Historical aspects of American trypanosomiasis (Chagas' disease)

734

BOOK REVIEWS

D. S. Kumararatne Regional Immunology Department Birmingham Heartlands Hospital Bordesley Green East Birmingham, B9 SSS, UK

Use of Carotene-Rich Foods to Combat Vitamin A Deficiency in India-A Multicentric Study. S. Seshadri (editor). India: Nutrition Foundation of India, 1996: Scientific Report 12. 180 pp. Price not known. Vitamin A deficiency in India is still one of the major public health nutritional problems although there has been a considerable decline in the prevalence of keratomalacia, and hence nutritional blindness, in the last 2 decades. Currently, the problem is a more moderate and widespread inadequacy causing low serum levels and its attendant functional effects on growth and immune function, and leading to night blindness and/or Bitot’s snots. With the decline in keratomalacia. nharmacological intervention with vitamin A is noslinger necessary and the emphasis now is on ways of continuing the trends in dietary improvements. This book is an attempt to address this problem and it describes a collection of studies in areas in the north, west, south and east of India, to determine the sources of dietary vitamin A currently available to the different communities and the limitations in the present situation. The authors also describe some investigations on ways by which dietary vitamin A might be increased, including new recipes to promote some of the lesser used green leafy vegetables (GLV) and some interesting community studies to introduce red palm oil into the Indian diet. There are 2 main dietary sources of vitamin A: preformed retinol in foods of animal origin and the pro-vitamin A carotenes in plant foods, of which the most important is P-carotene. In India and many developing countries, foods containing P-carotene contributed 60% or more of the household vitamin A intake. In India, the main foods providing P-carotene are GLV, carrots and a few fruits like mango, papaya and tomatoes. A wide variety of carotene-containing foods is available and 60% of these are GLV. Approximately 30% were rich sources of P-carotene, providing more than 5 mgilO0 g and 20% supplied a more modest l-5 mg/lOO g. However, several uncommon GLV were found to be consumed in rural and tribal areas, the composition of which was not known. The point is made by the authors that potentially, for some vegetables, only small amounts are needed to satisfy daily requirements. For example, only 5 g/d of drumstick leaves (Molinga olefiera) would be sufficient to meet the requirements of a young child. In the 4 regions, the authors identified 52 carotenerich foods and these are listed in one of the several appendices; 37 were available in the western region and about 25 in the others. Common to all regions was the consumption of amaranth, carrots and mango fruit. Coriander and curry leaves, and green chillies, were also consumed by most people but mainly as garnishes and therefore may contribute little to the vitamin A intake. Certainly, chilli was identified as a disincentive to the consumption of GLV by young children, for it was frequently added to provide flavour in local recipes. The authors also provide much information on rhe relative cost of different GLV, fruits etc. and identify expense as one reason for the low consumption of certain GLV. However, seasonal non-availability and poor quality were major factors limiting supply, and cooking methods were identified as a source of considerable loss of vitamin A activity. This book will be of considerable interest to workers who are studying ways of promoting improvements in vitamin A status using dietary means, for although it addresses the problems in India, these problems are com-

mon in many other developing countries. The book does not provide solutions, but it does provide ideas and an honest appraisal of the situation in India. _^ David I. Thurnhan School of Biomedical Faculty >f Science University of Ulster

Sciences

Coleraine County Londonderry,

BT52

ISA,

Northern

Ireland

A New Taxonomic and Geographical Inventory of World Blackflies (Dintera: Simuliidae) . R. W. Crosskey &T. M. Howarh. condon:The Natural History Museum, 1997.144~~. Price E20.00 ISBN o-565-09021-6. The rapidly enlarging literature dealing with some insects of medical importance can provide something of a nightmare for ecologists and other field workers in certain parts of the world. In particular, works on the Siphonaptera and Diptera, Simuliidae have increased numerically a great deal in recent years as the relatively obscure and untranslated literature from China filters into the western world. In the case of the Simuliidae, the picture has been further confused by quite widely disparate taxonomic approaches of workers in different parts of the world and-in extensive use of ‘local’ synonyms. This book, although suuerficiallv an uvdatine of a nrevious work, &ually~epla~es it co&plet& and& intended to provide baseline data of the diversity of this family. All known species are listed, together with synonyms, misspellings and misidentifications, and also various other names that have no formal scientific status but have appeared in the literature and are mostly associated with geographical distribution or genetic analyses. Each species has information on its known geographical distribution in the text, and similar data appear in tabular form for supraspecific taxa. Overall, the authors have taken a middle line with regard to classification at the generic and subgeneric level, whilst allowing for the probability that the relationships of these taxa will become clearer once DNA analysis has been more extensively employed. A selected bibliography and explanatory notes on certain names and terms complete a volume that should prove to be an essential tool for anyone working on this family. Ian F. Burgess Medical Entomology Centre Cambridge Road Fulbourn Cambridge, CBl SEL, UK

