PUBLIC RECORD OFFICE
Reference :-
C.O. 885
23 PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO
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(10) The treatment of cases in hospitals or in their own homes will, in itself, be quite insufficient to eradicate the disease from the Colony.
Proper latrine accommodation must be placed within the reach of all, followed by a rigorous enforcement of a law compelling people to use them. Inspectors should be appointed to see that this law is carried out.
Grenada,
12th October, 1913.
E. F. HATTON,
G. W. PATERSON, T. C. ORFORD,
Members of Committee.
REPORT BY THE HOUSE SURGEON OF THE COLONY HOSPITAL ON ANKYLOSTOMIASIS IN GRENADA.
Ankylostomiasis is an endemic anemia caused by the parasite Ankylostomum duodenale or Uncinaria duodenalis, and if untreated is a dangerous disease. In this island the disease appears to be widespread, affecting chiefly the labouring classes. From the 1st April, 1904, to the 31st December, a period of nine months, 150 cases of this disease were treated at the Colony Hospital, 80 cases were admitted for the disease pure and simple, and the other 70 cases were complicated with other diseases.
The following table shows the district distribution of the cases treated :-
St. George's District
St. Mark's
21
St. John's
**
St. Patrick's
""
St. David's
17
St. Andrew's
Total
59
26
26
19
14
6
150
In the St. George's district, the villages from which the largest number of cases came were Mount Moritz, Happy Hill, and Constantine.
The true diagnosis of this disease depends on the discovery of the ova in the fæces of the patient, besides the other well-known symptoms, both subjective and objective; and it is doubtful whether the disease has been recognised in the districts without the use of the microscope to confirm the diagnosis; but in any case, it has not, and in fact cannot, be treated at the patients' houses, owing to the tonic and dangerous nature of the drug employed, viz., thymol, and also that the patient requires to be properly prepared for the administration of the drug days previously. This disease is an important one to all planters and estate owners from the labour point of view, owing to the inefficiency it causes among the labourers on the estates, and also to the community, as inability to work among a class who depend entirely on manual labour for their existence leads to pauperism and a deterioration, both mental and physical. Its results are very grave, as a long-continued infection, combined with inadequate food, both as regards quantity and quality, leads to degeneration of various organs, especially the heart, from which recovery is often impossible, and a fatal issue probable. The rate of progress of the disease is usually a slow one, going on for months and even years, and utterly unfitting the sufferer for any form of manual labour.
Symptoms.—The disease, as stated before, begins very insidiously, usually with dyspeptic troubles, such as pain or uneasiness in the epigastric region after food; in many cases the pain is constantly present, and then often is greatly aggravated by the ingestion of food and sometimes relieved. The appetite is very often lost, but, on the other hand, may be ravenous. Fever of an irregular, intermitting type is common. Many of the cases seek treatment at this stage, and unless a careful microscopic examination of the fæces is made, a true diagnosis is not arrived at and the case treated for months as one of simple dyspepsia with no beneficial result.
Other cases seek treatment in the next or the stage of anemia, either just beginning or very advanced; this stage is also gradually reached, the symptoms com- plained of are severe and continued headache, vertigo and giddiness on stooping, breathlessness and palpitation on the slightest exertion, dimness of sight and extreme tinnitus; the skin assumes a dull earthy-looking hue, and the mucous surfaces are pale and bloodless. The feet and ankles become swollen and oedematous, and in children there is general anasarca; great langour, lassitude, and disinclination for
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any kind of work, mental or physical, is complained of, and the temperature in such cases often is subnormal.
If these cases are now carefully examined hæmic bruits are heard over the heart and great vessels, and in advanced cases dilatation and serious cardiac troubles may be present; in many cases the patients looking well nourished.
If the blood is now carefully examined with the microscope a marked esinophylia
is present; this is seen in certain other diseases as well, but on making another care- ful microscopic examination of the fæces the ova of the parasite will be found; sometimes only a few may be seen and at others a large number.
Pigmentation of Tongue.--Among the blacks and also the East Indian labourers I have noticed a peculiar pigmentation of the tip and sides of the tongue, consisting in some cases of minute spots, blue or blue-black in colour, and in others of larger areas. This pigmentation is not seen in Europeans or the poor whites of this island, but, as I mention, only the pigmented races, and is found invariably associated with the anemia and the presence of the ova of the parasite in the fæces. I am certain that this sign is of diagnostic value, and the theory set forward by one of the Medical Officers in St. Lucia, that it is due to the staining produced by chewing the phan plant, may be set aside, as the pigmentation is seen in children whom Ï have had under treatment in the Colony Hospital, and who have never heard of or eaten the phan leaf.
Prophylaxis. It has been conclusively proved that this disease is communicated through the fæces containing the ova of the parasite, the infection taking place through the skin, usually the feet, the ova developing in the soil. Hence the chief essential is a prevention of fæcal contamination of the soil in order to eradicate the diseases. The promiscuous depositing of fæces about the huts, villages, and fields should, if possible, be prevented, but, owing to the low standard of intelligence among the class chiefly affected, this is an impossibility. But on all estates where huts are provided for the labourers, easily accessible privy accommodation should be provided; no elaborate system of sanitation is required; pits or trenches would do, these to be filled in from time to time and fresh ones opened.
66
or
16
The ova develop in fresh earth in the presence of water, and thus the deposition of the fæces in the fields where the labourers work, or around the huts and villages, forms the essential requirement. The embryo finds an entrance into the system through the skin, and the dermatitis affecting the hands and feet chiefly of labourers, or chauffie in these islands, has been known as
water itch ground itch"
The water proved to be due to the penetration of the skin by these embryos. supply may in like manner carry the infection, as the ova during the rains are washed down into the springs, wells, or pools which form the usual source of the water supply to many of the villages. Therefore the essential points for the pre- vention of this disease are-
(1) to prevent fæcal contamination of the soil by suitable privy accommo-
dation in all villages, in fact, each hut should have its own;
(2) the water supply must be properly guarded against all sources of con-
tamination;
(3) any field or land which is shown to be largely contaminated should be
completely dug over, and bush fires burnt over it.
The proper procedure on all large estates would be an examination of all labourers from time to time, and all cases of dyspeptic troubles and anæmia should have a microscopic examination of the fæces made, and, if the ova are found, imme- diate treatment of the case would prevent a serious disease in the labourer himself, and also prevent him from being a source of danger to his fellows. This cannot be done without an outlay on the part of the planter or estate owner, but in my opinion a yearly expenditure would prevent the disease spreading among their labourers, and so prevent the inefficiency and loss of labour which must ensue, tending to increase pauperism; and the result in the end would be a very adequate increase in the monetary as well as the labour point of view. But as long as estate owners, &c., do not stir to help, nothing can be expected from the labouring class with their The health authorities of each district should see to the limited intelligence. prevention of fæcal contamination, both of the soil and of the water supply.
Owing to the danger attending the use of the drug employed in this disease, the treatment, despite former reports that it is and has been done, cannot be car- ried out in the houses of the patients, but must be carried out in a hospital, where the cases can be properly prepared, a suitable diet ordered, and the administration