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.
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.
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.
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.
TREATMENT- There is no remedy known which will kill the parasites in the tissues. At the same time the treatment of the resulting cystitis, etc., may do much to enable the parasites to be dislodged and the symptoms relieved. Hamamelis, Terebinth, Cantharis, Ocimum Can., Ac., Benz., Cann. Sat. are remedies to be considered for the bladder symptoms, and Hydrastis, Ac-Nit., Paeonia, Ruta for the rectal symptoms.
This is a disease due to a sand flea called Pulex Penetrans, or Jigger. It is entirely local, affects chiefly the feet, and is caused by the insect penetrating the skin and burrowing there, producing an inflammation with a vesicular or even pustular swelling. The treatment consists in removal of the parasite with a needle. The application of essential oils to the feet is a useful preventive where the parasites are known to be numerous. The West Indies and South America are the places where the insect thrives.
252. Malaria Ague Intermittent Fever.
DEFINITION- An infectious disease, characterized by (a) paroxysms of intermittent fever, each paroxysm consisting of a cold, a hot and sweating stage, while between the paroxysms the patient is comparatively well. There are three chief types of this form of disease: Quotidian, with a daily paroxysm; Tertian, with an attack every other day; and Quartan, with an attack every third day; (b) a continued fever with marked remissions; (c) a pernicious rapidly fatal form; (d) a chronic cachexia with anaemia and enlarged spleen. All these forms of the disease are due to parasites living in the blood, the so-called plasmodia. The parasites are not identical in the different varieties of Malaria, but belong to the same order. There is a parasite for tertian, and a somewhat different one for quartan. Quotidian ague is due to infection with two groups of tertian, or three groups of quartan, organisms maturing on successive days, for the paroxysm of ague corresponds to a definite stage of development in the parasite. The parasite grows in the red blood corpuscles up to the stage of segmentation, and then escapes into the blood stream. Outside the human body the parasite passes through another stage of development in the body of mosquitoes of a certain genus, called Anopheles. The mosquito is infected from sucking human blood, and in its turn infects man by biting, when the parasite is growing in its body. The anopheles, unlike the ordinary mosquito (culex), breeds in small shallow puddles, or slowly-running streams. Hence the association of Malaria with swampy and undrained districts, and the prevention of it by efficient drainage, removing the breeding places of the anopheles. The relation of the mosquito to Malaria was worked out by the genius of Sir R. Ross, working on the theory formulated by Sir P. Manson.
SYMPTOMS- These may set in suddenly, or they may appear gradually, until a regular paroxysm occurs. The first stage comes on with a feeling of debility, weariness, chilliness, and rigors; then follow sensations as of cold water trickling down the spine and a shivering of the whole body; the teeth chatter, the nails turn blue, and the whole frame trembles, often with such violence as to shake the patient’s bed. The face becomes pale, the features and skin contracted, and the papillae of the skin are rendered prominent, giving it the appearance described as goose- skin, such as may at any time be produced by exposure to cold. The countenance acquires an anxious expression, the eyes are dull and sunken, the pulse frequent and small, the breathing hurried and oppressed, the tongue white, and the urine scanty and passed frequently. After a time, varying from half an hour to three or four hours, the second or hot stage comes on with flushings, until the entire body becomes hot, with extreme thirst, full bounding pulse, throbbing headache, and restlessness, the urine being still scanty, but high-coloured. At length, after two, three, and even six or twelve hours, the third or perspiring stage succeeds, and the patient feels much relieved. Thirst diminishes, the pulse declines in frequency, and the appetite returns; at the same time there is a red deposit of urates in the urine. The perspiration first breaks out on the forehead and chest, and gradually extends over the entire surface; sometimes it is only slight, but at other times it is very copious, saturating the patient’s linen and bed-clothes. A paroxysm usually lasts about six hours, allowing two hours for each stage. The period between the paroxysms, as already explained, is called the intermission; but by an internal is meant the whole period or cycle between the beginning of one paroxysm and the beginning of the next.
EFFECTS- From the recurrence of internal congestions in each cold stage, the functions of the liver, bowels, and sometimes the kidneys, are disordered; the patient becomes sallow, his limbs waste, the abdomen is distended, and the bowels are constipated. The spleen is especially liable to be enlarged, some-times attaining a weight of many pounds, when it can be felt externally. An enlarged spleen is popularly called ague-cake. “The heat-generating power of all victims to Malaria is impaired; hence they suffer from atmospheric changes, of which healthy men take no note” (Maclean). Another result is extreme liability to repeated attacks, for the disease often leaves the body so enfeebled that ague may be reproduced by agencies which, under other circumstances, would produce no ill-effects.
There is also an irregular remittent form of ague, occurring chiefly in temperate climates, and oftenest in late summer and autumn. Hence it is called aestivo-autumnal fever. It is due to a definite parasite which can be identified in the blood and the diagnosis of the disease thus confirmed. The symptoms of this form of ague are irregular. Continuous fever may be present with remissions or regular paroxysms for a time and then a more or less irregular course. Jaundice is not uncommon. The mild cases readily yield to treatment. The more severe may suggest typhoid fever, but the presence of the organisms in the blood will distinguish the disease. There is also a pernicious Malaria, rare in temperature climates. It occurs in two forms, the comatose, in which the patient is suddenly overwhelmed with cerebral symptoms, either acute delirium or more often coma, with high fever. The unconscious stage may last twelve or twenty-four hours, and may end in death; or the patient may regain consciousness and a second attack may come on and prove fatal. The other pernicious form is called Algid, and the symptoms are mainly gastric, vomiting with intense prostration and sense of cold. The patient may die in a condition of profound prostration.
