The American Journal of Tropical Medicine and Hygiene - Volume s1-6, Issue 5, September 1926

Material

The three cases to be described were treated on the Service for Tropical Diseases of the Boston City Hospital. The diagnosis in every case was based upon the finding of typical Donovan bodies in scrapings from the lesion. The first case was diagnosed in the pathological laboratory of Dr. F. B. Mallory while under treatment by the Gynecological Service. In the other two cases the diagnosis was made by members of the Tropical Service and concurred in by Dr. Mallory's laboratory.

All three of the patients undoubtedly contracted the disease in or near Boston. This point is of interest, because so far as known to us, only one case of inguinal granuloma in which typical Donovan bodies were demonstrated has previously been reported from Boston, and in that case the infection was contracted in Savannah, Georgia. 2

Of the three cases now to be reported one was in a white woman, the wife of a negro, and the other two in negroes.

The use of the cultural method 2 for the detection of Endamoeba histolytica has probably stimulated anew the interest of medical men in the intestinal protozoa. Because of the advantages of the method over the usual hit-or-miss procedures, amoebae heretofore infrequently encountered will be presented for consideration. It is true that, in so far as the patient is concerned, it is sufficient merely to eliminate Endamoeba histolytica. The inquisitive mind, however, not being content with half measures, will seek the full satisfaction of classifying the organism exactly.

There is no remarkable change in structural detail or behavior of the amoebae in their changed environment. There is found some slight deviation from normal but the main identifying features conform closely to the accepted descriptions. In culture, however, the unlimited number of amoebae available for study permits of greater emphasis being placed on minor individual peculiarities.

• 1.  A medium consisting of Locke solution containing one part to seven of inactivated human, horse, or rabbit blood serum has been found very efficient in the cultivation of Endamoeba histolytica. The best results were obtained when inactivated human blood serum was used.
• 2.  The excellent growth of Endamoeba histolytica obtained in this medium demonstrates that coagulated egg or blood agar slants used as a sub-stratum, are not essential for the growth and development of this species, and that neither egg or blood are essential as a part of the food supply of this species.
• 3.  In this medium Endamoeba histolytica has remained alive and motile for a period of eleven days and successful transfers have been obtained in the medium after a period of eight days. The best results in transferring cultures are obtained by making transfers every twenty-four or forty-eight hours.
• 4.  Transfers of Endamoeba histolytica, in this medium, made at intervals of twenty-four and forty-eight hours, have been continued for over three months in this laboratory and the amoebae have not changed in morphology or in their capability for reproduction during this time.

In a recent paper, Rivas (1926) has reported the results of duodenal and colonic lavage for the treatment of gastro-intestinal parasitism, poisoning and other conditions in man and dogs. On the basis of in vitro tests he concludes that protozoan and metazoan parasites are killed in about ten minutes at 45°C. and in a few minutes at 47°C. and believes that the passage of worms during febrile conditions, a thing quite generally thought to be of common occurrence, is due to the increase in temperature.

His experiments on dogs were as follows: One dog was treated, following a preliminary laparotomy, by inserting a trocar in the duodenum and flushing the intestines with 900 cc. of water at 52° to 55°C.; this removed 7 tapeworms, 19 ascarids, and 11 hookworms; dog died four days later; postmortem, no parasites, but a hemorrhagic enteritis present.

Introduction

I think that it would be useful to make known the bacterial and parasitic diseases which especially concern Costa Rica: those which exist and those which are unknown because they have not been studied yet.

The geographical situation of Central America, of which Costa Rica is a part, may be represented as a bridge which joins both large mainlands of North and South America: that is the reason why, during historical periods, different people settled their temporary or permanent dwellings in this country and that the different exponents of the American fauna and flora seems to have met here. For instance: the great variety of birds has always attracted the attention of the ornithologist. Some investigations have been made in Costa Rica, specially by expupils of French schools, but there is still much to be done and it is desirable that new foreign investigators visit this country where their observations would add to the knowledge already acquired.

The earliest statement in the literature that we can find relative to the occurrence of HCl in the stomach secretions in pellagra, is that of Angostoni in 1893 (1) quoted by H. F. Harris (9): “The study of the chemistry of the stomach of pellagrins shows a notable degree of hypopepsia and hypochlorhydia, with catarrh of the mucosa of the stomach and weakness of its motorpower and its innervation. While in some instances the total acidity was normal. The average was distinctly less than half of this amount. Likewise hydrochloric acid varied from none at all to an amount, in some instances above the normal” Harris himself says, in discussion, “There is a general agreement among the writers that there is as a rule, absence or great diminution in hydrochloric acid.” Nesbit, (11) at the National Conference for Pellagra (1909) reported analyses of the stomach contents of ten cases.

The present paper reports the essential results of the experimental inoculation with plague of 2278 wild rats (Mus norvegicus). It was expected and hoped that the series might be run to ten thousand but it became necessary to terminate the experiment on account of the disappearance of plague in the community in which it was carried on. The small number of cases of late bacteremia and resolving plague render the results inconclusive. They are published, however, for the information of other workers in this field. It is believed that this work constitutes the first demonstration of the existence of a B. pestis bacteremia in some cases of resolving plague.

The original plan was to determine at various intervals after inoculation what proportion of rats would show lesions of resolving plague and for how long plague bacilli would survive in their tissues.

Since Ross' interesting observation 1 that the abdomen of an adult anopheline when at rest forms an angle with the surface, while that of a culicine roughly parallels it, the statement, in the light of subsequent experience of many workers, has taken on axiomatic significance. To be sure this condition holds apparently in most cases. At least two exceptions to this generalization however, are known for anophelines. James and Liston 2 mentioned Anopheles culicifacies in India as resting in a Culex-like attitude. A similar resting position is taken by A. quadrimaculatus according to Darling. 3

The two species of Anopheles known from Haiti both rest in the anopheline manner. Nevertheless merely a glance suffices to distinguish one from the other. A. albimanus falls into the more or less orthodox type, that is, the body projects at about a 45° angle from a vertical surface on which the insect is resting.

To encourage investigations of alimentary tract function, Dr. Frank Smithies, Chicago, has presented to the School of Medicine of The University of Illinois, bonds in amount sufficient to yield annually, in perpetuity, not less than $100.00. This fund is known as “The William Beaumont Memorial Fund” and the income therefrom, as “The Annual Beaumont Memorial Award.”

The Award is to be made each year to the research or clinical investigator, who, in the judgment of a Faculty Committee, has contributed the most important work during the year, in the field designated.

The first Award will be made in 1927. Manuscripts covering investigations do not have to be entered specifically for the Award nor is it required that they be submitted to the Faculty Committee. The Award is to be granted by the Committee after it has considered carefully all investigations published during any year in periodicals throughout the United States.