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REVIEW— TROPICAL MEDICINE, ETC. 



Onyalai— more tropical and luuuid regions of the Sudan, such as the Bahr-El-Ghazal Province 



contiiwcd It IS perhaps well to direct attention to it, the more so that Feldman has seen a somewhat 



similar disease in East Africa called " Edjuo," and Mouse, on the Congo, met with a 



condition exhibiting some of the symptoms of "Onyalai" and termed " Kafiudo " by the 



Unyamwezi people. 



The etiology is quite obscure. Wclluian seoms to have proved that it has nothing 

 to do with malaria, trypanosomiasis, Schonlein's disease, Henoch's purpura. Purpura 

 hasmorrhagica, accidental or intentional poisoning or snake bite, though it may resemble 

 the effects produced by the bite of the puff-adder {Glotho arietans, Gray). 



Wellman, indeed, considers the disease to be a specific entity, an acute infectious 

 disease, the cause of which is as yet undetermined. 



The account given of the clinical features is here reproduced : — 



Most of my cases were attacked suddenly. Lassitude and a sort of dazed appearance was generally marked 

 In some cases the parotid glands were tender to the touch. The eyes appeared heavy and sonaetinies reddened 

 In most instances the tongue was swollen and painful. A slight temperature was noted in about a third of the 

 cases. I have had patients complain of numbness and of pain in various parts of the body. One man who had 

 bloody diarrhoea sufiEered much from colicky pains. The appetite is usually poor. The bulla; may appear in the 

 mouth, pharynx, oesophagus, stomach and bowels. Vomiting of blood is not rare. The skin also usually shows 

 lesions. The genito-urinary system was affected in three of my cases. Hematuria was a prominent symptom in 

 all of those. When the process occurs in the cranial cavity various symptoms of profound central disturbance are 

 set up. Three cases of this kind have come to my attention. One of these was a young woman in rude health 

 She was laughing and playing on the evening of her attack. Suddenly she complained of being tired, and in an 

 hour or so bulla; appeared in her mouth. She steadily grew more depressed, and died about eight o'clock the next 

 morning, with all the symptoms of cerebral haemorrhage, i.e. loss of consciousness, inactive, dilated pupils, slow 

 noisy, stertorous breathing, etc. The pulse was very slow and increased in tension. Another fatal case in the same 

 house, a strong young man being the victmi, presented almost exactly the same symptoms. A third fatal case 

 showed no vesicles, either in the mouth or in the skin. The faeces and urine likewise'contained no blood Another 

 case which I have also referred to this disease likewise showed no vesicles, but died from the effect of what I 

 believe to be the same process in the liver, spleen and pancreas. (These last two cases were shown microscopically 

 not to be pernicious malaria.) The superficial bulla;, when present, are characteristic. They range from the size 

 of a split pea to several inches in diameter. The larger ones are irregular in outline, and are often umliilicated. 

 They arc deep, and involve the corium or submucous structure. There seems to take place an extensive histolysis, 

 only the fibrous elements persisting. These appear as trabecula;, the interstices of which are filled with partially 

 coagulated and otherwise altered blood which shows dark under the skin or mucous membrane. The red 

 corpuscles, however, are not all disintegrated, and may be seen under the microscope in the oozing fi-om the 

 blebs, and also m the fa;ces, urine, saliva, etc., according to the situation of the lesions. In one or two cases the 

 bulls were very small, and not numerous, and had the patients not directed attention to them would probably 

 have been overlooked. 



The Congo disease described by Mense^ is characterised by depression, malaise, 



headache, reddened conjunctivie, numbness, swelling of the tongue, loss of appetite and 



occasional bloody diarrhcea, dyspnoea, cardiac disturbances, etc., all of which have been 

 noted in " Onyalai." Bullae, however, were not observed. 



The prognosis of "Onyalai" is still an unknown quantity. The malignancy of the 

 disease appears to vary greatly. Natives often regard it as very fatal. No treatment seems 

 of much use, except possibly arsenic in large doses. 



Information is desired regarding the possible occurrence of this interesting condition 

 within the confines of the Sudan. 



Oriental Sore. So far as one can find out, this condition does not exist in the 

 Sudan. Colonel Hunter, P.M.O., tells me he has never seen it. At the same time, it is one 

 of much interest, and as it is associated with the presence of parasites identical with 

 the Leishman-Donovan body, and as kala-azar occurs in this country, it is necessary to 

 consider recent work upon it. 



In a recent important discussion on the subject, Manson- points out that the disease has 

 the peculiarity of being protective against itself. He also alludes to the difficulty in stating 

 the duration of the incubation period, which is sometimes short, but frequently runs into 

 months. Nearly always an exposed part of the body is affected, and Manson suggests that 

 the disease is inserted by some animal which attacks these parts. The bug, flea and similar 

 insects are therefore excluded. The mosquito and various flies would, however, probably be 

 effective carriers. The disease is inoculabh;, but inoculation experiments may fail possibly 

 because the parasites have disappeared from the sore or are in an unhealthy condition or 

 have undergone involution. 



> Meuse, C. (1906), Handbuch der Tropenkraokheiten, p. 789, Vol. III. 



■^ Manson, Sir P. (December 2nd, 1907), "Demonstration of Oriental Sore and its Parasite." Journal of 

 Tropical Malicinc and HytjicHc, Vol. X. 



