The diagnostics and treatment of tropical diseases

by E. R. Stitt

Tuberculosis.—The negro race seems to possess a greater susceptibility to tuberculosis than the white one, a fact well recognized in the United States, where the colored population suffers far more severely than their white neighbors. The yellow races also show marked susceptibility to the scourge and in the Philippines it is easily the greatest cause of death.

In tropical regions the natives of the sea-level regions suffer more than those of the mountain plateaus and where the humidity is high rather than in arid sections. Thus tuberculosis is very rare or almost unknown in the dry desert-like regions of upper Egypt and the Sahara desert.

The disease gains headway in the rainy season and diminishes in prevalence during the dry season.

One factor in the great spread of the disease is the intimate contact of natives living together in a small room.

It is generally recognized that susceptibility is greater in childhood and that infection by way of the alimentary tract is common in children.

When one notes the habit of expectorating anywhere and everywhere on the part of people untrained in hygienic rules, it is easy to recognize the opportunity babies and young children have of ingesting tuberculous material taken up on their hands while they are crawling about.

During the war there was a great deal of tuberculosis among the native African troops serving in France, and a study of the disease in these men has furnished us information as to the existence of two clinical types among them. In the soldiers from Morocco and Algiers, the type observed was similar to that occurring in Europeans, and this was explained on the basis of the opportunity that had been given the people of the areas from which the troops came to acquire tuberculosis from contact with white colonists and during a period of many years to have acquired a certain degree of resistance to the invasion of the tubercle bacillus.

In connection with the Senegalese troops and some others coming from sections of Africa where tuberculosis was rare or nonexistent another type was observed which corresponded with the tuberculosis one sees in a young child or a guinea pig.

In these cases the disease starts with enlargement of the glands at the roots of the lungs. This finding of course would require an X-ray plate but it was found that the enlargement of the supraclavicular glands at a point near the insertion of the sternocleidomastoid was one of the best early signs. The glandular stage lasted about five to ten weeks during which time the general health did not seem to be materially impaired. Following this stage and lasting only about two weeks or up to two months a stage of generalized tuberculosis sets in with fever, emaciation, caseous pneumonia or manifestations of miliary tuberculosis. There was no tendency to fibrosis or cure of the process, death almost invariably occurring. Borrel, who studied the disease in these natives, states that if put at rest and placed on a generous diet, while the case is in the glandular stage, one-half of them may recover. It was noted that sputum examinations of these cases were almost invariably negative.

Smallpox.—This disease may justly be considered the greatest scourge of the natives of tropical countries. It is responsible for much of the blindness noted in natives of sections where vaccination has not been employed.