១
the year 1910, as suggested in the draft return accompanying Professor Ronald Ross's revised note on the subject of the prevention of mosquito-borne diseases in the tropical Colonies and Protectorates, which formed an enclosure to your circular despatch of the 20th December, 1910.*
I have, &c.,
6034
$IR,
(No. 38.)
No. 4.
JAMAICA.
E. M. MEREWETHER,
Governor.
THE GOVERNOR to THE SECRETARY OF STATE. (Received 26 February, 1912.)
King's House, Jamaica, 7 February, 1912. In continuation of my despatch, No. 84, dated the 12th March, 1911,† I have the honour to transmit to you herewith the statistics relating to mosquito-borne diseases for the period froni the 1st January to 31st December, 1910.
6545
(No. 60.)
No. 5. CEYLON.
I have, &c.,
SYDNEY OLIVIER,
Governor.
THE GOVERNOR to THE SECRETARY OF STATE. (Received March 2, 1912.)
SIR,
3
Enclosure in No. 6.
(St. Christopher, Nevis. No. 47.)
Government House, St. Kitts, West Indies,
8th February, 1912. WITH reference to Your Excellency's despatch, No. 252, of the 17th May, 1911, I now have the honour to transmit, for Your Excellency's information, and for communication to the Secretary of State, Dr. J. N. Rat's Report on the result of the experiments made by him in the treatment with the preparation Salvarsan, or" 606," of persons suffering from the disease of yaws.
2. It is extremely gratifying to find that in every case so treated a complete cure has been effected, and Your Excellency will, I am sure, agree with me that Dr. Rat is to be complimented, not only on that fact but on the interest he has shown in the subject, on the great care with which his experiments have evidently been conducted, and on the full and interesting character of his report.
3. The experiments have been carried out at a comparatively trifling cost, the principal item of expenditure being the purchase of the drug itself. The amount Sufficient for a full injection costs about ten shillings, but it will be observed that in six of the cases treated by Dr. Rat, one injection of three grains of Salvarsan, or one-third of the usual ampule of nine grains, was sufficient.
4. The conclusion at which Dr. Rat has arrived, to the effect that persons suffering from yaws can be successfully treated with Salvarsan as out-patients, raises the hope that it may now be possible to stamp out this disease entirely. It will, of course, be necessary to make compulsory the attendance at the dispensaries of persons suffering from the disease, but if permission is granted, as I trust it may be, to prepare and pass an Ordinance for this purpose, I do not anticipate much difficulty in enforcing its provisions, provided the Medical Officers give their cordial assistance, as they doubtless will do. Dr. Rat goes into particulars regarding the arrangements for giving effect to such an Ordinance, but these will be dealt with when the Bill is being prepared, and need not be considered at the moment.
5.
Should Dr. Rat's Report be published in England by the Tropical Diseases Research Fund or the London School of Tropical Medicine, I should be obliged if Your Excellency would be so good as to arrange that two dozen copies of it be supplied to this Presidency.
On Tour, Trincomalee, Ceylon,
7th February, 1912.
[Published as No. 2 in Appendix V1. to [Cd. 6669], March, 1913.]
His Excellency
Sir Bickham Sweet Escott, K.C.M.G.,
I have, &c.,
T. LAURENCE ROXBURGH,
Administrator.
PUBLIC RECORD OFFICE
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8532
SIR,
(No. 81.)
No. 61
LEEWARD ISLANDS.
THE GOVERNOR to THE SECRETARY OF STATE.
(Received March 20, 1912.)
[Answered by No. 27a.]
Government House, Antigua, 20th February, 1912. WITH reference to the 6th paragraph of your despatch, No. 113, of the 25th March, 1911,§ I have the honour to forward the following despatch from the Administrator of St. Kitts-Nevis, enclosing an interesting and well-prepared report by Dr. J. N. Rat, Medical Officer, District No. 6, Nevis, on the result of the experi ments made by him in the treatment with the preparation "Salvarsan," or " 606," of persons suffering from the disease of yaws.
2. I recommend that the proposals made by Dr. Rat as to the future action to be taken with the view of eradicating the disease should receive your approval.
I have, &c.,
BICKHAM SWEET ESCOTT,
• No 11 in Appendix I. to [Cd. 5514].
‡ No. 10 in Appendix I. to [Cd.” 6669], March, 1913.
Governor.
