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Tropical phlebitis
CORRESPONDENCE
147
TROPICAL PHLEBITIS. SIR,--With reference to Dr. GELFAND'S review of tropical phlebitis (TRANSACTIONS 48, 369), I would like to emphasize two points : (1) T h e East African outbreak of tropical phlebitis referred to took place in two widely separated areas of the C o m m a n d ; in a venereal diseases centre in British Somaliland where Dr. CHARTERSwas working, and in a similar centre in K e n y a where I was working. T h e only factor c o m m o n to the two outbreaks which we could find was the intravenous administration of arsenicals. With regard to Dr. CHESTERMAN'S remarks that a similar disease did not appear in the Congo, where intravenous arsenicals were also used on a wide scale, I would point out that jaundice following N.A.B. was not usual in Africa before the war, but became c o m m o n during the war. (2) T h e " Pyrexia with stiff neck " part of the syndrome was not due to thrombophlebitis of the cervical neck veins btR was m u c h more like the neck pain found in the febrile periods in relapsing fever, and ,was part and parcel of the fever, only lasting for a few days. I feel that a search should be made in the future in these cases for rickettsiae , by animal inoculation of biopsy material, as negative serological tests cannot rule out the possibility that tropical phlebitis is a rickettsial disease. I am, etc., Suva, Fiji, 15th June, 1950.
P.E.C.
MANSON-BAHR.
A CASE OF MYOSITIS TROPICA.
SIR,--An adult female of the Ibo tribe, aged 25 years, was admitted to Kano City Hospital on 4th February, 1950. She came u n d e r the care of Dr. A. L. F. THOMSON, complaining of slight pain and swelling of her left thigh. On Examination.--There was a fusiform swelling involving the extensor quadratus muscle. Tenderness was diffuse and not marked. No oedema found. Movements limited by swelling and pain. The patient was well nourished and suffered from no other disability. Previous History.--Nil relevant. Family healthy. Progress Notes.--For the first week after admission, she had a remittent temperature up to 102° F. which did not react to intramuscular quinine. Blood slides were negative for malarial parasites and microfilaria. The condition of the thigh remained the same. 6.2.50.--Dr. THOMSON incised the anterior aspect of the thigh under general anaesthesia. All that was obtained from the muscle was a small quantity of pure blood. No pus found. The diagnosis of osteogenic sarcoma was then considered. 23.2.50.--X-ray of femur and pelvis showed no gross bony abnormality. * GELFAND, M., Trans. R. soc. trop. reed. Hyg., 43, 369, 439. K~
147
TROPICAL PHLEBITIS. SIR,--With reference to Dr. GELFAND'S review of tropical phlebitis (TRANSACTIONS 48, 369), I would like to emphasize two points : (1) T h e East African outbreak of tropical phlebitis referred to took place in two widely separated areas of the C o m m a n d ; in a venereal diseases centre in British Somaliland where Dr. CHARTERSwas working, and in a similar centre in K e n y a where I was working. T h e only factor c o m m o n to the two outbreaks which we could find was the intravenous administration of arsenicals. With regard to Dr. CHESTERMAN'S remarks that a similar disease did not appear in the Congo, where intravenous arsenicals were also used on a wide scale, I would point out that jaundice following N.A.B. was not usual in Africa before the war, but became c o m m o n during the war. (2) T h e " Pyrexia with stiff neck " part of the syndrome was not due to thrombophlebitis of the cervical neck veins btR was m u c h more like the neck pain found in the febrile periods in relapsing fever, and ,was part and parcel of the fever, only lasting for a few days. I feel that a search should be made in the future in these cases for rickettsiae , by animal inoculation of biopsy material, as negative serological tests cannot rule out the possibility that tropical phlebitis is a rickettsial disease. I am, etc., Suva, Fiji, 15th June, 1950.
P.E.C.
MANSON-BAHR.
A CASE OF MYOSITIS TROPICA.
SIR,--An adult female of the Ibo tribe, aged 25 years, was admitted to Kano City Hospital on 4th February, 1950. She came u n d e r the care of Dr. A. L. F. THOMSON, complaining of slight pain and swelling of her left thigh. On Examination.--There was a fusiform swelling involving the extensor quadratus muscle. Tenderness was diffuse and not marked. No oedema found. Movements limited by swelling and pain. The patient was well nourished and suffered from no other disability. Previous History.--Nil relevant. Family healthy. Progress Notes.--For the first week after admission, she had a remittent temperature up to 102° F. which did not react to intramuscular quinine. Blood slides were negative for malarial parasites and microfilaria. The condition of the thigh remained the same. 6.2.50.--Dr. THOMSON incised the anterior aspect of the thigh under general anaesthesia. All that was obtained from the muscle was a small quantity of pure blood. No pus found. The diagnosis of osteogenic sarcoma was then considered. 23.2.50.--X-ray of femur and pelvis showed no gross bony abnormality. * GELFAND, M., Trans. R. soc. trop. reed. Hyg., 43, 369, 439. K~