(J'liiTcnt ?oj)ics. action of the tropical sun.

Dr Hans Aron has an article in tlie Philli pI ine Journal of Science which, if a bit ilUanDoiutin", is nevertheless of considerable interest (Ph. -J. of Sci., Vol. VI, No. 2,

ion).

April

?

,

We quote in extenso Dr. Aron of his article :?

,

a

own

summary

Under climatic conditions, even during the cooler of the year in Manila, animals, such as labbits and monkeys, which by nature have only a limited power of physical heat regulation or animals the physical heat regulation of which is artificially inhibited (tiaeheotomised do^s) die if exposed to the sun, the bodv temperature rising to febrile heights If tl.e same animals are protected from the rays of the sun, or if the increase of heat due to radiation from the sun is compensated by an increased loss such as would be brought about by a strong wiud, then the animals suffer Insolation of the skull alone is no discomfort. without effect if the body temperature is kept within normal 1

season1?

^l^The

post-mortem findings 011 the animals dying result of insolation show decided hemorrhagic lesions of the meninges in the brain, and in monkeys in the heart. 3. In animals without sweat glands the subcutaneous tissues are heated by the radiated heat from the sun to temperatures above those compatible with life. 4. The human skin, if exposed to the sun is warmed to 3' to4? above the normal skin temperature (320,5 to 330,5C.) An increase, even to the normal body temperature, is prevented by evaporation of sweat. The cooling effect of the sweat secretion causes a fall of the skin temperature even if insolation is continued as

a

longer periods.

during

392

5.

THE INDIAN

The

brown skin

of

Malays,

while

MEDICAL GAZETTE.

theoretically

absorbing more heat in the sun, shows a smaller rise in temperature in the tropical sun than the skin of

under similar conditions. As an explanaan earlier and better water evaporation by sweat secretion takes place. 6. The air in the human hair, especially in black hair, under the influence of the tropical sun acquires temperatures far above those compatible with life. 7. It is demonstrated that in the tropical sun a man with a coloured skin is in a better position as regards heat regulation than is a man with a white skin. 8. Types of apparatus suitable for testing tempara-

white

men

tion, it is believed that

thermo-electrically are described. concluding I wish to invite attention to more general biologic questions as regards climate. The monkey, whose home is in the Tropics, withstands the sun less readily than any other animal I have observed, including even the white man. Of course, the monkey tures

In

does not live in the fields ; his home is in the forest, into which only a small proportion of the direct rays of the sun can enter. He instinctively avoids exposing himself to the sun for more than a few minutes. The same is true of the native of the Tropics, if he is left to his own customs Even if he is otherwise nearly naked, he often wears a large hat-like arrangement which shades not only his head but his body. Certain features of my climate must always be met. The temperate climate is only suitable for man if he heat But chemical protects his body against it. regulation would not be sufficient to allow us to withstand the cold of temperate climates without the protection of clothes and houses. The question of the best way to live in a certain climate will always be to learn how to avoid its injurious effects or to secure protection against them. No better example than the monkey which is killed by the tropical sun in from one to two hours can be found to confirm the above statement.

H/EMOGLO BIN URIC FEVER CANAL ZONE,*

IN

THE

This is the subject of an elaborate and complete pamphlet by Drs. Deeks and James. It forms a most complete review of the history,

and literature of this fascinating We can only quote the disease or complication. conclusions arrived at b}7 the writers:?

setiology,

fever proves that the was recognised and recorded prior to the time when the malady was distinguished either as an entity or as a symptom-complex of malaria. There is no proof that blackwater fever has spread from one country to another, as have kala-azar, yellow fever and sleeping sickness. On the contrary, the disease invariably manifests itself when certain conditions relative to the epidemiology of malaria and to that of no other disease are present. These conditions are :? 1. The presence of a population non-immune against malaria 2. The prevalence of malaria in such quantity as to produce an almost continuous infection in this population 3 A large proportion of festivo-autumnal malaria ; because the amount of blackwater fever is in direct proportion to the intensity of this variety. 4. The neglect of prompt and continued administration of quinine, especially in primary attacks to persons non-immune against malaria In every locality without exception, where these conditions obtain, hremoglobinuric fever is found The history of htemoglobinuric symptomatology of the disease

* Hiemoglobinuric Fever in tlie Canal Zone by D. E. Deeks and W. M. James. I. C. C. Press, Mount Hope, C. Z.

[Oct.,

1911.

