-
plete one when forwarded to the British Museum, for
whom the collection is being made.

There have been no cases recorded of any disease
deserving special mention, or report.

Colonial Medical Reports.—No. 23.—Gambia.

MEDICAL REPORT FOR THE YEAR 1905.

PATIENTS IN HOSPITAL.

| Remaining Admitted Remaining
| in Hospital during Died in Hospital
. Dec. 31st, 1904 the Year Dec. 31st, 1905
Europeans Nil | 17 2 | Nil
Natives Er 16 436 97 18
Civil Force .. 1 45 2 2
Syrians г Nil 29 2 Nil
W.A.F. F. .. 7 79 1 4
Total us | 24 606 34 24

The deaths were due to the following diseases :—
Beri-beri 1, blackwater fever 1, bronchial asthma 1,
broncho-pneumonia 1, burn 1, acute gastritis 1,
chronic pyæmia 1, chronic peritonitis 1, cardiac disease
2, chronic bronchitis 2, cerebral congestion 1, dysen-
tery 1, debility 2, hospital gangrene 1, malignant fever
with hyperpyrexia 1, meningitis 1, marasmus 1,
phthisis 1, phagadoena 1, inanition 1, pneumonia 1,
rheumatic fever 1, sleeping sickness 2, senile decay 2,
starvation 2, tetanus 2, renal disease 1, acute bron-
chitis, 1.

The prevailing diseases were the following :—Inter-
mittent fever, remittent fever, conjunctivitis, catarrh,
dyspepsia, orchitis, edema, whitlow, febricula, rheu-
matism, bronchitis, pneumonia, diarrhoea, abscess,
ulcers, boils.

Of the rarer diseases met with there were guinea
worm, syphillis, sleeping sickness, gout, leprosy, beri-
beri, tetanus.

The following table shows the number of cases of
illness and invalidings among Europeans during the
pest five years and the number resident in the colony
or each year.

Europeans 1901 1902 1903 1904 1905
Number of Residents ..| 88 98 | 105 | 100 | 114
Treated 2: de ..| 89 26 47 49 43
Died .. as Si 2% 4 9 2 Nil 1
Invalided .. Ж sts 3 2 2 Nil 1
Malarial Fever Cases | 54 11 15 24 16
Blackwater Fever .. 25 v = 24 es 6

The diseases suffered from were the following :—
Biliousness, cellulitis, pleurisy, ulcer, febricula, and
remittent fever. `

Total Deaths, Rate per 1,000 |Deaths under 5 Years| Rate per 1,000

Years |

1901 | 340 38:68 197 15:56
1902 266 30:22 112 12°72
1903 815 85:79 130 14:77
1904 303 84:40 124 14:07
1905 299 83:95 117 13:29

The statistics of population for the year 1905 are:
—Europeans 114, Africans 8,807; Increase 14
Europeans.

There has been no structural building or alteration
during the year.

The European Staff remains the same.

The tank supply of water has been ample, although
the two largest tanks are leaking.

Receipts.

Sale of Medicines and paying

patients ... m £82 7 1

Та os Mesentorioa `

(b) Iridectomy

July 16, 1906.] COLONIAL MEDICAL REPORTS—GAMBIA. 53
Colonial Medical Reports.—No. 23.— Gambia (continued).
RETURN oF Diseases AND DEATHS IN 1905, АТ THE
Colonial Hospital, Infectious Hospital, and Gaol Infirmary.
GENERAL DISEASES. Total Total
Admis- Cases Admis- Cases
sions. Deaths. Treated. sions, Deaths. Treated.

Alcoholism —.. —.. — GENERAL DisEasEs—continued.

Anemia -.. — — Other Tuberonlar 1 Diseases 1 — 1

Anthrax . 9 --.. -- — Varicella n — — —

Beri-beri : 12. 1 1 Whooping Cough — — —

Bilharziosis .. --.. -- -- Yaw — — —

Blackwater Fever o ire nen Yellow Fever .. — -- —

Chicken-pox .. -- 2. — —

Cholera ae — 22 — —

Choleraio Diarrhea . -- 2. — -—

Congenital Malformation ae RE =

Debility А А 8. 2 9 LOCAL DISEASES.

Delirium Tremens — e — —

Dengue —.. — — Diseases of the—

Diabetes Mellitus -- .. — = Cellular Tissue .. e бі 1 55

Diabetes Insipidus --.. — - Ciroulatory System—

Diphtheria -.. -- — (a) Valvular Disease of Heart .. . 2. 2 2

D T 4. 1 4 (5) Other Diseases il 8. 2 3

Enteric Fever.. --.. -- - Digestive System— .. M M mmo —

ak ag — .. — -- (а) Diarrhoea Я 2% Е 9.. — 9
ricula m 18 .. — 18 (b) Hill Diarrhoea. . -- 2. -- a

Filariasis m -- 2. — — (c) Hepatitis А 5% – .. - --

Gonorrhea 9. - 2 Congestion of Liver .. -- 2. -- =

Gout .. e lo s= 1 (d) Abscess of Liver —. — -

Hydrophobia .. --.. -- — (e) Tropical Liver.. РЕ --2.. - -

Influenza 4.. — 4 Jaundice, Catarrhal .. —.. — —

Kala-Azar .. —.. — — g Cirrhosis of Liver -- 2. — —
ro! А — еш — (A) Acute Yellow Atrophy, -— —
(а) Nodular 2% eta ез — (i) Sprue .. д C ees =
(b) Anæsthetic .. -- 2. — -- (7) Other Diseases. . 66 .. — 66
(c) Mixed.. . —.. - — Ear . . : 1.. — 1

Malarial Fever— . -- 1. -- ЯЕ Еуе 14+ .. — 16
(а) Intermittent— 50.. — 50 Generative 'System— -- 2.0 — —

Quotidian .. =.. — -- Male Organs 20 . 1 20
Tertian .. —.. — — Female Organs 15 .. — 15
Quartan -- 2. — — Lymphatic System 4. — 4

es dea .. 8... 9 3 Nervous System 12. 3 12
undiagnosed 2-2. - -- Nose 2.. — 2

(5) Балық .. 16 .. — 16 Organs of ‘Locomotion .. 8.. — 8
(с) Pernicious .. 55 -- 2.0 — - Respiratory System E 62. 7 70
(d) Malarial ооа vs -- 2. — — Skin— 2s --..0- =з

Malta Fever .. se — a) Scabies . 2.. — 2

Meaales y – .. = — 9 Ringw orm .. -- 2. — —

Cen — e — — id Tinea. арайын - .. —

New Growths— i -- 2. — — (d) Favus .. --.. — —
Non-malignant .. -- 2. — - (е) Eczema. . l.. — 1
Malignant —. — — (f) Other Diseases 133 .. -- 139

Old Age 2. 2 2 Urinary System.. 5. 2 5

Other" Diseases E usum — Injuries, General, Local— 49. 1 46

Pellagra -.. — - (а) Siriasis (Heatstroke) . -- 2. — —

Plague .. Bagh SS -- (6) Sunstroke (Heat Prostration) —-— сег =

Pyemia --.. = -- (с) Other Injuries -- .. — —

Rachitis -- 2. -- — Parasites— 6.. — 6

Rheumatic Fever 1. 1 1 Ascaris lumbricoides 1.. — 1

Rheumatism .. 15.. — 15 Oxyuris vermicularis .. --.. — —

Rheumatoid Arthritis -- 2. -- — Dochmius duodenalis, or Ankylos-

Scarlet Fever . —.. — — toma duodenale m -- —

Scurvy .. —.. — — Dracunculus medinensis (Guinea-

Septicemia lcs 1 worm) .. ee vs 22 as 2.. — 3

Sleeping Sickness .. an 4% i 2.. — 2 Tape-worm i 1

Sloughing Phagedæna £s is e =e - -- Poisons—

mall-pox .. .. .. T e — e — — Snake-bites T - es woo - m

= hilis— . a 55 нЕ 2 9. — 9 Corrosive Acids .. Si e — -— —
(a) Primary —.. — - Metallic Poisons — — —

(b) Secondary --.. = — Vegetable Alkaloids — — —

(c) Tertiary ae — Nature Unknown — — —

(d) Congenital --.. — - Other Poisons 2 1 3

Tetanus 4. 2 4 Surgical Operations—

Trypanosoma Fever .. -- .. - — Amputations, Major — — —

Tubercle— .. - .. — - Minor 7 — 7
(a) Phthisis Pulmonalis -- 2. = - Other Operations — — —
(b) Tuberculosis of Glands —.. — — Eye se - — —
y Lupus .. -- 2. — — (a) Cataract . — — —

(9 Tuberculous Disease of Bones

(c) Other Eye Operations z

54 THE JOURNAL

Expenditure.

Salaries and Allowance 2,427 0 9
Drugs and Maintenance 56110 7
£2,988 11 4

Among the 35 European officials there has been no
serious illness.

: The following diseases are recorded :—remittent
fever 11, cellulitis 1, pleurisy 3, biliousness 1, febri-
cula3. Accidents : dislocated shoulder 1, injury to foot
1, strain 1.

Of the non-official Europeans one was invalided to
Europe for persistent anemia following fever.

Other cases were :—fever 16, anæmia 1, nephritis 1,
catarrh 1, blackwater 3, biliousness 1, abscess 2; also
some slight wounds.

There has been great improvement in the health of
the prisoners in the Bathurst Goal. Only one case of
beri-beri occurred, and this was undergoing punish-
ment before the improvements were carried out (1903).

The prisoners are now more than ever employed
outside the gaol, and also they are available for work
on the new Victoria Recreation Ground (late McCarthy

Square). This has had much to do with their good
health.

The water supply is the same as before and has been
ample.

Fortnightly meetings of the Board of Health took
place regularly. Thirty labourers in the rains and
twenty at other times are continually employed in
sweeping and scavenging the town. Three carts and
three horses are in constant use. These carts re-
moved 4,780 loads of refuse, &c., also 311 loads of
tins, bottles, &c.

There were 91 ‘ Abatement of Nuisance ” notices
served, also 4,790 house-to-house visits, but no
summonses nor convictions. Thirty labourers were
employed.

Vaccinations were carried out regularly ; 987 vac-
cinated, of which 968 were successful. This is more
than double the number of the preceding year, and ‘01
unsuccessful only. Practically all were children or
young adults. The same lymph as used the year be-
fore has proved very successful.

The efforts at vaccination in the Protectorate have

OF TROPICAL MEDICINE.

[July 16, 1906.

been met with no response or appreciation by the
natives.

The name of “ McCarthy Square ” is now altered
to that of “ Victoria Recreation Ground." During
the rains of the year (1905) the square was enclosed
with an iron railing. Gates were placed іп the centre
of each side. A macadam path near the railing is be-
ing carried round the Square and shrubs and plants in
tubs are being planted. Eighteen garden seats (to hold
four each) have also been provided; also & lawn
mower.

Jubilee Hospital Fund.

Dr. "Total Receipts £801 3 3
Cr. "Total Expended ... 469 5 11
Balance Transferred to

McCarthy Square Manage-

ment Fund ... tes нЕ 381 17 4

Signed Е. А. BALDWIN,
Acting Senior Medical Officer,
February 28th, 1906.

In response to an official request Dr. Hopkinson
states :—Although I am afraid that the above remark
still holds good for the greater part of the Protec-
torate, there is at least one district (Kwinella and
neighbourhood) where vaccination is really appre-
ciated, and where genuine disappointment has been
shown when I have visited that part without enough
lymph to vaccinate all who apply. Again this yearin
the Upper River I found the same attitude. In other
parta, however, hitherto my only vaccinations have been
done when with His Excellency, his support and coun-
tenance having great weight with the people.

In response to an official request concerning the
number of children vaccinated Dr. Hopkinson replied :
—In 1905, 226 children were vaccinated by me in the
Protectorate—in the McCarthy Island and Upper
River Districts; and 265 by Dr. Franklin in the South
Bank and Kommbo. Total for 1905, 491. In 1906 I
have vaccinated 85 at Willingharra and Kwinella.
Total for 1905-6 up to date, 576.

In several places, notably Kwinella, Batelling and
in Dembo Danso’s District in the Upper River, I could
have done at least twice as many vaccinations had
lymph been available.

August 1, 1906.)

COLONIAL MEDICAL REPORTS—SOUTHERN NIGERIA.

or

c

Colonial Medical Reports.

No. 24.—Southern Nigeria.

MEDICAL REPORT FOR THE YEAR 1905.

European MEDICAL STAFF.

THE medical staff consists of 85 medical officers and
7 nursing sisters. During 1905 one medical officer was
permanently invalided, another was murdered, and
the Principal Medical Officer retired on a pension.

HEALTH.

The health of the Europeans throughout the Pro-
tectorate has been fairly satisfactory.

EUROPEAN POPULATION.

The average European population was 533, viz.,
494 males and 39 females.

EUROPEAN DEATH-RATS,

There were 12 deaths during the year, viz., 5 offi-
cials and 7 non-officials. In addition, 3 officials and
3 non-officials died a short time after their arrival in
England of diseases contracted in the Protectorate.
The death-rate calculated on those who died in the
Protectorate is at the rate of 29:5 per thousand, or
зое the 6 that died in England, 33:7 per thou-
sand.

When comparing the death-rate with that of Eng-
land, it is well to note that there are no deaths in
infancy or from old age.

Словев or DEATH.

Of the 12 deaths that occurred in the Protectorate,
7 were due to blackwater fover, 1 to malarial fever,
1 to cardiac failure in gastritis, 1 to apoplexy, 1 to
peat drowning, and 1 was murdered by the
natives.

INvaLIDINGS.

Forty-three European officials and 45 non-officials
were invalided.

‚Of the 43 officials 6 were permanently invalided out
of the service, and another died within а short time of
his arrival in England. Of the 88 invalided, 50 re-
turned to Europe and 38 were sent for a sea trip.
This gives an invaliding rate of 150 per thousand.
Undoubtedty ‘a high percentage, but probably the
means of reducing the death-rate, which compares
favourably with previous years.

DEATH-RATE AND INVALIDINGS COMPARED WITH
THOSE оғ 1904.

In 1904 the average resident European population
was 500, deaths 19 (including 2 in алыр, іпуа-
lidings 42.. — еі

Іп 1905 the population was increased by 33, the
deaths, including the 6 that died in England, are

1 less than in 1904, and the invalidings show an
increase of 46 over those of 1904.

PREVALENT DISEASES.

Europeans suffered principally from malaria and
disorders of the digestive system. The disorders
of the digestive system were, as а rule, functional.
A large percentage of Europeans suffered from some
form of dyspepsia. This, in my opinion, is due to
one of the following causes: (1) General deteriora-
tion in health; (2) bad cooking; (3) inappropriate
foods. It frequently happens that а person when he
first begins to suffer from dyspepsia considers it trivial
and not necessary to consult a doctor about, and it is
not till the complaint has become more or less chronic
that he seeks the advice of а medical man.

FILARIAL INFECTION,

I regret to say I came across two fresh cases of filarial
infection amongst the Europeans. These filarie are
about ;4,th of an inch in length, and millions are, as а
rule, present in the circulation. А large number of
natives suffer from filariss, and it is from them or from
the infécted European that the mosquito becomes in-
fected, and he in his turn infects the European. — All
resident Europeans are now aware, I presume, of the
mosquito theory of malaria, and a large number also
know of the mosquito theory of filaria, yet in spite of
this you find Europeans who do not consider it neces-
sary to use а mosquito curtain in districts where
the mosquitoes though present are not sufficiently
numerous to be troublesome. The question arises as
to what is to be done with a European infected with
filarie. I am of opinion that he should not be allowed
to remain in a place where there is a European reser-
vation.

QUININE.

There appears to be a growing tendency amongst
some European residents to underrate the value of
quinine as a prophylactic against malaria. They
become imbued with the idea that certain ailments,
such as loss of memory, neuritis, dyspepsia, black-
water fever, are caused by its use. This idea із, to- a
certain extent, fostered by some medical men in Eng-
land occasionally attributing a West African's ill-
health to the taking of too much quinine.

After many years of experience, I am of opinion
that the above-mentioned ailments are much more
likely to be caused by malarial infection than by tke
use of quinine as a prophylactic, and those, particu-
larly the more recent arrivals, who neglect to take
quinine as a prophylactic because of its possibly caue-
ing loss of memory, &c., are not acting with justice
to themselves or their employers.

56

THE JOURNAL ОЕ TROPICAL MEDICINE.

[August 1, 1906.

CALABAR (EUROPEANS).

The health of Calabar as regards serious illnesses
was good, though there was an increase in the number
of those treated for slighter ailments. Many of the
residents now realise the fact that a very narrow
margin scparates the slight fever from the malignant
one, the former being as a ruie a milder type of the
latter, and they send at once for a medical man when
they become ill, instead of waiting to see what will
happen.

European HosPiTAL.

I cannot speak too highly of the value of the
European hospital to the residents, nor of the great
assistance the nursing staff under Miss Graham is to
the medical officers.

A patient who is at all seriously ill is attended
day and night by one of the European sisters, and
it is to that аз much as anything else that I attribute
our successful treatment of hospital patients. I
strongly recommend such a system to those hospitals
in West Africa where European nurses are not em-
ployed on night duty.

Cases ADMITTED TO EUROPEAN HOSPITAL.

One hundred and seventy cases were admitted during
the year, with 2 deaths. Of the 2 deaths 1 died of
blackwater fever, and the other had been brought
from the Cross River suffering from malignant malaria.
He was in & moribund condition on admission, and
died within a few hours.

CALABAR GAOL.

The health of the prisoners during the first six
months of the year was bad, and the death-rate high.
The majority of the deaths occurred amongst those
who were old and decrepit. A type of dysentery,
which, with few exceptions, was invariably fatal when
it attacked those past middle age was responsible for
a large number of the deaths. All known forms of
treatment and the best possible nourishment appears
to be of little or no use in these cases. The growing
adult does well in prison, and as a rule puts on weight.
The health of the prisoners during the second six
months of the year was good.

Lunatic ASYLUM.

The asylum is at present only used for criminal
lunatics. Accommodation is provided for the lunatics
in three mud and wattle houses. Each house contains
4 rooms. In addition, there are 3 isolation wards
made of cement blocks.. I am of opinion that more
permanent buildings than the present mud and wattle
ones should be provided, and that a wall instead of
the present wire fence should separate the males from
the females.

Sr. Marcaret’s Native HOSPITAL, CALABAR.

There were remaining from 1904, 49 cases, and 767
were admitted, making a total of 809 intern patients
treated. Thirty-nine deaths occurred amongst those
treated. Twenty-two major operations were performed,
with 8 deaths,

MAJOR OPERATIONS PERFORMED, 1905.

RESULT
Nor aTa
Successful | Died
Amputation of Limbs 4 4 -
Excision of Breast 1 | 1 --
Excision of Tumours 8! 3 © —
Craniotomy E 1. — ; 1
Elephantiasis š А 4! 4 -
Radical Cure of Hernia .. 6 | 5 | 1
Hernia (Strangulated) 1 — 1
Hip-joint 52 1 1 —
Plastic 1 | 1 --
---------------------- ----- ------- —* ————i
22 19 | 8

The case of strangulated hernia was virtually mori-
bund when operated upon. In addition to the аһоуе,
I operated successfully оп а European with supra-
hepatic abscess. .

The two Roman Catholic Sisters are doing good
work at the native hospital. Their principal duty at
present is to attend to female patients and to assist
the medical officer in his gynsecological work.

ExrERN PATIENTS.

Seven thousand six hundred and eighty-two exteru
patients were treated. I attach a table of cases
treated.

WATER SUPPLY.

The water continues to maintain its high standard
of quality, and is practically unlimited. I attach
analysis of same. Тһе water has been laid on to the
various trading factories, and for the future they will
be able to use this water instead of rain as heretofore.

SMALL-POX.

I am pleased to be able to report that no case of
small-pox occurred in the Calabar district. A new
contagious diseases hospital has been built, and will be
open to patients next year.

VACCINATION.

‘Twenty-four thousand and seventy-nine successful
vaccinations are reported as baving been performed
throughout the Protectorate.

METEOROLOGICAL RETURNS. .-

е

(АП temperatures are recorded in degrees’ Fahrenheit.)

At Calabar the maximum shade temperature re-
corded was 92°71, and the minimum 70°67, The
former was in February and the latter in August.
The highest monthly mean temperature was 84°37 in
March, and the lowest 77:15 in August. The mean
temperature for the year being 81:21. Тһе total rain-
fall was 167:39 inches. Тһе mean degree of humidity,
84-29. еа

August 1, 1906.)

COLONIAL MEDICAL REPORTS—SOUTHERN NIGERIA. 57

Bonny.

The maximum shade temperature was 96:21 re-
corded in February, and the minimum shade tempera-
ture 62:13, also in February. The highest mean
monthly temperature was іп March, viz., 81:66, and
the lowest 76:63 in August. The mean temperature
for the year was 79:58. Тһе total rainfall was
167/75 inches. Тһе mean degree of humidity, 83-78.

SAPELE.

The maximum shade temperature was 90:32 re-
corded in February, and the minimum 70:42, also in
February. The highest monthly mean temperature
was 79:97 in March, and the lowest 75:15 in August ;
the mean temperature for the year being 77:86. The
total rainfall was 116:25 inches. The mean degree of
humidity, 81:55.

ASABA.

The maximum shade temperature was 96:19 re-
corded in March, and the minimum 67:83 in Decem-
ber. The highest mean monthly temperature was
80:88 in March, and the lowest, 75:79 in July. The
mean temperature for the year was 77:89. The total
duh 59:42 inches. The mean degree of humidity,
81:88.

BENDE.

The maximum shade temperature was 91:29 re-
corded in March, and the minimum 67:87 in Decem-
ber. The highest mean monthly temperature was
80:29 in March, and the lowest, 74:87 in August. The
mean temperature for the year was 77:21. The total
rainfall, (4-67 inches. The mean degree of humidity,
89:12.

OWERRI.

Returns only made out from April to November.
Rainfall, 92 inches. Maximum shade temperature,
91:07 in Apri. Minimum shade temperature, 71:25
in August.

Ғовсагов.

Returns only made out from July to December.
Rainfall, 87-81 inches. Mean degree of humidity, 86:44.
Maximum shade temperature, 87:61, recorded іп
rember: Minimum shade temperature, 72:48 in
uly.

OnitHsA PLANTATION.

The maximum shade temperature was 92:83 re.
corded in April, and the minimum shade temperature
72:16 in January. The highest mean monthly tem-
perature was 81:61 in March, and the lowest, 75:73
in July. The mean temperature for the year was
7873. Тһе total rainfall, 60:07 inches. The mean
degree of humidity, 79:01.

BENIN City.

No returns were furnished for March, April, and
May. The maximum shade temperature was 88:71
recorded in February, and the minimum shade, 67:83
in December. The highest mean monthly tempera-

ture was 79:83 in June, and the lowest 74°71 in
August. The meau recorded temperature for the year,
77:29. Recorded rainfall, 138-75 inches. Mean degree
of humidity, 83:09.

AFIKPO.

The maximum shade temperature was 91:70 re-
corded in April, and the minimum shade temperature,
69:22 in December. The mean monthly temperature
was 82:69 in March, and the lowest, 76:87 іп Sep-
tember. The mean temperature for the year was 79:00.
The total rainfall, 83:88 inches. Тһе mean degree
of humidity, 89:66.

CaraBAR Town.

The sanitary condition is much improved. Roads
and drains are being made throughout the town.
Four latrines have been built, and are of great con-
venience to the natives. I think another four might
with advantage be erected. The town is growing
rapidly. Iam of opinion that this growth is due to
aliens from Lagos, Gold Coast, and Sierra Leone,
rather than to the aborigines of the place.

The removal of the soldiers, with their wives and
families, to the new barracks will be an important
step towards European reservations. Owing to the
large percentage of children that harbour the malarial

arasites, they are undoubtedly a source of great

anger to Europeans.

The sick returns throughout the Protectorate have
heretofore not been made out in accordance with the
“ model return,” so regret that, with the exception of
Calabar, I am not in а position to furnish the: model
return for out-stations.

Bonny.

The health of both Europeans and natives was
good. At present the medical officer has only one
room in which to store his medicines, dispense and
attend to patients. In the native hospital which is
being built proper accommodation in the form of a
consulting-room, dispensary and storeroom are pro-
vided. One of the stores at Tunnicliffe House has
been fitted up as a prison. This store is well venti-
lated, and the floor has been raised, and as a lock-up
is most suitable. Excluding the cases of beri-beri
sent on from Calabar only four cases requiring to be
isolated occurred in Bonny during last twelve months,
two having been landed from a steamer. Тһе health
of the children at the Government school has. been
very good, and the water supply excellent.

European deaths, nil. Invalidings, nil.

EGWANGA.

The health during 1905 was good. The native
hospital is а very good type of native hospital. At
one end there is a consulting-room, dispensary and
storeroom, and at the other end quarters are pro-
vided for the native dispenser. The natives are now
beginning to appreciate the advantages of such a hos-
pital. The medical ofticer bas done what he can to
improve the sanitary condition of Opobo town, but
owing to its low-lying situation and swampy condition
little can be done in this direction. Much good work

58 THE JOURNAL OF TROPICAL MEDICINE.

[August 1, 1906.

has been done by carrying out the vaccination scheme,
and small-pox, which was once very prevalent, is but
seldom met with. Тһе native town of Lgwanga,
whieh was а hotbed of disease, and was in close
proximity to the European residences, has been cleared
away.

Deaths amongst Europeans, nil. Invalidings, 7.
DEGANA.

All Europeans now live on the beach, and the hulk
George Shotton, which was for a number of years
used as а residence for European oflicials, has been
done away with.

A native hospital, with consulting-room, store, and
dispensary is being built. When completed this will
be of great assistance to the medical officer, who up to
now has had to put up with the most limited accom-
modation. The health of the prisoners has been fairly
good. There was an outbreak of dysentery amongst
them which caused several deaths. No cause for this
outbreak could be found. The native town of Abo-
nema still maintains its reputation of being one of
the cleanest and best kept towns in the Protectorate.
Vaccination is still largely carried on, with the result
that a case of small-pox is but rarely met with.

