The American Journal of Tropical Medicine and Hygiene - Volume 9, Issue 5, 1960

One of the most significant events in the history of sanitary engineering in the twentieth century may well be the decision made by the World Health Organization (WHO) and the International Cooperation Administration (ICA) to cooperate in the promotion of a global program of municipal water supplies.

The World Health Assembly, meeting in Geneva in May, 1959, re-emphasized its previous stand regarding the need and importance of public water supplies, and unanimously approved the Environmental Sanitation Division's plan for a spearhead attack as the first stage in a global program. While WHO has consistently advocated the use of safe water as an important public-health measure, the global plan has two important new features. It recognizes the economic importance of public water supplies and that only part of the cost of a supply is chargeable to health protection.The bulk of the expenditure,to quote the minutes of the Assembly, “is for the provision of a convenience and a commodity”— water supplies should not be promoted as a kind of dole but should be—“operated,managed and maintained on sound business lines.”

Seasonal variation in toxicity for white mice of intraperitoneal injections of triturated cephalothoraces of freshly caught black widow spiders, Latrodectus mactans (Fabr., 1775), was demonstrated. Spiders used in these tests were collected at Camp Bullis, Texas. Twenty-eight day old white mice from a single source were used as test animals. Intraperitoneal injections were of varying strength with respect to fraction of a cephalothorax included in a constant volume of 0.25 ml of saline solution. LD50's were expressed as fractions of a venom gland contained in the injection. Highest toxicity, as indicated by LD50's of .33 and .23, occurred in November of 1958 and 1959. Lowest toxicity, as shown by LD50's of 3.29 and 2.45, occurred in April and May, 1959.

Fourteen baits were tested in a “Y”-shaped maze for their attractiveness to the snail Australorbis glabratus. Wheat germ and an alginate-based snail food containing wheat germ were the only baits which attracted snails. One bait, ground watercress leaf, acted as a repellent. All other baits were found to be non-reactive. Human feces and urine did not appear to attract this snail.

Experiments also demonstrated that the osphradial organ is a chemoreceptor in A. glabratus and functions in the detection of attractive substances.

The hydroxynaphthoate salt of bephenium was tried 168 times against worm infections in mental patients. Tetrachloroethylene was tried 41 times for comparison.

Bephenium hydroxynaphthoate, in granular form (Alcopara®), exerted good effects against hookworm (Necator americanus). It was more effective than tetrachloroethylene. Dosages of 5.0 grams base single dose daily for 3 or more consecutive days reduced heavy hookworm infections by 95% or more with about 55% of the infections cured. Five-gram doses for 1 or 2 days greatly reduced the hookworm burden but the cure rate was low. The optimum regimen appears to be 5 grams single dose for 3 days or, for mass therapy, a single 5-gram dose.

The drug was highly effective against Ascaris lumbricoides, giving an over-all egg reduction of over 99%; 12 of 13 infections were eliminated.

Bephenium also was moderately effective against Trichuris trichiura infections. Dosages totaling 15 or more grams resulted in a substantial reduction in worm burden and produced some cures.

Of two known Enterobius vermicularis infections treated, neither was cured. A single Hymenolepis nana infection was not eliminated.

Side effects, principally vomiting, occurred in about 7 per cent of the patients. However, in only one patient was it necessary to discontinue treatment.

Of 214 children with hookworm infection in Lowndes County, Georgia, 80 were treated with tetrachloroethylene, 95 with one, two, or three doses of bephenium, and 39 were not treated. Following treatment, percentage reductions in mean egg counts were approximately 99, 89, 84, 64 and 50, respectively; and percentages of children completely cleared were 81, 29, 30, 16 and 26, respectively. It was concluded that bephenium possessed some anthelmintic activity but that tetrachloroethylene was superior. Side effects were more commonly produced by the bephenium preparation than by the tetrachloroethylene.

Bephenium hydroxynaphthoate administered to children 10 to 15 years of age in total amounts of 4.0 to 17.5 grams (base) over a period of 1 to 7 days proved to be highly effective against Ancylostoma duodenale and Ascaris lumbricoides. It was less effective against Necator americanus and Trichuris trichiura. The side effects from the 5- and 7-day courses of therapy were of sufficient severity and frequency to limit the use of these therapeutic regimes in mass therapy. However, when a total of 5.0 grams of the base was given in two doses on 1 day, the side reactions were not significant or extensive and the Ancylostoma and Ascaris cure rates were excellent. This latter regime appears to be the most desirable one at present, although it is possible that further study may show that 1-day therapy with doses smaller than 5.0 grams is effective. Pharmacologic studies indicate that this drug is safe in therapeutic dosage.

