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TISSUE STAGE OF MALARIA PARASITES
531 rheumatoid sera but not with normal sera : however, the positive reactions with the rheumatoid sera occurred as frequently with the " normal " antigen as with the antigen from rheumatoid tissue ; so that the experiments lend no support to the hypothesis of an altered connective tissue acting as an antigen. Whether these two reactions are in any way directly related cannot yet be said : it has become clear that a large number of the " colloidal reactions " in hepatic disease are all essentially modified tests for the presence of increased quantities of y-globulin, and it seems equally likely that many of the reactions observed in rheumatoid arthritis may be found eventually to be due to some The rapid progress in the study of the common factor. disease with ’Cortisone’ and A.c.T.H:makes it likely that an answer will be discovered sooner rather than later. ACROSS THE CHANNEL
"
On the other hand the creation of a French National School of Public Health in 1947 in Paris, and the striking fall in the number of D.P.H. students in this country since 1948, make it look as if we were in some danger of losing our longstanding lead in public-health training. Indeed, unless the position here changes-as no doubt it willwe may find it impossible to fill the vacancies for publichealth medical officers, which is already causing difficulty in the central services." TISSUE STAGE OF MALARIA PARASITES THE existence of tissue forms of the malaria parasite man and other mammals had been postulated for twenty years before Shortt and Garnham in 1948 located the long-sought parasites in the parenchyma cells of the liver, where they were unexpectedly large. They were demonstrated first with P. cynomolgi1 in monkeys, and then with P. vivax,2 and lastly P. falciparum3 i in biopsy specimens from volunteers. These dis-
in
objectives of the Brussels Treaty is ’’ to coveries were acclaimed by malariologists throughout develop corresponding lines the social and other(the but a dissenting voice has now been raised world, related services " of the five countries of Western Union. by Dr. Clay G. Huff, one of the leading American parasiIn public health a beginning has bten made with personal tologists, who has done classical work on the development contacts between officials and exchange of information. of the sporozoites of avian malaria through cryptozoites Dr. N. M. Goodman, in his Chadwick lecture of Oct. 24, in the reticulo-endothelial cells to reach the familiar sketched the public-health administration of Belgium, forms in the red cells. In a letter published in America France, Luxembourg, and the Netherlands, and pointed Huff 4 points out that no-one has yet demonstrated the to some of the differences from our own. The French and the sporozoites with the forms found stage Belgians, he said, regard administration as a science ; in the connecting liver four later. Material supplied by Shortt days the British regard it as an art (or even a craft) ; and the has fixed been and stained by Huff’s methods and Huff Dutch are somewhere between the two. In other words, has found the bodies that Shortt differencesbetween the Franco-Belgian approach is logical and sometimes described and the forms of the avian and recognised (in British eyes) unpractical ; the British approach is saurian plasmodia. He concludes that " there seems to and The Dutch tradition practical nearly always illogical. be no alternative to doubting the malarial nature of the of individual and local self-reliance has tended towards bodies described by Colonel Shortt and his collaborators." a conservation of voluntary effort in public health as He does not deny -that these bodies may be exoerywell as other fields ; the French, and to a lesser extent forms of malaria, but he urges that- much throcytic the Belgian, systems owe much to the Napoleonic conmore work is needed before the claim can be considered cepts of the droit administratif and of centralisation ; proved. while the British tradition of sanitary reform has fixed Further research, particularly into the development of the broad lines of our public-health system on a local the sporozoites during the first four days, is certainly basis. Except in the older and larger municipalities desirable ; but there are good reasons for expecting it to a the M.o.H. he is sometimes (where part-time clinician) confirm the claim. The -objects seen in liver sections, in the other Western Union countries is generally an Carnoy and stained with Giemsa, are employee of the central government, responsible to the when fixed withsimilar to the tissue forms of avian fundamentally of his as well department (county) prefect or governor malaria, though Huff’s technique of fixing in Zenker-formol as to the local municipal council. In France each