BEVIBW — TKOPICAL MEDICINE, ETC. 171 



Ashloy-Eiiiile' describes Zambesi uleer, which is of a phagedienic nature, and Skin 

 which has been supposed to be many things. He states that it is duo to myiasis, Diseases- 

 being produced by the larva of a fly, which is certainly not that of BenyaUa depressa. coiUimied 

 Alter reading the paper, one cornea to the conclusion that CordyUihia anfhropophaga is 

 to blame. {See " Myiasis," page 137.) 



Shattuck- has notes on chronic ulcers occurring in the Philippines. He describes four 

 types and discusses their etiology, but without coming to any definite diagnosis. 



Of greater interest is a peculiar skin disease described by Ziemann^* as affecting the 

 negroes on the West Coast of Africa. It is a leucoderma, and apparently something like it 

 exists in British Central Africa. Ziemann says : — 



The disease is characterised Ijy the appearance of roiiud, oval, or irregularly-shaped patches of a bright, pale, 

 ycUovvish-red colour on the skin of the extensor and flexor surfaces of the hands and feet. The predominant 

 colour of the affected areas is of a whitish tinge, and the general aspect may be compared to that of extensive 

 superficial burns which have healed without the formation of granulation tissue. The disease begins at the 

 age of from 10 to 15 years ; its course is symmetrical, either attacking the hands first and then the feet, or 

 the feet first and the hands afterwards, or both at the same time. The progress of the disease is extremely chronic. 



Dr. Ziemann has never seen more than four-fifths of the surface of the hands or feet 

 affected with pigment atrophy, and at this stage the process appears to have terminated. 

 The flexor surfaces appear to be more extensively affected than the extensor. Another 

 characteristic of the disease is that the pigment atrophy is practically confined to the hands 

 and feet, only a slight further extension being noticeable after the lapse of ten, fifteen or 

 twenty years. There is a gradual and more or less complete loss of pigment in the hairs 

 situated in the atrophied regions. Sensibility appears to be normal; at least. Dr. Ziemann 

 has not been able to ascertain any impairment in the sensations of either touch, temperature, 

 or pain ; nor was there any alteration in the muscle sense. The sweat glands in the affected 

 areas were normal. The electrical reactions of the affected limbs were normal, and there 

 was no evidence in any part of the body of any lesions affecting either the nervous system, 

 the blood, or the excretory functions. 



Leucoderma is not uncommon in the Sudan, but seems to be generally regarded as most 

 frequently the result of syphilis. 



Cantlie,'* in a general and suggestive paper to be considered later, remarks : — 



The condition I have termed " foot totter," for want of a better name, as the exact pathology of this disease 

 is not yet made out, is a troublesome affection of the soles of the feet, characterised by areas of raised epidermis, 

 which become scaly and hard ; cracks and fissures appear about the toes, causing at times lameness, and attended by 

 intense itching. The disease is very persistent, and may last for years — ten or even more after the patient has left, the 

 Tropics, recurring during hot summer weather in this country, although never wholly dying out during the winter. 



The treatment is to completely cover the affected parts with some paste or plaster which will wholly exclude 

 the air for several weeks ; as this treatment is troublesome and inconvenient, few will be found to carry it out. 



Of the many skin affections, most are common to both temperate and tropical countries, although a few are 

 part and parcel of some general condition of tropical origin. Perhaps the most interesting of these, and the most 

 difficult to rightly interpret, are the skin lesions found in sleeping sickness. Strange as it may seem, cases of this 

 disease do occur in white men coming to Britain, and the peculiar wandering, irregular, eczematous-looking patches 

 presented by the skin would be impossible, in the present state of our knowledge, to explain aright, had we not 

 other symptoms and signs to guide us. 



Molluscum contagiosum occurs in the Sudan. I recall a case in an Egyptian soldier, 

 and examining the growth histologically. The etiology of the condition still seems obscure. 



Casagrandi,^* after filtering the ground mass of human tnolluscum through a Berkefeld 

 bougie, on examining the fresh filtrate found small motile corpuscles elongated or pear- 

 shaped, while on staining by Giemsa he found two different elements, the one taking on a 

 carmine-red colour, the other a blue tint. The latter are the least interesting. The red 

 elements, which seem to possess a granular structure, are possibly protozoa. 



Lipschutz''* found different elements which appear to be identical with those described 

 by Borrel. They are immobile in the fresh state and do not possess cilia. Stained by 

 Giemsa for two hours these elements appear as masses of small, homogeneous granules, 

 which may occur singly, in the form of diplococci, or as short chains like streptoccoci. 



1 Ashley-Emile, L. E. (September 15th, 1905), " Zambesi Ulcer." Journal of Tropical Medicine and 

 Hijgiene, Vol. VIII. 



^ Shattuck, Q. C. (December, 1907), "Notes on Chronic Ulcers in the Philippines." Philippine Journal of 

 Science, Vol. II., B. Sled. Science. 



" Ziemann, H., Arch, fur Derm, and tlyiih., Bd. 74, Heft. 2, No. 3. Quoted in British Medical Journal, 

 May 13th, 1905, Vol. I. 



■* Cantlie, .J. (.June 22nd, 1907), " Clinical Observations on Tropical Diseases as they are met with in Britain." 

 British Medical Journal, p. 1468, Vol. I. 



= Casagrandi, O. Quoted in Ball, de Vlnslitut Pasteur, January 15th, 1907, Vol. V. 



6 Lipschutz, B. (1907). Wicn. Klin. IFoch., t. XX., No. 9. 



* Article not consulted in the original. 



