The American Journal of Tropical Medicine and Hygiene - Volume 7, Issue 3, 1958

For the benefit of the younger and recently acquired members of the Society, who may not be well acquainted with the life and achievements of the figure for whom this lecture series is named, I have the following information to offer.

Colonel Charles Franklin Craig, U. S. Army, was born in Danbury, Conn., on the fourth of July, 1872, the son of a country doctor. He obtained his medical degree at Yale in 1894, practiced medicine in his home town, and became a contract surgeon in the U. S. Army in 1898. Five years later he was commissioned as a First Lieutenant in what was then known as the Army Medical Corps, receiving his colonelcy in 1918. He served in Manila, Hawaii, Texas, Kansas, and the District of Columbia, where he had extended tours of duty at the Army Medical School.He made and reported numerous observations on tropical and related diseases in the field and had much to do with developing the laboratory technology of tropical medicine.

Reminiscence. The concept of the eradication of malaria was born in the United States but its growth was slow. It had to overcome the dictum that while malaria could be controlled eradication should not be attempted.

This was so in spite of the urging of one man who did have the vision of eradication and who stated it forcefully, Dr. Frederick L. Hoffman. Perhaps his vision was too broad for his day and the tools at hand too expensive or not sufficiently effective. Perhaps he ranked quinine too high as an antimalaria tool or else he described his plan too much as a movement and too little as a specific program. In any case, it received no support at the time.

In his paper, “A Plea for a National Committee on the Eradication of Malaria”(Hoffman, 1916),he told of the adoption by the Second Pan American Scientific Congress on 8 January, 1916, of his resolution “That all American countries inaugurate a well considered plan of malaria eradication and control based upon the recognition of the principles that the disease is preventable to a much larger degree than has thus far been achieved, and that the education of the public in the elementary facts of malaria is of the first order of importance to the countries concerned.”

An epidemic of infectious hepatitis has been described, involving at least 222 individuals in a college, for a total attack rate of 8 per cent. Cases were distributed throughout the campus population with great uniformity, with two exceptions: disproportionately low attack rates (0.4%) were observed in students who lived off campus, and disproportionately high attack rates (17 to 50%) were observed in student workers in the common dining hall.

Although every evidence pointed to a common source and mode of infection, these could not be determined with certainty. The outbreak is described as a “case report” of a large and interesting epidemic, the explanation for which remains frustratingly obscure.

Further data are presented which show uniform attack rates among persons of all ages, among persons from large and from small families, among residents of urban areas and of rural areas, among veterans and nonveterans, and among persons claiming and not claiming previous infections with infectious hepatitis. Several possible explanations of these phenomena are discussed.

Wuchereria bancrofti of the nocturnal type is endemic in the kampung areas of Djakarta. In a representative area the filarial infection rate of 4,311 persons resident there for at least 3 years was 10.4 per cent. Men showed somewhat more infection than women, but the difference was not significant. The number of microfilariae found in the blood was usually small, the average infection being 28.3 microfilariae in 20 mm3 of blood, but the microfilarial count was 10 or less in more than 45 per cent of the cases.

In the area examined no elephantiasis was found. Generally it is rarely seen in Djakarta. On the other hand, hydrocele was found in 14 of the 92 men (15.2%) examined above 15 years of age. The youngest person showing hydrocele was 20 years of age. Thickening of the spermatic cord was found five times. The youngest person showing this abnormality was 14 years of age.

Lymph-node enlargement was frequently found in both men and women, but there is no certainty as to the etiology of these enlargements.

The experimental histopathology of the spleen, intestine, lungs, bone marrow and lymph nodes were studied in mice infected with Schistosomatium douthitti. The inflammatory response in the spleen toward eggs was not as circumscribed as noted in typical pseudotubercles surrounding eggs in the liver. No evidence for an enhanced hematopoietic response or increase in lymphocytic nodules in the white pulp was discerned.

In the intestine eggs were found in the submucosa and mucosal lamina propria. Thickening of the serosa and the inhibiting action of the muscularis mucosa in confining eggs and the inflammatory response to the submucosa and muscle layers were noted. In no instance were abscesses of the mucosa seen. In the lungs inflammatory nodules surrounding eggs were observed 60 days after infection. Mature, living worms were seen in the lungs eliciting no apparent cellular response. The histology of the bone marrow, kidney and lymph nodes in infected animals was very similar to that of tissues in the normal, uninfected controls.

Comparison of lesions caused by eggs in the spleen of Peromyscus maniculatus, (deer mice) and lesions caused by eggs of S. mansoni in white mice indicated differences in the cellular response of those hosts and may be a reflection of the mechanism of parasite survival.

An immersion test for screening chemicals for molluscicidal activity against Oncomelania nosophora snails and a modification of the McMullen plate test are described. Results of screening 89 compounds by these methods are given. Twenty-four compounds had an LD50 of less than 0.1 mg (5 ppm) by the immersion test and 0.2 mg (100 ppm) by the plate test. Sodium pentachlorophenate and dinitro-o-cyclohexylphenol were control chemicals. It is believed that the immersion test eliminates several variables inherent in the plate test and that it is preferable for screening of molluscicides in the laboratory.

