TROPICAL LIVER 55 



Operation has reduced the mortality to 32 per cent. 



Canthe had 115 recoveries with 27 deaths. 



Some aspirate the abscess and inject c^uinine bihydrochloride, 

 0-50 grm. to the litre (Rogers and Wilson). 



Quinine kills the amoebae on the abscess wall, and the pus becomes 

 less copious and almost serous as long as it is sterile. 



Change the dressing at least twice daily; the pus tends to run by 

 the side rather than into the dressing. 



Failure of this treatment is due to : — 



(i) A secondary abscess which may burst into the first cavity. 



(2) Septic infection. Culture the pus organisms. 



(3) Insufficient emetine. 



(4) Intercurrent disease, e.g., enteric fever, &c. 



TROPICAL LIVER. 



This is a distinctive disease affecting Europeans residing in the 

 tropics. It is more prevalent generally during the early years of 

 residence. 



The foul tongue, painful liver, earthy skin, and irritable temper of 

 such affections are well known. 



The liver functions are adversely affected by heat, food, alcohol, 

 malaria, abuse of exercise, congestion and inflammation. 



TREATMENT (Rogers). 



Absolute rest in bed. 



External applications, such as hot fomentations on oleate of iodine. 



Internal medication, e.g., salicylate of sodium, ammon. chloride, 

 sodium sulphate, pot. iodide, ipecacuanha. Also calomel, blue pill, 

 soda and phenalgin, followed by a saline purge. 



Ipecacuanha is most useful if there is hepatitis. Give it in large 

 doses on an empty stomach, 20 — 40 grains at night, preceded by 

 chloral, 20 grains. 



Ipecacuanha in keratine capsules does not act until it has reached 

 the intestine, and hence is to be recommended. 



THE LEISHMANIASES. 



These will be considered under the following heads : — 

 (i) Kala-azar. 



(2) Infantile kala-azar. 



(3) Dermal Leishmaniasis (Oriental sore). 



(4) Naso-oral and Oro-phalangeal Leishmaniasis. 



(5) Canine Leishmaniasis. 



(6) Pseudo-kala-azar (Tropical febrile splenomegaly). 



