REVIEW — TEOPICAL MEDICINE, ETC. 29 



in primary cultures involution forms often occurred. The organism was found to ferment Cerebro- 

 gluoose and maltose, but not levulose. The diagnostic value of the agglutination test is Spinal Fever 

 slight. The Diplococois crassits which occurs along with the meningococcus is agglutinated — continual 

 by meningococcus serum. A valuable and very practical paper is that by Eobertson' of 

 Leith, who deals specially with administrative control, and advocates the douching of the 

 nasal cavities of all " intermediaries " with chlorine water. His method was to douche at 

 intervals of two days, and three times in all. He also draws attention to the value of 

 formamint lozenges, especially for children. He also recommends the isolation of all 

 those living in infected houses. Thorough spraying of infected premises with formaldehyde 

 was deemed useful, and, a point which might be missed, the confiscation and destruction 

 of all foodstuffs found in lower class houses is stated to be a valuable preventive measure. 



As regards diagnosis, Birnie and Smith-* successfully isolated and cultivated the specific 

 organism from the blood by the simple procedure of puncturing a vein and distributing 

 4 cubic centimetres of blood equally between two flasks containing 75 cubic centimetres of 

 sterile bouillon. Kutscher' finds an agar, made with human placental juice, an excellent 

 medium for the growth of the first generation of the meningococcus. 



In the only case I have seen in the Sudan I was able to isolate and cultivate a 

 Jiplococcus from the meninges, which answered in every respect to that of Weichselbaum. 



Chlorine water would probably be of little use as a nasal douche in this country, but the 

 menthol wash recommended by the Germans might be tried. It would, I think, be 

 comparatively easy, in the light of recent knowledge, to control an outbreak in Khartoum, 

 where the people are amenable to sanitary control, and very thorough disinfection methods 

 followed by compensation can often be adopted owing to the small value of native dwellings 

 and belongings. [Note. — A recent outbreak has enabled one to prove the truth of this 

 assertion.] 



Chicken-pox. In the Sudan, where one deals chiefly with black skins, the diagnosis 

 of chicken-pox from small-pox is sometimes very difficult. The following points, which have 

 served one as fairly trustworthy guides, and have been gathered from various sources, may 

 be helpful. Rogers* suggests that the blood changes in the two conditions might well 

 repay study : — 



1. Prodromata. Often no prodromal period in chicken-pox. Usually present in small-pox. 



2. Feeling of illness when rash appears in chicken-pox. The opposite is true in mild or moditied small-pox. 



3. Facial appearance. Nothing special in chicken-pox ; heavy, anxious or stuporose in small-pox. 

 Amongst the natives these three are of less value than the following : — 



4. Frequently a rise in temperature accompanies appearance of rash in chicken-pox. In small-pox the 

 temperature falls at this time. 



5. Eash appears first on the trunk in chicken-pox, on the face in small-pox. 



6. Distribution of rash. Trunk and proximal portions of extremities in chicken-pox. Face and distal 

 portions in small-pox, together with back of trunk. {Six, however, note under " Small-pox," page 183). 



7. If a so-ca,lled " skin window " be marked off, the irregularity of the rash is well seen in chicken-pox. 

 i.e. vesicles and pustules together in the area. Not so in small-pox. 



8. Rapid change from papule to vesicle in chicken-pox, frequently in a few hours and within 24 hours. 

 At least 24 hours in small-pox, often 72 hours. 



9. Centre of vesicle its highest point in chicken-pox ; depressed in small-pox. 



10. Papules of chicken-pox not so firm and shotty as those of small-pox. 



11. Depth of skin involved. Less in chicken-pox than in small-pox. Hence "seeds" in palms and soles 

 usually found only in the Utter. 



12. The character of the scales, thin in chicken-pox, thick in small-pox, is said to aid one, but I have 

 not noticed this in native cases. Early cupped scabs in chicken-pox are, however, very characteristic. 



13. The scars of chicken-pox are smooth and have irregular edges, while those of small-pox are pitted 

 and as if punched out. The former are often wider as the vesicles tend to spread laterally. 



^ Robertson, W. (July 27th, 1907), "Remarks on the Outbreak of Epidemic Cerebro-Spinal Meningitis." 

 British Malical Journal, p. 185. 



- Birnie, J. M., and Smith, M. T. (October, 1907). American Journal of Medical .Science. 



'■' Kutscher, K. (November 9th, 1907), " Ein Beitrag zur Ztichtung des Meningococcus." C'c7U. filr Bakt. 

 Abt., 1907, Vol. XLV., No. 3, p. 286. 



•* Rogers, L., " Fevers in the Tropics," London, 1908. 



* Article not consulted in the original. 



