TRANSACTIONS OF THE ROYAL SOCIETY OF TROPICAL MEDICINE AND HYGIENE (1999) 93,222

Correspondence

Mortality attributed to malaria versus HIV/AIDS in Africa

During their report on the 75th anniversary of the East Afizcan Medical ‘fbumal, Dobson et al. (1998: Transac- t&s, 92, 686) stated that malaria continues to be the largest cause of death in East Africa, as in much of sub- Sagaran Africa (SSA). In fact, this is-no longer the truth. Although malaria remains a major cause of childhood mortality in most African communities, and even with substantial evidence for widespread chloroquine resis- tance increasing rates of malaria mortality, during the past decade HIV/AIDS has become a major cause of childhood mortality and the leading cause of adult mortalitv in most Darts of East and Central Africa. This has beendemonstiated by solid epidemiological research carried out in a number of rural and urban communities of Tanzania and Uganda (Miiller et al., 1990: Lancet, 335, 236; Sewankanbo et’al., 1994: AZDS, 8, 1707; Kitane et al., 1996: British Medical Journal, 312, 216; Nunn et al., 1997: British MedicalJournal, 315, 767).

UNAIDS estimates that some 2.3 million AIDS deaths occurred during 1997 alone, and that the majority of those were in young adults of SSA (UNAIDS, Report, Tune 1998). This is eauivalent to or even higher than &rent e&mates of &rican deaths due to malaria, of which the treat maioritv occur in voung children WHO, 1997: Weekly Epidimioiogical Record, 75,269). Given the already high number of adult HIV infections in SSA (estimated at 21 million by the end of 1997) and considering the current dramatic development of the epidemic in the southern and western parts of Africa (with prevention programmes successful in few coun- &es, and with no vaccine or cure in sight), by the beginning of the next century HIV/AIDS will doubtless become the overall major cause of death and of sharply reduced life expectancies in the majority of SSA coun- tries (Gregson et al., 1994: Journal of Acquired Immune Deficiency Syndromes, 7, 839).

Olaf Miiller Department of Tropical Hypiene and Public Health Riprecht-Kails-U&versi&-Heidelberg Zm Neuenheimer Feld 324. 69120 Heidelbew Germany iJanuary 1999

1 Book Reviews 1 I I

The Beast in the Mosquito: the Correspondence of Ronald Ross and Patrick Manson. W. F. Bvnum & C. Overy (editors). Amsterdam: Editions Rbdopi B. V., 1998. xxxvif528pp. Price: Paperback Hfl 7%/US$41.5O/UKA24.50; Hardback Hfl 240-/ US$132.OO/UKL78.50. ISBN 90-4200-0721-4.

The communications between Ronald Ross and Pa- trick Manson have become part of the folklore of tropical medicine and the story told is that of Ross, working on the mosquito transmission of the malaria parasite in India, guided step by step by Patrick Manson in England, triumphantly elucidating the life-cycle shortly before the discoveries of his Italian rivals. Ross usually comes across as the hero of this story but, with the notable exception of E. R. Nye and Mary Gibson’s biography (reviewed in the Transactions, 91, 735:1997), most of what we know comes from Ross’s own Memoirs pub- lished after Manson’s death. This correspondence puts the flesh and bones on the story and reveals not only details of the scientific discovery but also the more human side. Ross was a prolific letter writer and hoarder; in 1923 he wrote that he ‘had kept almost all my letters. .’ and mentions 11 89 1 documents in his collec- tion. Now, for the first time, over 250 letters between Ross and Manson have become available to a wide audience. This is a fascinating collection that deserves to be read in full. Things did not begin well and in Manson’s first letter he writes curtly ‘you have not seen the plasmodium malariae the reason you have not seen it is the technique you employ’. Things then get better as the mutual respect between these 2 men develops and sociologists-might like to consider the transition from ‘Dear Surgeon Major Ross’ to ‘Mv dear Ross’. However, it is the scientifid aspects that piovide the background to what became one of the greatest discoveries in tropical medicine. Everything is here: the ideas, the experimental details, the scientific caution, the false starts and finallv the revealing insights into the early days of the London School and-the Liverpool School (which Ross wanted to call the Liverpool School of Tropical Medicine and Animal Parasitology) and the Societv of Tronical Medicine concerning which Manson writesjn 1909.‘I had hoped to see you a< the Trop. Sot.

on Friday. . .’ ‘It was a very poor meeting.’ There is also the more human side: Manson’s dislike of foreigners, especially the Italian rivals ‘I feel that these furrineers [sic] are inclined to filch as much as they can’ and die-hards such as Edward Lawrie who vigorously attacked the mosquito transmission theory. It is interesting to read Manson’s grudging congratulations on the award of the Nobel Prize to Ross, and much of the subsequent correspondence shows signs of the cooling relationships between the 2 men and Ross’s obsession with his own self-importance. This is a book to be read for pleasure again and again both by those with an interest in the history of tropical medicine and also by those just embarking on their own careers because of the parallels that still exist a century later: I particularly liked Ross’s concerns about his pay and pension and Manson’ s ‘I am fed up with preparing lectures’.

