Introduction.
THERE are a number of diseases which affect principally or entirely those who have to live in or to visit tropical countries, and other diseases (like Malaria) which, though more widely distributed, are nevertheless mainly associated with warmer climates than that of England. The principal disorders of both kinds are described in this chapter under the one general heading of Tropical Diseases, together with a few like Pellagra and Hookworm disease, which have no claim to be called Tropical, but are nevertheless unknown or very uncommon in England. These diseases are virtually all parasitic: those due to larger parasites are first described, and then those due to bacteria. In previous editions of this book ague and yellow fever were included in the main body of the work, but they are better transferred to this chapter, for although malaria was once an English disease and is still prevalent in parts of Europe, it is most dangerous and important in regard to tropical countries.
246. Filariasis.
There seem to be several forms of filaria, which are nematode worms, inhabiting the blood and lymph stream of the patients. They gain access through the bite of the mosquito, which in its turn is infected by sucking the blood of a person suffering from an invasion of these parasites. They breed in the human body, and the eggs develop up to a certain stage; the full development of these embryos is completed in the mosquito.
SYMPTOMS- Filariae may be present without causing any symptoms. Those that occur are mainly the result of obstruction of lymph channels by the worms or their ova. When the lymph channels are blocked anywhere, the parts drained by these channels swell, and the tissues become enormously thickened. The scrotum is often affected in this way, and certain cases of Elephantiasis are due to filariae (see below). Another symptom frequently observed is the passage of chyle (a product of fatty digestion) in the urine, together with a little blood (haematochyluria). It is due to interference with the abdominal lymph channels from the parasites. The urine presents a curious opaque milky appearance. The general health as a rule suffers little with filaria. The Elephantiasis, or enlarged glands which frequently appear can be dealt with surgically sometimes. No treatment seems to be able to destroy the embryos in the blood, although if the patient presents any well-marked general symptoms the constitutional remedy indicated by them should be given. The bites of mosquitoes should be guarded against and the drinking water in infected districts boiled, as it is quite conceivable that an entrance of the worms may be effected in water.
247. Elephantiasis.
In tropical countries filariae are responsible for most cases of this disease. In temperate climates the disease arises independently of them, but it is convenient to describe it here following Filariasis. The appearances are similar, whatever the cause of the disease.
SYMPTOMS- These are all due to the blocking of the lymph channels. If not due to filariae it can be caused by repeated inflammation, erysipelas, phlegmasia dolens, even long-continued eczema. Often the cause is obscure. The subcutaneous tissue becomes enormously hypertrophied, vessels, muscles, nerves, all the tissues, even the bones increase in size. Vesicles and bullae may form and discharge a serous or milky fluid. Eczema and ulceration of the skin are common. There are aggravations from time to time, accompanied by fever. The limb affected, or in males the scrotum, ultimately becomes of enormous size.
TREATMENT- The removal of the affected part may be the only remedy. Fever, eczema, or ulceration can be treated as described elsewhere in this book, and if there are any indications for a constitutional remedy it should be given, but where the cause of a disease is mechanical, mere medicinal treatment is not hopeful. Hydrocotyle, (O or 1x) has been praised, however, for this condition.
248. Guinea Worm Disease (Dracontiasis).
This disease is due to another filaria, Dracunculus medinensis, which is widespread in Africa and East Indies. Cases have occurred in the United States.
SYMPTOMS- Only the female worm is known. It gains entrance by being swallowed in an embryonic form. Probably both male and female are swallowed and develop. The female is impregnated and the male then dies and is discharged, while the female penetrates the intestine and burrows into the subcutaneous tissues, where for a time it may remain quiescent, feeling like a ball of string. Presently it begins to travel beneath the skin towards the foot and ankle, where it usually penetrates the skin, making a small ulcer, through which the embryos are discharged. The worm then spontaneously leaves its host.
TREATMENT- The worm is recognized without difficulty in the later stages. It can be excised or killed by mercurial injections. When it begins to come out spontaneously, the usual plan is to roll it round a smooth stick, and each day wind a little more. Great care is taken not to break it.
The leaves of a plant called amarpattee are said to be specific and Asafoetida in large doses is praised. Teucrium O might be tried, but as soon as the worm is recognized efforts should be made to remove it.
249. Ankylostomiasis Hookworm Disease.
This disease is due to a nematode worm, Ankylostoma duodenale, which inhabits the intestine. The embryo lives in water or moist ground, and often gains access to the body by being swallowed, but it appears to be established that the embryo worms can also pierce the skin, enter into the blood vessels, pass from the pulmonary vessels into the air spaces of the lungs, up the trachea and down the pharynx. The disease is prevalent in tropical and sub-tropical countries. The so-called Egyptian Chlorosis is due to it; it particularly affects miners and workers in tunnels, and is endemic in the Southern States of America; it is also well-known in Germany and Austro-Hungary, and an epidemic has occurred in Cornwall. Both sexes are found; the female worm is the larger, and the worms live chiefly in the small intestine.
SYMPTOMS- A considerable number of parasites must be present to cause symptoms. The worms fasten on to the wall of the intestine with their teeth and (probably) live by sucking the blood. Blood also escapes from the wounds made in the bowel wall, which may in time become inflamed and thickened. The presence of the worms causes gastric and intestinal irritation and often fever, and soon from the loss of blood a profound degree of anaemia ensues. It is this that usually attracts attention and sends the patient to the physician. The skin is of a dull, muddy colour or waxy white, the eyes lack-lustred. In children growth is impaired and stunted. The anaemia causes palpitation, oedema of the feet, cardiac weakness. Liver and spleen often enlarge and the abdomen becomes swollen. If the blood is examined by an expert there is found a great increase in the number of one kind of white corpuscle known as the eosinophile. This blood change is characteristic of worm diseases of all kinds, but is very marked in this disorder. The diagnosis is made by examining the faeces. The eggs of the worm are readily found under the microscope; they are present in severe cases in large numbers.
TREATMENT- As soon as the diagnosis is made an attempt must be made to kill the worms. The patient should be kept on spare diet for a day to two, and then half a drachm of thymol given. This dose is repeated in two hours, and two hours later castor oil is administered. Smaller doses over a longer time can be used for weakly patients or children. The thymol can be given in brandy. Oil of Male Fern can be used instead of thymol, but the latter seems more efficacious.
The general treatment is that of anaemia. China, Ferrum and Acid. Phosphorus will be found useful. Stannum should be remembered as it seems to be of real value in worm cases. In children Spigelia, Teucrium, and Cina may very likely be needed. The stools must be regularly examined, to make sure that the worms are destroyed. In places where the disease is prevalent the greatest care should be exercised with regard to sanitation, especially if possible the thorough disinfection of stools.
250. Bilharziasis.
DEFINITION- This is a disease due to an animal parasite, a blood fluke, Bilharzia haematobia. It prevails particularly in Egypt, but also is common in North Africa, and less common in South Africa, Arabia, Persia and Western India. The mode of entrance into the body is uncertain. It may be through the skin, or by the mouth, or urethra. Probably the eggs are swallowed with water, or on cresses. The eggs develop, the worms reach the portal vein, and then other parts of the body, particularly the bladder and rectum. The eggs are laid in the tissues and cause irritation, fibroid changes, even papillomata, or form the nuclei of calculi in the bladder.
SYMPTOMS- These depends on the principal site of the parasites. There may be little or no inconvenience. Irritability of the bladder, with dull pain and haematuria are the commonest symptoms. If the rectum is much involved there will be tenesmus, straining and passage of blood and mucus. Definite cystitis or inflammation of the rectum come later, and calculi in bladder or kidney may demand surgical interference.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."