168 



EEVIEW — TBOPICAIi MEDICINE, ETC. 



continued 



Scurvy— ^ though they have repeatedly, in guinea pigs, seen abortive cases of scurvy recalling the latter 

 flisease. This problem is, however, by no means clear, nor have they hitherto been able to 

 make experiments explaining, in an unmistakeable way, why the one-sided diets mentioned 

 above produce scurvy. 



Okada and Saito^* found a micrococcus in the blood of scurvy patients, and regard this 

 as the actual cause of the disease. 



Mac Vicar-* came to the following conclusions from observations made on natives in 

 Cape Colony : — • 



1. The disease common amongst the natives of his district, known to them as 

 " umtshetsha," is true scurvy. 



2. The main cause of the disease is the absence from the diet of fresh food, animal or 

 vegetable. This in some cases was not entirely absent, but present in the diet in insuflacient 

 quantity. 



3. Muscular exertion precipitates scurvy. Thus, in several cases, though the patients 

 had been living at their homes on a diet lacking in the fresh element, they showed no marked 

 symptoms of scurvy till they commenced active work. 



4. Food may be in perfectly good preservation and yet lack the anti-scorbutic power of 

 " fresh " food. Thus, men on polar expeditions using tinned vegetables and even lime-juice, 

 became scorbutic, but lost their symptoms of scurvy as soon as they had access to " fresh " 

 seal-meat. 



Scurvy visited the old civil prison, Khartoum, and was present in a severe form, 

 simulating beri-beri and causing one death. As to the cause, it is very difficult to come to 

 any conclusion, though one is inclined to favour Barnardo's view. The diet was certainly 

 of a monotonous nature, and rapid disappearance of the symptoms occurred when fresh milk 

 and beans were added to the dietary together with melons, and when oral hygiene received 

 proper attention. 



Sewage. It is, of course, impossible to enter at all fully into so huge a subject, and in 

 any case certain aspects of it fall to be discussed under " Sanitary Notes " (Third Eeport). 

 Here we propose merely to indicate some general papers of special interest to those working 

 in the Tropics, and to consider others containing points not commonly found in text-books. 

 It may be said at once that one of the most useful little works on sewage disposal in the 

 Tropics is the essay by Major Smith. s It does not lend itself to quotation nor are the 

 conditions mentioned altogether those prevailing in the Northern Sudan. The work deals 

 with true, humid, tropical regions where the rainfall is heavy and problems are more difficult 

 than in dry and desert districts. Much, however, applies forcibly to the posts in the 

 Southern Sudan and will repay careful study. 



An excellent paper is that by Cornwall on the system of drainage and sewage (domestic 

 and municipal) best suited for tropical climates. The various systems are briefly but 

 adequately considered, and their advantages and disadvantages discussed. One has found 

 this article of great service on several occasions. 



Of the same class, but more extended, are the papers by Simpson* on tropical hygiene, 

 who notes that the seoi-et of success in any conservancy system in the Tropics is the 

 protection from rain and fioodings. 



Of books, " Drainage Problems of the East," by James ; " The Purification of Sewage," 

 by Barwise ; and the latest edition of a work on the same subject, by Dibdin, will be found 

 of value. 



A useful, illustrated description of the Liernur system will be found in the Lajicet of 

 July 11th, 1908. 



1 Okada, K., and Saito, Y. (1907). Quoted in Medical Annual, 1907, p. 493. 

 ^ JIacVicar, N. (1907). Quoted in Medical Annual, 1907, p. 494. 



■"• Smith, P. (London, 1904), " Drainage, Sewerage and Conservancy in Tropical Countries and Elsewhere." 

 * Cornwall, J. W. (August 1st, 190.3), "The System of Drainage and Sewerage (Domestic and Municipal) best 

 suited for Tropical Climates." Journal of Tropical Medicine, Vol. VI. 



» Simpson, W. J. (December 15th, 1903, and January 1st, 1904), "Collection, Kemoval and Disposal of Waste 

 Waters." Journal of Tropical Medicine, Vols. VI. and VII. 



• Article not consulted in the original. 