Various new formulations of tablets of dithiasanine iodide were administered to 81 teen-age individuals infected with Enterobius vermicularis. As compared with commercial tablets, administered to 43 patients, the new formulations gave evidence of improved patient tolerance without loss of therapeutic efficacy.

Commercial tablets at a dosage level of 300 mg daily for 5 days apparently cured all 16 subjects treated. Thirteen subjects complained of side effects, among whom 7 vomited once and 3 vomited twice or more. In a similar group receiving half the dose, the incidence of side effects was significantly reduced; but there were 4 treatment failures.

The incidence of side effects in the group receiving the four tablet-modifications was significantly reduced as compared with that in the group receiving the commercial tablets in full dosage or half dosage. There were two treatment failures. Best tolerance was noted in 23 patients receiving the tablets containing a methylcellulose core. Four had some side effects, among whom only one vomited once and none vomited twice.

Thirty-five patients with multiple infections of Ascaris lumbricoides, Trichuris trichiura, and Ancylostoma duodenale were treated with dithiazanine iodide at a dosage of 200 mg three times daily for 1, 2, 3, 4, or 4 days.

Significant anthelmintic activity was observed in both trichuriasis and ascariasis but not in hookworm infection. Eighteen of 35 patients had side reactions in the form of nausea or vomiting, or both. In 4 patients the vomiting was so severe and persistent that the treatment had to be discontinued.

Because of its lack of activity against hookworm infection and the large number of patients with side reactions, it is felt that dithiazanine will be unsuitable for mass treatment in this country.

A mechanical device, producing a permanent communication between the lumen of the cecum and the exterior, offers a satisfactory method of studying the course of amebic infection in guinea pigs. Such animals thrive normally with the tube in situ and when inoculated in the cecum with a 48-hour crude culture of Entamoeba histolytica acquire the infection within 12 days. The infection takes an acute fatal course without diarrheal manifestations. With early treatment the condition may be controlled, but it usually recurs, simulating chronic intestinal amebiasis, as observed in infected animals kept under observation for several months.

Necropsy showed amebic ulcers in the colon, a large number of amebae being demonstrated in the deeper tissue and crypts. The weight of the liver in relation to the body weight was significantly increased as observed in the relapsing animals as compared to normal ones. Cutaneous amebic ulcers due to local contamination developed in three infected guinea pigs; they were cleared up readily with local anti-amebic treatment.

While illustrating the utility of the mechanical device not only in observing the natural course of amebic infection in guinea pigs but also in assessing the effect of amebicidal drugs on the parasites in the colon, no conclusion was drawn as to the relative efficacy of the different drugs used in the present study.

In attempts to develop a specifically reactive complement fixing antigen, desiccated Trypanosoma cruzi rendered essentially lipid-free by extraction with anhydrous ether were extracted in buffered saline solution and the saline extract treated with chloroform and n-amyl alcohol under conditions considered to minimize deterioration. This yielded protein and carbohydrate antigens separable, respectively, in the gel and aqueous phase of extracts thus treated. Each showed a high degree of specific reactivity, as demonstrated in complement fixation tests of sera representing the homologous and several heterologous infections. The findings indicated that the protein fraction was the antigen of choice for diagnostic complement fixation tests.

The range of histoplasmin sensitivity in 821 Guatemalan hospital patients between the ages of 15 and 60 years of age was found to be 23 to 81% depending on the test area.

The uniformity of histoplasmin sensitivity rates in all age groups tested suggests that most infections are acquired prior to age 15.

The ratio of males to females was approximately 5 to 3, with sensitivity rates of 62 and 49 per cent, respectively.

Six new adenovirus serotypes are proposed. The prototypes were encountered among 65 strains of adenoviruses which were isolated from eastern Saudi Arabia in the period 1955 to 1957. Suitable prototype materials have been forwarded to the subcommittee on adenoviruses of the National Institutes of Health.

Irradiation of dilute aqueous solutions of sodium pentachlorophenate (NaPCP) with light in the wavelength range of 290 to 330 mµ causes a chemical alteration of the NaPCP with a concomitant loss of molluscicidal activity. The reaction follows first-order kinetics, and the velocity constant is directly proportional to light intensity.

When NaPCP is used to treat the water of shallow ponds or streams exposed to bright sunlight, photochemical degradation of this agent may be an important variable, especially when the water is clear and free of solutes which interfere with light penetration.