Deaths amongst Europeans, nil. Invalidings, 8.

Brass.

The health of this station has been good. Though
£400 bad been allowed in the Estimates, 1905-1906,
for a native hospital, it has not yet been built, though
І am given to understand that building operations will
shortly commence. Up to September the only accom-
modation the medical officer had, to see his patients
in and dispense from, was a room 6 feet by 12 feet.
In September Mr. James, who was acting as Deputy
High Commissioner, handed over to the medical
officer a native house to be used asa hospital and dis-
pensary until such time as the native hospital was
built. The health of the residents, both European
and native, was good.

Deaths amongst Europeans, nil. Invalidings, 2.

AKASBA.

The health amongst the Government officials, both
European and native, was satisfactory. Two rooms
&re occupied by the medical officer in the Rest House,
one of which he uses as а dispensary and the other as
& Storeroom. There is no accommodation for sick
Europeans or natives. I think it would be advan-
tageous if the dispensary and storeroom were placed
on the ground floor, and two rooms were fitted up for
sick Europeans. The drainage system between the
Marine and Engineer's beach has becn most success-
ful, but I think some of the swamp in the immediate
vicinity of Marine beach might, with advantage, be
filled in.

There is а covered-in well between the Marine and
Engineer's beach. I consider this type of well most
suitable for out here.

Deaths amongst Europeans, 1.

Оһітвна.
This station is rapidly developing, and the head-

uarters of central division, which were originally at
saba, have been transferred there. Within a short

Invalidings, 9.

time Onitsha will bave both a European and native
hospital. Up to now the medical officer has been
placed at a disadvantage in not having such hospitals.
The drinking water is stored rain-water. I believe
the Director of Public Works has under consideration
a scheme for supplying water from a stream in the
vicinity. I was able, іп August, to station a second
medical officer at Asaba and Onitsha. The exigencies
of the services in January necessitated my leaving
Asaba and Onitsha in charge of one medical officer.
І hope to be able to send a second medical officer
there shortly.

Deaths amongst Europeans, 3. Invalidings, 8.

SAPELE,

The health of the Europeans at this station was
good. A result, I have but little doubt, due to the
Board of Health that exists here. I would strongly
recommend the formation of similar boards at other
stations.

With respect to the other stations throughout the
Protectorate, I am pleased to report that the various
medical officers are most energetic in trying to
improve the health of the residents and sanitation of
districts.

А. H. Hanury, C.M.G., F.R.C.S.I., &c.,
Acting Principal Medical Officer.

COMPARATIVE EUROPEAN VITAL STATISTICS FROM 1901 то 1905.

led | Death-rate | Invaliding

533 12 88 22:5

Year Number | Died. | Токай per mil, per mil,

Officials –--

1901 .. "E 121 t 15 33 1239

1902 .. КЕ 125 3 31 24 248

1909 .. ay 159 2 27 12°57 169:84

1904 .. m 157 7 18 44:58 114:64

1905 .. ET 190 ! 5 43 251 216
Non-officials -—— .

1901 .. 276 13 32 471 115:9

1902 .. K 279 | 8 17 28:67 60 93

1903 .. ..' 8301 10 27 33:22 | 58970

1904 .. e. 0 33 19 24 34:98 69:97

1905 .. ss 334 ; 7 15 20:9 134: 7
Officials and |

Non-officials | :

combined — |

1901 .. eq BUT 17 47 4982 | 11842

1902 .. 5 404 11 18 21:22 118:81

1903 .. ..: 460 12 51 26:08 117:39

1904 .. af 500 19 42 38 84

1965 .. 150

Notr.—Three officials and three non-cfficials died in England
in 1905, not included in above figures. 5

ADMISSIONS TO EUROPEAN HOSPITAL SINCE 1901.

Year Admissions Died | Invalided
pono ftri E Е | ed т
1901 us а | 13
1902 126 | 5 | 2
1903 38 | 2 | 18
1904 lig.) 3 Up 4
1905 170 | 240104
|

August 15, 1906.)

COLONIAL MEDICAL REPORTS—SOUTHERN NIGERIA.

Colonial Medical Reports.—No. 24.—Southern Nigeria (continued).
RETURN oF DISEASES AND DEATHS оғ EUROPEANS IN 1901 THROUGHOUT THE

Protectorate of

Blackwater Fever
Chicken-pox ..

GENERAL DISEASES. Total

Admis- Cases

sions. Deaths. Treated.

Alcoholism .. a vs ss ve Abre A 4
Anemia ex e M 5 .. 62... — 62
Anthrax UR Vs s " us азайды аа. еі
Beri-beri » НЕ АН Sy 2% 5. —.. 5
Bilharziosis - — --

(d) Таһев Mesenterica .
(e) Tuberculous Disease of Bones

Cholera 2 5а се а Е
Choleraic Diarrho: hee vs ez MEM SL
Congenital Malformation .. vs e o =e --.. —
Debility Av. Tai El fv. e ШИ S 41
Delirium Tremens .. vs vs 40с-- — —
Dengue e E T d — =a
Diabetes Mellitus es ЕЕ e — —- —
Diabetes Insipidus -- — =
Diphtheria .. T ұу 25 М5 —
Dysentery = .. m z e 17.. — 17
Enteric Fever.. В gs ES 22 3 E 3
Ervsipelas - - —
Febricula 26 - — -
Filariasis 2% " 2% ES (RO vM 4a mM. --
Gonorrhaa .. e 0 E . 22... —.. 23
Gout .. EM 24 T ba E 2 2
Hydrophobia .. me se Е om --
Influenza ss 4% 5 23 5 1. — 1
Kala-Azar 3% is M os - — --
Leprosy 3 m — -- --
(а) Nodular — — —
(b) Anssthetic .. Я - --
(с) Mixed.. Et $e s e =e — —
Malarial Fever— — . бе Е 4580.09 458
(а) Intermittent- — .. ss e 04. 4... 14
Quotidian . S oe өз. mus SSE --
Tertian .. Fi - se eas ae, SS
Quartan .. us Б 1Г2.00--.. --.. Я
Irregular .. vs »s -.. — Е
Туре undiagnosed | -" e 16b. — 11
(b) Remittent .. . Ls 4e 057 de -- --
(c) Pernicious .. 2% a Mee ыы 415 жез s=
(d) Malarial Cachexia .. 5% e m -- =
Malta Fever .. "s ES E НИ ала
Measles 2% m 4% ae T Ee eh седі
Mumps ae ре -. .. e — - —
New Growths— zs 2% ee e 0). — 63
Non-malignant .. se 52 АСЕ
Malignant $2 ia 52 1Г200-- om -
Old Age a 22 НЕ s .0--..--.. -
Other Diseases avs m 5% .. 136.. --.. 136
Pellagra 5% an bs d Mo m --.. -
Plague .. КА be 2% xs e Se --.. -
Pyæmia е i as 55, Ve. Se aati, SS
Rachitis АБ a - ВЯ ЧИЕ
Rheumatic Fever .. 2 vs ИИИ
Rheumatism .. В $e D e 59.. 59
Rheumatoid Arthritis z gre 10-0. -.. -
Scarlet Fever .. oe vs a 1Г200--.. --.. --
Scurvy... m АА 2% РА oe — e e —
Septicemia .. és HE e 1Г200--.. --.. —
Sleeping Sickness st 2 e — --.. --
Sloughing Phagedana T, "T 7.00--..0--.. —
Small-pox — .. .. E ae .0--..--. —
Syphilis— .. ТА X. m 2% 4. --.. 4
(а) Ргішагу T4 9% 4% ке GERA Mel uem
(0) Secondary .. с; oe МИНИС
(с) Tertiary E 5% 59 e >e oo
(d) Congenital .. vs he eee
Tetanus КА e 4% --.. --.. -
Trypanosoma Fever .. а? ii Sak. Жақ d
Tubercle— E о ol oe
(a) Phthisis Pulmonalis E е жел TT -
(6) Tuberculosis of Glands — — —
(с) Lupus Е а —

Southern Nigeria.

Admis-
SIONS,
GENERAL DisEAsES— continued.

Other Tubercular Diseases e. —
Varicella x Es Ss 5% e —
Whooping Cough és e - e —
Yaws .. +e M i ..0--

Yellow Fever ..

LOCAL DISEASES.

Diseases of the—

Other Poisons ..

Surgical Operations—

Amputations, Major ..

ee ew ee

Cellular Tissue .. 4% oe e 40..

Circulatory System— . Р x

(a) Valvular Disease of Heart <a Oe te

(b) Other Diseases ян 4...

Digestive System— 355 ..

(а) Diarrhoea ae ES e =e

(6) Hill Diarrhea.. B e —

(c) Hepatitis si Ше Ses

Congestion of Liver .. Pee EM

(d) Abscess of Liver бар Ca

(e) Tropical Liver.. oe Me ne

(f) Jaundice, Catarrhal . oe

(0) Cirrhosis ‘of Liver — .. es

(Л) Acute Yellow Atrophy — ..

(i) Ѕргие .. m we e oe

(J) Other Diseases.. is .Г.0--.

Ear Es Не T P e A.

Eye vi - e 15..

Genorative 'Sy stem— 4% a PELLIT

Male Organs РА A ELLOS

Female Organs .. gs e = e

Lymphatic System — .. ar e 40..

Nervous System S v 0048...

Nose . zs ae 2-4

Organs of Locomotion . m 2% A. 2s

Respiratory System .. B e 95 ..

Skin— .. 45. 754% .. 119 ..

(а) Scabies . a sx e =e

(b) Ringworm s .. LL"

(c) Tinea Imbricata 2% ..0--..

(а) Favus .. 3. m 480 A

(e) Eczema. : a" FS З

( f) Other Diseases m Wis Sem

Urinary System.. ss 5 s 4l

Injuries, General, Local— ds 0 50..

(а) Siriasis (Heatstroke) 1Г200--..

(b) Sunstroke (Heat Prostration) eee А
(c) Other Injuries - .

Parasites— bs ils ~ 92..

Ascaris lumbricoides .. as e

Oxyuris vermicularis .. we gu RES

Dochmius duodenalis, or Ankylos-
toma duodenale vis 5% em se
Dracunculus medinensis (Guinea-

worm) .. 4% e vis 2% И

Tape-worm xe gE n LLL
Poisons—
Snake-bites ar 2% its qe en
Corrosive Acids .. As ав ee
Metallic Poisons ee НЕ e —.

Vegetable Alkaloids .. 26 s 1..
Nature Unknown e se ELLOS

Minor .
Other Operations 22 22% МСЕ
Eye. m ы а=.

(а) Cataract a £a. PS

(b) lridectomy. 5 Е -- o

(с) Other Eye Operations We Be

ГІТ

НИЕТ АЕ УЫ АТЫР Ce Tail

It ШЕКЕ

Total

Cases
. Deaths. Treated.

TUE

to
no

Sal

ТТЕБ Т lili ibid

d Ta Mesenterica. .

60 THE JOURNAL OF TROPICAL MEDICINE. [August 15, 1906.
RETURN or DisEAsES AND DEATHS IN 1901 AT THE
Native Hospital, Calabar, Southern Nigeria.
GENERAL DISEASES. Total 3 Total
Admis- Cases Admis Cases
sions, Deaths. Treated. sions. Deaths. Treated.
Alcoholism э. . 29 GENERAL DiskEAsES-- continued,
Aniemi& | eres 1 Other Tubercular Diseases ee CMS - —
Anthrax ee fk, лға .. Varicella 25 69 .. -. 17
Beri-beri 3. 1. 3 Whooping Cough — —.. —
Bilbarziosis -- 2. = — Үамя 9..--.. 9
Blackwater Fever — Yellow Fever.. = — +5 =
Chicken.pox .. Sse — — —
Cholera : " — = —
Choleraic Diarrhea . — —.. =
Congenital Malformation -- -- ..
Debility e ; 25) . 0250 LOCAL DISEASES.
Delirium Tremens - DUE
Dengue os " - Diseases of the-— »
Diabetes Mellitus E -- : Cellular Tissue .. : 980 . 1 992
Diabetes [nsipidus -- Е Circulatory System-- .. i- 2T 2.. 7
Diphtheria Wo ee. mde (а) Valvular Disease of Heart eo T us --
Dysentery | .. 40 6.. 40 (b) Other Diseases. — -- ee
Enteric Fever -- eee ae Digestive System— " 1,729 10 ..1,729
Erysipelas l. ; e 1 (а) Diarrhcea ot a — -- .. --
Febricula 26 ЕЗ (b) Hill Diarrhea. . ae eee
Filariasis js НА Е -- — 2.00 -- (с) Hepatitis ee — —.. —
Gonorrhea .. 24 gs 100 — .. 100 Congestion of the Liver — -- 2.0 --
Gout... — -- 2.00 -- (d) Abscess of Liver — — .. —
Hydrophobia .. –.. — 2. 7 (е) Tropical Liver.. -— —.. -
Influenza es s loss eee 1 (/) Jaundice, Catarrhal . — —.. —
Kale-Azar .. Hr Е (9) Cirrhosis of Liver -- ta iets —
Leprosy . -- 2.0 -- (4) Acute Yellow Atrophy — e -
(a) Nodular А - 10- (i) Sprue : = e --.. --
(b) Ansesthetic .. 2 SS ey 2 () Other Diseases es — --.. —
(c) Mixed — Sass VH Far 2% 95 Ж si 69 .. —.. 69
Malarial Fever— . -- -- 2.0 — Еуе 5% d 173 .. — .. 173
(a) Intermittent 10--.. --.. - Generative System— i өр — — .. —
Quotidian.. A 43 25] .. ---: 952 Male Organs " s 72... — .. T6
Tertian .. ee 5% -- ..0--.. - Female Organs . 18. 1.. 14
Quartan .. eee Lymphatic System · 38... — .. 38
Irregular . -- 2. me Nervous System . 201 2.. 202
Type undiagnosed 79. 1.. 79 Хове : — .. — —
(b) Remittent 26 1.. 9 Organs of Locomotion. 192 .. --.. 192
(c) Pernicious .. -- -- .. — Respiratory rem 694 4.. 695
(d) Malarial Cachexia . — -- 2.0 — Skin— .. 4% 356 .. — .. 357
Malta Fever .. ea T. --.. -- (а) Scabies . --.. --.. —
Measles 4% 2. -.. 9 (b) Ringworm si -- =
Mumps Р we — =.. — (c) Tinea Imbricata — .. ee
Мем Growths— vit - see (d) Favus .. 4% -- 2. 0--.. --
Non-malignant .. -- —.2 -- (е) Kezema.. 45 — .. " —
Malignant : Е -- .. - (f) Other Diseases -- 4. =. ES
Old Age ar ss 4.1.0 -- Urinary System E Е 25 .. — 27
Other Diseases 77 2.. "77 Injuries, General, Local-- T 11 add . 3 .. 1,033
Pellagra : қашыр ME (а) Siriasis (Heatstroke) Ser ааа ы ==
Plague .. А (6) Sunstroke (Heat Prostration) —.. 0. I
Pyemia S T 125; 1 (с) Other Injuries ^ .. -- 2.2. --.. ---
Rachitis НЕ 25 e - o .. — Parasites— vs 218 — .. Эм
Rheumatic Fever .. РЕ zi 1,178 -- .. 1,184 Ascaris lumbricoides s ©. — —
Rheumatism . 5% - А Oxyuris vermicularis .. -- -- —
Rheumatoid Anthritis -= a. -- Dochmius duodenalis, or Anky los-
Scarlet Fever.. — –.. = toma duodenale — — —
Scurvy .. .. 2 — ee Dracunculus — medinensis (Guinea-
Septicemia .. .. .. - - -- worm) .. 4% .. .. ы --..0--
Sleeping Sickness .. Ae — — — Tape-worm аа — ағыла Di
ploughing Ehserdens РЕ - Poisons—-
Small- e . . — Suake-bites i e k ..00--.. --. -
Syphilis T . . -- 4. -- — Corrosive Acids .. ar es e 0m ce —
(a) Prima .. . 30 .. — 30 Metallic Poisons 9s Meee ak SEEN х2
b Secondary .. . 52... — 52 Vegetable Alkaloids — .. ae ЕНИС
pistes z ÁU m — -- Nature Unknown A 5% © =e c —
d) Congenital tU Б == ES — Other Poisons . 1.. —.. 1
Tetanus .: : E a — Surgical Operations—
panosoma Fever.. x = -- Amputations, Major 22 .. 8.. 99
T Erde... 1 2 Minor 360.. — .. 860
(a) Phthisis Pulmonalis БЕ - — Other Operations ea vem =
Tuberculosis of Glands a x. = Eye .. » ane ae
Lupus .. + = e (a) Cataract .. - = =

9) Tuberculosis Disease of Bones

(0) Iridectomy

(с) Other Eye Operations S

August 15, 1906.)

COLONIAL MEDICAL REPORTS—SOUTHERN NIGERIA. 61

NUMBER оғ NATIVES TREATED AT NINETEEN OUTSTATIONS

DURING 1905.

DISEASES.

Malarial Fever

Hæmoglobinuric Fever

Unclassified Fever ..

Enteric Fever

Variola

Varicella

Dysentery

Beri-beri

Erysipelas

Pyemia

Yaws

Tetanus

Tubercle

Leprosy

Syphilis m

Gonorrh@a ..

Rheumatism

Aniemia

Influenza

Gout ..

Meningitis

Epilepsy

Debility

Paralysis

Alcoholism .. ЕН А 2%

Diseases of Circulatory System ..
35 Cellular Tissue
4s Digestive Syste
3s Ear .. s
5 Eye ae - РА
T Genito-Urinary System
a Lymphatic System ..
5 Nervous System
» Nose Us H
рн Organs of Locomotion
$5 Respiratory System ..
» Connective Tissue

ï Skin
Injuries, General
» Local

Poisons 5%
Parasitic Diseases ..
Guinea-worms
Ascaris Lumbricoides
Filarial Loa ..

T.ocal Diseases
Measles

Other Diseases
Appendicitis . .
Insanity ds
Sleeping Sickness ..
Ulcers and Abscesses

Total
Cases
Treated.

1,175
1

Deaths.

ТЕС ШІ

ы!

toc
Cars

гак ТТЫ

ІЕРШІІШГІШН! с =.

APPENDIX А.

Report ом LEPER ÁSYLUM, ASABA.

The Leper Asylum is a collection of reed huts in
which live, on an average, 29 lepers, 13 male and 16
female.

These people, on the whole, seem to lead a happy
existence, they are well fed and cared for; they are
not enclosed and are practically free to wander where
they like.

The admissions during the year numbered seven ;
& considerable number of lepers demanded admission,
which in most cases was refused, owing to lack of
funds for their support. Three children were born
in the asylum, all of whom died within a short period ;
four lepers died and three left of their own accord.

In these cases I did not try to prevent their depar-
ture whenever satisfied that they were able to support
themselves, as, apart from the absence of means of
compulsion, I consider the limited accommodation of
the settlement could be turned to the best account by
being reserved for refugees and prisoners.

The staff consists of one native overseer, who has
discharged his duties exceptionally well, and who is
extremely gentle to the patients. It appears that the
staff is undermanned, and that it is impossible to pre-
vent patients wandering through the markets when
they feel inclined during the absence of the overseer.

It is intended that the asylum be removed to
Onitsha side in the near future, and, therefore, I do
not think it worth while to suggest improvements in
the Asaba settlement.

I do not know whether it is the intention of the
Government to enforce isolation in cases of leprosy, if
so it will be necessary to provide accommodation for
at least 1,000 lepers from this district alone, and a
scheme which does not embrace all cases is useless. І
suggest as the only way of carrying out isolation on a
large scale that the villages be required to provide
settlements for their lepers, each to be supervised by
an overseer appointed by the Government, who, with
the headmen, will be responsible that lepers do not
wander into the compounds of the healthy; this plan
could be tried without oxpense in one or two of the
native court towns and extended if found workable ;
the settlement at Onitsha could then be reserved for
criminals and refugees, of whom there will be a suffi-
cient number to tax its accommodation.

Е. Moore,
District Medical Officer.

62

Colonial Medical Reports.

THE JOURNAL OF TROPICAL MEDICINE.

[August 15, 1906.

No. 25.—Northern Nigeria.

MEDICAL REPORT FOR THE YEAR 1905.
By Dr. S. W. THOMPSTONE.

Principal Medical Officer.

THE average number of Europeans resident in the
Protectorate during the year was 342, of whom 277
were officials and 65 non officials—331 being males
and 11 females.

The native population was estimated as being
9,000,000 approximately.

Ten Europeans died during the year,
were officials and 3 non-oflicials.

The total crude European death-rate for the year,
calculated on the average resident population, was
29:23 рег 1,000. As in former years, there was а very
marked difference in the mortality rate of officials and
that of other members of the community, there having
been 7 deaths among 277 oflicials and 3 amongst 65
non-officials, giving an official death-rate of 25:27 per
1,000 as against а non-official one of 46:15 per 1,000.
The difference is, however, much less marked this
year than last, when the rates were 20:62 and 96:15
respectively.

These death-rates are, as stated above, “ crude”
death-rates, and they are not corrected for age and
sex distribution, and are therefore not comparable
with that of communities consisting of persons of all
ages and both sexes in the proportions met with in
Europe.

There has been an increase in the average resident
European population as compared with 1904 of 20,
last year's population having been estimated at 322.
The death-rate has decreased by 11:14 per 1,000, and
the invaliding rate by 64:73 per 1,000, the latter rate
being 143:27 for the year 1905, as against 208 per
1,000 for 1904.

Ав in former years, the rainy season has proved the
most unhealthy for Europeans, the greatest amount of
sickness having occurred during the months of July,
August and September. Тһе wettest month, August,
was the worst month, and March showed the fewest
admissions—the former month having the highest
relative humidity and the latter being the driest in the
year.

The general character of the diseases prevailing
showed little or no change. The case mortality of
hemoglobinuric fever was slightly higher than in 1904,
but much lower than in 1903. The figures for the
three years being 37:3 per cent. in 1903, 16:1 per cent.
in 1904, and 20 per cent. in 1905; the actual number
of admissions from this disease being 20, and the
number of deaths 4, as against 31 cases with 5 deaths
last year.

During the first three months of the уеаг а very
severe epidemic of cerebro-spinal fever broke out in
all the provinces of the Protectorate—Borgu, Konta-
gora, Sokoto, and Bornu being the only places that
escaped. With the exception of an outbreak among
the East African carriers at Cape Coast Castle during

7

of whom

the Ashanti Expedition of 1900, this is the first re-
corded epidemic of this disease in West Africa, though
A. Plehn mentions it as being amongst the diseases
met with іп Kamorun.

From enquiries made among the older natives it
would seem that epidemics of this disease occur period-
ically over the whole of Northern Nigeria, and
have been usually even more severe. The tradition is
that it came originally from the north-east, but not
in the memory of living man. Fifty years ago ап
epidemie is said to have occurred at Egga on the
Niger, and ten years ago Kano was decimated by a
very severe outbreak.

It is impossible to estimate the actual number of
deaths, but there were certainly over 100 in Bautchi,
250 in Ilorin, and 60 in Zungeru, during the month of
February alone, and the natives say that here were
50 deaths a day in Zaria, and 100 & day in Kano
during January. Dr. McGahey reported from the
Yola district that some of the villages lost 5 per cent.
of the population during the three months, that in
Yola town itself there were 300 deaths from the
disease, and that the case mortality was approxi-
mately 50 per cent.

All native accounts agree in its being essentially a
dry season disease, which always disappears when the
rain begins. January, February and March being the
bad months, the dust-storms being probably the cause
of its spread, by disseminating the dread nasal secre-
tions containing the causal organisms far and wide.
At the commencement of the epidemic the case mor-
tality was appalling—many of those attacked practi-
cally falling dead at their work—later, however, its
virulence became attenuated and many of the later
cases recovered.

Only two Europeans were attacked, both of whom
died—one in Kano and one between Zaria and Zun-
geru; this comparative immunity being almost
certainly due to the principle which has been adopted
when laying out new stations, of building the Euro-
pean quarters at a distance from the native towns.

Several epidemics of small-pox also occurred during
the dry season, but none of any great magnitude.

- The town of Katagum and an adjacent village called

Kudabir suffered somewhat severely, and in the town
of Bautchi the Emir stated that there had been 100
deaths during January and February from small-pox.
In the Bautchi district it would appear that the disease
spread from Kassina, a hamlet south of Zoranda, and
from there was carried to Bautchi, and thence spread
into the surrounding districts. The village of Кейіп
Fulani, between Bautchi and Ningwe, was practically
emptied owing to the ravages of the disease. With
the exception of a soldier and a horse-boy, no cases
occurred in the camp.

September 1, 1906.)

Colonial Medical Reports.—No. 25.—Northern Nigeria
(continued).

AN interesting fact reported by the medical officer
at Bautchi is that the cow fulani almost invariably
escape small-pox : they are said to practise a form of
inoculation of cow-pox virus, having apparently dis-
covered for themselves that the one disease renders
them immune from the other. Amongst other natives
inoculation with small-pox virus is common—the
sufferer being paid a small sum to allow the procedure.

There was practically no difference in the relative
mortality amongst the Europeans in the different
seasons. There were, however, many more native
deaths during the first three months of the year—the
increased mortality being. principally due to the
epidemics of cerebro-spinal fever and small-pox which
broke out during the period.

Zungeru.—The rainfall during the year was 41:31
inches, or 9:8 inches less than іп 1904; the wettest
month being September with 8:04 inches. Rain fell
during eight months of the year—March to October
inclusive—the heaviest fall recorded being 9:63 inches
in the twenty-four hours, on October 15th.

The maximum shade temperature was 106° F.,
which was recorded on April 8th; the minimum,
56° Ғ., on December Ist. The highest mean tempera-
ture for the month was 87°F. in March and April,
and the lowest 77:39 Е. in August; the mean tempera-
iure for the year being 80:1? F. Тһе mean relative
humidity for the year was 58, the highest mean
being 81:6 for August, and the lowest 33 for
January and February—caloulated from readings taken
at 9 a.m. The lowest actual relative humidity
recorded was 16, from hygrometer readings taken
at 4 p.m. on April 7th, and December 21st and 30th.

