Document 6429996

A Swim in the Nile
CHAPTER 8
Nils
A Swwn,tnthe
THE FIRsrrtue VEnNoNBennY (as I'll call him) took sick on
his trip aroundthe world was in a SalvationArmy hostelin the
Kowloon sectionof Hong Kong. Berry woke up that morningit was a Monday morning toward the end of February' 1958a sorethroat,and the shivers.He wasn't
with a rockingheadache,
(ust twenty-five),his healthhad
young
was
much alarmed.He
alwaysbeenexcellent,and only a weekor ten daysearliera doctor
back home in JerseyCity had immunized him againsttetanus,
smallpox,typhoid fever, yellow fever, and cholera.What he
mostly felt wasannoyance.He wastravelingon an extremelytight
budget (a few hundred dollars in savings,and a recentsmall
and he couldn'tafforda seriousillness'Accordingly,
inheritance),
he decidedto take no chances.He draggedhimselfout of bed and
down to the SalvationArmy clinic, which adjoinsthe Kowloon
hostel. The doctor on duty there heard his unexceptionalcomThey indicated,
plaint and madethe usualdiagnosticsoundings.
Berry wastold, a touchof acutebronchitis.The doctorgavehim
a shot of penicillinand instructionsto comeback the next day for
laA
$ r 25
another.Meanwhile,he was to stay in bed and rest.Berry stayed
in bed, exceptfor visits to the clinic, until Thursday.On Friday
morning, feelingfully recovered,he left by plane for Singapore.
Berry spentthe weekendin Singapore.He sleptat a YMCA
restaurant
hotelon OrchardRoad,had his mealsat an inexpensive
rn the neighborhood,
and sawthe sightsofthe port. The nextstop
on his itinerary was Bangkok,and he choseto go by train-a
journey of somefourteenhundredmiles through the mountain
jungles of Malaya and southern Thailand. He left on Monday
andtheThaibetweenSingapore
morning.That night,somewhere
land border, he took sick for the secondtime. His feet beganto
itch and swell.Then he beganto itch all over. Then his joints
and he
beganto hurt. He couldn'timaginewhat had happened,
didn't know what to do. Therewasno one he could eventalk to.
That alonewas unsettling.He beganto feel a bit frightened.By
morning,he wasin a kind of panic,and whenthe train pulledinto
Songkhla,in southernThailand, he grabbedhis bag and got off.
doctor and askedfor an explanaHe found an English-speaking
he said,that
tion. The doctorwasnoncommittal.It waspossible,
gave him a
he
Berry had developeda calcium deficiency,and
restorativeinjection.It didn't seemto help. The next morning,
afteranotherwretchednight,Berryresumedhisjourney,asmiserableasever.He itchedandached,and hisfeetweresoswollenthat
it was all he could do to walk. Also, he had diarrhea.
Berry arrivedin Bangkokaroundnoon on Saturday,March l.
l{is firstconcernwashis health.A clerkat a YMCA hostelwhere
he arrangedfor a bed and left his bag directedhim to a hospital
operatedby the SeventhDay Adventist Church, on Pitsannloke
Road.He madehis way there,and into the outpatientclinic.The
cxaminingphysicianlookedhim over, noted his recenthistory,
irnd offeredan opinion, It was his beliefthat Berry was suffering
I'romtwo unrelatedailments.One appearedto be a mild attack of
bacillarydysentery.
That wasa commoncomplaintamongWestin the East,and it usuallyrespondedsatisfactorilyto
travelers
''rn
was almost certainlyan allergicreaction.
