The American Journal of Tropical Medicine and Hygiene - Volume s1-7, Issue 4, 1927

It is generally recognized that the present classification of bacterial dysenteries as well as of the dysentery bacilli is in a somewhat unsatisfactory position. I venture therefore to bring forward again a classification I suggested some years ago, which so far has attracted very little attention. This classification to a great extent was followed by Chalmers and myself in the third edition of our Manual of Tropical Medicine.

According to this classification bacterial dysenteries are separated into three groups:

• 1.  Bacterial dysentery, sensu stricto (synonyms Shigadysentery, Shiga-Kruse dysentery), due to dysentery organisms which do not ferment lactose or mannitol and do not clot milk (Shiga-Kruse bacillus).
• 2.  Paradysentery, due to organisms which do not ferment lactose, ferment mannitol (acid only), do not clot milk (Flexner, Hiss-Russell, etc.).
• 3.  Metadysentery, due to organisms which, as is the case with the true dysentery bacilli, do not produce gas in any sugar, but either ferment lactose (acid only) and clot milk, or ferment lactose (acid only) without clotting milk, or clot milk without fermenting lactose (organisms of the genus Dysenteroides and Lankoides).

Up to the present about 150 cases of infection with Isospora hominis (Rivolta) Dobell, 1919, have been reported (1). The earlier cases, roughly one-half of them, were recorded during and immediately following the Great War and there was a suggestion that these infections were contracted by service in the Near East or by association with troops returning from that area. Seven infections were discovered in American soldiers returning from overseas; but four more were found in Americans who had had only home service (2). The geographical distribution of cases more recently reported indicates that the area of endemicity probably includes all tropical and subtropical countries and possibly is world-wide.

Only one case of infection with I. hominis has heretofore been reported from the Philippine Islands, by Haughwout (3) who suggests that the patient may have contracted the infection in the United States.

In view of the paucity of our information regarding the occurrence of Oriental sore in the United States, it seems worthwhile to add to the growing list of cases a report of one more. At least four cases of cutaneous leishmaniasis of oriental origin have been diagnosed in the United States (Spence, 1921; Fox, 1922; and Faber and Schussler, 1923); four more cases have been reported from Canada (Smith, 1922).

REPORT OF CASE The infected individual, a young Turkish physician, was a student at the Johns Hopkins School of Hygiene and Public Health. Most of his life he has been a resident of Constantinople where Oriental sore does occur but not commonly. Three years ago, he went to Dyar, Bekir, a four days journey from Constantinople. In this locality practically every man, woman and child has either active ulcers or scars from them. He remained there two years and returned to Constantinople.

The conception that the pathogenic effect of Endamoeba histolytica upon the tissues of man and experimental animals is due to a toxin, or toxins, cytolytic in nature, secreted by the organism, has long been held by students of this interesting and important parasite. However, it must be admitted that no one hitherto has been able to demonstrate experimentally the existence of such toxins in Endamoeba histolytica, the evidence of their presence and activity being based entirely upon the pathology of the lesions produced by the parasite in the tissues of the intestine, liver and other organs of man and experimental animals.

The facility with which this parasite may be cultivated upon the media devised by Boeck and Drbohlav (1), Dobell and Laidlaw (2), Craig (3) and others, has rendered it possible to make observations upon the physiology of Endamoeba histolytica and it is the purpose of this contribution to describe the hemolytic, cytolytic and complement-binding properties of extracts of this parasite prepared from cultures of the organism.

The treatment of our three cases of nodular leprosy did not cause significant increase of the blood lipase. It caused an increase in the total leucocyte counts, with an increase in the lymphocyte percentage at the expense of the neutrophiles. During the treatment the patients lost much body weight. The Sanocrysin treatment did not cause the disappearance of nodules, nor did it modify their appearance. It showed no curative effect, though it caused rise of temperature and general and cutaneous reactions.

A new “milk method” is described for rapid identification of Anopheles larvae and the distinguishing characters of the Anopheles larvae of the Canal Zone are pointed out.

• 1.  Spleen indices taken in southern Illinois indicate a substantial incidence of malaria in this section; the incidence of enlarged spleens is given.
• 2.  The distribution of the disease in the southern part of the state is shown to be not uniform, but to follow certain characteristics of the physiography of the section. These characteristics are described, and on the basis of this finding the area of heaviest malaria incidence is delineated.
• 3.  It is shown that within the area of heaviest infection the distribution of incidence is, generally speaking, not even and regular, but tends to be highly focal and localized usually in comparatively small areas. A large number of these foci have been localized on spot maps and the detailed data regarding them made available for future malaria control work.
• 4.  In the hill sections of lower malaria incidence, there is shown an apparent relationship between the occurrence of malaria and proximity to a larger stream bed valley.
• 5.  Certain observations in regard to the interpretation of spleen data generally are presented, and an illustration of one method of estimating the magnitude of a malaria problem in a limited area is presented.

This publication, being Monograph 20, from the Institute for Medical Research, Federated Malay States, considers certain aspects of the mosquito problem in Malaya. There is a discussion of the larvae of the Malayan mosquitoes, together with a description of the geographical distribution of the various species, and their relation to malaria. The work contains much useful information for practitioners in the Far East. The illustrations are excellent and the printing and binding are good.

This work, by one of the foremost physicians of China, is, without exception, the most thorough and scientific account of pneumonic plague that has ever been written. The author, who has probably had more experience with this type of plague than any other observer, has placed upon record all that he knows regarding this vital and most interesting type of plague. The work is of intense interest to all physicians who have to do with this important infection and considers the subject from the standpoint not only of the clinician, but of the laboratory worker and pathologist. The author's acquaintance with the literature of the subject is very extensive and his bibliographic references are most complete. The reviewer can recommend this work as by far the best upon the subject that has ever appeared in any language and well worthy the perusal and careful study of all interested in tropical diseases.

This mongraph upon spirochetes by Doctor Collier of Buenos Aires is Part II, Vol. III, of the Handbuch der biologischen Arbeitsmethoden, published by the well known Berlin firm—Urban & Schwarzenberg. The work is an excellent summary of all that we know at present regarding the methods of examining, culturing and staining the spirochetes, together with the technique used in animal experimentation. It is a useful compendium of our knowledge regarding the subject and includes not only much that is new, but also all of the old technical methods that have proven reliable. It is refreshing to note that the author quotes English and American authorities quite widely, something which we regret to note is not always done by German writers of the present day. This work should prove most useful to all physicians who are interested in the subject of the relation of spirochetes to disease, and to technicians who have to do with these organisms in the laboratory.