[Bureau of Medicine and Surgery. Technical Film Report.]

[Schistosomiasis in Egypt. MED-I-56.]

[Produced by: Namru-3; Cairo, Egypt And Naval Medical School.]

[The opinions expressed in this film are not necessarily those of the Department of the Navy.]

For most of us, Egypt is the land of antiquity.

Pyramids.

Ancient gods.

And a center of Islamic culture and influence.

For millenniums, the valley of the Nile River has been the breadbasket of Egypt.

Its fertile soil supports herds of meat animals.

Lots of grains and cotton.

And a variety of vegetables, frequently providing more than two crops a year.

The majority of the population lives in villages along the banks of an extensive irrigation system whose source of water is the Nile.

These villages are crowded and sanitary standards are low.

The fields, dried-out canals, and water sources are contaminated by the people and their animals.

The contaminated waters are the source of the daily household water supply.

The same waters are used for the family laundry and washing household utensils.

Or taking the daily bath, or irrigation of fields.

The man who operates the shaduf is in daily contact with Schistosom-infested water, as are the men who operate the tambour or archimedes screw.

These men are fishing in contaminated waters.

They display a dermatitis or papule as evidence of Schistosom invasion of their bodies.

[Mataria Dispensary - Ankylostoma Annex]

The people who appear at village clinics seek medical assistance for Schistosomiasis and other parasitic infections.

Samples of feces and urine are collected.

Subsequent examination indicates that Schistosomiasis is widespread and accounts for the presence of many of the people at the clinic.

Egg-laden and bloody urine are common. Fecal specimens contain large quantities of blood and mucus.

In city hospitals, entire wards may be given over to Schistosomiasis patients. This farmer had complained about schistosomiasis symptoms for years. He had passed eggs of Schistosoma mansoni in feces and Schistosoma hematobium in his urine.

He had liver tenderness, malaise, jaundice, and marked [unintelligible].

Both the spleen and liver were enlarged. Pathologically, there was tissue damage in the urinary bladder, the intestine, and in other organs in which eggs were deposited.

Schistosomiasis has been known to occur in Africa for centuries.

Two species of Schistosoma are common: Schistosoma mansoni and Schistosoma hematobium.

Both species of Schistosoma are found in Egypt. Schistosoma mansoni is restricted to the Nile delta of lower Egypt.

Schistosoma hematobium extends along the Nile into upper Egypt.

With 60 percent of the population infected, the Egyptian Ministry of Public Health operates an extensive program for controlling or reducing the incidence of Schistosomiasis.

Its Schistosomiasis Control Section early turned its attention to conscientious vector control.

Ponds were constructed near the laboratory to permit observation of the habits and the biology of mollusken vectors.

Training of technicians is an old, established feature of the control program. They are instructed on the distribution and biology of the snail host. They learn the principles of field and survey work.

They are taught plant and snail identification. The technicians are indoctrinated in methods for computation of water volume of canals selected for treatment.

They learn to use the palm leaf plant to estimate snail density.

The technicians are acquainted with the various molluscicides such as copper sulfate, used in vector control.

They learn simple methods for the treatment of Schistosom-infested waters.

They are taught to be alert in their search for the snails. For example, snails may be found in dry patches of grass and aquatic vegetation during the low-water period.

The Egyptian Ministry of Health also operates an extensive treatment program. All villagers are checked for Schistosoma infection. There is compulsory treatment for infected persons.

For employment an individual must present a health record indicating non-infection by Schistosoms.

Several hundred injections may be administered daily at these clinics.

The percentage of infection in schoolchildren in any community is an accurate indication of the incidence of Schistosomiasis.

Schoolmasters and students gladly cooperate in the task of identifying those who may be infected.

Mobile medical groups stop at the schools at regular intervals to give antimonial injections to the children.

At fairs and other public gatherings, propaganda is used as another weapon in the battle against Schistosomiasis.

The public is informed on the basic facts of the epidemiology of the disease.

Emphasis is given to the hotspots of infection and to symptomatology.

However, people must earn a living, and use the dangerous waters.

So, it is expected that the incidence of Schistosomiasis will remain high.

The government of the United States of America is cooperating in the study of this disease.

In the outskirts of Cairo, the United States Navy has a well-equipped laboratory, Naval Medical Research Unit #3. This unit has facilities for the clinical, pathological, and biological study of diseases common to this part of the world, especially Schistosomiasis.

Some patients come to the unit to seek treatment, others serve voluntarily as subjects for clinical observation.

In the biological field, emphasis has been given to susceptibility studies. Studies to learn which animals are satisfactory hosts for experimental Schistosomiasis.

This work has shown which of the wild hosts could serve as reservoirs in the life cycles of the Schistosoms of man.

Acceptable hosts are also needed for research work pertaining to physiology, chemotherapy, and pathology.

Special attention is given to the study of snails and to the study of toxic substances that can be employed as molluscicides.

There are initial in-vitro tests, then further tests in aquaria containing Nile mud, organic matter, and plants.

Selected compounds are retested in outdoor tub aquariums. These provide a habitat similar to that of the canals and unexposed to natural meteorological conditions.

Molluscicide evaluation is carried a step further as the agent is taken into the field for trial.

And now with Schistosom vectors, biomphalaria [unintelligible] and bulinus truncatus are selected as test sites.

The water system is carefully surveyed to determine the species of snail present and to estimate snail density.

Accurate measurement is made to allow for a volume computation and for use in calculating the amount of molluscicide to be used on a parts-per-million basis.

The molluscicide is applied. Then follows a period of observation and evaluation to determine the success of the tests.

But, in spite of the dangers of Schistosomiasis, the people must continue to expose themselves to infested waters in order to eke out an existence.

So, as the many aspects to the Schistosom story are studied,

as treatment programs are carried on,

as research programs are intensified,

as propaganda is broadened, it is hoped that these efforts, combined, will lead to the successful control of Schistosomiasis.

[The End]