e * v——. Pome ‘ es ee set Fire ins a a ~— -hw -sp sit Spe OT Sa AS RSS Si ceie Se eee | Leen Ae had as Ait, bie) Mia se Oem be ty Saget ye eee bon > Se ce Pak tat Pa? Nea al —e- 5% ‘ sa —9-Sn ar aS Roca Male SATO Poet an Ike tales REVIEW—TROPICAL MEDICINE, ETC. 95 constipation. There is then arise of temperature, the globes of the eyes become tender Insects— and there is a characteristic injection of the conjunctiva, hence the name ‘‘ Dog disease” continued applied to the condition from the fancied resemblance of the affected eye to that of a dog. Mild bronchitis, gastric tenderness, cramps and epistaxis are the chief symptoms, together with a rash like urticaria or erythema multiforme. The disease lasts two to four days and terminates by crisis, but convalescence is slow and there may be considerable anemia. A lasting immunity to further attacks seems to be conferred by the disease. It has been attributed to the bites of certain gnats but there seems more reason to believe that bed-bugs may be the vectors.

King! has described a very tiny blood-sucking Hemipteron, which he found in Khartoum. It attacks without provocation, but only causes slight local irritation.

As hornets are common in the Sudan, though apparently for the most part quite inoffensive, attention may be directed to a note wherein MacWatters? details three cases in which serious symptoms of collapse followed the sting of a hornet (Vespa orientalis).

Wellman’ draws attention to the noxious larve of Coleoptera and Lepidoptera above mentioned, some of which may cause severe pain and skin eruption, while nervous symptoms may follow contact with stinging caterpillars. He has also a note on two species of Myriapods, and states that their poisonous secretion is probably from the foramina repugnatoria which are at the sides of the segments and look like trachael stigmata. One has had Myriapods sent from the Southern Sudan, some of which are said to be much dreaded by the natives. They are being determined by Professor Werner of Vienna.

Jaundice (Infectious). See Weil’s Disease, page 231.

Kala-azar. See Leishmaniosis (below).

Leishmaniosis. Various reports have shown that this deadly disease is of much wider distribution than was at first thought to be the case. Assam, Bengal, Southern India, Ceylon, Burma, China, Arabia, Egypt, Sudan, Tunis, Algeria, South Africa and Crete are the places where it has been known to occur.

Most of the facts presented in various papers, together with original matter, are to be found in Rogers’ work.* We can only quote some of the more important points to which he refers and supplement them from more recent papers.

In speaking of a certain epidemic, he explains the peculiarity of its course by the fact that the disease travelled through the virgin soils of a certain northern valley in Assam, previously unaffected by the sporadic form of the disease, and there found a population fully susceptible to its deadly influence. Hence it was able to work terrible havoc. This, if confirmed, is interesting in the light of a similar state of things probably existing in Central abe as regards Sleeping Sickness, which invaded Uganda from the west with such dire results.

The early stages are very hard to diagnose, the differentiation from typhoid and paratyphoid being especially difficult. Rogers says the high continued type of fever, especially with a slow pulse, is almost conclusive evidence of typhoid as against early kala-azar, while the high remittent type is almost equally rare in the latter disease. Some typhoids, however, show the slow remittent type which is common in kala-azar, and if a negative serum test has also been obtained, the blood changes must be turned to for help.

Three of the most important early signs are :— 1, Double remittent type of pyrexia.

2. Persistent remittent fever with absence of severe constitutional disturbance and of abdominal or respiratory symptoms.

3. Enlargement of spleen down to the navel. Rogers has shown that a marked relative leucopenia, say less than 1 white to about 1000 red corpuscles, is practically diagnostic of the disease and is of bad prognostic significance. There is nothing special to note as regards general symptoms, except possibly , poring, H. H. (December 15th, 1906), ‘‘ Blood-Sucking Hemipteron.” Journal of Tropical Medicine, p. 373, ol. IX.

* MacWatters, R. C. (June, 1908), “ Some Effects from Stinging by a Hornet (Vespa Orientalis).” Indian Medical Gazette.

* Wellman, F. C. (June 1st, 1907), “ Notes on some Noxious Larve from Angola.” Journal of Tropical Medicine and Hygiene, p. 185, Vol. X.

* Rogers, L., “ Fever in the Tropics.” (Loc. cit.),