London School Of Tropical Medicine Research Articles

Editorial introductions.

Editorial introductions.

Covid-19: Medicine and Colonialism, Past and Present

This essay begins in the past, with the hope of developing a different way of thinking through the transformations of the present. Many commentators and media outlets have referred to the era of the Covid-19 pandemic as ‘unprecedented’, but there is nothing unprecedented about a pandemic. What seem unprecedented are the measures which have been taken to control the public, measures that have been implemented via a series of states of emergency: the exercise of medical power through the vehicle of the neoliberal state did lead to a pattern of state and society which was unprecedented in democratic states. On the other hand, and as I will argue in this essay, this relationship was certainly not unprecedented when it came to the history of the Western state in Africa. In fact, when we take the perspective of medical history and its relationship with colonial power, we can historicise more easily the transformations which have taken place during the Covid-19 pandemic. *** Image Credit: A medical officer taking a sample of blood from an inhabitant of Buruma Island, suffering from sleeping sickness. Photograph, 1965, after photograph 1902. In 1901, a severe sleeping sickness epidemic in Uganda claimed more than 20,000 lives. The first Uganda Sleeping Sickness Commission went out from the London School of Tropical medicine, the senior member was Dr Cuthbert Christy. It also included Dr Carmichael Low and Count Aldo Castellani. The album, which consists of copy photographs, was sent to Dr Poynter at the Wellcome Institute library by Professor Foster from the Department of Medical Microbiology in Uganda, in 1965. It was put together to record Foster's comments on the photographs sleeping sickness (trypanosomiasis), an infectious disease which affects the fluid of the spinal cord, causing lethargy and loss of physical function. In Uganda it was passed most virulently by the bite of the tsetse fly. Created 1965. Contributors: Uganda Sleeping Sickness Commission. Meeting (1902). https://www.lookandlearn.com/history-images/YW029102V/A-medical-officer-taking-a-sample-of-blood-from-an-inhabitant-of-Buruma-Island-suffering-from-sleeping-sickness

Editorial introductions.

Editorial introductions.

Editorial introductions.

Editorial introductions.

P031 Whipple's disease: a multidisciplinary conundrum

Abstract Background/Aims A 45-year-old male patient presented in 2015 with a six-month history of relapsing and remitting polyarthralgia. Hand X-rays appeared normal. Serology showed mildly elevated inflammatory markers. Autoimmune profile including anti-CCP antibody, rheumatoid factor and ANA was negative. His initial diagnosis was palindromic rheumatism. He was under watchful waiting in rheumatology clinic having declined a trial of hydroxychloroquine, when in 2018 he developed severe epigastric pain. Over the subsequent 18 months he was noted to have dramatic weight loss, fatigue and drenching night sweats. Methods Investigations showed microcytic anaemia with elevated inflammatory markers (Hb 98 g/L, CRP 161 mg/L, ESR 68 mm/hr). Serum ACE, bone profile, thyroid function and urate levels were normal. Chest X-ray was unremarkable. HIV and hepatitis screening was negative. Endoscopy with jejunal biopsy was performed, with mild gastritis only on histopathology and normal D2 biopsies. He was found to be H pylori positive, and notably felt his B-symptoms much improved with triple antibiotic and PPI eradication therapy. CT abdomen demonstrated widespread mesenteric lymphadenopathy. Para-aortic lymph node biopsy showed non-necrotising granulomata suggestive of either sarcoidosis or an infective etiology such as tuberculosis (TB). Given the clinical picture, the patient was commenced on high dose oral prednisolone and methotrexate for suspected sarcoidosis. Results The patient made some clinical improvement, particularly with regards to arthralgia, however his B-symptoms returned with any reduction in steroid dose. Serology showed worsening anaemia with iron and folate deficiency, and increasing inflammatory markers. We therefore decided to perform a PET CT and refer to Haematology for consideration of a lymphoproliferative disease. PET CT demonstrated lymphadenopathy without avid uptake. A second lymph node biopsy was performed which showed florid histiocytic infiltration within which there were numerous PAS positive particles consistent with Whipple's disease. This was confirmed as tropheryma whipplei on PCR. Whipple's disease is a rare systemic infectious disease causing arthralgia, diarrhoea, abdominal pain and weight loss. Treatment consists of antibiotic therapy. On further questioning, the patient had grown up on a farm. There is a known association with Whipple's disease in the agricultural community as it is a soil-borne organism. Conclusion Our patient has made an excellent recovery. He remains under the care of our rheumatology team and the London School of Tropical Medicine and Hygiene. Treatment plan is 12 months of combined therapy with doxycycline and hydroxychloroquine. He underwent a lumbar puncture to rule out meningeal Whipple disease. We have also commenced sulfasalazine for persistent arthritis, which we feel could be a reactive phenomenon. Our key learning points from this case were to use a stepwise approach to diagnosis, involve relevant specialty teams and that it in complex cases it is useful to go back to the history. Disclosure F. Baldeweg: None. A. Nuttall: None. D. Arul: None. A. Childerhouse: None.

