SOME NERJ'OUS DISTURBANCES IN THE TROPICS 405 



It mav go on from ten to thirty-five years, progressively or inter- 

 mittently. 



Wassermann's reaction is always positive. 



As a rule the o-eneral health is little affected. 



It is rarelv fatal^ and all tend to recover ultimately. 



DIAGNOSIS. 



There are neither signs nor symptoms of s}'pliilis (Johnson does 

 not agree). 



The spirocha?te cannot be found and iodides are useless. 



There are no leprosy nodules nor anesthetic patches. 



Hansen's bacillus has not been found. 



Its histological characters are not those of epithelioma. 



There are no metastases and its course is protracted. 



Tuberculosis is excluded by the absence of Koch's bacillus and 

 other symptoms. 



Guinea-pigs cannot be inoculated successfully. 



TREATMENT. 



Nothing will stop its onward course. 



Application of iodine tincture or the actual cautery can be tried. 

 Wash the foul ulcers with potassium permanganate or peroxide of 

 hydrogen. 



Segregation is essential for stamping out the disease. 



SOME NERVOUS DISTURBANCES IN THE TROPICS. 

 (1) TROPICAL NEURASTHENIA. 



This is a condition somewhat common in white people, and the 

 better class coloured people residing in the tropics, especially where 

 there is a moist warm atmosphere. 



There are many predisposing causes, such as malarial fever, or 

 other illness, overwork and alcoholism. 



Perhaps 30 per cent, to 50 per cent, of white residents become semi- 

 invalids from this malady. 



Palpitation with heat flushes is usually present. Phobia, especially 

 with regard to diseases, is a common feature. Sleeplessness and 

 irritability are common. 



The condition is the cause of many clerical errors and inaccuracies 

 which lead to numerous petty worries and manifestations of bad 

 temper. 



The patient should have a change of work and climate. 



Neither sedatives nor tonics have been much use in the writer's 

 experience. 



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