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Birth weight and prematurity, Tanganyika
CORRESPONDENCE
363
Dr. Porterfield replies to the foregoing letter, as follows : SIR,--It is indeed regrettable that the English appear to endeavour to speak (and read) only English. Nevertheless in this case we may crave indulgence for our omission in that the paper by Pellissier is concerned only with the unanalysed results of complement-fixation tests, whereas our paper was primarily aimed to determine the degree of inter-relationship of neutralizing antibodies. We have, however, taken careful note of the paper by Pellissier and the fifteen references to his works. I am, etc., J. s. PORTERFIELD National Institute for Medical Research,
London. 7th July, 1959.
BIRTH WEIGHT AND PREMATURITY, TANGANYIKA. SIR,--Dr. McLaren's paper (Transactions, 1959, 53, 173) is of considerable interest. It seems, however, that in this investigation some attention could have been devoted to the relationship between prematurity in Africa and the presence of malaria infection in the placenta. This problem was studied mainly on the West Coast of Africa, first tentatively by Blacklock and Gordon in Sierra Leone and then by my colleagues and myself in Nigeria. In all the investigations carried out so far there has been a definite relationship between the mean birth weight of African babies and the malaria infection of their placenta. The even more striking thing is the direct relationship between the incidence of prematurity
Influence of malaria infection of placentae on the birth weight of Nigerian infants. Birth weight below 2,500 g.
Difference in mean birth weight between babies born from infected and non-infected placentae.
No. in series
No. with infected placenta
%
Bruce-Chwatt Lagos (Nigeria)
310
73
23.6
20.3
11.0
113 g.
Archibald Ilaro (S.W. Nigeria)
463
77
15.0
29.4
16.5
170 g.
Cannon Ilesha (N. Nigeria)
392
130
33.0
37.0
12.0
311 g.
Archibald (N. Nigeria)
440
62
14.1
20.6
8.2
298 g.
Spitz (S.E. Nigeria)
576
136
23.7
41.2
27.0
89 g.
Series.
Infected Nonplacenta infected placenta
364
CORRESPONDm~CE
judged by the birth weight below 2,500 g. and the proportion of infected placentae of the mothers. The table above quotes the results obtained by a series of investigators in Nigeria. I am, etc., L. J. BRUCE-CHWATT. World Health Organization, Geneva. 26th June, 1959. REFERENCES : BLACKLOCK,B. & GORDON,R. M. (1925). Ann. trop. Med. Parasit., 19, 37. BRUcE-CHWATT,L. J. (1952). Ibid., 46, 173. AaCHmALD,H. M. (1956). Bull. World Hlth. Org., 15, 842. (1958). Brit. med. J., 2, 1512. CANNON,D. S. (1958). Ibid., 2, 877. SPITZ, A. J. (1959) WHO/Mal 223 (mimeographed).
RELATIONSHIP OF MEDITERRANEANKALA-AZAR TO CANINE KALA-AZAR SIR,--Dr. Manson-Bahr's (1959) findings on East African kala-azar prompted me to report my observations on infantile kala-azar in Northern Syria and its possible relationship to the occuk infection in dogs. In the fall of 1946, within a brief span of 3 months, three infants suffering from kalaazar were sent to the hospitals of the American University of Beirut by Dr. Injejikian, physician of Kessab - - a North Syrian village bordering on the Sandjak province of Turkey. The admission of three infants from one isolated locality 250 miles north of the city of Beirut instigated an on-the-spot investigation. We visited Kessab (pop. 5,200) on Dec. 26, 1946. The municipal doctor of the district, who had been practising in the district for almost 50 years, said that he knew of no other case of splenomegaly in the district, but recalled having lost a child suffering from splenic enlargement the previous summer. He surmised that the disease might have been introduced by a contingent of soldiers brought to the area during the Second World War. We examined a total of 380 infants and children, without discovering a single additional case of kala-azar. We then decided to examine by biopsy the dogs in the village for canine leishmaniasis (cutaneous and visceral). Of 24 dogs examined, none presented cutaneous lesions or splenic enlargement. However, we found a few leishmaniae in the smear from a liver puncture of an apparently healthy 20 kg. German shepherd dog. We autopsied the animal, and although its spleen was not enlarged, leishmaniae were observed in impression smears from spleen, liver, and skin juices expressed from 10 representative areas on the dog. All 24 dogs were then killed and examined ; and a few leishmaniae were found in the skin and viscera of five animals. Only one of the five dogs was emaciated ; its spleen was not enlarged, and no cutaneous lesions were present. All five dogs were, therefore, carriers of kala-azar. Between 1935 and 1947, I saw and examined in Beirut four typical cases of canine kalaazar with visceral and cutaneous lesions. All four were pedigreed dogs brought into the city from abroad. Leishmania bodies were present in great numbers in papular lesions of the skin, in viscera and throughout the tissues elsewhere. After returning from Kessab,
363
Dr. Porterfield replies to the foregoing letter, as follows : SIR,--It is indeed regrettable that the English appear to endeavour to speak (and read) only English. Nevertheless in this case we may crave indulgence for our omission in that the paper by Pellissier is concerned only with the unanalysed results of complement-fixation tests, whereas our paper was primarily aimed to determine the degree of inter-relationship of neutralizing antibodies. We have, however, taken careful note of the paper by Pellissier and the fifteen references to his works. I am, etc., J. s. PORTERFIELD National Institute for Medical Research,
London. 7th July, 1959.
