tropical medicine book review

Critical Reviews in Tropical Medicine

• © 1984
• R. K. Chandra 0

Memorial University of Newfoundland, St. John’s, Canada

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Neglected Diseases in Developing Countries I

Burden of neglected tropical diseases and access to medicine and diagnostics in Ethiopia: a scoping review

Neglected Tropical Diseases

• Schistosomiasis
• tropical medicine

Table of contents (9 chapters)

Front matter, the special programme for research and training in tropical diseases.

• David S. Rowe

Infant and Child Mortality in Developing Countries

Oral rehydration therapy.

• Dilip Mahalanabis

Functional Consequences of Iron Deficiency Nonerythroid Effects

• R. K. Chandra, Devhuti Vyas

Hypolactasia Geographical Distribution, Diagnosis, and Practical Significance

Immune response to leishmania.

• Reza Behin, Jacques Louis

Immunological Alterations in Chagas’ Disease

• J. A. O’Daly, J. Azocar

Immunity to Helminths and Prospects for Control

• Derek Wakelin

Structured Vaccines for Control of Fertility and Communicable Diseases

• G. P. Talwar

Back Matter

Editors and affiliations.

R. K. Chandra

Bibliographic Information

Book Title : Critical Reviews in Tropical Medicine

Book Subtitle : Volume 2

Editors : R. K. Chandra

DOI : https://doi.org/10.1007/978-1-4613-2723-3

Publisher : Springer New York, NY

eBook Packages : Springer Book Archive

Copyright Information : Plenum Press, New York 1984

Softcover ISBN : 978-1-4612-9689-8 Published: 02 October 2011

eBook ISBN : 978-1-4613-2723-3 Published: 06 December 2012

Edition Number : 1

Number of Pages : 290

Topics : Tropical Medicine

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Oxford Handbook of Tropical Medicine 5e (5 edn)

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The Oxford Handbook of Tropical Medicine provides an authoritative, accessible and comprehensive, signs-and-symptoms-based source of information on medical problems commonly seen in the tropics. Designed to be used as a practical tool for diagnosis and management, it is an essential and handy guide for trainees and clinicians in the tropics, and medical officers working in district or rural level hospitals in the developing world.

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• v.52(3); 2008 Jul

Book Review

Warwick Anderson. Colonial pathologies: American tropical medicine, race, and hygiene in the Philippines Durham and London,  Duke University Press. 2006 pp. ix, 355, illus., £64.00, $84.95, ( hardback 0-8223-3804-1) ; £14.99, $23.95 ( paperback 0-8223-3843-2).  

Recent literature has shown that western tropical medicine has a 400-year-old history in Asia, Africa and the Americas. Scholars have explored the role of tropical medicine in the European search for medicinal plants and spices, in the exchange and acquisition of medicinal and botanical knowledge, in shaping western perceptions of distant lands, in controlling the indigenous populations of those lands, and, not least, in ensuring the physical survival of Europeans in alien environments. Since the very earliest European voyages, medicine occupied a central place in Europe's exploration and conquest of the world. In this long history, American tropical medicine does not appear significantly until the early twentieth century, a relative late-comer. But its practitioners—their attitudes, ideas and methods—would establish models of health care that would have a far-reaching influence around the globe and well into the future. Yet, strikingly, there is little in the way of critical scholarship on the colonial experience of American public health care regimes in the tropics, most especially in the Philippines, America's largest colony. In focusing on militarized medicine, health care and hygiene in the US colonization of these islands, Warwick Anderson's Colonial pathologies addresses this gap and, importantly, interweaves the perspectives of race and gender in the relationship between tropical medicine and US imperial policy.

