ONCHOCERCIASIS IN BOTH HEMISPHERES
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1456 appear to be bacillary rather than coccal in form, measuring approximately 0-1-0-2 by 03-05 .e. Similar granular masses were occasionally seen in the cytoplasm of nerve and glial cells and more rarely in the endothelial cells of capillaries and the mono- nuclear cells infiltrating the meninges and brain tissue, from which it would seem that the virus multiplied both in cytoplasm and nucleoplasm, though more commonly in the latter medium. According to these investigators, the typical acidophil inclusions represent a later stage of the infection arising in virus colonies as the result of agglutination and fusion of virus particles-a degenerative process in fact- and they go so far as to say that the presence of homogeneous acidophil inclusions in a cell is a sign that the cell is resisting the infection satisfactorily. Whether or not one agrees with Nicolau and Kopciowska in this interpretation of the fully formed inclusion, and probably many would dispute it, they have certainly brought forward strong evidence that herpes virus forms colonies in the nuclei and more rarely in the cytoplasm of the cells which it infects. While awaiting confirmation of this work we can congratulate our French colleagues on a most interesting paper. ONCHOCERCIASIS IN BOTH HEMISPHERES INVESTIGATIONS were undertaken by Prof. Richard P. Strong and his colleagues in 1934 into tropical diseases in remote parts of the Belgian Congo, and their report on this research, so far as it concerns onchocerciasis, has now been published.l In 1926-27 Strong visited Liberia and the Belgian Congo, and between these two African expeditions his work covered onchocerciasis in Central America. The first part of the monograph compares the disease as found in the two hemispheres. Although onchocerciasis as a blinding disease was first generally appreciated in America-indeed it was essentially for that reason that the late Prof. F. Fiilleborn raised the American parasite to specific rank as Onclaoce7ccc emeutiepts-the amount of blindness produced by 0. volvulus among Bantus and Pigmies in the part of Africa lying between 5° and 6° South latitude and 23° and 24° East longitude is far more tragic even than in Central America. In the region where the expedition settled, every inhabitant they examined-and they examined all but a few -had the infection ; and at the clinics there were led to them daily several hundred blind persons who waited with patience in the sun until their time came to be examined. Moreover the degree of individual infection was great ; for whereas in America and other parts of Africa it was unusual to find 5 or 6 nodules in any person, in Kassende 25 to 100 were not uncommonly demonstrated. In Guatemala the incidence of infection among those simulium flies which transmit the infection was never more than 5 per cent., but in this African area it was 33 per cent. The blindness is caused by micro- filariae getting into the eye ; they are, at least commonly, born within the nodules in which the host’s reticulo-endothelial tissue has imprisoned their parents ; their numbers lessen in a piece of snipped-off skin as the distance of its site from nodules increases ; and in persons who have become blind there are nearly always nodules on or close to the head. Strong is unconvinced, however, that the nodule signifies the spot where the simulium fed and 1 Onchocerciasis in Africa and Central America. By Richard P. Strong, Jean Hissette, Jack H. Sandground, and Joseph C. Bequaert, Amer. J. trop. Med. 1938, 18, No. 1, Suppl. the’ infective larvae entered the man ; he points out that nodules are found particularly where lymphatics converge, or where there is pressure, or where bone is prominent-his inference perhaps being that in these spots an infective larva wandering in the sub- cutaneous tissue meets an obstruction and settles down. In America it has been amply shown that removal of nodules is a valuable method of lessening the amount of infection in localities where the simulium has a limited range and where the infection is correspondingly circumscribed. In Africa, with heavy fly infection and no such circumscription, it is felt that the