PUBLIC RECORD OFFICE
Reference :-
TICO. 885
23 PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH—NOT TO
1881-1891
1891-13 1,
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honour to report that, in the absence of a Principal Medical Officer to whom I could refer, I requested all the Medical Officers to prepare the particulars called for in the last paragraph of the despatch.
2. Copies are enclosed of reports by Doctors S. Branch, A. F. Hughes, and D. M. Macphail, which contain all the information that can be supplied. Dr. Branch was formerly in charge of the Victoria Hospital and Dr. Macphail has been in charge of that institution since the 10th November, 1912.
His Excellency
1.
Edward Drayton, C.M.G.,
&c.,
&c., Grenada.
&c.,
I have, &c.,
ANTHONY DE FREITAS,
Administrator (Acting).
REPORT BY DR. BRANCH ON ANKYLOSTomiasis in St. Lucia.
History,
1
The earliest hospital records contain frequent allusions to the symptomatic signs of ankylostomiasis. In 1881 it is stated that cases that at first, from the absence of all evidence of disease beyond the patients' own assertions, might be suspected of malingering soon showed evidence of profound malarial poisoning In 1884 the coolies who arrived terminating in a progressive pernicious anæmia.' by the" Bracadaile," who presented so promising an appearance on their landing, have since proved a great disappointment. In October they commenced to crowd into hospital suffering from malarial fever, debility, anæmia, heart complications, and various skin eruptions." In 1888 " coolies are, as a rule, admitted suffering from anæmia, apnoea, muscular prostration, and cachexy, more or less pronounced "; and in the same year the Medical Officer at Vieuxfort reported cases of "earth eating, anæmia, and dropsy."
During the years of indentured labour the preference of hospital treatment was given to the coolies; as early as 1881 it is noted" that there was little room to spare the creoles (negroes) in hospital."
2. In his report for 1895 the late Dr. Galgey wrote that
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Anemia, tropical anæmia, and progressive anæmia is a disease of such severity, and is so prevalent in the Island, especially among coolies, that the discovery of any means of curing it may be regarded as a decided advance in therapeutics. The number of admissions into Victoria Hospital for anæmia. in 1892 was 209; in 1893, 277; and in 1894, 272. On March 27th, 1895, I got hundreds of specimens as the result of a post-mortem on a coolie woman who. had died of pernicious anæmia in the Victoria Hospital. These specimens correspond exactly with the description of Ankylostoma duodenale of Griesinger."
Early in May of the same year treatment with thymol was begun, two doses of 20 grs. each at intervals of two hours. Furthering his investigations, in his report for 1896 Dr. Galgey wrote-
"These cases prove beyond a doubt that the parasite does not confine its habitat to coolies, but is equally favourable to creoles; and a further perusal of the cases will disclose the fact that not only those located in the Cul-de-Sac and Roseau Valleys are subject to the disease, but that both creoles and coolies living in almost every valley in the Island suffer from it. I think the fact is also established that ankylostomiasis is not confined to St. Lucia, because natives of every part of the West Indies who were but a few weeks here were proved to be suffering from it."
Without in any sense wishing to detract from the excellence of Dr. Galgey's work, it is curious to note that there was never any attempt to form a diagnosis by the microscopical examination of the fæces. The disease was so prevalent, and the symptoms so marked, that thymol was administered wherever a cardinal sign presented itself, and the justification for the treatment verified by a careful washing of stools, and counting the numbers of parasites voided. Though not doubting the accuracy of the statement of the infection of other islands, it should be noted that residence of three or four weeks in infected foci in this Colony is sufficient to warrant infection among newcomers.
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In 1897 the learned doctor, though believing that the source of infection was by ingestion, urged as a preventive measure the introduction of "pit latrines" on all estates, and for collections of dwelling houses in country areas.
In November, 1898, I was appointed to the district of Soufrière. In 1899 I "in that district by microscopical demonstrated the presence of the "hookworm examination, and 22 cases of infection were treated in the district hospital that year.
3. After a period of service in Uganda, I returned to the West Indies in 1903, 1901–1913 and worked for a year in St. Vincent. There I was impressed with the enormous success of the campaign that was being carried on by my brother, the late Dr. C. W. Branch, to whose advice is also due the campaign which was started in Grenada by Dr. Leonard Russell. On taking up the appointment at the Victoria Hospital in 1904 I started a series of examinations for all admissions to hospital, and where- ever infection was found thymol in very liberal doses was administered. By degrees the dispensers were trained to recognise the ova under the microscope, and the examination of fæcal specimens was extended to the general dispensary for the district. It was difficult to make the people understand what the worm was, or that So I collected favourable cases from various it could produce so much harm. localities, treated them, washed the stools, and put each patient's worms, carefully numbered, in separate glass tubes, and used these as object lessons for other patients and their friends. The late Sir Rubert Boyce was much impressed with this little
tubes. artifice, and took away several of
my
It is unfortunate that the natives of the Colony understand and speak so little English. The new-comer, like myself, has to learn the "patois," but even then, perhaps, he finds it difficult to drive home the lessons he wishes to teach. During the time referred to and since there has been hearty co-operation among the medical officers throughout the Colony; and all the recognised forms of treatment are admin- istered both in hospital and among out-patients in every district.
Source of Infection.
4. It is perhaps now impossible to trace the first introduction of the parasite into this Colony. was born in the West Indies, the son of the late Principal Medical Officer of St. Kitts, of great experience; I have worked in that Colony, and cannot recall cases of infection there, and I learn that that has also been the experi- ence of my father. I have conversed freely with the older planters, who have lived and worked all their lives in St. Lucia. They cannot recall any such disease in the hillside. days when the hundreds of mills were crushing canes in every valley on every When the estates were failing, and were being gradually shut down, the native popu- lation began freely to move backward and forward to the gold mines of Cayenne, to Colon, and to Martinique, the latter Island also being in close touch with Cayenne. No one has The parasite is the American hookworm, the Necator americanus. ever found the Ankylostoma duodenale. I do not think there is any possibility that the parasite could have been introduced with coolie immigration. Healthy coolies soon after arriving became infected. I am myself strongly of opinion that Cayenne was the source. The reckless disregard of the native to all sanitary precautions, or even common cleanliness, was all that was required to spread the infection, until it is now wide cast over the whole Island, and spares neither age nor class.
Localities infected.
5. I have appended tables for the years 1909 and 1910, showing that the infection is found in every district. Of 1,243 admissions into the Victoria Hospital for all causes in 1909 no less than 781 were infected, and in 1910 of 1,047 admissions 702 were infected.
Ankylostoma infection in Animals.
6. In 1907 I found that my horse was infected with a parasite that appeared
to be undoubtedly an ankylostome. Since that time both Drs. King and Nicholls have carried out a series of examinations. According to their observations nearly all the domestic stock, i.e., horses, cattle, sheep, and dogs are infected; in some cases death has been attributed to this class of parasite; suitable treatment and preventive measures were recommended.