The American Journal of Tropical Medicine and Hygiene - Volume s1-15, Issue 5, September 1935

In reply to a state wide questionnaire survey on the occurrence of relapsing fever in Texas, 258 cases were reported for the years 1930 to 1934 inclusive. In eighty of these cases the clinical diagnosis was confirmed by finding the spirochete in blood films from the patient. In the others the diagnosis seems well established by careful clinical observation including specific response to antispirochetal treatment.

Practically all these cases occurred among farm and ranch people. In the few which occurred within city populations, there were definite possibilities for the infection having had its origin during some trip to the rural districts. Seasonal incidence, late summer and fall, coincides with the seasonal activity of the Texas relapsing fever tick, O. turicata. The actual incidence of the disease appears to be restricted to certain tick infested localities within a given district.

Race, age, or sex appear to have no part in immunity to the disease as it occurs in Texas.

In Texas the disease must be differentiated from malaria, dengue, typhus and, in some instances, tularemia. In its symptomatology, relapsing fever in Texas presents as acute type of reaction as may be observed in other parts of the world. In relapsing fever in Texas the patient's temperature may reach 105° to 106°F., during the onsetting reaction. In the absence of specific treatment there is little or no abatement in temperature or discomfort during the next three recurrences. Relapses subsequent to these, however, gradually become less severe. In the severe cases there is a marked irregularity in the length of the afebrile period. In the less severe cases, the period between relapses is four to five days. A macular rash is present in about one half the cases. There seems to be no correlation between the severity of the disease and the presence of the rash. Splenic enlargement and tenderness are quite common. Jaundice is rather uncommon. Liver enlargement is but infrequently observed. Severe organic damage as manifested by complications and sequellae is not characteristic of relapsing fever in Texas, only 2 cases in 258 showing a neuropathy (facial paralysis) and some 5 cases displaying evidence of myocardial damage. On the other hand, myalgia and a stubborn muscular asthenia are common sequellae of the disease as it occurs in this state. Single doses of neosalvarsan (0.01 gram per kilogram of body weight) very often prove to be inadequate for effecting a cure. No fatal cases were reported to this survey.

• 1.  No multiplication of acid-fast bacteria has been observed in our cultures of rat leprosy in minced embryonic (foetal or neoplastic) tissues suspended in Tyrode solution.
• 2.  An acid-sensitive, but facultative acid-fast and pleomorphic organism did grow in certain of these cultures. This type of organism is identical with that repeatedly cultivated by us and others from human and rat leprosies in other media.
• 3.  The minced embryo medium appears to be less suitable than a leaner medium for the growth of the cultivable organism from leprosy.
• 4.  It is suggested that the diverse cultural results with embryonic tissue medium reported by other authors may be due, on the one hand, to the great number and serial transfer of acidfast bacteria of the inoculum; and, on the other hand, to the interpretation of the acid-sensitive organisms appearing in the cultures as contaminants.

Mayer (1) reported no side-effects from intravenous injection of atabrine in 7 patients, given up to 0.3 gram at a dose in 9 cc. of distilled water. Eckhardt (2) found in one patient 0.3 gram tolerated, but the following day 0.4 gram was followed two hours later by violent vomiting, collapse, rapid weak pulse, anxiety, and stupor; he was revived by hot black coffee; there were no sequelae. Eckhardt (2) and Mayer (1) both recommend that not over 0.2 gram be given at one dose. In an article (3) seen only in abstract kindly supplied by the manufacturers of atabrine, the authors suggest not using higher doses by vein than 0.2 gram, nor higher total dose daily by vein than 0.3 gram, and further advise against injecting the whole daily dose of 0.3 gram at one time. Appelbaum and Gelfand (4) treated estivo-autumnal malarial coma in 3 patients with atabrine by vein.

• 1.  In two separate experiments, Anopheles bachmanni females were infected with Plasmodium vivax. In one experiment, 3 out of 7 A. bachmanni were infected with oöcysts, and all of the 5 A. albimanus controls were found to be positive. In the other experiment, 3 out of 11 A. bachmanni females were infected with either oöcysts or sporozoites; while approximately 94 oöcysts were found in the stomach wall of the single A. albimanus control.
• 2.  Sporozoites were found in one of the positive A. bachmanni nine days after the infective blood meal.
• 3.  Mosquitoes that quite probably were A. bachmanni were also infected with P. falciparum. Two out of 13 of these mosquitoes had oöcysts in the stomach wall, while 7 of the 14 A. albimanus controls were positive.
• 4.  Not only were more individuals of A. bachmanni refractory to infection, but it appeared that those mosquitoes which didbecome infected displayed a higher degree of immunity than A. albimanus.
• 5.  A. bachmanni larvae in Panama are found chiefly in Pistia stratiotes. In a limited area that was under observation for over four months, a certain patch of Pistia seemed to be more attractive to ovipositing females than other patches, and this appeared to be true even as regards certain areas within a single patch.
• 6.  A. bachmanni females have been observed to attack man in the jungle by daylight.

Mercurochrome, as an intravenous therapeutic agent in the treatment of avian malaria, is not of sufficient value to warrant its use. This is also probably true of human malaria, but it may be of some value as an adjunct to other drugs or in cases where there is an idiosyncrasy to other malariacides. 1 hydroxy, 3 nitro, 2, 4 diacetoxymercuri anisole is of no value as a malariacide. Early in the infection it may have retarded, but later it seemed to stimulate, multiplication of the parasite. Neither carbarsone nor vioform has any malariacidal effect. Infection by the intravenous route is followed by a shorter incubation period. This seems to be a desirable method for experimental use in avian malaria.