Blackwater Fever- The passage of urine containing haemoglobin, the colouring matter of the blood, is not at all uncommon in Malaria; but in some parts of Africa there is an endemic disorder called Blackwater Fever, wherein this urinary symptom is constantly present. The disease is severe and often fatal. It generally occurs in persons who have suffered or are suffering from Malaria. It has been suggested that the haemoglobinuria is due to the Quinine that is habitually given. Quinine certainly sometimes seems to aggravate a paroxysm of Blackwater Fever, but it is most likely that it does not often originate an attack. Haemoglobinuria is a true symptom of Malaria, but Quinine has the power to cause it also. Thus Quinine is homoeopathic to the Blackwater symptom as well as to the general malarial condition, only this homoeopathicity makes the administration of a large dose liable to cause an aggravation.
TREATMENT- Prophylactic. Since the disease is communicated by the mosquito it is quite obvious that the destruction of the mosquitoes and protection from their bites are measures of the utmost importance. Screens and mosquito nets round houses, therefore, and the protection of the sleeper at night, should be rigidly carried out.
Pools, ponds, marshes, should be drained to destroy breeding- places of the mosquitoes. Petroleum should be freely used to any standing water in the malarial season. It floats on the top and kills the mosquito larvae when they rise to the surface.
Quinine is not only generally curative, but also is a preventive, and therefore small doses should be taken regularly (4 or 5 grains) if there is any risk of exposure to the disease. Also every case that develops should be thoroughly treated.
TREATMENT- Medicinal. The principal remedies are China, Quinine, Arsen., Ipecac., Carbo vegetabilis, Nat-Mur., Cedron., Nux vomica, Eup. Perf., etc.
For the enlarged spleen, Merc-Bin. is often useful, and Ceanothus, Phosphorus, and Ac-Phosphorus are often indicated in the cachexia of chronic Malaria.
SPECIAL INDICATIONS- China and Quinine are the chief remedies, and will cure probably ninety per cent. of recent cases. When they fail, other remedies should be chosen without persisting in the use of these two, for in most cases they give aid quickly. The success of Quinine is attributed by orthodox physicians to its action as a parasiticide, and it is supposed to act directly upon the organisms. It is true that the plasmodium generally dies after Quinine has been administered, but it is just as likely that its death is due to an increase in the natural defences of the body brought about by the Quinine, as to the Quinine acting immediately on it. This view at any rate must commend itself to the homoeopathist, for the power of Cinchona to reproduce the symptoms of Malaria (a power which is indubitable and admitted by orthodox authorities, although it has at times been questioned), was the discovery of Hahnemann, which put him upon the track of the Law of Similars.
Cinchona and Quinine cure ague because they are homoeopathic to most cases of it, and they will cure it often in small doses. Orthodox physicians will give ten to thirty grains or more in twenty-four hours, but frequently doses of two and three grains are sufficient. Tincture of Cinchona proved its efficacy in Malaria years before Quinine was extracted from it, and if the symptoms correspond large doses of Quinine are unnecessary. The typical symptoms for Cinchona are as follow. Thirst before the attack, ceasing when chill begins. Chill without thirst, and heat without thirst, but great thirst in the sweating stage, which is very profuse and debilitating; there is usually hunger and drowsiness (<) by eating and drinking; desire to uncover in hot stage, but chilly when uncovered; pains in the hepatic region; throbbing headache.
Arsenicum- Often when Quinine fails. Great thirst all through for small quantities frequently repeated. Sweat gives relief to symptoms. The chill is often irregularly developed or even absent. Semi-lateral headache is frequent, and intermittent neuralgia.
Ipecacuanha- Nausea, vomiting, and other gastric disturbances, occurring before and during chill and heat; thickly-coated, yellowish, moist fur on the tongue; cold hands and feet; great oppression of the chest.
Ipecac. has a curious power of bringing out a clear symptom- picture for a good prescription in intermittents which have become chronic and endured a great deal of ineffectual treatment. Marked nausea is the chief indication for it, but it will help to clear up almost any obscure case of the disease.
Cedron- It is considered to be a true anti-periodic, and in simple intermittents is said to be infallible. It also is recommended for regularly recurring paroxysms of neuralgia.
Nat-Mur- Chronic intermittents, with bilious vomiting before and during the chill; great thirst, with chill; marked relief from perspiration; blistered lips, and sores about the mouth. Attacks very apt to begin about 8 or 9 a.m. It is in high repute in America, especially in chronic cases. Nat-Mur. is the great antidote to Quinine poisoning.
Carbo-Veg.- Is recommended when the cold stage had greatly predominated. We have found it valuable in chronic cases, and have witnessed its power in preventing a recurrence of the disease. It should be useful in the algid form, and Camphor should also be considered in this connection.
DIET- On the days in which the fits occur, the food should be light, taken in small quantities, and great dietetic precautions observed until the paroxysms entirely disappear. Gruel, arrowroot, tapioca, sago, or corn-flour; mutton or chicken broth, or tender meat may be taken in the intervals between the fits. Cold water ad libitum.