1750 DISEASES OF THE MOUTH, THROAT, AND STOMACH 



Black thinks that, like other members of that class, it generates no free 

 toxins, but its pathological effect is produced, on its death and disintegration, 

 by the liberation and absorption of toxins. 



The mode of conveyance is not conclusively determined, but it seems to be 

 by means of contaminated food or water. In one district in Western Aus- 

 tralia all the evidence pointed to milk as the medium. In Queensland, on the 

 other hand, many years ago there was no fresh milk used in a district where 

 the disease was common. 



Climatology and Incidence. — In Queensland it persisted in the past in an 

 endemic area in spite of a drought lasting several years. In Western Australia 

 the outbreaks are strictly limited to the wet season, and start with the rapid 

 growth of grass after the first rains. Hence its local name in that district. 



Persons of both sexes, any age, and all races may be affected, those in robust 

 health equally with those in ill-health. 



Symptomatology. — The solitary symptom is vomiting, which occurs only 

 after taking food. This may be within a few minutes, or may be delayed for 

 some time after a meal. The character of the vomiting is quite distinctive, 

 and reminds one of the action of apomorphia. It is very sudden, and rarely 

 preceded, accompanied, or followed by any nausea, straining, or pain. There 

 is seldom any premonitory sensation ; consequently it is so sudden as often to 

 be extremely embarrassing. It may occur after every meal or only after one 

 or two meals in a day. It may be every day, or there may be intervals of one 

 or several days between the attacks, which also vary in their duration. From 

 the results of experiments. Black has come to the conclusion that the attacks 

 are concurrent with and due to the death of some of the organisms, and that 

 the intermissions are periods during which none or too few die. In the inter- 

 mittent form there is little if any interference with the general health, but in 

 the more or less continuous cases there is sometimes considerable loss of 

 weight, the malnutrition then resulting in ill-health. There is no loss of appe- 

 tite; but rather the reverse. If the attacks are short and the intermissions 

 long, patients, especially children, sometimes increase in weight. 



Treatment.— According to Black, the aim of the treatment is to destroy 

 the causal organism in the mucous membrane of the stomach. Cyllin in pala- 

 tinoids of 3 minims each with a wine-glassful of water three times a day is gener- 

 ally effectual and convenient. Thymol may be given in i -grain doses three 

 times a day, the patient being warned not to take any alcohol or oil. Chlorine 

 solution, freshly prepared, has been strongly recommended. Other drugs 

 suggested are carbolic acid, creosote, and /3-naphthol. Whatever drug i? 

 used, it should be given at least half an hour before meals. 



Prophylaxis. — Nothing is known about this. 



ENTALACAO. 

 » 



Synonyms. — Mai d'engasgo, Dysphagie Tropicale, Tropical Cardiospasm. 



Remarks. — This disease has been known for a long time in certain parts 

 of Brazil, having been described by Botelo, Langard, and by Paranhos. 

 Bouchard has noticed a somewhat similar disease in pheasants which is due 

 to a worm. 



Climatology. — It appears to be localized to some districts in the interior 

 of Brazil. 



iEtiology. — The causation is unknown, but it has been suggested that it 

 is a parasitic disease, that it is a neurosis, or that it is connected with eating 

 diseased manioc. The last theory has been brought forward by Paranhos. 



Morbid Anatomy. — No macroscopical lesions have so far been discovered. 



Symptomatology. — The patient complains of severe dif&culty in swallowing 

 even liquids, and feels as though the food had stopped in the oesophagus 

 and had not reached the stomach; hence the name ' d'engasgo,* meaning 

 choked. During the attack the patient becomes anxious-looking, throws 

 the arms about, and becomes dyspnoeic. The face is congested and the eyes 

 protrude. The swallowed food is brought up by a process of regurgitation 



