Volume 49 · Issue 05 · 1935

This address on Chemotherapy is chosen for two reasons: first because Chemotherapy has been found and built up principally by German workers and second because the Hamburg Institute for Tropical Diseases has played a rather prominent part in the clinical test of some important new chemotherapeutic compounds, working out its dosage and general methods of application. To begin with I want to explain what is the meaning of chemotherapy in its strict sense.

The clinical picture of congestive heart failure is all too familiar. The onset may be dramatically sudden and terrifying, but it is more commonly slow, gradual, or even insidious. The history sometimes tells of some event associated with the beginning of the trouble, such as an acute infection or some unusual physical or mental strain; such factors, however, are often not uncovered. The patient describes the development of unnatural fatigue, loss of energy, and shortness of breath. Swelling of the ankles and other parts, cough and sputum, perhaps containing blood (occasionally this first of all), make their appearance. The patient may lose his appetite, and become dyspeptic, suffering from epigastric discomfort or pain, in some cases from nausea and vomiting. The urinary output is progressively decreased. Not infrequently pre-cordial pain occurs, which may rise to the height of angina, although this is not often the case.

Trigeminal neuralgia gives the most agonizing type of pain from which the human being can possibly suffer. The paroxysms are not very frequent at first bu.t they increase in number, duration and severity as time goes on. In some cases the pain is so great that the patient is driven to commit suicide. One of my patients attempted to commit suicide over twenty times before he came to the hospital. Text books often warn people not to give morphia as a drug habit is apt to be formed. But none of my 36 cases had developed such a habit. Some of these smoked opium and some of them tried injections of morphia, but all of them had to give it up because they obtained very little relief.

The term osteomyelitis of the mandible should be reserved for that condition in which the jaw is involved in a suppurative necrotizing process. From the pathologic standpoint, one might use the term to describe any inflammatory process occurring in this bone, for in such lesions as are seen microscopically in chronic periapical infection and periodontoclasia, one finds exudative and proliferative changes in the alveolar bone and marrow spaces. These latter processes, however, remain localized in the alveolus and are not productive of macroscopic sequestration. Removal of the involved teeth ends the pathologic process, leaving the body of the mandible free from disease.

In China human tapeworm infestation was known in ancient times, since the famous Pen Ts'ao, the Chinese Classical Herbal, written about 1,500 B.C., contains records of tapeworms and their treatment.

Chief complaint: Severe abdominal pain and enlargement of the abdomen. Seven months ago, she had a short attack of epigastric pain associated with nausea, vomiting, chills and fever. At that time, she noticed enlargement of the abdomen. and this has steadily; increased to the present time. There have been occasional mild attacks of abdominal pain, but no severe ones until two weeks ago. This came on rather suddenly, agonizing in character, and for three days practically continuous. An improvement was noted for three or four days, then more pain. Three days before admission, another severe attack came, this time in the lower abdomen, associated with vomiting and fever. Bowels moved once daily.

The present study is based upon 196 cases of Malaria in Elizabeth Blake Hospital from January first to the end of November 1933. Malaria was very prevalent during the year, there being one case in every seven admissions to the hospital. On account of the limited bed capacity, we admitted only severe cases. There were 124 cases, (63 per cent) of Subtertian Malaria, 62 (or 32 per cent) Tertian, and one (or 0.05 per cent) Quartan. The remaining g cases were diagnosed malaria clinically. In one or two cases, we found parasites only after culturing the blood for malaria. The death rate in the entire group was 1.5 per cent.

The subject of the present report may be fittingly introduced by the following statement from Burnet (1): "It is sufficient to recall the fact that tuberculosis attacks all races, all ages, and all classes of human society, and animals living in contact with man. Alike endemic and epidemic, it is more deeply embedded in the social body than any other infectious disease. Directly one begins to study it, one feels that to stamp it out, it would be necessarv to revolutionise society. To employ a familiar expression, it is, as it were, a leprosy rather than a plague............."

The annual report of the Rockefeller Foundation for 1933 contains, among other activities of the Foundation, a modest summary of a gigantic task, silently pursued and nobly accomplished. The West African Yellow Fever Commission established in 1925 in Lagos for the study of the incidence, distribution and epidemiology of the disease announced the completion of one of its main objects - the survey of endemic areas of Yellow Fever in Africa. The demarcation of these centres was made possible only after much preliminary field and laboratory work which disclosed the facts that the non-indigenous Macacus rhesus monkey and.the white mouse were susceptible to the disease and that the serum of a person who had once had Yellow Fever protected not only himself for life, but also the susceptible laboratory animals against the virus.

With an area of 210 sq. li, anf a population of 38,000, Kao-Chiao, a part of Greater Shanghai, is situated in Pootung, the eastern side of the Whangpoo River (see the map).

The seasonal density of Anopheles hyrcanus var. sinensis is of some significance in relation to the epidemiology of malaria in the Shanghai area, as this is the only species of anopheline mosquitoes found so far in this region. Some data were obtained concerning the relative adult density of this local species of Anopheles during 1933 in our field entomological station at Kaochiao.

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