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PALUDRINE IN THE FIELD
278
;
since 1938, reflecting the increase of delinquency brought about by the war, of 41 schools and of 2548 children. Of these 145 schools, 34 are owned and managed by local authorities and III are still the responsibility of voluntary managers. One headmaster, asked why the children stayed, replied " Food " ; and it is a fact that many of them on admission are undernourished and in poor health. One important task of the school is to get them fit by feeding them properly, and giving them enough sleep and enough healthy exercise. Infestations and chronic infections have to be cleared up, and all children are immunised against diphtheria. At some girls’ schools there are clinics for the treatment of venereal disease. In all, the school doctor visits once a week, and examines children on admission and once a quarter afterwards. Correction of a disfigurement often restores the selfrespect of the child affected. Other changes are brought about by the community spirit in the schools, the personal interest which some children now experience for the first time, and the opportunity to do the sorts of things that children like to do. When choosing an approved school for a given child the courts usually seek the advice of the children’s branch of the Home Office, but sometimes one or two trials have to be made before the right school is found, and this is unsettling for the child. The Home Office is overcoming this difficulty by establishing classifying schools, staffed by educational psychologists and teachers able to assess ability, temperameait, and character, where a child can stay for 1-3 months before being sent to the appropriate approved
school.
,
The review explains why the work of the approved schools is successful in the great majority of casesnearly three-quarters of the children never get into any further trouble. It does not explain why the residue are failures, or speculate on the ways in which their numbers might be reduced, but a hint may be picked up from these informative pages. Like so many important enterprises today the approved schools are understaffed ; and they need staff of a specially keen and devoted type. Young people interested in psychology and social work might do well to consider training as teachers for these schools. PALUDRINE IN THE FIELD
REPORTS are now coming in on the fuller field-trial of’Paludrine,’ the synthetic antimalarial drug evolved by Imperial Chemical Industries.l Brigadier Hamilton Fairley and his colleagues at the Australian Army Medical Research Institute at Cairns in Queensland have examined the effect ofpaludrine on mosquito-conveyed strains of Plasmodium vivax, P. falciparum, and P. ?K6rMp from the standpoint of its action as a clinical suppressive, as a true causal prophylactic, as a therapeutic agent, and as a gametocidal agent. They have tried to determine its mode of action, more particularly its activity on the presumptive exo-erythrocytic stages of the parasites, and have sought for toxic manifestations. Their work was done on volunteers from the Australian Forces who had not served in endemic malarial areas, using strains of parasites obtained from New Guinea and transmitted by experimentally infected Anopheles
punctulatus
punctulatus. preliminary investigations in Australia fully var
The confirm the earlier studies made in the British Isles, and also indicate that paludrine in small daily dosage is an effective clinical suppressive and a true causal prophylactic in malignant tertian malaria. It is an equally effective clinical suppressive in benign tertian malaria, but it does not invariably afford effective causal prophylaxis against this infection, which subsequently developed in at least a proportion of cases receiving fairly sub1. See Ann. trop. Med. Parasit. December, 1945. ii, 639.
Lancet, 1945,
stantial daily doses of the drug for 3 weeks after the last bites of the infecting mosquitoes. An interesting observation made in the Australian experiments was that the inoculation of 200 c.cm. of blood from cases of benign tertian malaria, known to be infected because they subsequently relapsed, failed to infect volunteers while the donors were taking paludrine. In similar circumstances quinine or mepacrine does not prevent infection, which suggests that paludrine on the one hand and quinine and mepacrine on the other act on different forms of the parasites. With paludrine it is the exoerythrocytic forms of the parasite in man that are presumably destroyed, as they certainly are in birds. The efficacy of paludrine in the clinical cure of attacks of benign tertian, malignant tertian, and quartan malaria was confirmed. In malignant tertian malaria radical cure of the infection usually followed a 10-day course of therapeutic treatment. As a direct gametocide paludrine has little action, the production of gametocytes of either P. vivax or P. falciparum and their numbers and morphology in the peripheral blood not being materially altered by the drug. The gametocytes, however, did not mature when ingested by mosquitoes while the patient was on the drug ; but a week after cessation of the drug the circulating gametocytes would once more
infect mosquitoes.
