1. 1. Paris green was used as a larvicide on an inland hilly estate where A. maculatus was the carrier-and where most of the water treated was moving, more or less rapidly. 2. 2. Three different diluents were tried, viz., lime, talcum and soapstone powder. 3. 3. The strength of the mixture was one part of Paris green to ninety-nine parts of diluent by volume. 4. 4. Distribution was carried out by mechanical blowers and sprayers. 5. 5. The application was checked twenty-four hours afterwards. For one month it was checked forty-eight hours afterwards. 6. 6. There was an increase in breeding places-most of which were found in moving water. 7. 7. There was an increase in larvæ, many of them being over two days old. 8. 8. In spite of treatment of epidemics with plasmochin and quinine, the malaria rate was higher than during the previous year. The rise was more or less consistent, pointing to constant infections. 9. 9. The morbidity rate, death rate and infantile mortality were apparently not adversely affected, but in view of the treatments given with plasmochin, they are of no help in deciding the value of Paris green. 10. 10. There was a distinct fall in anti-larval costs, but the total anti-malarial costs were still high on account of the treatments necessary for epidemics of malaria. 11. 11. The advantages and disadvantages of Paris green are discussed.
1.This paper records the treatment by a continuous intravenous quinine drip technique of fifteen cases of heavy P. falciparum infection in malnourished prisoners of war in a Singapore camp. These cases were selected from a series of approximately 1,000.2.The efficiency of the method, its simplicity, and the ease with which it can be combined with blood transfusion or the slow administration of thiamin are stressed.3.Recovery by this method of treatment is recorded of three cases with a peripheral intensity of infection higher than has hitherto been reported in Malaya with survival.4.The author is of the opinion that this is a safe and effective method for the treatment of pernicious falciparum infections.
(1) A number of indications and analogies snggest the trial of coal-tar dyes and their derivativ es in leprosy. (2) Intravenous injections of a large number of dyes have been given to 85 patients. (3) A number of these dyes show marked selective concentration in the leprotic lesions, a phenomenon not seen in certain non-leprotic lesions. (4) With trypan blue, brilliant green, fluorescein and perhaps eosin a definite diminution of the external manifestations of leprosy has been observed, accompanied by other signs of clinical improvement. (5) With the other dy es administered no signs of clinical improvement were observed. (6) This report is a study of the immediate reaction of the lesions; we have as yet no knowledge of the later effects of the injection of these dyes. We consider from this preliminary report that further trial and study of these dyes is definitely indicated in the hope that it may lead to further possibilities in the chemotherapy of this disease.
An account of two cases seen in Sarawak, both being Europeans and in bothAncylostoma caninum being responsible. Infection was acquired in a swampy part of the golf course which is frequented by pariah dogs heavily infected with this parasite. Many treatments proved unavailing, cure at length being obtained by rubbing oil of chenopodium into the track for ten minutes. Subsequently 1 part of this oil was mixed with 3 parts of castor oil, the mixture being applied in the same way. Whilst the one application to one area was sufficient, it took 10 to 14 days to work over both feet in each case
I. A disease occurring in Malaya, particularly in institutions, is described. The main lesions in the early stage are eczema of the scrotum, eczema of the angles of the mouth and superficial glossitis. In the late stage the symptoms are those of combined degeneration of the cord and poor vision. A brief survey of the literature shows that symptoms of this type are widespread throughout the woHd.
2. The etiology is discussed and evidence given to show that the early stage is due to an avitaminosis B2 and that the late stage is probably due to a similar deficiency.
1. A disease occurring among Chinese in Malaya is described. The main complaints are weakness and numbness of the legs ; and the main signs absent tendon reflexes, sensory loss and ataxia.
2. The aetiology is discussed and the disease is thought to be a form of pellagra modified by other factors in the diet or circumstances of those affected.
1. An investigation is described in which eighty cases of acute malaria treated with prontosil are compared with sixty-eight cases treated with quinine bihydrochloride. 2. It is found that prontosil is not as efficient as quinine in P. falciparum malaria. 3. Prontosil is still less effective in P. vivax and P. malariae malaria. 4. Prontosil is not an efficient gametocide in either P. falciparum or P. vivax malaria. Mosquitoes were fed on “crescent” carriers who had been given prontosil for 7 days and were found to be readily infected. 5. No toxic effects were noted. 6. It is concluded that prontosil, though it has some lethal action on malaria parasites, especially P. falciparum, has no place in the practical treatment of malaria owing to its low efficiency, possible toxicity, and relatively high cost.