'ulfadiazine.The other
I herewere,of course,any number of possibleallergens.The list
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T H E M ED IC A L
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.4 Swim in rhe Nile
g
127
He was advised to take it easy.The next day, he caught a plane
to Egypt. After a couple of post-convalescentdays in Cairo, he
traveledup the Nile as far as Luxor. He spent three days in Luxor,
wandering among its many antiquities and swimming in the Nile,
and then returned to Cairo. From Cairo, he flew to Amman, from
included foods, drugs, dusts, and pollens. In this instance,however. the circumstancesseemedclearly to implicate a drug-the
penicillin injections that Berry had been given in Honk Kong'
Allergic symptoms, too, could be satisfactorily controlled, with
cortisoneand antihistamines:But Berry must also do his part' He
was to rest in bed, drink plenty of water, and report to the clinic
daily for treatment and observation until further notice'
Berry did as he was told. He reported to the Adventist clinic
Amman to Beirut, from Beirut to Ankara, and from Ankara to
Athens. He halted there, at a students'hostel, for two nights and
a day. On April 28, he left by plane for Zurich and a tour of
Western Europe. In the course of the next six or eight weeks,he
visited Geneva, Marsetlie, Barcelona, Madrid, Paris, Brussels,
Amsterdam, Frankfort. Muntch, and Vienna' An allergic puffi-
every day for nine days. At the end of that time, he was discharged
to convalesceon his own. The following day, he took a train to
Rangoon. Except for a httle swelling around the eyes'his allergic
symptoms had largely subsided, but he still was somewhat
diarrheic. He spent the next week traveling by plane and train and
bus through Burma and East Pakistan to Calcutta. He reached
nessaround the eyesplaguedhim off and on, but otherwsiehe felt
encouragingly well. On hrs second morning in Vienna, he was
awakenedby a twinge of abdominal pain. It came again while he
was dressing,and agatn on the way to breakfast. Then it went
there feeling tired and apprehensive,He had lost twenty-five
pounds in the past two weeks and had had to force himself to eat'
He rested for a day in a Salvation Army hostel and then sought
out a doctor. The doctor found him nervous and undernourished,
and recommended vitamins. Berry took his advice. A few days
later, having exhaustedthe sights of Calcutta, he moved on, by
away. Nevertheless,it made him uneasy,and that afternoon he
had himself directed to the office of a urologist. The urologist
questionedhim closely about his Damascus experience,and did
a urinalysis.The results,he reported, were entirely normal. Thus
reassured,Berry resumedhis travels.Betweenthe end of June and
the end of July, he visited Berhn. Copenhagen,Stockholm, Oslo,
and London. Early in August, he sailedfrom Southamptonon the
train, to New Delhi. From there, he flew to Karachi. It had been
his intention to spend severaldays in Karachi, but he stayedonly
threw on his clothes,
overnight. He awoke in a knot of restlessness,
and caught a plane for Damascus.On the way, he becameaware
Queen Elizabeth for New York.
of a leaden ache low rn his back and flanks. It smoldered there
throughout the rest of the flight. Then, as the plane came bumping
down at Damascus, it shifted around to his abdomen and sharpened into a twitching pain. Berry rode uncomfortably into the
Berry settled down in JerseyCity again, and after a week or two
ol looking around he found a.lob as a draftsman with an architectural firm. He lived with his parents and saw his old friends and
did as he had always done. It was not, however,as if he had never
city with the glum conviction that he was going to be sick again'
A French doctor confirmed his fears. Berry had a temperatureof
just over a hundred, and there was a trace of blood in his urine'
Those findings, together with the location of the pain, suggested
heen away. The allergic puffinessaround his eyes persisted,and
the itches and swellingselsewhereon his body continued to come
lnd go. In addition, early tn Septemberhe began to feel a vague
and vagrant nausea.The feeling was particularly pronouncedjust
a kidney infection. Either that or renal colic.
Whatever the nature of Berry's illness,it kept him in a nursing
home in Damascus for a little over a week. He emerged,wobbly
but well, on April 14, and had a final consultationwith the doctor'
before meals. He told himself that it would soon go away, and
w hen i t di dn' t, he tried t o t gnor eit . At t he end of a week,he gave
rrp and called the family doctor for an appointment. The doctor
rramined him with care, and admitted that he was stumped. In
i
.l
1
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THE
M EDI C A I -
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every respectbut one, he said, Berry seemedto be in his usual
excellenthealth.The exceptionwas revealedby a blood count. It
showeda morbidly significantincreasein white blood cells of a
That tendedto suggestthe presence
kind known as eosinophiles.