Will COVID-19 Vaccination Be Successful Without Social Distancing? A Simulation of an Outbreak in Sri Lanka

Coronavirus disease (COVID-19) pandemic is causing morbidity, mortality and economic damage in an unprecedented manner across the world. Many non-pharmacological interventions such as restricting community mobility, social distancing, handwashing and face mask use have been carried out to prevent COVID-19. Promising vaccine results and their approval for emergency use in some countries has created much interest in their use as the ultimate solution to control the outbreak at global level, Sri Lanka being no exception. Objective of this study was to compare the success of a COVID-19 vaccination with or without social distancing during a simulated outbreak of widespread transmission of COVID-19 in Sri Lanka. The beta version of the online application of the mathematical model developed by the London School of Tropical Medicine and Hygiene using the Susceptible, Exposed, Infected and Removed Model was used for the simulation. The results show that COVID-19 vaccination in Sri Lanka without social distancing is unlikely to reduce case number, symptomatic admissions or deaths. In the absence of social distancing, making vaccines available earlier, faster or in increased quantities will not contribute to any meaningful reduction of the disease outcomes. The continued adherence to social distancing is recommended for any benefits of vaccination to be meaningful.

COVID-19 Vaccine: Promoting Vaccine Acceptance.

COVID-19 Vaccine: Promoting Vaccine Acceptance.

Sir Patrick Manson at home: 21 Queen Anne Street as a hybrid space.

Colonial physician and father of tropical medicine Sir Patrick Manson (1844-1922) is most closely associated with his research in China or teaching at the London School of Tropical Medicine, which he founded in 1899. This paper reconsiders Manson's life and work through a new spatial lens - that of his home at 21 Queen Anne Street. Drawing on glimpses of Manson's London house from his biographies and surviving archives, 21 Queen Anne Street is presented as a hybrid space - drawing together scientific, clinical and social networks and activities. Taking the form of a tour, this paper interrogates the internal divisions of the five-story building - focusing in particular on Manson's home laboratory, the 'muck room', and his consulting room. It explores how boundaries between spaces within the house were managed but also transgressed by Manson and his imperial family. It suggests the need to think more broadly about the spatial contexts of medical practice and research in late nineteenth and early twentieth centuries.

Editorial introductions

Editorial introductions

Transnationalism in Missionary Medicine

Kala-azar is a parasitic disease that was endemic in India, parts of Africa and China. During the first half of the twentieth century, developing means of treatment and identification of the host and transmission vectors for this deadly disease would be the subject of transnational research and controversy. In the formative period for this research, two Canadian Medical missionaries, Drs. Jean Dow and Ernest Struthers, pioneered work on Kala-azar in the North Henan Mission. The great international prestige of the London School of Tropical Medicine and the Indian Medical Service would stand against recognition of the clinical discoveries of missionary doctors in remote North Henan. It was only after Struthers forged personal relations with Dr. Lionel. E. Napier and his colleagues at the Calcutta School of Tropical Medicine that there was a meeting of minds to promote the hypothesis that the sand fly was the transmission vector.

