?tjc KnUiait JJtetrical July 1, 1876.

SKIN AND OTHER DISEASES OP INDIA AND HOT CLIMATES GENERALLY.

(Continued from page 159 J

In our last issue we briefly noticed some of the diseases

treated of in Drs. lox and Farquhar's work, "On certain

endemic skin and other diseases of India and hot climates

generally," and now we proceed to consider those which

remain. After " lymph scrotum" the next in order is

Mycetoma, or fungus foot of India.?In our number for

February 1875, we noticed Dr. Vandyke Carter's elaborate

monograph, and in our issue for March last, we made some

remarks on Drs. Lewis and Cunningham's valuable report on

this disease. In order that our readers may the more fully understand Drs. Fox and Farquhar's remarks, we must for a

little space, go over old ground and re-consider Drs. Lewis and Cunningham's conclusions. These geutlemeu say :?" It has been seen that the disease appears iu two principal forms;

that the lesions produced, the particular tissues affected, and the general course of the disease present much in common, but that the morbid products, whether examined chemically or microscopically, are found to be most dissimilar. In the pale variety "(ochroid of Carter) "the product is for the most part of a fatty nature whereas in the dark variety" (me~ lanoid of Carter) " the fatty matter forms a far less prominent feature." They adduced reasons in support of their opinion that the pale is not a later stage of the dark variety of the

affection, but they say that it is quite possible " that the

original cause of the two may be very closely allied if not

identical." They very carefully investigated the roe-like

bodies (malacrotia of Carter), the pink particles, and the black masses (sclerotia of Carter). The first they " have shown to be fat in various modified forms ; the second were found to be

pigmented concretions?not the slightest trace of a fungus or of other vegetable organisms being present in either;" and the third they " have shown to consist of degenerated tissue, mixed to a greater or less extent with black pigment and fungoid filaments." This pigment contained iron, and when treated with re-agents manifested properties " similar to those of or-

dinary pigment." The fuugoid elements, associated with the pigment, showed " all the properties of ordinary fungal forms except vitality." Drs. Lewis and Cunningham have

expressed their conviction that the Chionyphe Carteri " not

only does not cause the disease, but that it cannot be develop- ed from the fungoid elements contained in the morbid mat-

ter." They say that to account for these fungoid elements, deeply imbedded in the tissues, is

" most puzzling." "The

supposition that a sporule had managed to insinuate itself

by means of some natura lly or artificially produced spore, is

untenable To us it appears much more reasonable

to infer that localized spots in the tissues undergo a degenera- tive change into a substance peculiarly adapted to the develop- ment of filamentous growths. We ourselves have shown, and

it has been shown by others, that under certain conditions?the

principal being the absence of vitality, or vitality greatly depress-

ed?every tissue in the tody is capable of giving rise to the abun-

dant development of complex organisms." Drs. Fox and Far-

quhar remark " This truth of the necessary existence of

a favourable nidus for the growth of fungi is an accepted scien-

tific doctrine. But whence comes the fungus ? Is it spontane-

ously generated, or is it a degradation of pre-existing animal tex-

tures, as the remarks of Drs. Lewis and Cunningham, which we

have specially italicized, seem to imply, or are the germs derived ab externo ?" Drs. Lewis and Cunningham concluded their

report by saying :?" Taking every thing into consideration, it

seems probable to us that soms local degeneration takes place in the Madura-disease, giving rise to a product which is, in

one of its varieties, peculiarly adapted to the development of

vegetable organisms." Our readers will remember the figure of the " organisms found in the tissues of htalthy animals a few hours after death" which these observers gave in their re-

ports on the fungus-disease. They made several experiments with the object of ascertaining

" whether, by interfering with the vascular supply of certain tissues and organs of the body of an animal wi thout injuring the isolated tissue," they would " be able within the course of some hours to detect organisms in those parts in the same manner as" they " had been able fa

do when uu animal had been killed under chl.'roform and get

July 1, 1876.] SKIN AND OTHER DISEASES IN INDIA. 137

aside in a warm place." They say :?" We found that such was the result, and that a kidney for example" (the italics are ours) " when carefully ligatured without interfering with its position in the abdomen, woul d be found after some hours to contain precisely similar organisms; whereas the other kidney?whose circulation had not been interfered with?contained no trace of any vegeta- tion whatever." Drs. Fox and Farquhar sny :?"In the special case to which reference is made by Drs. Lewis and Cunningham, viz., where the kidney was concerned, it cannot be denied that air from without may have entered the kidney passage, and so far it is not a satisfactory example." But the kidney was brought forward by Drs. Lewis and Cunningham not as a solitary instance but as one example out of several experiments. After

detailing briefly?much too briefly it appears to us?these

results of Drs. Lewis and Cunningham's investigations, our

authors say:?"The special new points presented by these

observers are the assertion that the nucleus of the fish-roe-like

mass is, in reality, caseous, and the proof that the red particles are concretions. In all other particulars they confirm pre- vious conclusions But the origin and source of the

fungus in the black variety, deep down in the tissues, when there has been no apparent communication with the exterior still remain unexplained." They say that

" it comes to be

a fair question whether the presence of the black fungus be not after all an accidental complication All the essen-

tial features of the mycetoma, viz., the general disorganization of parts, may be present without any black fungus particles.