of infection.The possibilitieswere too numerousto mention,but
a consultationwith a specialistmight help to sort them out' He
would make an appointmentfor Berry with an internist of his
A few dayslater, Berry emergedfrom anotherthoracquaintance.
ough examinationwith another equivocalreport' Except for a
notably elevatedeosinophilecount, all testsand soundingsPerformed by the internist had had negativeresults.The internist,
however,was not completelydeterred.He had formed,he said,a
certainimpression-a hunch. Eosinophilia,he remindedthe family doctor,is characteristicof tnchinosis.Soareallergic-likeswellings around the eyes,and urticarial itches.He wonderedif a mild
trichinal infection might not be the causeof the patient'scomplaint. The family doctor passedthis tenuous diagnosison to
Berry, adding that he was generallyinclined to concur.
There is no specifictreatmentfor trichinosis,but in the great
majority of casestime will effecta cure. The curativepowersof
time did next to nothing for Berry. Although the swelling
around his eyessubsided,and the occasionalhives and itches
graduallyceasedto recur, the draggingmealtimenauseaand the
ambiguous eosinophilia continued unabated-for weeks, for
months, for a year. Then, one Saturdayafternoonin October'
1959,Berry passedin his stool a ten-inchworm. He submitted
the specimen,in consternation,to the family doctor. The latter
was able to reassurehim. The worm was a speciesof round
worm (Ascarislumbricoides),an intestinalparasiteonly slightly
less common than a tapeworm. It was also, the doctor went
manfully on to say, the probablecauseof what had seemedto
point to trichinosis.Nor wasthat all. Ascariasis'unliketrichinosis, was readily responsiveto treatment.The drug of choicewas
piperazinecitrate,and a singledosewas usuallysufficient.It was
in Berry's case.Within a week, his stomach had steadiedand
settled,and he felt almost like himself again' The only trouble
.1Swim in the Nile
$
129
rvas his eosinophile count. It had dropped, but it still stood abrrormally high.
Around the middle of November, Berry was seized with a new
:rffiiction.It hurt him to urinate. He endured this puzzling complaint for several uneasy days, and then went down to see the
,loctor. The doctor heard his symptoms with reliel and an examination, which disclosed an inflammation of the prostate gland,
eonfirmed his first impression. Berry had prostatitis. The doctor
then turned his attention to treatment. It consistedof a prostatic
rnassage,a prescription for sulfisoxazole,and a warmly encouragrng prognosis. He was hopeful that by the end of the week Berry
would be greatly improved. It didn't turn out that way' The pain
,:clntinuedas before. A cystoscopic, or direct, examination of the
urinary tract was made, and thesefindings,too, were inconclusive'
fhe doctor saw no reasonto alter his diagnosis.Or his treatment'
[{e was convinced that periodic prostatic massagewould eventu'
rullyhave a salutary effect.
And so, before long, it apparently did. Berry's occasionalabdominal cramps becameincreasinglyoccasional,and presentlycarly in 1960--they vanishedaltogether'This was followed by an
('rlcouragingchangein his original urinary complaint' For a while,
rt seemedto Berry that his troublesmight be almost over. But only
lirr a while. The remissions,it soon became clear, were nothing
rnore than remissions.In time, the pain always returned' Toward
rhe end of I 960, Berry gaveup any real hope of a cure and resigned
hrmselfto a life of chronic prostatitis.
Berry's life as a chronic invalid lasted almost a year' It
tnded, with a jolt, one December evening in 1961, when he
noticed a stain of blood in his urine. The next morning, it had
rroticeablydeepenedand darkened. Sick with dismay, he telephoned the family doctor. The doctor told him to come to the
,rfficeat once. From there, on the doctor's referral, he went to
\ce a urologist. The urologist asked some careful questions,
.rnd then led him into his surgery for another cystoscopicexrrnination. At nine o'clock the following morning, Sunday, De.ember 17, Berry was admitted to Memorial Hospital, in Man-
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THE
M ED I C A L
DETECTIVES
hattan, with a diagnosis of suspected cancer of the bladder'
22'
Berry spent six days in Memorial Hospital' On December
the
he was discharged in the care of Dr. Harry Most, chairman of
Department of Preventive Medicine at New York UniversityBellevue Medical Center, and an authority on tropical diseases'
The report of his staY read:
Physical examination on admission revealeda WDWN [welldeveloped,well-nourished]white male with ' prostateminimally
enlargedand non-tender.
