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Tinea imbricata, a common disease in the lowland climate of New Guinea, has been studied in four populations near Maprik, Sepik District, where the prevalence varies from 8 to 30 per cent. Personal cleanliness may lessen the risk of primary infection or of reinfection after treatment but it does not, by itself, bring about remission. Most infections appear in the first 2 years of life and spontaneous remission is rare in the village environment. Studies of the sites of primary infection in infancy and of incidences inside families indicate that intimate contact with the disease increases the risk of infection, but there is also some evidence suggesting that a genetic factor may confer some protection against it. Under 6 months of age and during the years of child-bearing, tinea imbricata is more common among females than males; this can be explained by differences in death rates and nutritional stresses. The following observations suggest that dietary or conditioned malnutrition strongly predisposes towards infection: 1. 1) Among children under 2 years of age there is a statistically significant correlation between an episode of failure to gain weight and the subsequent early appearance of the disease. 2. 2) Among adults study of arithmetic and geometric mean body weights shows a significant association between low weight and the presence of the disease. 3. 3) The villagers living in the worst agricultural conditions in the area have significantly lower weight/height ratios, and suffer significantly higher incidences of tinea imbricata, than other better nourished people who live in the same climate and belong to the same language group. 4. 4) Most of the small number of men who first contracted the disease as adults gave a history that a serious loss of weight immediately preceded its appearance. All the women first infected in adult life said their disease appeared during pregnancy or early lactation. It has been shown previously that pregnancy and lactation among these women are associated with permanent loss of weight. 5. 5) Half of all otherwise untreated infected men lost their infections when they received an official ration scale which has been found greatly to improve their nutritional state. Almost everybody, whether cured by treatment or by improved diet, became reinfected after resuming the village diet. The disease restricts the choice of a marriage partner and is an important contributing cause of bachelorhood among men. Because of its social effects it probably decreases reproduction rates but it does not, per se , appear medically to lessen female fertility or increase child mortality. Economically and educationally it is a severe handicap. Griseofulvin cures tinea imbricata, but reinfection invariably occurs in the village environment. Suggestions have been made which may benefit a selected minority of patients but eradication is not yet in sight.

1. 1) The palpable liver and spleen rates of children in the Maprik area, Sepik District, show no differences between the sexes and are characteristic of holoendemic malaria in the south-west Pacific. 2. 2) Women have significantly higher liver and spleen rates over the age of 20 years than men. 3. 3) Analysis reveals that this sex difference in liver and spleen rates occurs even with nulliparous women, but also that it becomes significantly increased further with increasing parity. 4. 4) Lactation, rather than pregnancy alone, appears to be related to this increase of liver and spleen rates with parity. 5. 5) Loss of weight among women during the child-bearing ages is very marked. Reasons are put forward for the assumption that this is due to a protein deficiency which most severely affects lactating mothers. 6. 6) No relationship was found between the palpable liver or spleen rates of adults, grouped by age, sex and racial origin, and their body heights or weights. It is concluded that malnutrition in childhood or any other experience that may have permanently affected their growth has had no observable effect on the incidence of hepatomegaly or splenomegaly among those individuals who survived to adult life. 7. 7) Malaria parasite rates in adults of both sexes do not differ significantly, but women in their first lactation have significantly higher rates than women of the same age who have never lactated. It is suggested that, owing to a relatively more severe protein deprivation, the livers of lactating women may produce more tissue reaction in response to malarial parasitaemia than those of men or nulliparous women, and that their state of premunition is temporarily decreased by the stress of lactation. However the possibility that other infective or toxic factors besides malaria are also operative cannot be excluded. 8. 8) Significantly lowered haemoglobin values have been found to be associated with hepatomegaly, but not with splenomegaly alone, in women over 30 years of age. It is suggested that this may indicate that there exists in the Sepik District, on a large scale, a syndrome of anaemia with hepatomegaly in multiparous women deprived of protein that has previously been found among patients in Nigerian maternity wards.

Two cases of damage to solitary peripheral nerves in loiasis are described. It is argued that the lesions were due to the death or encystment of L. loa worms in close anatomical proximity to the nerves.

In an attempt to prove an association between the small race of E. histolytica and certain intestinal symptoms, the incidence of this parasite was compared with that of other pathogenic and non-pathogenic bowel parasites in defined groups of patients from the tropics, with and without intestinal symptoms. No evidence could be found of any association of the small race of E. histolytica with diarrhoea, abdominal pain, flatulence or constipation.