Furthermore, mosquitoes given
a
blood meal on a patient taking paludrine, and then allowed to complete their meal on a gametocytecarrying case not on the drug, did not become infected, suggesting that paludrine acts on the early developmental stages ofthe malaria parasites in the mosquito. This action on the developmental forms in the mosquito was not exerted when the mosquito had been infected some days before the blood meal on a patient receiving the drug. Fairley and his collaborators have studied the effect of single doses of paludrine, both as a prophylactic and as a therapeutic agent in malignant tertian and benign tertian infections. Their work suggests that a single small dose ofpaludrine weekly, given for an indefinite period after therapeutic control of the primary attack, will prevent relapse of the more resistant benign tertian malaria until its eradication is ultimately achieved. They have also re-examined the toxicity of the drug, which has been found to be negligible within the wide therapeutically effective range of dosage. They confirm the statements already made on the merits of this compound compared with the older remedies.
partial
On Active Service AWARDS M.C.
°
K. W.
BBETHAM,
M.B.
Captain G, H. McPHBRSON, M.B. Edin., R.A.M.C. Edin., R.A.3,1[.0. Captain B. L. P. BROSSEAU, Captain H. E. S. MARSHALL, R.C.A.M.O. L.R.C.P., R.A.M.C. Captain W. M. BYERS, J. G. MoTT, M.B. Captain R.O.A.M.C. R.A.M.C. L’pool, Captain L. S. COOPER, M.D. J. C. WATTS, M.B. Lond., Major R.A.3f.C. Jefferson, R.A.M.C. Lieutenant W. J. GALLAGHER, Captain C. T. H. WHiTnsiDE, M.B. N.U.I., R.A.M.C.
Captain
Captain
J. H. HALDANE, L.R.C.P.E., R.A.M.C. Captain H. M. KERSHAW, M.B.
Leeds,
L.R.C.P., R.A.M.C. J. W.
Captain W. M.B. Dubl.,
WOLFE,
R.A.M.C.
R.A.M.C.
KING’S COMMENDATION
Major G. C. K. REID,
FOR BRAVE CONDUCT
St. And., B.A.M.c. The American Bronze Star medal has been awarded to Major W. R. HENDERSON, R.A.M.C., for saving American lives while working in German hospitals from 1940 to 1945. Major Henderson, who before the war was lecturer in neurological surgery in the University of Leeds, formed and equipped the first neurosurgical unit of the British Army, which he took to France in May, 1940. He remained behind at Dunkirk to look after 800 British wounded and later he was transferred to large German camps where he took care of Allied prisoners-of-war, including hundreds of American airmen and soldiers. So that he could continue this work he refused repatriation. M.B.
;
since 1938, reflecting the increase of delinquency brought about by the war, of 41 schools and of 2548 children. Of these 145 schools, 34 are owned and managed by local authorities and III are still the responsibility of voluntary managers. One headmaster, asked why the children stayed, replied " Food " ; and it is a fact that many of them on admission are undernourished and in poor health. One important task of the school is to get them fit by feeding them properly, and giving them enough sleep and enough healthy exercise. Infestations and chronic infections have to be cleared up, and all children are immunised against diphtheria. At some girls’ schools there are clinics for the treatment of venereal disease. In all, the school doctor visits once a week, and examines children on admission and once a quarter afterwards. Correction of a disfigurement often restores the selfrespect of the child affected. Other changes are brought about by the community spirit in the schools, the personal interest which some children now experience for the first time, and the opportunity to do the sorts of things that children like to do. When choosing an approved school for a given child the courts usually seek the advice of the children’s branch of the Home Office, but sometimes one or two trials have to be made before the right school is found, and this is unsettling for the child. The Home Office is overcoming this difficulty by establishing classifying schools, staffed by educational psychologists and teachers able to assess ability, temperameait, and character, where a child can stay for 1-3 months before being sent to the appropriate approved
school.
,
The review explains why the work of the approved schools is successful in the great majority of casesnearly three-quarters of the children never get into any further trouble. It does not explain why the residue are failures, or speculate on the ways in which their numbers might be reduced, but a hint may be picked up from these informative pages. Like so many important enterprises today the approved schools are understaffed ; and they need staff of a specially keen and devoted type. Young people interested in psychology and social work might do well to consider training as teachers for these schools. PALUDRINE IN THE FIELD
REPORTS are now coming in on the fuller field-trial of’Paludrine,’ the synthetic antimalarial drug evolved by Imperial Chemical Industries.l Brigadier Hamilton Fairley and his colleagues at the Australian Army Medical Research Institute at Cairns in Queensland have examined the effect ofpaludrine on mosquito-conveyed strains of Plasmodium vivax, P. falciparum, and P. ?K6rMp from the standpoint of its action as a clinical suppressive, as a true causal prophylactic, as a therapeutic agent, and as a gametocidal agent. They have tried to determine its mode of action, more particularly its activity on the presumptive exo-erythrocytic stages of the parasites, and have sought for toxic manifestations. Their work was done on volunteers from the Australian Forces who had not served in endemic malarial areas, using strains of parasites obtained from New Guinea and transmitted by experimentally infected Anopheles
punctulatus
punctulatus. preliminary investigations in Australia fully var
The confirm the earlier studies made in the British Isles, and also indicate that paludrine in small daily dosage is an effective clinical suppressive and a true causal prophylactic in malignant tertian malaria. It is an equally effective clinical suppressive in benign tertian malaria, but it does not invariably afford effective causal prophylaxis against this infection, which subsequently developed in at least a proportion of cases receiving fairly sub1. See Ann. trop. Med. Parasit. December, 1945. ii, 639.
