REVIEW 



Of some of the moke Ebcent Advances in Tbopical Medicine, Hygiene 

 AND Tropical Veteeinary Science, with special reference to their 



POSSIBLE BEARING ON MeDICAL, SaNITARY AND VETERINARY WORK IN THE 



Anglo-Egyptian Sudan.* 



Ainhum. Ashley-Emile,^ in an interesting paper on ainhum, is inclined to 

 trace a connection between ainhum and leprosy, regarding the former as a modified 

 expression of the latter in persons of a "leprous diathesis." His argument is rather 

 laboured, but there may be something in the anatomical reasons he advances for 

 the seat of election of the disease. He believes the flexor tendon of the small toe to 

 be specially subject to strain during the act of carrying heavy burdens, and that this, 

 combined with an enfeebled nerve supply, leads to fibroid degeneration round the joint with 

 resulting occlusion of arteries and strangulation of the toe, which enlarges owing to venous 

 dilatation. 



Wellman,^ on the other hand, adduces evidence to show that ainhum and leprosy are 

 not related, and in a later paper suggests that the chigger may play an important part in the 

 development of the complaint. He points out that this theory accounts in large measure 

 for the geographical distribution of the disease. Apart from these theories, ainhum has been 

 stated to be due to injury, to be a trophoneurosis, a circumscribed scleroderma, a con- 

 genital, spontaneous amputation, and the result of self-mutilation by ligatures, wearing of 

 toe-rings, etc. 



Manson^ favours the traumatic theory, and cites a similar condition affecting the tail 

 of a pet monkey. There is nothing new to record regarding treatment. Ainhum occurs in 

 the Sudan, and I have seen an imported case in Khartoum. 



So far as is at present known, the chigger is confined to the Bahr-El-Ghazal Province, 

 while Dr. Wenyon reports ainhum to be common at Bor on the White Nile. The natives 

 attribute the condition to injury caused by the coarse grass. It would be interesting to 

 determine accurately if the distribution of the disease and of the chigger coincide in the 

 Southern Sudan. 



Air. The remarkable influence of rain as a purifier of the atmosphere was well shown 

 by an investigation^ carried out in London in the summer of 1903. A rainfall of about 

 3-8 inches in five days actually was responsible for the removal of 3738 tons of solid 

 impurities. Of these no less than 2000 tons consisted of soot and suspended matter, 

 common salt and sulphate of ammonia constituting the remainder. 



This does not take into account the great bacterial purification also effected. 



Much of the Northern Sudan is practically rainless, and there can be no doubt we suffer 

 from the lack of the freshening effect of rain upon the atmosphere. This, as has been 

 pointed out, is due possibly to an oxidising action and perhaps to the formation of peroxide 

 of hydrogen. No one who has lived long in Khartoum but knows there are times when the 

 air seems lifeless and heavy. Indeed, this is frequently the case in the late afternoons in the 

 winter. Doubtless the feeling is in part due to the dying down of the breeze, but though 

 the air is free from gross impurities it is charged with organisms, especially with moulds. 



In this connection allusion may he made to Gordon's^! work on the presence of 

 streptococcus brevis in the saliva, and its use as an indicator of air pollution. By this 

 means he has shown the presence of particles of saliva in the air at a distance of 40 feet 

 in front of a speaker. It would be interesting to know if conditions differ greatly in a hot, 



• With the exception of the article on Typhus Fever, the notes referring to the Sudan and a few other 

 paragraphs, the portion of the Review from " Tuberculosis " onwards is the work of Mr. R. Q. Archibald. 



The Review only extends to papers, etc., appearing in journals not later than about the middle of July, 1908. 



' Ashley-Emile, L. E. (February 1st, 1905), "On the Etiology of Ainhum." Journal of Tropical 

 Mediciru:, p. 33. 



' Wellman, F. C. (October 2nd, 1905), "Ainhum and Leprosy, a Critical Note." Journnl of Tropical 

 Medicine, p. 285. 



" Manson, Sir Patrick, London, "Tropical Diseases." 4th Edition. 1907. 



* "Some Interesting Pacts Regarding the Purifying Effect on the Air of the Recent Rain." Lancet, 

 p. 1759, Vol. I. June 20th, 1903. 



" Gordon, M. H., Report of Medical Officer Local Government Board, 1902-1903. 



t Article not consulted in the original. 