departand staining by Maximow’s method has led to different In all the ment has a full-time director of health. results. Then the ripening into merozoites on the 8th health and other technical countries, except ours, doctors to 10th day (P. cy7zomolgi) fits exactly with the time at staff are eligible for, and in fact hold, executive positions which the blood first becomes infective on subinoculation. on a par with those of lay administrators ; thus in France, Moreover, the findings of Shortt and Garnham with the of Netherlands heads permanent Belgium, and the P. cynomolgi have been completely confirmed, on differthe health ministries are doctors, and so are the directors ent material, at the National Institute for Medical of most of the divisions dealing directly with health. Research.55 The appearance of the parasites with only In Britain, of course, doctors in central health departa single generation between the sporozoite and the forms ments are advisory, not executive ; but Ethiopia, said in the blood agrees with the fact that liver tissue (even Dr. Goodman, " is I believe the only other country in if it contains parasites) does not become infective on the world, including the Dominions, which follows our 8th day. Large numbers of example." Perhaps we are too apt, he added, to think subinoculation until the taken at necropsies, have been human liver sections, of something as strange and peculiar because we do not do it ourselves, whereas inquiry will show that it is we diligently searched as controls and have not yielded any who are peculiar and in a minority." In public health objects resembling those found by Shortt and his colthe convergent development aimed at by the Brussels leagues in their biopsies taken from the volunteers will be if attainable we Treaty only begin by knowing just when the presence of the pre-erythrocytic forms something about the organisation in the other Western had been foretold. One may therefore safely predict that future work will remove even the last lingering Union countries. ONE of the on
’
’
"
Jjr. (jroodman also had some
cogent things to
say about
instruction in public health. His impression is that the instruction of undergraduates in this subject is more thorough on the Continent than in some at least of our own schools. For postgraduates we have had a statutory course and diploma controlled by the General Medical Council for 64 years, whereas in the other countries uniformity of standards has only lately been introduced.
doubts Shortt, H. E., Garnham, P. C. C. Nature, Lond. 1948, 161, 126. With Malamos, B. Brit. med. J. 1948, i, 192. 2. Shortt, H. E., Garnham, P. C. C., Covell, G., Shute, P. G. Brit. med. J. 1948, i, 547. 3. Shortt, H. E., Hamilton Fairley, N., Covell, G., Shute, P. G., Garnham, P. C. C. Ibid. 1949, ii, 1006. 4. Huff, C. G. Trop. Med. News, 1950, 7, 22. 5. Hawking, F., Perry, W. L. M., Thurston, J. P. Lancet, 1948, i, 1.
783.
"
On the other hand the creation of a French National School of Public Health in 1947 in Paris, and the striking fall in the number of D.P.H. students in this country since 1948, make it look as if we were in some danger of losing our longstanding lead in public-health training. Indeed, unless the position here changes-as no doubt it willwe may find it impossible to fill the vacancies for publichealth medical officers, which is already causing difficulty in the central services." TISSUE STAGE OF MALARIA PARASITES THE existence of tissue forms of the malaria parasite man and other mammals had been postulated for twenty years before Shortt and Garnham in 1948 located the long-sought parasites in the parenchyma cells of the liver, where they were unexpectedly large. They were demonstrated first with P. cynomolgi1 in monkeys, and then with P. vivax,2 and lastly P. falciparum3 i in biopsy specimens from volunteers. These dis-
in
objectives of the Brussels Treaty is ’’ to coveries were acclaimed by malariologists throughout develop corresponding lines the social and other(the but a dissenting voice has now been raised world, related services " of the five countries of Western Union. by Dr. Clay G. Huff, one of the leading American parasiIn public health a beginning has bten made with personal tologists, who has done classical work on the development contacts between officials and exchange of information. of the sporozoites of avian malaria through cryptozoites Dr. N. M. Goodman, in his Chadwick lecture of Oct. 24, in the reticulo-endothelial cells to reach the familiar sketched the public-health administration of Belgium, forms in the red cells. In a letter published in America France, Luxembourg, and the Netherlands, and pointed Huff 4 points out that no-one has yet demonstrated the to some of the differences from our own. The French and the sporozoites with the forms found stage Belgians, he said, regard administration as a