92 



REVIEW — TROPICAL MEDICINE, ETC. 



Infectious Piu.-illy, when called t.o see a child suffering from an infectious disease, it is one's duty to examine the other 



Diseases — children in the family who liave been exposed, and, it the nodes are found to be enlarged, they too should be 



continued ^'''^^'•^^^^ immediately, and thus do away with the dangerous custom of billeting children upon friends and relatives, 



with the iuevitalile result of spreading the disease broadcast. I am satisfied that in the future the practice of 



isolating children already suffering from infected nodes will largely do away with epidemics in public schools. 



A glance at the mortality tallies of all our large cities will show a high death-rate from infectious diseases, and 

 the early recognition of infectious diseases by means of the node involvement would result in these precautious, 

 which would prevent the spread of the disease, thus materially reducing the death-rate resulting from infectious 

 diseaseii. 



Influenza. Influenza, or what is said to be influenza, although I do not know that 

 any cases have been diagnosed bacteriologically, has occurred more than once in Khartoum, 

 and doubtless true influenza is not unconuiion in the Sudan, for the disease is by no means 

 confined to countries with cold or temperate climates. Hence some very interesting and 

 apparently none too well known facts brought out by Allbutt' may be mentioned with 

 advantage. 1 have tabulated them just as they occur in the course of his lecture : — 



1. Gases in which the respiratory tract is unaffected are not infectious, the disease being propagated in the 

 sputum and spr.-iy from the respiratory tract and apparently in no other manner save, perhaps, at the very 

 beginning ol epidemics, for between epidemics the bacillus must be latent somewhere, unless, indeed, it is normally 

 present in human beings, i.e. in the oral cavity, and for some reason or other takes on pathogenic properties. 



2. The origin and habits of the parasite are still unknown. 



3. Five to six months immunisation after attack is generally conferred even on very susceptible people. 

 Twelve months is the more usual respite. 



4. The inllammation appears to be of an erysipelatous type. There is a tendency to small cell and nuclear 

 infiltration, there being far more intestinal infiltration than in croupous pneumonia. 



5. The disease is very seldom confined to one lung. 

 G. Influenza, like phthisis, may excavate the lung. 



7. In convalescence the malaise very often departs as suddenly as it came on, that is to say, a brusque 

 recovery occurs in the course of a protracted convalescence. 



8. Allbutt adds a fourth to those usually recognised, namely the continuous form. There is a persistent 

 febrile state, though the temperatures are not high nor the .symptoins severe. 



9. In making the diagnosis, it is important to note that, unlike what is found in other febrile conditions, the 

 urine in infiueuza is not high coloured and is not lateritious as in " chill." This would appear to bo a practical 

 point of very considerable importance. 



10. Paraplegic attacks and peripheral neuritis may occur as sequelae. 



11. Angina pectoris may also be a sequel. 



12. ^ It is not safe to give a patient chloroform for some time after an influenzal attack, owing to the cardiac 

 disability which ensues upon it. 



Eogers- mentions that in India the type of the disease does not differ from that met with 

 in Europe. The great frequency of respiratory and throat complications help to distinguish 

 it from malaria and seven days' fever. Its diagnosis from dengue has been considered. 



Williams,-' following Corvisart and Wilks, speaks of the great value of an initial dose of 

 opium in influenza. A full dose of 20 to 30 minims of liq. opii. sedativ. is given, and as a 

 rule abolishes the distressing pains in a short space of time and ensures refreshing sleep. 

 Indeed the action is so marked that it is probable the drug exercises a specific action on 

 the Pfeiffer bacillus. 



Nash^ states that in every case of influenza there is a swelling and cedema of the uvula, 

 which, as a result, has a pale, waxy, cedematous appearance. It is found at the commence- 

 ment of the attack and usually lasts for several days. He regards it as a certain sign of 

 the disease. 



Insects. A good general article on the relation of insects to human diseases, albeit 

 now a little out of date, will be found in " Harrington's Hygiene."''' From this and other 

 sources one has compiled a list of injurious insects and the human diseases they are known, 

 or supposed, to transfer. 



1. Ants. Cholera? dysentery? enteric fever? and indeed all those diseases due to 

 contamination of food (.sep " Flies," page lb). There is no definite proof that ants act as 

 vectors, but considering their habits in tropical countries, it is far from unlikely. 



' Allbutt, T. C. (May 6th, 1905), " Discussion on Influenza." Brilish Medical Journal, p. 977, Vol. I. 



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



= Williams, W. L., " Minor Maladies." 



" Nash, W. G. (April 4th, 1908). Lmicct, p. 1032, Vol. I. 



' Harrington, C, " Practical Hygiene." London, 1905. 