The Philippine wars of resistance against Spain (1896–1898) and then the United States (1899–1902) left the local population decimated. During the American conquest, one historian has conservatively indicated a total mortality of 1.7 million people from warfare and disease in less than five years. Despite this appalling figure, the US colonization was predicated on what was termed “benevolent assimilation”, which was imagined and argued as being quite distinct from the crime of invasion and conquest. Rather, colonization was explained as an act of benevolence, a noble and moral imperative that sought to raise a purportedly barbarous, infantile race from a state of savagery and immaturity, and imbue it with a love of civilization. A number of scholars have closely examined the rhetorics of benevolent assimilation in the Philippines, but few have looked at its paternalistic logic through the lens of public health care. For Anderson, the institution of American colonial health care and hygiene regimes in these islands was both an intrinsic part of the civilizing procedure and a process of Americanization. He tells a compelling story of how US military physicians and civil health officers strove to transform Filipino bodies and their everyday bodily habits and customs into sanitized “germ-free” subjects and “probationary” citizens, that is “hygienic” subjects who might one day be judged as capable of governing themselves. Under heavily militarized conditions that subjected Filipinos to intense surveillance and disciplinary measures, US sanitation officials focused on rendering cities, villages and native bodies clean and wholesome. Chapter Two, for instance, does an impressive job of showing the suturing of medicine and occupation. The establishment of a Board of Health in 1902, the very same year civil government was proclaimed, ushered in a host of sanitary laws and regulations, as well as programmes to re-train American physicians as sanitary inspectors, who dispersed throughout the archipelago to scrutinize the habitations and bodies of the natives—“men, manners, mind, diet, dress and discipline all fall legitimately within the province of the sanitary inspector” as one military hygienist is quoted as saying (p. 50).

While predictably pestilential environments and intractable natives are discovered, there is an interesting twist in Anderson's story. American bourgeois white culture in the colonies underwent its own radical transformations. The tropical conditions proved to be very difficult and trying for American manhood. American scientists and physicians, already fretting over bodily and mental degeneration, believed to be caused by the debilitating environment, had their fears compounded by the risk of contagion from contact with germ-carrying natives. Moist heat, filthy Filipinos and their unhygienic social customs appeared to attack and erode the integrity, the wholeness of white male bodies and minds. Unmarried and frequently socially isolated, American white men, as Anderson describes, found themselves mentally breaking down, losing their nerve, becoming literally “unmanned”, their “whiteness and manliness” proving “disappointingly fragile or corruptible”. In Chapter 5 Anderson examines what he terms the “White man's psychic burden” or the heavy toll exacted by overwork and the hot moist climate. Even the most productive of American imperialists, as Anderson shows, were laid low by “tropical neurasthenia” and the disease called “philippinitis”.

This experience strikes a familiar note in relation to the British and Dutch susceptibilities in India, Africa and the Dutch East Indies, and Anderson's Colonial pathologies draws productively from the insights of much of this excellent post-colonial literature. Anderson's Philippine case study uncovers a new dimension of the colonial process by re-considering colonial medicine as a web of interconnecting practices, people, technologies and ideas that dynamically link metropole with colony. This movement of ideas and people has profitably allowed for a balanced appreciation of the “experience of empire” in a far too neglected part of the world.

Perhaps it might have been useful to provide a brief account of late-nineteenth-century Spanish sanitation measures and how these, and Spanish science more generally, were effectively denigrated and denied by American secular and Protestant colonialists. Moreover, some mention might have been made of efforts by European-trained Filipino physicians to reform their own people's sense of hygiene, which began well before the arrival of the Americans. Overall however, this is a fantastic book which is richly nuanced, meticulously researched and wittily written.

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Clinical Tropical Medicine Exam Articles (236)

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Jack j springer md, dtm, h(2) assistant professor hofstra northwell school of medicine facep, facem san diego ca, mark f brady md, mph, mms, dtm&h assistant professor alpert medical school of brown university facep providence ri, shawn horrall md assistant professor baylor scott & white diploma in tropical medicine and hygiene georgetown tx, use the mouse wheel to zoom in and out, click and drag to pan the image.

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Guest Essay

In Medicine, the Morally Unthinkable Too Easily Comes to Seem Normal

By Carl Elliott

Dr. Elliott teaches medical ethics at the University of Minnesota. He is the author of the forthcoming book “The Occasional Human Sacrifice: Medical Experimentation and the Price of Saying No,” from which this essay is adapted.

Here is the way I remember it: The year is 1985, and a few medical students are gathered around an operating table where an anesthetized woman has been prepared for surgery. The attending physician, a gynecologist, asks the group: “Has everyone felt a cervix? Here’s your chance.” One after another, we take turns inserting two gloved fingers into the unconscious woman’s vagina.

Had the woman consented to a pelvic exam? Did she understand that when the lights went dim she would be treated like a clinical practice dummy, her genitalia palpated by a succession of untrained hands? I don’t know. Like most medical students, I just did as I was told.

Last month the Department of Health and Human Services issued new guidance requiring written informed consent for pelvic exams and other intimate procedures performed under anesthesia. Much of the force behind the new requirement came from distressed medical students who saw these pelvic exams as wrong and summoned the courage to speak out.

