The American Journal of Tropical Medicine and Hygiene - Volume s1-4, Issue 3, 1924

Under the patronage of His Excellency Sir Laurence Guillemard, K.C.B., K.C.M.G., Governor and Commander in Chief of the Straits Settlements, and High Commissioner for Malaya, and the presidency of the Honorable Dr. A. L. Hoops, Principal Civil Medical Officer, Straits Settlements, the Fifth Congress of the Far Eastern Association of Tropical Medicine was held at Singapore, Straits Settlements during the week beginning September 3 last. An additional week was spent by many of the delegates in an interesting and profitable tour to points of interest in British Malaya as far north as Penang, including Kuala Lumpur, Port Swettenham and Ipoh.

Hospitality was provided on a most generous scale by the British hosts and hostesses, everything that could possibly have contributed to the comfort and enjoyment of the occasion by the attendants on the Congress apparently having been foreseen and provided. To this was added two weeks of uninterrupted fine weather at the pleasantest time of the year in British Malaya.

Unquestionably a modern piped water system, delivering an ample supply of potable water and available to all homes in the community at all hours of day and night, is the most effective measure for the permanent elimination of yellow fever. It is equally effective in rendering an infectible area non-infectible, as it automatically eliminates the necessity for using receptacles for conserving the domestic water-supply.

Unfortunately, many communities are hampered by inability to secure enough potable water to meet their needs, and by financial depression. The sanitarian, therefore, must resort to the next best plan for combating the infection, namely, to reduce to a minimum the breeding of the only known vector of the causative agent of this disease, i.e., Aëdes aegypti (more popularly known as the Stegomyia), by mosquito-proofing or destroying the receptacles selected by this mosquito for depositing her eggs, which are the containers used in and near human habitations for storing fresh water.

I

• 1.  Specimens of feces containing cysts of E. histolytica but no trophozoites were injected directly into the large bowel of kittens. Using material not more than six days old, 6 out of 8 animals were infected.
• 2.  The circumstances of the experiments suggest very strongly indeed that excystation occurred in the large bowel.
• 3.  Additional evidence was obtained that stasis is an important factor in producing an infection of the intestine with E. histolytica.

II

• 4.  Kittens were infected with E. histolytica and the large intestine was then deprived of its normal supply of water by placing a ligature around the gut.
• 5.  The amoebae disappeared promptly in three animals in which this procedure was carried out early in the course of the infection. The progress of the disease was not checked in one animal in which the operation was delayed for several days after symptoms appeared.

III

• 6.  According to our conception, the cysts of E. histolytica when ingested by mouth are carried rapidly by peristalsis through the small bowel and set up lesions at points of stasis in the large intestine. In 3 kittens amoebic infection of the colon readily invaded the ileum when the ileo-colic sphincter was rendered functionless. Under the conditions of these experiments, the sphincter was an important factor in the mechanical protection of the ileum.
• 7.  In 3 animals, ligation of the small bowel and inoculation of active amoebae immediately above the ligature failed to produce an infection. This failure to produce a primary infection of the small intestine suggests that the environmental conditions in the ileum are somewhat unfavorable for the development of amoebae. It does not necessarily indicate that the mucosa per se of the ileum is less susceptible than that of the colon to the action of E. histolytica.

The positive results of our experiments establish facts, but the negative ones only indicate one possibility. We realize that in the investigations of this nature one has always to count on some lack of success due to the variations in the strength of the infecting agent or that of the host. Only a great number of observations, which are always difficult to obtain, might avoid such results.

We established:

• 1.  That our leishmaniasis is auto-inoculable.
• 2.  That it is a contagious disease.
• 3.  That the pathology of the lesions is different from that ordinarily observed in spontaneous leishmania infections.
• 4.  The quantity and quality of the infiltrating cells vary with the phase of evolution or involution of the lesion.
• 5.  Healthy individuals can be successfully inoculated by the material obtained from a sick one.
• 6.  Inoculations of Leishmania culture in an already infected person were negative.
• 7.  Inoculations by puncture were not successful.
• 8.  The incubation period was about three weeks.

This book deals with visceral Leishmaniasis or Kala Azar as it occurs in India. Epidemiology and Etiology are briefly but adequately presented. Then follow Symptomatology, Pathology, and Laboratory Technique, Diagnosis, and, finally, Treatment, four sections which make up an excellent exposition of the clinical aspects of the disease.

We like this book. There is a minimum of the speculative and conjectural element. The authors know Kala Azar at first hand; they have observed, treated and studied hundreds of cases. Though working in a hospital in Calcutta, they are aware that the major part of the diagnosis and treatment, and much of the future progress in knowledge of the disease, rests with the general practitioner in the endemic districts. This book must be almost indispensable to the physicians so located; it must prove a valuable weapon in the effort to control and perhaps stamp out this important menace to public health in India.

It is reported that arrangements have been made between the Insular Government of Porto Rico and Columbia University of New York for the establishment of a School of Tropical Medicine at San Juan. It is understood that the Insular Government will furnish a hospital, a laboratory building and several professors, while Columbia University will furnish a dean, additional professors and financial support. The first course will begin Novement 1, 1924, and will continue about six months. It will cover the usual postgraduate work in tropical medicine and hygiene and will also include a course in Spanish. The tuition fee will probably be about $300 a year and will lead to a degree of Doctor of Tropical Medicine, after a two years' course. The first year of course will be limited to fifteen students. This school later may be a part of a Pan-American University.