It would seem that in the pale variety there is often

deep-seated mischief withoiit any fuugus, and if so then this

is an argument against the parasitic nature of the disease. But indeed the whole question needs careful clinical and anato- mical inquiry, and we have endeavoured to indicate the points upon which, at present, authorities differ." They conclude

by saying :?" That the fungus in " mycetoma" is dereloped

deeply in the tissues out of pre-existing animal textures, and

that it is not derived ab externo has yet to be proved."

Drs. Lewis and Canningham's report has stimulated many com-

petent observers in India to continue theirinvestigations so that,

as regards the elucidation of the true nature of the disease,

with Drs. Fox and Farquhar, "we fain would believe that the

solution of the question is not far off. Dr. Cooper says:?"It is a very serious endemic

disease in Hissar." Dr. W. Moore states that "it is

frequently met with in Marwar, in Bickaneer, and

throughout the whole of the semi-desert districts of Western

Bnjpootana." Dr. Robert Harvey has treated cases of it in

Eastern Kajpootana, Central India and Bundelkhand. He states

that he knows cases occur in the Deccan, parts of the Bombay

Presidency, and Central Provinces. It is very rarely met with

in Bengal, North-Western Provinces, Oudh, Umballa, or China.

Leprosy. ?The reports on this disease, our authors tell us,

hare been made over to Dr. Vandyke Carter, who is at work

in the matter, but " they do not add any thing new to the

main pathological or the etiological facts of the disease" as

detailed in their " Scheme." The disease has not as yet been

demonstrated to be contagious, although it may be inoculable.

Drs. Fox and Farquhar " see no reason, on the score of con-

tagiousness, why lepers should not be admitted into our

general hospitals and carefully treated there" ? ? ? ? " The

institution of leper hospitals or villages for the better housing, feeding, and general care of lepers is," in their opinion, "an

urgent and desirable step." They have no faith in the

power of any drug to cure leprosy, and ascribe most of the

success, observed after drugs and treatment, to the influence

of the concomitant hygienic measures which are adopted. " That, however, leprosy can be alleviated, and is even arrested

is certain. Indeed nature herself does this under favourable

conditions." Tliey say, " the alleviation of leprosy is not a

new fact Ghirjun oil, by its stimulating effects, aids

the reabsorption of the leprous deposit in the skin," but

nothing more. This is the view which is held in India by most men who have had experience of the treatment of lepers

by gurjun oil, and which has been further confirmed by Dr.

Roy's observations in the Andamans as embodied in his paper

in this journal for May last.

Leueoderma.?As regards this disease our authors have very few comments to offer. It " is well understood by medical men

abroad " and " it is rightly regarded by them as entirely uncon-

nected with leprosy, and as consisting solely in an abnormality in the pigmentation of the skin." They appeal to professional men to discountenance the application of the term white

leprosy to leueoderma. It appears to attack fair-skinned races

by preference, though exception is taken to this statement by some observers.

Tinea circinata tropica, or Oriental ringworm.**These terms

include the affections known as Burmese, Indian, and China

ringworm, ' dad,'' dadru,' ' majee's dad,' ' denaii,' ' dhobie's

itch,'and by some erroneously called "eczema marginatum." The disease is caused by the fungus, trichophyton, a figure of

which, consisting of conidia and mycelial filaments,is given in the book. Drs. Fox and Farquhar say that, " there is no essential

difference between the disease, ringworm, as seen in Europe, in India, and China, save in its degree of severity, due, as we

have explained, to the greater degree of heat and moisture

prevalent in Oriental parts as compared with England." The

Tokelau ringworm, also caused by a vegetable fungus, of which two figures are depicted, is a much more severe and obstinate

affection. In the " scrapings of the cuticle" Drs. Fox and

Farquhar " found abundant evidence of a vegetable fungus of

a most luxuriant kind. This fungus exists in great abundance; but, though so plentiful, its presence may readily be over* looked, unless a very thin layer of the scrapings,,f examined." They "

are not at present prepared to say whether the fungus is a modification of the trichophyton, or a new and special one, and await further experiments before

deciding. After applying sulphur ointment, Dr. Turner and

others observed dipterous insects bursting through it and flying away. In the " scrapings" Drs. Fox and Farquhar could not

detect any trace of these insects. They say that, " it is clear to us that their presence is accidental, and that they are at- tracted to the skin, in Tokelau ringworm, by the ointments applied to it, and in whioh they become imbedded." Our authors devote a chapter to the treatment of tropical ring- worm. They say that perhaps the best specific is Goa powder, but in some cases it fails. They add :?" It is important to re-

member one or two points in reference to the use of parasiticides. They should be brought into direct contact with?that is to say, be made to penetrate sufficiently deeply so as to reach?tho

188 '

THE INDIAN MEDICAL GAZETTE. [July 1, 1876.

