BEVIEW — TKOPICAL MEDICINE, ETC. 95 



constipation. There is then a rise of temperature, the globes of the eyes become tender Insects— 

 and there is a characteristic injection of the conjunctiva, hence the name "Dog disease" conHimed 



applied to the condition from the fancied resemblance of the affected eye to that of a dog. 

 Mild bronchitis, gastric tenderness, cramps and epistaxis are the chief symptoms, together 

 with a rash like urticaria or erythema multiforme. The disease lasts two to four days and 

 terminates by crisis, but convalescence is slow and there may be considerable anaemia. 

 A lasting immunity to further attacks seems to be conferred by the disease. It has 

 been attributed to the bites of certain gnats but there seems more reason to believe that 

 bed-bugs may be the vectors. 



King' has described a very tiny blood-sucking Hemipfernn, which he found in Khartoum. 

 It attacks without provocation, but only causes slight local irritation. 



As hornets are common in the Sudan, though apparently for the most part quite 

 inoffensive, attention may be directed to a note wherein MacWatters- details three cases in 

 which serious symptoms of collapse followed the sting of a hornet {Vesjja urieNlalis). 



Wellman"' draws attention to the noxious larvae of Coleoptera and Lepidoptera above 

 mentioned, some of which may cause severe pain and skin eruption, while nervous symptoms 

 may follow contact with stinging caterpillars. He has also a note on two species of 

 Myriapods, and states that their poisonous secretion is probably from the foramina 

 repugnatoria which are at the sides of the segments and look like trachael stigmata. One 

 has had Myriapods sent from the Southern Sudan, some of which are said to be much 

 dreaded by the natives. They are being determined by Professor Werner of Vienna. 



Jaundice (Infectious). See Weil's Disease, page 231. 



Kala-azar. See Leishmaniosis (below). 



Leishmaniosis. Various reports have shown that this deadly disease is of much 

 wider distribution than was at first tliought to be the case. Assam, Bengal, Southern India, 

 Ceylon, Burma, China, Arabia, Egypt, Sudan, Tunis, Algeria, South Africa and Crete are 

 the places where it has been known to occur. 



Most of the facts presented in various papers, together with original matter, are to be 

 found in Rogers' work.* We can only quote some of the more important points to which 

 he refers and supplement them from more recent papers. 



In speaking of a certain epidemic, he explains the peculiarity of its course by the fact 

 that the disease travelled through the virgin soils of a certain northern valley in Assam, 

 previously unaffected by the sporadic form of the disease, and there found a population fully 

 susceptible to its deadly influence. Hence it was able to work terrible havoc. This, if 

 confirmed, is interesting in the light of a similar state of things probably existing in Central 

 Africa as regards Sleeping Sickness, which invaded Uganda from the west with such dire 

 results. 



The early stages are very hard to diagnose, the differentiation from typhoid and para- 

 typhoid being especially difficult. Eogers says the high continued type of fever, especially 

 with a slow pulse, is almost conclusive evidence of typhoid as against early kala-azar, 

 while the high remittent type is almost equally rare in the latter disease. Some typhoids, 

 however, show the slow remittent type which is common in kala-azar, and if a negative 

 serum test has also been obtained, the blood changes must be turned to for help. 



Three of the most important early signs are : — 



1. Double remittent type of pyrexi.a. 



2. Persistent remittent fever with absence of severe coastitutional disturbance and of abdominal or 

 respiratory symptoms. 



3. Enlargement of spleen down to the navel. 



Rogers has shown that a marked relative leucopaenia, say less than 1 white to about 

 1000 red corpuscles, is practically diagnostic of the disease and is of bad prognostic 

 significance. There is nothing special to note as regards general symptoms, except possibly 



' King, H. H. (December l.ith, 1906), "Blood-Sucking Hemipteron." Journal of Tropica! Medicine, p. 373, 

 Vol. IX. 



^ MacWatters, R. C. (June, 1908), "Some Effects from Stinging by a Hornet {Vespn Oricntalis):' Indian 

 Medical GcateUe. 



' Wellman, P. C. (June 1st, 1907), " Notes on some Noxious Larvse from .\ngola." .Tournal of Tropical 

 Medicine and Hi/i/ieiic, p. 185, Vol. X. 



■* Rogers, L., " Fever in the Tropics." (Loc. cit.). 



