A centenary of Robert T. Leiper's lasting legacy on schistosomiasis and a COUNTDOWN on control of neglected tropical diseases

Abstract

Part of Robert T. Leiper's (1881-1969) lasting legacy in medical helminthology is grounded on his pioneering work on schistosomiasis (Bilharzia). Having undertaken many expeditions to the tropics, his fascination with parasite life cycles typically allowed him to devise simple preventive measures that curtailed transmission. Building on his formative work with others in Africa and Asia, and again in Egypt in 1915, he elucidated the life cycles of African schistosomes. His mandate, then commissioned by the British War Office, was to prevent and break transmission of this disease in British troops. This he did by raising standing orders based on simple water hygiene measures. Whilst feasible in military camp settings, today their routine implementation is sadly out of reach for millions of Africans living in poverty. Whilst we celebrate the centenary of Leiper's research we draw attention to some of his lesser known colleagues, then focus on schistosomiasis in Uganda discussing why expanded access to treatment with praziquantel is needed now. Looking to WHO 2020 targets for neglected tropical diseases, we introduce COUNTDOWN, an implementation research consortium funded by DFID, UK, which fosters the scale-up of interventions and confirm the current relevance of Leiper's original research.

Keywords: Schistosoma; NTD scorecard; R. T. Leiper; Uganda; life cycle; praziquantel; schistosomiasis.

Fig. 1.

As commissioned upon his 80th birthday, a portrait in oils of Professor R.T. Leiper by Andrew Freeth (Royal Society of Portrait Painters) has been on display in the London School of Hygiene and Tropical Medicine since 1972. There are two rather subtle points to note. First, as Leiper was a chain-smoker his habitual cigarette in his right hand was later removed so as not to offend anti-smoking campaigns. Second, the untitled booklet in his hands clearly has images of Bulinus and Biomphalaria, the freshwater snails involved in transmission of Schistosoma spp.. Despite being the world's eminent helminthologist, he seems happy to be remembered for these two things, a smoker and a pioneer of medical malacology, perhaps a testament to his mischievous humour.

Fig. 2.

In celebration of Leiper's work on schistosomiasis. (A) Cartoon sketch by Joy Gordon of his 1915 work in Egypt as part of his 1961 festscrift in Journal of Helminthology. (B) Black and White photograph of Leiper's collectors working in the small irrigation canals in Egypt foraging for snails where one might infer how arduous field-collecting can be in the midday sun.

Fig. 3.

Leiper's initial studies on Asian schistosomiasis with Atkinson. (A) Black and White photograph of Edward Atkinson in 1911 taken by Herbert Ponting (1870–1935) during his research on the Terra Nova expedition. Atkinson had recently suffered severe frost-bite on his hands and face, the remnants can be seen by his cheek scars and swollen right index finger. Upon his return to the UK, he worked with Leiper on his collection of parasitic worms from the Antarctic. (B) Black and White photograph of snail collecting in China along the marshes surrounding rice paddies.

Fig. 4.

Leiper unsettles Harold Baylis, for it was exceptional practice for British Museum (Natural History) staff to work on Saturdays. This note from Baylis to S.F. Harmer RFS (1862–1950) the Keeper of Zoology at the B.M.(N.H.) clearly shows how active Leiper could be pushing ahead the Terra Nova manuscript and how on Christmas Eve 1914 and Baylis was worried about the fuss Leiper might create if unsatisfied. Nevertheless, nearly half a century later Baylis was happy to sign Leiper's festscrift.

Fig. 5.

Malacological and parasitological studies in Uganda on the Lake Albert shoreline. (A) Sketch map of 10 collection points for Biomphalaria and associated location of 5 primary schools (Bugoigo, Walakuba, Runga, Biiso & Busingiro) examined for intestinal schistosomiasis in May 2015. Whilst Pakwach is located at the northern end of Lake Albert, the settlement of Butiaba occupies much of the peninsula indicated at snail collection site 4. The table denotes the number of snails collected and occurrence of snails shedding S. mansoni. (B) Ongoing water contact, contradictory to Leiper's advice, such as collecting water in yellow plastic jerry cans and washing clothes [inset] at Itutwe is still a common occurrence along the Lake Albert shoreline. While Bulinus and Lymnaea have been regularly collected from Itutwe since 2002, it was not until May 2015 that Biomphalaria has been encountered making this a possible transmission site away from the lakeshore and in need of further surveillance.