PUBLIC RECORD OFFICE
Reference :-
mmimmimC.O. 885.
23 PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO
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(b) The extra expense would be heavy, necessitating an extra vote.
(c) The number of cases treated in a year would be so small that it would take many years to take in and treat the existing cases, without counting the new cases, that, of necessity, must arise from the cases awaiting treatment.
I soon saw that the only way, under our conditions, was to treat as many cases as possible in the shortest possible time, and the only way to do this was to pass the cases as rapidly as possible through the hospital. In this method lies our only hope of eradicating yaws entirely from Antigua. We are well on our way now and, I hope, nearing the last case: this would have been already accomplished if the supply of salvarsan had been sufficient, but the number of cases of yaws is far in excess of the estimated number.
It might be interesting to compare our methods and results with those of other islands, say, St. Kitts.
During the whole of 1914, in the special yaws hospital in St. Kitts, only 120 cases of yaws were treated by salvarsan, and the upkeep and salaries of the staff were £127 4s. 2d., or, roughly speaking, a little more than £1 a case (not counting the cost of salvarsan). Here in Antigua we have treated 286 cases of yaws without adding a penny to the current notes. In St. Kitts they have treated 120 cases and added £127 4s. 2d, to the votes.
Again, suppose they have 400 cases of yaws in St. Kitts (a very low estimate) it would take them three-and-a-half years to pass their cases through their hospital, and during that time new cases would be arising from infection from the cases waiting treatment. The chances of overtaking and eradicating yaws under those methods are indeed remote or well-nigh impossible.
To the end of December, 1914, we have treated 286 cases of yaws with salvarsan and all are now cured. Recently we have received a fresh supply of salvarsan, and These will be to date (10th February, 1915) have treated thirty-six more cases. reported on later, as some of them were treated only a few days ago.
This is all very well, and I think the results are most brilliant and encouraging: but two things further must be done :
(1) The last case in the island must be hunted up and promptly treated; this will necessitate an efficient medical examination of all school children and even infants of all ages.
(2) The refusal to admit cases of yaws into the island from neighbouring islands, except through the hospital for prompt treatment.
Some provision must be made for the medical inspection of all persons arriving (in sloops and small boats specially) from neighbouring islands. Otherwise there is nothing to prevent fresh cases of vaws arriving from Montserrat, Dominica, or St. Kitts where yaws is rampant. This, indeed, would be a calamity, after having cured our last case in Antigua.
10th February, 1915.
21314
No. 110.
W. MCDONALD Medical Superintendent.
THE LIVERPOOL SCHOOL OF TROPICAL MEDICINE to COLONIAL
SIB,
OFFICE.
(Received 8th May, 1915.)
B 10, Exchange Buildings, Liverpool, 30th April, 1915. I HAVE the honour to enclose, for the information of the Tropical Diseases Advisory Committee, the following reports of the Liverpool School of Tropical Medicine, for the six months ending 30th April, 1915, on the work done in con- nexion with the Government grant, viz. :—
1. Report of the Sir Alfred Jones Professor of Tropical Medicine (Pro-
fessor J. W. W. Stephens).
2. Report of the Dutton Memorial Professor of Entomology (Professor
Robert Newstead).
3. Report of the Lecturer in Parasitology (Dr. H. B. Fantham).
4. Report of the Director of the Runcorn Research Laboratories of the
School (Dr. B. Blacklock).
103
I also enclose statement showing the expenditure of the Government grant for the year ending 31st December, 1914.
The Sir Alfred Jones Tropical Ward of the School. I have also to inform you that, on the 23rd July, 1914, the new ward, which has been built out of funds voted to the school by the executor of the late Sir Alfred Jones, was opened by the Countess of Derby.
Reference has been made by the Sir Alfred Jones Professor of Tropical Medicine regarding the same in his report, and I enclose herewith printed copy* of the proceedings at the opening ceremony.
SIR,
Enclosure 1 in No. 110.
I am, &c.,
A. H. MILNE,
Secretary.
B 10, Exchange Buildings, Liverpool, 1st May, 1915.
I BEG to submit the following report on the work done during the period from 1st November to 30th April, 1915.
Students. The number of students who attended the autumn term was 11, and the number for the Lent term 4; total 15.
Diploma of Tropical Medicine. The number of candidates for the examina- tion in December was 8, all of whom passed. The number of candidates for the April examination was 3, all of whom passed.
Museum.-The thanks of the school are due to the following gentlemen for their kindness in sending specimens to the school during the last six months:-Major Kenrick, I.M.S., Pachmari; Lieutenant-Colonel J. A. Wyllie, Island of Principe; Dr. Moore Alexander, Liverpool; Mr. N. Pillers, F.R.C.V.S., Liverpool; Dr. J. W. Scott Macfie, Lagos; Dr. J. F. Corson, Gold Coast; Dr. J. Hill Abram, Liverpool: Major Hooton, I.M.S., Rajhot, India; Mr. Atherton, New Guinea; Major Clayton Lane, I.M.S., India; Dr. Arnold, Transvaal; Dr. T. Gann, British Honduras; Major E. D. W. Greig, I.M.S., Calcutta.
Blackwater Fever. The third of my "Studies in Blackwater Fever," entitled "The Relationship of Quinine to Blackwater Fever," was written in conjunction with Mr. W. Stott, Honorary Statistician to the school. We proceeded to examine whether any relationship exists between the time at which quinine is taken and the time at which blackwater is passed or the rigor ensues. One of the difficulties that confronted us, to which I have already referred in my previous studies, was the vagueness and incompleteness of the records. For instance, in very many reports the time at which the blackwater came on was not more definitely stated than "in the early morning," "at night," etc. It would have been as easy and much more valuable to have stated the exact time. From an examination of the records in litera- ture we were able to avail ourselves only of 372 cases. We found from an examina- tion of these that there is a correlation or relationship between the time at which quinine is taken and the time at which blackwater (or the rigor) occurs.
1. The most frequent time (or "mode' as it is called) at which quinine is taken is 6-9 a.m. (based on 157 cases). This interesting result of our analysis was quite unexpected by us. Now, in all probability, it is true that quinine is most commonly taken at breakfast time. If this is so, it, of course, explains our result, and, moreover (a most important point), it shows that we had escaped the error due to random sampling (i.e., due to not taking a sufficiently large sample). Our data with regard to quinine are in fact consistent with what is very probably the truth, viz., that "breakfast time" is the commonest time at which quinine is taken. If, then, we have eliminated the error due to random sampling as regards quinine, we have also done so in the data regarding blackwater and rigor, for these latter are from the same cases.
2. The most frequent time (or mode) at which blackwater occurs is 9 a.in.- 12 noon (based on 103 cases).
3. The most frequent time at which the rigor ensues is 9 a.m.-12 noon (based on 88 cases).
4. Statistically we then showed that a strong correlation (or fit) existed between the times at which quinine was taken and blackwater or rigor occurred.
* Not reprinted.
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