fungoid elements. ? * ? Free use of soap and water is called

for before the application of any parasiticide in -watery solution. They mention pentasulphide of lime, solution of

hyposulphite of soda (a drachm to the ounce) ; " bichloride

of mercury lotion; iodide of sulphur ointment; sulphuret of potassium, lotion, and ointment, and Costor's paste, made

by adding two drachms of iodine to an ounce and a half of

" colourless oil of tar," but it must be the genuine purified oil of tar. The latter is a potent semi-vesicating remedy, and must be used with caution." To these we may add

boracic acid, and nitrate of silver solution. Malabar Itch, has no relation to ringworm, and has been

recognised by Dra. Fox and Farquliar as scabies ferox. Except in those who are exceptionally filthy and dirty, it is rarely seen

in England, but is met with " under similar circumstances" in

Norway, Germany, Malabar, Columbo, China, &c. It " dif-

fers from the simple scabies in the more extensive eruption, whilst the skin becomes thickened and greatly crusted and

scabbed from the drying up of the discharge from pustules, eczematous inflammation and the like ; the crusts being made

up of this discharge with acari and their exuvias in abundance."

Pityriasis Versicolor, " is unquestionably more common in

the East than in Europe As seen in the native, the

deceased surface is externally paler than the rest of the skin,

though it recovers its natural tint on the disappearance of the

disease." It "appears to be well understood, and properly

recognized in the East," and is as common in China and the

Samoan Islands as in India.

Lichen Tropicus, or Prickly Seat, comes next in order. For

an expression of the views of Drs. Fox and Farquhar as to the

pathology of this affection, we refer our readers to a paper which appears among the

'

Original communications.'

Pellagra.?The report concludes with a few remarks on this

disease, based on an excellent paper by Dr. Vandyke Carter

which has been published as Appendix XV by desire of the

Secretary of State for India. " As it has only an indirect in-

terest in relation to Oriental diseases of the surface" special attention was not called to it in Drs. Fox and Farquhar's ori"

ginal "Scheme." Dr. Carter says that it " is a malady occur-

ring amongst the poorer classes of peasants who inhabit certain

parts of North Italy, &c., and who make habitual and almost

exclusive use of a diet consisting of " Maize" flour, in a more or less damaged state Perhaps in this vegetarian diet, often of unsound grain, this exposure to the sun and

malaria, and this defective sanitation, a sort of parallel may be drawn between the Indian ryot and the Italian peasant ;

and the idea may be entertained so far as it serves to stimulate

comparative inquiries into their common condition and result-

ing states It is originally quite a seasonal complaint and it advances by recurrent attacks, also seasonal in their

character, until, that is, the whole system becomes affected

(or infected). It is not attended (so far as I can learn) with an invariable or specific skin-eruption; the local nerve lesion

(if any) is very slight; the complaint ends in mental derange- ment not unfrequently; at first it is curable. In these res-

pects pellagra is unlike lepra. On the other hand, the two

diseases are alike in the following features. the face, back of

the hands and feet are the seat of special irritation (and the same parts are affected in some more clearly parasitic mala-

dies); the nervous system is implicated in both ; both malad ies

induce a cachectic condition of the body, which is attended

with visceral disease ; confirmed stages of both are incurable.

There is a widely-known complaint of the natives of India, which is called "

burning feet." Now, the same

symptom, sometimes in a marked degree and attended with

nocturnal exacerbations, is noticed in pellagra," Alluding to " the occurrence in pellagra of staining of the skin, which

is comparable to the same symptom in Addison's disease," Dr. Vandyke Carter says :?" I may just add that there are

some points of similarity between the two diseases. Thus, in

both, the aneemia is marked and spontaneous ; it is persistent and finally fatal, but there is not, strictly speaking, a want

of nutrition of the frame." Dr. Carter could obtain no evi-

dence of the existence of supra-renal capsular disease in

these cases.

He puts the following question which has particular interest for our readers in India?" Whether or not the not rare

mental disturbances seen amongst Hindus are connected with

the persistent use of unsound grain ?" In pellagra the usual mode of onset of the disease

appears to be by pain in the abdomen, diarrhoea and

local erythema, followed by ansemia, oedema of the feet

and dropsy. Drs. Fox and Farquhar write:?" The view that

pellagra belongs to the class of diseases due to diseased

grains, is at all events the one which has long seemed altogether probable in our opinion, particularly in view of the evidence

adduced by Lombroso, Roussel, Typaldos, and others. We

are, therefore, inclined to be more positive than Dr. Carter in

accepting as the real cause of pellagra the use of diseased

maize." In India many cases similar to' pellagra are frequent- ly coming under notice, and have nearly always been ascribed

to malarial poisoning. We know that paralysis is produced by the excessive or constant use of " Kessari dal," but is this

the only disease in India which is produced by grain either

in a sound or diseased state ? We add this to Dr. Carter's

question as given above. Drs. Fox and Farquhar conclude their valuable report by

making an earnest appeal to " workers in India, China, and

elsewhere, to continue their investigations and to give the re-

sults thereof, as opportunity may occur, for the benefit of the

Medical Art and Science."

We have endeavoured to give as much information, as

the space at our disposal would allow, chiefly for the benefit

of those who are, and will be, unable to obtain the volume for

themselves. We strongly advise all, who can do so, to give it a place in their libraries.