† 10163 not printed.
§ 7424: not printed.
Governor of the Leeward Islands.
ST. KITTS-NEVIS.
REIORT On Experiments performed in the Treatment of Yaws by Salvarsan in Nevis in October and November, 1911, by Dr. J. Numa Rat, Medical Officer, District No. 6.
Bellevue, Nevis, 24th January, 1912.
SIR,
I HAVE the honour to report as follows to Your Honour with regard to the experiments made by me, in accordance with your instructions, with the drug Salvar- san, in the treatment of yaws patients.
2. In February last year I drew Your Honour's attention to the effective usc of Salvarsan in syphilis, and pointed out that, judging from the very close resemb- lance between the morphological characters of the spirochete which are the active agents in the production of the two diseases, and the similarity of the symptoms of these affections, I thought it very probable that the medicine would be equally efficacious in the treatment of yaws. I subsequently, in the same month, brought to your notice the favourable results which had been obtained in Trinidad and Ceylon by the use of Salvarsan in yaws cases, and suggested that the drug should be employed throughout this Colony, or that, at least, experiments should be made in this island to demonstrate its value.
3. At a later date I received from Your Honour the correspondence between the Right Honourable the Secretary of State for the Colonies and His Excellency,
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Governor Sir Bickham Sweet Escott, on the subject of treating yaws cases with Salvarsan, and in connection with this, an enquiry from you as to the results which I had not then been I might have obtained from the use of the drug in such cases. able to utilise the drug, for want of the necessary accommodation for the patients, and I consequently proposed to Your Honour that arrangements should be made for experimenting with Salvarsan in order to decide whether it could be safely and effectively administered to children of all ages up to twelve, who would be treated with it as out-patients at special dispensaries. I then received your sanction to make the necessary experiments within certain financial limits.
4. The impossibility of securing suitable accommodation for the cases to be dealt with caused considerable delay in initiating the experiments, and I was finally compelled to utilise, with Your Honour's approval, a separate ward of the Alexandra Hospital, which was effectually isolated for the purpose.
5. The next difficulty encountered was the unwillingness of patients to allow their children to be taken to the hospital to be treated for yaws. They objected, I was told, to its being made generally known that their children were suffering from a disease which usually attacks only the lowest classes.
6. After a long search for suitable cases, ten patients, whose ages ranged between 7 and 9, were admitted to the yaws ward between 11th September and 3rd November, 1911, as well as one lad, who was 15 years old. Of the ten cases, two were of a doubtful nature, and presented symptoms which may have been those of either syphilis or yaws. The remaining eight were typical cases, the cutaneous eruption in these consisting of the well-known granuloniata of yaws covered with the characteristic yellow crusts. The patient, aged 15, was said to have suffered from yaws from early childhood, and was in what is called the tertiary period of the disease.
7. The injection of Salvarsan employed by me was one made by dissolving 9 grains of it in 180 minims of sterile water. The water was filtered through the usual filtering paper and boiled for five minutes over a spirit lamp in a glass vessel which had been previously washed with a dilution of one per cent. formalin in rectified spirit. The injections were administered intramuscularly in the upper and outer part of each gluteal muscle, the needle of the syringe being inserted at the level of a line drawn midway between the trochanter and the crest of the ilium. The whole of the syringe, including the needle, was disinfected with one per cent. formalin in rectified spirit. The barrel of the syringe, which held 60 minims, was 21 inches long and inch in diameter; the needle was 2 inches in length and had a wide bore. (This syringe was sufficiently large for injecting into children, but one of nearly twice the size, with a needle 4 inches long, is recommended for deal- ing with adults.)
8. Ten minutes before introducing the needle the tincture of iodine was applied with a feather to the skin at and around the site of the injection over an area of three inches square. Immediately after the injection the parts into which the needle had heen inserted were massaged for five minutes.
9. The quantity of Salvarsan used in each of the first four cases treated was 24 grains, a fourth of the usual ampoule of nine grains. At the end of a week another injection of 1'/ths of a grain was administered to each of these patients, as well as to a fifth one, who was then treated with the drug for the first time.