Lokoja.—The total rainfall was 49:64 inches for the
year, or 7:92 inches more than last year—the heaviest
rainfall occurred in September, 16:28 inches. The
maximum shade temperature was 101° F., which was
recorded on March 10th, and the minimum 53° F.,
on December 31st. The highest mean temperature
for the month was 87° F. for March and April, and the
lowest 78° F. for August and December—the mean
temperature for the year being 81° F.

The mean relative humidity for the year was 72,
the highest mean being 78-7 for September, and the
lowest 60 for March.

The highest temperature recorded in Northern
Nigeria during the year was 118? F. at Maifani on
April 8th, and the lowest 39? F. at Kano on Feb-
ruary 2nd: the highest mean temperature for the
year being at Kontagora, 82° F., and the lowest,
Zaria, 74° Е. The greatest rainfall was at Zaria with
51:27 inches, and the lowest, Sokoto, with 33:39
inches. The maximum fall on one day being at
Ilorin, on June 2nd, 4:04 inches.

The general direction of the wind throughout the
Protectorate was from the south-west from June to
November, and from the north-east during the гешдіп-
ing months of the year, the Harmattan lasting, with
slight intermissions, from December to the end of
May ; the first tornado occurring in March, and the
rainy season ending in October.

The meteorological conditions have considerable іп-
fluenee on the health of the community, the dry sea-

COLONIAL MEDICAL REPORTS—NORTHERN NIGERIA. 63

son being comparatively more favourable to Europeans,
owing to the absence of mosquitoes and the more
bracing condition of the atmosphere—the nights being
cool, and the temperature, though high during the day,
owing to the low relative humidity, being much more
easily borne than the damp relaxing heat of the rains.
The number of admissions from malaria rise rapidly
after the first tornadoes, and reach their maximum
when the rains are heaviest. The natives, on the
contrary, suffer more during the dry season, not only
from epidemics, but from respiratory and digestive
diseases brought on by the cold nights and scarce
and impure water supply.

The greatest amount of sickness during the year
among Europeans has been due to malaria. The total
number of admissions from this disease (excluding
blackwater fever for the sake of convenience) having
been 445 with no deaths, compared with 515 admis-
sions with 3 deaths last year.

Twenty cases of hsmoglobinuric fever occurred,
with 4 deaths, and 34 of dysentery with no deaths.
There were 2 cases of small-pox in Europeans during
the year. Among the natives treated there were 1,090
cases of malaria with 19 deaths, 451 cases of dysentery
with 48 deaths, and 769 cases of rheumatism with 1
death. Complete lists of all diseases treated both
among Europeans and natives are attached at the end
of this report.

The general sanitary condition of the European
stations is good—the great need being better quarters.
The expense of transport of materialis so great that in
practically all the stations off the rivers officers have to
live in mud or grass native-built houses, which harbour
insect life and are anything but weatherproof.

The water supplies have been improved where
possible, the small condensers supplied to outstations
having proved а great success. They have іп con-
junction with other sanitary measures been the cause
of a large reduction in the number of cases of dysen-
tery met with, no death having occurred from this
disease during the last two years. .

Under the influence of European teaching the large
native towns аге beginning to show some signs of im-
provement, but it will be many years before much can
be done in this direction.

Zungeru.—The average resident European popula-
tion during the year was 66—61:6 officials and 4-4 non-
officials. Тһе sanitary condition of the cantonment is
excellent, the drainage being effective and the water
supply good. The series of dams which was con-
structed last year for the purpose of holding up the
water in the Dago and providing for а continuous flow,
has answered its purpose admirably, and has now
stood the test of two dry seasons.

The drinking water supplied by the condenser is of
good quality and sufficient for all requirements.

The general health of the population has been good.
The number of admissions to hospital was 92 with
2 deaths, one of which was the case of & patient
who was brought into hospital from Barajuko, and
whose illness was contracted on the river. Last
year there were 123 admissions with 4 deaths—a very
marked reduction both in the number of admissions
and the case mortality.

Gaol.—The sanitary condition is good, the cells

64

THE JOURNAL ОЕ TROPICAL MEDICINE.

[September 1, 1906.

being kept clean, and the yard dry and well swept.
The ventilation works out at about 550 cubic feet per
inmate, and as the doors are grated and ample open-
ings are provided in the walls the air in the buildings
is always fresh. The water supply is obtained from
the Kaduna and Dago Rivers, and is of good quality
and ample іп amount, no limit being laid down as
to the quantity supplied. Combustible refuse is
burnt, and excreta carried out in pans aud buried in
trenches.

The general health of the prisoners during the year
has been fair, but many of the inmates were in
wretched condition when admitted. The principal
diseases which occurred were dysentery, diarrhwa,
rheumatism, guinea-wcrm and pneumonia.

The average number of prisoners was 162; and the
quality of the prison diet good.

Freed Slaves’ Home.— Both the compound and the
buildings are kept clean and in excellent sanitary
condition. The average number of inmates during
the year was 167, and their general health was good.

Ventilation is free and suflicient, and the water
supply, which is obtained from the Kaduna and
Dago, is good and ample. All drinking water is
boiled before use. The refuse is disposed of by
burning and burying іп trenches—the pan system
for excreta being in use.

The prevalent diseases were stomatitis, diarrhwa,
intestinal parasites, and dysentery.

Lokoja.—The average resident European population
was 73:8, 60 being officials and 13:8 non-ollicials.
The sanitary condition of the cantonment is very
good, great improvement having being etfected during
the past year. The diainage is satisfactory, and the
European compounds and native lines well kept and
clean. The drinking water from the condenser has
been of excellent quality and sufficient in amount.

The general health of the community has been
much better than in any previous year—the admis-
sions to hospital having been only 101, as against
145 in 1904.

Gaol.—The sanitary condition of the gaol is
extremely good, and the general health of the
prisoners satisfactory. Тһе water supply is obtained
from a stream which runs near the prison, and from
rain-water tanks on the premises. The supply is
ample and the quality good. Ventilation is free and
sufficient. ·

The average number of prisoners during the year
was 67; and the prevalent diseases were diarrhoau
and malaria.

Kano.—The average resident European population
during the year was 21:3. The sanitary condition of
the station is as good as circuinstances will allow, but
drainage is unsatisfactory, as owing to the nature of
the ground no proper fall is obtainable at Nassarawa.
А new site at Goza has been occupied by the military
during the year with a view of testing its suitability
for a permanent cantonment, and the results of the
year's experience are being submitted separately.

The general health has beon unsatisfactory, but
so far as can be gathered from the statistics at present
to hand, the new site presents distinct advantages
over that now occupied by the civil population.

The water supply is derived from wells at Nassa-

rawa, which have proved insufficient for the needs
of a large population during the dry season. At Goza
it is obtained from pools fed by springs, and has 80
far proved sullicient.

There were 1,305 successful vaccinations performed
during the year, all stations being now supplied with
small consignments of lymph by each mail. The
greatest difficulty is still experienced in obtaining it in
an active condition at those stations which are farthest
away from the sea-coast—the results for the year at
Sokoto and Katagum being nil. In spite of this dift-
culty considerable progress has been made towards pro-
tecting the native troops and the inhabitants of the
towns nearer headquarters.

Small-pox is endemic—a very considerable propor-
tion of the adult population showing marks of previous
attacks, and those who have not suffered from the
disease are becoming keenly alive to the proteotion
afforded by vaccination, being most anxious to have
the operation performed whenever an outbreak occurs.
To overcome the difliculty of obtaining active lymph
the experiment of forming small vaccine stations at
two or three stations intermediate in distance from the
sea, such as Zaria, Kontagora, and Koffi, would be well
worth trying. If these prove а success the system
could then be extended with some hope of protecting
the population in those portions of the Protectorate 1n
which it has up to now proved impossible to obtain
successful results.

Two cases of small-pox have occurred among the
European oflicials, both of which, however, recovered.

The general heulth of the European community has
been better than in any year on record. Both the
death-rate and invaliding rate have been much lower
than last year, the death-rate, which was 29:23 per
1,000, having been 20:33 per 1,000 less than the aver-
age of the previous five years, which works out at
49:56 per 1,000.

STATISTICS OF EUROPEAN POPULATION.

1904 | 1905

|
Europeans 1000 | 1901 | 1902 | 1903
po ——— i ---- ------- _
Average actually іш 165 | 165 ' 290 | 309 328 | 342
the Protectorate i
Number of Deaths ..| 13 9 9 18 18 10
Number of Invalids..| 21 | 30 | | 4а 67| 9
Ax EIER n

ANALYSIS OF 1905 STATISTICS.

Invaliding

1
Europeans | Total Deaths ae ue Invalids | Rate per

| | 100! 1,000

Average actually in 342° 10 | 2923 ! 49 | 143-27

the Protectorate !

Oflicials . | a77 7 | 2595 39 14079

Non-oflicials .. | 65 3 | 4015 ! 10 | 1538
| 1

1

The invaliding rate was 143-27 per 1,000, the average
for the last five years being 144-6. 4
The health of the native population was very 08
during the earlier months of the year, owing to the
epidemics of cerebro-spinal fever and small-pox above
referred to. The total number of natives treated 8

September 1, 1906.] COLONIAL MEDICAL REPORTS—NORTHERN NIGERIA.

(d) Tabes Mesenterica .

(0) Iridectomy —

65
RETURN or DISEASES AND DEATHS оғ EUROPEANS IN 1905 THROUGHOUT THE
Proteotorate of Northern Nigeria.
GENERAL DISEASES. Total Total
Admis- Cases Adinis- Cases
sions. Deaths. Treated, sions, Deaths. Treated,
Alcoholism m Қ Тер ERU 1 GENERAL DISEASES - continued.
Anemia. .. 22 E: 20 .. — .. 99 Other Tubercular Diseases 1.200--.. = —
Anthrax — .. —- .. -- Varicella 3 x. a2 a e — s — —
Beri-beri —.. —.. — Whooping Cough ite 2 es 1100-22. - -
Bilharziosis ee zap — Yaws .. 2% m 5% ..00--.. - —
Blackwater Fever -- .. --.. -— Yellow Fever.. 2% Ys 5% be Ceng -- —
Chicken-pox .. ag v -- 2. 0--.. -
Cholera E . 3% -- 22. — -—
Choleraic Diarrho .. --.. — ъ=
Congenital Malformation — — —
Debility " s 5 = 45 LOCAL DISEASES.
Delirium Tremens .. n -- а. — —
Dengue 55 =.. — — Diseases of the—
Diabetes Mellitus — - Aes Cellular Tissue .. i -. S 12.. —.. 12
Diabetes Insipidus -- -- — Circulatory System— . =
Diphtheria .. E - — — (a) Valvular Disease of Heart. .. 1.. — .. 1
Dysentery | .. e SE e Bh. — 35 (b) Other Diseases -. .. 4..1. 4
Enteric Fever.. M. vs 2s 2. 2. 2 Digestive System— — .. xe .. 109 .. — .. 109
Erysipelas Е Wo a em ig ае (а) Diarrhea Ұз 3 « 20.. —.. 90
Febricula zs -- ЕЕ (b) Hill Diarrhoa.. Ne а. --.. --
Filariasis -- -- .. — (c) Hepatitis ez — --.. —
Gonorrhea... EN 2% a - —.. — Congestion of Liver M ee --.. —
Gout .. се 4% vs e - Шаа ы; ыы (d) Abscess of Liver 45 ahs бла: SS 6
Hydrophobia .. -ə-...--.. - (е) Tropical Liver.. 4100-5.. --Д. —
Influenza ak ey ое (f) Jaundice, C atarrhal . m 2.. —.. 9
Kala-Azar e. 2s --.. --.. - (g) Cirrhosis of Liver а. —
Leprosy e e —.4. —4. -- (^) Acute Yellow моу, e se --.. -
(а) Nodular 2% НЕ -- 2.0--.. - (i) Sprue .. ES ы CREW me Nm
(b) Anwsthetic .. Б -- 2. eee (J) Other Diseases. 5% e 16.. —.. 16
(с) Mixed.. vs 5 ИХ Ear З а 92 а; 41. —.. 4
Malarial Fever— — .. 2% 445 .. — .. 448 Еуе 2% 25 А e 14. —.. 15
(a) Intermittent-— nie 44 M. = o -. Generative Sy stem- - ue 5% 5% 13: БИ 14
Quotidian .. a zi Beo Enia Male Organs 2% vs 7Г200--.. --.. —
Tertian .. E Т --.. --.. - Female Organs .. es queo Слет елд o
Quartan — -- 2.0 c Lymphatic System .. T e 15.. --.. 15
Irregular -.0-.. - Nervous System 24 4% . 10.. —.. 10
Type undiagnosed 10. —.. 1 Nose 5 ai 2x 1.. —.. 1
(b) Remittont . -- 2.0 --.. -- ар of Locomotion . - e 3... —.. 3
(c) Pernicious .. 55 90 .. 4.. 23 Respiratory System — .. RA 2l.. —.. 21
(d) Malarial Cachexia .. = ať ať o Skin— .. Е Е wes mp Г Е
Malta Fever .. AE: E -- 2.0 — 2.0 — (а) Scabies . T 4% 1.00--.. --.. -
Measles is ss -- 2.0 -- 2.0 -- (^) Ringworm 2% s e оға
Mumps 7 See c 4 - (c) Tinea Imbricata E e — --.. —
New Growths— V —. --.. — (d) Favus .. 6 s .Г.0--.. -- -
Non-malignant .. m - eee (е) Eczema . . An se 6.. — 6
Malignant - etek -- (f) Other Dise: tses y 0 40.. — 40
Old Age e - EC Urinary System.. ji nl $us plas —
Other Diseases - — .. — Injuries, General, Local " e 46 .. — 49
Pellagra 2% -- 2. --.. - (а) Siriasis (Heatstroke) ie 1Г200--.. --.. --
Plague .. EN E. 5% -- 24.0 -- .. d (0) Sunstroke (Heat ае i 6 .. — 6
Pyemia 55 e s e - wi UEM n (c) Other Injuries " vs 14 .. : 14
Rachitis - T4. o — Parasites— 2.5 5% 24 6. — 6
Rheumatic Fever oj mm 1.00 -- Ascaris lumbricoides .. 29 TTD —
Rheumatism .. 37... — .. 3T Oxyuris vermicularis .. - 1200--.. -- —
Rheumatoid Arthritis. Ls -— .. = Dochmius duodenalis, ог Aukylos-
Scarlet Fever .. 2% 44 5% Toa. os toma duodenale E vs — —
Scurvy .. us ты eee Dracunculus medinensis (Guinca-
Septicemia .. Cw due та € worm) .. 2 m 5% Pee Әне Т; —
Sleeping Sickness -- 21.20 -- .. Tape-worm es ws Е Pes 99 yu Ro
Sloughing Phagediena 0. ee — oo Poisons—
Smallpox — .. ES Е d 3 Snake-bites 5% s 22 eso — 4.20 ome
Syphilis— — .. ES - 4. 25 Corrosive Acids .. 24 s We mE АН жә RE
(a) Primary —.4. - Metallie Poisons E ЕН es
(b) Secondary .. — 0--.. -- Vegetable Alkaloids — .. oe .0--.. --.. --
(с) Tertiary на ТИСИ - Nature Unknown € ps e ee ee
(d) Congenital .. an СЕ Other Poisons .. k 2 ss 4. -.. 4
Tetanus - Н - T e --.. — — Suryical Operations. -
Trypanosoma Fev cr. Е — Amputations, Major .. d m ee
Tubercle— . =e — - Minor .. e ..0--.. --.. -
(а) Phthisis Pulmonalis % TM. е Other Operations 2% m ..00--.. --.. -
(b) Tuberculosis of Glands .. -- 2. — .. Eye .. г. ne ..0--.. --. 5
(с) Lupus Е Е — me (a) Cataract. .. 6 .00-.. -. —

(e) Tuberculous Disease ‘of Bones "..

(c) Other Eye Operations . e —

66 THE JOURNAL ОЕ TROPICAL MEDICINE.

{September 1, 1906.

the government hospitals and dispensaries during the
year was 16,557, an increase of 3,052 over last year.
Of these, 1,090 were cases of malarial fever.

Dispensaries have been established during the vear
in most of the provinces, and although they have
necessarily been equipped on а very small scale, 2,531
paupers have been treated throughout the Protectorate
during the year.

The permanent enclosures to which I referred in my
report last year, which were erected at Lokoja and
Zungeru for isolating cases of infectious disease, have
been invaluable, grass huts being run up inside them
for the accommodation of patients, and burnt when

the epidemic subsides. In former years it was found
to be practically impossible to prevent the friends of
the patients visiting them at night and spreading the
disease abroad. This has now been effectually stopped
and effective isolation provided.

Venereal diseases are still very prevalent, there
having been 1,063 cases of gonorrhea and 370 of
syphilis treated among natives during the year. The
further away a station is from the sea the more cases
of syphilis are met with, Bornu having the greatest
number in Northern Nigeria; scarcity of water and
consequent lack of personal cleanliness probably ex-
plaining the fact in part.

Colonial Medical Reports.—No. 26.—Saint Lucia.
ANNUAL REPORTS ON THE HOSPITALS AND
DISPENSARIES, 1904.

CASTRIES.

Alex. King, M.B., Ch.B., D.P.H., 2nd District
Medical Officer for Castries.

In Castries better means of sewage collection and
disposal should be adopted. The bucket system can
hardly be dispensed with, but could easily be
carried out on better lines, as it is capable of great
improvement.

ye-laws as to the disposal of domestic waste
water should be enforced. The habit is to throw it
on the ground in the most convenient place, thus
producing a very foul state of the subsoil. This is
especially objectionable as wells still exist, though
apparently they are little used. The large prevalence
of intestinal parasites is traceable to the same careless
habit of throwing down filth around the houses.

There is a good deal of overcrowding both of per-
sons in houses and of houses on the land. As things
stand at present the space round each house is hope-
lessly deficient, resulting in the crowding together
of outhouses which should be widely separate; for
instance, privies are found next to and communicating
with kitchens and servants’ quarters, and cowhouses
in the same relation to bakehouses.

It is an accepted fact that the death-rate varies
directly with the density of the population, and
though the Castries death-rate is wonderfully small
it could be further reduced. At the same time this
death-rate is not, I think, a very true index of the
town’s freedom from disease. In the present con-
stitution of the population, owing to industrial con-

ditions, there is an excess of young adults, and a
population so constituted has naturally a small
death-rate. .

Although the town has a good supply of gravita-
tion water, tanks still abound. They are very well
as a Stand by, but should be built во as to be easily
inspected ; should be covered во as to prevent access
of mosquitoes, and should be cleansed at regular
intervals. Until these provisions are carried out
tanks should be looked on with suspicion, if not
actually as а nuisance.

The rivers round the town are in general use
for washing clothes and are not suitable for the
purpose. The flow of water is small at best, and
now the beds are fouled with soapsuds, &c. The
woman who washes furthest upstream may get clean
water; those below certainly do not. Disease might
easily be spread in this way.

Anse-la-Raye village requires a better water supply.
The plots round the houses are not well kept, and
there are heaps of rubbish all through the village.
The wash of the surf has piled up the sand till one
of the beach privies has been left high and dry. The
villagers continue to use it, so now there is a large
collection of filth which is apparently never removed
or even covered. The whole system of beach privies
is objectionable, but when accidents of this kind
happen it becomes injurious.

The ditch which runs parallel to the back of the
village is stagnant, forming a splendid breeding-
ground for mosquitoes. It also smells foul.

The village round Roseau Factory is dirty апа
badly kept.

September 15, 1906.)

Colonial Medical Reports.—No. 26.—Saint Lucia
(continued).

ANSE-LA-RAYE DISPENSARY.

THE diseases treated at Anse-la-Raye Dispensary
for the year 1904 were as follows :—

Spina bifida ...
Teeth Extracted

Intestinal Parasites See 134
Malaria $us 2% DN 2432094
Diseases of Digestive System se н .. 46
» Respiratory ,, us s .. 94
i Nervous T 7
» -Circulatory ,, 5
9% Urinary б 1
5 Ear PT ie 2
5 Eye .. 7
» . Throat ... 3
75 Nose... 2
2% Male Organs 1
" Female ,, 12
M Blood 6
Skin 8
Syphilis ES 11
Ulcers, Abscesses, бе. 13
Injuries ae 6
Tuberculosis... 1
Hernia 2
Rachitis 1
Rheumatism... 9
Arthritis 1
1
4
Indefinite 20
Total ... 384
Gros-Istet Dispensary.
Alex. King.

The number of patients attending was 554. The

following is an analysis :—
Diseases of Digestive System sus ves el 75
95 "Respiratory ,, 2% 2% 2... 89
5 Circulatory ,, ad ET 222-109
35 Urinary 5 v. аза "|
i Nervous 5 m ds sek glk
^ Lymphatic ... A дез mu. 14
Е Eye .. s 4
3 Ear 10
5» Throat 9
3 Skin... NM ы E .. 19
ыз Male Organs ... "S ed s 24
е Female ,, wed he n .. 18
Blood ... sis B 22% ucl
Malignant New Growth .. 251 ae ы
Rheumatism .. ; ME e ута 2s LL
Hernia we т е TA КИ ive 1
Tuberculosis.. 4s 2; Ls A uc 79
Malaria 2 е -— fe ҚК 121
Intestinal Parasites s ne ae .. 88
Influenza .. mA use T s d
Uleers, Abscesses, бе, v s had we cq
Injuries sis ots oe ie РЕ ae oS
Pregnant ... T ii s is ms 4
Senility 25% se dis M des e 8
Indefinite ... x ies m x .. 21
Returns | .. zs s E we e. 7$
Total 554

COLONIAL MEDICAL REPORTS—SAINT LUCIA. 67

The most remarkable feature is the total absence
from the list of syphilis and gonorrhea. Next is the
extremely low percentage (3 per cent.) of tuberculosis.
Following on the absence of venereal disease the
percentage of cases of disease of male organs is very
small.

Malaria increased enormously in the last two
months of the year. The others are fairly evenly
distributed.

DENNERY.

Edwin Wells, M.B.(Edin.).

At the end of July, Dr. Payne resigned charge of
this district and I took over from him on August Ist.

The number of persons who consulted me in both
Micoud and Dennery Dispensaries during the year
was 1,470. Malarial fevers, worms and digestive dis-
turbances claim the lion’s share of attention.

Malarial fevers are prevalent in the autumn, though
cases are seen here and there all the year round.

In August and September an epidemic of whooping-
cough invaded the district, but was quickly got under
control and stamped out.

The estimated population for the year 1904 was
4,500. There were 91 deaths during the year, giving
a death-rate of 202 per 1,000. One hundred and
sixty-seven births took place in the district, the rate
being 37:1 per 1,000.

SANITATION.

The sanitary condition has been fairly good all
round. No diseases could be traced directly to in-
sanitary conditions.

The sanitary condition of Micoud has been very
good, and it is one of the cleanest villages in the island.

I append a list of the diseases treated at the
Dennery and Micoud Dispensaries and the annual
return for the hospital.

List of diseases treated at Dennery Dispensary
during 1904 :—

Alimentary System ... e d s .. 96
Hexmopoietic ,, .. es m iis ax d
Respiratory io. ses A s is .. 99
Genito-urinary ,, ... sus - "a .. 54
Special Senses AS As vus io 2. 86
Malarial Fevers s T 190
Worms 2 " 202
Angmia and Debility Ку егі ы .. 99
Ulcers : : Sa sse was .. 16
Teeth Extraction ... 285 z oo .. 32
Suppuration and Abscess ... 6
Ankylostomiasis 6
Skin ... ед 81
Hysteria 8
Pregnant 3
Nervous 34
Senility is 5
Rheumatism and Lumbago 15
Elephantiasis (ошағы) 1
Deformity 1
Bones and Joints 12
Hernia 1
Leprosy 1
Fracture 1
No Disease ... 28

Total

25}
bo
н-

68 THE JOURNAL OF TROPICAL MEDICINE.

[September 15, 1906.

List of diseases treated at Micoud Dispensary during

1904 :—
Alimentary System ... ae Ja 55% e 47
Hemopoietic ,, ... 842 е " 22004
Respiratory ig Mus t - 15% .. 61
Genito-urinary ,, .. "E e s .. 11
Special Senses T РА e А s». 219
Malarial Fevers Я ET i i .. 81
Worms zs 452 E ae 176
Anemia and Debility iN n s se AL
Ulcers 54% ae ET Ке гіш 2. 97
Teeth Extraction ... Е ant ds .. 14
Suppuration and Abscess ... й: E 0 011
Ankylostomiasis ... m se m .. 12
Skin ... sss ee ids 5 e .. 19
Pregnant... ses 5% su sis ux Т
Nervous wes я i ES "sh 2.2005
Senility sd is ie s HT .. 12
Rheumatism and Lumbago es: ves .. 31
Elephantiasis А 3
Deformities ... n Lan - РЕ nS,
Bones and Joints... 5% 2i - mE TT
Hernia 3
Bursitis 242 oh ics ru ae of
No Disease ... isa зы Ss E .. 15
Total 546

DEÉNNERY HosPITAL. RETURN OF ADMISSIONS, DISCHARGES,
AND DEATHS DURING THE YEAR 1904.

3 2
108 A E |
1 шы ересен

Ж E Е |

НЕА НЕЕ

ЕІНЕЕНЕЗІЗ ЕЕ &

посад саае
Number in Hospital at last; 1 2 3 1l.. .. 3 7)

Return | ' A 221
Admitted during year .. 50 3787 80110 4057 30 87| 214 |
200 Total.. 2281 isle ial

n н 1

Discharged cured .. 33 25 58125, 6 3149170, 159 |

Discharged uncured .. ..:12' 890] 5 106 7 2 9| 35 -209

Deaths .. 12/3 12 3 2/7 9| 15)
Total .. ..463581 $1 942088088 200
! los
Remaining in Hospital at the | 4: 5 9..... ..| 3.. 312
close of the year |. ; |
SOUFRIERE.
J. А. Lestrade, M.B., C.M., District Medical Officer,
Soufriére.