When primaquine diphosphate was subjected to conditions simulating those ordinarily occurring in the preparation of food, it was found to be unstable. Spectrophotometric analysis indicated a destruction of from 5% to 94% depending upon the conditions of heating. However, when the heated samples were tested against Plasmodium gallinaceum in young chicks, all activity was absent except in the sample boiled in water for 24 hours and in this instance the activity was of a very low order. These findings exclude the use of primaquine as a salt additive in malaria eradication programs.

Amsterdam, March 7, 1960

To the Editor.

Sir,

Considering the interesting piece of work by Varela, Kean, Barrett and Keegan on the important problem of diarrhea among travelers, which has been published in your Journal (1959, 8: 353–357), it seems that the results of this investigation deserve more attention than the seemingly disappointing conclusion, stating that the enteropathogenic E. coli, Paracolobactrum and Klebsiella could not be incriminated as the cause of the diarrhea of travelers to Mexico.

Among the 27 students, who contracted diarrhea, bacterial pathogens were significantly more often isolated than among the 35 well students. The probability that the preponderance of pathogens among the sick students could be due to mere chance is less than 5% (x 2 = 5.0407; one degree of freedom).

More important, however, is the observation that the occurrence of isolated bacterial pathogens among the total group of 62 students is not equally distributed during the period of study.

New York, April 25,1960

To the Editor.

Sir,

The analysis of our data by Dr. O. Kranendonk is astute and provocative, and I hope you will find it possible to publish it. The conclusions in the original paper may well have been too conservative. Further studies were made during the summer of 1959 and will be reported before long. Unfortunately, the technique was not similar to that of 1958 and comparisons are not feasible.

Aedes aegypti (L); The Yellow Fever Mosquito, by Sir S. Rickard Christophers, C.I.E., O.B.E., F.R.S., I.M.S. (Ret'd). 739 + xii pages, ill. Cambridge, Cambridge University Press (32 E. 57th St., N. Y. 22, N. Y.), 1960. $14.50.

Antibiotics Annual 1959–1960 (7th Annual Symposium on Antibiotics). Henry Welch, Ph.D., and Felix Marti-Ibañez, M.D., editors. 1034 + xx pages, ill. New York, N. Y., Antibiotica, Inc., 1960. $15.00.

Biological Organisation: Cellular and Subcellular (A Symposium), C. H. Waddington, editor, 328 + xviii pages, ill. New York 22, N. Y., Pergamon Press, Inc., 1959. $12.50.

The Origin of Life on The Earth (A Symposium). Edited for the Academy of Sciences of U.S.S.R., by A. I. Oparin, A. G. Pasynskii, A. E. Braunshtein, and T. E. Pavlovskaya. English, French and German edition edited for International Union of Biochemistry by F. Clark and R.L.M. Synge. Vol. I, 691 + xv pages, ill. New York 22, N. Y., Pergamon Press, Inc., 1959. $15.00.

This textbook is designed primarily for the medical student “who is being introduced to hematology for the first time while he is in the midst of a crowded curriculum.” It is also intended to be of use to busy physicians and to ancillary workers as an up-to-date review and reorientation in the field. It achieves both of these aims. The style is concise, direct and factual yet readable. The material is up-to-date.

The approach is based on “comprehensive but not encyclopedic” descriptions of normal morphology, biochemistry, physiology and function of various cell lines, and of normal erythropoiesis, leukopoiesis, hemostasis, etc. These lead into the anemias, polycythemia, coagulation and disorders of hemostasis, the leukemias and therapy of leukemia and malignant lymphoma, and into other diseases of lymphoid tissues and bone marrow.

The tabulated classification of anemias introducing a major section of the book is based primarily on Mechanism of Production:(I. Diminished Erythropoiesis: A. Nutritional, B. Bone Marrow failure; II Blood Loss, acute and chronic; III. IncreasedHemolysis:A, Intracorpuscular, B. Extracorpuscular) with Causes and Diseases or Clinical Syndromes listed under coordinate headings.

“This book is intended primarily for students as a practical guide to the clinical study and treatment of diseases of the skin.” With this objective as his goal the author has succeeded in compressing much useful information and many illustrative photographs into the confines of a volume small enough to be inviting.

To be useful, however, such a guide should contain only information which is correct by present standards and it should not lead into error those readers who are insufficiently experienced to recognize debatable teachings. One may question the validity of several statements in the text, especially that “the lesions of impetigo tend to spontaneous cure in about three weeks,” that “Sarcoidosis is probably a peculiar form of hematogenous skin tuberculosis associated with visceral tuberculosis” and that in pityriasis rubra pilaris “the general tendency is to spontaneous cure.”In discussing lupus erythematosus the author states that “Lupusvulgaris is simulated by a rare type called lupus vulgaris erythematoides,” implying erroneously that this entity is a form of lupus erythematosus.