Urilnemicroscopicallyshoweda few RBC [red blood cells] and
few WBC [white blood cells].Hgb. [hemoglobin]was 15 gms' Hct'
count] 5 9 with 4Voeosrno[hematocrit]42Eo.WBC [white blood
on a second'Eosinopt it.s on oni differentiaI and2OVoeosinophiles
per cc'lmm' Blood sugar[was]
showed98 eosinophiles
phil.
"oun,
within normal limits. Urinary cytologieswere negativefor malignant c el l s ....
Cystoscopyand biopsywerecarriedout' Bladderwas of normal
capacityand contour. Scatteredthroughout the bladder were nu,rr..ou. small, virtually punctateelevationsof the bladdermucosa
wit houta n y v i s i b l e c h a n g e i n th e n o rmal l emon-yel l ow col orofthe
in location'High
bladderlining.Theselesionsappearedsubmucosal
on the posteriorwall of the bladderwereirregular,partially confluent, reddened,raisedareaswith a surfacemidway ln app€arance
betweenthat of papillary neoplasmand bullous edema' but not
characteristicof either.The latter areastotalledseveralsq. cm. but
were resectedcompletelytransurethrally'
P at h o l o g i c e x a mi n a ti o n re v e a l e dunequi vocal evi denceo| schi s.
tosomlasls.
The cause of schistosomiasisis a small but readily visible endoparasitic worm of the genus schistosomT that has an essential
environmental predilection for human blood' Its name derives
from the Greek schistos,meaning "cleft," and soma' meaning
"body," and refers to a deep longitudinal crevice in the body of
the male worm in which the female more or less permanently
though humbly placedin the evolutionresides.The schistosomes,
ary scale,lead highly complicatedlives' They reach maturity on!y
after three total metamorphoses in three distinctly different set-
.4 Swim in the Nile
$
131
tings. The organism first manifests itself as a newly hatched larva
rn a pond or lake or river. If all goes well, the larva soon finds and
enters the body ofa suitable speciesoffresh-water snail. It is there
transformed into an aggregation ofreproductive spores,and these,
after several weeks of ceaselessproliferation' emerge from the
snail as a multitude of tadpole-likewrigglers. The wrigglers must
promptly find a suitable animal host, and one host to which they
have irrevocably adapted themselves is man. Wrigglers fortunate
enough to come upon the necessaryhost attach themselvesto the
skin, discard their tails, and (with the help of a tissue-dissolving
enzyme) burrow through the epidermal barrier' Penetrationusually takes about twenty-four hours and is unperceivedby the host'
Once through the skin, the wrigglers launch themselvesin the
current ofthe peripheralblood vesselsand are carried along to the
veinsand through the heart and into the systemiccirculation. The
survivors of this intricate voyage (which may take severaldays)
then gather in the richly nutntious blood that flows from the
gastro-intestinaltract to the liver and beyond. There they grow to
maturity (about an inch in length for the females,and less than
half that for the males),and mate. They then retire to the comfort
of a tiny backwater vein, where the female, still enclosedin the
male's embrace,deposits-for incubation and eventual excretion
with the body's wastes-the first of an almost infinite number of
eggs. It is not unheard of for a female schistosometo live and
breed for thi rty years.
