The Milroy lectures on kala-azar, delivered before the Royal College of Physicians of London. Lecture II, Kala-azar as a disease / by Leonard Rogers.
- Leonard Rogers
- Date:
- 1907
Licence: Public Domain Mark
Credit: The Milroy lectures on kala-azar, delivered before the Royal College of Physicians of London. Lecture II, Kala-azar as a disease / by Leonard Rogers. Source: Wellcome Collection.
13/14 page 494
![Tur Brizise ] MrpicaL JOURNAL 9494 [Marce zB, 1907. shown it to be widely distributed all over Lower Bengal and Assam, except the eastern part of the Brahmaputra Valley. It also occurs somewhat less frequently in Western Bengal or Bihar, and extends into the neigh- bouring eastern end of the United Provinces of Agra and Oudh, cases in soldiers having been verified by the officers of the Royal Army Medical Corps at Benares, while I have also seen two who appear to have contracted the disease in Allahabad, and others have been met with among Gurkhas as far west as Dehra Dun. On the other hand, during an examination of the records of all the fever cases admitted to the Lahore Medical College Hospital for three years I failed to find any cases resembling sporadic kala-azar, while it is ‘also specially noteworthy that I met with no double remittent, low continued or other doubtful long fevers among them. The Bombay records also show a similar absence of the disease, except rare importations from Madras, so that the disease appears to be limited to the eastern side of India, al- though I am informed that Burmah, like Bombay, only has cases contracted at Madras. In connexion with this distribution it is of interest to note that the areas affected all have a very mild cold season, during which the mean temperature for three or four months remains between 60° to 75° F., for I shall show in my concluding lecture that these are the limits between which I have been able to cultivate the parasite outside the human body. On the other hand, in the un- affected north-west parts of India the mean temperature during the cold months falls lower, while owing to the brevity of spring and autumn in India, the temperature conditions most favourable to the organism outside the human body last a very short time in those areas. EFFECTS OF SEASONAL VARIATIONS ON THE PREVALENCE AND ORIGIN OF THE DISEASE. I have already shown that the infection of kala-azar is probably limited to the cold season, so an exceptionally long “ cold weather” might be expected to temporarily in- crease the occurrence of the disease. This is actually so, for two years ago such a cold season occurred, and during it and the following early hot weather months an unusually large number of sporadic kala-azar cases were admitted to both the native and European hospitals of Caleutta—many more than in the following year, with a normal cold season. Now this long “cold weather” followed an early cessation of the previous monsoon rains, for the withdrawal of the south-west monsoon is succeeded by a cold north breeze; and it will be remembered that in my first lecture I pointed out that the Assam epidemic arose as a consequence of four out of five successive years of deficient rainfall in the early Seventies, due to an early cessation of the monsoon current. I have not been able to get complete meteorological data for Rungpore in the Seventies, but those of Calcutta of that period do show that during several of the years of deficient rain the mean temperatures of the ensuing cold season were below the average. . Now, if a single cold year had such a marked influence in- increasing the sporadic kala-azar in Calcutta, on account of the longer period which was favourable to the infection, it becomes easy to understand how an unusual succession of such seasons might have increased the number of cases, and so the foci of infection, year by year, until the fever became so widespread that the people began to leave their villages, and thus carried the in- fection into areas at the foot of the Garo Hills and in the Goalpara subdivision, which had hitherto been almost, or quite, free from it, and so started the spreading disease in Assam in a people who were extremely susceptible to it, owing to not having previously suffered from the sporadic form. Such an origin of the Assam epidemic kala-azar ig most in accordance with the known facts, and also with the life-history of the parasite and mode of in- fection, which I shall deal with in my remaining lecture. Tue Sleeping Sickness Commission of the Royal Society has issued a further report (No. VIII) which contains a continuation of the report on the disease in Uganda. by Lieutenant Gray, R.A.M.C., and the late Lieutenant Tu loch, R.A.M.C., a report on the disease in Unyoro and t Nile Valley, and an account of experiments on the po Minchin and others. MEMORANDA: MEDICAL, SURGICAL, OBSTETRICAL. THE TREATMENT OF ECZEMA. it is now admitted that eczema is not caused by a parae Sitic organism. The coccus, which appears in mulberry- shaped masses, and which was named moroceccus by Unna, is now thought to be a staphylococcus of low virulence frequently found on the skin. Sabouraud has. shown that the vesicle of eczema is at first sterile, which quite puts out of court the presence of any specific micro- organism, It follows, therefore, that anti-germicidal applications are not called for, and indeed have often made a pure and simple eczema much worse by irritating it. Care must be taken to exclude seborrhoeic dermatitis, which is only benefited by certain antiseptic remedies. No doubt various food toxins and the products of im- perfect metabolism and malassimilation by circulating in the blood can produce erythemata as well as other con- ditions of the skin, and if they cannot often produce an. eczema, they may aggravate it and possibly produce it in a predisposed subject. To counteract this tendency,. diet the patient, and prescribe correctives, of which salicin is one of the best in these cases. Water taken between meals is also helpful. . All that is required locally are quieting and protective applications. If for any reason sodium chloride is retained beyond the normal quantity, the excess entails the retention of an additional quantity of water to. hold it in solution. The surplus salt and water under certain circulatory conditions passes out of the blood into the tissues, and in this way eczema may be kept up. So that it may be necessary to lessen or cut off the common salt the patient is accus- tomed to take with food. So many cases of eczema are produced by susceptible individuals handling poisonous plants, such as the Primula obconica, as well as many chemical and other substances, that one has to be constantly on the look-out for this cause. ; Eczema depending chiefly on a neurotic tendency, and usually occurring in people who are broken down in general health, is difficult to manage, and is not much benefited by ordinary treatment, unless a change into the country is insisted on. If this is not practicable, perhaps. cod-liver oil does as much good as any internal remedy. Inquiry as to the amount of sleep the patient gets is also important, as there is no better restorative for nervous conditions. It is almost unnecessary to mention that cleanliness of the eczematous surface should be carried out with a weak alcohol, as diluted methylated spirits; or, if the eczema is very acute, with weak warm gruel instead of soap and water. As Lionel Beale used to say, few people know what. a healing remedy spirit is to the skin. ; A Where much thickening has occurred, and especially if fissures have formed, eczema rimosum, nothing does SO- well as local dressings of some reducing agent, as salicylic acid in various strengths. In severe cases of eczema, and - when an extensive surface is involved, the good effect of rest should be remembered, and the patient confined to bed. . ; Although alcohol is valuable externally, it disagrees if given internally in eczema by dilating the peripheral vessels. It is not too much to say that if an adult's eczema is receiving suitable treatment to which it does “not favourably respond, the abuse of alcohol should be suspected. If the surface of an eczema does not show much redness, a weak preparation of spirit and tar painted on once or twice in the twenty-four hours, in addition to the ordinary application, at once relieves the itching and cures the eczema if the case selected is found to tolerate this interference. Clifton, Bristol. OBSTRUCTION OF THE OESOPHAGUS. Bue report by Dr. H. E. Davison! of a case of oesophageat truction due to the presence of a bolus of meat, whieh ieved by a timely dose of apomorphine, reminds me wnewhat similar case I had the opportunity of seeing HENRY WALDO. 11 Was |ealled to see a woman, aged 52, who had, it was swallowed a hard pea, and was choking. On my SRITISH MEDICAL JOURNAL, January 19th, 1907, p. 133.](https://iiif.wellcomecollection.org/image/b33455119_0013.jp2/full/800%2C/0/default.jpg)
