PUBLIC RECORD OFFICE
Reference :-
C.O.885
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO
19 PUBLIC RECORD OFFICE, LONDON
SIR,
(No. 65.)
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SENIOR MEDICAL OFFICER to the ADMINISTRATOR.
Dominica, 9 July, 1908. I HAVE the honour to report as follows, for the information of the Secretary of State, on anchylostomiasis in Dominica.
2. The disease cannot be said to be prevalent in the island, for during the three years ending 31st December, 1907, only ten cases of it were admitted to the Roseau Hospital. Instances, however, of minor infection with the parasite are, I believe, common; indeed, I have often found the ova of Anchylostome duodenale in dejecta examined microscopically in the course of clinical investiga- tion. Minor infections with the worms give rise to no distinguishable symptoms, and in places where sanitary conditions exist such infections are not of any conse- quence; but in the insanitary surroundings of the huts of the labouring population they are calculated to infect repeatedly the host of the parasite as well as his neighbours, so that persons subject to minor infections in this way become sufferers from anchylostomiasis.
3. In 1899, in a report on anchylostomiasis in Antigua, which I wrote at the request of Sir Francis Fleming, then Governor of the Leeward Islands, I stated that "The parasite is not uncommon in Dominica; but, owing to the sparse popula- tion and the abundant supply of pure running water in this large island, the chances of infection are much less than in Antigua."
4. Of the ten hospital cases above referred to, I find that six came from the keward districts of the island, and four from the southern windward district extending from Laplaine village to Victoria village. But, as I have had several cases in private practice of persons residing near to Laplaine, it would appear that the disease is more prevalent in this part of the island.
5. The number of cases that have been admitted to the hospital is too small to decide the question of the effect of the rainy season on the severity or prevalence of the disease. Of the ten cases three were admitted in the first quarter of the year, three in the second quarter, and four in the third quarter—which is the rainy season in the island. The date of the admissions, too, is no guide as to the period of infection with the worm to the extent of producing, by their effect on the system, the train of symptoms known as anchylostomiasis or "hook-worm disease." Besides, as these symptoms come on slowly and gradually, it is almost impossible to obtain accurate histories from the class of people most usually affected.
6. Although the disease has attracted attention only within the last few years, I believe it was prevalent in slavery times, and it was probably introduced into the West Indies from Africa at the period of the slave trade. In my report above referred to, I alluded to this matter in the following words: "I do not believe that the parasite has been newly introduced into these countries, for a study of the question can lead to no other conclusion than that many of the cases of Cachexia Africana, or "Mal d'Estomac," so prevalent in slavery times, were due to the effects of anchylostomata. Indeed, the symptoms detailed by the early writers on West Indian diseases as characteristic of "negro cachexy are identical with those set down in modern text books as diagnostic of anchylostomiasis."
7. The treatment of anchylostomiasis by thymol, in those cases in which the disease has not existed a sufficiently long period to cause serious damage to the heart, is simple, and invariably successful. The details of this treatment as adopted at the Roseau Hospital are as follows:-
On the previous day a purgative of calomel, or castor oil or sulphate of soda is given, and an enema is administered afterwards to clear the large intestine.
Early the following morning, on an empty stomach, two doses. of from twenty to thirty grains of thymol are given at intervals of two hours.
The patients are kept in bed and on slop diet. Thymol is only dangerous when absorbed, so that care should be taken to prevent the patient taking any alcohol during its administration. I have given even larger doses of thymol than thirty grains without any untoward effects.
If the thymol do not act on the bowels within twelve hours after its administra- tion, an aperient should be given, for if it be allowed to remain in the intestinal canal it may become absorbed and give rise to dangerous symptoms.
Whilst the doses of thymol are given no food is allowed, but water may be drunk freely.
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The first stools do not contain the worms, but in later ones they are usually abundant.
In cases of anchylostomiasis under treatment at the Roseau Hospital, the nurses always search the stools for the parasite, and they have become expert in finding the little worm. I drew up the following instructions in the first instance for their guidance :-
To find the Parasite.
The excreta should be submitted to at least six washings, and the deposit should be allowed to settle at each washing. The final deposit is then to be carefully examined, and the minute worms-measuring about a half to three- quarters of an inch in length-will be discovered at the bottom of the vessel. The nurses have improved on these instructions; for, at the final washing, they throw the contents of the vessel on to a sieve made of fine muslin, and so the worms are easily seen when the water drains away.
After the thymol treatment ferruginous and, later, arsenical tonics are given; the pernitrate of iron (with glycerine) appearing to me to be better than any other ferruginous preparation.
8. Anchylostomiasis is a dirt disease, and cleanly persons adopting ordinary sanitary measures are practically exempt from infection. It is propagated by the larvæ of the "hook worms" that are hatched in the soil from the eggs cast out by human beings who adopt primitive methods of disposal of their dejecta. The larvæ are hatched in damp soil, they are minute, and they may be found on fruit and vegetables that fall and lie on the ground infected by them. They may enter the human system by the mouth or find their way through the skin. The curious disease of the soles of the feet known as "ground itch" has been determined to be due to irritation caused by the entry into the dermis of the larvae of anchylostomata. The danger of walking bare-footed in dirty muddy places near to insanitary huts is well known to the negroes, who fear in such circumstances to get ground itch, or as it is called in the French patois "jo jo-fie."
9. It follows from these facts that there is no particular difficulty in protect- ing the people from the spread of anchylostomiasis. Indeed, in 1899, in the report I have referred to, I said "That as the larvae are developed in the soil from eggs deposited thereon in human dejecta, certain obvious and simple sanitary measures are all that are necessary to arrest the propagation of the parasite, and, therefore, to rid any district of anchylostomiasis."
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10. There are no general sanitary measures in force in Dominica for dealing with the disease. The only authority armed with legislative power to act in such a matter is the Board of Health, but this board has been dormant for a number of years.
There are several public latrines in the town of Roseau on the sea-shore, but there are none on the estates and in the villages and other centres of population; and it is worthy of note in this connection that I have never known of a case of anchylostomiasis occurring in Roseau. In the country districts of the island the labouring classes dispose of excremental matters by depositing them near to their houses on the surface of land cultivated in "ground provisions," and amongst which fruit trees often grow. If the population were dense, this system would be a source of considerable danger to the public health; but, by means of the sparseness of the population, and of the quick and complete decay of animal matters in a tropical climate, no very serious harm appears to the casual observer to result from such insanitation.
12. This state of affairs is due as much to ignorance of its danger as to wilful disregard of cleanliness, as will be seen from the facts set forth in the following extract from a paper on anchylostomiasis I published in "The Journal of Tropical Medicine" in October, 1900:-
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"As regards anchylostomiasis in these West Indian islands much can be done by medical men themselves to arrest its prevalence. The West Indian people are not so ignorant as they are often made out to be, and they have a keen appreciation of anything that is for their benefit when they are quite satisfied it is really for their benefit. A case in point occurred in my practice a few months ago. A young man was sent in to me from a distant country district as he was very ill. I found him to be suffering from
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