The course and outcome of experimental yellow fever in Macacus rhesus when specific immune serum was injected into the animals at various intervals after the administration of the virus, has been studied by Davis (1).

Penna (2) has described the changes which he observed in a viscerotropic (the Asibi) strain of yellow fever virus as a result of serial passage through the central nervous tissues of rhesus monkeys that were protected against serious visceral damage by the inoculation of specific immune serum. After about forty such passages the virus was so modified as to be primarily neurotropic.

In the study here reported observations were made upon the course and outcome of yellow fever encephalitis in M. rhesus that received immune serum via the cisterna magna—after the removal of some cerebrospinal fluid—at various intervals before the intracerebral inoculation of the modified Asibi virus with which Penna was working.

The importance of iron-hematoxylin staining in the diagnosis of protozoa is well recognized. While it is used extensively in research institutions, and in many clinical laboratories, it has never become a routine laboratory procedure for the average technician on account of the difficult and laborious technique. The particular difficulty seems to have been the control of the decolorization process which had to be carried out under the microscope, a step requiring considerable experience in the use of the stain and more than average knowledge of protozoology.

A technique has been evolved that removes this step which has been responsible for its unsuccessful use, and which makes it possible for any laboratory technician to use the iron-hematoxylin method and obtain uniform and satisfactory results.

The only new feature of this technique is the use of a 0.25 per cent solution of iron-alum for decolorization instead of the stronger 1 and 2 per cent solutions.

In one respect, the restriction of our subject to the New Orleans locale gives me a distinct advantage over the other speakers on this program, for while they must depend upon the records of the past for at least a portion of their material, I have but to refer to my own memory, practically the entire history of bubonic plague in New Orleans having transpired within my personal experience. In another respect, this places me at a disadvantage because I am not alone in having lived through plague in New Orleans, there being many present to note promptly such variations from the straight line of accuracy as are unfortunately normal to the functioning of the human memory. Furthermore, the interpretation placed upon the facts by others who have observed them may differ from my own. This, then, must remain the history of bubonic plague in New Orleans as I have seen it.

• 1.  Characteristic changes in the small intestine have been demonstrated by x-ray in seventeen cases of sprue.
• 2.  Similar changes have been observed in other conditions exhibiting clinical evidence of multiply deficiency states.
• 3.  The intensity and extent of the abnormalities in the small intestine vary directly with the severity of the clinical picture in sprue, and they regress under specific therapy.
• 4.  It is suggested that they may play a part in the defective absorption or utilization of essential food factors.

In the decade following the close of the world war great numbers of southerners were enticed northward by the higher wages and better living conditions of our rapidly expanding industrial centers. The word “enticed” is used advisedly, for from certain of our northern cities active newspaper propaganda went throughout the South, setting forth the advantages of such migration. It was apparently much the same desire for obtaining cheaper labor that was so long an effective block to restriction of European immigration. At any rate Cincinnati, along with many other cities of the North, found herself early in the present depression with a large number of indigent southerners, both white and colored, to support. For the past four years almost the entire medical care of these people has fallen on the free clinics of the city, sorely taxing the capacity of the General Hospital and Out-Patient Dispensary.

The splendid work on bacteriology by Drs. Kolle and Hetsch needs no introduction to students of this subject, but the profession is greatly indebted to the translator for his excellent translation of this very valuable work into English. For many years it has been felt by those interested in the subject that an English translation would be of great service, and the translator, the editor and the publishers are to be congratulated upon the publication of the present translation.

The seventh German edition of Kolle and Hetsch was published in 1929 and this translation follows so closely the original and there are so few additions by the editor that the work practically pictures the status of bacteriology only to the year that the seventh edition was issued. The sections upon bacteriology are excellent and are fairly well brought to date, but the sections upon protozoal diseases are lamentably out of date and were not well up-to-date even in the seventh German edition.

This excellent book is exactly what its author asserts it to be, viz., “a collection in convenient form of methods which through experience have been found of value.”

Besides the preface the manual comprises nine sections, the last being one containing references for further reading.

The first chapter or section deals with general instructions which are clear and concise and the second pertains to the cleaning and sterilization of glassware, while the remainder have to do with preparation of media, stains and reagents and the care, feeding, breeding and handling of laboratory animals. Surely the latter is an innovation which is both unique and welcome in manuals of this sort.

Sections six, seven and eight are devoted respectively to clinical serology, clinical bacteriology and the examination of pathogenic fungi. One topic in the section on clinical bacteriology, headed “Examination of Rabies,” is perhaps open to criticism, since no method of staining either smears or sections is mentioned.

In 1930 the reviewer had the pleasure of reviewing the first edition of this work at which time he stated that it was “one of the best written and most valuable books upon tropical medicine,” and the second edition which has just appeared does not change his opinion regarding the work. There have been a few additions made to the text, although the size of the work has not been notably increased. A brief chapter has been added on tropical fevers and case taking and the various subjects considered have been brought up to date as far as possible. Each chapter is signed by the author which adds greatly to the value of the work and it is noted that the diseases treated by the two authors are those with which their names are usually connected because of their experience.

The fact that this book has been presented in three editions in six years argues well for its qualifications and usefulness. It deals with what the American physician would call Physical Diagnosis rather than with what the title which the author selects, suggesting therapeusis as well.

The author attempts to fill a large order within the relatively narrow confines of the eight hundred odd small pages. That he has succeeded very well there is no doubt, but the limitations of space have imposed corresponding limitations in the text, which are not always desirable, but which have been met to a certain degree by alteration in the size of the type.

The author is to be congratulated on the general arrangement of the material and the presentation of the symptomatology and differential diagnosis when necessary. His great teaching ability is clearly evident from the systematic and concise manner with which he has presented and analyzed each disease entity.