F. E. G. Cox Depanment of Infectious and Tropical Diseases London School of Hygiene and Tropical Medicine Keppel Street London WClE 7HT, UK

Your Child’s Health Abroad: a Manual for Travel- ling Parents. 1. Wilson-Howarth & M. Ellis. Chalfont St Peter: Bra& Publications: 1998. x+198pp. Price ES.95 ($12.95). ISBN 1-898323-63-1.

This book is intended to give practical advice for those planning to take children overseas whether it be for a short holidav or a long-stav posting in a developing country. The dook is disded into 2-main sectio&Planning: Disease Prevention and Accidents and Illnesses. The first part covers topics such as what equipment to take, medical kits and seeking medical advice abroad, travelling around overseas, avoiding diarrhoea, and natural and environ- mental hazards. The practical advice ranges from man- agement of trivial but tedious problems, e.g., colic, teething and not sleeping, to avoidance and treatment of insect and animal bites and stings. Chapter 6, Avoiding Diarrhoea, gives parents clear advice on what foods are best avoided and how to make water safe to drink, even at bathtime. The authors suggest that those who are con- cerned about their offspring drinking contaminated bath- water should consider the addition of a few potassium permanganate crystals which has 2 benefits. This ‘turns the bathwater purple (an exciting phenomenon!), it

BOOK REVIEWS

changes colour again when soap is used (magic!) and it helps clean scratches and abrasions’.

The second part of this manual deals with the treat- ment of illnesses and accidents in travelling children, including instruction on resuscitation, the emergency management of the unconscious child, choking, fits and convulsions, burns, and cuts and grazes. Chapter 9 covers illnesses in children up to the age of 12 months and is designed to assist the parent in determining whether the child’s symptoms indicate a significant disease. Chapter 10 covers diagnosis and treatment of illnesses in children aged over 1 year. Practical checklists in these chapters include the ‘Baby Check’ and ‘Distin- guishing a Faint from a Fit’.

In the appendix of this manual can be found useful addresses for obtaining health information in the UK, Australia, USA and Nepal, suppliers of travel health products and travel insurance, and a comprehensive further reading list. The final section contains some questions and phrases in 5 languages which may assist parents in communicating the essentials when a child is unwell.

Parents considering taking children to developing countries would be wise to obtain a copy of this manual as it not only offers practical advice for disease prevention and treatment based on personal experiences, but also gives inspiration to parents who may have doubts about travelling with offspring abroad. Travel health advisors will also find this book a useful addition to their library of travel health literature.

Paul Clarke and Sue Taylor MASTA (Medical Adviso y Services for Travellers Abroad) London School of Hygiene and Tropical Medicine Keppel Street London WClE 7HT, UK

The Ticks of the World. Nomenclature, Described Stages, Hosts, Distribution (Acarida, Ixodida). J.-L. Camicas, J.-P. Hervy, F. Adam & P.-C. Morel. Paris: ORSTOM, 1998. 223~~. Price FF. 300. ISBN 2-7099-1418-2.

Zoological nomenclature with its synonyms and naming priorities can be confusing at the best of times,

223

particularly if one is not a taxonomist. Some taxono- mists are ‘lumpers’, others are ‘splitters’ and this makes nomenclature even more confusing. The applied en- tomologist working in the fields of agricultural, medical or veterinary entomology wants a name, whether it be of a genus, subgenus or species, that he/she can be sure is valid. This is not always easy since some entomologists have the perverse habit of sticking to names they think are right or names that have been in use for a long time. This catalogue of ticks of the world by Camicas et al. is a taxonomic listing of all the species of ticks and offers an annotated list of all the valid and invalid Latin tick names occurring in the literature. The Introduction and the following ‘Writing Rules’, which is essentially a ‘how to use the catalogue’ section, are in French and English. Initially I found it a bit difficult to use the catalogue (the English translation of the ‘Writing Rules’ section could have been better). Under this section on page 22 what do the authors mean by ‘princeps’ species and what does ‘avatars’ on page 23 refer to? Avatar according to my dictionary derives from the Sanskrit term for the incarnations of Hindu gods. Once one has mastered the writing rules, the catalogue is very informative and useful (the more than 50 synonyms for Ixodes (Ixodes) ricinus and Boophilus microplus are listed in full) and should rectify some of the confusion in tick taxonomy provided the authors’ new combinations at generic, subgeneric and species level are universally accepted. A helpful feature of the catalogue is the listing of the described stages (i.e., male, female, nymph, larva), the main hosts and the geographical distribution of each valid species. At about A30 I consider the book good value for money because of the wealth of information it contains.

M. G. R. Varma Depanment of Farm Animal and Equine Health The Royal Veterirza y College Boltons Park Hawkshead Road Potters Bar, Herts EN6 INB, UK

To purchase the book, first contact ORSTOM I?ditions DifYu- sion, 32, Avenue Henri Varagnat, F-93143 Bondy cedex, France; fax (0) 148 02 79 09, e-mail diEusion@bondy.orstom.fr

[ Correction 1

Maxwell, C. A. et al. Comparison of bednets impregnated with different pyrethroids for their impact on mosquitoes and on reinfection with malaria after clearance of pre-existing infections with chlorproguanil- dapsone. Transactions, 93,4- 11. The authors have amended Table 6 (use the opposite page): the altered numbers are indicated in bold print.