An examination of 349 fecal specimens fixed by the MIF (Merthiolate-iodine-formalin) preservation method revealed the presence of ten species of protozoa, seven of nematodes, four of cestodes, eight species of trematodes and a tyroglyphoid mite. There was a predominance of the small race of Entamoeba histolytica over the large race and only a single infection with Isospora was noted.

Although there was an unusually high incidence of eggs of Dicrocelium the conditions of these eggs in stool specimens indicate spurious infections. Fasciolopsis and Clonorchis in Turkish soldiers from the Korean campaign implicate travel as the probable reason for infection; Schistosoma mansoni infections probably were contracted as a result of pilgrimages to Mecca.

The formation of round bodies by the anaerobic, Gram-negative streptobacillus used in the S-F medium under the influence of penicillin G has been reported.

Actively propagating E. histolytica trophozoites ingest the round bodies roughly in proportion to the numbers available.

Streptobacillus variants that do not support propagation of E. histolytica do not produce the round bodies. There is a rough parallel between round body production and ability to support propagation of E. histolytica in six variants studied.

Normal horse serum and glucose do not influence the production of the round bodies.

Those variants not producing round bodies in the presence of penicillin G are somewhat more resistant to the antibiotic than are those which produce round bodies.

In southwestern Georgia observations on the effects of low termperatures on the survival of naturally occurring Aedes aegypti larvae in various types of breeding containers were made throughout the winter. Average weekly air temperatures below 60° F killed most larvae but, because of the sheltered positions of some containers, a few survived during periods when the average weekly temperature was as low as 48° F. During warmer parts of the winter, larval development continued and adults emerged. No indications of feeding or oviposition were observed during the colder months. In the area studied, normal breeding and oviposition apparently commenced during May.

It was found that Vibrio comma phages absorbed on filter paper maintain their lytic property for a long period of time. A mixture of four phages covering a wide range of true cholera vibrios was prepared and absorbed on filter paper disks which were stored for 4 months. These disks proved helpful in the identification of V. comma.

The management and complications of 32 cases of tetanus neonatorum with eight deaths are discussed. Tetanus is a preventable disease and in countries where doctors are not available for deliveries every effort should be made to train midwives in the proper care of the newborn.

An experimental study is reported on the plague-vector capacity of the wild-rodent flea, Hystrichopsylla linsdalei, compared with the rat flea, Xenopsylla cheopis. The average temperature under which the infected fleas were held (19°C) was lower than that in previous tests with H. linsdalei.

Although the H. linsdalei blocked sooner than the X. cheopis, the rate of blocking in the latter species was more rapid and resulted in a greater number of blocked individuals.

The plague-vector indices of male and female fleas combined were 0.002 for H. linsdalei and 0.03 for X. cheopis. The lower efficiency of H. linsdalei, under the conditions of the experiment, are partially ascribed to a lower blocking rate and a shorter survival period for the blocked individuals. Thus, the wild rodent flea had fewer opportunities to transmit P. pestis than the rat flea.

There was no evidence that infectious feedings by the fleas on different mice with comparable plague septicemia influenced subsequent infection or blocking rates. Rather, differences between the two species suggested the presence of unknown physiological factors which may enter into the receptivity of a flea species to the growth of plague within its intestinal tract.

The average death time of mice succumbing to plague transmitted by H. linsdalei was about 5 days, whereas the death time for mice infected by X. cheopis averaged about 4 days. This may have some bearing on the number of bacilli injected by blocked fleas.

In confirmation of past work, it was found that culture of feces from, and microscopic observation of, fleas infected with P. pestis are useful procedures, but they do not provide an unequivocal basis for the determination of individual flea infection. The culture of individual fleas is the method of choice.

Viruses in this study, because of the many antigenic overlappings, cannot all be identified on the basis of serological response alone. It appears highly probable, however, that JBE, dengue and EEE viruses are present, plus at least two others from group B (one of these possibly Ntaya) and at least one other from group A, closely related to Semliki Forest virus if not that virus. As a result of this preliminary survey an expedition was organized to attempt to isolate and thus actually identify the agents present. Testing of these latter materials is still under way.

Dithiasanine is an effective, oral, therapeutic agent for clinical and subclinical trichuriasis. This new anthelmintic is useful for mass therapy for trichuriasis. Since dithiazanine also has significant anthelmintic activity against A. lumbricoides, it is suitable for the treatment of mixed infections of trichuriasis and ascariasis, two helminthiases which frequently coexist in persons in endemic areas. An effective dosage of this drug for the therapy of trichuriasis and/or ascariasis is 20 mg per lb, with a maximum of 600 mg per day given in divided doses 3 times daily (i.e., 200 mg t.i.d.), for 5 or more days depending upon the size and severity of the infection. No serious side effects have occurred in several hundred children and adults treated with this anthelmintic.

