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If this is done no harm can follow.
These instructions are for your own benefit to prevent you from falling sick from this disease.
by a saline purge. This is repeated when required, or doses of beta-naphthol are given every night for some time.
DIGBY MACPHAIL.
Victoria Hospital,
St. Lucia,
2nd October, 1913.
PUBLIC RECORD OFFICE
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Reference :-
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23 PUBLIC RECORD OFFICE, LONDON
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C
REPORT BY Dr. HUGHES.
ANKYLOSTOMIASIS."
Prevalence.
Ankylostomiasis is extremely prevalent throughout the Colony, and I should say that over 50 per cent. of the labouring class harbour the parasite. I do not think that the condition is now very much more prevalent than formerly, the apparent increase in the number of cases being due to the fact that the disease is more easily recognised now, and medical men are on the look-out for it. In all doubtful and early bases examination of the fæces removes all doubt.
Distribution.
The disease is distributed throughout the Colony, but is met with more particu- larly around the central sugar factories, where large bodies of agricultural labourers live under conditions which are far from sanitary. Practically every individual returning from the Cayenne gold fields is infected.
Prophylaxis.
I attach a leaflet* which was issued some time ago by the Board of Health, and which, it was hoped, would help to educate the people as to what prophylactic measures were to be adopted. This, I fear, has not met with the response that was expected. Managers and owners of large estates do not provide proper latrine arrangements for their labourers, with the result that excreta are deposited in all conceivable places, and so infection is spread. It must be borne in mind that we are very much handicapped, as the labouring class here cannot read or understand English, only wear boots on state occasions, and do not pay any attention to the elements of hygiene or cleanliness.
An effort is being made now to teach elementary hygiene in the public schools, and this, it is hoped, will have some effect.
Treatment with drugs is our sheet-anchor. Each case coming under notice is put under treatment, in addition to explaining to the patient how the disease is spread, and how to avoid it; of late, after the preliminary routine treatment, I put the patients on B-naphthol every night for some time, as recommended by Dr. Ferguson, of British Guiana.
Castries,
19th September, 1913.
REPORT BY Dr. MACPHAIL.
A. F. HUGHES, M.B.
Ankylostomiasis is extremely prevalent throughout the whole Island. I do not know of any one locality which can be said to be markedly more affected than another, but the population of the country districts appears to be somewhat more generally infested with the parasite than the population of the towns and villages. The parasites infest not only human beings, but also some of the lower animals, but of the latter I have little experience.
A large number of patients admitted to the Victoria Hospital for other diseases are found, on examination of the fæces, to be also infested with these parasites. Wherever there is the slightest suspicion of an ankylostome infection, an examination is made, and if the ova are found, the necessary treatment is carried out. naphthol is the drug which I am accustomed to use, and I find it quite satisfactory and safe to use. I give it generally in 3 or 4, 10 or 15, gram [ grain] doses, followed
• Appendix to Dr. Branch's report.
Beta-
Enclosure 3 in No. 8.
THE ROCKEFELLER INTERNATIONAL HEALTH COMMISSION: ANKYLOSTOMIASIS.
The Committee appointed by His Excellency the Acting Governor to inquire into the prevalence of ankylostomiasis in Grenada, and draw up a report for the Rockefeller International Health Commission, has examined the reports of the District Medical Officers, and has obtained all the information available on the subject.
The Committee finds :—
(1) That the disease is prevalent throughout the Colony, but the actual extent of this prevalence is not known, as there never has been any systematic inquiry into the matter except for a short time at the Colony Hospital by Dr. Leonard in 1905, and by Dr. Cockin in 1911.
A few of the Medical Officers have expressed opinions that the disease was not prevalent in their districts, but the number of cases admitted to the Colony Hospital from these districts would indicate that it was prevalent.
These patients were probably admitted for other complaints, and found to be suffering from ankylostomiasis as well.
(2) That ankylostomiasis has been known in Grenada since 1896, when the parasites were found at post-mortems held at the Colony Hospital.
(3) That the districts mentioned in Dr. Leonard's report in 1905 as being most infected are still sending the most cases to the Colony Hospital.
(4) That while St. Andrew's Parish, the largest parish in the Colony, would appear to be less affected than the others, it will probably be found that the explana- tion of this is that few patients of any kind are sent to the Colony Hospital from St. Andrew's, that parish having its own hospital.
(5) At the conference on tuberculosis held in Trinidad in March last, it was made clear that ankylostomiasis was a considerable factor in the spread of tuberculosis in the West Indies.
(6) Dr. Leonard, in 1905, and Dr. Cockin, in 1911, published articles on the prevalence of ankylostomiasis in Grenada.
These officers were in charge of the Colony Hospital at the time the respective articles were written. Copies of these articles are attached, as well as a return from Dr. W. S. Mitchell, at present Acting Resident Surgeon of the Colony Hospital. (7) The cause of the prevalence of the disease is not far to seek; there is no rural conservancy to control the disposal of human excreta; everyone disposes of it as he or she thinks fit.
Usually it is thrown on the surface of the soil under the cocoa, in the garden, or in a drain.
In the country, anyone leaving the main road and taking a short cut, or passing along a narrow path, soon has his sense of smell offended by human filth.
A very large proportion of the people of Grenada go about without boots or shoes, and many of those who wear boots away from home go about their gardens in bare feet.
In some parts of the Colony people have to drink water from drains and small rivulets contaminated by this filth.
(8) An Ankylostomiasis Ordinance was passed in 1910, but many of the pro- visions of this Ordinance are difficult to carry out, and the machinery provided is inadequate.
The Ordinance is also defective in some respects.
A leaflet on hookworm has been published and circulated by the Board of Health. (9) Persons suffering from ankylostomiasis are usually sent to the hospitals, but some of the Medical Officers treat cases at their own homes by thymol and beta- naphthol, the treatment having been preceded by a saline purge, and followed by a inixture of iron and arsenic.
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