- Email: [email protected]
Graham Greene, the fathers and leprosy transmission
CORRESPONDENCE
240
ability of mononuclear cells from healthy individuals not exposed to malaria to generate nitric oxide is very low (Weinbere et al.. 1995: Blood. 86. 1184). As nitrate in the serum”is a reflection of the total nitrate pool, without any indication of its origin, it is possible that serum nitrate in cerebral malaria has a different cellular origin from that observed among healthy or asymptomatic parasitaemic children in endemic areas. Fadwa Al-Yaman* Ian A. Clark
puted to the nose in leprosy transmission by I. Schaffer in 1898, as reported by Nordeen and Pannikar (Zoc.cit.). Mark N. Lowenthal Division of Medicine Department of Geriatric Medicine Soroka Medical Centre and Ben Gurion University of the Negev Beer Sheva 84101 Israel 26 August 1996
Division of Biochemistry and Molecular Biology Faculty of Science School of Life Sciences The Australian National University Canberra, ACT 0200 Australia 23 September 1996
[Publication
*Author for correspondence; phone +61 6 249 4940, fax +61 6 249 0313, email [email protected]
Graham Greene, the fathers and leprosy transmission The standard tropical medical text (Munson’s Tropical Diseases) has. in the course of 2% decades and 4 editions, become more definite (thoigh not dogmatic) in its statement regarding the mode of transmission of leprosy: ‘... some belie&that it can be contracted via the unoer resniratorv tract’ (Wilcocks. 1972: 17th edition*. p: -413); ;... entry” through . the respiratory route seems most probable...’ (Nordeen & Pannikar, 1996: 20th edition**, p. 1020). Priests working in the leproserie [sic] of the novel by Graham Greene (1960: A Burnt-out Case. London: Heineman), as described in another non-fiction, work, were seemingly more convinced than the foregoing of the mode of transmission: ‘The fathers had an idea that contagion might be carried by the breath and always in the confessional box held a handkerchief between their mouth and the leper’s (Greene, 1968: In Search of a Character. London: Penguin+, p. 23 footnote). It is interesting that a medical suspicion influenced the conduct of ritual in the wav Greene described. The source of the fathers’ suspicion is not stated and remains moot. The influence could possibly have been their local medical colleagues, who may have been aware of the role im-
delayed due to loss of proofs in the post.]
*Wilcocks, C. (editor). Baltimore: Williams &Wilkins. **Cook, G. C. (editor). London: W. B. Saunders. +First edition published in 1961 byThe Bodley Head, London.
Blood films in the diagnosis of anaemia We have earlier reported on the high prevalence of severe megaloblastic anaemia among Somalis in Wajir District, Kenya (Grdberger-Willcox & Willcox, 1997: Transactions, 91, 190). After a short assignment at the Mission Hospital at Mutomo, Kitui District, Kenya we found that, although not so prevalent as in Wajir, megaloblastic anaemia is by no means uncommon there also. We were unable to carry out a systematic search among all admitted anaemias but we identified 5 cases of severe megaloblastic anaemia in 6 weeks. The diagnosis was made through examination of a Leishmanstained peripheral blood film using the same criteria as before. All cases were female; one needed blood transfusion but all were treated with folic acid and showed an early and vigorous response. As at Wajir, these anaemias seemed to be primarily nutritional in origin. We consider the examination of a blood film to be essential in the investigation of anaemia whatever its suspected cause and are surprised at the number of papers on anaemia that have apparently not reported doing this. We urge that morphological examination of a blood film always be part of the routine investigation of anaemia. G. Grgberger-Willcox M. C. Willcox Department of Paediatrics County Hospital S-801 87 GZivle Sweden 3 February 1997
240
ability of mononuclear cells from healthy individuals not exposed to malaria to generate nitric oxide is very low (Weinbere et al.. 1995: Blood. 86. 1184). As nitrate in the serum”is a reflection of the total nitrate pool, without any indication of its origin, it is possible that serum nitrate in cerebral malaria has a different cellular origin from that observed among healthy or asymptomatic parasitaemic children in endemic areas. Fadwa Al-Yaman* Ian A. Clark
puted to the nose in leprosy transmission by I. Schaffer in 1898, as reported by Nordeen and Pannikar (Zoc.cit.). Mark N. Lowenthal Division of Medicine Department of Geriatric Medicine Soroka Medical Centre and Ben Gurion University of the Negev Beer Sheva 84101 Israel 26 August 1996
Division of Biochemistry and Molecular Biology Faculty of Science School of Life Sciences The Australian National University Canberra, ACT 0200 Australia 23 September 1996
[Publication
*Author for correspondence; phone +61 6 249 4940, fax +61 6 249 0313, email [email protected]
Graham Greene, the fathers and leprosy transmission The standard tropical medical text (Munson’s Tropical Diseases) has. in the course of 2% decades and 4 editions, become more definite (thoigh not dogmatic) in its statement regarding the mode of transmission of leprosy: ‘... some belie&that it can be contracted via the unoer resniratorv tract’ (Wilcocks. 1972: 17th edition*. p: -413); ;... entry” through . the respiratory route seems most probable...’ (Nordeen & Pannikar, 1996: 20th edition**, p. 1020). Priests working in the leproserie [sic] of the novel by Graham Greene (1960: A Burnt-out Case. London: Heineman), as described in another non-fiction, work, were seemingly more convinced than the foregoing of the mode of transmission: ‘The fathers had an idea that contagion might be carried by the breath and always in the confessional box held a handkerchief between their mouth and the leper’s (Greene, 1968: In Search of a Character. London: Penguin+, p. 23 footnote). It is interesting that a medical suspicion influenced the conduct of ritual in the wav Greene described. The source of the fathers’ suspicion is not stated and remains moot. The influence could possibly have been their local medical colleagues, who may have been aware of the role im-
delayed due to loss of proofs in the post.]
*Wilcocks, C. (editor). Baltimore: Williams &Wilkins. **Cook, G. C. (editor). London: W. B. Saunders. +First edition published in 1961 byThe Bodley Head, London.
Blood films in the diagnosis of anaemia We have earlier reported on the high prevalence of severe megaloblastic anaemia among Somalis in Wajir District, Kenya (Grdberger-Willcox & Willcox, 1997: Transactions, 91, 190). After a short assignment at the Mission Hospital at Mutomo, Kitui District, Kenya we found that, although not so prevalent as in Wajir, megaloblastic anaemia is by no means uncommon there also. We were unable to carry out a systematic search among all admitted anaemias but we identified 5 cases of severe megaloblastic anaemia in 6 weeks. The diagnosis was made through examination of a Leishmanstained peripheral blood film using the same criteria as before. All cases were female; one needed blood transfusion but all were treated with folic acid and showed an early and vigorous response. As at Wajir, these anaemias seemed to be primarily nutritional in origin. We consider the examination of a blood film to be essential in the investigation of anaemia whatever its suspected cause and are surprised at the number of papers on anaemia that have apparently not reported doing this. We urge that morphological examination of a blood film always be part of the routine investigation of anaemia. G. Grgberger-Willcox M. C. Willcox Department of Paediatrics County Hospital S-801 87 GZivle Sweden 3 February 1997