The health of the Second District was good. Be-
yond ordinary ailments there were very few noticeable
diseases of a severe type among the people. I attri-
bute this to the better scavenging now going on for
some time, but principally to the new water supply
given to the town. One sees very few cases now of
those continued fevers and bowel complaints which
raged formerly in the town during the hottest part of
the summer and autumn season ; though there were

three mild epidemics of a contagious character during
the year. Throughout the year, but principally about
the time of the hot season, a skin disease, which was
also prevalent the year before, was noticed. I believe
this was caused by the irritation of minute particles of
dust present in the atmosphere whenever the volcano
of “ Mont Pélée”’ at Martinique erupted, as it was
first noticed after the first eruption in 1902.

About August, and for some time after, influenza
was mildly prevalent, but it was practically of a harm-
less character.

At about the end of the year measles, with diar-
гоа and bowel disturbances as an after symptom,
began to show itself. It then spread іп а southerly
direction, and was still raging up to July last, when I
gave over the district to Dr. Wells.

The institutions under my charge were well patron-
ised. At the Soufriére Dispensary 1,224 people applied
for treatment, of whom the greatest number were
infants and children, brought for treatment for fevers
caused by the irritation of teething and worms, and
and often also of bad innutritious food.

At the Choiseul Dispensary the number of patients
treated was 198, with 175 successful vaccinations.

At the Poor Asylum the number treated was 137 ;
94 were admitted during the year. The number of
indigent and sick paupers must be increasing at the
present moment in Saint Lucia by leaps and bounds.

The number of yaws patients treated during the
year was 80. The appellation of “ yaws patients" is
patently а misnomer, as three cases of leprosy were
sent to me from Castries for admittance, making a
total, with those already in the asylum, of 7 cases
treated during the year.

There were 11 deaths at the institution during the
year; of these, 7 were due to yaws, 2 to debility and
exhaustion consequent on tertiary syphilis, and 2 to
leprosy.

At the Lunatic Asylum there were, at the beginning
of 1904-4 female inmates; 7 were admitted, making
& total of 11 treated during the year. One was dis-
charged and 2 died. Тһе cases treated were mostly
epileptics and those suffering from senile dementia.

At the Soufriére Hospital 85 patients were treated,
апа of those 63 were admitted during the year: 65
were discharged cured or relieved, and there were 18
deaths.

VIEUX-FORT.
A. B. Duprey.

The last census seems to have been taken in the
year 1901, the populations of Vieux-Fort and
Laborie being then estimated respectively at 3,500
and 3,278 souls. The number of peop'e іп Laborie
district for 1902 was estimated at 3,324, there being
a small increase of 46. The Vieux-Fort and Laborie
districts are very sparsely populated and consist of
principally a labouring class of people mostly engaged
in agriculture.

The births and deaths during the year 1904 as
compared to those of 1903 are hereby represented in
tabulated form :—

September 15, 1906.)

COLONIAL MEDICAL REPORTS—SAINT LUCIA. 69

1903.
Birth- | Death.
Districts Births Deaths late per , rate per
1,000 | 1,00
Vieux-Fort .. .. 198 53 | 365 | 15-1
Laborie s E 2% 149 58 433 | 176
1904.
Birth- Death.
Districts Births Deaths Tate per | rate per
Н 1,000 1,0 w
Vieux-Fort .. 117 | 45 83:1 12:8
Laborie 125 65 38 19:8

There were no serious epidemics duriug the year ;
& few cases of influenza occurred in January and
February, but these were mild in nature. At the
latter part of the year, viz., in August, a few cases of
whooping-cough were treated in the dispensaries, but
these soon disappeared. Malarial fever was prevalent
but usually of a mild intermittent character, chiefly at
the end of the year. -

There appeared to be more deaths during the latter
part of the year, say, between the months of August
and November, than at the commencement of the
year. Sudden deaths among children occurred fairly
frequently, mostly due to untreated malaria contracted
in the heights of the districts, and to a great extent
also from infection by the Ascaris lumbricoides.

Throughout the year there was a want of rain felt
in both districts. At Laborie there were more fre-
quent showers than at Vieux-Fort. "The highest
records occurred during the months of June and
August, when the rainfalls were 6:68 and 5:21 inches
respectively ; the total number of inches for the
whole year being 45:27 inches, or 15:21 inches
less than the preceding year. The commencement of
1905 was likewise characterised by а drought, the
records being 1:69 for January, 1:64 for February, and
up to date, March 20th, 1-10 inches. Between Janu-
ary and the middle of March, 1905, there was a
constant piercing east wind blowing almost to a half
gale; its effect upon the health curve of Vieux-Fort
district was distinctly depressing. Bronchial affec-
tions and acute tonsillitis were then very frequent.

MALARIAL FEVER.

There were а good many cases of fever treated as
usual at both dispensaries, though far less in number
than the preceding year. This may be owing to the
drought which more or less characterised the greater
part of the year, thus lessening the pools and drying
up stagnant swamp water. Malaria is, however,
latent in most people and only requires some slight
depressing cause to bring out the whole phenomena
of an attack of malarial fever. Of 1,031 persons seen
at the Vieux-Fort Dispensary, 142, or 13:7 per cent.,
suffered from malaria, and in every case was benefited
by quinine. There were two severe cases of fever
treated in this hospital.

DysENTERY.

This disease is present in sporadic form and in no
particular season of the year. There were 14 cases
during the year, scattered in different parts in both
districts and these received special attention. I have
no means of investigating microbic dysentery, but I
would only like to suggest here a probable cause of
dysentery, whether sporadic or epidemic. Dysentery,
if I may be allowed to suggest, has a direct relation to
the advance of agriculture in the West Indies. It is
noticeably во in hilly countries, especially where large
quantities of manure are being used for furthering the
growth and keeping up the standard of West Indian
products. The heavy rains are apt to wash down the
rather loose manure into the streams and rivers,
thereby constituting a source of danger to the popu-
lation lower down who drink these waters. This
disaster is to a great extent prevented in this district
owing to the nature of the country, which is more or
less level. Still, however, the danger exists, and
the nature of the manure used, whether chemical or
organic, makes little difference.

In the treatment of acute or chronic dysentery, I
put great reliance on the use of sublimed sulphur,

‘which in my hands invariably gives excellent results.

The method of administering the drug has already
been communicated in the JOURNAL or TROPICAL
MepicinE in 1901. I bave since found though, that
the good results obtained do not depend upon the
Dover's powder combined with it, but to the virtues of
the sulphur alone.

ANKYLOSTOMIASIS.

This so-called ansmia is widely prevalent in both
districts, though cases do not often come to hospital
for treatment. In one instance, that of a black man
and a labourer, the ansemia was intense and the
number of worms passed were few, yet he, however,
recovered sufficient strength and colour to be dis-
charged ina week. This man said on admission he
could hardly get the necessary food to keep him
standing. He improved rapidly on a liberal diet, and
one could not doubt that his case was primarily one
of starvation.

Гоха DISEASE.

This cannot be said to be of very common occur-
rence. I have seen some cases of asthma, the treat-
ment of which condition is very unsatisfactory, owing
to the irregular attendance of these to the dispensaries:

VENEREAL.

Gonorrheal affections are very common indeed
and there are many who are crippled from gonorrheal
rheumatism. Ophthalmia and blindness from the
same cause are frequent; I have seen 3 cases during
the year of total blindness from this cause, one of
whom died from pysmia.. Syphilis is exceedingly
common and is on the increase. A goodly number
are imported by labourers who have returned from
Cayenne, but a great many get infected locally. Тһе.
tertiary manifestations of syphilitic brain disease are
sometimes seen ; I saw two such cases last year.

70 THE JOURNAL OF TROPICAL MEDICINE. (September 15, 1906.
ASCARIDES. Fractures 2
This affection is by far the most common in the Abscess ^
districts. In fact, I do not remember any other place Tumours =
where the ascaris is more readily found. It is difficult Strumous 5
to assume & cause for this extensive worm disease ; Yaws .. 4
sea-coast towns and villages are not more apt to be Ankylostomiasis 3
infested than inland towns and villages, but it is Pregnant | 6
possible that the great quantity of pigs that are Ha mopoietic
reared inside and around the towns may furnish a Total 1,034

probable cause. Notter and Firth in, their “ Theory апа
Practice of Hygiene," mention that pigs are infested
by the same worm as are human beings and thus the
disease is transmitted to man by contamination of
“water from streams and ponds," or even the sands
and loose earth where potatoes and other vegetables
are grown. Nota few cases simulate acute meningitis.

RHEUMATISM.

I have already drawn attention to the frequency with
which children and adults are affected with subacute
rheumatism and heart disease. Considering how
often it has been stated that acute or subacute
rheumatism is not to be found in the Tropics, this
should draw particular attention to the fact of its
presence.

Yaws.

These were not many; only 5 cases attended the
Vieux-Fort Dispensary; at Laborie also there were a
few cases. It is a disease that affects the lowest
classes and is to be found only in certain islands of
the West Indies, and then only in certain localities.
Yaws come from the heights of the districts.

The districts of Vieux-Fort and Laborie were fairly
healthy during 1904. There is no special sanitary
arrangement or water supply. The dry earth system
prevails here.

The villages of Vieux-Fort and Laborie are full of
small huts negligently built without any due regard to
air space per head or to ventilation. A whole family
are sometimes crowded in a small hut at night
without even a window open to allow the admittance
of fresh air, but on the contrary, all crevices are
hermetically sealed either with cotton-wool or rags.

Table of diseases treated at Vieux-Fort Dispensary
during the усаг 1904 :—

Fevers ... 192
Worms .. 162
Digestive i eae ae . 201
Respiratory ... dus 294 Е e .. B4
Cireulatory ... М Бе ss hes e 8
Ulcers id it is А: ae .. 88
Wounds NM is En m vs 2. 20
Venereal 6 as x 5 eu .. 30
Rheumatic ... E шік "- ie e. 4l
Headache ... ien sl E Ее .. 13
Gynweological ЯТ гар sss 256 el 97
Kidney I. i 4s is -- e. l4
Skin ... ae -- ss Ls 22 e. d4
Special Senses s. Y uus 2% Be we 24
Debility ед т M. a 965 e. 94
Toothache ... "E - E "e .. 18
Throat : T ее d Er Аа 09
Bones and Joints n У we Тн is, 218
Nervous 2% dus D - КЕН wa, 13

Table of diseases treated at the Laborie Dispensary
during 1904 :—

Fever ... 86
Worms 98
Digestive 94
Respiratory ... re Dis 51% I .. 96
Circulatory ... sm bes =e и 2%, 226
Ulcers wes Les ius aks ae .. 15
Venereal 5% $us is sis € .. 10
Rheumatic... à Gs Қ N 27294
Headache .. TA 15% oie lee > iue 19
Gynecological ЕТ res m e .. 19
Kidney ae ie sch vs 215 E
Skin ... x is PEE 25% .. 95
' Special Senses i E oe zu .. l4
Senility and Pei E sia $06 n.. 26
Toothache ... РА E uus " T
Throat - whe se T aa ide õ
Bones and Joints шан zi да бі .. 18
Nervous PA E 53 .. 15
Abscess 4
Yaws.. а E "m 226 3
Ankylostomiasis is 25 ies on 1
Pregnant 1
Hemopoietic 5
Hernia 2
Cellular Tissue 4
Cancer 1
Total . 018

NuMERICAL RETURNS.

During the year 1904 there were 1,262 cases ad-
mitted into hospital; in the previous year there were
1,639. Only those who urgently required attendance
could be admitted, and this led to the exclusion of a
large class of ** No appreciable disease.”

There were 82 deaths in а total of 1,348 cases
treated, giving a death-rate of 6:1 per cent. There
were 123 operations performed, of which a classifi-
cation is appended.

The most important diseases treated are syphilis,
malaria and intestinal parasites. Pulmonary tubercle
is responsible for 16 deaths.

As a working basis it may safely be assumed that
every adult labourer in Saint Lucia has had, or is
actually suffering from, venereal disease.

(a) Soft chancres are not to my knowledge very
prevalent; and unless they take on а phagedsenic
type are not seen by a medical officer, but are treated
by the druggists or other bush vendors.

(b) Gonorrheea seldom comes under observation
unless complicated.

During the year 1904, 20 cases of stricture were
treated in the Victoria Hospital.

October 1, 1906.)

COLONIAL MEDICAL REPORTS—SAINT LUCIA. 71

Colonial Medical Reports.—No. 26.—Saint Lucia
(continued).

. It. is exceedingly rare to come across a woman who
has not some pathological condition of the generative
organs, or in other words, one who has not been the
victim of gonorrhuea, syphilis, or sexual psychopathy.

(c): Syphilis is very -prevalent,..and .along with
malaria and intestinal parasites constitutes the bulk
of cases treated throughout the island.

In 1904 the total number of cases treated in the
Victoria Hospital was 1,343; of these malaria ac-
counted for 227, syphilis 321, intestinal parasites 156.
This does not represent the true percentage, which is
really much higher. Thus, on March 31st, of 68
patients in the hospital, indisputable evidence of
syphilis was found in 33, and -there were at least 10
others about whom no satisfactory conclusion could
be formed. Е

Іп һе study of West Indian syphilis it is of the
greatest importance to realise- the certainty and fre-
quency of non-venereal syphilis; neither age nor
moral standing is a barrier against contagion. The so-
called. varieties of ‘‘ Yaws ” are true manifestations of
syphilis. i

Among certain tribes in Africa early infection with
syphilis is practised as a safeguard to the future

health of the child, and in the West Indies the same
belief prevails with regard to “ Yaws."

Of late years it has been noticed that venereal
syphilis has been on the increase in the town of
Gastries. Unfortunately, there are no available
statistics. The facility with which work was obtained
in the garrison town, which was also a coaling station,
attracted large numbers of immigrants, many of whom
were wanton vagrants from the neighbouring islands.
Among this lot infection became very rife. In 1904
among males there were 20 cases of infection requiring
operative interference, even to the extent of amputa-
tion of the penis. ;

The disregard of the ‘populace to all sanitary and
precautionary measures against diseases makes it a
difficult problem to stamp out ог even attempt &
reduction in the parasitic affections.

САВТВІЕВ DISPENSARY.

During the year 1904, 7,102 cases were treated at
the Castries dispensary, and 9,626 ulcers were dressed.

It appears needless to classify the ailments treated,
as was done in former years under the various systems
of the body. The type of cases treated presents no
difference from the more correct classification afforded
by the hospital returns. The prominent features in
both are syphilis, malaria and intestinal parasites.

Colonial Medical Reports.—No. 27. — Basutoland.

MEDICAL REPORT FOR THE YEAR 1905.

By Dr. E. C. LONG.
Principal Medical Officer.

GENERAL HEALTH.

THE year 1905 was not so healthy as 1904. There
were no epidemics ‘of any magnitude or severity, but
an increased number of minor ailments. .

Speaking broadly, I should say that the general
health of the Basuto is tending to a progressively
lower standard, and the physical development to-day
is inferior to that of the past generation.

This last point is illustrated by the low standard of
the recruits seeking admission to the Bechuanaland
Police. Of the last 50 candidates examined, all young
men between the ages of 22 and 35, 20 per cent.
were rejected on account of defective physique or
bodily ailments.

I have, for some years now, noticed a decline in the
physique of those who have attended school for several
years, and I attribute it in part to the overcrowding

and deficient ventilation in many of the school build-
ings. .

The increase of tubercular disease іп the country
during recent years emphasises the danger of these
defective buildings. There is а distinct danger that
unless steps are taken to render school aecommodation
better, that the schools will become centres for the
spread of tuberculosis.

The question of the cubic space and ventilation of
school buildings in relation to the number of pupils is
of great importance, more especially in those schools
which receive boarders.

Something might be done by insisting on a limit to
the number of pupils accommodated in any given build-
ing, making the Government grant contingent on this
proviso being adopted, and insisting that plans of all
School buildings should be first submitted to the
Government architect,

THE. JOURNAL ОЕ TROPICAL MEDICINE.

[October 1, 1906.

RETURN oF Diseases AND DEATHS IN 1905 AT THE
Basutoland Hospitals.

GENERAL DISEASES.
Admis-
sions.

Alcoholism

Ansemia js
Anthrax... e
Beri-beri

Bilharziosis
Blackwater Fever

Choleraic Diarrhea .
Congenital Malformation
Debility

Delirium Tremens `

ngue is
Diabetes Mellitus
Diabetes Insipidus
Diphtheria
Dysentery я ee $i
Enteric Fever.. `.. ge
Erysipelas қ
Febricula
Filariasis
Gonorrhoa
Gout .. s
Hydrophobia ..
Influenza
Kala-Azar.
Leprosy
(a) Nodular
(b) Anmsthetic ..
(c) Mixed..
Malarial Fever— 5
(а) Intermittent— . ..
Quotidian .. -. A
Tertian .. :
Quartan ..
Irregular .
Type undiagnosed
(5) Remittent
(с) Pernicious .. is
(d) Malarial Cachexia ..
Malta Fever .. oe 2
Measles гә 5%
Mum io
New Growths— d.
Non-malignant .

Old Age ae
Other Diseases
Pellagra
Plague ..
Pyemia
Rachitis
Rheumatic Fever
Rheumatism ..
Rheumatoid Arthritis
Scarlet Fever.
Scurvy .. ..
Bepticemia ..
Sleeping Sickness ..
Sloughing Phagadena
Small-pox .. .
Mr T
Ча) Prithary |
(b) Secondary ә»
(c) Tertiary | .. m
(d) Congenital 5;
panis Y
&nhosoma ever .
тане. :
(а) Phthisis Pulmonalis
.. (à) Tuberculosis of Glands,
- (c) Lupus | ‘
Қа) Tabes Moesenteriea .

(e) Tuberculous Disease ‘of Bones . ..

ЕН i ase eli diste

| |

Pl bol ll dbael lel $E loll ll 4 1 04 ld | bers:

Deaths.

2.......

КНР ТУА КИТЕР ЦЕЛИ AS EE ELSE EDD ТУИТ ИЕККЕ

Total
Cases

Treated.

2
Ісі

[ud ЕТТІ

5
2

5

1
977
4l
200
9

2

GENERAL DisEASES— continued.
; Other Tubercular Diseases

Varicella è 5% Ре "

Whooping Cough bs

Yaws .. 5%

Yellow Fever .

LOCAL DISEASES.

Diseases of the—
Cellular Tissue .. EN
Circulatory System— ..

(a) Valvular Disease of Heart : :

(5) Other Diseases
Digestive System— ..
(а) Diarrhoea A
(b) Hill Diarrhoea...
(e) Hepatitis ^ .. T
: Congestion of Liver ..
(d) Abscess of Liver vs
(e) Tropical Liver..
(f) Jaundice, Catarrhal .
(а) Cirrhosis ‘of Liver.
(A) Acute Yellow Atrophy
(i) Sprue ..
(7) Other Diseases. .
Ear .
Eye
Generative 'Bystem—
Male Organs
Female Organs
Lymphatic System
Nervous System
Nose К
Organs of Locomotion .
Respiratory See
Skin— ..
(a) Scabies . xs
(b) Ringworm vs
4 Tinea Imbricata
(d) Favus .. .
(e) Eczema . 5
(f) Other Diseases
Urinary System.. T
Injuries, General, Local—
(a) Siriasis (Heatstroke) А
(b) Sunstroke (Heat Prostration)
(c) Other Injuries
Parasites—
Ascaris lumbricoides
Oxyuris vermicularis ..

Dochmius duodenalis, or Ankylos-

toma duodenale k
Dracunculus medinensis
worm) .. .. ..
Tape-worm %% 5%
Роівопв--
Snake-bites

Corrosive Acids ..
Metallic Poisons
Vegetable Alkaloids
Nature Unknown
Other Poisons ..
Surgical Operations—
Amputations, Major

Minor
Other Operations
Eye. os -.

(a) Cataract .
(5) Iridectomy

(c) Other Eye Opcrations i

(Guinea-

o
ы

4
1

Pritt

Pid debt

Elba LL Pl] BeolS

[11g lleelll il SSISaS8I

Ace

А Deaths.

MEME

Pl del tte i tt bi bette bet PP Pb bbb br tt tt beateot |

Pitti

October 1, 1906.) COLONIAL MEDICAL

At the vacation course for teachers, held at Maseru,
in January, 1906, a few lectures on elementary hygiene
were included in the course, and the teachers showed
great intelligence in appreciating the lessons incul-
cated in these lectures. A yearor so ago a small
pamphlet on elementary hygiene was written and
translated into Sesuto, but it should be included in one
of the compulsory school readers.

SMALL-POX.

There were only two small outbreaks of this disease
during the year. They were promptly stamped out by
isolation and vaccination.

Fifteen thousand three hundred and eighty-five
vaccinations were performed during the year, and the
general condition of the people in this respect is satis-
factory.

Enteric FEVER.

Comparatively few cases have been recorded, and, as
in other years, these were mostly imported cases.

5 . TUBERCULOSIS.
This is still increasing, 199 cases being recorded as
against 155 in 1904. Tubercular glands in young

people between the ages of 18 and 30 is the most
common form.

LEPROSY.
Only a few new eases have been noted.

SYPHILIS.

This disease shows no.abatement. It is noteworthy
that of some thousands of cases recorded during the
year, in only six instances was the primary lesion
observed. | РУО ES :

The increased number of cases of congenital syphilis
shows that-a large number of people go untreated.
The secondary manifestations are usually so mild that
the people neglect them, and only come up for treat-

‘ment for severe tertiary lesions.

Scurvy.

Very few cases came under notice, and those were
all imported from the various labour centres.

RHEUMATISM.

All forms of rheumatism have been very prevalent.
The acute cases are seldom seen, but judging by the
large amount of valvular disease of the heart, they
must be fairly common. · ->

, ПҮмРнАтіс SYSTEM.

A case of lymph scrotum was admitted into the
Maseru Hospital in December, 1905. The blood was
carefully examined for filariæ, but with negative
results. He is a well-nourished young man, aged
about 22, and the swelling was first noticed eight
years ago, and has been gradually increasing in size.
The tunica vaginalis contained an ounce of colourless
serum,

REPORTS—BASUTOLAND. 73

This case is interesting, taken in connection with
one of elephantoid swelling of the foot reported some
years ago, in which filarie were thought to have
been observed in the blood. Specimens of the blood of
this patient were forwarded to Sir P. Manson, who
was, however, unable to confirm the presence of
filariæ. , i l [n]

I have quite recently beard of a. supposed case of
elephantiasis of the leg in а native. in Letsie's ward.
My informant, who had spent some years in Central
Africa, states that it is exactly like the ¢ases he was
accustomed to see there, I am endeavouring to get
this patient under observation, and if . successful a
report with specimens of the blood: will be forwarded
for examination. _ тасалау

Urinary System, | ——

An interesting fact has been elicited in connection
with Bright's disease. Jt is that the patients are
invariably chiefs or well-to-do natives who indulge
largely in a ment diet. It is practically unknown
amongst the common people. · . -.

MALE GENERATIVE SYSTEM.

A successful case of enucleation of the prostate was
undertaken in the Maseru Hospital. The patient,
aged 65, prior to the operation had two ounces of
residual urine. Urine was passed by the normal
channel fourteen days after the operation, and when
the patient left the hospital there was no residual
urine. 5
_ Diseases оғ THE Ете.

Forty-five cases of cataract were operated on during
the year. They were all of the senile variety, except
one congenital cataract. "The results were uniformly
good, only one eye being lost from suppuration.

Glaucoma is still frequently met with, but only
three cases were benefited by treatment. Тһе remain-
ing cases all came up for treatment after the glaucoma
had been absolute for some years. .

METEOROLOGICAL RETURN FOR THE YEAR.

TEMPERATURE RAINFALL *
Б PEN a t, алқ NR zi
Maximum Minimum Range | Mean | Аполо in
January 101 50 51 75 4:54
February 90 53 37 71. 9:20
March 89 45 . 44 67. 4°26
April .. 80 40 40 . 60. '96
ay . 81.. 26 55 53 119
June 85. 20 65 53 21
July 72 22 2-50. 48.
August 78 22 .- 56 48. 91
September 88 25 .. 63 51 2-02
October 92 -e 31 .. 61 64 41
November 95 43 52 69 1°81
December 96 4T 51 72 5:28

* Total rainfall 30°09 inches.

THE JOURNAL ОЕ TROPICAL MEDICINE.

[October 1, 1906.

Colonial Medical Reports.—No. 28.— Grenada.

RETURN ов DISEASES AND Dearas IN 1905 ат Cotony, Yaws, St. ANDREWS, AND CARRIACON HOSPITALS.

GENERAL DISEASES.

Alcoholism

Anemia

Anthrax

Beri-beri

Bilharziosis
Blackwater Fover
Chicken pox ..
Cholera T
Choleraic Diarrhca .
Congenital Malformation
Debility - .
Delirium Tremens ..

Dengue as
Diabetes Mellitus
Diabetes Insipidus
Diphtheria
Dysentery .. e 25
Enteric Fever ae e
sipelas
Febricula
Filariasis ER su
Gonorrhea .. 25 БЕ
Gout ..
Hydrophobia ..
Influenza
Kala-Azar
Leprosy
(a) N odular
(5) Anesthetic ..
(c) Mixed MM
Malaria] Fever— ..
(a) Intermittent
Quotidian.. ve En
| Tertian .. .. oe
Poorten es
rregulat .
ines undiagnosed
(b) Remittent .. ws ais
(c) Pernicious .. :
(d) Malagial Cachexia .

Malta Fever ..
Measles 722% 4% us
Mumps . m Be
New Growthe— 24
Non-malignant ..
Malignant 5%
Old Ago ..
Other Diseases
Pellagra ы
Plague.. ss ate
Pyemia oe 54 oe 35
Rachitis 2% ER Vx А
Rheumatio Fever .. oe ei
Rheumatism . s
Rheumatoid Anthritis
Scarlet Fever... .. SS КЕ
Scurvy m .. es 4%

Septicemia .. T B E
Sleeping Sickness... ..
Sloughing Phagedeena 55 oe
Small- -рох -> RE 54 ез
Syphilis LET

a) Primary...
b) Secondary s
Я, Tertiary 4
(d) Congenital `
Tetanus s .
Trypanosoma ever.. .
Tubercle— ..