The site that a schistosomechoosesfor its eggs is not a haphazardchoice. It is predeterminedby the speciesof worm' There
are three species to which man is warmly hospitable-Scilstosoma hoemotobium, Schistosoma mansoni, and Schistosoma
urilaponicum. Gravid S. huematobilrn worms are drawn to the
nary bladder. Those of the other speciesprefer the bowels, 5'
in the
laponicum lodging in the small intestine, and S. monsoni
They
well'
as
large intestine,The speciesdiffer rn other respects
have different intermediate hosts, different geographical ranges,
and different rates of growth. Each schistosome species has so
cvolved that it can Dassfrom the larval to the wriggler stage in
I
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T H E M ED IC A L
D E TE C TIvE S
acceptthe body of only certain speciesof snail, and the snails
the
thus
is
It
able to one are unacceptableto either of the others.
distribusnail that determrnes the distribution of the worm. The
and the
China
coastal
to
tion of S. iaponicum is largely confined
haeS'
Yangtze Valley, parts of Japan, and the Philippines'
Valley (its
motobium, though probably indigenous to the Nile
of the
mummies
calcified eggs have been found in Egyptian
most of
twef fth pre-Christian century), occurs throughout
southern
the
at
and
East,
humid Africa, in much of the Middle
the Midtip of Portugal. The range of S' mansoni extends from
(the Nile
dle East (Arabia and Yemen), through much of Africa
to
congo),
the
of
Delta, the southeast coast, and the rain forests
to
Brazil, Venezuela,and the Caribbean islands' Its extension
slave
the
to
attributed
the Western Hemisphere is generally
African
trade, but there is more to the matter than that, for the
decisive
slaves were infested with S. haematobium as well' The
(Australorbis
factor was the presence here of a species of snail
glabratus) to which S. mansoni could adapt' Just why the differsatisfacent species have different rates of growth is yet to be
matures
torily explained.The only certainty is that S' iaponicum
haein four or five weeks,S. mansoni in six or seven' and S'
m at obium in te n o r tw e l v e .
essenFor all their several differences, the schistosomes are
they
tially much alike. So are the varieties of schistosomiasis
usual
the
in
produce. A schistosomeis not a toxic organism
that any
sense.Except for certain allergic reactions (of the sort
The
mechanical'
foreign protein may excite), its impact is largely
to hold
eggs of a schistosomeare equipped with clawlike spines
of the
pull
constant
the
them in their venous incubator against
tearcirculating blood, and it is from this constant tugging and
reaFor
stems'
schistosomiasis
ing that the chief discomfort of
(as
infesta'
japonica
an
sons not entirely clear, schistosomiasis
of
tion of S. iaponicum is called) tends to be the most destructive
unpleasant,
the three forms, but all are seriousdiseases-always
often debilitating, and not infrequently fatal-and the symptoms
inof their presenceare fundamentally the same' They typically
A Swim in the Nile
$ 133
clude, as in the caseof Vernon Berry, an outbreakof hives,an
elevated eosinophilecount, and internal (gastro-intestinalor
genito-urinary)bleeding.
Berry's referral to still anotherphysicianwas unusualbut in no
senseexceptional.It was arranged, with the enthusiasticapproval of the JerseyCity urologist,by the head of the urological
serviceat Memorial Hospital,and was madefor the best of reasons.Dr. Most is not just another physician.He is one of the
few physiciansin the New York metropolitanareawith a particand one of even fewer exular knowledgeof schistosomiasis,
periencedin its sometimestricky treatment.