The conditions may vary from time to time in the or in different localities, with a corresponding increase or decrease in the amount of hamioglobinutic fever are restricted in areas and absent They present from those contiguous When any condition varies, hcemoglobinuric fever varies in proportion. Tn this respect the malady differs from every infectious disease other than malaria, for it does not enter a hitherto non-malarial district except by the introduction of sestivo-autumnal malaria when this malaria becomes pievalent in a region formerly free, blackwater fever follows in proportion to the intensity of malaria and the capacity of the population to acquire immunity. Also, restivo-autumnal malaria may obtain very extensively among children when in places where the adult population by reason of continued attacks in childhood, has acquired immunity. If non-immunes do not enter such places or if after entrance prompt prophylactic and therapeutical measures are instituted against malaria blackwater fever does not prevail. These propositions are supported by positive evidence, and do not admit of controversy. Every statement made in support of them has concrete facts and the witness of authoritative observers as its basis The conditions necessary for the generation of hremoglobinuric fever explain clearly why the disease is absent from places where it once prevailed or is present in those fiom which it was formerly absent; why it occurs in not in others ; why it some malarious countries and obtains in certain areas only in malaria-infected districts ; and why in restricted localities or even in certain houses the malady may present itself, while those adjacent are free. Although the evidence associating hiemoglobinuric fever with the presence of malarial parasites is circumstantial, since it relies in great part on the skill and experience of observers, it is none the less strong and authoritative in actuality far more so than that which implies a lack of such association. Notwithstanding the reported absence in isolated instances of proof of malarial infection in blackwater fever during life or at autopsy, the connection between the two is not materially affected thereby, for when all circumstances of the relationship are considered in their entirety, the dependency of the latter upon the former is manifested to an extent unparalleled in the fetiology of infectious diseases. Then to the epidemiological evidence of this relationship is added these proofs : that in no other malady is malarial infection so constantly present; that in malarious countries other diseases fail to show even an approximate amount of such infection ; that mechanical and therapeutical measures instituted against malaria are equally efficient against hiemoglobinuric fever ; that prompt and efficient treatment against the one, no matter how greatly it obtains, is successful also in reducing the prevalence of the other ; either the truth of the relationship as asserted must be admitted or the existence of an organism dependent upon the conditions enumerated must be assumed. Such an assumption is not supported in biology, either by analogy or fact, unless some vague conjecture of an improbable symbiosis be so included Throughout our thesis we have referred to luemoglobinuric fever as a disease or else have used a synonymous term. We have done this partly in deference to the present custom, and partly to avoid ambiguity. Tn our opinion it is better to describe hremoglobinuric fever, as Marchiafava and Bignami have done, as " a syndrome which is encountered not rarely, especially in hot climates, in the course of a malarial infection." For, although medical usage may sanction in some instances the classification of different conditions dependent upon the same ^etiological factor as is no need for such distinctive "diseases," there application to the description " of the hemoglobinuria and associated symptoms that occur in the course of a malarial infection." Unlike some writers, we do not fii\d difficulty in calling blackwater fever a syndrome. It is not necessary same

THE PASTEUR INSTITUTE AT COONOOR.

Oct., 1911,]

to assume that all malarial infections of a certain intensity are followed hiemoglobinuria ; because, for such

by

determination

an individual predisposition is necessary. In most cases, but not in all, this predisposition is enhanced by repeated attacks of malaria. That is why regions of the most intense malaria produce the most blackwater fever; for the chances of very susceptible persons becoming infected with malaria are thereby made certainties, while the likelihood of determining a predisposition in less susceptible persons is correspondingly increased. Except in localities where malarial infection and repeated re-infection and relapses are continuous, hfemoglobinuric fever is comparatively rare, but it is not more uncommon than are the comatose and algid types of malaria, or any one of the syndromes depending upon interference with the functioning of the nervous system such as a paralysis or a neuritis. These like htemoglobinuric fever may occur at any time in the course of a malarial infection, especially in an untreated or improperly treated one, and do occur most often where malaria is most intense. Since it is not possible to predicate the amount of infection that results in the determination of any of these other malarial syndromes, otherwise than to say that they occur in proportion to the intensity of malaria, it is illogical to assert, as some have done, that blackwater fever should invariably follow when a certain degree of personal malarial infection has been attained. One might as Avell say that every infection with B. tuberculosis is followed by the same symptoms ; or that meningitis ensues when a certain number of the diplococci of pneumonia are present. We know that when such organisms localise in certain parts of the body, definite symptoms follow, and we believe that under certain conditions the toxins of malarial poison produce hemolysis ; but why some persons are thus acted upon, while others with equal amount of infection are not, is a problem that still awaits solution, nor does our lack of knowledge in this respect affect our cognizance of the primary cause. The primary cause in htemoglobinuric fever is either prior or coincident malaria, or both ; the immediate cause is sometimes the administration of quinine, but this never acts unless the primary cause has been or is Present. With this knowledge we are able to treat the syndrome intelligently, and often to prevent its occurrence, by the removal of the primary cause ; and by sending away from the source of infection those who since by reison of personal idiosyncrasy they cannot take quinine at any time without the production of blackwater fever, should not remain in a malarious

country.