science ; in the connecting liver four later. Material supplied by Shortt days the British regard it as an art (or even a craft) ; and the has fixed been and stained by Huff’s methods and Huff Dutch are somewhere between the two. In other words, has found the bodies that Shortt differencesbetween the Franco-Belgian approach is logical and sometimes described and the forms of the avian and recognised (in British eyes) unpractical ; the British approach is saurian plasmodia. He concludes that " there seems to and The Dutch tradition practical nearly always illogical. be no alternative to doubting the malarial nature of the of individual and local self-reliance has tended towards bodies described by Colonel Shortt and his collaborators." a conservation of voluntary effort in public health as He does not deny -that these bodies may be exoerywell as other fields ; the French, and to a lesser extent forms of malaria, but he urges that- much throcytic the Belgian, systems owe much to the Napoleonic conmore work is needed before the claim can be considered cepts of the droit administratif and of centralisation ; proved. while the British tradition of sanitary reform has fixed Further research, particularly into the development of the broad lines of our public-health system on a local the sporozoites during the first four days, is certainly basis. Except in the older and larger municipalities desirable ; but there are good reasons for expecting it to a the M.o.H. he is sometimes (where part-time clinician) confirm the claim. The -objects seen in liver sections, in the other Western Union countries is generally an Carnoy and stained with Giemsa, are employee of the central government, responsible to the when fixed withsimilar to the tissue forms of avian fundamentally of his as well department (county) prefect or governor malaria, though Huff’s technique of fixing in Zenker-formol as to the local municipal council. In France each departand staining by Maximow’s method has led to different In all the ment has a full-time director of health. results. Then the ripening into merozoites on the 8th health and other technical countries, except ours, doctors to 10th day (P. cy7zomolgi) fits exactly with the time at staff are eligible for, and in fact hold, executive positions which the blood first becomes infective on subinoculation. on a par with those of lay administrators ; thus in France, Moreover, the findings of Shortt and Garnham with the of Netherlands heads permanent Belgium, and the P. cynomolgi have been completely confirmed, on differthe health ministries are doctors, and so are the directors ent material, at the National Institute for Medical of most of the divisions dealing directly with health. Research.55 The appearance of the parasites with only In Britain, of course, doctors in central health departa single generation between the sporozoite and the forms ments are advisory, not executive ; but Ethiopia, said in the blood agrees with the fact that liver tissue (even Dr. Goodman, " is I believe the only other country in if it contains parasites) does not become infective on the world, including the Dominions, which follows our 8th day. Large numbers of example." Perhaps we are too apt, he added, to think subinoculation until the taken at necropsies, have been human liver sections, of something as strange and peculiar because we do not do it ourselves, whereas inquiry will show that it is we diligently searched as controls and have not yielded any who are peculiar and in a minority." In public health objects resembling those found by Shortt and his colthe convergent development aimed at by the Brussels leagues in their biopsies taken from the volunteers will be if attainable we Treaty only begin by knowing just when the presence of the pre-erythrocytic forms something about the organisation in the other Western had been foretold. One may therefore safely predict that future work will remove even the last lingering Union countries. ONE of the on
’
’
"
Jjr. (jroodman also had some
cogent things to
say about
instruction in public health. His impression is that the instruction of undergraduates in this subject is more thorough on the Continent than in some at least of our own schools. For postgraduates we have had a statutory course and diploma controlled by the General Medical Council for 64 years, whereas in the other countries uniformity of standards has only lately been introduced.
doubts Shortt, H. E., Garnham, P. C. C. Nature, Lond. 1948, 161, 126. With Malamos, B. Brit. med. J. 1948, i, 192. 2. Shortt, H. E., Garnham, P. C. C., Covell, G., Shute, P. G. Brit. med. J. 1948, i, 547. 3. Shortt, H. E., Hamilton Fairley, N., Covell, G., Shute, P. G., Garnham, P. C. C. Ibid. 1949, ii, 1006. 4. Huff, C. G. Trop. Med. News, 1950, 7, 22. 5. Hawking, F., Perry, W. L. M., Thurston, J. P. Lancet, 1948, i, 1.
783.