Editorial introductions

Editorial introductions

John Cymerman Craig

John C Craig, an Emeritus Professor of Chemistry and Pharmaceutical Chemistry at the University of California, San Francisco, died suddenly on 26 September of complications related to cardiac disease. John was 92 years old and still maintained an office at the School of Pharmacy at UCSF. His final research was a series of six papers with colleagues at the London School of Tropical Medicine to find out ‘just how the antimalarials kill the parasites inside the human red blood cells.' John's career began at the University of London where he received Bachelor of Science degrees in both Physics and Chemistry (with first class Honors) followed by a PhD in Organic Chemistry from Imperial College, London. From 1942 to 45 John was a Gas Identification Officer and instructed both military and civilians in Chemical Defense, for which he was awarded the Defense Medal. John taught at London University's Charing Cross Hospital in Organic Chemistry, was Senior Lecturer in Organic Chemistry at the University of Sydney (St Paul's College) from 1948 to 1961, and also received the D.Sc. degree from Sydney University in 1962, for his research in Organic and Medicinal Chemistry. In 1958 he became Visiting Scientist at The National Institutes of Health and Walter Reed Army Medical Center for research in anti-radiation drugs. John began his 30-year career at UCSF in 1960, teaching both at the undergraduate and graduate level. He was Professor of Chemistry from 1963 to 1971, Department of Pharmaceutical Chemistry Chairman from 1963 to 71, and Associate Dean of Research from 1971 to 1992. He was selected by the UCSF Academic Senate as the Annual UCSF Faculty Research Lecturer in 1974, and received the first Academic Senate UCSF Service Award in 1993. His research produced over 250 publications in Organic and Medicinal Chemistry and focused on chemical structure and biological activity, including work on the synthesis of vitamin A, chemotherapy of tuberculosis and malaria, and development of stable isotope tracer technology for diagnostic tests for genetic diseases in infants and newborns (to replace the use of radioactive tracers). John was awarded the Research Award in Natural Products from the American Pharmaceutical Association Foundation in 1967, and the Research Achievement Award in Pharmaceutical Analysis from the American Pharmaceutical Scientists in 1988. He was elected to Fellowship in the Academy of Pharmaceutical Scientist in 1967 and to membership in the American College of Neuropsychopharmacology in 1975. For the past 21 years John was a member of the UCSF board of the Faculty Emeriti Association and served as Vice chairman, Chairman and Historian of the state-wide Council of UC Emeriti. John was active in amateur radio from the age of 14 years. In San Francisco he was a member of the SF Radio Club and the Cathay Radio Club. He participated in the UCSF Emergency Network. Since finding a rare early English cookery book (the earliest cookery books were full of medicinal cures) on a barrow in London as a student, John was busy collecting antiquarian English cookery books. In 1988 the Bancroft Library, University California Berkeley presented 100 volumes of John's collection in an exhibit titled ‘Four Hundred Years of English Diet and Cookery: 1541–1939'. He was a member of the Bancroft Council, Bancroft Library, 1989–1997, and edited ‘The Cookery Manuscript of Lillie Hitchcock Coit, 1870–1890, San Francisco' which the Bancroft published in 1998. He is survived by his wife Elaine of San Francisco, his daughter, Elizabeth (Eric) and grandchildren Benjamin and Katherine of Park City, Utah; his son, Anthony (Ruth) of Dorset, UK, and grandsons Thomas (Kelly) of Perth, Australia, and Matthew (Ruth) of Devon, UK, and four great grandchildren.

