410 DISEASES OF UNCERTAIN ETIOLOGY 



There mav be oedema of the feet and hands with ascites. 

 Death from rholccmia ensues in a few weeks to a few months. 



PATHOLOGY. 



The bihary cirrhosis seems to be the resuh of some gastric irritant 

 acting upon the hver cells. The cells at first become degenerate, then 

 the intercellular connective tissue is increased, follow^ed by that of the 

 portal sheaths. 



There is a marked attempt to form new bile ducts between the 

 hepatic cells (Gibbons). 



TREATMENT. 



Early removal from the district has been suggested. 

 A change of wet nurse and infant foods could be tried. 



GOITRE. 



In the Tropics this condition does not appear to be associated with 

 any geographical or geological condition. 



Many authorities believe it to be of parasitic origin, and suspect an 

 amoeba which is ingested with water. 



A new-comer to an endemic district notices that after a few weeks 

 his neck begins to swell gradually. At times it may be stationary, at 

 others progressive until a permanent hypertrophy results. 



The whole thyroid gland is usually affected. 



Later it may undergo cystic or adenomatous changes. 



Removal to another non-endemic district will cause it to diminish 

 in size and to clear up in earlv cases. 



Salol and thymol arc sometimes given. 



CLIMATIC BUBO. 

 DEFINITION. 



A painful gradual enlargement of the inguinal Ivmphatic glands 

 with fever of uncertain as^^tiology. 



DISTRIBUTION. 



The East Coast of Africa, West Indies, Straits Settlements, China, 

 Madagascar, Chille, Uganda, and many other places. 



iETIOLOGY. 



Hewlett has isolated a bacillus not decolorized by Gram and not 

 unlike the B. pestis. 



Cantlie believes it to be a form of attenuated plague, pestis minor, 

 Hewlitt's isolation supporting it. 



Others hold that the disease is a distinct entity. 



