Following on from part one, and in the same vein for which Punch magazine was known, I bring you four more of the most disgusting diseases in the world.

I had to include acromegaly as the insistence of my son whose interest in endocrinology began at the tender age of four when we were on holiday in Switzerland and happened on a particularly florid case of the condition. By then, the diagnosis could have been made from a cable car 50 metres away (which it was).

“Mummy, why are that man’s hands so big? And why has he got pillows instead of shoes?” He pointed, I told him not to, and so on, until I noticed the man in question who really was sporting pillows strapped to his feet.

I explained about the pituitary gland and growth hormone, and my youngster thereafter abandoned Postman Pat books in favour of the British Medical Journal.

However florid acromegaly may become, the onset is invariably subtle, with coarse skin, greasy hair, an increase in hat size, a little deepening of the yodel, and difficulty making watches or doing up lederhosen. To avoid resembling our Alpine acquaintance, it’s best to seek help while you can still fit into your ski boots.

Even pillows may not be roomy enough if you’re infected with wuchereria bancrofti. Everyone seems to have heard of elephantiasis but there are two important things to note: you don’t catch it from elephants, and it usually begins with just a few enlarged lymph glands on the groin. Walking is therefore still possible, for a while. Swelling sets in later, often only in one leg, and sometimes in the scrotum too, should you possess one.

Eventually the skin develops rough folds and warty outgrowths, and the scrotum, if affected, can hang down to the knees, which poses problems at the tailor’s, and elsewhere. Prevention is key. Use a mosquito net, and avoid falling into Burmese septic tanks if you want to wear both legs of your trousers at the same time.

If you dislike rodents, you’ll hate Lassa fever. Transmitted by rats, it was discovered in the Nigerian village of the same name, which you might like to make a note to avoid on your travels.

After it was first described in 1969, the department of health send circulars so that no GP would miss this diagnosis.  As the years passed, I never saw a case, but the bumph was useful for wobbly dining tables.

Lassa has an insidious onset with symptoms that resemble other conditions, like fever, malaise, a flushed face, red eyes, nausea, and vomiting. Later, the nose, gums, mouth, stomach, and lungs bleed spontaneously – a plague of blood, with a high mortality rate. As I recall, Lassa is similar to other haemorrhagic fevers such as Marburg-Ebola, Green Monkey Disease, and Crimean-haemorrhagic-Congo-Hazara fever, though I’d have to check under the dining table to be sure.

Anyone who’s unconscious when arriving by plane from West Africa runs the risk of his drunken state being mistaken for Lassa fever, with the result that masked attendants whisk him off to a plastic tent in the nearest isolation unit until the tests are back. I need hardly add that the outlook is far worse when Lassa fever is mistaken for excess alcohol.

Next up is typhus, not to be confused with typhoid. Typhus is caused by germs called rickettsiae which breed in the gut of the louse, and spread to humans via louse faeces. Louse bites are itchy, and scratching them rubs infected droppings into the skin.

Weakness is one of the early symptoms, and it all goes downhill from there, eventually, if untreated, leading to multiple organ failure.

As alarming as typhus is, Tsutsugamushi fever (aka scrub typhus) is much more popular with medical students, because it has so many syllables and because it forms a painless but picturesque ulcer covered with a crust. More importantly, unlike other forms of typhus, an attack of Tsutsugamushi gives no immunity against further infection. Medics can therefore imagine repeated episodes of scrub typhus at each outbreak of acne, and some of them have been known to scratch for years after exposure to a single lecture.

In the next instalment of The Most Disgusting Diseases in the World (and How to Catch Them): head, shoulders, knees, and toes.

You may also like to catch up on The Most Disgusting Diseases part one.