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(2) The cases of ankylostomiasis in Grenada no treatment en masse is called for.
are so few and far between that
(3) Asprivies and latrines are conspicuous by their absence in our rural districts, the construction of these sanitary conveniences should be encouraged, and the proper authorities should see that they are frequently cleaned and their contents rightly disposed of; these suggestions apply especially to some of the schools, which are not always the pattern of sanitation they ought to be.
If the fact that the destruction of all human excrement would eradicate this disease (and many others) is borne in mind, the line of treatment is very simple in theory; but the practical application of these indications is not going to be an
easy matter.
As regards the drugs used in the treatment of ankylostomiasis, thymol is the one most generally employed; but the extract of "male fern" and others are also
used.
As both these drugs have to be given with great care, and after a certain preliminary preparation of the patient, all severe cases should be admitted into a hospital; for if a person took thymol in his own home, and at the same time indulged in whisky or rum, the results would probably be very serious: the drug is a poison and very soluble in spirits, and, when in solution, is rapidly diffused through the body; the use of oils, too, with thymol would produce the same dan- gerous effects.
In January, 1905, Dr. Leonard, the then junior member of the medical staff, In this wrote a report on this disease which was published by the Government. report he implied that the complaint was not recognised by the other medical officers: but the late Dr. Boyd had written about it years before, and other local medical practitioners had treated the discase with thymol long before Dr. Leonard arrived.
I am, &c.,
The Honourable
The Colonial Secretary,
St. George's.
H. J. L. BENNETT,
Medical Officer, No. 8 District.
St. Patrick's, January 20th, 1903.
SIR,
I HAVE the honour to acknowledge the receipt of your circular of the 7th instant, covering a copy of the Secretary of State's despatch on the subject of ankylostomiasis.
I must state at the outset that, although that disease is fairly common in this Colony, I am not yet convinced that it is so general or the degree of infection usually so severe as to justify the expenditure that would be involved in taking thorough steps to control its progress with a view to its ultimate eradication. It also seems to me from observation that many of the milder cases tend to spon- taneous cure - how or why I am not able to explain.
Since, however, the disease does exist in the Colony to a very appreciable extent, and from its very nature will probably increase, it is only right that measures should be taken to suppress it.
So far as my district is concerned there are no sanitary measures in force for dealing with the disease, neither is there any latrine accommodation provided, either on estates or in other centres of population, so that the possible sources of infection are immense.
The plan generally adopted for treatment is as follows:-
The more severe cases are sent on to the Colony Hospital where they are The results of generally submitted to what is known as the thymol treatment. this treatment. so far as my experience goes, seem to be uniformly successful, but unfortunately those that are cured, when discharged from hospital, have to return to their old surroundings and many of them get re infected. The milder cases seems to yield readily to the ordinary vermifuges followed by tonies in which iran and arsenic play an important part.
To deal' in a radical manier with ankylostomiasis, it would be nevessary to provide a central hospital for treating the disease and to pass such drastic legisla tive measures as would effe,tually prevent any possibility af re infestion
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Under the conditions that exist in a Colony like this where the houses are so irregularly distributed over the whole island and where from time immemorial the habits of the people have made them quite indifferent to any sanitary measures. it seems to me that some difficulty will be experienced in evolving a scheme which would be at once complete and effective, whilst on the other hand any half measures would be a useless waste.
I have, &c.,
The Honourable
SIR.
The Colonial Secretary,
St. George's.
W. A. D. WHITEMAN,
Medical Officer, No. 6 District.
St. Patrick's, January 19th, 1908.
In reply to your circular letter of the 7th instant enclosing a copy of the Secretary of State's despatch, General, of the 26th November last on the subject of the prevalence, &c., of ankylostomiasis, I have the honour to report as follows:-
2. That the disease is prevalent in the district there is no doubt. 3. In the absence of a diagnosis based on microscopical evidence it is impos- Allowing, sible to indicate, except in a general way, the prevalence of the disease. however, for cases of idiopathic anemia and anemia attendant on malarial cachexia, gastro-enteritis, impoverished diet, &c., where ankylostomiasis might be a contri- Butory cause, there remains an appreciable percentage where the anemia must be attributed mainly if not solely to ankylostomiasis.
The degree of prevalence, however, is not such as to affect the capacity of the population for labour but warrants the adoption of some active measures to prevent continual re-infection and the propagation of the disease to a dangerous limit.
4. I am unable to report that there is any marked increase in the severity of the disease in the rainy season.
5. No sanitary measures for dealing with the disease exist in the district generally. On the contrary, conditions favourable for the dissemination of the materies morbi are very apparent, viz. :--the indiscriminate disposal of excreta in the immediate vicinity of houses and the contamination of water supplies from surface drainage.
6. No latrine accommodation exists in the district except in the town of Victoria where the accommodation is ample and satisfactory-the latrines being built on concrete pillars between high and low-water mark. It is nevertheless difficult to enforce the use of these latrines by children, who habitually resort to However, the employ- the vacant lots and other convenient places in the town. ment by the St. Mark's District Board of a sanitary watchman has done much to abate the nuisance arising from this dirty practice.
7. The severe cases of the disease, which are few, are sent to the hospital for
treatment.
8. As to what local measures might be undertaken to combat the disease I would suggest (1) The abolition of the existing method, or want of method, of dis- posing of excreta that obtains inland and the establishment of suitable trench privies for the deposit of all excreta. These trenches to be covered over with earth when three-parts full and fresh ones opened. The latrines as exist at Victoria could be adopted in the centres of population on the coast. (2) The protection of the various sources of water supply in the district. This needs no elaliorate system of waterworks. Of the many springs from which the population derive their water supply the most suitable could at small cost be tapped, concreted over, and a small outlet pipe provided.
9. There is no need for the treatment of ankylostomiasis in plantations nor en masse, and I am not of opinion that the population of the district as a whole is susceptible to education in the methods of preventing infection. The appointment of a sanitary inspector to enforce the necessary measures is a sine quá non.
The Honourable
The Colonial Secretary.
I have, &c.,
H. BISHOP,
Medical Officer, No. 5 District.
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