I904 DISEASES OF THE CIRCULATORY SYSTEM 



GENERAL DROPSY. 



Cases of general dropsy not due to heart or renal disease may be 

 caused by beri-beri or ankylostomiasis. 



THE HEART. 



Heart disease has not been carefully studied by modern methods 

 in the tropics, but cases of heart-block due to malaria and syphilis 

 have been recorded by us. 



Pericarditis and endocarditis are not as common as in other regions, 

 probably because rheumatism is rare, and therefore they are due 

 to such other causes as gonococcal infection, etc. Atrophies of the 

 heart, especially brown atrophy, are quite common as the result of 

 some general disease. Heart-block is rare, but has been met with. 

 Rupture of a perfectly normal myocardium, the pericardium being 

 intact, is recorded by Herzog as due to fracture of the second, 

 fourth, and fifth ribs. 



Tropical Heart. 



Under this heading MacLeod has described the conditions of 

 palpitation and dyspnoea on going up hills, met with in persons who 

 have resided long in the tropics. He assigns this to degeneration of 

 the heart, brought on by the heat and by the exceptional work which 

 it has to do owing to the changes in the circulation which result 

 from the high temperature of the tropics. He considers this to be 

 the basis of the syncopal form of heat exhaustion. Ernest Black 

 believes that the condition is associated with subnormal blood 

 coagulability, and recommends the administration of calcium salts. 

 The salt he prefers is calcium lactate, which he gives in lo-grain 

 doses. He points out that calcium salts are essential for the systole 

 of the heart as well as for the normal cogulability of the blood, and 

 refers their beneficial action to this property. He considers that 

 citric acid or its salts should be avoided when calcium salts are 

 administered, as they increase the calcium excretion. 



THE VESSELS. 



Atheromatous degeneration of the arteries is quite common, and 

 aneurysm is found, generally affecting the thoracic aorta, while 

 varicose veins and varicocele are usual, .and, associated with 

 hypertrophy of the heart, are very common among rickshaw coolies. 



Thrombosis is often met with as the result of typhoid fever and 

 other diseases, and we have seen thrombosis of a coronary artery 

 with myomalacia cordis or aneurysm of the heart. 



THE SPLEEN. 



The spleen is affected in malaria, kala-azar, relapsing fever, etc., 

 as already described. Capsulitis is very commonly met with in 