Whether the guidance will actually change clinical practice I don’t know. Medical traditions are notoriously difficult to uproot, and academic medicine does not easily tolerate ethical dissent. I doubt the medical profession can be trusted to reform itself.

What is it that leads a rare individual to say no to practices that are deceptive, exploitative or harmful when everyone else thinks they are fine? For a long time I assumed that saying no was mainly an issue of moral courage. The relevant question was: If you are a witness to wrongdoing, will you be brave enough to speak out?

But then I started talking to insiders who had blown the whistle on abusive medical research. Soon I realized that I had overlooked the importance of moral perception. Before you decide to speak out about wrongdoing, you have to recognize it for what it is.

This is not as simple as it seems. Part of what makes medical training so unsettling is how often you are thrust into situations in which you don’t really know how to behave. Nothing in your life up to that point has prepared you to dissect a cadaver, perform a rectal exam or deliver a baby. Never before have you seen a psychotic patient involuntarily sedated and strapped to a bed or a brain-dead body wheeled out of a hospital room to have its organs harvested for transplantation. Your initial reaction is often a combination of revulsion, anxiety and self-consciousness.

To embark on a career in medicine is like moving to a foreign country where you do not understand the customs, rituals, manners or language. Your main concern on arrival is how to fit in and avoid causing offense. This is true even if the local customs seem backward or cruel. What’s more, this particular country has an authoritarian government and a rigid status hierarchy where dissent is not just discouraged but also punished. Living happily in this country requires convincing yourself that whatever discomfort you feel comes from your own ignorance and lack of experience. Over time, you learn how to assimilate. You may even come to laugh at how naïve you were when you first arrived.

A rare few people hang onto that discomfort and learn from it. When Michael Wilkins and William Bronston started working at the Willowbrook State School in Staten Island as young doctors in the early 1970s, they found thousands of mentally disabled children condemned to the most horrific conditions imaginable: naked children rocking and moaning on concrete floors in puddles of their own urine; an overpowering stench of illness and filth; a research unit where children were deliberately infected with hepatitis A and B.

“It was truly an American concentration camp,” Dr. Bronston told me. Yet when he and Dr. Wilkins tried to enlist Willowbrook doctors and nurses to reform the institution, they were met with indifference or hostility. It seemed as if no one else on the medical staff could see what they saw. It was only when Dr. Wilkins went to a reporter and showed the world what was happening behind the Willowbrook walls that anything began to change.

When I asked Dr. Bronston how it was possible for doctors and nurses to work at Willowbrook without seeing it as a crime scene, he told me it began with the way the institution was structured and organized. “Medically secured, medically managed, doctor-validated,” he said. Medical professionals just accommodated themselves to the status quo. “You get with the program because that’s what you’re being hired to do,” he said.

One of the great mysteries of human behavior is how institutions create social worlds where unthinkable practices come to seem normal. This is as true of academic medical centers as it is of prisons and military units. When we are told about a horrific medical research scandal, we assume that we would see it just as the whistle-blower Peter Buxtun saw the Tuskegee syphilis study : an abuse so shocking that only a sociopath could fail to perceive it.

Yet it rarely happens this way. It took Mr. Buxtun seven years to convince others to see the abuses for what they were. It has taken other whistle-blowers even longer. Even when the outside world condemns a practice, medical institutions typically insist that the outsiders don’t really understand.

According to Irving Janis, a Yale psychologist who popularized the notion of groupthink, the forces of social conformity are especially powerful in organizations that are driven by a deep sense of moral purpose. If the aims of the organization are righteous, its members feel, it is wrong to put barriers in the way.

This observation helps explain why academic medicine not only defends researchers accused of wrongdoing but also sometimes rewards them. Many of the researchers responsible for the most notorious abuses in recent medical history — the Tuskegee syphilis study, the Willowbrook hepatitis studies, the Cincinnati radiation studies , the Holmesburg prison studies — were celebrated with professional accolades even after the abuses were first called out.

The culture of medicine is notoriously resistant to change. During the 1970s, it was thought that the solution to medical misconduct was formal education in ethics. Major academic medical centers began establishing bioethics centers and programs throughout the 1980s and ’90s, and today virtually every medical school in the country requires ethics training.