From Hygiene and Tropical Medicine to Global Health

The author reviews the history of the Tulane School of Public Health and Tropical Medicine. In 1912, Dr. Creighton Wellman published a groundbreaking paper entitled "The New Orleans School of Tropical Medicine and Hygiene," outlining a clear plan for a new independent school of public health. He became the founding dean of the Tulane School of Hygiene and Tropical Medicine. Dr. Wellman had spent 9 years practicing medicine in Angola and graduated from the London School of Tropical Medicine before launching a career in tropical medicine in the United States. Tulane already had a formal course of hygiene established as early as 1881. The founding of Tulane School of Hygiene and Tropical Medicine was made possible by a gift from Samuel Zemurray, who would become the president of the United Fruit Company. In January of 1914, Dr. Wellman abruptly left New Orleans to live in Brazil. The school lost its independence in 1919 and again became part of the School of Medicine until 1967. The school initiated by Dr. Wellman is the foundation on which today's Tulane School of Public Health and Tropical Medicine is built.

Etymologia:Pseudoterranova azarasi

To the Editor: Regarding the March 2011 Etymologia on Pseudoterranova azarasi (1), we think that someone literally missed the boat on the derivation of Pseudoterranova. Although the Greco-Latin amalgam, Pseudoterranova, translates to “false new earth,” the generic name of the organism refers to the ship, the Terra Nova, which Robert Falcon Scott captained en route to Antarctica exactly 100 years ago in his ill-fated attempt to be the first person to reach the South Pole. During the Antarctic summer of 1911–12, while Scott and 4 companions trudged toward the South Pole, the ship’s surgeon, Edward Leicester Atkinson, who remained with the Terra Nova, dissected polar fish, birds, and sea mammals, looking for parasites. Atkinson found an unusual nematode in a shark, and in 1914, he, along with parasitologist Robert Thomson Leiper of the London School of Tropical Medicine, commemorated the ship by conferring the name Terranova antarctica upon this newly discovered creature (2). The genus Pseudoterranova was established by Aleksei Mozgovoi in 1951 for a somewhat similar nematode obtained from a pygmy sperm whale. Pseudoterranova azarasi, the subject of the Etymologia, was originally described in 1942 as Porrocecum azarasi, but recent molecular work, as described by Arizono et al. (3) and Mattiucci and Nascetti (4), showed that this nematode is part of a large species complex within Pseudoterranova. Thus, it has been transferred to this genus as part of the P. decipiens species complex. The nomenclatural specifics are complex and arcane. However, in this centennial year of the Terra Nova expedition, we think it is worthwhile to remember the historic origins of these names.

A National School of Tropical Medicine and Neglected Infections of Poverty for North America

