KEVIEW — TROI'ICAL MEDICINE, ETC. 87 



This was a single observation, and it seems a little doubtful if the interpretation was correct. Hsmatozoa 

 The parasites were 7 /it to 10 |tt in length and from 1 /it 6 to 2 /u in breadth, and had rounded —omUnuo/ 

 ends. Inoculation experiments failed. Mention may also be made of the Spirochieta 

 thdhri found in cattle in the Transvaal and the Cameroons, the Sp. ovis of sheep in 

 Erythrca, which is possibly identical with the Sp. tlmileri and the Sp. eqiti which occurs 

 in mammals in the French Sudan. 



Sambon' has drawn attention to certain appearances in the haemogregarines of snakes, 

 namely, delicate oblique lines passing transversely across the long axis of the parasite at 

 from 1 /I to 2 ^t from one or both of its extremities. He regards these as possibly representing 

 lines of future cleavage of the capsule of the sporont, sporont being the term applied to the 

 new forms developed from the merozoites and destined to pass into the body of the definitive 

 host and so carry on the further life of the parasite. He also describes a beak-like 

 projection at the anterior extremity of the sporont, and in one species noted a definite 

 dimorphism which may represent sexual differentiation. 



Two other discoveries may be quoted, as their confirmation might well be worked out in 

 the Sudan. These are {1) the observations by the Sergents-* that Hfeinoproteus (Haltcridium) 

 columhn? passes through its stage of sporogony in one of the Hi.ppohoscidce, Lynchia maura. 

 The incubation period in the pigeon is from 34 to 38 days, and the earliest forms in the 

 bird's blood are very minute, i.e. 1 ^t to 2 /» in diameter. (5) The confirmation of this 

 observation as regards Hip>pobvscida3 by Aragao,^* and his statement that part of the cycle 

 of evolution is passed in the lung of the pigeon, cysts containing the merozoites being 

 found in the large mononuclear leucocytes of the pulmonary capillaries. 



Heat Stroke. Duncan^ describes the clinical varieties as follows : — 



A. Heat collapse. K. Heat stroke. («) Direct heat stroke or sunstroke proper ; {b) Indii'ect heat stroke. 



.\. Heat collapse. The patient suddenly turns giddy and falls. Skin moist and cool. Breathing hurried 

 but never stertorous, pulse small and soft, pui^ils dilated, temperature at or below the normal. No loss of 

 consciousness, and recovery the rule. 



B. Heat stroke («). Direct heat stroke or sun stroke. There are several forms. 1. Occurs in persons 

 unaccustomed to marching and attacks them specially when the air is moist. There is violent headache and 

 oppression followed by convulsions, loss of consciousness, difficult respiration, small and irregular pulse and often 

 incontinence of urine. 



2. Is characterised by excessive sweating, pallor, cyanosis, shallow breathing, injected eyes, swollen veins and 

 partial collapse without complete unconsciousness. Revival occurs under proper treatment. 



3. No fatigue is complained of, but the patient is thirsty and suddenly falls forward comatose. The coma 

 may last 24 to 36 hours and end in death. 



4. After exertion and exposure to the sun a racking headache sets in. This becomes intense and finally 

 agonising. Great intolerance of light ensues, followed perhaps in 48 hours by unconsciousness. If death does not 

 occur, the intense pain in the head may last from six to eight weeks unrelieved by any drug, but there may be 

 slight evening remissions. It then gradually abates. (6) Indirect heat stroke. This is the syncopal form, occurring 

 not in the open but in the hot house or bungalow. Duncan finds it the most frequent tj'pe. At the onset the skin 

 becomes pale; there is nausea, colic and incontinence of urine. Convulsions now follow, to be succeeded by cyanosis, 

 dyspncea and insensibility. The breathing is stertorous, the pupils contracted and the body temperature may 

 reach 108' F. to 110° F., remaining high post mortem. 



I have seen such a case, terminating fatally, in a young British soldier in Khartoum. 



The diagnosis at first was very difficult, renal colic being the condition which suggested 

 itself. The post mortem appearances, especially a peculiar bluish and milky opacity of the 

 brain membranes, recalled another case which was not diagnosed during life and which was 

 complicated by a form of irritant poisoning. I have known type No. 3 occur in Khartoum, 

 but I am inclined to think, from what I can gather, that heat stroke is rare in the Sudan, 

 doubtless in part because of the excessive dryness of the atmosphere throughout the greater 

 part of the summer. Dr. Crispin notes that it is commoner on the moist Eed Sea Coast. 



Duncan deals with the indirect causes and considers treatment under Preventive and 

 Curative Measures. As regards the former, he mentions the custom, common to old 

 European residents in Egypt, of wearing under the helmet, a tight jean skull cap similar to 

 that worn by the Arabs under the turban or tarboosh. I have never heard of this custom 



> Sambon, L. W. (June loth, 1907), " Haemogregarines of Snakes." Lmicet, p. 1650, Vol. I. 

 - Sergent, Ed. & Et. (November 24th, 1906). C. E. Hoc. Biol., t. LXI. 



' Aragao, de B., Brazil Medico, t. XXI., No. 31, August lath, 1907. Quoted in Ball, dc I'lustil. Pasteur, 

 November 15th, 1907. 



* Duncan, A. (April 1st, 1903), " On Heat Stroke." Journal of Tropical Medicine, p. 101, Vol. V. 



* Article not consulted in the original. 