Historical Aspects of American Trypanosomiasis (Chagas’ Disease). M. Perleth. Frankfurt am Main: Peter Lang, 1997. 174~~. Price E22.00. ISBN 3-63131063-3. In 1907, Carlos Justiniano das Chagas was directing an antimalaria campaign in the northern part of Minas Gerais, Brazil. His attention was drawn to blood-sucking bugs infesting houses of the rural workers. In the gut contents of these bugs, and in the bloodstream of a young girl with fever, he found flagellated trypanosomes which he described as Trypanosoma cruzi in honour of his mentor, Oswald0 Cruz, and so began the impressive series of studies to unravel the biology of this parasite and the clinical course of the disease which now bears his name*. *It would be churlish fo draw attention to the occasional typographical inaccuracies, but for the sake of clarity it is perhaps worth mentioning that Chagas himself did not have Chagas disease. This eponymous term does not, therefore, merit an apostrophe (and is not given one in the 1987 edition of the International Nomenclature of Diseases) [nor in rhe Transactions (editor)].

735

BOOK BEVIEWS

Chagas published his original discoveries in 1909-praised and honoured by some, criticized and mocked by others. In a remarkable series of papers up to his death in 1934, Chagas demonstrated almost all aspects of the life cycle of T. cmzi, together with details of its insect vectors, reservoir hosts, course of infection, pathology and experimental animal models. But Chagas had mistaken endemic goitre as a symptom of T. cmzi infection, leading many other researchers-especially in Argentina-to ridicule his findings. It was not until the 1930s that Chagas disease was ‘rediscovered’ by the indomitable Salvador Mazza in Argentina, leading to a full appreciation of the enormity of the public health problem posed by this disease in Latin America. Today it is estimated that T. cruzi infects 16-l 8 million people, and Chagas disease is now ranked by the World Bank as the most serious parasitic disease of the Americas by virtue of its debilitating effects. Chagas’s meticulous work has been frequently reviewed, often held as a ‘perfect rehearsal’ of Koch’s postulates to demonstrate disease aetiology. Less well known, perhaps, is the historical context of public health in Brazil at the time. In this sense, Matthias Perleth’s admirably researched booklet is both an interesting and useful resource. The book provides a general overview of the disease, the events of Chagas’s discoveries, and the political context. Regrettably, the general overview is rather weak, and understandably deficient in descriptions of modern control campaigns. Particularly lacking is any discussion of the spread of human populations and of the main vectors, and the influence this may have had on the timing of Chagas’s (and Mazza’s) discoveries. As Perleth notes, there is evidence to suggest preColombian Chagas disease in the Andean region, but he omits to mention that the main expansion of human Chagas disease elsewhere (in Brazil, for example) probably occurred much more recently, so that the polemic between Brazilian and Argentinian clinicians during the 1920s may well have had a real epidemiological basis. Most unfortunately, given the very wide expansion of Chagas disease-from Mexico to southern Argentina-there is scant mention of the major contributions to our understanding of the infection made by Chagas’s contemporaries in other parts of Latin America. The great strength of this work, however, is the detailed discussion of Brazilian public health politics and the influence of Chagas and his findings on the development of the Brazilian public health movement. Chagas himself became a major authority on Brazilian public health-influential in control policies against malaria, yellow fever and other prevalent afflictions. But he was continually dogged by controversy over his discoveries, his titles, and some unfortunate claims for the possibility of eliminating trypanosomiasis. The influence of the US-based Rockefeller Foundation is made clear, with a fascinating account of how public health priorities were developed and implemented at various stages. Such are the parallels with modern public health debates, that I would recommend this to any student of health policies. C. J. Schofield Department of Medical Parasitology London School of Hygiene and Tropical Keppel Street London, WClE 7HT, UK