Tropical typhus bears a close clinical resemblance to mild typhus fever, but it does not spread from man to man, nor does it give rise to epidemics. Lice are not the vectors of the virus. There are two kinds of tropical typhus, the W. form and the K. form. In the W. form, the serum agglutinates the ordinary strains of B. proteus X. 19, and Wilson's B. agglutinabilis, but it does not agglutinate the non-indologenic strain, Kingsbury. In the K. form the serum agglutinates the non-indologenic strain, Kingsbury, but it does not agglutinate the ordinary strains of B. proteus X. 19, or B. agglutinabilis.
The W. form of tropical typhus is a disease of the house and the town; the majority of those affected are indoor workers, such as clerks and shopkeepers, particularly those who deal with foodstuffs. MAXCY has found that the " endemic typhus " or Brill's disease of the United States, which is clinically identical with tropical typhus, has a similar distribution. The like is true of the typhus-like fever described by HONE in Australia which is probably the same disease as the W. form of tropical typhus.
The distribution of the K. form is very different, it is essentially a disease of the open country and affects outdoor workers. It has a patchy distribution and outbreaks occur particularly in areas which, after being cleared of jungle, are allowed to grow up in weeds and scrub. For this reason, we propose the name scrub-typhus for the K. form of tropical typhus. Some of the cases of typhus-like diseases described in India are probably the same as scrub-typhus.
An account is given of an outbreak of sixty-one cases of scrub-typhus on an oil-palm estate where cases of the tsutsugamushi disease had occurred among the European staff. This outbreak illustrates the limited distribution of the disease. Five adjacent estates, served by the same hospital, were unaffected, and the outbreak was confined almost entirely to one of the three Divisions of the oil-palm estate. This Division differed from the other two in being overrun with weeds and undergrowth, with which scrub-typhus is always associated. An attack appears to confer immunity. The cases occurred among the newly recruited labourers, those who had been on the estate for a long time escaped infection. Coolies recruited in the Federated Malay States were as susceptible as those from India, from which it appears that the Indian population of Malaya has not been generally exposed to infection. The outbreak consisted entirely of the K. form of tropical typhus (scrub-typhus); there were no cases of the W. form (? endemic typhus).
Attention is drawn to the relationship of scrub-typhus and the tsutsugamushi disease by the occurrence of the latter on the same estate. The tsutsugamushi disease of the East Indies and scrub-typhus both occur in circumscribed areas which are covered with undergrowth, and their symptoms are much alike There are, however, the following points of distinction : (a) The fever of tsutsugamushi does not end abruptly at the end of the second week as it does in scrub-typhus, nor is convalescence so rapid. (b) A primary sore and bubo are present in tsutsugamushi, but absent in scrub-typhus. (c) The titre of agglutination with B. proteus, Kingsbury, is low in the tsutsugamushi disease but very high in scrub-typhus. In some cases of the tsutsugamushi disease, the serum agglutinates B. proteus, Kingsbury, in higher dilutions than that of normal persons, but not to titres nearly so high as in scrub-typhus.
It is suggested that the two diseases have a similar ~etiology and that scrubtyphus, like the tsutsugamushi disease, is carried by trombiculae.
A short description of the tsutsugamushi disease is given, followed by a note on the conditions under which it occurs in Sumatra and the Malay States. Abandoned agricultural land which has grown up in weeds is particularly dangerous. Small rodents are the reservoirs of the virus which is carried from them to man by larval mites. Trombicula akamushi is the carrier in Japan, and T. deliensis in Sumatra. The disease has been conveyed to monkeys by inoculation and also by the bites of infected mites. A description is given of four mites which are commonly found in the ears of rats in the Malay States, and a method for the examination of the mites is described. Black rats, to the number of 130, were examined. Sixteen were trapped in an abandoned portion of an oil-palm estate where three Europeans became infected with the tsutsugamushi disease, and T. deliensis, the Sumatran carrier, was found on ten of them. Thirty rats were caught in other parts of the estate, and T. deliensis was found on nine. Thirty rats were caught in other rural districts, where the disease was not known, and T. deliensis was found on only one. Fifty-four rats caught in the town of Kuala Lumpur were examined, with the result that T. deliensis was found in none. The conclusion is reached that T. deliensis is probably the carrier in the Malay States, as it is in Sumatra.