Page:Encyclopædia Britannica, Ninth Edition, v. 18.djvu/288

270 versicolor, consisting of patches of brownish discolorations of various sizes and shapes, mostly on the front of the body, and often attended with itching, especially after heating exercise. The pigmentation seems to radiate from the orifices of hair-follicles. The epidermis is in a scaly condition over the patch, and among the debris of the epidermic cell there may be seen minute oval spores, which are sup posed to belong to a fungus, the Microsporou Furfur. The disease is mostly one of adult age, found all over the world, and not associ ated in any special way with poor general health. The treatment consists of rubbing in an ointment of sulphuret of potassium, or one of the mercurial ointments, or using sulphur-soap habitually. The remarkable brown, black, and blue spots of discoloration of the whole body met with endemically in Mexico, Panama, New Granada, and Venezuela, and known under the name of " pinto " or "mal de los pintos," have been claimed by Gastambide (Prcssc Mcd. Beige, 1881, Nos. 33-41) as due to the presence of a fungus, whose spores and even mycelial filaments may be detected among the deeper rows of cejls of the rete mucosum. The disease, which is some what serious from its large superficial area, would appear to be one of the many forms of morbus miserix ; but it is contagious, and is sometimes seen in the well-to-do. In some villages of the western districts of Tabasco (Mexico), it has been estimated that 9 per cent, of the inhabitants suffer from the pinto ; M Clellan says that in 1826 in the city of Mexico he saw a whole regiment of " pintados." Before leaving the parasitic fungi of the skin, it should be mentioned that Oidiiim albicans is apt to plant itself on the mucous membrane of the mouth in young and ailing children, causing whitish patches known as thrush. 2. Actinomycosis. In certain tumour-like formations of cattle, usually growing from the alveoli of the lower molar teeth, and protruding externally near the angle of the jaw, Bellinger in 1877 detected the presence of a number of sulphur-yellow bodies about the size of a hemp seed and of a fatty consistence. These were found to be aggregates of a pecu liar radiate fungus (Actinomyces ), which assumed the form of minute rosettes, the mycelial filaments expanding into flask-like swellings at their free or circumferential ends. The yellow seed-like con glomerates lay in spaces of the tumour, and they were also found within cavities on the tongue, fauces, larynx, mucous membrane of the stomach, in lymphatic glands, and (by a later observer) in the lungs. In 1879 Ponfick found the same sulphur-yellow bodies in the body of a man who had died of chronic disease of the chest, and who had a number of sinuses in the skin of the back. Some twenty cases of actinomycosis in man have now been described in Germany ; in most of them- there have been centres of chronic inflammation in front of the vertebra in the cervical, dorsal, or lumbar regions, with numerous sinuses penetrating the muscles and opening on the skin. The yellow conglomerates of Actinomyces are found in or upon the granulations of these sinuses, or in the sero-purulent discharge from them, or in the muscles, or more rarely in centres of granulation- like new growth in some of the viscera. The relation of the fungus to the primary tumour-like new growth of the ox has not yet been made out, and there is hardly any clue to the connexion between the bovine disease and the somewhat modified form of it in man. In some respects there is an analogy between actinomycosis and the fungus-foot of India as described by Vandyke Carter. 3. Scabies. Of the human diseases due to animal parasites there is only one of any importance affecting the skin, namely, scabies or the itch. The parasite is the Sarcoptcs scabiei (see MITE, vol. xvi. p. 529), which burrows under the epidermis at any part of the body, but hardly ever in the face or scalp of adults ; it usually begins at the clefts of the fingers, where its presence may be inferred from several scattered pimples, which will probably have been torn at their sum mits by the scratching of the patient, or have been otherwise con verted into vesicles or pustules. The remedy is soap and water, and sulphur ointment. 4. Diseases due to Ncmatodc ami Trcmatodc Worms. The common thread- worm (Oxyuris), a small white object about half an inch long, is very frequent in all countries, mostly in children; its habitat is the lower bowel, but it is often a troublesome irritant outside the bowel as well. The round-worm (Ascaris lumbricoides), about 6 inches long when full-sized, and not unlike the common earth-worm, is less common in England and other Western countries ; but it is enormously common all over the East, and in the tropics generally. Hundreds of them may accumulate in the body, causing an obvious enlargement of the abdomen. The most valuable remedy against them is santonine powder. A third intestinal nematode is the whip-worm ( Trichoceplialus dispar], about 2 inches long, having a slender anterior extremity joined on to the body like the thong to the handle of a whip. It is said to be very common in some countries, such as France, but it has no great importance as regards disease. The nematodes of greatest pathological interest arc Trichina spiralis, causing the serious malady of trichinosis ; Anchylostoma [l> MEDICINE. duodcnalc, often associated with the profound anaemia of men work ing in mines, making tunnels, and