TROPICAL NEURASTHENIA 



subject to moist heat, and in some cases an important predisposing 

 cause is the sun's rays, the effects of which are often disregarded. 

 Moreover, the white man is generally compelled to work hard 

 throughout the heat of the day, and is often exposed to the midday 

 sun. The liability to the disease increases with the length of resi- 

 dence in the tropics. Predisposing causes are any previous illness, 

 alcoholism, and overwork. Fales states that he found 30 per cent, 

 of the men and 50 per cent, of the women who had resided for a 

 year or longer in the Philippine Islands the subjects of such severe 

 neurasthenia as to be semi-invalids. In our experience the disease 

 is extremely common all over the tropics in Europeans as well as 

 in the natives of the educated class. 



Symptomatology. — In addition to the ordinary signs of neuras- 

 thenia, the tropical form seems to markedly affect the vascular 

 system; palpitation is very common, and the patients suffer from 

 various kinds of phobia, especially relating to diseases of the 

 tropics. 



Treatment. — The best treatment is rest and change of chmate 

 and mild hydropathic treatment. If this is not possible, hypo- 

 dermic injections of sodium glycero-phosphatC' — o-i gramme daily 

 in bad cases — or some form of glycero-phosphate, with or without 

 polyformates, by the mouth in mild cases, may be tried. The 

 patient should discontinue cold baths, and should use warm baths, 

 which should be taken at night if there is sleeplessness. Bromides 

 are occasionally useful. 



Prophylaxis. — As in some cases the disease is predisposed by 

 exposure to the sun, protection is required against th) sun's rays 

 by topees lined with red, and, if necessary, by red underclothing 

 or clothes made from the ' solaro ' fabric already mentioned, and 

 by avoidance of the midday sun as much as possible, and the total 

 abstinence from alcohol. 



Persons who are compelled lo work hard under unfavourable 

 conditions require change to the Temperate Zone at relatively short 

 intervals — i.e., about once in two or three years. 



ENDEMIC PERIPHERAL NEURITIS. 

 Synonym. — Akatama. 



Definition. — Endemic peripheral neuritis is a disease of unknown 

 origin, characterized by numbness and intense prickling and 

 burning sensations in the presence of cold or damp, which are 

 temporarily relieved by the application of dry heat. 



History. — The disease was first noticed by Wellman in Central 

 Africa in 1896, and described by him in 1903. It affects 3 to 5 per 

 cent, of the Bantu people, who are by profession porters, and are 

 much impeded in their work by this complaint, which affects young 

 and old, male and female alike. Their staple food is maize, which 

 is eaten partially cooked. 



Climatology. — ^The disease i - found in that plateau of Africa 



