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Trachoma and Allied Infections in a Gambian Village
BOOK REVIEWS fractive correction to achieve the most sat isfying results after successful cataract ex traction, corneal transplantation or retinopexy. James E. Leben söhn
TRACHOMA AND ALLIED INFECTIONS IN A
By Shiona Sowa, J. Sowa, L. H. Collier, and W. Blyth. Lon don, Her Majesty's Stationery Office, 1965. Paperbound, 88 pages, 11 figures, 6 plates (4 in color), 49 tables, refer ences, 2 appendices. Price: £1.0s.0d.net. The monograph summarizes a study of the eyes of all the inhabitants of a Gambian village that was begun in 1959 by a team of investigators from Great Britain's Medi cal Research Council's Trachoma Research Unit at the Lister Institute, London. Over 80% of the inhabitants had some form of ophthalmic abnormality. TRIC (trachomainclusion conjunctivitis) infection was found to affect as many as 9 1 % of the fiveto nine-year age group. Severe post-trachomatous sequelae were rare; in spite of the high prevalence of the disease, severe visual defects attributable to it were found in only 2.5% of the total population. There was no example of total blindness due to trachoma. The isolation method was more reliable than the finding of inclusions for demon strating the TRIC agent in the conjunctiva. In one survey, the agent was isolated on the egg in 69% of clinically positive cases, but was identified in the form of inclusion bodies in iodine-stained preparations in only 47%. No carrier state was found in nonGAMBIAN VILLAGE.
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trachomatous subjects. Pannus was not seen regularly in stage I trachoma. The eyes of 79 babies born in the vil lage over a period of three years were ex amined at frequent intervals for periods of up to two years or more. TRIC-agent in fection was found in five infants shortly after birth, and isolation of TRIC agents from the genital tracts of three of the mothers suggested that the ophthalmic in fection was acquired at birth ; in three in fants the ocular disease resembled trachoma rather than inclusion conjunctivitis. In bactériologie studies of 384 villagers, streptococci were recovered from 53%, po tentially pathogenic staphylococci from 40% and bacteria of the Hemophilus group from 30%. There was no clear-cut evidence that these organisms affected the course of tra choma. Tests of survival time of the trachoma agent suggested that recently contaminated fomites could be sources of infection. At tempts to use hydrocortisone as a "provoca tive test" in cases of suspected trachoma were unsuccessful. Neither skin tests nor complement fixation tests were found to be useful in diagnosis. Cytologie studies showed that polymorphs and lymphocytes in quantity characterized active trachoma and that plasma cells were to be found prin cipally in the early stages of the disease. The conjunctival cytology returned to nor mal when healing began. The authors suggest that a comparison of their results with results of similar com prehensive studies made in other parts of the world would be most valuable. Phillips Thygeson
TRACHOMA AND ALLIED INFECTIONS IN A
By Shiona Sowa, J. Sowa, L. H. Collier, and W. Blyth. Lon don, Her Majesty's Stationery Office, 1965. Paperbound, 88 pages, 11 figures, 6 plates (4 in color), 49 tables, refer ences, 2 appendices. Price: £1.0s.0d.net. The monograph summarizes a study of the eyes of all the inhabitants of a Gambian village that was begun in 1959 by a team of investigators from Great Britain's Medi cal Research Council's Trachoma Research Unit at the Lister Institute, London. Over 80% of the inhabitants had some form of ophthalmic abnormality. TRIC (trachomainclusion conjunctivitis) infection was found to affect as many as 9 1 % of the fiveto nine-year age group. Severe post-trachomatous sequelae were rare; in spite of the high prevalence of the disease, severe visual defects attributable to it were found in only 2.5% of the total population. There was no example of total blindness due to trachoma. The isolation method was more reliable than the finding of inclusions for demon strating the TRIC agent in the conjunctiva. In one survey, the agent was isolated on the egg in 69% of clinically positive cases, but was identified in the form of inclusion bodies in iodine-stained preparations in only 47%. No carrier state was found in nonGAMBIAN VILLAGE.
923
trachomatous subjects. Pannus was not seen regularly in stage I trachoma. The eyes of 79 babies born in the vil lage over a period of three years were ex amined at frequent intervals for periods of up to two years or more. TRIC-agent in fection was found in five infants shortly after birth, and isolation of TRIC agents from the genital tracts of three of the mothers suggested that the ophthalmic in fection was acquired at birth ; in three in fants the ocular disease resembled trachoma rather than inclusion conjunctivitis. In bactériologie studies of 384 villagers, streptococci were recovered from 53%, po tentially pathogenic staphylococci from 40% and bacteria of the Hemophilus group from 30%. There was no clear-cut evidence that these organisms affected the course of tra choma. Tests of survival time of the trachoma agent suggested that recently contaminated fomites could be sources of infection. At tempts to use hydrocortisone as a "provoca tive test" in cases of suspected trachoma were unsuccessful. Neither skin tests nor complement fixation tests were found to be useful in diagnosis. Cytologie studies showed that polymorphs and lymphocytes in quantity characterized active trachoma and that plasma cells were to be found prin cipally in the early stages of the disease. The conjunctival cytology returned to nor mal when healing began. The authors suggest that a comparison of their results with results of similar com prehensive studies made in other parts of the world would be most valuable. Phillips Thygeson