(c) Phthisis Pulmonalis
b) Tuberculosis of Glands
t Lupus ee
Tabes Mesentorica. .
(e) Tuberculosis Disease of Bones

p

Admis-
sions.

үрім

!
1

ка

ЕТЕТ el]

-1
oo

ГІТІМІІІБс5і-ІІІ ІЗ

Deaths,

Pi dtd db æl TEP LEE LE EL 21 14]

ЕЕК eon EP SPE E BS e sd

1
!

Pl blellleleltitlituetllll

Treated.

i djeilllisitletiletllltillgz-

i |

z 1—4
ml lcwol l -ЕӘЗЕІІГІМІТІЗгі ІІІ ЕЗІН ІІІ ІІІ

GENERAL ПіБЕлвЕв-- continued,
Other Tubercular Diseases

Varicella 4. Us os

Whooping Cough

Yaws ..

Yellow Fever..

LOCAL DISEASES.

Diseases of the—
Cellular Tissue .. 5s
Circulatory System— ..

(a) Valvular Disease of Heart ..

(b) Other Diseases. .
Digestive System —

а) Diarrhea B

b) Hill Diarrboa..

(c) Hepatitis ..

Congestion of the Liver

(d) Abscess of Liver

(e) Tropical Liver. . E
(f) Jaundice, Catarrhal .
(g) Cirrhosis of Liver .
(А) Acute Yellow cid
(i) Sprue ..

(0) Other Diseases - .-

аын Syatem— Е
Male Organs
Female Organs

Lymphatic System

Nervous System

Nose S. m P
в of Locomotion. .
Respiratory open
Skin— ae v
(a) Scabies . e НЯ
(b) Ringworm e
с) Tinea Imbricata
d) Favus ..
е) Eczema.. .. ..

Other Diseases
Urinary System
Injuries, General, Local—
(a) Siriasis (Heatstroke) Vs
(b) Sunstroke (Heat Prostration)
(c) Other Injuries
Parasites— .
Ascaris lumbricoides
Oxyuris vermicularis ..

Dochmius duodenalis, or Ankylos.
toma duodenale vs i
Dracunculus medinensis (Guinea-
worm) .. os ate
Tape-worm |
Poisons—
Snake-bites

Corrosive Acids ..
Metallic Poisons
Vegetable Alkaloids
Nature Unknown
Other Poisons ..
Surgical Operations —
Amputations, Major
Minor
Other "Operations
Eye ..
(a) Cataract .
(5) Iridectomy |

(c) Other Eye Operations É

Admis-
sions.

LIIL]

MENTI

е NN

al | | ol #855881 Зь 1 оь о1о 1 181 8

‘Total

Casen
Deaths. Treated.

MEME

| |

ШЕКЕ

ЕТТЕ

PET Tt bem ТІНІ bebe EEE Sell іміеі іші

Pld tt

Wa
©

(«€

ө -і
We ND н ee

al | lol tBokaBs |

October 15, 1906.)

COLONIAL MEDICAL REPORTS—CYPRUS.

Colonial Medical Reports.—No. 28. Grenada— (continued). Number of births during the year 1905 2,863

POPULATION FOR THE YEAR 1905. Е deaths .. ... v 1,586

. » inhabitants in 1905 69,530

Number of inhabitants in 1904 68,253 Increase of " 5 1,277

METEOROLOGICAL RETURN FOR THE YEAR 1904.
LR. 2 |
TEMPERATURE RAINFALL WINDS

g ce Е c a ы a Remarks
ыз -25 as оз ý 2; De os pe Ф
ав ЗЕБ ЗЕ Ze EI a z2 83 2% ЕН
sz 359 = да a о 5% Е в g б
$2 5 Е ae 23 е > 55 gg os i
January 141:2 136:0 819 | 719 10:0 | "698 2-92 | 714 Е. 114
February 145-0 138:2 81:9 | 702 11:0 "667 9:11 69:2 Е. 155
March .. 1405 1322. 829 71:8 10:4 "737 4:70 77:6 Е. 154
April -| 140:1 1200 83:6 73:9 971 "756 9:95 74:6 N.E. 140
May x 1403 184:2 , 839 747 92 "741 4:61 78:4 E. 143
June 137:8 1300! 83:6 147 89 "774 6:64 78:6 Е. 185
July 137°4 1909 837 74:9 8:8 "193 10:28 80:3 E. 112
August .. 138:2 125:0 84:5 750 9:5 787 11:64 | 781 E. 98
September 142:5 1980 | 848 15:0 9:8 | "199 5:42 | 76:2 E. 91
October.. 144:8 127-0 84:9 75:8 9:6 "805 8:78 76:8 Е. 89
November 07.4 1425 1180 837 74:9 88 | 1083 12:28 | 95:0 E. 58
December + e .. | 1407 | 1200 | 820 72:9 91 775 5:66 | 783 Е. 97

| | | |
Averages 1409 | 1969 | 883 797 | 96 "780 17:89 | 774 | Е. 115

* At Richmond Hill Meteorological Station in the south of the island.

Colonial Medical Reports.—No. 29.—Cyprus.
MEDICAL REPORT FOR THE YEAR 1905.

By the CHIEF MEDICAL OFFICER.

Pustec НЕдітн.

Tue health of the island during the past усаг has, оп
the whole, been satisfactory, as, with the exception of
an outbreak of measles, generally speaking of a mild
type, which prevailed at the early part of the year
almost throughout the whole of the island, and spo-
radic cases of typhoid fever, with conspicuously rare
cases of diphtheria, no other infectious or contagious
zymotic disease occurred during the year under
report.

Malarial fevers, however, owing to the frequent late
rains, were prevalent, particularly in the western

portion of the island, where also the rains were more
abundant. Unfortunately, the rural population, as a
whole, place little importance on this disease, which is
considered as a natural course of things, and not the
slightest prophylactic precautions are taken to avoid it.

The opinions expressed by the different medical
officers on the subject of the general health bave been
satisfactory, and I submit reports from the districts
of Nicosia and Larnaca.

Новгітлів AND Ovut-Door DISPENSARIES.

In the six hospitals, 1,945 patients were treated,
118 deaths occurred, and 261 surgical operations were

76 THE JOURNAL OF TROPICAL MEDICINE.

Return or Diseases AND DEATHS For 1905 ім Епант Бокар Divisions oF

GENERAL DISEASES.

Adinis-

sious. Deaths.
Alcoholism .. sai с s ..0--.. -
Anemia ^ 4% oe ay Т --.. —
Anthrax КЕ 2% js я 2% -- 2.0 --
Beri-beri es 2% 2% РЕ: ұ “ae, 9
Bilharziosis .. S = S 7 -- .. —
Blackwater Fever .. A 24 e—a o-
Chicken-pox .. m .. ae ЕЕ
Cholera s ks X: 1Г2.00--.. --
Choleraic Diarrhoa y m. oe 5
Congenital Malformation .. " ie. MA. Uum
Debility M x rs es oo
Delirium Tremens T e e =e —
Dengue es oe s ho ea E
Diabetes Mellitus -- —
Diabetes Insipidus 95 ae oo
Diphtheria .. 4% us Е M m —
Dysentery s s ae ЕЗ .Г.00--.. --
Enteric Fever.. pi 22 4 1Г200--.. --
Erysipelas .. .. m es ..0--.. -
Febricula е бе 2" us ..0--.. —
Filariasis ass As 22 be 0. —
Gonorrhea .. 2% 5i 2% TED --
Gout .. es ie А гЕ ..0--.. -
Hydrophobia .. 0, is T e oe =
Influenza % Ұз s AN ..0--.. -
Kala-Azar ET E s v. ..0--.. -
Leprosy НЕ m 2% e| =. -
(a) Nodular T m e — -
(b) Anesthetic .. os ES e =. —
(c) Mixed.. 2x 22 os e =n —
Malarial Fever— .. a s ..00--.. --
(а) Intermittent— — .. 24 ..0--.. --
Quotidian .. ^s vu ..00--.. --
Tertian .. vs m we -- 2. —

Quartan .. a s» e —

Irregular

Type undiagnosed —

(b) Remittent . ys --

(c) Pernicious .. as Ж -

(4) Malarial Cachexia .. —
Malta Fever .. zs —
Measles —
Mumps —
New Growths— Va oe —
Non malignant .. 82 oa --
Malignant —

Old Age 2% —
Other Diseases --
Pellagra —
Plague .. —
Pyemia -
Rachitis —
Rheumatic Fever .. EN T eo
Rheumatism .. —
Rheumatoid Arthritis -
Scarlet Fever . -
Scurvy .. —

Septicemia

Sleeping Sickness $i T T"
Sloughing eg - ie ..
Small. pox ae als €: ..
Syphilis —

(a) Primary
(0) Secondary
(c) Tertiary
(7) Congenital
Tetanus
Trypanosoma Fever
Tubercle.
(a) Phthisis Pulmonalis
(0) Tuberculosis of Glands
c) Lupus ЕЕ
(а) Tabes Mesenterica Ке
(e) Tuberculous Disease of Bones

| [October 15, 1906.

Cyprus.
Total Total
Cases Admis- Cases
Treated. sions, Deaths. Treated
» 2 GENERAL DiskasEs — continued.
. 192 Other Tubercular Diseases "M eee
n — Varicella 52 ae 2% ss -- .. — .. —
. - Whooping Cough 2% өр 2% e =. --
. — Yaws .. ES 4% e -- 2.2. --..
. — Yellow Fever .. 2% ars Se --.. =
439 LOCAL DISEASES.
— Diseases of the—
8 Cellular Tissue .. AE 5% ee “Seas .. 124
— Circulatory System— . e ee --.. 86
- (а) Valvular Disease of Heart ao Wed AE ee opu
94 (b) Other Diseases is Г.00--.. --.. —
. 87 Digestive System— .. 22 ui . — .. 950
32 (а) Diarrhea ds es Mk ме ты € сыз
136 (b) Hill Diarrhoea. . 2< ГЗ00--.. --.. --
— (c) Hepatitis ..00. e =ne --.. --
103 Congestion of Liver .. e >e ce
. 6 (d) Abscess of Liver 55 AL тесе ee
-- (е) Tropical Liver.. . Әз аа C p лн
. 981 (f) Jaundice, Catarrhal . ұс co аа M
— (g) Cirrhosis of Liver VEGA mme mE
— (А) Acute Yellow Atrophy sa UTR oo
- (i) ӛрге .. wa 2% жұл аса See um
6 (j) Other Diseases. . ee "X
3 Ear Si A .. sis ..0--.. --.. 74
— Eye è zs Е e ee —.. 620
—. Generative "System— 2% .. e =e --.. --
515 Male Organs —.. --.. 32
. 272 Female Organs s e —. --.. 64
102 Lymphatic System .. re Se ie si IT
151 Nervous System T C e mee --.. SI
189 Nose B as Г.00--.. --.. 45
. 108 Organs of ‘Locomotion 2% e =e --.. 47
8 Respiratory System .. 2% 5 — .. .. 659
— Skin— .. m ar AC e — e --.. 743
— (a) Scabies .. vs 54 --.. --. —
221 (6) Ringworm - zs ..0--.. M —
— (9 Tinea Imbricata Ls Pe ume sae VE
— ) Favus .. 9% ace e =e e --
21 (e) Eczema .. 2% .. e =e -.. --
4 ( f) Other Diseases PP -- 4. — o --
— Urinary System.. m os e —. —.. 56
15 Injuries, General, Local— Ж e ee --.. 498
- (а) Siriasis (Heatstroke) 2% © =e --.. -
-- (b) Sunstroke (Heat алы ы Lx. f£ е?
5 (с) Other Injuries e =e --.. --
— . Parasites— vs Ls 9 ommo 8
31 Ascaris lumbricoides .. 2% ees Cea A im
132 Oxyuris vermicularis .. -- 2. --.. --
— Dochmius duodenalis, or Ankylos-
— toma duodenale ie ане qmm 5 --
— Dracunculus medinensis (Guinea.
3 worm) .. 23 .. ..74..0--.. --.. --
- Tape-worm 55 T - era ҚЫ ы ms
Poisons—
- Snake-bites 2i 62 E sho dev woe
- Corrosive Acids .. 55 = TER
13 Metallic Poisons s sis Re oT We. (MA MN
13 Vegetable Alkaloids — .. 2% e ee --
— Nature Unknown «s x e BS ee С %%0 mm
4 Other Poisons .. 5% xA ro me --... 1
— Surgical Operations- -
— Amputations, Major —.. — e’ log
57 Minor -- .. --.. |}
Other Operations -| —. -
- nye .. X aH e =e --. —
= (а) Cataract sie Е Тс —
- (b) Iridectomy e — —. —
— (c) Other Eye Operations .0- -e —

October 15, 1906.)

COLONIAL MEDICAL REPORTS—CYPRUS.

77

performed. In the six district dispensaries 22,919
patients attended, whilst in the eight rural divisions
8,686 patients were visited by the rural medical
officers during the year, the whole of these received
medicines gratis.

LEPER FARM.

The number of inmates in the farm on December
31st, 1904, was 109; there were 13 admissions during
the year, 9 deaths occurred, whilst 112 remained on
December 31st, 1905.

The general health was very satisfactory, as also
that of the children of lepers who have been now for
some time removed from the Leper Farm to a separate
house in the town; they continue to be very healthy,
without as yet showing the slightest sign of leprosy,
and their elementary education is looked after by one
of the attendants, who also acts as governess.

Lunatic Warps.

There were 19 admissions during the year to this
institution, and 15 were discharged relieved or cured ;
1 death occurred and 42 remained in the wards on
December 31st, 1905.

The health of all the inmates was good, notwith-
standing that many cases are brought in in a very de-
bilitated condition, and the wards had more inmates
than the accommodation should hygienically permit.

QUARANTINE.

Owing to the continuation of plague in Egypt, all
arrivals thence were subjected to medical inspection
and the disinfection of susceptible articles.

Three cases of small-pox were detected aud promptly
dealt with at the quarantine ports; the disease did
not enter the island,

VACCINATION.

During the year 7,837 vaccinations were performed,
of these, 7,420 were primary operations, whilst 417
were revaccinations.

Of these operations 6,739 were reported as being
successful, 607 as unsuccessful, whilst 491 were not
seen by the vaccinatore a second time.

ANIMAL DISEASE.
The veterinary surgeon's report, which I submit,
deals fully with this subject.
CHEMICAL LABORATORY.

This branch of the department continues its most
useful work with ever increasing satisfactory results.

NICOSIA.

Report by Dr. Robert А. Cleveland, District Medical
Officer.

The general health of this district for this year has
been fairly satisfactory. In the earlier months of the
year there was an epidemic of measles which, I
believe, was general throughout the island. No
patients with this disease were admitted to hospital,
and only 8 cases attended the out-patient department.
There were many cases seen by me in private practice.

METEOROLOGICAL RETURN FOR THE YEAR 1905.

TEMPERATURE

Е Ex Е 8
ыз 5 vp
|i 23 de H
А a Ша ne ns
г Ж ae E =
--------------------.----- ————— E E
January | 55-9 36:8
February | | 581 | 360
. March .. | | 63-9 | a
April 740 | 472
May | 861 | 556
une 88:9 60:8
July... 97:4 67-4
August .. 980 | 675
September 93:2 63:1
October . . 888 1 58-1
November 767 | 51:5
December 591 414
Year 78:0 | 52:8

RAINFALL Winns
= У > а Remarks
g z | #2 |R| B
4 c 5 ы z 9o
й = | 8 X | 83 | 45
а NIMES MS Es
Nly.
191 | 464 | 162 | 814 |4 Ely. 15
Wily.
9. . ә. А Wily. Я
921 | 471 | 218 808 (ED } 10
Nly.
99-9 | 508 | 149 . 805 |4Ely. 17
Wily.
26:8 | 606 | 194 | 708 EA | 17
305 | 709 | O50 | 580 | Wly 17
981 | 749 | 0:00 601 | Wy 24
300 | 894 | 000 546 | Wly 17
314 | 833 | 000 | 574 | Why. 15 |
301 | 782 | O18 | 592 | Wly , 13 |
357 | Т10 1 197 | 670 | Why 13 ,
JR. > DETS Sly.
252 | 641 282 ноз {wy | 09 |
Nly. |
17 | 503 987 173 |4Wiy. (| 11
1 біу. J i
i | Posen i
65:2 ^ 1457 Í 690 Wly 15 |

| 25:7

Total
pases
Treated.

BEEN

ІІІ

о 4
10
oo

118111

Prt II |]

'
I

о |

78 ТНЕ JOURNAL OF TROPICAL MEDICINE. (October 15, 1906.
Return or DisEAsES AND Окатнв IN 1905 АТ THE віх District DISPENSAHIES,
Cyprus. "
GENERAL DISEASES. Total А
Admi»- Cases Admis-
sions, Deaths. Treated. А sions. Deaths.

Alcoholism .. КЕ Bs " 2 -— -.. — GENERAL DisEases - continued,

Angnia .. 241 Other Tubercular Diseases — —

Anthrax Sa Ue Varicella - -

Beri-beri - Whooping Cough -- --

Bilharziosis — Yaws os st es Du = шт

Blackwater Fever — Yellow Fever.. = d

Chicken pox .. 2 oe ee ае 2

Cholera : A ki - AW. e == =

Choleraic Diarrhea 5% iy e — s —

Congenital Malformation = e

Debility 619 LOCAL DISEASES.

Delirium Tremens =

Dengue = Diseases of the--

Diabetes Mellitus Cellular Tissue .. a -

Diabetes Insipidus = Circulatory System- - -

Diphtheria 5 (a) Valvalar Disease of Heart -

Dysentery 363 (0) Other Diseases. . :

Enteric Fever 25 Digestive System —

Erysipelas 25 (а) Diarrhcea 5s

Febricula — (b) Hill Diarrheeu..

Filariasis (c) Hepatitis .

Gonorrhæa 152 Congestion of the Liver

Gout .. i - (d) Abscess of Liver

Hydrophobia .. АЕ (е) Tropical Liver.. .

Influenza 1,416 (f) Jaundice, Catarrhal .

Kala-Azar = (g) Cirrhosis of Liver . - -

Leprosy -- (4) Acute Yellow Atrophy
(а) Nodular Ж js ts T - (i) Sprue .

(b) Anresthetic .. А 34 Se аза - (/) Other Discases -
(с) Міхей : - Ear ze "D л -
Malarial Fever-- — .. = Eye : ..
(а) Intermittent Generative System— ds = --
Quotidian.. 1,874 Male Organs
Tertian .. os ks Ре er 1,004 Female Organs - —
Quartan .. 24 2: Yar, ч 100 Lymphatic System -
Irregular .. e ex) dx. 120 Nervous Systom x -
Туре undiagnosed 2% y ULP S 1,033 Nose . —
(b) Remittent .. s 53 е FP se 684 Organs of Locomotion. . E
(c) Pernicious .. 59 x =e — 21 Respiratory System 2s ie
(d) Malarial Cachexia . 42 e m — - Skin— . Б -

Malta Fever .. i . 2 TENE IL - (а) Scabies . . — —

Measles oe 4% E. a wa SR, Oe 48 (b) Ringworm m --

Mumps 2% Ж - ils уе ue 9 (c) Tinea Imbricata -

New Growths— НЕ ЗА і wu. а — (d) Favus .. e -
Non-malignant .. 42 vs d^ ANUS dE 19 (е) Eczema.. = - -
Malignant еі m M "ELEC 34 (f) Other Diseases Е

Old Age sx oth 25 a sda -- Urinary System d zi —

Other Diseases 11 Injuries, General, Local— % x

Pellagra — (a) Siriasis (Heatstroke) Ut -

Plague.. i ee ix 2% em = (5) Sunstroke (Heat Prostration) —

Pyæmia sis 23 s - 2% = c — (c) Other Injuries --- --

Rachitis . $5 E $i "M — . Parasites— - --

Rheumatic Fever .. 2 s MEL 37 Ascaris lumbricoides -- -

Rheumatism .. : 640 Oxyuris vermicularis .. -- -

Rheumatoid Anthritis "m ia M -- Dochmius duodenalis, or Anky los.

Scarlet Fever.. Zr m m TEE әз СШ — toma duodenale — —

Scurvy ЧЕ БА 2% a bed n 14 Dracunculus medinensis (Guinea-

Septicemia .. s ag a pi os 1 worm) .. . 5% л --

Sleeping Sickness .. 52 25 TEL - Tape-worm 29 ге ЖЕН

Sloughing Phagedena "m 44 c — Poisons--

Small-pox 54 e T emos — Snake-bites - EE

Syphilis 26 is : in e Corrosive Acids .. - -
(а) Primary 125 Metallic Poisons - -
(b) Secondary 133 Vegetable Alkaloids - T
(c) Tertiary : — Nature Unknown
(d) ранае ЯР 45 Other Poisons -- -

Tetanus 3 2 Surgical Operations—

Trypanosoma Fev er. -- Amputations, Major -

Tubercle— .. 140 Minor - --
(а) Phthisis Pulmonalis - Other "Operations - —

(b) Tuberculosis of Glands

(c) Lupus :

(d) Tabes Mexenterica. .

(е) Tuberculous Disease of Bones

Eye .. 5% E

(a) Cataract ..

(b) Iridectomy . pe
(c) Other Eye Operations

-x
11681

November 1, 1906.)

Colonial Medical Reports.—No. 29.—Cyprus— (continued).

Тне epidemic was of a fairly mild type, and I saw
no case of death from the disease. .

There was no case of diphtheria during the year as
far as the hospital statistics show, and I saw no case
in private practice.

Typhoid fever is responsible for 3 deaths of patients
treated in hospital, of which there were 8 cases. I
have seen a good number of cases outside the hospital,
and I believe the disease was fairly prevalent through-
out the whole year. There was no case, however,
amongst prisoners. I believe the Nicosia Town water
supply to be pure till it reaches the aqueducts for dis-
tribution throughout the town, when it becomes liable
to contamination. Some of the cases séen by me were
no doubt traceable to the use of shallow well waters.

Malarial fevers seem to have been common in the
towns and villages, chiefly in the hotter months, from
June to October; cases, however, occur throughout
the year. Where possible, a microscopical diagnosis
is made, but it is impossible to deal with every case in
this way, but all cases admitted to hospital are so
diagnosed. In this connection an effort was made by
me to institute a system of mosquito destruction during
the spring and summer, and I was materially assisted by
the Municipal Commission of the town of Nicosia. In
one instance millions of Anopheles larve were dis-

covered in the month of August in pools, caused by :

leakage from the town aqueduct. These were promptly
destroyed, and the pools filled in, and the leak in the
aqueduct stopped.

I am of opinion that the health of the towns and
districts might be improved by the adoption of some
system of mosquito prevention and destruction. In
other parts of the world such efforts have been attended
with success, as in the case of Havanna, Ismalia, and
Port Smeltenham, and I believe the matter is worthy
of the consideration of this Government.

Nicosia GENERAL HosPITAL.

This institution has been of service to the inhabi-
tants of the town and district, and in not & few in-
stances patients have travelled long distances, and
even from other districts of the Island in order to get
treatment. The number of beds is small and the
figures remain much the same as last year. The
hospital buildings are badly in need of repair and re-
painting, it being some years since this was thoroughly
done, and I trust money will be available in the next
financial year to carry out this very necessary work.
I also beg again to draw attention to the absence of
proper accommodation for the treatment of women,
and also to the state of the floors of all parts of the
building.

The dispensary and out-patients' departments are
much in need of re-painting, but in other respects the
buildings are in good repair.

In this department 6,359 dressings were applied,
and the Nurse of the Colonial Nursing Association
(Cyprus Branch) is employed in the out-patient
department, when her services are not required out-
side the hospital. А total of 4,517 patients attended
for more than one visit.

COLONIAL MEDICAL REPURTS—CYPRUS. | 79

TABLE SHOWING ToTAL NUMBER оғ IN- AND OUT-PATIENTS
TREATED AT THE NICOSIA GENERAL HOSPITAL IN THE YEAR

1905.
Е алқ dE f
| Civilian Deatha| Police | Deaths Total сені.
| 1
ry ME REEL mene rr X mL
І
In. patients xe 287 29 204 0 491| 29

Out-patients LO 435 0 |6,46| 0

6,937 | 29

TABLE SHOWING THE ABOVE TOTAL AND THOSE OF PREVIOUS

YEARS.
Year i Total In- and Out-patients | Deaths
1900 5,511 | 81
1901 5,989 t 22
1902 6,568 25
1903 6,769 20
1904 7,297 22
1905 6,937 29

Report by George A. Williamson, District Medical
Officer.

GENERAL REMARKS.

As in former years, the diseases bulking largely are
malarial fever, diseases of the digestive and respiratory
systems, neuralgia, debility, diseases of the eye, of
the cellular tissue, and of the skin.

SEASONAL PREVALENCE.

Purulent conjunctivitis, the seasonal prevalence of
which may be given as from the middle of August to
the middle of November, was not so frequently met
with this summer as usual. :

Ав might be expected, diseases of the respiratory
System occurred chiefly during the late autumn,
winter and spring.

Influenza appeared in epidemic form during the
first quarter of the year, 100 out of the year's total of
117 cases being treated during these three months.

Fibricule was observed during the whole year, but
was commoner during the first six months.

Dysentery, of which only 29 cases were treated
during the year, occurred chiefly from April to August,
22 of the cases being treated during that period.

Rheumatism was seen chiefly during the early
months of the year.

On the other diseases (except malarial fever, to
which I refer in the next paragraph) season appeared
to have no special influence.

MALARIAL FEVER.

The Malarial Incidence Chart for 1905, which I
submit, is of the type I have formerly shown to be
characteristic of the disease in Larnaca. The out-
standing features are: (1) The presence of cares
during January and February; (2) the almost entire

80

THE JOURNAL OF TROPICAL MEDICINE.

