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CSU 28/2009: POLIO IMPORTATIONS/ ROSS ON MALARIA TRANSMISSION / ROSS ON MOSQUITO BRIGADES/ BRITISH ANTIMALARIAL ACTIVITY IN WORLD WARS I AND II

Friday, 8th of May 2009 Print

CHILD SURVIVAL UPDATE 28/2009: POLIO IMPORTATIONS/ ROSS ON MALARIA TRANSMISSION /
 ROSS ON MOSQUITO BRIGADES / BRITISH ANTIMALARIAL ACTIVITY IN WORLD WARS I AND II
 
 
 1) POLIO IMPORTATIONS AND RESPONSE
 
 Even as India, the largest of the four polio endemic countries, makes
 striking advances against Type 1 and Type 3 polio transmission, fifteen
 African countries have seen polio importations in 2008-09. Details of the
 importations and the outbreak response are at
 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5814a1.htm
 
 From the editorial note: 'The risk for importation is greatest for
 countries adjacent to those countries where WPV transmission continues;
 however, globalized transportation and international migration pose a risk
 for WPV reintroduction for all countries. Recent findings of WPV in sewage
 samples in Switzerland and Egypt, where no polio cases have been detected
 since 1984 and 2004, respectively, confirm that long-distance importations
 can occur and that high levels of vaccination coverage limit local
 transmission.'
 
 2) ROSS ON MALARIA TRANSMISSION
 
 Working in India, Ronald Ross showed that malaria was a mosquito borne
 disease.
 
 From the CDC homepage, http://www.cdc.gov/malaria/history/ross.htm
 
 Sir Ronald Ross was born in Almora, India in 1857 to Sir C.C.G. Ross, a
 General in the Indian Army and his wife Matilda. At   the age of eight he
 was sent to England to be educated and spent much of his childhood with an
 aunt and uncle on the Isle of   Wight. During his early years he developed
 interests in poetry, literature, music, and mathematics, all of which he
 continued to engage in for the rest of his life.
 
   Although he had no predisposition to medicine, at the age of 17 he
 submitted to his father's wish to see him enter the Indian Medical Service.
 He began his medical studies at St Bartholomew's Hospital Medical College,
 London in 1874 and sat the examinations for the Royal College of Surgeons
 of England in 1879. He took the post of ship surgeon on a transatlantic
 steamship while studying for, and gaining the Licentiate of the Society of
 Apothecaries, which allowed him to enter the Indian   Medical Service in
 1881, where he held temporary appointments in Madras, Burma, and the
 Andaman Islands. During a year's  leave, from June 1888 to May 1889, he
 developed his scientific interests and studied for the Diploma in Public
 Health from the Royal Colleges of Physicians and Surgeons in England and
 took a course in bacteriology under Professor E. E. Klein. He also married
 Miss Rosa Bloxam who accompanied him to Bangalore when he returned for duty
 as a staff surgeon.
 
   In 1892 he became interested in malaria and, having originally doubted
 the parasites' existence, became an enthusiastic convert to the belief that
 malaria parasites were in the blood stream when this was demonstrated to
 him by Patrick Manson during a period of home leave in 1894. (Sir Patrick
 Manson is considered by many to be the father of tropical medicine. He was
 the first person to demonstrate, in 1878, that a parasite that causes human
 disease could infect a mosquito—in this case, the filarial worm that causes
 elephantiasis. He was also physician to the Seamen's Hospital Society, the
 Medical Advisor to the Colonial Office and later the founder of the London
 School of Tropical Medicine and the Hong Kong College of Medicine.)
 
   On his return to India in 1895, Ross began his quest to prove the
 hypothesis of Alphonse Laveran and Manson that mosquitoes were connected
 with the propagation of malaria, and regularly corresponded with Manson on
 his findings. However his progress  was hampered by the Indian Medical
 Service which ordered him from Madras to a malaria-free environment in
 Rajputana. Ross  threatened to resign but, following representations on his
 behalf by Manson, the Indian Government put him on special duty for a year
 to investigate malaria and kala azar (visceral leishmaniasis).
 
   On 20 August 1897, in Secunderabad, Ross made his landmark discovery.
 While dissecting the stomach tissue of an anopheline mosquito fed four days
 previously on a malarious patient, he found the malaria parasite and went
 on to prove the role of Anopheles mosquitoes in the transmission of malaria
 parasites in humans.
 
   He continued his research into malaria in India, using a more convenient
 experimental model, malaria in birds. By July 1898,   he had demonstrated
 that mosquitoes could serve as intermediate hosts for bird malaria. After
 feeding mosquitoes on infected   birds, he found that the malaria parasites
 could develop in the mosquitoes and migrate to the insects' salivary
 glands,   allowing the mosquitoes to infect other birds during subsequent
 blood meals.
 