Lancet, 1945,
stantial daily doses of the drug for 3 weeks after the last bites of the infecting mosquitoes. An interesting observation made in the Australian experiments was that the inoculation of 200 c.cm. of blood from cases of benign tertian malaria, known to be infected because they subsequently relapsed, failed to infect volunteers while the donors were taking paludrine. In similar circumstances quinine or mepacrine does not prevent infection, which suggests that paludrine on the one hand and quinine and mepacrine on the other act on different forms of the parasites. With paludrine it is the exoerythrocytic forms of the parasite in man that are presumably destroyed, as they certainly are in birds. The efficacy of paludrine in the clinical cure of attacks of benign tertian, malignant tertian, and quartan malaria was confirmed. In malignant tertian malaria radical cure of the infection usually followed a 10-day course of therapeutic treatment. As a direct gametocide paludrine has little action, the production of gametocytes of either P. vivax or P. falciparum and their numbers and morphology in the peripheral blood not being materially altered by the drug. The gametocytes, however, did not mature when ingested by mosquitoes while the patient was on the drug ; but a week after cessation of the drug the circulating gametocytes would once more
infect mosquitoes.
Furthermore, mosquitoes given
a
blood meal on a patient taking paludrine, and then allowed to complete their meal on a gametocytecarrying case not on the drug, did not become infected, suggesting that paludrine acts on the early developmental stages ofthe malaria parasites in the mosquito. This action on the developmental forms in the mosquito was not exerted when the mosquito had been infected some days before the blood meal on a patient receiving the drug. Fairley and his collaborators have studied the effect of single doses of paludrine, both as a prophylactic and as a therapeutic agent in malignant tertian and benign tertian infections. Their work suggests that a single small dose ofpaludrine weekly, given for an indefinite period after therapeutic control of the primary attack, will prevent relapse of the more resistant benign tertian malaria until its eradication is ultimately achieved. They have also re-examined the toxicity of the drug, which has been found to be negligible within the wide therapeutically effective range of dosage. They confirm the statements already made on the merits of this compound compared with the older remedies.
partial
On Active Service AWARDS M.C.
°
K. W.
BBETHAM,
M.B.
Captain G, H. McPHBRSON, M.B. Edin., R.A.M.C. Edin., R.A.3,1[.0. Captain B. L. P. BROSSEAU, Captain H. E. S. MARSHALL, R.C.A.M.O. L.R.C.P., R.A.M.C. Captain W. M. BYERS, J. G. MoTT, M.B. Captain R.O.A.M.C. R.A.M.C. L’pool, Captain L. S. COOPER, M.D. J. C. WATTS, M.B. Lond., Major R.A.3f.C. Jefferson, R.A.M.C. Lieutenant W. J. GALLAGHER, Captain C. T. H. WHiTnsiDE, M.B. N.U.I., R.A.M.C.
Captain
Captain
J. H. HALDANE, L.R.C.P.E., R.A.M.C. Captain H. M. KERSHAW, M.B.
Leeds,
L.R.C.P., R.A.M.C. J. W.
Captain W. M.B. Dubl.,
WOLFE,
R.A.M.C.
R.A.M.C.
KING’S COMMENDATION
Major G. C. K. REID,
FOR BRAVE CONDUCT
St. And., B.A.M.c. The American Bronze Star medal has been awarded to Major W. R. HENDERSON, R.A.M.C., for saving American lives while working in German hospitals from 1940 to 1945. Major Henderson, who before the war was lecturer in neurological surgery in the University of Leeds, formed and equipped the first neurosurgical unit of the British Army, which he took to France in May, 1940. He remained behind at Dunkirk to look after 800 British wounded and later he was transferred to large German camps where he took care of Allied prisoners-of-war, including hundreds of American airmen and soldiers. So that he could continue this work he refused repatriation. M.B.