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Bilharziasis : its Prevention andTreatment.

SCHISTOSOMIASIS is the name given to infectionsproduced by a genus of trematode parasitesindividually known as Schistosoma hcematobium,S. mansoni, and S. japonicum. Following LEIPER,the genus has been renamed after its discoverer,BILHARZ, the name of the disease becoming inaccordance therewith bilharziosis or, preferably,bilharziasis. I Bilharzia haematobia and B. mansoniare very prevalent in Egypt, and have given riseto, and still give rise to, much invaliding anddisease. Up till quite recently no treatment, pre-ventive or curative, had given good results, and theunfortunate individual infected had to bear histroubles as best he could, with the help of whatpalliative drugs that medicine was able to putforward. But a better era is now dawning forthe trematode host. In our present issue Dr.HAMILTON FAIRLEY gives an account of the recentresearches that have been carried out in the diseaseas seen in Egypt. The work of Dr. R. T. LEIPER, Dr.J. G. THOMSON, and the late Dr. R. P. COCKIN on theintermediate molluscan hosts of the two species ofbilharzia found in Egypt first made it possible toinstitute proper prophylactic measures to preventthe spread of the disease. Formerly we .were quitein the dark as to the life-history of the trematode,and, therefore, could take no steps to stop its

ravages. By a judicious campaign against molluscs,especially in a country like Egypt where the water-supplies are all under control, it is now quitewithin the bounds of possibility that the diseasemay be largely controlled, if not actually stampedout. The differentiation of B. haematobia fromB. mansoni is also a first-class piece of work.The difference in the eggs of these two speciesmight have made students pause and think whythe same worm should produce dissimilar eggs,but authorities, even like Looss, were obsessed bythe theory that the ova were produced by the sameworm. LEIPER and his colleagues cleared up themystery by a careful analysis of the life-history ofthe two worms. Dr. FAIRLEY, starting from thisbasis, has gone one stage further and has workedout the complement-fixation reaction in bilharz-iasis. He has produced an antigen from the liversof snails (Planorbis boissyi) infected with S. mansoni,utilising the method first described by BORDETand GENGou, and he has been able to announce apositive fixation test for bilharziasis. The appli-cation of such a test as a control to cases treated

by the new method will be invaluable.Prevention, then, opens up an attractive prospect.

In the meantime the treatment of cases of bilharz-iasis with intravenous injections of antimoniumtartaratum (tartar emetic) is deservedly receivingattention. Such injections had been used withso great success in different forms of tropicaldisease (trypanosomiasis, leishmaniasis, ulceratinggranuloma) that a trial of them for bilharzialdiseases was certain to be forthcoming. Mr. J. E. R.-MCDONAGH was the first to make the attempt,

1 H. B. Day: THE LANCET, 1911, ii., 1329.

and claimed " great success.,,2 2 This did not appa-rently give rise to much comment at the time,and, in fact, appears to have been unnoticed byDr. J. B. CHRISTOPHERSON, who began in May, 1917,to treat vesical and rectal bilharziasis by thismethod at the Khartoum Civil Hospital. From a

supplementary paper by him in this issue of

THE LANCET it will be seen that he claims veryexcellent results from such injections. Confirma-tion of these results has come’ from Lieutenant-Colonel C. J. WILEY, A.A.M.C., in Egypt andmore recently from Dr. G. C. Low in London.The latter describes a case, treated at theLondon School of Tropical Medicine,5 in which,just as in the cases described by CHRISTOPHERSONand WiLEY, all the symptoms quickly disappearedafter the injections of the tartar emetic, and ovacould no longer be found. These cases will requirefollowing up to see that relapse does not take place,and it is here that the complement-fixation test willcome in with such great value. If it can be reliedon, then it will be possible to say if the patient iscured or not. This new treatment looks, then, asif it was the ideal after which workers in tropicalmedicine have been striving for generations-viz., adrug that will cure bilharzial disease. Assumingthat further work bears out these initial successes-and private information has reached us of othercases that have also been successful-then a

chronic, hitherto incurable disease, with all itsattendant baleful consequences, will at last havecome under the control of the physician, and thesaving in life and suffering will be incalculable.As it is, the recent researches in bilharziasisform a page of which tropical workers may rightlybe proud.

Metropolitan Hospital Sunday Fund.IT is now 50 years since THE LANCET first

entered a plea for the formation of a HospitalFund for London similar to that which had

originated in Birmingham. In 1869 Dr. JAMESWAKLEY determined to devote himself to the taskof making the Hospital Sunday movement nationaland, if possible, universal by causing it to becomepopular throughout the length and breadth of theland ; though it was not until the year 1872 that hesucceeded in arousing sufficient interest in the

metropolis to launch his scheme successfully. In

this connexion it is not without interest to quotefrom a letter which we received from the late Mr.BRUDENELL CARTER a short time before his death :-

’’ Here is a little bit of ancient history," he says."When I joined THE LANCET staff in 1868 Dr. JamesWakley was editor, and he was very anxious to obtain theestablishment of Hospital Sunday. He caused severalarticles to be written on the subject by myself and others,and finally asked me whether I could not do something withthe Times. I went to Delane on the subject, and he said thathe was not prepared to commit the Times to the proposal,although he thought well of it, but that he would publishevery extract from THB LANCET with regard to it that was

2 The Biology and Treatment of Venereal Diseases. London :Harrison and Sons. 1915.

3 THE LANCET, 1918, ii., 325.4 Brit. Med. Jour.,1918,ii.,716.

5 Journ. of Trop. Med. and Hyg., May 15th, 1919.