"I was very glad to have Berry commendedto my care," Dr'
Most says."Nothing could haveinterestedme more' I thought I
could help him, and I was eagerto try. That, of course'was the
first consideration,but it wasn't the only one. I waseagerto talk
to him-to learn everythingI could about the case'BecauseI
knew enoughalreadyto know that it signifiedsomethingimportant. It seemedto confirm the developmentof a new and potentially rather ominous trend. I'll tell you what I mean' Schisin
tosomiasishas alwaysbeenamong the rarest of rare diseases
of a suitable
thiscountry.It doesn'texisthere,and in the absence
The only
it
can't'
host
speciesof snail to serveas intermediate
casesthat are ever seenin the united Statesare importations.A
lot of Americansoldierscamehomefrom the Philippinesafter the
japonica,and a certain
Secondworld war with schistosomiasis
mannumber of Puerto Rican immigrants with schistosomiasis
that's
year,
and
every
cities
soni turn up in the Eastern-seaboard
beenabout the story. Until recently.It seemsto be taking a new
rwist now. A new kind of victim has appeared.It isn't a soldier
stationedin an endemicarea and it isn't a native exposedfrom
carliestchildhood.It's a tourist-someone just passingthrough'
"Berry was the fourth of theseto cometo my attentionin less
than two years.The otherswere a physicianand his wife and a
spinsterfriend of theirs who took a three-weekCaribbeancruise
in the winter of 1960.Their exposureoccurred-it could only
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THE
M EDI C A L
DETECTIVES
have occurred-in a fresh-waterpool on St' Lucia' one of the
Windwardlslands.Thephysicianwasthefirsttobecomesick.He
thought for severaldaysthat he had the flu' Then he washospitalized, and a colleaguetook over' A high eosinophilecount inan
dicateda parasiticinfection,and the attendingphysiciansent
accountoftheclinicalfindingstothehealthofficersofthevarious
The replieshe
islandsvisitedand askedfor diagnosticsuggestions'
ascariahookworm'
got cameout most stronglyfor typhoid fever,
of
sis, amoebicdysentery,and strongyloidiasis'The possibility
was never even considereduntil I cameinto the
schistosomiasis
picture. I was consultedbecauseof my interestin tropical mediwas suggestedto me by a carefulreviewof
cine. Schistosomiasis
the itinerary, and a seriesof testsconfirmedmy hunch' A rectal
mansoni'That was
biopsyidentifiedthe varietyasschistosomiasis
clini.*u"tiy two weeksafter onset.In the circumstances---classic
and
area'
a known recentvisit to an endemic
cal manifestations,
first-ratehospital facilities-I think one might say that it could
havebeendiagnosedabitsooner.Thetwoothercaseswerefairly
promild at onset, and the symptoms were not particularly
nounced.Iftherehadn'tbeenthatobviouslinkwiththesick
physician,they might havegoneundetectedindefinitely'As Berry
practicallydid.Andyettheessentialclues-avisittoanendemic
there in his case,too' All that was
area and eosinophilia
neededwas an awarenessof the possibility'
..Thetroubleisthatthepossibilityofschistosomiasisjustdoesn,tenteranAmencanphysician'smind'That'sunderstandable
enough-or, rather,it usedto be. In my opinion,it isn't anymore'
Berry and the physician and his wife and their friend may be
merely isolatedcases,but I don't think so' I think more likely
thereare othersthat I haven'theardabout.That nobodyhas.And
I think there are many more to come' I'll tell you why' The
American tourist has changedin the past few years' There's a
wholenewbreed.ourtouristsarenolongermainlytherichorthe
well-to-dofrom a few big cities.They'reeverybody,and theycome
from everywhere.The reason,of course,is cheaperand fasterair
travel. There are more touristsnow, and they do more traveling'
A Swim in the Nile
$
135
and they visit more distant places.Including, increasingly,the
tropics.And everyyearthe chancesare greaterthat someof them
is
will be exposedto a serioustropical disease.Schistosomiasis
only one such disease,and it is far from beingthe worst. I'm not
thinking of plague and cholera and that sort of thing, I mean
or
like kala-azarand African trypanosomiasis,
bizarre diseases,
Malignant
termalaria.
tertian
malignant
sickness,
and
sleeping
tian malariais an extremelyseriousdiseasewith a high mortality
rate,and the otherscan alsobe fatal, but they havetheir redeeming features.They are all amenableto treatment.They can be
treatedand cured.They can, that is, if they are diagsuccessfully
nosedcorrectly and in time. But first they have to be suspected.
They haveto be brought to mind. Brian Maegraith,of the Liverpool School of Tropical Medicine, has proposedan up-to-date
that
additionto the routineinterrogationof a patient.He suggests
at somepoint the doctor ask,'Wherehaveyou been?'I secondthe
motion.