first step in prevention must be one of sanitary engineering ; and its necessary extent is sufficiently indicated by the fact that these simulium flies have twice invaded Kampala in Uganda, though their nearest breeding places are believed to be 45 miles away. It is thought likely, too, that antelope can act as a host alternative to man, and that there may be onchocerciasis without the tissue reaction in the’host which produces nodules. In the mono- graph under review the ocular conditions are ably dealt with by Dr. Jean Hissette of the Congo Govern- ment Service, whose conclusions are that the ultimate cause of onchocercal blindness is atrophy of the optic nerve and that much more elaborate examina- tions will have to be made before we have a true picture of the various pathological changes involved. J. K. Sandground deals in the main with the systematic position of this and allied parasites and reaches the conclusion that locally the parasite depends entirely on human beings for its maintenance and spread. J. C. Bequaert thinks that the twenty known species of simulium in the Belgian Congo are only a fraction of those that inhabit that vast and varied territory. These writers make clear how much more investiga- tion is needed. There seems little doubt however that understanding will be inadequate so long as this important problem is treated as something apart, and is not linked with the results of research into other filarial infections and the host reactions to them. Such comparisons can hardly fail to afford mutual enlightenment. P.F.O. IMPROVEMENT in anaesthetics and the ways of giving them has created a more personal relationship between patient and anaesthetist. As Dr. H. B. Wilson 1 regretfully observes, however, in hospitals the two parties seldom become acquainted until they meet in the operating theatre, a situation that need not arise in private practice. The effect on the patient of a personal assurance from the anaesthetist that all will be well is very valuable, and such an assurance should constitute an essential part of every " prepare for operation." The increased use of sedatives, hypnotics, and basal narcotics are other measures that contribute to the patient’s peace of mind and make the operation less of an ordeal. Where surgical shock is likely to follow operation, Dr. Wilson advocates the prophylactic injection of intravenous glucose and insulin, as recommended by Fisher, and he condemns once more the starving and purging which, though less common than formerly, are still too often a part of hospital and nursing-home routine. Starvation, coupled with anxiety, causes metabolic disturbance in nervous patients ; drastic purgatives 1 In St. Thomas’s Hospital Reports. Edited by Prof. O. L. V. S. de Wesselow, Mr. C. Max Page, assisted by Mr. N.R. Barrett, Dr. J. St. C. Elkington, and Dr. A. J. Wrigley. Second Series. Vol. II. St. Thomas’s Hospital, London. 1937. Pp. 271.
Transcript of ONCHOCERCIASIS IN BOTH HEMISPHERES
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appear to be bacillary rather than coccal in form,measuring approximately 0-1-0-2 by 03-05 .e.Similar granular masses were occasionally seen in thecytoplasm of nerve and glial cells and more rarelyin the endothelial cells of capillaries and the mono-nuclear cells infiltrating the meninges and braintissue, from which it would seem that the virus
multiplied both in cytoplasm and nucleoplasm, thoughmore commonly in the latter medium. Accordingto these investigators, the typical acidophil inclusionsrepresent a later stage of the infection arising in viruscolonies as the result of agglutination and fusionof virus particles-a degenerative process in fact-and they go so far as to say that the presence ofhomogeneous acidophil inclusions in a cell is a signthat the cell is resisting the infection satisfactorily.Whether or not one agrees with Nicolau and
Kopciowska in this interpretation of the fully formedinclusion, and probably many would dispute it,they have certainly brought forward strong evidencethat herpes virus forms colonies in the nuclei andmore rarely in the cytoplasm of the cells which itinfects. While awaiting confirmation of this workwe can congratulate our French colleagues on a mostinteresting paper.