Medicine

Ronald Ross: Malariologist and Polymath: A Biography. E. R. Nye & M. E. Gibson. Basingstoke: Macmillan Press. 1997. xii+316 DD. Price L45.00. ISBN O312-16296-h. Ronald Ross (1857-1932)

penned an autobiography

(Memoirs: With a Full Account of the Great Malaria Problem and its Solution) which was nublished in 1923. Since

his death much has been w&ten about him-a good deal portraying his irascibility and generally uncoopera-

tive nature-but we have lacked a carefully researched, unbiased. full-lenath bioerauhv. Now. in the centenarv year of his seminal discoGe& ai Secunderabad, India, 2 knowledgeable enthusiasts (the Associate Professor of Medicine at the University of Otago, New Zealand (E.R.N.) and an Assistant Librarian at the London School of Hygiene and Tropical Medicine (M.E.G.)) have delved deeply into the Ross Archives at the London School of Hygiene and Tropical Medicine and the Royal College of Physicians and Surgeons in Glasgow and have produced what will doubtless become the definitive biography of this great, albeit controversial, polymath. The majority of the 18 chapters concentrate on Ross’s personal life (he served in the Indian Medical Service from 188 l-l 899) and malaria work (for which, together with numerous other accolades, he received the Nobel Prize in 1902, the background of which is summarized in chapter 7); however, his literary work, poetic ability, and contributions to ‘pathometty’ (epidemiology) and mathematics are by no means neglected. Afte;-he returned to Eneland in 1899. Ross was verv closelv associated (some\f his relationship was extremely stormy) with the Liverpool School of Tropical Medicine (chapter 8: 102 pages) and its numerous expeditions-many of them to West Africa. This authoritatively produced volume contains a useful chapter (no. 3) on the history of malaria and its life-cycle-including a brief review of the use of ‘Jesuits’ Bark-and is ‘rounded off with chapters entitled ‘Malaria Today’ and ‘A Perspective: Ross’ Achievement’. There are 3 Figures and 25 Plates. I found the arrangement of the latter somewhat idiosyncratic: why, for example, are a contemporary map ofIndia and the Ross familv tree releaated to 22nd and 24th places, respectively? Also, the ihotograph of Ross (in 1929) following his cerebrovascular accident is printed before that of the microscope (chapter 11) used for his pioneering discoveries. An all-too-short ‘Introduction’ places Ross’s discovery in the context of contemporary views on the mechanism(s) of transmission of infective agents and the pioneering observations of Pasteur, Koch (also alluded to in chapter 4) and Lister. Although his major work was carried out between 1895 and 1898 in relative isolation, Ross was constantly in touch with his great mentor, Patrick Manson (1844-1922) and. althoueh Ross rightly takes credit for the monumental discoveries in 1897 and 1898, it becomes increasingly difficult to view this simply as the work of a ‘loner’-which Ross undoubtedly was. The text is extremely well researched and errors are few and far between; however, Dutton’s name was Joseph (not John). Ross’s role in the (Royal) Society of Trooical Medicine and Hvaiene (he was President from 1909 to 1911) is under-r&resented. There is a bibliography of 13 pages and the index (16 pages) is adequate. Overall, this is a work of the highest scholarship, and everyone with an interest in the history of disease transmission, the brilliant discoveries of a century ago, and the now fading specialty of (clinical) tropical medicine will be greatly indebted to these 2 authors for this timely masterpiece. G. C. Cook ,

I

The Wellcome Institute for the Histo y of Medicine 183 Euston Road London, NW1 2BE, UK

The Great Pox: The French Disease in Renaissance Europe. J. Arrizabalaga, J. Henderson & R. French. London: Yale University Press, 1997. xv+352pp. Price E25.00. ISBN 0-300-06934-O. Much has been written about the history of syphilis. The name is derived from the title of a poem by Fracastoro, completed in 1525 and published in 1530; it did not become popular until the late eighteenth centu-