Tropical medicine in war and peace

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Abstract
In addition to better sanitary and hygienic precautions, the present war in the tropics has shown a material advance in the medical knowledge of tropical diseases. Sanitation and Medicine have worked to reduce the incidence of tropical diseases to a very low level. Advances in tropical medicine during 1914-1919 were mainly negative. Quinine for malaria and emetine for dysentery were shown to be inadequate treatments. Positive advances were the solving of the bilharzia problem in Egypt, and the discovery that the louse is the vector of typhus fever in Europe and the Near East, as well as the development of the Weil-Felix reaction for the diagnosis of typhus. From 1919 to 1939, the 2 major contributions to tropical medicine were the introduction of atabrin for treatment of malaria (Germany), and the development of a practical immunization technique for yellow fever (U. S. A.). The period 1939-1945 witnessed rapid strides in medical knowledge. (1) Atabrin is a nearly perfect prophylactic for most types of malaria[long dash]far better than quinine. It is, however, not a perfect cure, especially for benign tertian malaria. (2) Based on comparison with avian malaria, it seems probable that the parasites of human malaria pass through an exoerythrocytic stage before entering the blood corpuscles and during such a period are relatively immune to atabrin. (3) Insecticides and repellants such as DDT and the phthalates have proved to be of enormous value. (4) Vaccines for both scrub typhus and for louse-borne typhus were being tested at the end of the fighting in the Orient[long dash]and with great promise of success. (5) Bacil-lary dysentery was greatly reduced and almost eliminated through the use of sulfaguanidine and other sulfonamides. (6) Amoebic dysentery was greatly reduced through the use of penicillin to reduce the bacterial flora of the intestine and thus prepare the way for emetine or other amoebacides. Emetine resistance seemed to disappear in all cases when penicillin was used. (7) 20 yrs. of work culminated during the war yrs. in proving that leishmaniasis is carried by sand-flies, and that in some types of the disease, rodents serve as the natural reservoir of infection. Some advance has been made in developing treatments for schistosomiasis, filariasis, leprosy, etc., but as yet the work is not complete enough to justify adoptions of the methods on any large scale. The author closes with a plea for concentrated continuation of such researches in a London Center in hopes of bringing further knowledge to light and particularly to restore England to the forefront in the field of Tropical Medicine[long dash]a position lost during the 1930''s to Germany, and now held by the U. S.

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