Chapter VIII (3)

Boils are extremely common, and are most painful and debilitating when present in large numbers, as they often are in hot climates, and I believe they should be really regarded merely as _sequelæ_ of neglected prickly heat and not as a distinct condition. For these reasons the writer is strongly of opinion that prickly heat should always be treated, especially as it is usually quite possible to keep it within moderate bounds, by the use of appropriate remedies. At sea the use of salt water for bathing should be avoided, but frequent bathing in fresh, and especially in rain water, is not only a great alleviation, but tends towards cure by removing the irritating accumulation of saline matter that results from the constant evaporation of the perspiration. Almost any metallic astringent, such as sulphate of copper or sulphate of zinc, 4 grains to the ounce, will be found to be extremely useful in reducing the extent of the irritation, but none of these are nearly as effectual as a lotion of perchloride of mercury of a strength of one per thousand.

This agent can be obtained ready measured out into tabloids, which are always coloured blue to prevent mistakes in handling the solution; which is a most useful one, not only for this purpose, but as a general antiseptic. Care should, of course, be taken in the custody of these tabloids, and also in the handling of the solution; but the latter is not really more poisonous than the copper solution, or than many other antiseptics which, like carbolic acid, are nowadays in constant domestic use. This mercurial solution is undoubtedly by far the best remedy we have for prickly heat, and I have never seen any harm or signs of absorption of the mercury result, even from its copious use. The tabloids should be got of such a size as to make about a quarter of a pint of the solution, and after the bath and before retiring to bed, all affected parts of the skin should be dabbed with a bit of lint dipped in the solution, which should be allowed to dry on to a certain extent before putting on one’s clothes. A further great advantage over the other metallic astringents is that, owing to the weakness of the solution, it does not injure the clothes, and the slight blue aniline colouration easily washes out. It will be found, too, an almost complete preventive against boils, if resorted to from the commencement of the hot season. Powdering with violet powder is also useful in subduing the irritation, which by the adoption of the above-described plan, may almost always be kept within moderate bounds.

“Dhobi’s itch” is a troublesome irritation of the skin often met with in hot climates, which is due to the growth of a minute fungus within the structure of the scarf-skin. It commonly attacks those parts of the body where the surfaces of the skin come in contact with each other, as, for example, between the legs, and in the armpits. The general appearance is very much that of a “ringworm,” the patches spreading by their edges, where they are red and irritable and tending to fade in the middle. There can be little doubt that the disease is generally caught by the infection of clothing that has been washed in dirty pools along with that of previous sufferers from the disease, which is very common among the native races. If neglected, it is apt to spread so as to cover a large area, under which circumstances it is apt to be troublesome, but if taken early, there is generally no difficulty in dealing with it. All that is necessary is to destroy the fungus by means of strong antiseptics, but in doing so it must be remembered that any solution strong enough to kill the fungus must necessarily also cause more or less inflammation and, for the time, increased irritation of the skin.

On this account, if any considerable area be involved, it is a mistake to attempt to treat the whole of it at once, as such a course may easily result in producing an amount of soreness and inflammation which may involve confinement to bed. The patches should be attacked piecemeal, a couple of separate patches the size of a shilling being quite as much as is prudent to attack on any one occasion.

Equal parts of tincture of iodine, carbolic acid and glycerine painted over each patch, to the extent above described, is a safe and efficient remedy, as also is Goa powder; but the essential point is to be on the look-out for the contingency, and to at once treat any patch that may appear before it has time to spread.

The disease is, I believe, common enough in other warm climates, but I am not acquainted with its popular designation elsewhere than in India, where it is known by the above name.

ON THE PREVENTION OF DISEASES CAUSED BY INTERNAL WORMS.

_Internal worms_ are extremely common in most hot countries, and especially in those climates where moisture and heat are combined. Where they prevail to a serious extent, they often constitute one of the principal causes of mortality amongst natives, but white residents rarely suffer, as the habits of the better-class European to a very great extent protect him from being invaded by these pests.

