REVIEW — TROPICAL MEDICINE, ETC. 



203 



The disease is one of the imprudently strenuous life, and an exciting cause is over-indulgence Tropical 

 in hard exercise. Medicine — 



Timely treatment may arrest the destructive process aud may possibly eveu remedy the oouditiou to some ccmlmucd 



extent. The cardiac muscle is starved, not for lack of nourishment but from want of ability to absorb the 

 nutritive material which is around and about it in superfluity. If its metabolic capacity and nutrition can be 

 restored, so, certainly, will its contractibility and ability for work. To this end, rest in bed is the first essential, 

 and diet must, in couseiiucuce, ha limited. General massage is nece.ssary to maintain and restore muscle function 

 and assimilation. Heart stimulants — digitalis, ether, strychnine — are to be avoided ; strong cigars, than which 

 there is no more powerful cardiac depressant, must be prohibited. If the patient is a moderate drinker, alcohol 

 should be stopped ; if he is a free liver and stimulants appear iudispeu-sable, consideration is necessary. But in 

 deciding the point, which is very important, it should be borne in mind — and this is specially true of the 

 Tropics — that the sudden withdrawal of alcohol aud tobacco from a patient thoroughly habituated to their use may 

 induce such deep dis,satisfaction .as to seriously prejudice all assimilative processes. As to drugs, opium is of 

 special value. In the Tropics, where heat exhaustion is in daily evidence, its efficacy is more generally appreciated 

 than in colder climates. There can be no question of the beneficial action of opium in the extreme fatigue that is 

 induced by continued and severe physical effort in hot climates, aud in the dyscrasias that result from over- 

 exertion. In no disorder in the Tropics is this more apparent than in degeneration of the myocardium ; apart 

 from its sedative effect, opium acts with promptitude and certainty as a restorative of cardiac tissue ; and in such 

 a condition it may be safely and usefully continued for long periods without other medicine than an occasional 

 laxative. All other hypnotics should be discarded ; some of them are dangerous, others m.ay be so. With suitable 

 treatment, the prognosis of this form of myocardial degeneration is by no means bad, and if taken in hand during 

 their earlier stages most cases will do well. 



Cantlie,^ in a useful paper, discusses tropical ailments as they are met with in Britain, 

 in the course of which he mentions that a man (even a medical man) may suffer from malaria 

 whilst resident in the Tropics and yet be unaware of the fact. He mentions a malarial 

 neuritis which may supervene on chronic malaria in Britain. He believes that it is not the 

 cold but the hot weather in Britain which is to be dreaded by the victim of chronic malaria. 

 He has found 10 minims of oil of turpentine, repeated every two hours until five doses were 

 given, useful in checking hsemoglobinuria occurring at home in persons who have had black- 

 water before, or who develop it for the first time in Britain. He cautions against mistaking 

 the presence of intestinal parasites for dysentery or sprue, especially in cases where loose stools 

 alternate with normal motions. In such cases the effects of santonin should be noted. In 

 women suffering from any kind of intestinal flux, the pelvic organs should be examined and 

 any gynaecological trouble remedied. 



True tropical dysentery in Britain is, he thinks, best treated by ipecacuanha. A good 

 section is that on " Tropical Liver." Cantlie points out that one must not expect to find the 

 "livery" tropical subject with an enlarged liver. It is just as frequently diminished in 

 size. When the liver is small (he says) give it work to do, give the patient meat ; when it is 

 large and tender and there is increased temperature, take the strain off it and give milk. 



As useful drugs, he mentions chloride of ammonium, rhubarb and soda, one of the 

 purgative waters, and occasional doses of calomel or ipecacuanha are indicated. 



Castellani- has described as occurring in Ceylon an " Endemic Funiculitis," being an 

 acute, inflammatory condition of the spinal cord, which is apt to lead to general septiciemia 

 and death, unless prompt operative measures (orchiotomy) are taken. He describes the 

 pathology, and states that he has found a diplo-streptococcus in all cases. He is inclined 

 to believe that this organism is merely a secondary agent, playing a role only in the 

 suppurative stage of the malady. 



Military medical officers may refer with advantage to a review^ of a paper by Steuber 

 on European troops in the Tropics. Unfortunately the original article is in German, and 

 there is nothing to show that it has been translated into French or English, but it seems to 

 possess much of interest and alludes to the last Sudan campaign. 



Bousfield^ has described in the Sudan an intractable, slow-spreading, destructive ulcer 

 of the penis. He saw three cases occurring in the Sudanese. The ulcers, which were 

 practically painless and apparently non-syphilitic, are described as having no covering slough 

 and exuding a serous fluid which at times was slightly purulent. Smears revealed nothing 

 special — nothing like Ducrey's bacillus of soft sore was found, and there were no spirochaetes. 

 Various kinds of treatment failed until, in one case, oil of turpentine was tried with happy 

 results, apparently due to the medication. 



' Cantlie, J. (June •22nd, 1907), "Tropical AUmeuts as they are met with in Britain." British Medical 

 Jmirnal, Vol. I. 



■' Castellani, A. (.July 4th, 1908), "Endemic Funiculitis." Lancet, Vol. II. 



" Steuber, — (August 10th, 1907), " European Troops in the Tropics." BritUh .Unlical Journal, Vol. II. 



■■ Bousfield, L. (September 14th, 1907), " Observations from the Soudan." Lancet, Vol. II. 