ONCHOCERCIASIS IN BOTH HEMISPHERES
INVESTIGATIONS were undertaken by Prof. RichardP. Strong and his colleagues in 1934 into tropicaldiseases in remote parts of the Belgian Congo, andtheir report on this research, so far as it concerns
onchocerciasis, has now been published.l In 1926-27
Strong visited Liberia and the Belgian Congo, andbetween these two African expeditions his workcovered onchocerciasis in Central America.The first part of the monograph compares the
disease as found in the two hemispheres. Althoughonchocerciasis as a blinding disease was first generallyappreciated in America-indeed it was essentiallyfor that reason that the late Prof. F. Fiilleborn raisedthe American parasite to specific rank as Onclaoce7cccemeutiepts-the amount of blindness produced by0. volvulus among Bantus and Pigmies in the partof Africa lying between 5° and 6° South latitude and23° and 24° East longitude is far more tragiceven than in Central America. In the regionwhere the expedition settled, every inhabitant
they examined-and they examined all but a few-had the infection ; and at the clinics therewere led to them daily several hundred blind
persons who waited with patience in the sun untiltheir time came to be examined. Moreover the
degree of individual infection was great ; for whereasin America and other parts of Africa it was unusualto find 5 or 6 nodules in any person, in Kassende25 to 100 were not uncommonly demonstrated.In Guatemala the incidence of infection among thosesimulium flies which transmit the infection was
never more than 5 per cent., but in this African areait was 33 per cent. The blindness is caused by micro-filariae getting into the eye ; they are, at least
commonly, born within the nodules in which thehost’s reticulo-endothelial tissue has imprisonedtheir parents ; their numbers lessen in a piece ofsnipped-off skin as the distance of its site fromnodules increases ; and in persons who have becomeblind there are nearly always nodules on or close tothe head. Strong is unconvinced, however, that thenodule signifies the spot where the simulium fed and
1 Onchocerciasis in Africa and Central America. By Richard P.Strong, Jean Hissette, Jack H. Sandground, and Joseph C.Bequaert, Amer. J. trop. Med. 1938, 18, No. 1, Suppl.
the’ infective larvae entered the man ; he points outthat nodules are found particularly where lymphaticsconverge, or where there is pressure, or where boneis prominent-his inference perhaps being that inthese spots an infective larva wandering in the sub-cutaneous tissue meets an obstruction and settlesdown. In America it has been amply shown thatremoval of nodules is a valuable method of lesseningthe amount of infection in localities where thesimulium has a limited range and where the infectionis correspondingly circumscribed. In Africa, with
heavy fly infection and no such circumscription, itis felt that the first step in prevention must be oneof sanitary engineering ; and its necessary extent is
sufficiently indicated by the fact that these simuliumflies have twice invaded Kampala in Uganda, thoughtheir nearest breeding places are believed to be45 miles away. It is thought likely, too, that antelopecan act as a host alternative to man, and that theremay be onchocerciasis without the tissue reactionin the’host which produces nodules. In the mono-graph under review the ocular conditions are ablydealt with by Dr. Jean Hissette of the Congo Govern-ment Service, whose conclusions are that the ultimatecause of onchocercal blindness is atrophy of the
optic nerve and that much more elaborate examina-tions will have to be made before we have a truepicture of the various pathological changes involved.J. K. Sandground deals in the main with the
systematic position of this and allied parasites andreaches the conclusion that locally the parasitedepends entirely on human beings for its maintenanceand spread. J. C. Bequaert thinks that the twentyknown species of simulium in the Belgian Congoare only a fraction of those that inhabit that vast andvaried territory.
These writers make clear how much more investiga-tion is needed. There seems little doubt howeverthat understanding will be inadequate so long as
this important problem is treated as something apart,and is not linked with the results of research intoother filarial infections and the host reactions to
them. Such comparisons can hardly fail to affordmutual enlightenment.
P.F.O.
IMPROVEMENT in anaesthetics and the ways of givingthem has created a more personal relationship betweenpatient and anaesthetist. As Dr. H. B. Wilson 1
regretfully observes, however, in hospitals the twoparties seldom become acquainted until they meetin the operating theatre, a situation that need notarise in private practice. The effect on the patientof a personal assurance from the anaesthetist that allwill be well is very valuable, and such an assuranceshould constitute an essential part of every " preparefor operation." The increased use of sedatives,hypnotics, and basal narcotics are other measures thatcontribute to the patient’s peace of mind and make theoperation less of an ordeal. Where surgical shockis likely to follow operation, Dr. Wilson advocatesthe prophylactic injection of intravenous glucoseand insulin, as recommended by Fisher, and hecondemns once more the starving and purgingwhich, though less common than formerly, are still toooften a part of hospital and nursing-home routine.Starvation, coupled with anxiety, causes metabolicdisturbance in nervous patients ; drastic purgatives
1 In St. Thomas’s Hospital Reports. Edited by Prof.O. L. V. S. de Wesselow, Mr. C. Max Page, assisted by Mr. N.R.Barrett, Dr. J. St. C. Elkington, and Dr. A. J. Wrigley.Second Series. Vol. II. St. Thomas’s Hospital, London. 1937.Pp. 271.