"Maegraith assumesthat the doctor will hear and heed the
answer.That, of course,is quite as important as the question.It
could havemadeall the differencein Berry's case'I realizethere
werecomplicatingfactorsthere.The early allergicmanifestations
were confusedwith the evenearlier penicillin
of schistosomiasis
reaction,and certainlythat intestinalparasitewasa most unfortuHowever,sincethe doctorsconcernedwerefully
natecoincidence.
very
beginningthat Berry had just returnedfrom
awarefrom the
a ruggedtrip throughsomeof the world's leasthygieniccountries,
onecan hardly saythat his casewas handledwith much sophistication.Or so it seemsto me after talking and working with Berry.
"I sawBerry for the first time abouta month after his discharge
from Memorial Hospital.Soonerwould havebeenbetter,but that
couldn't be helped.I wanted to be surejust what I was treating
debeforeI startedtreatment.The treatmentof schistosomiasis
pendsto someextenton the type.Or types.I knew that Berry had
madea tnp aroundthe world, so it waspossiblethat he had more
than onetype.He might evenhaveall three.First, I wantedto see
the slidesfrom which the hospitaldiagnosishad beenmade' and
I
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THE
M ED I C A L
DETECTIVES
Then I
there was somedelay in gettingthem down to my office'
the microwanted to examinesomestool and urine samplesfor
that meant
scopiceggsthat would identify the type,or types'and
I had the
29'
uno1h.. delay. We finally got started on January
surprises'
resultsof the sampletestsby then,and they held no ugly
Berry
findings'
They simply confirmedthe originalbladder-biopsy
Where
haematobium,and only haematobium'
had schistosomiasis
different
he got it is a little hard to say' He visited half a dozen
and
East'
ptuc"s in the endemicareasin Egypt and the tvliddle
or basins
most of the washingand bathinghe did therewasin tubs
contaminated
possibly
filled by hand with water from some
in Egypt-at
source.lt's my guess,though, that he picked it up
Nile'
the
in
Luxor, when he went swimming
involvessome form of an"The treatmentof schistosomiasis
potent tolerable
timony. Potasstumantimony tartrate, the most
japonica'
Its adminisform, is generallyusedfor schistosomiasis
process'A
tration is intravenous,and is an exceedinglydelicate
someserislip can causereal trouble.Moreover,therehavebeen
powerful
less
A
ous, and evenfatal, toxic reactionsto the drug'
is effective
form containingsodiumantimonyand calledstibophen
manschistosomiasis
and
haematobium
in both schistosomiasis
the
as
bad
as
soni, and it can be givenintramuscularly'It isn't
29 was a
other, but lt can causeits share of trouble' January
afterthat
cc's
of
five
Monday. I gaveBerry a stibopheninjection
four days'
noon, and the sameamounteachafternoonfor the next
did the
then
and
breather'
a
We skippedthe weekendto give him
got
through
samethe following week.He stoodit pretty well' We
the drugseventeeninjections-or a total of eighty-fivecc's of
22' the
beforehe had any important toxic reaction'On February
and
day of the seventeenthinjection, he had a wave of nausea
job'
I
stopped'
so
vomiterl.Eighty-fivecc.swas enoughto do the
the
He wasn,t cured, but he was well on the way. Testsduring
the
by
and
clear,
courseof treatmentshowedhis urine increasingly
few
a
eggsand only
end of the courseit containedno schistosome
also showed a
eosinophilia
His
microscopic traces of blood.
healthychange.At the beginningof treatment,he had an eosino-
4 Swim in the Nile
$ 137
phile readtngof fifteenper cent. When I withdrew the drug, it was
down to ten. A month later, when he came in for a checkup, it
was down to four, and in the next few months it continued that
encouragingdecline. Another cystoscopywas performed on August 22. It showed no evidence of acute inflammation, and in
general the look of the bladder was compatible with the other
signsof improvement. Sevenmonths later, on March 13, 1963,a
final cystoscopywas done, and this time there was no doubt about
rt. We could safely say he was cured"'
lr e64l