   In 1899 Ross resigned from the Indian Medical Service and returned to
 England. He worked for the newly established Liverpool School of Tropical
 Medicine, taking a post as lecturer and later becoming Professor of
 Tropical Medicine, and accepted a personal chair in Tropical Sanitation at
 Liverpool University. One of his first roles at the School was to
 investigate and   devise anti-malaria schemes in West Africa. This was the
 first of many expeditions that Ross undertook to investigate and  develop
 malaria control measures including visits to Ismailia in Egypt at the
 request of the Suez Canal Company in 1902,   Panama in 1904, Greece in
 1906, and Mauritius in 1907-1908.
 
   In 1901 Ross was elected a Fellow of the Royal College of Surgeons of
 England and also a Fellow of the Royal Society, of which   he became
 Vice-President from 1911 to 1913. In 1902 he was awarded the Nobel Prize
 for Medicine "for his work on malaria, by   which he has shown how it
 enters the organism and thereby has laid the foundation for successful
 research on this disease and   methods of combating it". In 1902 he was
 appointed a Companion of the Most Honourable Order of Bath by His Majesty
 the King of Great Britain, and in 1911 he was elevated to the rank of
 Knight Commander of the same Order. He received an honorary M.D.   degree
 in Stockholm at the centenary celebration of the Karolinska Institute in
 1910 and was awarded honorary membership of many learned societies around
 the world throughout his career.
 
   During the First World War (1914-1918), Ross was appointed a consultant
 physician on tropical diseases to Indian troops and was sent to Alexandria
 for four months to investigate an outbreak of dysentery that was hampering
 troops in the Dardanelles.
 
   In 1917 he was appointed a consultant physician to the War Office and in
 1919 he received an honorary post as consultant to   the Ministry of
 Pensions.
 
   In 1926 the Ross Institute and Hospital for Tropical Diseases was opened
 on Putney Heath, London by the Prince of Wales as a memorial to and in
 recognition of Ross' work. The main focus of the Institute was the study of
 the nature and treatment,  propagation and prevention of tropical diseases.
 Ross assumed the post of Director in Chief, which he held until his death
 in   1932. The Institute was incorporated into the London School of Hygiene
 & Tropical Medicine in 1934. . . .
 
   While Ross is remembered for his malaria work, this remarkable man was
 also a mathematician, epidemiologist, sanitarian, editor, novelist,
 dramatist, poet, amateur musician, composer, and artist. He died, after a
 long illness, at the Ross Institute on 16 September 1932.
 
   Text contributed by the Archivist, London School of Hygiene & Tropical
 Medicine.
 
 
  3) 'Mosquito Brigades and how to Organise them'
 
 Ross's 1902 'how to' book, at http://pds.lib.harvard.edu/pds/view/5995849
 is a practical guide to malaria vector control, based on what was then
 known on the subject. Full text is at this site.
 
 For those interested, this Harvard site also reproduces a century old
 pamphlet on Ross's introduction of mosquito brigades for drainage and
 vector control in Sierra Leone.
 
 4) The heritage of Ross: British Army Antimalarial Activity in World Wars I
 and II
 
 Mark Harrison, writing in Medical History, reviews the internal debates
 within the British military on the relative importance of different
 approaches (both quinine chemoprophylaxis and vector contro had their
 champions). Ross was an adviser to the military, but his preference for
 vector control was not universally accepted. Mutatis mutandis, the
 discussions of 100 years ago on choice of preferred technology are being
 repeated today. Here is an excerpt:
 
 [Ross stated that]"Experience shows that if mosquitoes are left to abound
 as before, quinine, even in very considerable prophylactic doses, merely
 has the effect of keeping down the fever, while allowing the men to become
 infected". Although the committee decided that quinine prophylaxis should
 continue in the most dangerous areas, it placed greater emphasis on the
 need for drainage and mosquito destruction. This represented a major
 professional victory for Ross, whose much vaunted "mosquito brigades" were
 to form the basis of malaria control in the British Empire until the end of
 the Second World War.
 
 Yet there were some British MOs who insisted that quinine prophylaxis could
 be valuable as a routine measure, provided that a standardized dose was
 given regularly to troops. In S R Christophers' opinion, everything
 depended on good discipline and expert supervision. Indeed, it may well
 have been that the ineffectiveness of prophylaxis during the First World
 War (and before) was due as much to lax discipline as to the limitations of
 quinine itself. Commanding officers generally took a relaxed view of such
 matters and were sometimes reluctant to enforce quinine consumption because
 of its unpopularity with troops. Thus, although General Allenby provided
 his force in Palestine with mosquito repellent ointments and nets, quinine
 prophylaxis was not compulsory and was left to the discretion of unit
 commanders. In Mesopotamia an order was given to compel the prophylactic
 use of quinine but, as the Advisory Committee reported in 1916, it was
 "more honoured in the breach than the observance". Indian troops there were
 also exempted from the general order insisting on the use of mosquito nets,
 on the grounds that they were unpopular with the sepoys, who had, in many
 cases, acquired an immunity to the disease.
 
 Full text is at
 www.pubmedcentral.nih.gov/picrender.fcgi?artid=1037165&blobtype=pdf
 

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