40 KEVIEW — TROPICAL MEDICINE, ETC. 



Diarrhcea— played a part, and in any case I question if flies were operative to any large extent as carriers 

 cmiiiiiicd of infection. The house-fly is at no time a great nuisance iu Khartoum and is usually killed 

 off in large numbers by the hot weather which begins in April as a rule. I am inclined to 

 think that infected dust played a part, even though the conditions for sewage removal had 

 been improved and there was little dysentery amongst the civil population. The chief cause, 

 however, I believe to be the filthy conditions associated with the transport and distribution 

 of the milk, which persist, despite efl'orts made to suppress them, and will persist until the 

 measures which have been repeatedly recommended are put in force. This matter is dealt 

 with under " Sanitary Notes," and so need not be discussed here at length : — 



Turning now to symptoms and treatment : — 

 Batten'* classifies infantile diarrhoea as follows : — 



1. Irritative, due to improper or undigested food. Stools bulky, green, sour and 

 with curds. 



2. Catarrhal, due to prolonged indigestion. Stools brownish-green with mucus and 

 foul smell. 



3. Ulcerative colitis. Bare. Blood and mucus stool. 



4. Acute infective. Stools watery, often greenish, offensive. Choleraic symptoms. 



The last is the " summer diarrhoea " type, and it is in this form that cerebral symptoms 

 occur, due probably to toxic action. 



As regards treatment in the very severe cases, liquor strychninas hypodermically is said 

 to be the best preventive of collapse, while ether and brandy hypodermically are contra- 

 indicated. Transfusion with normal saline, followed by a hot bath and, when the rally has 

 taken place, by stomach-washing are recommended as an effectual line of treatment. Sodium 

 bicarbonate 2 grains to the ounce is used for the lavage. Eectal irrigation is useful, and 

 Younge" speaks very highly of quassia infusion for this purpose, in doses of ^ to 1 dr. repeated 

 every 3 or 4 hours as required. It is best given after a dose of castor oil to clear the bowel". 



For feeding, albumen water, barley water, rice water, etc., all have their advocates, 

 while in a case recorded by Myers^* nothing succeeded till a solution of gmii arable, 1 ounce 

 to the pint, was given. This, at least, is a remedy easily obtainable in the Sudan. 



As regards other forms of diarrhoea, Thresh'' has recorded a widespread and serious 

 epidemic due to a water supply having become polluted by washings from garden soil 

 manured with road sweepings and the like. Such a condition is rare, but shows how 

 carefully a public water supply should be guarded. In the Civil Prison at Khartoum cases 

 of severe diarrhoea have occurred, due possibly to soakage of foul matters into a well. The 

 area of cement round the mouth of the well had become cracked and broken, and it was the 

 custom to wash vessels which had contained food on this spot. When the practice 

 was discontinued the cases of diarrhoea no longer occurred. In some of them B. pyocyaneus 

 may have been the exciting cause, as it was found post mortem in a case terminating fatally. 



Castellani,* in Ceylon, found flagellates in the excreta of cases of diarrhoea. He describes 

 three types and suggests that they were etiological factors in the production of the condition. 



The role of Balantidium coli in diarrhoea is mentioned by Strong,'"' who thinks that man 

 may sometimes derive this parasite from the hog. The encysted forms become dried and get 

 blown about so that water or food may become contaminated. The diarrhcea is often 

 associated with colic and persists until treatment is directed against the parasite. 



The view that the hill diarrhcea of India is due to the presence of mica in water is 

 criticised adversely by Maynard.' He regards it as due to liver congestion, the result of chill. 



' Batten, F. E. (January 3rd, 1906), Clinical Journal. 



" Younge, S. H. (September 8th, 1906), " Treatment of Infantile Diarrhoea." British Medical Journal, 

 p. 573, Vol. II. 



=" Myers, G. T. (June, 1906) Medical Record. 



* Thresh, J. C. (November 28th, 1903), " Diarrhcea and Polluted Water." Lancet, p. 1519, Vol. II. 



' Castellani, A. (November 11th, 1905), " Diarrhcea from Flagellates." British Medical Journal, p. 1285, Vol. II. 



" Strong, R. P. (December, 1905), " The Pathological Significance of Balantidium coli." Indian Medical 

 Gazelle, p. 470, Vol. XL. 



■" Maynard, A. E. (January 20th, 1906), " Hill Diarrhcea." British Medical Journal, p. 141, Vol. I. 



• Article not consulted in the original. 