The turn of the 20th century witnessedthe creation of the world’s first two schoolsof tropical medicine. The LiverpoolSchool of Tropical Medicine admitted itsfirst student in May of 1899, and theLondon School of Tropical Medicine,which eventually became the LondonSchool of Hygiene & Tropical Medicine,six months later [1]. At the beginning, thetwo British tropical medicine schools werefounded on different principles [1,2]. TheLiverpool School was built to providemedical support for a vigorous shippingtrade between Liverpool, one of England’smost active ports, and the coasts of Africa,Asia, and the Caribbean [1]. Launchedwith an initial gift from Alfred Lewis Jones,who made his fortune from shippinginterests in West Africa and elsewhere,the majority of the Liverpool School’spatients who were admitted to the tropicalward of its affiliated Royal SouthernHospital worked in the shipping trade[1]. From 1899 until the outbreak ofWorld War I a cornerstone of the Liver-pool School was expeditions financed bythe Suez Canal Company, the PanamaCanal Commission, and other overseasshipping concerns [1]. The LondonSchool had a somewhat different focus.Established through the force of personal-ity of Sir Patrick Manson (‘‘the father oftropical medicine’’), the London School’soriginal mission was to train generalcolonial medical officers employed in theservices of a vast British empire, whichincluded the military and the IndianMedical Service [2]. By the early 1900s,it was estimated that 10% or more ofBritish physicians were employed as over-seas practitioners [2].Many of the other Western Europeancountries with large colonial holdingssubsequently created schools or institutesof tropical medicine, including the Bern-hard Nocht Institute for Tropical Medi-cine in Hamburg, Germany (1900), theInstitute of Tropical Medicine in Antwerp,Belgium (1905), the Royal Tropical Insti-tute (KIT) in Amsterdam, The Nether-lands (1910), and the Swiss Tropical andPublic Health Institute in Basel (1943),among others. In addition to trainingmedical practitioners to work overseas, intime both the British schools and Europe-an Institutes evolved distinguished andvital programs of biomedical research thatled to the discoveries of the life cycles ofseveral important human parasites andmany of the drugs and diagnostics forneglected tropical diseases (NTDs) still inuse today. Thus, while some of theseinstitutions may have been founded withcolonialist intentions, in short order theybecame international resources for re-search and development to combat someof the most important NTDs afflicting theworld’s poor. Today, the same institutionsalso maintain strong research trainingprograms in the biomedical sciences withexcellent track records of trainees whopopulate institutions in both the Northand the South.Fast forward 100 years, and at thebeginning of this new Millennium there isstill no fully dedicated school or institutelocated in North America with the depthand breadth in NTDs research, develop-ment, and training, as those maintained bythe two British tropical medicine schoolsor even some of the larger tropicalinstitutes on the European continent. Tobe sure, there are pockets of greatexcellence in research and training forselected tropical diseases in the schools ofpublic health at Harvard, Johns Hopkins,Tulane, University of California, Berkeley,University of Washington, and the Na-tional Institute of Public Health in Cuer-navaca, Mexico. There is also importantbasic research conducted at the NationalInstitutes of Health and the Institute ofParasitology at McGill; superb publichealth training at the U.S. Centers forDisease Control and Prevention; andinnovation leading to the development ofnew control tools at product developmentpartnerships in Seattle, Washington; SanFrancisco, California; and Washington,D.C. However, today in North Americathere is no comprehensive school orinstitute for NTDs that hosts a fullcomplement of these activities, especiallyfor multiple tropical infections. Similarly,there is no equivalent entity located inNorth America that provides extensivetraining in whole-organism biology for therecognition and manipulation of most ofthe major NTD parasitic, bacterial, andviral agents or their vectors. Thus it is notclear whether there is a school in NorthAmerica whose graduates could pass amodern equivalent of the 100-year-oldfinal examination of the London School ofTropical Medicine:‘‘Students were asked to describe themethods for demonstrating the WidalReaction in typhoid and Mediterraneanfever and for purifying water on the march;to distinguish between the Anopheles andthe Culex mosquito and the differentfilarial embryos; to diagnose leprosy,syphilis, lupus and malaria; and to describethe recommended treatments for cholera andDhobi itch. The laboratory practicum testedfor competence and little more. Studentswere asked to describe the steps to identifyan unknown broth in a test tube, to stain

The Nematode Genus Physaloptera Rud.*

Proceedings of the Zoological Society of LondonVolume 92, Issue 4 p. 999-1107 The Nematode Genus Physaloptera Rud.* R. J. Ortlepp M.A., R. J. Ortlepp M.A. Research Assistant, Dept. of Helminthology, London School of Tropical Medicine; Hon. Parasitologist to the Society 1921–1922.Search for more papers by this author R. J. Ortlepp M.A., R. J. Ortlepp M.A. Research Assistant, Dept. of Helminthology, London School of Tropical Medicine; Hon. Parasitologist to the Society 1921–1922.Search for more papers by this author First published: December 1922 https://doi.org/10.1111/j.1469-7998.1922.tb07095.xCitations: 22 *Communicated by Prof. R. T. Leiper, F.Z.S. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume92, Issue4December 1922Pages 999-1107 RelatedInformation