[November 1, 1906.

RETURN OF DIsEAsES AND DEATHS IN 1905 AT THE HOSPITALS, INCLUDING THE Lunatic ASYLUM
AND LEPER Farm.—Cyprus.

GENERAL DISEASES.

Alcoholism .. ne
Anemia

Anthrax . 22
Reri-beri S x
Bilharziosis i

Blackwater Fever
Chicken pox ..

Cholera "
Choleraic Diarrhea .
Congenital Mal formation

Debility -
Delirium Tremens
Dengue

Dial өбзз Mellitus
Diaket»s Insipidus

Diphtheria
Dysentery
Enteric Fever
Erysipelas — .. oe m
Febricula as dis
Filariasis su s t
Gonorrhea .. 23 =
Gout ..
Hy drophobia ..
Influenza 22
Kala-Azar .. P
Leprosy ga
(а) Nodular -
(b) Апевіһейе .. 25
(с) Міхса e

Malarial Fever- —

(a) Intermittent ar
Quotidian.. x
Tertian ..
Quartan
Irregular ..
Type undiagnosed

(b) Remittent .. is

(c) Pernicious

(d) Malarial Cachexia .

Malta Fever .. 5% s

Measles s a

Mumps ais 2%

New Growths— ži
Non-malignant ..
Malignant

Old Age - we

Other Diseases

Pellagra

Plague..

Pyemia

Rachitis
Rheumatic Fever
Rheumatism .. ..
Rheumatoid Anthritis
Scarlet Fever..
Scurvy
Septicæmia
Sleeping Sickness
Sloughing Phagediena
Small-pox D .
Syphilis 4

(а) Primary

(b) Secondary ..

(c) Tertiary me

(d) алдыр x
Tetanus гі .
‘Trypanosoma Fever.
Tuberele—

(a) P hthisis Pulmonalis

(b) Tuberculosis of Glands

(c) Lupus ws E
(d) Tabes Mesenterica.

Adinis-
Nions,

(е) Tuberculous Disease of Bones : 22

16 ..

Deaths.

Treated,

Total
Cases

17

ilesi I ERII IIe) Gal nel

^
c

| ol ex

Total
Admis- Cases
А sions, Deaths. Treated.
GENERAL DISEASES -—continued.

Other Tubercular Diseases DIET DAC
Varicella . КЖ Ms i - — — --
Whooping Cough — — --
Yaws .. — -- -

Yellow Fev er. Е

LOCAL DISEASES.

Diseases of the— -
Cellular Tissue .. ..
Circulatory System— ..

(a) Valvular Disease of Heart x

(b) Other Diseases. .
Digestive System—

(а) Diarrhea .

(6) Hill Diarrhea. .

(c) Hepatitis

Congestion of the Liver

(d) Abscess of Liver
(e) Tropical Liver..

(f) Jaundice, Catarrhal ..

(4) Cirrhosis of Liver

(h) Acute Yellow Atrophy

(i) Sprue ..
(/) Other Diseases |
Ear oe m
Eye .. ..
Generative System— a
Male Organs
Female Organs
Lymphatic System
Nervous System
Nose ..
Organs of Locomotion...
Respiratory System
Skin— .
(a) Scabies .
(5) Ringworm На
(с) Tinea Imbricata
(d) Favus .. .
(е) Eczema..
(f) Other Diseases |
Urinary System
Injuries, General, Local—
(a) Siriasis (Heatstroke)

(5) Sunstroke (Heat Prostration) =

(c) Other Injuries n
Parasites— e
Ascaris lumbricoides

Oxyuris vermicularis ..

.. ..

ІІІ Prowl oa
m

Dochmius duodenalis, or Ankylos-

toma duodenale

Dracunculus medinensis
worm) .. e
Tape-worm s
Poisons—
Snake-bites
Corrosive Acids ..

Metallic Poisons
Vegetable Alkaloids
Nature Unknown
Other Poisons
Surgical Operations —
Amputations, Major
Minor
Other "Operations
Eye. ae
(a) Cataract v
(b) Iridectomy

(c) Other Eye Operations М

B. :
a. і
229202. . 90
2 SS АЕ
р: ор
E Ы. абзи Tog
3.. 2.. 8
a 121 .. 13.. 133
: .. 109.. — .. 180
қ Wah wem T
- METTI ^
EE RERO
25.. —.. 2
52.. 4.. 91
и Ға see d
: D 886. —.. 88
$^ n5 108.. 18.. 116
: 18 25 2 18
46.. 11.. 47
235 .. 16 .. 249
ҰНАТА а
(Guinea-
fe eae, c
: AM PESE"
8.. — 10
210 |. -—.. 207
di 4
ae 7
р аса 1
94.. — .. 96

November 1, 1906.)

absence during March, April, May, and the first half
of June; (3) the large increase in the number of
cases in July, August, September, and October;
(4) the considerable fall in November with a slight
rise in December.

The heavy late spring rains of 1905 have had the
result that such raius practically invariably have, of
causing а severe malarial summer and autumn.

I have been much struck by the large proportion
of cases of smstivo-autumnal fever and the very few
cases of quartan fever this year. Тһе former has
greatly increased and the latter considerably dimin-
ished, while tertian fever retains more or less its usual
proportion to the total number of cases of malarial
fever, or is, perhaps, slightly less than ordinary.

I am quite unable to give any explanation of this
distribution of the several types of malaria this year.
АП that сап be said is that quartan fever is more
typical of a cold malarial country, and estivo-
autumnal of a tropical malarial country, while it is
probable that tertian fever occurs more commonly
where there is a warm climate, with, however, a
distinct difference in temperature between winter and
summer.

During the year I һауе endeavoured to explain to
the patients the method by which malarial fever is
carried and the consequent rational means by which
infection may be avoided. My object was to try to
lessen the incidence, but I can truthfully say that the
most intelligent remark made was simply “Just
fancy!" and I am sure not one person followed the
advice given.

Not only did my attempts at making the natives
adopt preventive measures fail, but even in treatment
they preferred to be guided by their own ignorance.

I fear that a people who will neither carry out the
prophylactic measures explained to them, nor even
take the trouble to come for the medicine which is
supplied gratis to them, must continue to suffer: my
sympathy lies with the poor children whose parents
so neglect them, and whose lives are so frequently
jeopardised by this criminal carelessness.

Would the people but use (such of them as possess
nets) mosquito-nets and carry out the medical instruc-
tions ая to treatment, the incidence and recurrence
of malarial fever would both be remarkably diminished.

It has been asserted that malarial fever and cancer
are not found together—an assertion with which my
experience does not agree; but I may mention in this
connection that only one case of cancer has come to
my notice during the year. It is reported on else-
where.

BACTERIOLOGICAL WORK.

I have, since 1900, done a considerable amount of
bacteriological work, having fitted up, at my own
expense, a laboratory here. It has been very gratify-
ing to find that such facilities to diagnosis as the
bacteriological work gives has been appreciated by
several of the medical practitioners. Thus, besides
from medical men in Larnaca, I have received speci-
mens for examination from Limassol, Polymedia, and
Troödos.

COLONIAL MEDICAL REPORTS—CYPRUS. 81

Tue Pustec HEALTH.

The public health in this district has been, apart
from the large amount of malarial fever, good; no
cases of diphtheria occurred during the year. Chicken-
pox and measles occurred in Larnaca and in several
villages, but most of the cases were mild. Enteric
fever occurred less frequently than last year, and
never reached epidemic form. Conjunctivitis was
somewhat less than in 1904.

I have in former reports drawn attention to the
absence of means by which the birth rate, marriage
rate, and death rate can be calculated. These vital
statistics are of very considerable value.

The District Hospital has been taken advantage of,
as in former years, by large numbers of the sick poor,
and is admitted to be a boon to the town and district.

Report by George 7. Harvey, Veterinary Surgeon.

The animals inspected by me for exportation were :
sheep, 6,894; lambs, 1,651; goats, 259; oxen, 1,253;
pigs, 1,205 ; donkeys and mules inspected being 6 and
11 respectively.

Lambs were exported principally in Maroh, April,
May and June. Pigs all the year, bar June, July and
Angust, and oxen all the year round.

There would have been far larger exportations but
for quarantine having to be carried out in Egypt on
Cyprus animals, when there were one or two local
outbreaks of quarter-ill, anthrax and sheep-pox here.
The law at present requires that the infected places,
where only one or two animals die, should be gazetted
and quarantined before legalised restrictions and
penalties can be enforced, preventive measures taken,
and the safe destruction of dead bodies enforced.

Thus, in one small place, such quarantine affects
the export of the whole island.

A law as to the disposal of the body of any animal
dying suddenly or within twenty-four hours from any
unknown cause, by burial of the carcase whole,
with lime if possible, and with penalties against the
owner for not reporting or doing it, would save the
villagers thousands of pounds a year.

The diseases prevalent during the past year have
been quarter-ill, sheep- and goat-pox, and strangles,
anthrax, generally distributed from Papho to the
Carpas, and where the blacklegine vaccine has been
used it has been most successful, and I have heard of
no case of death after inoculation this year.

Sheep- and goat-pox have fortunately only appeared
in an endemic form, and not generally, and been kept
under control.

This I attribute to the instruction given by this
office to the villagers in the method of preventive vacci-
nation, which differs from their old method.

Strangles was very prevalent in the spring, and I
attribute its spread to the movement of the Zaptiehs’
horses. Whether it originated in the villages or towns
I cannot say, but nearly all the Zaptiehs’ horses were
affected, and spread it. It may have been introduced
by the imported Syrian horses.

Anthrax has only been reported in a few cases.
The Government introduced some 500 double doses
of vaccine, which was offered free to the native popu-

89 THE JOURNAL ОЕ TROPICAL MEDICINE.

[November 1, 1906.

lation by advertisement, but only fifteen doses were
used.

Report by W. Francis, Government Analyst and
Lecturer in Chemistry.

I submit my report on the work done in the
Government Analytical and Bacteriological Laboratory
during 1905.

During the past year 239 samples were analysed,
and 18 bacteriological examinations were made for the
Government. One hundred and fifty-eight prepara-
tions of a chemical or bacteriological nature were
made.

The number of private samples analysed was 23,
and in connection with two of which I gave evidence
in court.

One hundred and fifty-eight exhibits were received
from the police for analyses and examination. For
several years past cases of poisoning animals have
been reported in the Limassol and Papko districts,
but, thanks to the prompt action of the police in
seizing all poisons from unauthorised persons, this
serious practice has now ceased. At the request of
the Chief Commandant of Police, I made, some years
ago, а preparation for taking footprints in connection
with criminal cases. The preparation was found to

be satisfactory, except that in very warm weather it
would not set quickly without the aid of cold water.
I am now experimenting with a view of making a
composition that will set in the warmest weather
without the aid of a cooling agent. The new Food
and Drugs Law came into force on January Ist, 1906.

The question of the purity of the water supplies
has, as in previous years, occupied my attention. I
have analysed forty-eight samples taken from wells in
different parts of the Island. Samples of water taken
from the source of supply are pure, but are often con-
taminated by bad earthenware pipes before consump-
tion. For this reason I would suggest that filters
һе more universally used. Mr. J. A. Wanklyn, the
famous water analyst, made many investigations con-
cerning the removal of germs of disease and organic
matter from water by filtration through silicated
carbon. The result of all his experiments proved
conclusively the great benefits that can be derived
from the use of good filters. I would strongly suggest
that filters be attached to all drinking fountains,
and this would greatly improve the public health.

À considerable number of soils have been analysed
dong the year, both from manured and unmanured
and.

The poorer soils are deficient in nitrogenous matter
and phosphates.

Colonial Medical Reports.—No. 30.—Seychelles.

MEDICAL REPORT FOR THE YEAR 1905.

By Dr. J. E. ADDISON.
Acting Chief Medical Officer.

ViTAL STATISTICS.

The estimated population on December 31st, 1905,
was 20:767, being an increase of 349 over the pre-
ceding year.

Annexure I. gives the number of persons who
arrived at and left Seychelles, and the number of
births and deaths during the year.

“Тһе birth-rate was 33:30 per thousand, and was
lower than that of 1904, which was 34:92 per
thousand.

The average birth-rate for the last seven years has
been 31:94 per thousand.

The death-rate shows a satisfactory decrease,
being 14-98 per thousand against 16:12 in 1904.

The average death-rate for the last seven years has
been 17:21 per thousand. Ў І

“Тһе mortality among infants and young children
was higher during this year, the number of children

who died before reaching the age of five years was
126, being an increase of 31 on last year.

The number of juvenile deaths during the last seven
years has been as follows :—1899, 121; 1900, 120;
HN 148; 1902, 122; 1903, 155; 1904, 95; 1905,
196.

The principal causes of the mortality were to be
found in intestinal complaints, chiefly due to worms
and injudicious feeding, and to the epidemic of
whooping-cough which was prevalent during the last
two months of the year.

There were fifty-four still births and seven twin
births during the year. |

METEOROLOGICAL STATISTICS.

Annexure II. shows that the year 1905 was warmer
and drier than 1904. The mean temperature was
79-9, against 77°66 for 1904, which was the lowest
temperature recorded.

November 15, 1906.)

Colonial Medical Reports.— Ко. 30.—Seychelles (continued).

The total rainfall for the year was only 88:91
inches, against 107:05 inches for 1904. The rainfall
was 18:14 inches less than last year.

The rainfall for the last seven years has been as
follows :— 1899, 88:41; 1900, 111-75; 1901, 102-26;
1902, 87-81; 1903, 132:96; 1904, 107:05; .1905,
88:91.

Тһе average rainfall for the last seven years is
102-73 inches.

The south-east trade wind commenced to blow
early in May, and continued until the end of Novem-
ber. It was not so strong and steady as is usually
the case.

PREVALENCE OF SICKNESS АТ DIFFERENT SEASONS.

The only epidemic disease which prevailed in the
Island during the year was whooping-cough, which
commenced in the month of November, and con-
tinued till the end of the year, this disease not having
visited the colony for very many years; the number of
cases was large.

The type of the disease was severe, and it is in-
teresting to note that іп a precisely similar way to the
measles, of which there was an epidemic some three
years ago, the complications of the disease did not
fall, as is usually the case, on the respiratory, but on
the digestive system ; a very large number of children
' were attacked, usually about the third or fourth week
of their illness, by a form of enteritis, accompanied by
the passage of blood and mucus in the stools, and, as

might be expected, the children who harboured a .

number of worms suffered the most.

Nearly all the fatal cases were due to this com-
plication.

As noted in the report of the Assistant Medical
Officer, South Mahé, cases of tuberculosis of the lungs
are on the increase; it would appear that the greater
number of individuals attacked by this disease belong
to the Indian creoles, who come from Mauritius, and
I am of opinion that the increase in the number of
cases is chiefly due to the fact that the number of this
class coming to and residing in Mahé is greater every
year, and of course each case that occurs forms a fresh
focus of infection ; and thus it is to be feared that
a disease which a few years ago was quite uncommon
will become of greater frequency.

As in the past malarial fever originating in this
colony is unknown; the only cases seen are indi-
viduals who come to the Island from other countries
already infected, these cases invariably do remarkably
well. ; Я

Without doubt the immunity from this disease is
due to the absence of the Anopheles mosquito.

Intestinal parasites form the greatest menace to
young life, if neglected; the variety of parasite is
almost invariably the Ascaris lumbricoides, it may be
said that scarcely any of the juvenile population are
free from this scourge, and the careful mother recog-
nising this, always as a routine administers a vermifuye
to her children two or three times a year; in many
cases, however, where this precaution is neglected,
the child gets his intestinal tract practically full of
these parasites ; which fact naturally interferes con-
siderably with the proper nourishment of the child ;

COLONIAL MEDICAL REPORTS—SEYCHELLES. 83

cases are often seen when the parasites are present in
sufficient quantity to give rise to elongated palpable
tumours in the child's abdomen, and in several in-
stances I have met with cases of subacute intestinal
obstruction due simply to this cause. But, as men-
tioned when speaking of the whooping cough epidemic,
the most danger is caused when the worms act as
в complication, or perhaps the cause, of a form of
enteritis, which seems to follow the exanthematous
diseases.

SANITARY CONDITION OF THE TOWN OF VICTORIA.

The scavenging and night soil service have been
performed in a manner distinctly more satisfactory
than in former years.

The water supply was abundant all through the
year, but owing to the fact that the water is taken
directly out of a reservoir without having time to
settle and to no system of filtration being used, the
water, after heavy rains, is very highly coloured, and
contains a very large amount of vegetable matter,
which is washed into the rivers by the rains.

Report by J. E. Addison, Acting Chief Medical Officer.

Reports of the Assistant Medical Officers of South
Mahé and Praslin districts are submitted herewith.
Both reports point out the great improvement in the
general health of their districts.

The death-rate of 11:06 for South Mahé is very low,
being a decrease of 2:95 per thousand as compared
with 1904.

Praslin has а death-rate of 13:77 per thousand, being
less than the preceding year, which was 14:08 per
thousand.

VACCINATION.

Vaccination this year bas given good results, viz. :—

Victoria South Mahé
Successful 1st time .. 332 it 138
5 2nd ,, 42 oci "T 17
oe 3rd ,, sa 18 52 --
Unsuccessful ... .. 98 um —
443 155

In August, 1905, compulsory re-vaccination was
performed in the town of Victoria, as small-pox was
very prevalent in the ports with which Mahé is in
communication. Happily, the inhabitants of Sey-
chelles have escaped infection.

QUARANTINE SERVICES.

The quarantine station at Long Island was used
during the earlier part of the year.

The station has a steam disinfector, which is always
kept in good condition and ready for use at any
moment.

The guardian continues to keep the property under
his charge in a very satisfactory condition.

HOSPITALS AND DISPENSARIES.

Annexure III. gives the monthly return of out-
patients treated at the public dispensaries and number

81

THE JOURNAL OF TROPICAL MEDICINE.

[November 15, 1906.

of cases treated at the Victoria Hospital during the
yerr 1905.

The number of patients treated at the public dispen-
saries has been higher than usual, this being entirely
due to the prevailing poverty amongst the populace.

This insutution received 332 patients for treatment
during the year 1905, viz: 958 males and 74 females.

The number of deaths in hospital was 14; being
6 less than during 1904, and giving a death-rate of
42 per cent.

Annexure IV. gives the cases treated at the Victoria
Hospital, and cause of death.

Dr. Robert Denman, the Chief Medical Officer,
left the Colony on April 9th, 1905, on leave of
absence, meanwhile Dr. Ande Gruchy acted as Chief
Medical Officer.

ANNEXURE I.

Vital Statistics Males Feinales Total

Estimated population on
Dec. 31st, 1904 .. 10,500 9,918 20,418

Increase by births during
1905 .. E ae 352 328 680
` 10,852 10,246 21,098
Arrivals during 1905 171 88 259
11,023 10,334 21,357

Decrease by deaths during
1905 ... 2 d 168 138 306
10,855 10,196 21,051

Decrease by departures
during 1905 ... m 917 67 284

Estimated population on
Dec. 31st, 1905 10,088 10,129 20,767
Total births during 1905... 352 328 680
Total arrivals during 1905 171 88 259
593 416 939
Total deaths during 1905 168 138 306

Total departures during
1905 .. ahs "n 217 67 284
Total decrease 385 205 590
Total increase as above 523 416 939
Total decrease as above ... 385 205 590

Vital Statistics Males Females Total

Real increase 138 211 349
Births during 1905 352 328 680
Deaths during 1905 163 138 306
Excess of births over deaths 184 190 374
Departures in 1905 217 67 284
Arrivals іп 1905 ... 171 88 259
Excess of departures over

arrivals ... 2 +46 -21 +25
Excess of births over deaths 184 190 374
Excess of departures over

deaths Я" ove +46 -21 +25
Total increase 138 211 349
Number of males on

Dec. 31st, 1905 10,638
Number of females on

Dec. 31st, 1905 10,129
Excess of males over

females 909
Number of males in 1905 10,638
Number of males in 1904 10,500
Increase iss А 188
Number of females іп 1905 10,129
Number of females in 1904 9,918
Increase 211

The population has increased by 849; the males by
138, and the females by 211. The increase of females
in 1905 exceeded by 73 the increase of males.

AGES AT WHICH DEATH HAS OCCURRED.

tere

Under 1 yeari 1to5 years | 5to 70 years | 70 to 100 years

МЕ MR | мек | MF

45 i 40'21 | 20] 80/64 22 | 14

—— |---- M EM X
80104“ | 144 86

‘Still births, 33 males and 21 females. Total 54.
There were 7 twin births during the year.

ANNEXURE П.

RESULT oF CASES

| Reinaining in ;
h © Admitted 8
е ‚Нох at ) A H
Sexes E EID during 1905. | Total treated
Males 6 252 258
Females | 3 11 74
t
M mx j pe ET
Total .. Я 9 323 332

TREATED AT THE VICTORIA HOSPITAL.

1
Cured | Relieved | Unrelieved Died enon tices | — Total
|! 194 33 11 11 10 258
47 12 9 8 2 74
941 45 90 14 12 832
|

November 15, 1906.1

METEOROLOGICAL RETURN,

Deaths

; i Sol ini ЕЕЕ ЕТТІ “Amount in Depth of | Direction [Average АН ile
Months emer Maximin v NUN FM hires Range: Mesh | Taches | Humidity of wind Porce inihi i Remarka
ERE: EREE ае 2и LONDRES кезен ЕСЕБИ Ae pene е ee SEIS. E HU an ee
January | 30:07 161: 72:8 831 | 76:8 | 6:3 80: 1340 : 3:05 N.W. | 61 41
February .. 30:07 160: 78:9 83:5 | 71:0 65 | 809; 603 ! 5:22 N.W. 165 27 *S.E. winds
March | 80:05 168: 74:0 | 83:7 ! 794 4:3 | 820 3:47 6:50 N. 57 23 . from
April i 30:07 162: 72°3 | 860 | 78:6 та | 195! 422 8:35 I | 51 32 | May 15th,
May .. 3007 | 1609 | 720 | 851 , 187 G4 |804] 904 575 (сұ | 72. Bt | Non
June | 9010 15 716 | 8&1 | TUTO 51 | 795 089 | 11-99 S.E. 13 aN beckon
July 41 3011 157- 702 ' 826 | 769 4T 189 0:62 6:17 S.E. 10:6 м. оте”
August .. 30:08 150 2 72° 813 : 764 49 78:8 6:25 739 | SLE. 1928! 18 ^N. W. from
September | 30:08 ! 155: : 698 ` 821 ' 761 60 | 79-1 1292 407 | SE. 111! 16 "Бес зга
October .. 30 07 ; 1588 | 701 | 834 | 767 67 79:9 0.48 563 | S.E. 83. 29 1905 ?
November 30:08 t.. 71:6 815 TTO 75 | 790 5:58 529 ;E.&calm 54. 15 PIE
December | 30-03 ЕР oe 716 83: 7T:3 67 | 801 9551 3:96 | М.М. 7:4! 99
RETURN OF OUT-PATIENTS TREATED AT THE PUBLIC DISPENSARIES.
soni на. аео g mnn = x pee
Victoria Hospital Anse Royale Anse Boileau Praslin Total
Month --- |
M. F. l м. Е. м. Е. м. | F. M. and Е.
January 53 151 | 31 u 5 7 19 16 | 323
February 66 1 199 19 15 3 5 44 8 359
March 77 285 23 13 3 5 28 20 154
April 63 246 | 25 15 3 3 | 24 15 | әм
Mey.. 52 217 32 16 3 4 30 21: 4 375
June 33 182 i 30 20 1 10 31 15 322
July.. 36 219 27 17 2 5 24 92 852
August x 50 172 24 23 2 T 24 18 320
September .. M T 79 153 25 22 5 6 17 16 823
October .. t 9 53 223 20 18 3 6 17 34 374
November .. m ES 73 213 20 19 1 8 18 | 1 369
December .. 69 197 21 18 2 5 17 10 339
1
Тоа... $04 2487 , 997 207 3. — 7 0343 202 4,301

Report of First and Second Divisions South Mahe.
By John Thos. Bradley, Assistant Medical Officer,
Anse Royale.

Part I.

The health of the district continued good until the
endof November. At theend of that month whooping-
cough entered the district, although no deaths from
this disease occurred up to the end of the year, yet
I am of opinion that as the disease progresses its
virulence will increase, and it will result in the weeding
out of weak and debilitated children.

In former reports I drew attention to the fact that
tubercular disease was not to be found in South Mahé.
It is with regret that I note for the past two years
that this cruel disease is making progress. Slowly
but surely the insidious approach can be observed, and
in future years tuberculosis will have to be reckoned
as one of the diseases that active and prompt steps
will have to be taken against.

Phthisis is at present occupying world-wideattention ;
scientific societies all over the world occupy themselves
with its causation and treatment. At times it is sud-
denly reported that a remedy to combat the disease has
been discovered, and after a more or less extensive trial
the remedy is abandoned, and so year after year we get
reports of wonderful remedies, and after a time it is
found that the new remedies are no improvement on
the old. When a disease is complimented by having
so much attention paid to it there is no doubt that its
ravages and the death-roll caused by it must be con-
siderable, and I consider that tubercular disease, under
all its different forms and manifestations, is one of the
greatest scourges of the human race. Taken as a fact
that the disease has invaded Seychelles, the people
should be educated up to the disease; they should
have explained to them what science bas done and
is doing to stay and arrest its progress, and unless
a correct view is brought home to the people the
arrest of such an insidious disease is almost impossible.

86 THE JOURNAL ОЕ TROPICAL MEDICINE.

[November 15, 1906.

RETURN оғ DISEASES AND DEATHS or EUROPEANS IN 1905 THROUGHOUT THE

GENERAL DISEASES.
Admis-

sions.