There are three principal sorts of these parasites: the round-worms, which usually divide their time between some animal and the outer world, and the flat-worms and the flukes, both of which must pass through two or more animal hosts. The life-history of these troublesome guests, especially those belonging to the two latter classes, include some of the most wonderful and interesting pages of natural history, but unfortunately considerations of space prevent our describing these changes except by the barest allusions.

The commonest round-worms that establish themselves in mankind are the common thread-worms and round-worms (_Lumbrici_), and that much more formidable pest of tropical life, the _Ankylostoma_, or hook-worm.

Thread-worms and Lumbrici are common enough everywhere, but are far more commonly troublesome in hot climates than at home in Europe. The eggs of both are probably usually carried into the human intestine on food or in drinking water, and in the case of the Lumbricus this is the only way in which the numbers of the parasite can be maintained, as its eggs take a long time to hatch out; but those of the thread-worm, when deposited, are quite ready to burst at once, and though no individual worm as a rule resides within the intestine for any great length of time, the patient infested with them is continually reinfecting himself, so that their numbers have a tendency to increase. Thread-worms are especially common in children, on account of the strong tendency of the little folks to put their fingers in the mouth.

Thread-worms live in the lowest part of the bowel, and so cause much itching and tickling about its orifice. This prompts the child to scratch itself, with the result that some of the innumerable eggs laid by the worms adhere to the fingers, and once there soon find their way, along with the fingers, into its mouth. The intruders are usually easily expelled by an injection of salt and water, but it is difficult to get rid of all of them, and the child is nearly sure to reinfect itself unless it is made to sleep in drawers. Provided reinfection is prevented in this way, however, the remaining worms will soon be got rid of, as this species as a rule does not take up a prolonged residence.

Round-worms can be expelled by the means of a dose of santonin, but as neither these parasites nor tape-worms usually cause immediate serious symptoms, and both this drug and most other vermifuges require a certain amount of care and caution in their administration, it is better to wait any moderate time until the treatment can be supervised by a medical man.

The third common round-worm parasite--the hook-worm namely--though but little known in Europe, is so widely distributed in hot, moist countries, that in such climates the greater proportion of the indigenous races are often affected to a greater or less extent. It is quite a small worm, but fastens on the lining of the bowel in exactly the same way as leeches attack the outer integuments, and exhibits the same insatiable appetite for blood. The extent of the mischief wrought by them depends entirely on the number harboured. When only a few are present, they may be considered practically harmless, and thousands of such cases are to be met with in any country where they are common; but wherever this is so, numbers of subjects will be met with, in whom they are so numerous as to cause serious symptoms and death; so that there are many places where they constitute one of the most serious scourges of the Tropics. The eggs of this parasite, deposited along with the dejecta of persons infested with them, hatch out in the soil, and multiply there enormously, so that owing to the insanitary habits of the populace, the soil round about a native village comes to swarm with this free stage of the parasite. Now as the population is generally a purely agricultural one, and none too nice in its habits, it can be easily understood that persons, eating as they do with unwashed hands, must constantly carry to their mouths some of the earth containing the minute embryos which convey the disease, and hence the process of infection is commonly continuous and progressive. As a matter of fact, out of some hundreds of specimens of drinking water examined by the writer in Assam, where the disease is extremely rife, in no one case was there anything found to show that the malady was commonly conveyed in water, but the contingency is clearly a possible one; and in any case, it is clear that very moderate care as to food, water, and personal cleanliness would suffice to render infection impossible. From what has been said, it is easy to understand that the disease is practically unknown among European residents whose habits have reached the most moderate degree of refinement; but though it may not affect the planter’s health, it reacts most seriously on his pocket, owing to the disastrous amount of sickness and mortality it gives rise to among his native labourers. Now it is perfectly obvious that this disease can be easily prevented by the most ordinary measures of conservancy, and the question whether the evil can be obviated or not, is purely one of whether the master has the will and power to insist on the use of proper latrines. This, however, is by no means so simple a matter as it looks, where one has to deal with labourers belonging to a primitive stage of civilisation. Once seen, the disease is easily recognised by the deadly pallor of the lining membrane of the eyelids, and of the tongue, especially the latter, which looks much like a piece of a wet, pipe-clayed buff belt. By treatment with vermifuges and careful nursing there would be little difficulty in curing people of European habits; but only those who have had to attempt it know how impossible it is to get semi-civilised people to adopt, or even submit to, what to us are the most ordinary sick-room comforts, and as a matter of fact, there is very little hope for a native who is at all seriously affected with these parasites.