Blood sera from 100 persons from a plantation near Escuintla, Guatemala (elevation about 1,000 feet above sea level) were tested for Toxoplasma antibodies by the Sabin-Feldman dye test. Males and females, ages 16 to 70, were included. All sera from persons above 25 years of age gave positive reactions. The overall prevalence was 94.0 per cent.

A group of 30 Guatemalan military recruits was likewise tested. These were males, ages 15 to 26 years, from various localities in Guatemala but chiefly from the central highlands (elevation 5,000 feet or higher). The overall prevalence of positive tests was 50.0 per cent.

Similar tests were done on 156 sera collected at Turrialba, Costa Rica (1,800 feet elevation). Donors were males and females, ages 20 to 70 years. The overall prevalence of positive sera was 88.5 per cent.

Comparison of males, 15 to 29 years of age, from the three test groups indicated a tendency for lower titers to be produced at higher altitudes. The possibility is discussed that transmission may be more frequent in warm climates than in cold. The present data seem to fit such an hypothesis, since sera from the Guatemalan and Costa Rican lowlands showed much higher prevalences of positive sera and higher titers than did the sera from the Guatemalan military recruits, who came chiefly from higher elevations. However, sufficient data are not yet available to test this relationship adequately.

This handsomely produced small book is essentially a summary of reports of field observations carried out over a period of more than two years, on the distribution and bionomics of Simulium damnosum in the Northern Territories of the Gold Coast (Ghana). It contains a suggested control scheme for the fly, based on these observations. While some valuable data are presented on the hydrography of the territories and the specific breeding sites utilized by S. damnosum during the seasons of observation, little new information is added to the meager knowledge of the bionomics of the adult. From the data presented in this book it appears that the majority of the numerous and varied field experiments are inconclusive; it is not even clear that S. damnosum is the only vector involved. It might be questioned therefore whether the suggested control of the immature stages of S. damnosum would be the most effective and economical approach to the control of onchocerciasis in the area studied.

On pages 535 and 536 of the first volume of this Journal, published in 1952, this reviewer stated, relative to the 2nd edition, that “The Infectious Diseases of Domestic Animals by Hagan and Bruner is highly recommended for students as a text and reference book in microbiology of infectious diseases of animals, and to others interested in various phases of these diseases. It is also a useful and ready reference for those interested and concerned with human infectious diseases, especially those transmitted from animals.” The reviewer considers the 3rd edition worthy of similar strong recommendations and high praise. In the latest edition there are no important changes in the arrangement and treatment of the seven parts and 46 chapters of the text. A large volume of new and important information has been reported in the literature since the earlier edition was published.

In 968 pages of text, illustrations, references,and index, the book contains as much as could possibly be included and make it as lucid and as readable as Hagan and Bruner have done.

With the recognition of the fact that the treponemal diseases are a major world health problem, this monograph on the Biology of the Treponematoses is an outstanding contribution to medicine.

The fundamental biology of the treponematoses is surveyed in the first six chapters which discuss the treponemal strains investigated and the methods of isolation; pathogenesis in laboratory animals; in vitro characteristics of the organisms, the immune reactions to treponemes; and the in vitro and in vivo effect of drugs.

Interesting comparisons of the various strains and species of treponemes are made in the next three chapters. Comparisons of disease produced in laboratory animals, immune responses and antigenic relationship, and response of various strains to penicillin were studied in an attempt to establish strain identity.

The authors have thus demonstrated close relationship of treponemal strains from syphilis, yaws, bejel and other endemic syphilis syndromes, particularly as to drug response, immune reactions, and pathogenesis.

The first volume contains 29 miscellaneous articles of which 16 are in English. Of interest are Dinger's discussions of alastrim, and the immunologic overlap in dengue and yellow fever; and van Thiel's and Laarman's papers on Toxoplasma. The second volume is entirely devoted to a pilot project of insecticide control of the A. punctulatus group (i.e. farauti, koliensis and clowi) and A. karwari in Netherlands New Guinea, which had greater success than anticipated, in view of the exophilic habits of these anophelines. This gives a full account of the vectors and of the holoendemic they cause.

In a country where the ratio of doctors to the population is 1:55,000, the contrast between what exists and what is needed in public health is rather overwhelming. In fact, it may be assumed that the public health program in Indonesia must start almost from scratch.

Dr. Leimena has compiled with great precision and care a budget of needed skills, personnel and funds which he has presented against an equally precise outline of those already in existence. A chapter is devoted to each component of the public health program: environmental sanitation; mother and child welfare (no mention is made of a need for family planning); improvement of nutrition both quantitatively and qualitatively; control of yaws, trachoma, tuberculosis, hook-worm, plague, typhoid, malaria, leprosy, V.D.; medical care (there are 8 beds per 10,000 people); laboratory services; vital statistics; training of para-medical personnel; health education.The scope of the program is graphically described in a set of ten appendices, each with relevance to a particular chapter in the text.