the like ; Angmllula stercoralis, associated with a specific kind of diarrhoea in Cochin China ; Filaria sanguinis hominis, a blood-worm occurring mostly in China and other parts of the East, and often associated with the disease called lymph -scrotum, and with ha mato-ehyluria ; and Filaria mcdiiiensis, the Guinea-worm, very common on the Guinea coast and in many other tropical regions, a long and slender filament like a hair from a horse s tail, and mostly infesting the skin of the legs. Trichinosis. The presence of encysted trichina} in the muscles was discovered in one or more of the London dissecting-rooms in 1828 and following years ; but it was not until thirty years later that the clinical characters of the acute disease caused by the invasion of the parasite were discovered. This discovery was made in 1860 by Zenker, on examining the abdominal muscles of a patient who had died at Dresden, with symptoms taken to be those of typhoid fever, the case being afterwards accounted one of trichi nosis on the^osi mortem evidence. Epidemics of this disease occur from time to time, especially in north Germany, from the eating of uncooked swine s ilesh, in which trichina} are not uncommon. The greatest care is now taken in Germany to examine the carcases of swine for trichime, a piece of the diaphragm of every animal being searched with the microscope by an inspector specially appointed. The symptoms in man are occasioned by the presence of the free parasites in the intestine, by the development of young tri chinae from the eggs, and most of all by the migration of the parasites from the intestinal canal to the muscles, where they become quiescent within a calcareous shell. This cycle occupies from four to six weeks. "When consumed in small quantity, the parasites may give rise to no marked symptoms, and they are sometimes found acci dentally in muscular fibre in the bodies of those who had probably experienced no definite symptoms from their invasion. In the more acute and serious cases, sometimes ending fatally, the early symp toms are nausea, failure of appetite, diarrhoea, and fever ; later, when the migration to the muscles begins, there is more fever, stillness, pain, and swelling in the limbs, swelling of the eyelids, continued exhausting diarrhoea, perspirations, and sometimes de lirium. During convalescence there is descp.iamat.ion of the cuticle. If the diagnosis be made early in the case, brisk purgatives, par ticularly calomel, arc the best treatment ; if the parasites are already on their way to the muscles, the only thing left to do is to support the patient s strength. Ansemia and Cachcxia caused lij Anchylostoma duodenalc. A disease which caused a great mortality among the negroes in the West Indies towards the end of last century, and of which descrip tions were afterwards sent from Brazil and various other tropical and subtropical regions, was identified, chiefly through the labours of Bilharz and Griesinger in Egypt (1854), as being due to the presence in the intestine of nematoid worms from one-third to half an inch long, and variously named Anchylostoma, Sclerostoma, Strongylus, &c. The same disease has subsequently been found in some places among miners, and particularly among the men employed in making the St Gotthard tunnel. Various names have been given to the malady, such as mal d estomac, mal de caair, dirt-eating, anffiinia intertropicalis, cachexia Africana, and eachexie aqueuse. The symptoms, as first observed among the negroes, were pain in the stomach, capricious appetite, pica (or dirt-eating), obstinate constipation followed by diarrhoea, palpitations, small and unsteady pulse, coldness of the skin, pallor of the skin and mucous mem branes, diminution of the secretions, loss of strength, and, in cases running a fatal course, colliquative diarrhoea and dysentery, haemorrhages, and dropsies. The parasites, which cling to the intestinal mucous membrane, draw their nourishment from the blood-vessels of their host, and as they are found in hundreds in the body after death, the disorders of digestion, the increasing anaamia, and the consequent dropsies and other cachectic symptoms are easily explained. It seems probable that the parasite is intro duced in its larval stage through the medium of the drinking-water. Male-fern, santonine, or other anthelmintic remedies are prescribed for it ; but, inasmuch as it is most apt to lodge in the bodies of the ill-fed and otherwise ailing poor, there is little doubt that the most satisfactory remedy would be to increase the power of resistance by improving the general well-being. Chyluria and Lymph-Scrotum caused l)y Filaria sanguinis hominis. A milky appearance of the urine, due to the presence of a substance like chyle, which forms a clot, had been observed from time to time, especially in tropical and subtropical countries ; and it has been proved by the late Dr Wucherer of Bahia, and by Dr Timothy Lewis, that this peculiar condition is uniformly associated with the presence in the blood of minute- eel-like worms, visible only under the microscope, being the embryo forms of a Filaria. The parent worms are very difficult to find, and their characters and habits are imperfectly known ; but they are supposed to be about 3 inches long, and to inhabit dilatations of the lymph-carrying vessels. It is not yet clear how the chyle gets into the urine, but it seems probable that the blood in which filarise are present is altered in its constituents, although there is no obvious change in