170 REVIEW — ^TBOPICAL MEDICINE, ETC. 



Sewage — (ii.) Thiit 1 grain per gallon of chloride of lime is sufficient to sterilise au effluent, provided the lime 



coiUiiiacd wntaius over 30 per eout. available chlorine, that it is added in the Ijest method, and that tlie elllueiit is a good one. 

 (iii.) That .sunlight is the powerful factor in splitting up the unstable compounds of oxygen, hydrogen and 

 chlorine. 



(iv.) That a weak solution of chloride of lime is altered with extraordinary rapidity in the sunliglit ; the 

 strougor the solution the less it is altered. 



(v.) That even weak solutions lose very little of their available chlorine if kept out of the sun. 



(vi.) That the best method of adding chloride of lime to an effluent is to make a mixture of the powder in 

 water and run in the li(iuor. For this process it is necessary to make up a strong solution, six or twelve ounces per 

 gallon, and keep the lid on the receptacle. 



(vii.) That a weak solution of chloride of lime so rapidly oxidises in the sun that free chlorine cannot be 

 found in the river a short distance from the drainage outfall. 



(viii.) That the chloride of lime kept under suitable conditions docs not deteriorate so rapidly as to render 

 the process liable to failure. 



Discussing possible objections to this method, he says that even the best elHuent 

 contains millions of organisms per o.c, and that in India, where there are small installations 

 and a very concentrated sewage, which is practically wholly human excrement, it is advisable, 

 when it can be done cheaply, to sterilise the elHucnt. The objection that chlorinated lime is 

 very unsuitable, and rapidly deteriorates in a hot country, can (he says) be met with a little 

 arr^mgement. The papers are interesting, but one is inclined to think that in most districts 

 proper application to land would be preferable. Further information on this subject will be 

 found in a review of a paper by Korpjuiweit.'* 



O'Meara- furnishes a useful paper on sewage purification in India generally and 

 Mirzepur in particular, discussing septic tanks, continuous filters vemnt: contact beds, and 

 several other subjects. As he tabulates his conclusions in each section his results are easily 

 followed. 



Skin Diseases. Under this heading we deal with recent work on those complaints 

 as they present themselves in the Tropics or in sub-tropical countries. 



Madden^ has a paper on " Nile Boils in Egypt." These appear during the hot months 

 and especially in the damp weather towards the end of the summer, and chiefly attack 

 European residents, though the native Egyptian is by no means immune. The Nile boil is 

 an inflammatory and exceedingly painful condition, which does not last more than fourteen 

 days from beginning to end. The favourite site is the perinteum, especially all round the 

 anus, the buttocks, the arms, the hands, the lingers and the face. The boils are more 

 common in men than in women, but are no respecters of age or sex, though happily rare in 

 young children. 



Madden describes the boil originating in a hair follicle causing swellings, severe 

 throbbing and pain and inflammatory implication of the neighbouring lymphatics. The 

 surrounding zone of redness, the tiny central blister and the pea-green sloughs are very 

 typical. The swollen area may be very large. Once the " core " is evacuated the cavity 

 rapidly heals. A culture from the slough yielded a pure growth of Staphijlococcus pyogenes 

 aureus. Treatment, he notes, is very unsatisfactory, and consists chiefly in fomentations 

 and expectancy. Madden thinks the old " Bouton-de-Nil " does not now exist in Egypt, 

 and that its place has been taken by this acute inflammatory condition, which he regards as 

 a distinct entity. 



Elliott-* follows with a paper on " Natal Boils," but he seems to mix up true Oriental sore 

 with the simpler inflammatory conditions. He thinks conditions of tropical life combine to 

 lower vitality and render residents liable to such septic outbreaks. In Natal sores, if the slough 

 does not come away or is not removed, keloid results. He speaks very highly of the value 

 of quinine, which in his own case, although chronic, acted as a specific. Unfortunately, he 

 does not give the dosage. In Khartoum I have seen a case in which small boils occurred in 

 crops, chiefly behind the ears, recurring nearly every year and in many ways resembling the 

 Nile iDoil in miniature. They were not benefited by quinine. 



1 Korpjuiweit, 0. (.January, 1908), " The Treatment of Sewage with Chloride of Lime." Quoted in Journal 

 of the Royal ListUulc of Public Health, Vol. XVI. 



- O'Meara, E. J. (July, 1908), " Notes on Sewage Purification." Jvarnal uf llie Rmjul InsliluU of Public 

 Health, Vol. XVI., No. 7. 



■■' Madden, P. C. (October 1st, 190G), " Nile Boils." Journal of Trujiicul Medicine mid Hi/ijicne, Vol. IX. 



■' Elliott, J. P. (.Janu:»ry 1st, 1907), " Natal Boils." Journal of Tropical Medicine and Hijijicnc, Vol. X. 



* iVrticle not consulted in the original. 



