REVIEW — TROPICAL MEDICINE, ETC. 27 



Misad tribes. This is iilmost as remarkable as the virtual uon-existeuce of tubercular disease in Kordofan. Cancer — 

 Microbic diseases (thaaks, I imagine, to the wide air space and strong sun) are universally rare, while parasitic continued 



comi^laints — malaria, guinea worm, taenia and other intestinal worms— are of common occurrence." 



Captain Bousfield, of Kassala, stated that : — 



" During my year's stay in this Province I have not seen a single case that I could definitely diagnose as 

 malignant disease, either amongst the civil or the military. In the Military Hospital, Kassala, there have been 

 no cases of malignant disease during the years 1904-1907 inclusive. At Qodaref there has been a case, scirrhus 

 of the breast in a woman aged about 4.5, and a doubtful case of sarcoma of the leg (possibly a mycetoma) in a man 

 aged about 40. There have been no eases that could certainly be diagnosed as malignant disease in the Kassala 

 Civil Hospital. My own opinion is that epithelioma, carcinoma and sarcoma are extremely rare in this 

 Province." 



It is worthy of note that all these regions are somewhat remote, and the natives 

 inhabiting them do not come much into touch with Europeans. With the exception of 

 the Bahr-El-Ghazal, which is a negroid district, the prevailing type of inhabitants is the 

 Arab, who, however, very frequently has much negro or other blood in his veins. 



Cerebro-Spinal Fever. If the subject of cancer has no very intimate relation- 

 ship with the Sudan, the reverse is true of cerebro-spinal fever, which, in former years, was 

 much in evidence so far as can be ascertained, and accounted for many deaths, while every 

 now and again sporadic cases or small epidemics occur under existing conditions. It was 

 Buchanan who drew special attention to its appearance during the dusty months of the year 

 in India, and doubtless the inhalation of dust plays a part in its propagation. 



Goodwin'* in a large number of cases found the ineningococcus present in the nasal 

 cavity, while Vansteeuberghe and Grysez- discovered it in the noses of healthy men, cultivated 

 it, and proved that the cultures, when injected under the meninges of rabbits or guinea pigs, 

 produced the typical lesions of cerebro-spinal meningitis. The necessity of dealing with 

 infected nasal discharges is therefore apparent and disinfection of the nasal cavities of the 

 patient and all contacts is clearly indicated. 



The same points are also brought forward by Fraser and Comrie," who record that hot, 

 dusty, ill-ventilated atmospheres, which provide conditions favourable to the growth of 

 the ineningococcus and to the occurrence of naso-pharyngeal catarrh, are often associated 

 with the dissemination of epidemic cerebro-spinal meningitis. Tliey also state that " the 

 high comparative percentage of fathers whose naso-pharynx was found by us to contain the 

 meningococcus, points to the fact that they probably are the carriers of the disease to their 

 children." 



Speer'* describes an early pressure symptom which he has found regularly present 

 together with Keruig's sign. It consists of a turning in of one or both feet until, if not 

 disturbed, one lies across the other. The legs later become flexed and tend to cross each 

 other. The symptoms, he states, are due to a combination of toxin poisoning, nerve 

 irritation and pressure. The Indian Medical Gazette for September, 1905, publishes the 

 leaflet issued by the German Health Department. The only points requiring notice are that 

 children attending school, although in good health, must be kept from school if they live in 

 the same house as the patient, until the medical authorities permit their re-admission to 

 school, and the recommendation of a weak solution of menthol for the disinfection of the 

 throat and hands. Under the heading " Nursing" one notes that the gargling water of the 

 patient should be disinfected. As regards the rash, Chalmers' describes a case in a child 

 where the features of a typhus rash were exactly reproduced, while Wright" gives an account 

 of the rashes met with in the Glasgow epidemic. These were usually haemorrhagic and of a 

 purpuric nature, varying in size from a mere point to something smaller than a lentil, 

 and often being grouped in clusters. Occasionally these spots came out in crops. In one 

 case he describes purple and maroon spots together with larger, pale-blue blotches on 

 the trunk and limbs. 



' Goodwin (November 11th, 1905). Medical Record, 



'' Vansteenberghe, P., and Grysez (January, 1905), "Contribution a I'Etude du Meningocoque." Annals de 

 VInstitiU Pasteur, p. 69, t. XX. 



' Fraser, J. S., and Comrie, J. D. (July, 1907). Scottish Medical and Surgical Journal. 

 * Speer, G. G. (May 15th, 1905). Medical Record. 



' Chalmers, A. K. (July 7th, 190G), "The Rash of Cerebro-Spinal Fever." British Medical Journal, p. 23. 

 " Wright, W. (September loth, 1906), " The Rash in Cerebro-Spinal Meningitis." Lancet, p. 717, Vol. II. 



• Article not consulted in the original. 



