Excerpt from Review of Some of the Recent Advances in Tropical Medicine: Hygiene and Tropical Veterinary Science, With Special Reference to Their Possible Bearing on Medical, Sanitary and Veterinary Work in the Anglo-Egyptian Sudan, Being a Supplement to the Third Report of the Wellcome Research Laboratories at the Gordon Memo
Ainhum. Ashley-Emile, in an interesting paper on ainhum, is inclined to trace a connection between ainhum and leprosy, regarding the former as a modified expression of the latter in persons of a "leprous diathesis." His argument is rather laboured, but there may be something in the anatomical reasons he advances for the seat of election of the disease. He believes the flexor tendon of the small toe to be specially subject to strain during the act of carrying heavy burdens, and that this, combined with an enfeebled nerve supply, leads to fibroid degeneration round the joint with resulting occlusion of arteries and strangulation of the toe, which enlarges owing to venous dilatation.
Wellman, on the other hand, adduces evidence to show that ainhum and leprosy are not related, and in a later paper suggests that the chigger may play an important part in the development of the complaint. He points out that this theory accounts in large measure for the geographical distribution of the disease. Apart from these theories, ainhum has been stated to be due to injury, to be a trophoneurosis, a circumscribed scleroderma, a congenital, spontaneous amputation, and the result of self-mutilation by ligatures, wearing of toe-rings, etc.
Manson favours the traumatic theory, and cites a similar condition affecting the tail of a pet monkey. There is nothing new to record regarding treatment. Ainhum occurs in the Sudan, and I have seen an imported case in Khartoum.
So far as is at present known, the chigger is confined to the Bahr-El-Ghazal Province, while Dr. Wenyon reports ainhum to be common at Boron the White Nile. The natives attribute the condition to injury caused by the coarse grass. It would be interesting to determine accurately if the distribution of the disease and of the chigger coincide in the Southern Sudan.
Air. The remarkable influence of rain as a purifier of the atmosphere was well shown by an investigation carried out in London in the summer of 1903. A rainfall of about 3-8 inches in five days actually was responsible for the removal of 3738 tons of solid impurities. Of these no less than 2000 tons consisted of soot and suspended matter, common salt and sulphate of ammonia constituting the remainder.
This does not take into account the great bacterial purification also effected.
Much of the Northern Sudan is practically rainless, and there can be no doubt we suffer from the lack of the freshening effect of rain upon the atmosphere. This, as has been pointed out, is due possibly to an oxidising action and perhaps to the formation of peroxide of hydrogen. No one who has lived long in Khartoum but knows there are times when the air seems lifeless and heavy. Indeed, this is frequently the case in the late afternoons in the winter. Doubtless the feeling is in part due to the dying down of the breeze, but though the air is free from gross impurities it is charged with organisms, especially with moulds.
In this connection allusion may he made to Gordon's work on the presence of streptococcus brevis in the saliva, and its use as an indicator of air pollution. By this means he has shown the presence of particles of saliva in the air at a distance of 40 feet in front of a speaker.
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