Yet it is debatable whether that training has had any effect. Many of the most egregious ethical abuses in recent decades have taken place in medical centers with prominent bioethics programs, such as the University of Pennsylvania , Duke University , Columbia University and Johns Hopkins University , as well as my own institution, the University of Minnesota .

One could be forgiven for concluding that the only way the culture of medicine will change is if changes are forced on it from the outside — by oversight bodies, legislators or litigators. For example, many states have responded to the controversy over pelvic exams by passing laws banning the practice unless the patient has explicitly given consent.

You may find it hard to understand how pelvic exams on unconscious women without their consent could seem like anything but a terrible invasion. Yet a central aim of medical training is to transform your sensibility. You are taught to steel yourself against your natural emotional reactions to death and disfigurement; to set aside your customary views about privacy and shame; to see the human body as a thing to be examined, tested and studied.

One danger of this transformation is that you will see your colleagues and superiors do horrible things and be afraid to speak up. But the more subtle danger is that you will no longer see what they are doing as horrible. You will just think: This is the way it is done.

Carl Elliott ( @FearLoathingBTX ) teaches medical ethics at the University of Minnesota. He is the author of the forthcoming book “The Occasional Human Sacrifice: Medical Experimentation and the Price of Saying No,” from which this essay is adapted.

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By Martyn Post · May 17, 2024 · Archives , Books , Collections , Historical Collection , Uncategorised · No comments

Tags: Historical Collection , Library , Library Display , LSHTM , meat inspection , meat markets , public health , Special Collections

This is a blog post about the book “The Inspection of Meat: A Guide and Instruction Book to Officers Supervising Contract-Meat and to All Sanitary Inspectors Embodying the Teaching Imparted to the Army Service Corps.” By W. Wylde. This item is part of the London School of Hygiene and Tropical Medicine Library’s Historical Collection. The Barnard Classification shelfmark for this item is SFM (Meat and Meat Inspection).  

In the mid-19th century, meat was a staple of the Victorian diet, and the demand for it soared as London’s population swelled. However, the conditions in which animals were slaughtered and the meat was sold often left much to be desired. Slaughterhouses were commonly small, unregulated, and in densely populated areas. These facilities were typically unsanitary, with inadequate waste disposal systems leading to the contamination of water supplies and the spread of disease. The severity of these public health risks cannot be overstated, as they posed a significant threat to the well-being of the entire population (MacLachlan, 2007). 

Meat markets, a hotbed of unhygienic conditions, were a time bomb for public health. Stalls, packed to the brim, exposed the meat to the elements, inviting flies and other pests. The absence of refrigeration meant that meat could spoil rapidly, posing serious health risks to the population. These conditions were not just a nuisance but a full-blown public health crisis in the making . 

The dangers associated with unregulated meat markets and slaughterhouses became glaringly apparent with frequent outbreaks of diseases such as typhoid, cholera, and tuberculosis . These outbreaks were often traced back to contaminated meat and unsanitary handling practices. The public outcry grew louder as people became more aware of the direct link between these conditions and the health of their communities. (Waddington, 2007 & Metcalfe, 2016). 

The call for regulation was driven by the need to ensure that meat was safe for consumption and that public health was protected. Several measures were proposed and eventually implemented to address concerns.   Establishing centralised and regulated slaughterhouses outside densely populated areas crucial, these facilities were designed to adhere to sanitary standards and were equipped with proper waste disposal systems (Fitzgerald, 2010).  

Legislation was introduced to mandate meat inspection by qualified health officers. This included checking the health of animals before slaughter and examining the meat post-slaughter to ensure it was disease-free. Regulations were implemented to ensure that meat markets maintained cleanliness standards .  

The introduction of regulatory measures had an impact on public health in Victorian London. The standardisation and inspection of slaughterhouses and meat markets significantly reduced the incidence of foodborne illnesses (Hardy, 1999). Regulation helped instil a culture of hygiene and safety that extended beyond the meat industry to other public health and sanitation sectors. 

W. Wylde and his contributions to meat inspection  

W. Wylde was the chief inspector of meat for The City of London. He made a significant contribution to the field of meat inspection during this era with the 1890 publication, “The Inspection of Meat: A Guide and Instruction Book to Officers Supervising Contract-Meat and to All Sanitary Inspectors Embodying the Teaching Imparted to the Army Service Corps.” This comprehensive manual was designed as an instructional guide for officers responsible for supervising meat supplies and sanitary inspectors. Wylde’s book covered various crucial aspects, including inspection techniques, standards and regulations, handling and storage practices, and sanitary measures. 

