Discovery and clinical importance of the filariases.

Macrofilariae have been recognized for many millennia. Microfilariae were, however, not demonstrable until microscopy attained an advanced degree of perfection. Demonstration of the mode of transmission of the various filariases (Wuchereria bancrofti, Onchocerca volvulus, and Loa loa), dominated by Manson's work on lymphatic filariasis, constitutes one of the most exciting phases inhuman parasitology.

Nurse training at the 'Dreadnought' Hospital, Greenwich, in the late-19th century: Part 2.

The first part of this article appeared in the last issue of the 'International History of Nursing Journal' (pages 12-22). The second deals with the advisability of incorporating training for male nurses at the 'Dreadnought' Hospital. The important issues of pay and a pension scheme for nurses in the latter years of the 19th century are also addressed. There is more information on the day-to-day routine of the nurse during these years.

Nurse-training at the 'Dreadnought' Hospital, Greenwich in the late 19th century: Part I.

By the early 20th century, nurse-training at the Seamen's Hospital Society 'flagship' hospital at Greenwich was at least as well established as that in the London teaching hospitals. It had its origins in the late 19th century--in the light of Florence Nightingale's nursing reforms (she had initiated the training school at St Thomas's in 1860). Although Nightingale's major interests lay in the welfare of the soldier, she was clearly concerned with the health of the seafarer also. However, those early days of nurse training at the Dreadnought hospital posed numerous problems, not only for nurse training but for nursing in general. The second part of this article will appear in the next issue of the International History of Nursing Journal.

Safety evaluation of the drugs available to prevent malaria.

All drugs used for malaria prophylaxis have common adverse effects, in addition to rare and/or severe adverse effects. For many of the drugs in current use, the common adverse effects include neuropsychiatric harms. This property makes these drugs unpopular with tourists and business travellers, most of whom will be well at the start of chemoprophylaxis. Drugs available to prevent malaria have not been rigorously researched in terms of the phenomenology of their unwanted effects. Consequently, prescribers are not well placed to give useful information to travellers on the incidence, natural history and avoidability of the harms they may experience from malaria chemoprophylaxis. There is some evidence that the adverse effects of mefloquine may be a post-hepatic syndrome caused by drug-induced liver damage with, in some users, symptomatic thyroid disturbance. However, confusion in the interpretation of the scientific evidence has led to conflicting messages regarding the safety of mefloquine and other antimalaria drugs, and to incorrect self-therapy by individual travellers, sometimes with fatal outcomes. In this review, the existing knowledge base for the safety of drugs currently used to prevent malaria is described along with present designs for future studies that would allow a rigorous safety assessment of candidate chemoprophylactic agents and of new drugs introduced to prevent malaria. There is an urgent need for internationally-agreed, evidence-based malaria prevention guidelines. These guidelines should be explicitly linked to the best available research evidence (normally systematic reviews of trials and individual randomised trials) and should highlight gaps in the knowledge base as priority areas for research.