Alcoholism
Anemia
Anthrax
Beri-beri
Bilharziosis e
Blackwater Fever ..
Chicken pox .. m
Cholera š í ia 5
Choleraic Diarrhea . vs ae
Congenital Malformation
Debility
Delirium Tremens
Dengue
Diabetes Mellitus
Diabetes Insipidus
Diphtheria ..
Dysentery
Enteric Fever
Erysipelas
Febricula xs 42 Ее АЕ
Filariasis 4% 5% zs si
Gonorrhea .. Е i
Gout ..
Hy drophobia ..
Influenza es
Kala-Azar .. vs
Leprosy
(a) Nodular
(b) Anesthetic ..
(c) Mixed
Malarial Fever—
(а) Intermittent |
Quotidian..
Tertian
Quartan
Irregular ..
Type undiagnosed $e
(b) Remittent .. . 2%
(с) Pernicious Қ n
(d) Malarial Cachexia .
Malta Fever .. 2
Measles 2%
Mumps .
New С rowths-
Non- malignant . %
Malignant А
Old Age 5 4%
Other Diseases
Pellagra
Plague..
Pyemia
Rachitis
Rheumatic Fever
Rheumatism .. m
Rheumatoid Arthritis
Scarlet Fever. Я
Scurvy
Septiciemia
Sleeping Sickness
Sloughing Phagediena
Small-pox e
Syphilis
(a) Primary
(b) Secondary
(c) Tertiary
(d) Congenital s
Tetanus Я
Trypanosoma F ever..
Tubercle— .
(а) Phthisis Pulmon: dis
(b) Tuberculosis of Glands
(c) Lupus i
(d) Tabes Mesenterica. . .
(e) Tuberculous Disease of Bones

Deaths.

Yellow Fev er.

LOCAL DISEASES.

Diseases of the—

Cellular Tissue .. 5%

Circulatory Svstem— .. X
(а) Valvular Disease of Heart ..
(0) Other Diseases. .

Digestive System—
(а) Diarrhoea .
(0) Hill Diarrhea. .
(c) Hepatitis

Congestion of the Liver

(d) Abscess of Liver
(e) Tropical Liver.. 4% m
(f) Jaundice, Catarrhal .. Ae
(т) Cirrhosis of Liver . is
(л) Acute Yellow Atrophy

(i) Sprue

(j) Other Diseases
lar E m .
Eye ..

Generative Sy stem— 2
Male Organs T 2%
Female Organs .. es m

Lymphatic System

Nervous System

Nose А

Organs of Locomotion...

Respiratory nian

Skin—

(а) Scabies . 2% 2i -
(b) Ringworm 578 m m
(c) Tinea Imbricata 42
(d) Favus .. T m m
(е) Eczema.. ar ss

(f) Other Diseases -
Urinary System E
Injuries, General, Local— 44
(а) Siriasis (Heatstroke)
(5) Sunstroke (Heat Prostration)
(c) Other Injuries sta
Parasites—
Ascaris lumbr icoides
Oxvuris vermicularis .. .. ..
Dochmius duodenalis, or Ankylos-
toma duodenale 4% ne
Dracunculus medinensis (Guinea-
worm) .. 5
Tape-worm
Poisons- -
Snake-bites
Corrosive Acids ..
Metallic Poisons
Vegetable Alkaloids
Nature Unknown
Other Poisons
Surgical Operations —
Amputations, Major
Minor
Other ‘Operations
Eye .. 52
(а) Cataract 5% x p
(0) Iridectomy . oe
(c) Other Eye Operations gs

Seychelles.

ех Admis-
'reated. Я sions,

a 5 GENERAL DiskasEs-—continued.
9 Other Tubercular Diseases .. --
— Varicella й Е 5% ашу
— Whooping Cough =
— Yaws .. ac —

Deaths,

LEE EL ell EP tbl bib boi tl

Total
Cases

Treated

(21

тан ee

December 1, 1906.)

‘COLONIAL MEDICAL REPORTS—SEYCHELLES. 87

Colonial Medical Reports.—No. 30.—8eychelles (continued).

Firty years ago the treatment was one of hot and con-
fined rooms, all sources of air being carefully excluded,
and the patient was kept like a hot-house plant. To-
day the pendulum has gone to the opposite extreme:

Fresh air and plenty of it, is the cry, and instead of

keeping patients confined to close and stuffy chambers,
their treatment is what is called the out-door and
sanatorium. This wonderful change in treatment is
sanctioned not only on scientific grounds, but on the
splendid results now being published of the diminu-
tion in the death-rate where open-air treatment is
' carried out, and these results compared with those
obtained under the old régime.

The question now at issue is, Can an open-air treat-
ment be carried out with successful results at
Seychelles? There are а great many people at
Seychelles—in fact, the bulk of the population—who,
for lack of means, are unable to take a voyage to
South Africa, Algeria, or any of the usual health
resorts which are laid down as suitable for individuals
suffering from consumption. Under these circum-
stances the disease has to be combated at home, and
I am of opinion that success in the treatment of
phthisis can be obtained here, if the disease is taken
in time and before it has obtained too firm a grip on
the individual. І

The question is, what is an ideal climate for tuber-
culous patients, and how can Seychelles be looked at
from this point of view.- I hold that the question of
climate is less significant than that of régime, and
it is to the advantage of the great majority of patients

to be treated under the normal climatic condition of .

the individual. В :

An ideal climate for tuberculous patients is one
having a pure and dry air which is frequently in mild
movement, & maximum of sunlight, relatively equable
temperature and warmth, freedom from dust, a certain
amount of shelter, combined with a picturesque land-
scape and extreme stillness; this would be an ideal
climate, in my opinion, but I do not know any country
that fills exactly the conditions.

Varieties of climate for tubercular patients may be
grouped thus :— ;

(1) Sea-coast climates.

(2) Desert climates.

(8) Forest and woodland climates of relatively small
elevation (say 150 to 1,500 feet). i

(4) Mountain climates (say 1,500 to 10,000 feet or
more).

Seychelles is a sea-coast climate, is has the advan-
tages of a pure air, no extreme ranges of temperature ;
it has the disadvantage of being too humid, and is
often relaxing and enervating. I would not recom-
mend an individual to seek Seychelles as a health
resort, but I am strongly of opinion that cases of
phthisis can be combated with here, as well as in &
good many parts of Great Britain aud Ireland. The
French and Italian Riviera, Madeira, &c., are all sea-
coast climates, and are all used as health resorts for
consumptive individuals; in late years I understand
that the Madeira Islands are not so much used, owing
to the depressing and weakening influence on consump-
tive’people. Yet the great question is to cure the
patient, and to undertake the cure (other things being

сіп the community. . .

equal) under the conditions which he must meet when
recovery has taken place, and thisis the issue that has
to be faced by the inhabitants of Seychelles.

To sum up, the modern treatment of the disease

should be combated in Seychelles on the following

lines :— с

(1) Improve the resistance of the individual to the
disease. ike К

(2) Take measures to attack, or at least neutralise,
the products resulting from the growth and develop-
ment of the tubercle bacillus within the body.

(3) Relieve the more important symptoms and

‘complaints.

(4) Prevent the progress and advance of the disease

The improvement under (1) can be carried out on

‘the lines that are followed by the Pe sana-

toria of the world, viz., fresh air and sunlight, rest,
graduated and progressive exercise, dietary, skin
hygiene, and medication ; (9) and (3) аге ір the domain
of the physician, who should take advantage of the
latest атаа (4), which is probably the most
important, should be met with by educating the public
to the disease, by a system of segregation, and the
establishment of a sanatorium in which áll- patients
who were attacked by the disease would be compelled

to reside.

Referring to pneumonia : during the year five

deaths occurred; the mortality rate of this disease

increases ав you approach the Tropics, and from an
examination of statistics of different countries.I find
that this is borne out.

` "There is an epidemic of whooping cough amongst

the children, and I find that vaccination not only
modifies the course of the disease, but in some cases
is curative in its effects. I find that children, after
vaccination, get a very mild form of the disease, that
the spasms are absent, and the vomiting and other dis- -
agreeable symptoms do not make their appearance. `

The mortality of children under one year is 16; a
good number of. the children only survive birth an
hour or so, and some die within the first week of
birth; all the same, more than one-fourth of -the
сеи that occur can be placed. under the first year
of life. :

Равт II.
VrrAL STATISTICS.

As in former years, further on I have attached
tables, showing а comparison of the births, deaths, and
still-births of the years 1902 to 1905, also comparative
tables of the ages at which death occurred during
these years.

In my report of last year I tried to show what is the
danger zone, &c., in the life of the inhabitants of Sey-
chelles, and also the period more favourable to life.
The most favourable period is probably between the
ages of 30 and 45, and the dangerous zones the first
year of life and after 55.

There is practically no increase in the mortality of
children under 5 years, but in the. year 1906 I am
afraid the epidemic of whooping cough will have а
marked increase on the death-rate under 5 years. In
1902 the number of deaths of children under 5 years

88 THE JOURNAL OF TROPICAL MEDICINE.

[December 1, 1906.

——————————————————————————M——————————————————

‘was 28, іп 1903 it was 21, in 1904 it was 17, and in

1905 it was 20; so that practically for three years the
death-rate has not changed.

Taking the births as 166 for the year 1905 and the
deaths as 51, the increase in population for the year
1905 is 115; this increase, added to the increases of
1902, 1908, and 1904, makes a net increase of 408 for
these four years.

1901 (Census taken in that year), population... 4,203
1902 Estimated population to December 31st 4,301
1903 s 5 » is 4,404
1904 n " T » 4,496
1905 "uan » ” » 4,611

The number of deaths for the year in South Mahé
was 51, а diminution of 19 as compared with the year
1904. Ithink this is below the average ; anyway, it is
2 small average for the year. As usual, & good number
of old people died during the year. There were 7
deaths over 50 and under 60 years; 10 under 80
years; 1 under 90 years, and 1 over 90 years.

Taking the estimated population as 4,611, this
works out а death-rate of 11:06 per thousand, being
т а of 9:95 per thousand as compared with

904.

The principal diseases that caused death during
1905 as as follows: Senile decay, 10; gastritis, 8;
pneumonia, 5; hémiplegia, 2; endocarditis, 2;
aneurism of aorta, 2; Bright's disease, 2.

During the year 1905 there were only 4 still-births,
for the past three years the number was 11 each year.
' During the year 1905 there were 166 births, an in-
crease of 11 as compared with 1904.

The average birth-rate per thousand for 1905 is
36:00, being an increase of 1:53 per thousand as
compared with the preceding year.

Part III.
DisPENSARIES OF ANSE ROYALE AND ANSE BOILEAU.

The dispensary of Anse Royale was well attended
during the year on Mondays, Wednesdays, and Fri-
days, by the poor. During the year there were 504
consultations, being an increase оп the year 1904 of
104 patients.

The dispensary was held at Anse Boileau every
Thursday morning." The number of consultations for
the year was 104. i .

As in former years, I have attached tables showing
the diseases treated at the dispensaries and the
number of consultations under each disease.

VACCINATION.

The vaccine lymph supplied was excellent, and
reflects credit on the preparation and maker; even
after five and six weeks it still had its vitality. There
was a small-pox scare during the year, and an extra
supply of vaccine was supplied, some of it came from
Madagascar, and the quality from this source was not
good—after two weeks it was useless ; the extra supply
that came afterwards was excellent. -

During the year I vaccinated all Government em-

ployees in South Mahé, including the cantoneers ; the
bulk of the school children attending at Anse Royale
were also vaccinated. Of the general public, about 300
adults came to me for the free vaccination. In almost
all cases the vaccination was successful, but some of
the adulta got marked swelling of the arms and glands
іп the axilla, accompanied by a severe reaction.

During the year I vaccinated 155 children; all the
cases were successful; 138 at the first attempt, 17 at
the second.

Равт IV.
SuncEOoN's WorK IN PoLicE CASES.

During the year there were 32 police cases at Anse
Royale of wounds and blows, and 1 at Anse Boileau.
Most of the cases were of a trivial nature, none of
them were dangerous to life. : -—

Accompanied by the police I examined and enquir
into two deaths in my district, and one just outside
the limits of the ninth mile at Anse Boileau. The first
of these cases occurred on January 22nd, 1905. ac
panied by Sub-Inspector Tonnet, I went to Gran
Police, and after examination of the body I found that
death was due to drowning ; evidence brought forward
showed that it was accidental. The next case occurred
on December 25th, 1905, at Anse Boileau ; the man In
this case had committed suicide in his bath-room. The
case outside my district was that of an old man, age
about 80, who, one Sunday afternoon, cut short his
life by hanging himself in his bedroom. Hanging 18

. the method preferred by the natives when they wish

to commit suicide.

THS
COMPARATIVE TABLE OF BIRTHS, DEATHS AND STILL-BIR'
DURING THE YEARS 1902, 1903, 1904 AND 1905.

aa I ник ик ктк инна анын десі

Years | Births | Deaths | Still-births Remarks
Seneca) ЖЕ ae
1 Births in 1908 exceeded that of
aac rid Dr 1902 by 12; there is a dimuni-
tion otl in the yan mee
compared wit ; in
1903 | 169 ) 66 " the births exceed those of
1904 by 11.
The year 1905 is the lowest
1904 | 155 | 68 и death-rate in South Mahé for
the past four years. .
The still-births have fallen 1n
1905 166| 51 4 1905 to 4. :

———

Вівтнв, DEATHS, STILL-BIRTHS AND MARRIAGES, 1902 TO 1905.

А fg | 2
28 i 28 188 ' 55
Years ind an 55! 44 Remarks
BR | ар (gi. ДЕ
520
қық eH INE ! РУ . 902
1902 86:50 | 1971 | 2:55 | 5:34 | 23 marriages in ed
1903 3937 | 1498 249| 658 |29 4, М1 5
1904 93447 | 1401 944| 692 |28 ,„ е 1904
1905. 36:00 ! 1106 86 4°51 21 5 m
І hri. E е ЕНБЕК ын

December 1, 1906.)

COLONIAL MEDICAL REPORTS—SEYCHELLES.

89

COMPARATIVE TABLES OF THE PRINCIPAL DISEASES CAUSING DEATH IN SOUTH MAHÉ DURING THE YEARS 1902, 1903, 1904
AND 1905.

YEAR 1902

YEAR 1903

Year 1904

Year 1905

elele ele Аааа z| |. elelelelzle| |. еее еее

33235 тіз & |8 |3 |32 21515 312121315 - |18 181321213 2 5

ЕБЕ 5| 215 E|s|5|S|5 5|S]4 | 551555 5|515 15155 ЕЕЕ Е

ЗЕЕ 5| ЕЕЕ Е Е Е 2 2121555 a ЕЕЕ ЕЕ

515/555 Pie 655515 Л P| 55152159) |2555 |5 515 ады

= | t. - ұғ I— EM Жез; = |, pas 1 Сац Se —

Asthma .. ЛЦУ: СЕСЕ 86 рае = ТЕСЕ eme
Accidents, &c. ........2.... мео VIA RALE E ES ee pe s |t s КӨЗЕ ЕЕЕ «vss БАТЕ И Roo pom ex | e Pes in
Aneurism .. Sad Ы БІРДІ СС БТА ӨТЕСЕ ЗІ БЕН ЕС elo s [eel bis la el exl ches [ss ПРЕ ЕЕЕ
Cancer Б ОССЕ Е ТЕ PAPE ESSE RSS ES Deje espe eeenHeIAMHHeweeee
Cardiac Disease ..|..........11. 1Ц..41.11411|9.... ар у OR RE! ЗК ЗБ рМ ЕЙ»
Dysentery .. BE ake | 3]..| 3 4.44. Bo castes 1/3] edes [esu]: 2055 БЯ | Bsr 1... ЖЕҢ гі (ДІ ГР 05, |зе
Elephantiasis M ES rn BS DIEI I E А Р К ESI E S BSEC Н РО DRESS с ВОНА SNP ИА И А |9 (5
Gastritis .. г еа е Ваа аара АРЕ БАЮ! 2] Mos РАВА Е |...
Gangrene .. vs П рар. sels ЕЕ МЕН ИЕЕТИЙ ЕДІЛ ТІНДЕР als ejes ee] Bp e eda ОРАРА КҮРЕ ӘҢ ла | d
Hernia 1. ТІРЕ as eta б КЕЛЕ «| ns | deae АЕ eie es | e| dio] eon ЕСЕ;
Hemiplegia E S a A 1] 12 91s] 44. [|o] 19.01 PAR БЕ DD) sels ote} Hl ee] Sef e rn es rm ре e Hests
Leprosy .. ae Js esos] dos] des [sepe] ЕАС БЕРГ | es os eel oo | es lees es] dos cose] de s on qe [os [o ed eo [ns [e [edes] eol
Peroniis.. — .. |.. 4...1... 1..1... 8..1... ДЫМЫН ЫЫ
Pleurisy .. ЕСЕ nnne ЕЕ ЕСВЕБ ЕКЫ ЕВЕЯИЕЕЦЕЕ
Pneumonia 211071111901 аа ay 3) 13----| 4] al) 1| 1| 3 ----]--l-
Senile Decay ЕМЕНІ | s eere [e |n o ЕЕ 6.41.1178 516]..)....1......1.. 8| 01
Urethral Disease .. |../..|..|..!..| 1]. .]..]..]..] 4..1... eleeeeeeé ieu БИРИ А 0 АС
Syphilis delen ln] Ner ІШ 15 1 Md: 141849411 JE ц 2....|9| 1 ЕЕ

| | | | | ! i

TABLE OF DISEASES CAUSING DEATH IN SOUTH MAHÉ FIRST
AND SECOND DIVISIONS DURING 1905.

| |
BiB 2s) = lees

ssiiiiiiij

rl ap! >| a] a hajaj a >» P | =

Causes of Death "оаа = |за = = 8

= е cs /3)/515/5)/5 Sin le
JH IET
P|Pls|jsislisisi5 pjo

|

Abscess of the Liver.. НЕТ ЕР БЕЗДЕРІ ао ы
Anemia 24 А sara] ТИҢ ЕЕ Р onn ШЕК БЕЧ Xl СЗУ БЕ
Aneurism of Aorta .. | .. ss] cell PLA) ЭЕ РК de РЕ ІК
Bright's Disease — .. .. Lo] ver sale d oM n ЕРІМ
Drowning .. seis xe МЕ ТН БЕТ МЕСІ Ед Desa
Dysentery .. КОЗЕ ebpebeebe
Endocarditis . . «| hes bri Е es
Gastritis ЕР est S Тә ЗУУ 22
Hemiplegia .. .. |... .. 5 CX p].
Influenza 5; S LESS RS 4% 1. ара
Phthisis, Pulmonary | .. 1! sd] БР ИЕ
Pneumonia .. нен ір! 111 2 as or БЕЗ
Syphilis, Hereditary 1 Heh ise s

Syphilis vs ӨТ sy ee
Senile Decay .. ханта: Aare
Strangulation
Tetanus

UNCLASSIFIED CAUSE

Disease of the

Stomach .. Jr 46 xs
Exhaustion .. ы 6f
Colic .. ege.
Fever .. ser] eie] t

Infantile Disease .. | 1

16| 4

t Suicide.

T
2

lt

GIVEN BY RELATIVES.

. ка.
к.

M ФО | | QO | m tO tdm Бо оны

* A complete enquiry was made ; cause of death accidental.

t A good number of these children died a few hours after

birth.

COMPARATIVE TABLE OF THE AGES AT WHICH DEATH
OCCURRED DURING THE Ykans 1902, 1903,
1904 anv 1905.

Under 50 years

Dea‘ hs i $ | d d

during v ve БЇ 8

the year | $ | 5 8 5
= |з Е Е

э |Б в |Ә

Under 40 years

Under 60 years
Under 80 years
Under 90 years
dad 90 rr
Total

CO mm Or

| eo
-30 0
кн

ооо
mol co
н сњ |
288s

The following were the complaints treated at Anse
Royale and Anse Boileau Dispensaries :—

_Disease.
Anemia .. his
Si Pernicious .

Asthmatic Bronchitis ..

Aukylostomiasis
АтпепоттВова

Abscess of Knee-joint s

A Axilla

Bronchitis, Acute 4

» Chronic i
Bright's Disease А
Constipation .. "
Colitis 55 Р
Colic Y 4
Climacteric 5% Че
Conjunctivitis .. б
Cystitis .. В
Diarrhea .
Dysentery m 5
Dental Abscess .. .

Dysmenorrhea ..
Debility .. T

Anse Royale. Anse Boileau.
Number of Number of
қаратады Consultations,

1 З 12
4 ` —
1 . —
6 . -
9 . —
10 os --
1 Vis --
12 m 8
. 8 . 1
.. 1 . —
Si 14 . 3
zs 8 T —
2» 8 = 4
. 1 . —
E 3 2% —
> 3 . —
. 4 5 3
5 21 3
. 1 —
. 1 .. 2
m 65 ee 25

Total 1905

90 7 THE JOURNAL OF TROPICAL MEDICINE. {December 1, 1906.
Алиа Royale: -Anie Bollean. 15 paupers. That is, the diminished income of the
Disease. Consultations. Consultations. | labouring class, through lessened employment, has
Doubtful .. T vs oo Я 1 caused an increased demand for Government help in
Endocarditis .. .. 0. 0 .. - the case of the incapable and the infirm. Throughout
ULM "I i : 4 the year all the inmates have shown a spirit of content-
Fracture of Arm s Wes UM Lt. dg ment and gratitude. Although their daily life is limited
Gastritis .. M sy n 17 қ 4 and monotonous іп its interests, they have not been
Glossitis .. — .. we we 1 .. —— unhappy, or only when disease was acute. Basket-
ро NU MEL S EC ME EA: making, poultry-keeping, and rock-fishing are pursued
5 Bubo 2 2 by several іп a fitful fashion, and they are the most
Goitre eit ocu 7 - cheerful of al. The majority prefer to sit idle in the
Hemorrhoids .. .. .. 11 1 sun, and do nothing but talk and smoke, and so pro-
l oneri аба i ; claim’ practically their belief that idleness is happi-
Hepatitis 3 a ness ! ;
уре е T 1 District DISPENSARIES..
Inh to Left Side 1 BN The two dispensaries at St. Anne and Grand Ance,
Inflammation of Cord .. 8 e Praslin, and the third at Ladigue have.continued free
Indigestion z 9 2 medical help to the more destitute sick. This help,
pedi 1 І as formerly, has been much appreciated; and now and
Lumbago . 9 M then, where benefit received was marked, has been
Mastitis .. 2 very warmly acknowledged. е ;
Migraine .. 3 1 The number treated during the year has been : 323
Now Orowths u m new and 212 old cases, as against 243 new and 165
Otorrhea ” 3 = old the year before. i
Ovaritis 2. 4 = In an appendix the more frequently occurring ail-
Pregnancy 6 == ments are enumerated. Of these, the debilitating
глав sai i diseases dependent on or associated with anemia are
Pleurisy P i “ 1 the most important, and the most difficult to remedy.
Rheumatism + .. we 18 9 More than one generation, in not a few cases, have
; Muscular 2 = clearly contributed to the cachectic state and its con-
Syphilis s шы ср i = comitants. Бо, prolonged dietetic treatment is indi-
2 Tertiary | 5 7 cated as much as ordinary medical treatment.
Synovitis 4 —
Torticollis = 3 Parasitic DISEASES.
Ulead tro ical 3 d The chief parasitic disease is the round-worm, and
» Syphilitic 2 — few young people, if any, are exempt from. its attack.
» ҚЫ ар ^ = Recently, one vermifuge dose administered to a child
матога" 9 mi of six caused the evacualion of above 100 worms!
» Leg .. 3 = The more formidable tape-worm is rare. We met with
M Heel 2 -- one case only in the course of the year. · <
RE inger x 2% — i - : A : A А
Worms ( Meee Țumbricoides) 19 d Tineas of the scalp and skin are not’ uncommon ;

* Whooping cough declared in the commencement of December.
+ A good many of the cases were of а gonorrhoa] nature.

PRASLIN DISTRICT.

Medical Report for the Year 1905. Ву Dr. R.
E Laidlaw, A.M.O.

Tue inhabitants of the Praslin District have again
enjoyed, during 1905, а twelvemonth of comparative
freedom from sickness and disease, accompanied, as is
usual, by a low death-rate and a high birth-rate.

Some particular features of the health of the district
and its medical institutions require special notice.

Round IsLAND ÁSYLUM.

Inthe Leper Home and Pauper Camp, located on
Round Island, the population at the beginning of the
year was composed of 9 lepers and 10 paupers, and at
‘he end of the year it-was composed of 11 lepers and

they are chiefly found in the case of those who notori-
ously neglect personal cleanliness. A. widespread
notion prevails, even amongst the better educated,
that a scalp eruption should not Бе washed. Hence
the unsightly heads of many otherwise healthy
children... . .. . .
ERES . REfPrpEMIC DISEASE. -
. The district has throughout the year been entirely
exempt from epidemic forms of trouble, except in-
fluenza colds and sporadic chicken-pox, and the last
has been limited in extent, and not dangerous in
type. | `
К Leprosy. °
Leprosy. is not increasing. Ап enquiry has been
made regarding the possibility of procuring and using
in Seychelles the specific’ remedy associated with the
name of Captain Rost, of the I.M.S., which he had
termed “ leprolin." The announcements of its efficacy,
however, seem to have been premature, and it is not
as yet available. There is no doubt, however, but
that a serum remedy of that special type will ere long
be in effective use.

December 15, 1906.)

Colonial Medical Reports.—No. 80.—Seychelles (continued).

WOUNDS AND FRACTURES.

The accidents arising from edged tools still abound,
while dislocation and fracture occur occasionally. The
gross neglect of surgical instructions, and the attempts
io ui if something else will not hasten the cure, make
one desire & local hospital on & small scale, to control
and maintain, for the necessary time, the surgical
appliances.

VAOCINATION RESULTS.

The vaccine lymph has given good results on the
whole, as far as concerns that received from England.
The lymph received from Madagascar, in the sudden
precautionary measures against а possible invasion of
small-pox, did not seem in the district to give results
as favourably.

BIRTH AND DEATH-RATES.

The considerable number of 119 births were regis-
tered during the year. A large proportion of these are
children born out of wedlock. Of the 119 the legiti-
mate were 72 in number, and tbe illegitimate 47.