393

the year 1910-11, the following number came for treatment, 148 Europeans, 73 Eurasians and 60G Asiatics, or 827 in all. The following table is of interest, showing the animals that bit, scratched or licked the of

During

patients

patients

Species

Number of persons bitten, scratched

of animals.

or

Dog

Jackal

...

???

...

...

...

...

THE PASTEUR INSTITUTE OF S. INDIA.

though subscriptions require more are needed.

to be

kept

up and

f ^ 3^0U

1

bitten

by

animals known to have been rabid ;

by animals probably rabid, judging by the histories

tamable; 164 by animals of which nothing was nown. Prophylactic treatment was indicated for all hese. Ninety-two persons who had come into some ort of contact with animals known to have been rabid ere treated because they refused to take any risks, jn .onjy 21 instances was there no evidence that the ,ng animals had suffered from rabies."

14

Guinea-pig

Man Horse Buffalo Cow Ass

82";

Scientific men will appreciate the publication of the following cases, of which we quote a few

examples

:?

Deaths

fhom

During A Hindu

1. a

dog severely

boy on

1910"

Hydrophobia. treatment.

from Mysore was bitten by right hand, on 21st April

He arrived here for treatment on 14th 1910. Hydrophobia developed on 23rd May 1910 during the course of treatment, i.e., 31 days after the bite.

May

2 A Hindu boy of Tirukkoyilur, South A root District, was bitten by a dog on the left hand on 24th July 1910. He came here for treatment on 10th September 1910. Hydrophobia developed on the 4th day of treatment, i.e., 53 days after the bite. A calf bitten by the same dog died of rabies 3 weeks after the bite. "

3

Another Hindu

boy, aged 7,

Presidency),

(Bombay by a doc*

who

was

of

Karabgaon

severely bitten January 1911,

on the chest on 6th here for treatment on 22nd January He developed symptoms of hydrophobia 1911 or. 31st January 1911, i.e., 25 days after the bite during the course of treatment and died on 1st February 1911.

A

who

woman bitten by the for treatment suivived.

Mahomedan came

Deaths within 15

Ihe

contains much of Director's report jnterest and of value. The virus in use was 1,1 'ts 334th passage on 28th Februaiy 1910. From Table IV it will be seen that 200 persons ^le 827 who received the full course of treatment rl .

788

...

Cat

arrived?

The report of this Institute reached us in ? middle of August. It deals with the 3-ear which ended on 28th February 1911. The Institution is financially flourishing,

licked.

...

tion 1.

A

of

days after

dog

comple-

treatment,.

Mahomedan boy of the face

the

same

frindupur,

bitten

14th April 1910, arrived here for treatment on 17th April 1911. He died of hydrophobia on 8th May 1911, 8 days after completion. 2. A police duftadnr from Mysore was bitten by a dog on the right ring finger on 28th June He came here for treatment on 17th 1910. July 1910. He died of hydrophobia ou the 6th day after the completion of treatment.

by

a

dog

on

on

THE INDIAN MEDICAL GAZETTE.

394

The

following

"Facts Bearing

monoideist and

is of interest:?

on the

Virulence

of

Rabies

in

India.

Velur case.?Three persons were bitten by one dogOne died from hydrophobia 40 days later, one was living 70 days after the bite, one was treated at Coonoor and survived. Arcot case.?Seven persons were bitten by one dog. Two died from hydrophobia 40 and 60 days later. Three were alive after three months. One could not be traced One was treated at Coonoor and survived. Semndcrabad case.?Two persons were bitten by a dog. One died from hydrophobia 45 days later, the other was treated at Coonoor and survived. Kurumbranad case.?A dog bit a calf, a cow, and a boy. The cow and calf both died from hydrophobia 27 and 29 days later. The boy was treated at Coonoor and survived. Kolhapur case.?A dog bit 8 persons. Three died from hydrophobia from 5 to 6 weeks later. Five came to Coonoor for treatment and survived." " 'llie number of persons coming to Coonoor for treatment is steadily increasing year by year, and it is impossible to forecast when the limit will be reached. It is impossible to ascertain what the real mortality from rabies in villages is, unless the special measures which have now been suggested to Government be taken. There can be no doubt that the persons bitten who arrive in Coonoor form an inconsiderable proportion of the total number of the bitten. The number of our patients, in consequence, depends largely on the interest displayed by local authorities in promulgating news of the existence and object of the Institute and in persuading people to go to Coonoor. For instance, from the neighbourhood of Badagara alone 30 patients have come to Coonoor for treatment during the past two and-a-half months. This is in all probability not so much due to the exceptional prevalence of rabies round Badagara at the present time, but to the alacrity of the Talisildar in sending everyone for treatment whom he hears has been bitten by a rabid dog.'"'

