Presentation given by Russell Stothard at the Glasgow Encounters with Tropical Disease conference in January 2016.

1. Robert Leiper and Medical Helminthology
Russell Stothard
Liverpool School of Tropical Medicine
russell.stothard@lstmed.ac.uk

2. Britain’s most celebrated helminthologist
• Born in Scotland
• Qualifies in medicine at Glasgow
• Appointed to LSHTM by Manson in 1905
• Fascinated by natural history of parasites
 equally for those of fish, livestock & man
 undertook many field-based expeditions
 devised simple control interventionscirca. 1915

3. Britain’s most celebrated helminthologist
Dracunculiasis Loaiasis Schistosomiasis
Librarian at Millport, Isle of Cumbrae
Founder of Journal of Helminthology
1902, Nature 66: 641

4. Contents
Celebrating the discovery of the lifecycle 100 years ago
- Leiper in China
- Introducing Atkinson
- Leiper in Egypt
Schistosomiasis today
- Uganda & COUNTDOWN

5. A new disease in Egypt (endemic haematuria)
Bilharz’s original report created later confusion and argument

6. Man
schistosome
??
The schistosome’s lifecycle was up for grabs
‘Endemic haematuria’ blights Napoleonic troops
 schistosome eggs in urine – how did it spread?

7. Importance of schistosomiasis before WW1
• High numbers of Chelsea pensioners sick with the disease
 troops from Sudan/Egypt and Boer war
• Disease was common (?) in British navy gunboat personal in China
 Lambert and Houghton’s articles in Transactions of RSTMH
• Scale-up of British forces soldiering in Egypt (& near East) during WWI
 could the disease be curtailed/might it proliferate elsewhere?

8. Schistosomiasis – the British in China
• Royal Navy personnel reported to contract mysterious disease
 Houghton’s observations on fever with urticarial rash
• British missionaries interested in health of Chinese communities
 the disease appeared common in Yangtze River inhabitants

9. Leiper’s travels abroad – visit to Shanghai
Sent to China with E.L. Atkinson
to investigate lifecycle of
Schistosoma japonicum along
Yangtze River in spring 1914

10. But Leiper had done his homework…
• Studied with Helmut Loos in Egypt in 1906, but no breakthroughs

11. Edward Leicester Atkinson – Naval Surgeon
British Antarctic Expedition (1910-1912)
Scott’s Terra Nova Expedition
Dr Edward Wilson (CSO/Zoologist)
Edward L. Atkinson (Parasitologist)
Apsley Cherry-Garrard (Asst. Zoologist)
For further info: see William C. Campbell (1988) J. Parasitol 74: 1-12.

12. Edward Leicester Atkinson – Naval Surgeon
• Physician, fascinated by natural
history and parasites
• Initially trained by Leiper
• Following Scott’s death he took
charge of the expedition
 discovered Scott’s tent
 read burial sermon
 collected the artefacts
1881 - 1929
Atch’s forgotten influence in British parasitology
Upon return, worked with Leiper on this collection at LSHTM/BMNH

13. Scott Polar Research Institute, Cambs
Calculating expedition rations
With cook fishing for parasites

14. ‘Atch’ in the Antarctic – recovery of Scott’s team
'We recovered all their gear and dug out the sledge…amongst these were 35 lb.
of very important geological specimens…collected on the Beardmore Glacier; at
Doctor Wilson's request they had stuck to these up to the very end, even when
disaster stared them in the face and they knew that the specimens were so
much weight added to what they had to pull.'

15. ‘Atch’ and Terra Nova samples back at LSHTM
Anisakis simplex (Kathleen scotti, Leiper & Atkinson, 1914)
Terranova antartctica Leiper & Atkinson, 1914
Lepodora garrardi, Leiper & Atkinson, 1914

16. Leiper’s travels abroad – visit to Shanghai
Sent to China with E.L. Atkinson
…also Apsley Cherry-Garrard tags along

17. Leiper & Atkinson in China
• Sadly they didn’t get on as ‘Atch’ confided to his friend ‘Cherry’
“the fellow has really been too demandable for words…he has
got everyone by the ears and it is not a pleasing job trying to
clear up after him…I ought to give him a sound thrashing, tell
him what he is for the good of his soul and then leave him.”
• Leiper was despondent by being ‘scooped’ by Japanese workers.
 Fujinami, Miyairi & Suzuki determined mode of transmission
and the utilisation of freshwater snails as hosts.
 Leiper and ‘Atch’ confirmed this work and demonstrated the
parasite occurred in China causing the same disease.

18. Schistosomiasis in China (and Japan)
Leiper travels back to London in late
1914, then makes ready for Egypt

19. Christmas at the Museum – and fish parasites

20. Leiper’s returns to Egypt with his recent knowledge

21. Background – LSHTM history
“
”
Wandsworth expedition with Reginald Cockin & John Gordon Thomson

22. Leiper goes to Egypt

23. • 100 years and today

24. Leiper & ‘Atch’ goes to war
• Upon return from China, ‘Atch’ goes to Gallipoli/Western Front
• Leiper also shows that there are 2 species of African schistosome.
• He recommends the following for British army:
 troops not to bathe or make use of infested-water,
 water to be filtered or simply rested for 24hrs before use.
 From a military perspective Bilharzia has been conquered
 a disease of poverty disease without treatment until 1970s

25. Contents
Celebrating the discovery of the lifecycle 100 years ago
- Leiper in China
- Introducing Atkinson
- Leiper in Egypt
Schistosomiasis today
- Uganda & COUNTDOWN

26. Uganda – schistosomiasis today
Snail collecting…
…it’s still exhausting

27. LAKE ALBERT, UGANDA - MAY 2015

28. Trematodes from snails and swimming behaviour

29. This is a very difficult disease to control

30. Preventive chemotherapy needs intensification
How can NTD treatments
be scaled-up to meet the
demand?
What bottlenecks need to
be opened?

31. Keeping in mind gaps in existing PC actions – completing scale-up
Drugs
donated/purchased/delivery
Deliverers
CDD or teachers or both
Maternal & child health
EPI
Expanded access to PZQ needed
Recipients
Pre-SAC
SAC (in-school and out-of-school)
Adults - ?pregnant
Environment
Vectors/sanitation/modification

32. Summary – Leiper’s legacy at the LSHTM
Buckley, Nelson, Leiper

33. Thank you: Wellcome Trust Centre for Molecular Parasitology
Amaya Bustinduy
Hajri Al-Shehri
John Archer
Rachael Thompson Edridah Tukahebwa
Aida Wamboko
Moses Arianitwe
Moses Adriko
Aaron Atuhaire
Fiddi Rugianna
Library & Archives
David Rollinson
David Brown
Vaughan Southgate
Alan Fenwick
Narcis Kabatereine