10. Each of the six cases subsequently admitted received only one injection of three grains.
11. In only two of the eleven cases were there any special symptoms observed after treatment. One of these was the lad of 15 who, as I have mentioned, was in the tertiary period of the disease, and was very emaciated. Like the others, he felt no discomfort except pain during and after the first injection, but the second injection was quickly followed by a feeling of oppression in the chest, and lasted for about three hours. It is doubtful whether this was due to the drug or was the result of the fear of the pain and the consequent excitement caused by the insertion of the needle. In the other patient, whose symptoms may have been those of syphilis, the temperature, which did not rise above 101° in nine of the cases, and rose to 102 in only two of them after the first and second injections, reached 104° three days after the second injection. It, however, fell to 100 on the following day.
12. Pain and a rise of temperature were the only two symptoms observed in connection with these experiments. It is difficult to estimate the amount of pain caused by the introduction of the needle into the buttock. Some of the children
5
cried out loudly enough to suggest they were suffering great agony, but as the shout- ing began before they were touched with the needle, and ceased immediately after its removal, it is probable that they suffered but little physical pain during the opera- tion, which did not last more than two or three seconds in each case. Some received the injection in perfect silence, and showed no sign of pain. The insertion of the needle is certainly not as painful as the extraction of a tooth, and is probably not more so than the operation of vaccination. The pain that follows the injection This is shown by the fact varies in duration and degree, but is never very severe.
that
very shortly after having been injected with the Salvarsan, the boys went about the ward as usual. They all said they felt some pain when they sat down, but they never lost their appetites, and they slept as soundly as usual. (The object of inject- ing the Salvarsan into the upper and outer part of the buttock is to prevent pressure on the painful site of the injection when the patient sits down or lies down.)
13. With regard to the temperature, the charts* and the summary of them sent herewith show that in only two cases did it rise to 102° after a single injection; that in all the others it did not exceed 101°; and that it did not remain above 100° In one patient the temperature rose for more than two days in any instance. gradually to 104° on the fourth day after a second injection of Salvarsan, when only I', of a grain was administered, and fell to 100° on the following day. This was the boy the nature of whose symptoms, as I have already mentioned, was doubtful, and who may have been suffering from syphilis.
The
14. The curative effects of the Salvarsan were observable soon after its injection into the patients in all the cases in which the symptoms were evidently those of yaws. Within a week the eruption underwent a marked change; there were noticeable, even after the first three days of the treatment, a subsidence and shrinking of the growths on the skin. This improvement continued until the end of the second, or of the third week, at latest, when the crusts on the growth fell off, and the sites of the eruption were seen to be as smooth and as healthy as the adjacent skin. previously-affected spots remained for some weeks lighter than the surrounding surface, and encircled by narrow bands of darker shade than that of the skin gener- ally, but they and the hands around them generally regained their natural colour. In those cases in which there was uncertainty as to the character of the disease, the action of the drug was not as striking. There was an equally rapid improvement in the skin eruption, but the alteration was not as complete. In these instances the serpiginous ulcers surrounding the scars were healed, but the disfigurement left by the broad scars due to previous ulceration, of course, remained.
15. Salvarsan is now generally administered in one of two ways, either intra- venously or intra-muscularly. The former is considered the more effective method, but as it is one which would not be practicable among out-patients, I selected the latter in dealing with the cases on which I experimented.
16.
There are different methods of preparing the drug for intramuscular injections, for which directions are given in the literature on the subject, but I chose the one which seemed to me the simplest of all. I used a solution of the Salvarsan in sterile water. The dilution recommended is 1 in 10, but the one I injected in all the experiments except two, which are reported further on, was 1 in 20. The nine grains of the powder contained in one of the ampoules in which the medicine is sold was dissolved in 180 minims of water, and the dose, whatever it was, was injected in equal parts in both buttocks.
17. Besides the above experiments I made others on two adults suffering from yaws. One of these was a man about 40 years of age, who was over six feet high and very muscular. He had been suffering from the disease for over a year, and the eruption on his face and body was as characteristic and as pronounced as in any case that had come under my observation. The contents of one ampoule of Salvarsan (9 grains) were prepared in neutral suspension with ten drops of a 15 per cent. caustic soda solution and sterile water up to 120 minims. Half of this was injected intramuscularly into one buttock, and the other half into the other. This was followed by some pain and a slight fever, which lasted for a few days, but as the patient was treated in his home, which was at some distance, no exact particulars can be given with regard to the temperature. At the end of three weeks the eruption had completely disappeared, the skin at the sites of the yaws excrescences having become as smooth and as healthy as that of the surrounding parts.
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