Forty-two deaths were registered throughout the
year, and of these ten were the deaths of infants under
one year, occurring very much, it is to be feared, from
maternal ignorance or lack of sufficient care.

The estimated population of the district on January
1st, 1905, was 3,049, and the deaths being 42, gives
a death-rate of 18:77 per thousand of the population.
The year immediately preceding this figure was slightly
higher, viz., 14-08.

APPENDIX.

THE мове Common Dispensary DISEASES.
Abscess. Anal fissure.
Amenorrhea. Anemia.
Amputation. Anorexia.

Antrum abscess,
Asthma.
Ascites.
Blenorrhagia.
Bronchitis.
Bubo.
Cardiac palpitation.
ardiac valvular disease.
Cataract.
Cephalalgia.
Cerebritis.
Colic.
Congestio enteri,
Conjunctivitis.
Coryza.
Constipation.
Cystitis.
Diarrhoea.
Dropsy.
Dysentery.
Dysmenorrhea.
Dyspepsia.
Eczema.
Enteritis.
Epididymitis.
Epilepsy.
Fever.
Fibroids.
Fracture.
Hemiplegia.
Hepatitis.
Herpes zoster.
Hemorrhoids.
Hydrocele.
Hysteria.
Insanity.
Intracapsular fracture of
neck of femur.
Ichthyosis.
Influenza.
Kidney rupture.
Laryngitis.
Leprosy.

COLONIAL MEDICAL REPORTS—SEYCHELLES. 91

Leucorrheea.
Locomotor ataxia.
Lumbago.

Nasal polypus.
Necrosis.
Nephritis.
Neuralgia.
Ophthalmia neonatorum.
Orchitis.
Otorrhaa.
Ovaritis.
Paralysis agitans
Periostitis.
Peribepatitis.
Perineal abscess.
Polyuria.
Prostatitis.

Poly pus.
Psoriasis.
Pulmonary congestion.
Retinitis.
Rheumatism.
Sciatica.

Spinal meningitis.
Sprain.
Stomatitis.

Sy ncope.
Syphilis.
Synovitis.

Tenia favoaca.
Tenia tonsurans
Thrush. ы
Тіс douloureux.
Tonsillitis.
Toothache.
Torticollis.
Ulcers.
Urticaria.
Varicella.

Warts.

Whitlow.
Worms.
Wounds.

92

THE JOURNAL ОЕ TROPICAL MEDICINE.

[December 15, 1906.

Colonial Medical Reports.—No. 31.—British Guiana.

MEDICAL REPORT FOR THE YEAR 1905.

By J. E. GODFREY.

Surgeon-General.

Europeans | Africans | ав | Chinese Mixed | Dative

Number of Inhabitants in 1904 ЕЕ 15,698 1,718 125,896 2,538 38,838 116,444

5; Births during the year 1905 377 m А 75 1,202 | 4,

$5 Deaths ,, 2 R 453 109 3,239 89 679 8,891

55 Immigrants m sa sm 2,218 181 | ‘i

$i Emigrants 4 2 2,561 201 m
Number of Inhabitants in 1905 15,622 1,609 126,407 2,449 84,356 | 116,142
eee ees ЕН eee es Li -----------------І---
Increase 511 528 678
Decrease 76 109 84 : "m |

POPULATION.

Estimated population (1905), 303,390; births (1905),

10,194; deaths (1905), 8,314; birth-rate per 1,000

1905), 33:6, (1904) 30-3; death-rate per 1,000 (1905),
7:4, (1904) 28:8.

MORTALITIES.

The relative mortalities in the different quarters
were: March quarter, 2,172; June quarter, 1,808;
September quarter, 2,161; December quarter, 2,173.

MALARIAL FEVERS.

These showed the highest number of deaths, and
were again highest in the September quarter, the June
quarter also again showed the lowest number, and the
December quarter the next highest number of deaths.

DIARRHŒAL DISEASES.

These showed the next highest number of deaths,
the March quarter being responsible for the largest
number of cases and the December quarter for the
smallest. The June quarter was lower than the
September.

Ввомонітів AND PNEUMONIA.

These diseases were again principally confined to
the East Indian race. The totals for the third and
last quarters were about the same, and were higher
than the first and second quarters, which were about
equal. : EIOS

Рнтнівів AND OTHER Forms оғ TUBERCULOSIS.

These were highest in the December quarter, but
there was very little difference between that quarter
and the first. The second and third quarters were
about the same.

KripNEY DISEASES.

The deaths from these diseases were highest in the
December quarter, the March and September quarters
were about the same and were higher than the June
quarter.

There were a few sporadic cases of beri-beri, typhoid
or enteric and blackwater fevers, but I am again glad
to report that the deaths from these diseases were very
few.

None of these diseases appeared in an epidemic
form.

December 15, 1906.) COLONIAL MEDICAL REPORTS—BRITISH GUIANA. 93

RETURN or Diseases AND DEATHS IN 1905 ат THE FoLLowiNG INSTITUTIONS :—

Georgetown Hospital, Berbice Hospital, Suddie Hospitals, Bartica Hospital, Morawhanna Hospitals,
including Arakaka Ward.

o) Du Lupus
8 Mesenterica, .

b) Iridectomy

GENERAL DISEASES. | Total - dain: a
Admis: Daia Perd sions. Deaths. Treated.
Alcoholism .. % oe 18 .. 1.. 18 GENEBAL Diseases—continued,
Anemia 979 .. 8.. 979 Other Tubercular Diseases - ы. - =
Anthrax 1.. —.. 1 Varicella . те pec E
Ber-beri — . 1. —.. 1 Whooping Cough im T
Bilharziosis —. —. — Yaws .. I yy scs 1
Blackwater Fever – .. —. — Yellow Fever... T Hel
Chicken.pox .. 8.. —. 8
Cholera mx RES —
Choleraic Diarrhoea . =.. —. —
Congenital Malformation A E" —
Debility ; 103 .. 10.. 103 LOCAL DISEASES.
Delirium Tremens .. =.. —. —
Dengue -- 2. --. — Diseases of the—
Diabetes Mellitus 4 e cc. 4 Cellular Tissue .. s T .. 639 .. 21.. 639
Diabetes Insipidus -- .. 0 --. = Circulatory System — .. .. 146 .. 39.. 146
Diphtheria Iul CAR — (a) Valvular Disease of Heart .. ope dera. cms
Dysentery 294 .. 93 .. 294 (6) Other Diseases. . x eee ee
Enteric Fever md = Digestive System— .. уд .. 1,458 .. 236 .. 1,458
Erysipelas 14 . 2. 14 (а) Diarrhoea а oo Sas m
Febricula 711... —. 11 (b) Hill Diarrhea.. — —. —
Filariasis Rl" a (c) Hepatitis = --. ==
Gonorrhea 231 .. — .. 231 Congestion of the Liver — —. E
Gout . --.. =. ce (d) Abscess of Liver = --. =
Hydrophobia .. E orig — (e) Tropical Liver.. . — ==. =
Influenza 8. —. 8 (f) Jaundice, Catarrhal . - mA -
Kala-Azar -- 2. --. - (9) Cirrhosis of Liver - --. —
Leprosy -- 2. ==. = (А) Acute Yellow дверну, -- —. =
(a) Nodular — 2. --. = (i) ӛрге .. a - es =
(b) Anesthetic .. 60 . l 60 (j) Other Diseases. T PUO EXAM —
(c) Mixed 24. 4. 24 Ear es vs 2 Е 2.85. —. 85
Malarial Fever— 52 .. 84. 52 Еуе 3% 290 — .. 290
(a) Intermittent 1911 .. 53 ..1,911 Generative System— |. ИСНИ
Quotidian.. LE due E == Male Organs - e .. 481.. 2.. 481
Tertian — .. =, — Female Organs .. s ..1,157 .. 44 ..1,157
Quartan .. m е5 == Lymphatic System .. Е .. 149.. --.. 149
Irregular .. Sie = Nervous System ЯЯ xS .. 882 .. 66 .. 882
Type undiagnosed —.. -. — Nose . is "m 9.. —. 9
(b) Remittent 87 .. 10. 87 Organs of Locomotion. . vs .. 207.. 1.. 207
(c) Pernicious .. 927.. 22. 27 Respiratory oe is 2 .. 1,894 .. 455 .. 1,894
(d) Malarial Cachexia . 63 . 1-5 63 Skin— . - Ss .. 704 .. --.. 704
Malta Fever .. £s -- 2. --. -- (а) Scabies . 48 "E D
Measles 52. 1. 52 (b) Ringworm Не -- ee --. =
Mumps . -- 2. —. — (c) Tinea Imbricata --.. --. —
New Growths— — e -. — (d) Favus .. --. --. -
Non-malignant . 37... —. 37 (e) Eczema.. толас E SS
Malignant 61.. 24. 61 (f) Other Diseases | T— uv аал Р
Old Age 59 .. 18. 59. Urinary System m 602 .. 208 .. 602
Other Diseases -- 2... =. — Injuries, General, Local— 644 .. 28 .. 644
Pellagra =. =. — (a) Siriasis (Heatstroke) 45 -- 2. -.. -
Plague.. – .. —. — (b) Sunstroke (Heat Erostration) -- 2. --. -
Pyemia 1. —. 1 (c) Other Injuries =e ee
Rachitis --.. --. — Parasites— " 478 .. 42 .. 473
Rheumatic Fever — .. c. x Ascaris lumbricoides --.. —. —
Rheumatism .. 838 . 1.. 338 Oxyuris vermicularis .. =. om. -
Rheumatoid Arthritis -- .. --. — Dochmius duodenalis, or Ankylos.
Scarlet Fever.. -- 2. —. - toma duodenale . - — —
Scurvy -- 2. —. — Dracunculus medinensis (Guinea-
Septiceemia 54 .. 44. 54 worm) .. mi e 2% e — -- —
Sleeping Sickness EL GA — Tape-worm - — —
Sloughing Phegodæna — .. —. — _Роівопв—
Small-pox .. --.. —. — Snake-bites See
Syphilis 4% .. -- 4 -. - Corrosive Acids .. --.. -. —
(a) primary 5% .. e. 98. —. 28 Metallic Poisons Se --. —. —
(b) Secondary : m c Vegetable Alkaloids. .. —.. —. --
d Tertiary : os | a21 E E Md Nature Unknown ae T ra --. --
) Congenital .. - 14.. 6. 14 Other Poisons 24 5 24
Tetanve Š . 28.. 90. 28 Surgical Operations—
Тгурайовота ever. --.. --. -- Amputations, Major .. T m
Tubercle— .. 54 .. 16. 54 Minor . | 2,484 13 .. 2,484
(а) Phthisis Pulmonalis -- 2. —. - Other Operations —
b) Tuberculosis of landa =.. =. — Eye. T —
I .. жеты SSS — (a) Cataract Я .0-

(е) ген атна Disease of Bones

ИЕН

с) Other Eye Operations E:

94 THE JOURNAL ОЕ TROPICAL MEDICINE.

METEOROLOGICAL RETURN FOR THE YEAB 1905.

TEMPERATURK
Е Ев of | of & a
НЕ ЕЕ ЗЕ ЗВ H Ы
cx zo ся аз ! 5
g 88 es | 75 l 2
January.. fed іш ..| 18855 72:9 82:1 757 | 64 | 789
February » = ..| 1400 , 708 826 1 75:5 T1 79-0
March .. M X ..| 18990 | 713 83:6 | 76:0 76 79:8
April .. M a ..1 1855 ' 793 844 173 T1 80:8
May .. E e ..| 18939 , "717 83 6 Ti1 6:5 804
June... 2% я .. | 1855 71:6 889! 765 T4 80:2
July... 2% d ..| 1895 , 706 83:8 766 | 72 80:2
August .. Vs #5 .. | 1484 711 856 | 779 | 84 81:4
September... io ..| 1441 714 864 779 | 85 824
October .. ck 2s .. | 1441 70:6 86:2 176 | 86 81:9
November... m ..| 1401 72:8 857 78:4 | 73 | 820
December 4. ee .. | 1807 72:2 82:9 754 | 75 ; Wl
Total .. a % ..1,664-3 | 858-6 |1,0108 | 92:24 | 8686 9659
Mean .. ET " ..| 1887 71:5 849 768 | 75 80:5

! i

! Taken in the shade.

RAINFALL

E v2 48
МӨНІН
z3 8B | gz
B^ | Am ед
381 | 745 | МЕ. |
5:34 ' 765 :
489 1 775 5
4-07 77 s
1112 | 82 5
10:58 : 82 Є
7:84 | 775 5
4:95 | 74 s
4:81 13 2:
2:14 74 n
3-92 | 765 x
1549 | 825 2
17:70 | 927

647 | 772

[December 15, 1906.

Force

Average

со ~i со сл со cho md Ch OD

Remarks

eoo 2.

5o mW DERE
[For Contents see page iii.) BRAY. ТР Mc.
Cable and Telegraphic ret eet "LIMITABLE, LONDON." [For London School of Tropical Ma pue
Telephone; sy GERRAR ; вее р. уйі.)
Е

THE JOURNAL ОҒ

Cropicat Йеке and H vate patene

^ With which is incorporated "CLIMATE."

E Devoted to Medical, Surgical and Sanitary Work іт Warm Countries.
Embodying Selections from THE COLONIAL MEDICAL REPORTS.
EDITED BY JAMES CANTLIE, M. Ba F.R.O.8., W. J. SIMPSON, M.D., Е.В.С.Р., AND

G. M. GILES, M.B., Е.В.С.8., LT.-COL, I.M.8.(RETD.). -
ADVISORY COMMITTEE:
Sir PATRICK MANSON, K.0.M.G., F.R.S., LL.D. RONALD ROSS, 0.В., F.R.S., Major І.М.8.
No. 94. Vol. ІХ.) LONDON, SATURDAY, DECEMBER 15, 1906. mom. , [вис (186. Акиташ,

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The Journal of Tropical Medicine and Wygiene.

CONTENTS.—DECEMBER 15тн, 1906.

PAGE

PAGE

ORIGINAL COMMUNICATIONS. EDITORIAL.
Rodent Ulcer in a Nubian Woman. By ANDREW BAL- The Pega of Europeans on the West Coast of r
Four, M.D., &c.. : .. 373 HON. 75% + 916
А Blood-Sucking Hemipteron, By Hanon н. Kine 373 Liverpool School of Tropical 1 Medicine, Memoir XXI.,
Dengue in Egypt. Ву LLEWELLYN PHILLIPS, M.D., і September, 1906. 5 29877
В.С., M.A.Cantab., J'y. R.C. S. Eng., M. R.C.P. Lond. 373 corn: =

Vomiting Sickness of Jamaica. Ву С. W. BRANCH, — a: s e p V xl M" ЕС
M.B., C.M. sie Ае Sè s әй .. 974 Personal Notes S 5 "966
Liverpool School of Tropical Medicine ЫЕ 5% .. 886
New Instruments... 4% 5% .. 887
; А Notes and News 1 are ae 4% .. 887
Duane Notices ne ЕЕ 25 os zia - 376 Recent and Current Literature ye Vx ES .. 988
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iv. THE JOURNAL OF TROPICAL MEDICINE AND HYGIENE.—ADVERTISEMENTS.

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DISEASES OF WARM COUNTRIES

Ву Dr. B. SCHEUBE, tv
Translated from the German by P. Falcke and Edited by Jas. Cantlie, M.B., F.R.C.S.

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THE JOURNAL OF TROPICAL MEDICINE AND HYGIENE —ADVERTISEMENTS. vii.

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NOW READY.
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T*5 EXTRA PHARMACOPIEIA

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А REAL POCKET BOOK. SIZE 51x 3x1 in.
In the section on Antitoxins, the subjects of Anthrax,
Malaria, Leprosy, Plague, Cancer, Tetanus, Trypanoso-
miasis, &c., have all been brought up to date. Тһе

latest views on Opsonins are described.

London: H. K. LEWIS, 136, Gower St., W.C.

HERNIAS Its Etiology, Symptoms and Treatment.

Szcowp Epition. FuLLY ILLUSTRATED. Price 78. Gd. net.
By W. McADAM rios
R.C.8.

Lond
Assista:

London :
BAILLIÈRE, TINDALL & COX,
t Surgeon,

St. Bartholomew’ 8 Hospital.

8, Henrietta Street, London, W.C.

Just Published, Third Edition. Entirely Rewritten. Demy 8yo.
Price 5s. net; by post, 5s. 9d.

INDIGESTION: THE DIAGNOSIS & TREATMENT OF THE
FUNCTIONAL DERANGEMENTS OF THE STOMACH.
With an Appendix on Tux PREPARATION or Foop BY COOKINO.

By. GEORGE . HERSCHELL, . M.D.Lond.

H. J. GLAISHER, 57, WIGMORE STREET, W.

ANNOUNCEMENTS.

Now Reavy. Royal Svo, 874 Pages, Illustrated. Price 30/- net.

INFECTIOUS DISEASES:

Their ETIOLOGY, DIAGNOSIS aud TREATMENT.

By G. H. ROGER,
Professor Extraordinary in the Faculty of Medicine of Paris.

Translated by M. 8. GABRIEL, M.D.

Royal 8vo, 874 Pages, Illustrated, 43 Engravings, Cloth,
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Complete Catalogue Post Free upon Application.

London: HENRY KIMPTON, 13, Furnival Street, E.C., Eng.
Glasgow: ALEX. STENHOUSE, 40 & 42, University Avenue, Scot.

Demy svo, 122 pp., with 46 illustrations, cloth lettered, price 58. net.

ON TABES DORSALIS

The Lumleian Lectures, delivered before the Royal College of
Physicians, London, March, 1906.

By DAYID FERRIER, M.D., LL.D., F.R.S.
Demy 8vo, 100 pp., price бв. net.

CHEMICAL SIDE OF NERYOUS ACTIYITY.

Being the Croonian Lectures for 1901.
By W. D. HALLIBURTON, M.D., F.R.S.

Demy 8уо, cloth, gilt lettered, price Тв. 6d. net...

THE SURGICAL TREATMENT OF FACIAL NEURALGIA.

By J. HUTCHINSON, Junr., F.R.C.8.
BALE, SONS & DANIELSSON, Lrp., 59-91, Great Titchfield Strect, W.

IN CASES OF EXTREME EXHAUSTION

MACONOCHIE’S

SPECIALLY CONCENTRATED

ESSENCE

OF BEEF

Л IS THE BEST IN THE WORLD.

It is sold in all best stores in hermetically sealed glasses and in special tins,
about which "THE LANCET” says:—

“Тһе method of sealing the lid on the tin without the
use of solder is distinctly ingenious and will be
approved on hygienic grounds."

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Purveyors to His Majesty the King,
MILLWALL, LONDON, ENGLAND.

139 Gold Medats and Highest Awards.

vii. THE JOURNAL ОЕ TROPICAL MEDICINE AND HYGIENE.—ADVERTIBEMENTS.

MISSI

ONARY OUTFITS

CAREFULLY PREPARED for all Climates.

for saving space and wright.

perfect

& SUPPLIES

Travellers are invited to inspect the latest improvements

AIRTIGHT TRUNKS, with Flush Bolts and Locks, Wood Bottoms for Head Carriage.

COMFORTABLE CAMP BEDS, Tents, Canteens, Camp Furniture, Airtight Uniforin Cases, Compressed
Foods, «с. A large range of Unshrinkable Wool and Merino Gauze Underelothing and Flannels, Tropical
Tweeds, and Silk Suitings for all Climates ; also Natural Ceylon and All-Wool Sheets,

EVERY TRAYELLER should see Canopy, Umbrella, and Head Nets of Double warp Mosquito Net, a

m rotection against the MALARIAL MOSQUITO.

EXPEDITIONS completely Fitted Out and Provisioued for all Parts of the World.

The Chronicle of the London Missionary Society, April, 1901.

«Мг. Joseph Tucker, of 79, Newington Green Road, the well-known Foreign and Colonial Outtitter, has recently issued а new illustrated Price List. This
is specially designed to help missionaries and travellers to select suitable outfits at the lowest possible cost. Mr. Tucker appears to be a universal provider, and
the large number of testimonials һө has received from missionaries all over the world testify to the high standard of his business,”

Illustrated Price List (160 pages) Post Free on Application.

JOSEPH TUCKER, 9"

79, NEWINGTON GREEN ROAD, N.

Tclegrams: '" TURBULA, LONDON.”

As supplied to
School of
Tropical
Medicine,
R.A. Docks.

LONDON S

has been enlarged and extended.
London School of Clinical Medicine; the Royal Victoria and Albert Docks Hospital;

ctor to His Majesty's Government,
Passenger, Shipping & General Forwarding Agent,

(ESTABLISHED 1868.) Telephone : 2121 Dalston.

WATSON’S MICROSCOPES FOR BACTERIOLOGY AND BLOOD WORK.

“H” EDINBURGH STUDENTS’ MICRO- & s. d.
SCOPE, as figured, having Mechanical .
Stage, Compound Substage, and one Eye-

912 6

piece M Ж es = a гә
Ditto, completely fitted with two Eyepieces,
lin. and 1/6 in. Objectives, Abbe Ilr.,

with Iris Diaphragm, and Mahogany Case.. 15 0 0
FOR BACTERIOLOGY :—

1/12 in. Oil Immn. Objective.. E © 500

Triple Nosepiece, dustproof .. 100

In no Microscope, at so low a price, аге во тапу соп.
veniences and precision of working parts afforded. It is
unsurpassed for Bacteriological and General Medical

ork.
WATSON'S NEW SCOP MECHANICAL STAGE,
giving 8 INCHES of horizontal traverse, сап be
fitted to this Microscope.

WATSON'S FRAM STUDENTS’ MICROSCOPE is а
highest class Microscope at a very moderate cost.

7 WATSON'S HOLOS FRAM MICROSCOPE.

Designed for Bacteriology.

Ж M
HJEMAGLOBINOMETERS | Examination.

BACTERIOLOGICAL OUTFITS. 3
Full particulars of all the foregoing are contained in

Watson's Catalogue of Microscopes, post free on appli-

cation.

MICROSCOPIC OBJECTS.—Typical, Histological and
Pathological Preparations. Sats iustrating Public
Health, Bacteria, Urinary, Entozoa, and other
Subjects.

Catalogue of above (No. 3) post free on application.

W. WATSON & SONS, Opticians to Н.М. Govt., 313, High Holborn, London, М.С.

ESTABLISHED 1887.

16, Forrest Rd., Edinburgh, and 78, Swanston St., Melbourne, Australia.

CHOOL OF TROPICAL MEDICINE

(UNIVERSITY OF LONDON),
Under the Auspices of His Majesty's Government,
CONNAUGHT ROAD, ALBERT DOCKS, B. ;
In connection with the Branch Hospital of the SEAMEN’S HOSPITAL SOCIETY.
ТНЕ SEAMEN’S HOSPITAL SOCIETY was established in the year 1821 and incorporated іп 1889, and from time to time

Dispensary ; and the Gravesend Dispensary.
Over 26,000 Patients treated annually. Of this number many are Cases of Tropical Disease.
The School buildings are situated within the grounds of the Royal Victoria and Albert Docks Hospital.

MEDICAL STAFF OF THE HOSPITAL AND LECTURERS IN THE TROPICAL SCHOOL.

Sir PATRICK MANSON, K.C.M.G., F.R.S., LL.D.,
M.D., F.R.C.P.
Professor R. TANNER HEWLETT, M.D., F.R.

ANDREW DUNCAN,Esq., M.D.,F.R.C.
JAS. CANTLIE, Esq., M.B., F.R.C.S.

LECTURES AND DEMONSTRATIONS DAILY

L. VERNON CARGILL, Keq., Р.В.0.8
KENNETH W. GOADBY,
M.R.C.S., L. R.C.P., 1.20.5. К.С.5.
Professor W. J. SIMPSON, M.D., F.R.C.P.

DEAN-—Sir F. LOVELL, C.M.G.

С.Р.
S., M. R.C. P.

sq., D.P.H.(Camb.),

It now consists of the Dreadnought Hospital, Greenwich, to which is attached the

the East and West India Docks

ARTHUR EVANS, Esq., M.8., M. D.(Lond.), F.R.C.8., PEN MANT SANDWITH, Esq, M.D.,

L. W. SAMBON, Ен, м.р.
J. M. Н. MACLEOD, Esq., M.D., M.R.O.P.
E. TREACHER COLLINS, Esq., F.R.C.8.

HELMINTHOLOGIST—R. 7. LEIPER, Esq., M.B., Ch.B.
PROTOZOOLOGIST—C. M. WENYON, Esq., M.B., В.8., B.Sc.
SUPERINTENDENT AND MEDICAL TUTORC-C. W. DANIELS, Esq., M.B., M.R.C.S.

BY MEMBERS OF THE STAFF.

There are three Sessions yearly of three months each, viz., from October lst to December 31st, from January 15th to

April 14th, and from May 1st

to July 31st inclusive.

Women Graduates are received as Students.

Certificates аге granted after Exanin.ation at the end of each Session, and the course is accepted by Cambridge University
as Qualifying for Admission to their Examination for the Diploma in Tropical Medicine and Hygiene, and by London

University as Study for the M

.D. in Branch VI. (Tropical Medicine).

Fee for course £16 16s.; shorter periods by arrangement.
Students can be provided with Board and Residence, or partial Board, at the School, at moderate rates.
Medical men requiring posts in the Tropics may apply to the Tutor at the School, where a Register is kept.
A syllabus, with the general course of study, can be had on application to the undersigned, from whom further

School of Tropical Medicine, who join the London School of Clinical Medicine, will be allowed
ап &batement on their fees, and vice versá.
Sxamen’s HOSPITAL, GBEENWICH, S.E.

particulars may be obtained.
Students of the London

Printed and Published for the Proprietors by 2онк BALE, Sons & DaNIELstoN, Ілр., 83-91, Great Titchfield Street, London, W.

P. MICHELLI, C.M.G., Secretary.

—

Colonial Agente—Gorpon & Әотон, Melbourne, Sydney, Brisbane, West Australia, and Cape Town.

Т7
222. 39015077

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