10 REVIEW — TROl'ICAL MEDICINK, ETC. 



Ankylosto- As regards the larvte of Necator lunericanus (Uncinaria americana), Smith'* has shown 



miasis— that they produce a substauce which is very irritating to the skin and leads to severe itching 



coniiniial with a tendency to vesiculation. This irritation leads to scratching, and the latter may 

 actually facilitate the passage of the larviE through the skin. 



Leiper," who employs the term Agchylostumiasis, has shown that the so-called 

 " American " Hook-worm is widely distributed in Africa. It occurs on the West Coast, in 

 Uganda and in North-West Rhodesia, but apparently not in Egypt. It has also been 

 found in Ceylon, Assam and Burma, and probably is world-wide. 



I cannot speak to its presence in the Sudan. The eggs of what is apparently 

 A. duodenale are frequently found in the stools of Egyptian soldiers in Khartoum, but one 

 has not had time to work at this subject. The disease is certainly not so much in evidence 

 as in Egypt, but there seems no reason why it should not occur and spread in the Sudan, 

 though probably Egyptians are more liable to infection than Arabs or Sudanese. 



Saudwith^ indeed notes its prevalence in Upper Egypt and suggests that it will increase 

 as irrigation increases. I think this is very likely, and that measures should be taken to 

 guard the Sudan, as far as possible, from its invasion. This is admittedly a very difficult 

 matter at the present time, but seems worthy of consideration. The careful medical 

 inspection of recruits in Egypt no doubt weeds out a considerable number of advanced cases, 

 while up to the present there has been very little, if any, immigration of the Egyptian fellaheen 

 into the Sudan for purposes of agricultural work. Possibly this may change in the future 

 and then it would certainly be advisable to have some system of medical examination and to 

 either reject infected individuals or submit them to suitable treatment before admission to 

 the Sudan. In this connection one may** note the remarkable results obtained in the 

 campaign against ankylostomiasis in Porto Eico. The overwhelming importance of the 

 disease as a factor in the industrial efBeiency of that island having been fully established, 

 steps were taken to treat the infected with thymol, partly in hospital but mostly as 

 dispensary out-patients. Beta-naphthol, which is much cheaper, was also tried, but was not 

 nearly as good in the case of out-patients. Nearly 20,000 persons were treated within a 

 period of sis months and with most gratifying results. It was found that, as a rule, five doses 

 of thymol were sufficient to practically cure a patient, i.e. to render him healthy and to 

 reduce his power, by nineteen-twentieths, of infecting the soil afresh. The report is well 

 worth perusal, and the cost of the operations was remarkably low. It is evident that a great 

 deal can be done by energy and persistence, even in a country sorely stricken by this most 

 debilitating and frequently fatal disease. 



Hermann's method of treatment by means of eucalyptus oil, chloroform and castor oil 

 was described by Philipps,^ who recorded good results obtained with it in Cairo. It seems 

 to be efficient and practically free from danger. 



For the ankylostomiasis of mines, sodium chloride has been shown to be a prophylactic'' 

 and can be used in a 2 per cent, solution as a spray, but, as Looss points out in a paper'* 

 dealing with many particulars of the life-history of the larvas, the only efficient preventive 

 measure is an efficient system of conservancy. Hence the necessity of arranging for such, 

 especially in cultivated portions of the Northern Sudan where moist conditions of the soil 

 prevail and where, if this sanitary measure be neglected, the disease may establish itself 

 and in the future produce much invaliding and incapacity for work. It is worth noting, 

 however, that some hold the view, a view not shared by Looss, that the larvae show 

 remarkable powers of resisting dryness, so that even under ordinary conditions in the Sudan 

 there may be danger from the employment of imperfect conservancy methods which permit 

 systematic fouling of the surface soil of towns and villages. 



' Smith, C. A. (November 24th, 1906). Journal of American Medical Association. 



* Leiper, R. T. (March 23rd, 1907), "Distribution of American Hookworm." British Medical Jmtrnal, 

 p. 683, Vol. I. 



= Sandwith, F. M., " Medical Diseases of Egypt," Part I., 1905. 



* Prelim. Beport of the Comm. for the Suppression of Ankylostomiasis in Porto Eico, San Juan, 

 December 31st, 1905. 



' Philipps, L. P. (December 1st, 1905), "On Eucalyptus Oil as a vermifuge in Ankylostomiasis." Journal of 

 Tropical Medicine, p. 341, Vol. VIII. 



" Manouvriz, A. (November 25th, 1905), " The Prophylaxis of Ankylostomiasis.'' British Medical 

 Journal, p. 1418, Vol. I. 



■• Zeitschrift.fiir Klin. Med., t. LVIII., p. 43. 



• Article not consulted in the original. 