The best vermifuge we have is thymol; three doses of 30 grains each, given within six hours, followed up by a dose of castor oil. A certain amount of caution is required in giving this to cases in a very weak state, but after all it is the only chance for them. This medication may have to be repeated once or twice, at intervals of a week, and should be systematically carried out in all cases that have not gone too far. The worst of it is, that unless proper sanitary measures can be carried out, treatment is little better than a waste of drugs, as otherwise the patients will be sure to reinfect themselves within a few weeks, however thoroughly the vermifuge may have done its work.

The Guinea-worm is a curious parasite, which is found burrowing under the skin, and finds an exit through the opening formed by a sort of boil. It very rarely attacks Europeans, as it may be avoided by the most ordinary care in the matter of water used for drinking and bathing.

Another curious malady caused by one of the round-worms is the blood-worm disease, or filariasis. In this the parent worm is found embedded in the tissues of the host, and periodically discharges into the blood enormous numbers of its embryonic offspring. As this disease is undoubtedly communicable through the agency of mosquitoes alone, its prevention may obviously be secured by the adoption of the same measures that serve to protect us from malaria.

Tape-worms have a very curious life-history. The long, flat, jointed strip is really a chain of sexually mature individuals, but when their eggs are swallowed by an animal there is hatched out from it, not another tape-worm, but a minute embryo, which has the power of boring through the tissues of its host till it reaches some favourable resting-place, where it settles down, protected by a capsule, forming what is known as a bladder-worm. It may live for years in this condition, but cannot reach maturity until the capsule has been swallowed by some carnivorous animal, though some species can multiply non-sexually and so cause terrible damage to the animal that harbours it. Both stages of several species of these parasites infest man, but fortunately their prevention is a very simple matter, at any rate as far as the adult strings of worms are concerned, as infection is impossible provided all meat and fish eaten be thoroughly cooked. The mature stage of the bladder-worm which is found infesting man inhabits the intestine of the dog, and as it is capable, in this stage, of non-sexual multiplication, may give rise to large tumours, the effects of which may be most serious if a vital organ be invaded. Though almost a medical curiosity in Europe, it constitutes a really serious danger in certain pastoral colonies, such as Australia, where large numbers of dogs have to be kept for herding sheep, and are allowed unrestricted access to the offal of carcases, which is, of course, very abundant where meat-preserving is an important industry. The disease might be guarded against by preventing the dogs having access to anything but thoroughly cooked meat, and by avoiding undue fondling and too close association with these animals.

The third important class of parasites, the flukes, but rarely infest man, but in Egypt and, in fact, throughout Africa, a peculiar fluke, the _Bilharzia_, is found infesting the blood-vessels, especially those of the kidney, and gives rise to the appearance of blood in the urine. It is extremely common amongst the natives of Egypt, but it very rarely attacks Europeans, and though we are quite in the dark as to its life-history outside the human subject, there is little doubt that moderate care as to the water used for drinking and bathing is sufficient to afford complete protection against the disease.

PART II.

OUTLINES
OF
TROPICAL CLIMATOLOGY

ERRATA.

p. 9, line 9 from foot, _for_ “Camerun” _read_ “Cameroon”; and line 12
from foot, _for_ “Shilling” _read_ “Shillong.”

p. 58, line 11 from foot, _for_ “Sangor” _read_ “Saugor.”

p. 63, in table, line 11 from top, _for_ “Ayra” _read_ “Agra.”

p. 84, line 1 in table, and p. 85, line 3 in table, _for_ “Mazattan”
_read_ “Mazatlan.”

OUTLINES
OF
TROPICAL CLIMATOLOGY.