June 1907.] 405 Miscellaneous. 



moment for the administration of the drug, I leave to the intelligence of managers 

 or hospital assistants ; the ideal method would be to treat the whole batch at once. 

 Whip worms will require injections for their removal, and as they cause no actual 

 invaliding do not cause any material effect upon the work of the estate. BMltration 

 of or boiling of the drinking water is the proper preventive of these diseases. 



Elephantiasis, Chyluria and Varicose Glands.— The cause of all the 

 above diseases which occur, but are not common in this country, is a blood worm. 

 The worm is transmitted by the bite of Culex mosquitoes, so that our anti-raalarial 

 measures will help to prevent the diseases. Elephantiasis is diagnosed by the 

 swelling of a part, usually a leg or a foot, the swelling is hard and brawny, the 

 skin usually wrinkled, and very coarse, the disease is usually uni-lateral and the 

 affected part does not pit on pressure. 



Chyluria, due to the Pilaria also, consists in a milkiness of the urine- 

 Varicose glands usually occur in the groin, they are hard and painless. All these 

 diseases can only be diagnosed microscopically in their early stages and have 

 little effect upon health until long established. The majority of cases require the 

 scalpel for their treatment. 



Leprosy.— Unusual amongst coolies who have been medically examined, it is, 

 nevertheless, most important that the symptoms of this disease should receive all 

 possible publicity, in the interest of the public health. Any thickening of the 

 skin, circumscribed, and of a coppery red tinge, should be suspected. Loss of 

 feeling, even to sharp bodies, such as a pin, if it is found in a hardened patch 

 of skin is very suspicious. Thickening of the nerves, for example, an enlarge- 

 ment and hardness of the nerve at the inside of the elbow — " the funny- 

 bone" — should lead one to examine for anaesthetic patches elsewhere. Chronic 

 ulcers of the feet, particularly of the sole of the foot, are frequently leprous. The 

 physiognomy of a leper is quite distinctive to the trained eye, and when the seared, 

 leonine expression is present, cannot be mistaken. Irregular and usually slight 

 attacks of fever occur early in leprosy, the latter signs, such as the loss of fingers 

 and toes and repulsive ulcerations of the body are, mercifully, seldom seen save 

 in the asylums provided for these unfortunate beings. 



Abscess of the Liver.— The fever, emaciation and general illness preced- 

 ing the full development of this disease are so variable and progressive, that its 

 diagnosis is hardly a subject for this pamphlet. Early operation is the secret of 

 success, and all that I need mention about it will be a quotation from Sir Patrick 

 Mason's lectures at the London School of Tropical Medicine : " Whenever you find 

 a progressive deterioration of health and vigour occurring, accompanied by some 

 fever and sweats, always suspect liver abscess." 



Sprue.— I feel that a precis of sprue is a difficult task. Where tropical 

 diarrhoea ends and sprue begins is not easy of definition, tout if I were driven to a 

 descriptive epigram, I would say, " Sprue is a chronic deterioration of mucous 

 membranes of unknown causation." 



The symptoms may be represented by various combinations of or a con- 

 glomeration of the following : —Diarrhoea, sore tongue, ulceration of the mouth, 

 abdominal pains, pain on swallowing, pale stools, gassy stools, loss of weight and 

 energy, shrinkage of the liver. I consider sprue to be common amongst coolies in 

 this country, but the difficulty of accurate diagnosis causes the majority of the 

 cases to be returned as diarrhoea. 



The treatment, which should be commenced very early, consists in baby- 

 foods and milk, nourishing unseasoned dishes, such as freshly cooked minced chicken, 

 fresh fish, eggs, rusks, and such like. I believe that if this treatment were adopted 



