Page:Tropical Diseases.djvu/972

914 the size of a pigeon's egg. After a time, without the formation of an abscess, the skin over the nodule ulcerates and exposes a circular or oval ulcer with a fatty-looking base. The nodules may be single, but are more often multiple, and may be so close together that when ulceration ensues the ulcers coalesce, forming a serpiginous ulcer. Sometimes the nodules are absorbed without proceeding to ulceration. The ulcers are very chronic and last for years, sometimes healing at one place and gradually extending in another. The joints I have seen most affected are the knee, elbow, and wrist. The sense of fluctuation was so marked in one case that I opened the joint; but no fluid exuded, a fatty-looking material protruding through the incision. The disease after a time attacks the bones, and the joints may become totally disorganized." —(Journ. of Trop. Med. Oct. 15, 1901.) On comparing the photographs illustrating Read's paper with others of a very similar complaint common among the natives in certain parts of British East Africa, I am inclined to think both sets of photographs represent identical conditions. Possibly " chappa " is a tertiary phase of yaws. Treatment.— Neither potassium iodide nor mercury avails. Scraping, escharotics, and antiseptics seem to be more effective; but, although the disease may heal under treatment in one place, it breaks out in another.

Scheube has applied the term "climatic bubo" to a type of non-venereal adenitis not uncommon in tropical climates. So far as available statistics show, the disease is especially prevalent among the crews of warships on the eastern coast of Africa. It occurs also in the Straits of Malacca, in China (where I have seen a fair number of cases both in landsmen and in sailors), in the West Indies, Japan, the Mediterranean, and probably in many other places, including, perhaps, in a minor degree, Europe. It appears to be epidemic at times in certain places, and to prevail in groups of individuals living under similar hygienic conditions. Thus, Ruge reports 38 cases in the German squadron blockading the Zanzibar coast in 1888-89; Godding notes its frequency in the British fleet, also on the East African coast;