PUBLIC RECORD OFFICE
Reference :-
mmmmmin C.O.885
19 PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO
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latrines, and my opinion is that they will never erect them until they are compelled to do so. I consider that the time has now arrived when every sugar estate should, before any immigrants are allotted, provide proper latrine accommodation to the satisfaction of the Medical Department, as is done in regard to cottages for the accommodation of immigrants. It should also be made an offence for anyone to defæcate on any part of the estate except in those places specially set apart for the purpose.
L
With regard to the villages and country districts I consider the suggestion of These places are under the having Cards" printed and circulated a good one. control of local authorities, a large number of whom are alive to the necessity of proper latrine accommodation, but as I have said before, this matter is being dealt with by the Local Government Board and I do not at present advise that any further steps be taken.
I annex copies of the circulars,* &c., issued by the Department on the subject of anchylostomiasis.
28 February, 1909.
E.
J. E. GODFREY,
Surgeon-General.
REPORT by Dr. A. T. OZZARD on the Prevalence of Anchylostomiasis in Rainy Seasons and the Treatment usually employed in Severe Cases.
Public Hospital, Suddie, 11 January, 1908. WITH reference to your minute, No. 2143/07, of 9th instant, and the preva- lence of anchylostome infection, I beg to report as follows:-
HON. SURGEON-GENERAL,
(a) I have not noticed any marked increase in the severity of the disease in rainy seasons; but I have made no special observations on this particular point. Any increase in its prevalence would depend upon the conditions obtaining outside the body, ie, whether favourable or otherwise to the development of the anchy- lostome eggs and larva. Now it is a well-ascertained fact that besides oxygen and warmth, a considerable degree of humidity must be present for the successful In development of the egg. Obviously, therefore, one would expect a greater develop- ment of the parasite obtaining during wet weather than in a long dry season. fact, I think it may be definitely stated that no development can go on and conse- quently no infection take place if the fæces (contaminated) happen to fall on a dry surface. But given a certain degree of humidity, development of the eggs proceeds rapidly, and, as I have shown elsewhere, a free stage of the parasite outside the human body takes place under favourable conditions.
I should be inclined, therefore, to conclude that there would be a more marked increase of fresh infections at the commencement and towards the end of the rainy seasons, as during the middle of the rains there would probably be too much mois- ture for the successful development of the parasite.
(b) My method of treatment in severe cases is based on the administration of thymol. In an extremely weak patient I should either give small doses of thymol or give beta-napthol only. With regard to beta-napthol my experience unhesi- tatingly points to the opinion that it is not to be compared with thymol in efficacy.
As I have pointed out elsewhere, I consider the giving of thymol in 10-grain doses for several days continuously a very effectual method of employment. The large 30-grain doses have to be carefully watched; and almost any case so treated, at the end of the three or four large doses, will still show several ova in the fæces. In my experience, the only cases where thymol will fail to effect a cure are the cases which have remained untreated for some time and have passed into the con- dition of chronic anchylostomiasis or Anchylostomiasis cachexia.
E.
A. T. OZZARD.,
REPORT by Dr. C. P. KENNARD on the Prevalence of Anchylostomiasis in Rainy Seasons and the Treatment usually employed in Severe Cases.
Port Mourant, 12 January, 1908.
SIR,
I HAVE the honour to inform you that in answer to No. 2143/07, dated 9th January, 1908, re anchylostome infection that :-
-
I do not consider there is any marked increase in the severity of the disease in
• Some not reprinted.
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rainy seasons, on the contrary, I consider more cases of the disease and more severe cases are seen towards the end of the long dry season; I am unable to give any figures to prove this, and, if so, it will be only for this district. My statement is not limited to this district, but I can salely say that I have treated more severe cases suttering from anchylostomiasis in the last two or three months (latter part of the long dry and commencement of the wet season) than for a considerable time previous, and we had a particularly long wet season in the early part of 1907.
I consider the reason for this is that during the long dry season the people work harder, on account of the reaping of the crop in the cane and rice fields and become more worn out and, therefore, are more liable to show the effects and to suffer from any debilitating disease; the long dry season of itself appears to have generally a more depressing effect on the East Indian than the wet season.
Taking anchylostome infection more particularly, it can be divided under four heads:-
(A) Cases which have anchylostomes and do not show symptoms.-These cases are common as proved by post-mortems and by the numerous cases of infection found among the new coolies seen in apparent good health; when I find ova in a cuse, I know of no facts which would enable me to say this case had been infected at such and such a time previously, even if ova had not been found previously, as although the finding of the ova proves the presence of the worms, the not finding of the ova does not necessarily prove their absence; therefore, I am unable to give an opinion whether they are contracted more in dry than wet season or the contrary.
(B) Acute anchylostomiasis.—Where the symptoms are recent and severe and very many worms are present; these cases are rare, the few I have seen have been mostly in the dry season.
(c) Chronic anchylostomiasis.--A chronic disease which may be the result of the effect of the worms in the past entirely or where worms are present as well; is undoubtedly more frequent at the end of the dry season. (D) Acute anæmia.-Which may Le defined as a rapid blood destruction arising from anchylostomes in the past or with worms present as well. which terminate in apparent complete recovery, fatally, or in chronic anchylostomiasis, and is seen particularly in pregnant women; markedly more prevalent at the end of the long dry season. The method of treatment usually employed in severe cases.
is
(1) Where ova are found in the stools.-If the case is not in extremis, not beyond the seventh or eighth month in pregnancy, or not suffering from severe diarrhoea, I give mist magnesia, 11⁄2 ozs. to 2 ozs. at bedtime; early next morning three hourly doses of beta-napthol, grains 20 in cachets or wafer paper, fasting, and about two This may be repeated again if required hours after, mist magnesia, 1 to 2 ozs.
in a few days.
In advanced pregnant or diarrhoea cases I give beta-napthol, grains 10, and soda bicarb, grains 10, three times a day, or beta-napthol, grains 10, and bismuth subnit, grains 10, three times a day for two or three days or longer if no extra symptoms of gastro-intestinal derangement occurs, it is then left off and may be again repeated later.
I used to give thymol in large doses (up to grains 30 three-hourly doses) pre- ceded by calomel and mist magnesia and followed by mist magnesia, but it some- times has a depressing action, and I consider beta-napthol acts quite as well and it has no depressing action (unless the preparation is bad, of which I have had an experience). Beta-napthol is particularly good with children and is generally taken
better.
I tried the oil and eucalyptus treatment. but with the cases used, it had such a distinctly depressing effect that I do not use it, especially as Dr. De Freitas's results did not show it had any advantage over beta-napthol.
In far advanced pregnant women and very severe cases, especially as is seen in cases of acute anæmia, I do not give any vermifuge, as I found my results better when this was not given, waiting until they became improved and treating as below (2).
(2) Where ora are not found in the stools. The treatment I adopt is according to the symptoms, the object of which is to relieve the symptoms and to get good diges tion; if much temperature or headache I give a mixture of potass. bromide and