Introduction

David A Warrell
Centre for Tropical Medicine, University of Oxford, Oxford, UK

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This issue of the British Medical Bulletin marks the centenaries of the
Liverpool School of Tropical Medicine and the London School of Hygiene
& Tropical Medicine by reviewing the recent history of tropical medicine,
its current challenges and future prospects. These centenaries will be
celebrated at conferences in Liverpool (September 1998) and London
(July 1999). The past century has seen the most rapid acquisition of
knowledge about tropical diseases, but the historical antecedents of this
broad speciality can be traced back as far as Ancient Egypt. Several
different kinds of parasitic worms were named in the Ebers Papyrus of
1570 BC and there is palaeopathological evidence of guinea worm,
schistosomiasis and other helminthic infections in mummies of the New
Kingdom (1069-1795 BC)1. Hippocrates, 'the first malariologist'2,
observed the characteristic periodic fevers of malaria in the 4th century
BC and Garcia de Orta described herbal remedies for the local tropical
diseases in Goa, India, in the 16th century3. To Jacob Bontius is usually
credited the first book defining tropical medicine as a separate medical
speciality4. His De Medicina Indorum published in 1642, 11 years after
his death, contains clear accounts of beri beri (from which he suffered
himself), nutritional amblyopia and cholera which he had seen during the
last four years of his life in Java. The first English book on tropical
medicine was published by Thomas Trapham of Jamaica in 1679s-6.
In recent years, the definition and significance of tropical medicine has
been hotly debated7"9. In the first edition of his famous textbook of
tropical diseases10, Patrick Manson preferred to use the term 'tropical
diseases' in a meteorological rather than in a geographical sense:'diseases
occurring only, or which from one circumstance or another are specially
prevalent, in warm climates'. This usage is unambiguous for infectious
agents that thrived in, or were transmitted by, vectors that required a
warm climate (see Gilles & Lucas below). But tropical medicine has
Correspondence to always encompassed a much broader range of conditions, many of which
Prof DA Warrell, Centre
for Tropical Medicine,
have, in former times, been prevalent in temperate climes11. Despite these
Nuffield Department of semantic difficulties, the expanding concept of tropical medicine remains
Clinical Medicine, convincing and cannot satisfactorily be known by any other name. The
University of Oxford, collection of expert reviews contained in this issue of the British Medical
John Radcliffe Hospital,
Headington,
Bulletin provides powerful evidence of the continuing relevance and
Oxford OX3 9DU, UK vigour of the speciality. The two introductory chapters consider the

British Medical Bulletin 1998;54 (No. 2): 265-267 C The British Council 1998
Tropical medicine: achievements and prospects

achievements and failures of a century of established tropical medicine

in this country. Herbert Gilles and Adetokunbo Lucas describe four
overlapping phases in the evolution of tropical medicine: devastation,
discovery, development and deployment. Among their vignettes of key
historical events in the elucidation of major tropical disease, is the
'acrimonious and protracted quarrel' between Grassi and Ross about

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priority in the discovery of malaria transmission. This conflict will
surely be laid to rest at a joint conference of the Societa Italiana di
Parassitologia and the Royal Society of Tropical Medicine and Hygiene,
The malaria challenge after 100 years ofmalariology, which will be held
at the Accademia Nazionale dei Lincei in Rome in November 1998. Lise
Wilkinson and Helen Power describe the origins and development of
Britain's two Schools of Tropical Medicine. The overriding political
motive for the creation of the two Schools was the protection of the
health of British people living in the colonies, but few would question
their enormous contribution, through research and teaching, to the
health of endemic populations in tropical countries. Nine of the classical
tropical diseases have been selected here for special scrutiny. Bob Snow
and Kevin Marsh explore the consequences of interventions that might
interfere with the natural acquisition of protective immunity in those
growing up in malarious areas. Chris Curtis and Harold Townson
survey the techniques for controlling the mosquito vectors of malaria,
from traditional use of residual insecticides and the growing application
of insecticide impregnated bed nets to genetic manipulations aimed at
impairing the mosquito's vectorial ability. David Molyneux and Carlos
Morel catalogue progress in controlling onchocerciasis and Chagas'
disease. For those who believe that the classical tropical diseases are
becoming extinct, the paper by David Smith, Jacques Pepin and August
Stich will be a shocking revelation; there is a dramatic resurgence of
African trypanosomiasis, affecting as many as half a million people in
Central Africa. Anthony Butterworth discusses the growing under-
standing of immunological mechanisms in schistosomiasis, an essential
background to vaccine development. Diarrhoeal diseases (V I Mathan)
and intestinal nematodes (David Bundy & Nilanthi de Silva) remain
major causes of morbidity in the developing world. Michael Golden is
critical and iconoclastic in his review of the pathophysiology and
treatment of oedematous malnutrition. The global epidemic of HTV with
its attendant bacterial infections is a major threat and challenge
discussed by Alison Grant, Kevin de Cock and Charles Gilks. Jane
Cardosa considers the urgent problem of designing appropriate vaccines
for dengue, which is expanding its range into populous conurbations
especially in Asia and Latin America. Other emerging diseases in
tropical countries are the familiar scourges of Western industrialised
countries; cardiovascular disease, cancer and diabetes mellitus (Terence

266 British Medical Bulletin 1998;54 (No. 2)

 Introduction

Forrester, Richard Cooper and David Weatherall). Tropical climate

largely defines what we understand by 'tropical diseases' but climate
change is altering the geographical limits of 'the tropics' (Anthony
McMichael, Jonathan Patz & Sari Kovats). Finally, a glimpse of new
opportunities for tropical medicine in the next millennium: David
Weatherall considers the increasing role of molecular and cell biology in

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the understanding, diagnosis, treatment and control of tropical diseases
and Anne Mills anticipates some practical financial problems in the
continuing pursuit of 'health for all'.

References

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2 Russell PR Man's Mastery of Malaria. London: Oxford University Press, 1955
3 de Orta G. Coldquios dos simples e drogas e cousas medtcinais da India. Goa, 1563. English
edn, Markham C (ed). London: Southeran, 1913
4 Bontius JC. De medicina Indorum. Franciscum Hackium, Lugduni Batav, 1642
5 Trapham T. A Discourse on the State of Health in the Island ofJamaica. London: Boulter, 1679
6 Ashcroft MT. Tercentenary of the first English book on tropical medicine, by Thomas Trapham
of Jamaica. BM] 1979; 2: 475-7
7 Editorial. Will tropical medicine move to the tropics? Lancet 1996; 347: 629
8 Editorial. Tropical medicine for the 21st century. BM] 1996; 312: 247-8
9 Cook GC, Warrell DA, Bryceson ADM. Debate: tropical medicine as a formal discipline is dead
and should be buried. Trans R Soc Trop Med Hyg 1997; 91: 372-5
10 Manson P. Tropical Diseases. A Manual of the Diseases of Warm CItmates. London: Castle,
1898
11 Scott HH. A History of Tropical Medicine. London: Edward Arnold, 1939

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