202 REVIEW — TUOl'ICAL MEDICINE, ETC. 



Ticks— To anyone studying ticks, Christophers'' monograph on their anatomy and histology is 



coniinued indispensable. lie has a short chapter on ticks as transmitters of disease, and gives the 

 following as being human parasites : — 



Argas persicus (Fischer) 



Argas tholozani (Lab. et Meg.) 



Ornithodoros ruoubata (Murray) 



Ornithodoros savignyi (Andouiu) 



Ornithodoros savignyi var. cieca (Neumann) 



The last is probably identical with 0. mouhata. 0. sarigni/i is the human tick found in 

 the Northern Sudan. Other ticks which attack man are the Mexican species, Argas turicata 

 and A. megnini, and the pigeon tick, .4. refiexus. It will be noticed that all these belong to 

 the ArgasidfB. In Massey's list {loc. cit.), however, one notes a human tick, Rhipicentor 

 hicm-nis (Nuttall and Warburton), belonging to a new genus. It, and several other new 

 ticks, have been recently described and figured by Nuttall and Warburton. - 



Christophers deals with the bionomics, external anatomy and internal structure of 

 ticks, taking Oruitluidoro.s as one type and Bhipicephalus and Hyalomma as the other. The 

 method he recommends for dissection is, one can say from personal experience, not very 

 difficult, and, thanks to the excellent illustrations he gives, it is comparatively easy to 

 follow out the somewhat complex internal organs. 



Tropical Medicine. Under this comprehensive title one proposes to discuss a 

 few papers on very varied subjects which cannot well be considered under any of the other 

 headings, and yet deal with matters of very considerable interest and importance to the 

 student of Tropical Medicine. 



We note first a paper by Carnegie Brown^ on degeneration of the myocardium in hot 

 climates, in which he says : — 



A somewhat uufamiliar result of residence iu the Tropics, but one which is by no means infi-equent, is a 

 peculiar form of degeneration of the cardiac muscle. Clinically and pathologically the condition is of much 

 interest, for the evidences of myocardial change are apt to be misinterpreted, and sudden and unanticipated death 

 occurs not infrequently after an apparently trivial illness. 



The patient is usually a man who has been some years in the Tropics ; he is confident that he is organically 

 sound, and though he confesses he is not well, he is sure that there is little the matter. In answer to leading 

 questions he says he is tired, yet sleepless ; he is disinclined for e.xertion, mentally or bodily ; he yawns unaccount- 

 ably; he has flushings of the face, tingling and itching in the extremities; perspires more readily and copiously 

 than is his habit ; and he has a vague feeling of uneasiness and apprehension. There is no faintness, no dyspnosa, 

 no cough, no pre-cardiac oppression. Palpitation is absent, or it is slight, and felt only after exertion. There is, 

 perhaps, some indigestion, and he has remarked that the feeling of weariness comes on coiucidently with discomfort 

 in the stomach. He is thirsty, and wants more than his usual quantity of stimulant. He is not depressed, but he 

 worries unnecessarily about his affairs, and is kept awake at nights by a stream of thought and indefinite anxiety. 

 The pupils are large, and not actively responsive to volitional or reflex stimuli. The pulse is irregular, but it is 

 full, soft and deliberate ; the vasomotor system is inactive, and there is no hardening of the arteries. The skin is 

 moister and more lax than usual. The temperature is normal ; the tongue is clean, and gives no indication of any 

 morbid condition ; the urine is scanty and loaded with urates, though otherwise normal. The rhythm of the 

 natural cardiac cycle is unimpaired, but the heart's action is somewhat hesitating, and an occasional flutter or 

 tremor may be detected at the apex ; the impulse is softer, perhaps more diffuse, than normal, but it is not 

 displaced. The clearness of note in the sounds is diminished ; they seem a little distant, and the first is somewhat 

 weak. Little further aid is to be obtained from the stethoscope ; there are no adventitious murmurs, and 

 examination of the pulmonary area and conus arterious gives no indication of deficient or defective blood. 



He notes that the condition is apt to be considered as nervous or imaginary, and yet a 

 startling and tragic termination may ensue, possibly as a result of transitory fever or 

 indisposition. 



Contrasted with the commoner forms of myocardial decay the salient features of the disease are the absence 

 of fainting fits, the inconsiderable impairment of the circulation, the vagueness of the physical signs, and the fact 

 that the syncope usually supervenes in the absence of unwonted exertion. It is perhaps only a coincidence, but 

 one the importance of which will not be overlooked, that death frequently occurs at night and after the 

 administration of a soporific. 



The post mortem appearances are given and may be summed up as those of " soft 

 heart," so far as the macroscopical appearances are concerned. Its histo-pathology, 

 however, is quite different from that of the special condition which bears this term. The 

 appearance rather resembles cloudy swelling, and is evidently due to impaired nutrition. 



' Christophers, S. R. (1906), " The Anatomy and Histology of Ticks." Scientific Memoirs of Ific GovernmciU 

 of India, No. 23. 



■ Nuttall, Q. H. F., and Warburton, C. (1907). Proceedings of the Oambrirlgc Philosophical Society, 

 Vol. XIV,, Pt. IV. 



' Carnegie Brown, W. (June 23rd, 1906), " Degeneration of the Myocardium in Hot Climates." British 

 Medical Journal, Vol. I. 