The book includes 32 chromolithographic plates. These plates were visual aids for sanitary inspectors and officers of the time, as this was before photography was common. They illustrate various aspects of meat inspection and identify signs of disease in livestock. They provided detailed images of anatomical structures and pathological conditions, helping inspectors accurately assess meat quality. 

Wylde’s guide provided detailed methods for inspecting meat to detect signs of disease, spoilage, and contamination. It explained the standards for acceptable meat quality and the legal regulations that inspectors and suppliers must follow. The book also outlined best practices for handling, storing, and transporting meat to prevent contamination and ensure it remained safe for consumption. It emphasised the importance of maintaining cleanliness in slaughterhouses and markets and offered insights into the training programs for the Army Service Corps, underscoring the need for proper education for those responsible for meat inspection. 

Wylde’s book is an important resource on meat inspection in late Victorian Britain. At a time when public health concerns were becoming increasingly prominent, this manual provided essential knowledge and practical advice to those tasked with ensuring the safety of meat supplies It contributed to the professionalisation of meat inspection and the establishment of higher standards in food safety, this was largely at a time when those tasked with inspecting meat markets and slaughterhouses were mostly untrained as it was largely just a part of their jobs as Sanitary Inspectors (Wylde, 1890).  

The inspection of meat in Victorian London and the regulation of meat markets and slaughterhouses were crucial responses to the public health challenges of the time (MacLachlan, 2007). These measures were necessary for protecting the health of Londoners but also served as a catalyst for broader public health reforms. They form the foundation of modern food safety and public health standards. W. Wylde’s “The Inspection of Meat” is an important historical document, illustrating the early efforts to formalise and standardise meat inspection processes and reflecting the evolving practices in food safety and public health during the Victorian era. 

References: 

Fitzgerald, A. J. (2010) A social history of the slaughterhouse: From inception to contemporary implications. Research in Human Ecology, 17 (1) , 58-69. https://www.jstor.org/stable/24707515  

Hardy, A. (1999) Food, hygiene and the laboratory. A short history of food poisoning in Britain, circa 1850-1950. Social History of Medicine, 12 (2), 293-311. https://doi.org/10.1093/shm/12.2.293  

MacLachlan, I. (2007) A bloody offal nuisance: the persistence of private slaughter-houses in nineteenth-century London. Urban History. Urban History, 34 (2), 227-254. https://doi.org/10.1017/S0963926807004622  

Metcalfe, R. S. (2016) Meat, commerce and the city: The London food market, 1800-1855. Routledge. 

Waddington, K. (2011) The Dangerous Sausage: Diet, Meat and Disease in Victorian and Edwardian Britain. The Journal of the Social History Society, 8 (1) , 51-71. https://doi.org/10.2752/147800411X12858412044393     Wylde, W. (1890) The Inspection of Meat: A Guide and Instruction Book to Officers Supervising Contract-Meat and to All Sanitary Inspectors Embodying the Teaching Imparted to the Army Service Corps. Kegan Paul, Trench. Trubner & co. 

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a Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA E-mail: [email protected]

Developing safe and effective delivery strategies for localizing messenger RNA (mRNA) payloads to the spleen is an important goal in the field of genetic medicine. Accomplishing this goal is challenging due to the instability, size, and charge of mRNA payloads. Here, we provide an analysis of non-viral delivery technologies that have been developed to deliver mRNA payloads to the spleen. Specifically, our review begins by outlining the unique anatomy and potential targets for mRNA delivery within the spleen. Next, we describe approaches in mRNA sequence engineering that can be used to improve mRNA delivery to the spleen. Then, we describe advances in non-viral carrier systems that can package and deliver mRNA payloads to the spleen, highlighting key advances in the literature in lipid nanoparticle (LNP) and polymer nanoparticle (PNP) technology platforms. Finally, we provide commentary and outlook on how splenic mRNA delivery may afford next-generation treatments for autoimmune disorders and cancers. In undertaking this approach, our goal with this review is to both establish a fundamental understanding of drug delivery challenges associated with localizing mRNA payloads to the spleen, while also broadly highlighting the potential to use these genetic medicines to treat disease.

• This article is part of the themed collection: Biomaterials Science Recent Review Articles, 2024

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E. A. Narasipura and O. S. Fenton, Biomater. Sci. , 2024, Advance Article , DOI: 10.1039/D4BM00038B

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