The staff of the Institute consists of Major W. Cornwall, m.d., i.m.s. ; Captain A. G. McKendriek, M.D.; and Sub-Assistant-Surgeon S. Raraasawmy Aiyar, and they are to be congratulated on a very successful year of both practical and scientific work. J.

HEALING NOTHING BY DOING

NOTHING.

In the July number of the Caledonian Medical Journal Colonel Kenneth Macleod, M.D., LLD. (i.m.S., retd.), has a useful and interesting article on that strange product of the end of the 19th century?Eddyism or so-called Christian science. It has been defined as a thing which is certainly not Christian and certainly not science?but it exists, and Colonel K. Macleod in a very interesting way sums up Mrs. Eddy's strange and checkered career and the curious doctrine she has put forth. We need not here trace the history of this neurotic individual; a life of her has recently been published. It is quaint to notice that Mrs. Eddy claimed some relationship to that most distinguished officer of the Indian Medical Service, Sir John McNeill, G.C.13, Ambassador in Persia. Colonel K. Macleod gives good reason for believing that Mrs. Eddy was insane, certainly a

[Oct., visionary

and

a

1911.

pronounced

neuropath. THE NEW SYDENHAM SOCIETY,

The New Sydenham Society has come to an end, and Sir Jonathan Hutchinson who has done such stalwart work for the Society for many years past, has issued a small book entitled Retrospective Memoranda, which includes a subject index of all the many volumes published by the Society since its initiation in 1859. The good work done by the Society from 1859 to 1907 is known to all, and English Medical literature has been enriched by the translation or republication of some 200 standard works, not otherwise accessible to English readers. Among these may be mentioned Diday's Inherited Syphilis, the first work issued by the Society, and its last work was a collection of monographs on the Spirochseta of Syphilis. Other well-known volumes were Trousseau's

Clinical

Medicine;

Hirsch's

Geographical

Pathology?a work not yet superseded ; Hebra's Forensic Diseases of the Skin; Caspar's Medicine in 4 volumes; Charcot's works; Colcott Fox Edition of Morrow's work on Drug Eruptions; Cohnheim's Pathology; Kleb's and Thomas's book on Malaria; Laveran's book on Paladism and the wonderful series of Atlases, and the less successful Medical Lexicon. The New Sydenhan Society was wound up at a meeting held on January 19th, 1910, and this interesting Retrospective Memorandum closes its history and fitly records the great work done, more especially by Sir Jonathan Hutchinson, who for half a century was Secretary to the Society, and left his mark on all it has done. We are glad to see that the Ipecacuanha treatment of acute hepatitis is being increasingly used in the military hospitals both at home and in India. The Journal R. A. M. C. (in July 1911) has two cases reported, "Striking Examples" of its value. It is a pity that full reports of this successful method of treatment are not published ; there must be dozens of cases in the various station hospitals. Sir William Leishman, r.a.m.c., the newly elected President of the Suciety of Tropical Medicine and Hygiene, urges a great attendance at Meetings, and advocates some alterations in the Transactions, the establishment of a small technical library and the formation of type collections of microscopical and other specimens of tropical diseases. An Editorial Committee has been formed. The Managing Committee of the Sleeping Sickness Bureau has decided to publish from this the Office a Quarterly Bulletin dealing with Dr. C. M. Leishmania group of diseases.

0cT>

1911

j

BOOKS REVIEWED.

Wenyon, Protozoologist to the London School of Tropical Medicine, will undertake this part of the work. A list of references is now in preparation and will form the first number. Those who wish to receive the new Bulletin should send their names to the Director. He will be glad to have copies of publications on this subject for the Bureau Library. \Ve are glad to note a steady, if slow, progress in the Rangoon Medical School. The need of such in Burma is imperative, but the Burmese unfortunately are not inclined to join the medical profession. The school began only a few years ago, and the first batch of final year students, 10 in all, have qualified and have been immediately provided with employment. Fifteen new students joined in 1910. We wish this young school every success. The Journal of

Tropical Veterinary Science No. 3), published in August, is one of considerable interest. Major Baldrey has a good article on Antirinderpest serum and on the evolution of the Tiypanosoma evansi. The Notes on Parasites are excellent, and the summaries and extracts from parasitological literature are complete and full as usual. (Vol. VI,

]

395

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