Bilharzia

Professor Farley describes how governments and organizations faced one particular tropical disease, bilharzia or schistosomiasis.

In 1917, in Khartoum, Dr. J.B. Christopherson experimentally treated seventy bilharzia patients with injections of antimony tartrate, an early chemotherapy. His was the first successful treatment. Antimony had never been tried on bilharzia patients before, or so he believed. This biography examines the turbulent life of this medical pioneer, his fight for priority and his struggle for professional survival amid the politics of exclusion in General Wingate's Sudan. His was a career full of paradoxes: acclaimed for intercepting a smallpox outbreak, building a hospital and satellite clinics, he battled accusations and removal as director of the Medical Department. From the Boer War, two decades in Sudan, his capture and release in Serbia to his time in France in WW1, controversy seldom left him.

Schistosomiasis is Africa's second most common parasitic disease. Less than 20 years ago, over 200 million were infected. In many high-risk areas the Schistosomiasis Control Initiative (SCI) has been helping to tackle the disease by offering treatments to millions of children. This book tells the story of a man, Alan Fenwick, who founded the SCI to control the worms and snails and so improve the lives of many burdened with the disease as well as reducing the numbers infected. Over this period SCI and the Ministries of Health and Education in 16 countries delivered over 220 million treatments. Treatment coverage of up to 75% has been achieved. Widely recognised as a cost-effective and successful intervention, SCI's knock-on effects include improving overall physical health, school attendance and future prospects for millions of people.

During the past decade there has been an increasing awareness of the need for a different approach to the problem of bilharziasis. We do know that 180-200 million people are infected and that the infection is increasing but we have not as yet been able to answer the question: Are they suffering from a disease. Study of vital statistics or hospital records, mass biochemical or immunological tests and community surveys have not yet provided the full answer. Gradually and perhaps begrudgingly, we have come to realize that we must study the ma- initially by means of well controlled clinical observations to obtain evidence for the altered physiology, if any, due to bilharzial infection; secondly and equally important through pathological studies on individual patients to determine the structural changes, if any, as a result of infection with this parasite; and by post mortem studies. Experimental studies of bilharzial infection in animals, valuable as they may be for the elucidation of the pathogenesis of the lesions in the laboratory animal and in man cannot serve as a substitute for the precise information on the nature of the possible lesions induced by bilharziasis in man. Basically, the significance of any clinical observation can 'be evaluated only through reliable pathological confirmation.