REVIEW — TBOPICAL MEDICINE, 13TC. 215 



A very interesting and instructive paper by Eoberts and Bhandarkar on the existence Tuberculosis 

 of an acute tuberculous fever in India, leads one to think that this pathologial condition —cuiiiimud 

 in the Tropics requires investigation (nee " Fevers," paye 6G). As regards tuberculosis in the 

 Sudan, where the disease is far from uncommon, Cummin's paper in the BritUh Journal of 

 Tuberculosis for January, 1908, may be consulted. Bovine tuberculosis is rare or unknown. 



Typhus Fever. In the days of Baker and Schweinfurth typhus is said to have 

 been common in Khartoum. In 1864 and in previous years a malignant form of the disease 

 was reported from the old city. The Mahdi is said to have succumbed to it at Omdurman, 

 but there is reason to suppose that he really fell a victim to cerebro-spinal meningitis. 

 Indeed, it is quite possible that in those days typhus was confused with this disease and 

 with relapsing fever, but, at the same time, available records show that the conditions 

 favouring typhus were by no means lacking. These, according to Sand with,' are (1) Over- 

 crowding, (2) Deficient ventilation, (3) Uncleanliness, (4) Faulty conservancy arrangements, 

 (5) Insufficient diet for the work required. 



He thinks that it is likely to occur in the Sudan in the spring months, but from what 

 one has seen of typhus elsewhere one would be inclined to expect its appearance during the 

 winter months, which are sometimes comparatively cold. During this season the natives 

 are apt to huddle together for warmth, and, contrary to their usual habits, to sleep indoors, 

 so that certainly overcrowding and deficient ventilation are present. 



I understand, however, that since this country was reconquered typhus has not been 

 reported, and in some measure this is possibly due to the absence of famine conditions and 

 of vagrancy. 



Sandwith describes the disease as encountered in Egypt. He thinks that in the 

 Sudanese hypostatic congestion is to be regarded rather as a symptom than a complication, 

 and one which may materially aid the diagnosis. The adynamic is the most common form, 

 the nervous type with marked cerebral symptoms being met with in better class patients. 

 It appears that it may occur along with relapsing fever. 



Sandwith compares the characteristic odour to that emanating from a cupboard of well- 

 blacked boots, and I can confirm the aptness of this analogy, for there is a peculiar " acid" 

 flavour or "tang" about it which is reproduced by the "boot" smell and by nothing else 

 with which I am familiar. 



The cause is still unknown, although recently in Egypt a protozoon, Babesia hominis, 

 was described in 1903 by Gotschlich- as being the etiological factor. This requires 

 confirmation. 



Husband and MacWatters^ have a paper on the disease as encountered in Northern 

 India. They think it is more common than is generally supposed, having sometimes been 

 mistaken for epidemic pneumonia. The diagnosis from pneumonia is difficult, and they 

 came to rely chiefly on the following points : — 



1. Characteristic mental conditiou — the patients being usually apathetic, dull, stupid and drowsy. 2. The 

 dry, swollen and cracked tongue, caked with a patchy, rather thick, brown or even black deposit on the dorsum. 

 The sides and tip were often comparatively free, but red and sore-looking. Occasionally, however, the tongue 

 remains healthy. 3. The rash ; but it is sometimes entirely absent, and even when present is indefinite, evanescent 

 and difficult to see on a dark skin. 4. The blood examination. The differential leucocyte count differing from 

 that of most other fevers ; leucocytosis being present, and an increase in the red corpuscles. 



Details are promised later. The authors favour the protozoal origin of the disease, and 

 cite Sambon's belief that typhus and Eocky Mountain fever, in the latter of which a 

 piroplasm has been demonstrated, are identical. At the same time, they were unable to find 

 any blood parasite in their cases. They are inclined to believe that bed-bugs convey the 

 virus, and this view is upheld by Hepper's^ observations in Peshawar, which showed that 

 out of six cases five had been exposed to the attacks of these insects, and that the outbreak 

 ceased when all the bugs were killed and infection by them was rendered impossible. He 

 admits, however, that there is as yet no definite proof. 



Horiuchi^ mentions this discovery in a recent paper on an outbreak of exanthematic 



> Sandwith, F. M. (London, 1905), " The Medical Diseases of Egypt." Pt. I. 



^ Gotschlich, E. (1903). Beat. Mai. JFoch., Bd. XXIX., 329-331. 



" Husband, J., and MacWatters, B.C. (June, 1908), "Typhus Fever in Northern India." Linlt'in Mrrlical 

 Gazette. 



* Hepper, E. C. (June, 1908), " An Outbreak of Typhus Fever in Peshawar." Ibid. 



° Horiuchi, T. (May 16th, 1908), " Uebei' einen neuen Bazillus als Erreger eiuos exauthematischen Fiebei-s iu 

 der Mandschurei, etc." Cent, fiir Bakt. Origin., Abt. 1, No. 7, Bd. XLVI. 



