EEVIEW — TKOPICAL MEDICINE, ETC. 107 



Through the kindness of Colonel Hunter, I have had access to a very valuable and Leprosy- 

 suggestive report, by Captain E. G. Anderson, on Leprosy in Kordofan. He shows that it continued 

 is almost entirely limited to the Gebel district in the southern part of the Province, and 

 that, as an endemic disease, it seems to exist in no other part of the Province. The 

 ansesthetic type is by far the most common, cases of nodular leprosy being rare. Mixed 

 cases are encountered. The patients are usually between 20 and 30 years of age ; but, 

 unhappily, children are not infrequently victims, and these suffer from the rapid, 

 nodular variety and consequently undergo mutilation from the disease. Captain Anderson 

 believes that close personal contact is an important factor in spreading the disease, and 

 testifies to the influence of dirt and insanitary surroundings. Thus amongst the nomad, 

 cattle-owning Bagara Arabs the disease appears to be unknown, probably on account of 

 their cleanly habits, the care with which they anoint their bodies with oil, their healthy 

 open-air life, and their simple diet of milk, bread and butter. 



Of special interest are Captain Anderson's observations on the relation of leprosy in 

 Kordofan to the practice of eating imperfectly cured fish. In a paper in the Jotirnal of 

 Tropical Medicine for April 15th, 1904, I mentioned the presence of mud fish in certain 

 lakes in Kordofan, and stated that it would be interesting to know if these fish served as 

 food and if leprosy occurred in the neighbourhood. Captain Anderson shows that there is 

 a large fish industry, that the fish are greatly prized as articles of diet, being at the dry 

 season of the year dug out of the mud in which they bury themselves. These fish are very 

 badly cured, and are eaten when in an advanced state of decomposition, and it appears 

 certain that there is a relative and close distribution of leprosy throughout the localities 

 where fish eating is in vogue, while the disease does not exist where there is no fish traffic. 

 Captain Anderson's investigations strongly support Hutchinson's fish theory, so far as 

 Kordofan is concerned. His paper also includes proposals for isolation, segregation and 

 general sanitary measures, and is undoubtedly the most valuable contribution that has 

 been made to our knowledge of leprosy in the Sudan. 



A dried fish food is sold in the market at Khartoum. It is, however, well preserved and 

 is so desiccated that it bears no resemblance to the flesh of fish. The presence of bones 

 and fragments of cartilage testifies to its origin. It is largely consumed by natives, and 

 seems to produce no ill effects. 



Liver Abscess. On the ground that prevention is better than cure, Eogers'' work 

 on the " Pre-suppurative Stage of Amoebic Hepatitis : its Early Diagnosis and Cure," claims 

 first attention. First of all allusion is made to the prolonged fever which so often precedes 

 suppuration in the liver and which is commonly diagnosed and treated as malaria, and to 

 the frequent necessity, even in the presence of acute hepatitis, for exploratory puncture in 

 order to determine if an abscess has formed. Reference is made to earlier work on the 

 value of leucocytosis in acute hepatitis, which, if marked, points to suppuration having taken 

 place, but which in slighter degree may be present in the absence of pus and may indicate 

 an early and curable stage of amoebic hepatitis. This view has been further developed, and 

 as the author says : — ■ 



These cases constitute a distinct class of fever, usually of a chrouic intermittent type, sometimes with no very 

 definite symptoms of hepatitis, and rarely with any dysentery. They may be recognised, or at least strongly 

 suspected, by the presence of a moderate degree of leucocytosis, generally of the type which I have described 

 as common in amcebic abscess of the liver, namely, one in which the jiroportion of polynuclears is either normal 

 or only slightly in excess. Further, and this is the most important practical point — this kind of fever yields 

 rapidly to large doses of ipecacuanha in the absence of symptoms of dysentery, or even of hepatitis, and the 

 formation of tropical abscess of the liver is thus prevented. 



Notes and charts of 15 cases follow. The blood counts and differential leucocyte 

 counts are given. The polynuclears ranged from 74 to 87 per cent., the lymphocytes from 

 7 to 22 per cent., the mononuclears from 3 to 7 per cent., and the eosinophiles from 

 to 4 per cent. 



In only three cases was over 80 per cent, of polynuclears observed, hence the type of 

 leucocytosis present is similar to that which obtains in cases of amoebic abscess as noted 

 above. The effect of the ipecacuanha treatment certainly seems to have been both 

 immediate and remarkable and there can be no doubt but that it should be tried in all cases 

 prior to any operation. Eogers believes this pre-suppurative condition with its attendant 

 fever and apparently characteristic blood findings is due to the presence of a latent form of 

 dysentery, the amoeboe of which are causing an irritation of the liver, which organ they are 

 reaching mainly by the portal circulation. Ipecacuanha is to be regarded as a specific in 

 amcebic dysentery, hence it is easy to understand how large doses of the drug (not less 



' Eogers, L., " Fevers in the Tropics." See also Indian Medical Gazette, September, 1907. 