Citation indexing and the development of academic journals in tropical medicine

It has been suggested that the conquest of tropical diseases during the late XIX century represents one of modern medicines’ greatest triumphs (Brennen & Davey 1978). Much of the impetus for this achievement was spurred by the high prevalence of disease and epidemics that were at the time devastating new settlers, colonial servants or military occupiers within foreign colonial territories (Keiser & Utzinger 2005). The formal study of tropical medicine can trace its origins to the Indian Medical Service of the British Army, which was founded in 1764 (Brennen & Davey 1978). The Liverpool School of Tropical Medicine and the London School of Tropi-cal Medicine began in April and October, respectively, of 1899 (Wilkinson & Power 1998). With the arrival of pandemic plague to South America the Brazilian gov-ernment founded the Instituto Soroterapico no Rio de Ja-neiro in 1900, which was later renamed after its famous director, Oswaldo Cruz (Momen & Coura 2000). The Royal Society of Tropical Medicine and Hygiene was established at a “Meeting of Medical Men and Others Interested in Tropical Medicine” held in 1907 and where Sir Patrick Manson was elected president (Greenwood 2007). In 1929 the London School occupied a new prem-ises and changed its name to the London School of Hy-giene and Tropical Medicine, with a goal to centralize the study of all aspects of public health (Schilling & Mc-Donald 1990). It also offered a range of qualifications in various fields including both occupational and tropical medicine (Smith 1981).For the most part, the early study of tropical medicine was dominated by parasitic and infectious diseases with an affinity for warm climates (Gilles & Lucas 1998), and associated academic journals in the field reflected this trend. The formation of academic societies in tropical medicine was also followed by the publication of aca-demic journals, the first English-language version being a short-lived publication known as the

Assessing probable causes of death without death registration or certificates: a new science?

The study of mortality, with its measurement of numbers and death rates, has long been a priority for demographers. The study of causes of death and their role in public health is an area where collaboration between physicians and demographers has been particularly fruitful, as demonstrated in the research presented by Garenne & Fontaine in 1986. It was first published in French, (1) with a subsequent version in English which is extracted here. (2) The classification of causes of death is always a difficult exercise: difficult in developed countries where the registration of all deaths is relatively complete, necessitating 10 revisions of the International classification of diseases and causes of death; (3) more difficult in developing countries where often less than half of all deaths are registered. The deceased patients often received no medical attention, either because they lived too far from the health system or because the establishment of the cause was of no interest to anyone. In countries with incomplete statistics, Yves Biraud recommended, in 1956, the use of information supplied by the relatives of a deceased person, in an attempt to establish a "community diagnosis" of the cause of death. (4) The first simplified lists of causes of death for use in developing countries were published by WHO in 1978, (5) only six years before the study under review. A few teams of doctors and demographers had started to research the establishment of causes of death in the well-known "population laboratories" that provided a complete registration of vital events through longitudinal demographic surveillance: in Khanna, northern India, between 1955 and 1960; in Companigonj, Bangladesh, between 1975 and 1978; and in Santa Maria Cauque, Guatemala, and Narangwal, Punjab, between 1978 and 1982. The term "verbal autopsy" was first proposed by Arnold Kleiman and coworkers in a publication emanating from Narangwal in 1983. (6) Although the term is not used by Garenne & Fontaine in their article, it can be considered that they are among the "fathers" of this new technique, defined as "a procedure to exploit the information provided by the relatives of a deceased person to reconstruct the events and symptoms that preceded the death so as to deduct a medically acceptable cause, or causes, of the death". (7) During the following decade, several other research centres started to lay down experiments and theories about the assessment of causes of death by verbal autopsy, such as Matlab in Bangladesh, Niakhar in Senegal, Machakos in Kenya, and MRC Laboratories in the Gambia. The first international workshop to share experiences was organized by the Department of International Health of the Johns Hopkins School of Public Health in March 1989, (8) at which Garenne presented his standardized method developed in Morocco and Senegal. Five years later, a first workshop focusing on maternal deaths was convened by the London School of Tropical Medicine and Hygiene. (9) The work by Garenne & Fontaine came at the right time to demonstrate a favourable conjunction between demography and public health. It emanated from a study on the relationship between nutritional status and mortality of children under five years of age in Niakhar, a rural region of Senegal under demographic surveillance. This study of causes of deaths was first presented at a seminar on new approaches to the measurement and analysis of mortality organized in Sienna, Italy, in 1986 by the International Union for the Scientific Study of Population (IUSSP) and published in French as part of the proceedings. (1) It has been cited, in either French or English, in almost every subsequent publication on verbal autopsy. This paper represented an important step forward, because it came at a pioneering time when fellow researchers in the same area needed a bit of guidance and theory, particularly regarding the format of the questionnaire to be applied. …

Assessing probable causes of death without death registration or certificates: a new science?

