64 REVIEW — TROPICAL MEDICINE, ETC. 



Dysentery— Gillit^ also describes cases successfully treated at Midnapore Central Jail. The 



contimiM mortality before this line of treatment was adopted was 5-9 per cent., since its introduction 

 only 0-9 per cent. The number of cases recorded is not very large — 140 all told — but there 

 seems no doubt as to the efficacy of the treatment. 



Elephantiasis. Castellani- has used thiosinamin in the form of Merk Fibrolysin 

 (a water soluble combination of thiosinamin with sodium salicylate) in the palliative 

 treatment of elephantiasis. After bandaging and massaging of the infected parts the drug is 

 injected in doses of 2 c.c. every day or every other day for about a month. Then the 

 fibrolysin is stopped and rubber bandaging or ordinary bandaging again resumed for a week 

 or ten days. Thereafter another course of thirty or more injections is given, and so on as 

 required. In suitable cases he believes this treatment may prove useful. 



Christophers,^ in a paper entitled " What is really known of the cause of elephantiasis ? " 

 points out the grounds on which the assumption that it is due to the presence of Filaria 

 nocturna in the lymphatics is based. He shows that deductions drawn from geographical 

 relationship and race incidence may be faulty. He also states that we can only say that 

 presKinably elephantiasis is due to blockage of the lymph channels. One perhaps is on 

 firmer ground when noting the association of elephantiasis with other diseased conditions, 

 some of which are undoubtedly due to filaria, such as varicose lymph glands, lymph 

 scrotum, etc. Doubtless the active inflammation, and even liaBmorrhage produced by the 

 worms, have more to do with the pathological conditions than the mere presence of 

 the worms themselves. He lays stress on the difficulty of " explaining how with so complex 

 a collateral circulation the blocking can ever be so complete as to lead to the terrible 

 conditions one so frequently sees, and the need for actual and accurate observation on the 

 disease, especially as regards the blocking of glands by undeveloped embryos and a 

 consideration of the localisation of the blocking." 



Prout* has a long paper on the role of filariae in disease production, dealing, however, 

 solely with F. loa and F. nocturna. As regards the latter and its relations to elephantiasis, 

 Prout announces himself a sceptic with reference to Manson's theory, and, especially as 

 regards localised elephantiasis, is on the look-out for a specific micro-organism, gradually 

 spreading by the lymphatics from the periphery. 



In the discussion'' on this paper its author's views were rather severely criticised. 

 Low contended that filaria was at least one of the causes of elephantiasis. Carnegie Brown 

 held that though elephantoid disease was certainly due to filaria, the relation of the latter 

 to elephantiasis had not been proved. Basset Smith, however, mentioned a case of 

 apparently recent elephantoid disease in which no filaria were found. Manson discrimi- 

 nated between tropical and non-tropical forms of elephantiasis and elephantoid disease, and 

 stated that the filarial doctrine of elephantiasis, which was too readily accepted, was now 

 threatened with too hasty a rejection. The journal must be consulted for full details. 



As regards the Sudan the question of elephantiasis is briefly considered under the 

 heading " Filariasis " {fage 70). 



Enteric Fever. Probably the most valuable recent contribution to our knowledge 

 of Enteric Fever, from the tropical standpoint, is the work by Eoberts.'" One cannot refer to 

 it here at any great length, but of special importance to those working in the Sudan are the 

 conclusions regarding the liability of the native Indian to the disease. Eoberts believes 

 that the Indian possesses a natural immunity of a two-fold nature. It is in part racial, due 

 to anatomical differences in the intestine, for, as he points out, both the large and small 

 intestines in natives are in many instances considerably longer than in Europeans. He cites 

 a case of a Mohammedan in whom both guts combined totalled 50 feet. Further, the 

 intestinal walls in natives are thicker and more muscular, and Peyer's patches are not so 



' Qillit, W. (January, 1908), "Notes on Porster's Vaccine Treatment of Dysentery." Indian Medical Gazette, 

 p. 12, Vol. XLHI. 



" Castellani, A. (August 1st, 1907), " Note on a Palliative Treatment of Elephantiasis." Journal of Tropical 

 Medicine and Hygiene, p. 'IM, Vol. X. 



^ Christophers, S. R. (November, 1907), "What is really known of the Cause of Elephantiasis?" Indian 

 Medical Gazette, p. 404. 



* Prout, W. T. (April 1st, 1908), " On the R61e of Filaria in the Production of Disease." Journal of Tropical 

 Medicine and Hygiene, p. 109. 



' Discussion on above paper in Journal of Tropical Medicine and Hygiene of June 1st, 1908. 



" Roberts, E., " Enteric Fever in India and in other Tropical and Sub-Tropical Regions." Thacker Spink & Co., 

 Calcutta, 1906. 



