Search

1. (1) Eleven patients with anaemias of pregnancy were studied over a period of 4 months. Six with megaloblastic, one with normocytic, and one with microcytic anaemia were given a high protein dietary supplement, but no haematological response was observed. 2. (2) A study of eight patients with tropical macrocytic anaemia of pregnancy and bone marrows containing “transitional megaloblasts” leads to the proposition that two factors are present in the aetiology of this anaemia as found in the Gambia: 1. i. a haemolytic factor, which ceases directly on delivery and, in the production of which past malarial infection can be suspected of playing a part. 2. ii. a failure of utilization of haemopoietic substances in pregnancy which lasts for at least a week after delivery. The findings are thought to provide evidence that, in the Gambia, dietary deficiency of haemopoietic substances, or direct competition for them between foetus and mother, are not major factors in the production of this anaemia.

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.

1. (1) At the Hospital for Tropical Diseases, London, 417 patients suffering from intestinal amoebiasis have been treated and followed up under standard conditions. 2. (2) Emetine bismuth iodide was given in doses of 3 grains nightly for 10 nights to 220 patients. In 24 with E. histolytica trophozoites in the stool, this was preceded by 1 grain emetine by injection on 3 successive days. Of all these patients, 3 per cent. are known to have relapsed. 3. (3) The relapse rates :following treatment with chloramphenicol and aureomycin was so high that after short trials it was considered unjustifiable to continue the drugs. 4. (4) Of 14 patients followed up after treatment with oxytetracycline, two relapsed. 5. (5) Of 27 patients whose stools had contained E. histolytica cysts and who were followed up after treatment with fumagillin, one relapsed.Many toxic effects including dermatitis and albuminuria were encountered. 6. (6) Glaucarubin in doses of more than 4 mg. per kg. body weight was followed by a relapse rate of 12 per cent. among patients whose stools contained either E. histolytica cysts or trophozoites. 7. (7) A similar relapse rate followed the use of doses of 12 mg. or more dichloroacethydroxy-methylanilide in persons whose stools had contained E. histolytica cysts. 8. (8) It is concluded that emetine bismuth iodide is the most satisfactory drug at present available for the treatment of intestinal amoebiasis.

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.

1. (1) Thirty West African men have been divided into three groups according to the length of time they have spent continuously in Britain. The serum protein patterns of the groups are described, and the differences studied statistically. 2. (2) The pattern in recent arrivals is that usually found in tropical Africans. Over the course of more than 6 years the pattern approaches close to, but does not completely reach, that of normal Europeans. 3. (3) It is concluded that the pattern found in Africans in Africa is not due to genetic or physiological factors, but is due to pathological changes which are at least partly reversible if the environment can be altered. 4. (4) These pathological changes are in the liver and, in Africans from the tropics, are thought to be due to malaria as well as to malnutrition.