The study of mortality, with its measurement of numbers and death rates, has long been priority for demographers. The study of causes of death and their role in public health is an area where collaboration between physicians and demographers has been particularly fruitful, as demonstrated in the research presented by Garenne & Fontaine in 1986. It was first published in French, (1) with subsequent version in English which is extracted here. (2) The classification of causes of death is always difficult exercise: difficult in developed countries where the registration of all deaths is relatively complete, necessitating 10 revisions of the International classification of diseases and causes of death; (3) more difficult in developing countries where often less than half of all deaths are registered. The deceased patients often received no medical attention, either because they lived too far from the health system or because the establishment of the cause was of no interest to anyone. In countries with incomplete statistics, Yves Biraud recommended, in 1956, the use of information supplied by the relatives of deceased person, in an attempt to establish community diagnosis of the cause of (4) The first simplified lists of causes of death for use in developing countries were published by WHO in 1978, (5) only six years before the study under review. A few teams of doctors and demographers had started to research the establishment of causes of death in the well-known population laboratories that provided complete registration of vital events through longitudinal demographic surveillance: in Khanna, northern India, between 1955 and 1960; in Companigonj, Bangladesh, between 1975 and 1978; and in Santa Maria Cauque, Guatemala, and Narangwal, Punjab, between 1978 and 1982. The term autopsy was first proposed by Arnold Kleiman and coworkers in publication emanating from Narangwal in 1983. (6) Although the term is not used by Garenne & Fontaine in their article, it can be considered that they are among the fathers of this new technique, defined as a procedure to exploit the information provided by the relatives of deceased person to reconstruct the events and symptoms that preceded the death so as to deduct medically acceptable cause, or causes, of the death. (7) During the following decade, several other research centres started to lay down experiments and theories about the assessment of causes of death by verbal autopsy, such as Matlab in Bangladesh, Niakhar in Senegal, Machakos in Kenya, and MRC Laboratories in the Gambia. The first international workshop to share experiences was organized by the Department of International Health of the Johns Hopkins School of Public Health in March 1989, (8) at which Garenne presented his standardized method developed in Morocco and Senegal. Five years later, first workshop focusing on maternal deaths was convened by the London School of Tropical Medicine and Hygiene. (9) The work by Garenne & Fontaine came at the right time to demonstrate favourable conjunction between demography and public health. It emanated from study on the relationship between nutritional status and mortality of children under five years of age in Niakhar, rural region of Senegal under demographic surveillance. This study of causes of deaths was first presented at seminar on new approaches to the measurement and analysis of mortality organized in Sienna, Italy, in 1986 by the International Union for the Scientific Study of Population (IUSSP) and published in French as part of the proceedings. (1) It has been cited, in either French or English, in almost every subsequent publication on verbal autopsy. This paper represented an important step forward, because it came at pioneering time when fellow researchers in the same area needed bit of guidance and theory, particularly regarding the format of the questionnaire to be applied. …

Epistemological frameworks of tropical medicine

In order to understand the novelty, in theoretical and epistemelogical terms, of the emergence of tropical medicine, we analyse two models of research represented by the Pasteur de Ultramar Institute and the London School of Tropical Medicine. We seek to understand which arguments and concepts come into play in their discourse; in what way they construct their protocols for research; how these protocols, concepts and arguments are similar and different; indeed, whether it is possible to speak of something new, epistemologically speaking, or of the incommensurability of tropical medicine with the medicine inherited from Pasteur and the medical tradition concerned with disease in hot climates.