BIRTH WEIGHT AND PREMATURITY, TANGANYIKA. SIR,--Dr. McLaren's paper (Transactions, 1959, 53, 173) is of considerable interest. It seems, however, that in this investigation some attention could have been devoted to the relationship between prematurity in Africa and the presence of malaria infection in the placenta. This problem was studied mainly on the West Coast of Africa, first tentatively by Blacklock and Gordon in Sierra Leone and then by my colleagues and myself in Nigeria. In all the investigations carried out so far there has been a definite relationship between the mean birth weight of African babies and the malaria infection of their placenta. The even more striking thing is the direct relationship between the incidence of prematurity
Influence of malaria infection of placentae on the birth weight of Nigerian infants. Birth weight below 2,500 g.
Difference in mean birth weight between babies born from infected and non-infected placentae.
No. in series
No. with infected placenta
%
Bruce-Chwatt Lagos (Nigeria)
310
73
23.6
20.3
11.0
113 g.
Archibald Ilaro (S.W. Nigeria)
463
77
15.0
29.4
16.5
170 g.
Cannon Ilesha (N. Nigeria)
392
130
33.0
37.0
12.0
311 g.
Archibald (N. Nigeria)
440
62
14.1
20.6
8.2
298 g.
Spitz (S.E. Nigeria)
576
136
23.7
41.2
27.0
89 g.
Series.
Infected Nonplacenta infected placenta
364
CORRESPONDm~CE
judged by the birth weight below 2,500 g. and the proportion of infected placentae of the mothers. The table above quotes the results obtained by a series of investigators in Nigeria. I am, etc., L. J. BRUCE-CHWATT. World Health Organization, Geneva. 26th June, 1959. REFERENCES : BLACKLOCK,B. & GORDON,R. M. (1925). Ann. trop. Med. Parasit., 19, 37. BRUcE-CHWATT,L. J. (1952). Ibid., 46, 173. AaCHmALD,H. M. (1956). Bull. World Hlth. Org., 15, 842. (1958). Brit. med. J., 2, 1512. CANNON,D. S. (1958). Ibid., 2, 877. SPITZ, A. J. (1959) WHO/Mal 223 (mimeographed).
RELATIONSHIP OF MEDITERRANEANKALA-AZAR TO CANINE KALA-AZAR SIR,--Dr. Manson-Bahr's (1959) findings on East African kala-azar prompted me to report my observations on infantile kala-azar in Northern Syria and its possible relationship to the occuk infection in dogs. In the fall of 1946, within a brief span of 3 months, three infants suffering from kalaazar were sent to the hospitals of the American University of Beirut by Dr. Injejikian, physician of Kessab - - a North Syrian village bordering on the Sandjak province of Turkey. The admission of three infants from one isolated locality 250 miles north of the city of Beirut instigated an on-the-spot investigation. We visited Kessab (pop. 5,200) on Dec. 26, 1946. The municipal doctor of the district, who had been practising in the district for almost 50 years, said that he knew of no other case of splenomegaly in the district, but recalled having lost a child suffering from splenic enlargement the previous summer. He surmised that the disease might have been introduced by a contingent of soldiers brought to the area during the Second World War. We examined a total of 380 infants and children, without discovering a single additional case of kala-azar. We then decided to examine by biopsy the dogs in the village for canine leishmaniasis (cutaneous and visceral). Of 24 dogs examined, none presented cutaneous lesions or splenic enlargement. However, we found a few leishmaniae in the smear from a liver puncture of an apparently healthy 20 kg. German shepherd dog. We autopsied the animal, and although its spleen was not enlarged, leishmaniae were observed in impression smears from spleen, liver, and skin juices expressed from 10 representative areas on the dog. All 24 dogs were then killed and examined ; and a few leishmaniae were found in the skin and viscera of five animals. Only one of the five dogs was emaciated ; its spleen was not enlarged, and no cutaneous lesions were present. All five dogs were, therefore, carriers of kala-azar. Between 1935 and 1947, I saw and examined in Beirut four typical cases of canine kalaazar with visceral and cutaneous lesions. All four were pedigreed dogs brought into the city from abroad. Leishmania bodies were present in great numbers in papular lesions of the skin, in viscera and throughout the tissues elsewhere. After returning from Kessab,