PUBLIC RECORD OFFICE
Reference :-
PLLC.O. 885
23 PUBLIC RECORD OFFICE, LONDON
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I. ROUTINE WORK.
1. Widal examinations.-During the period under review 626 specimens of blood have been sent to the Laboratory for this test to be carried out, and of these 209, or 33-39 per cent., gave a positive result; 380, or 60-70 per cent., were negative; while 37, or 5-92 per cent., were doubtful. The number of positive reactions is 65 per cent. lower than in the previous six months.
"The thirty-seven noted as doubtful comprise those sent up too early in the disease, when there was, perhaps, loss of motility only, with little, if any, attempt at agglutination: under such circumstances another specimen was always asked for, to be sent in two or three days' time. But, even if all the doubtful cases were added to the positive, the number and proportion of the latter would still be below that of the preceding six months.
Table II. gives the results month by month, Table III. the results of the specimens sent up from Kingston, and Table IV. the districts whence the various specimens were forwarded.
2. Blood smears and specimens for malaria, filaria, etc.-The second of these may be dismissed at once. Repeated examinations have again failed to demonstrate filaria in a single instance of a Jamaican subject-filaria, that is, con- tracted in the Island. Two patients only showed filaria, and these were both students at the Training College at Shortwood, who had come to Jamaica from British Guiana to take their course.
As regards malaria, of 530 patients whose blood was examined for these parasites, the blood contained them in 59; of these, the Pl. falciparum alone was found in 40, Pl. viraz alone in 8, Pl. malaria alone in 5, Pl. vivax and falciparum in 2, Pl. malaria and falciparum in 1, Pl. vivax and malaria in 1, while in two the variety was uncertain.
3. Examinations of fæces for helminthiasis, dysentery, etc.-The latter may be readily disposed of. One hundred and thirteen specimens have been sent up from cases exhibiting dysenteric symptoms, and in sixty-one of these the amoeba was found to be present.
This
may
As regards the question of helminthiasis. In spite of treatment by thymol carried out in the various districts, there is apparently no diminution in the pre- valence of ankylostomiasis in the Island generally.
be attributed, judging by the laboratory examinations (it is only from this aspect of the question I feel entitled to speak), to one or both of two causes; either the treatment is not I think carried out energetically enough or else early reinfection takes place. that both causes play a part, for in some districts specimens are sent again and again from the same patients with little or no change in the numbers of ankylos- tomes seen, while in others the faces before treatment abound with the ova, at a second examination they are quite scarce and at a third cannot be found at all. showing how effectual the treatment has been. Within a short time, however-it may be a matter of three or four weeks only-another specimen from the same patient is again crowded with ova, pointing to reinfection.
The actual state of things in Jamaica in general, and in the various districts individually, is clearly shown by the appended Tables V., VI., and VII. Table V. gives the detailed findings in specimens sent up from the various districts, and shows not only the numbers found infected but also the different combinations of worms present. Table VI. gives the percentage of specimens found infected in each district from which one hundred or more have been sent up during the six Table VII, is months under review, and also the same ratio for the whole island. instructive in showing the percentage of each variety of worm, calculated on the basis of positive results-i.e., in place of percentage on the number sent up, it shows what the proportion of each parasite, singly and in combination, has been relative to the total found infected. Table VI. is additional to the figures given in my last report, because some who have read the previous ones have misunder- stood their import. The percentage table (corresponding to the present Table VII.) has been taken to imply the degree of infection of subjects in this island, whereas it is stated that the figures are the percentages of positive findings, and is instructive in giving the relative ratios in which the different varieties of worms are present, and not the ratios in which they were present in all specimens sent up. In order to avoid such a misunderstanding I have compiled Table VI., which gives the latter information.
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Volumes might be written on the points revealed by these tables, but the main one I would like to emphasize is the peculiar distribution of the worms in different. districts. For example, in Linstead, in the larger proportion of specimens, all three parasites are found together; in Black River the ascaris is commoner than any of the others; while in Buff Bay and Port Maria districts 78.92 per cent. and 8214 per cent. respectively of the positive findings contain ankylostome alone, and only an additional 16 per cent. in each case show combination with other worms.
Perhaps the point is more clearly brought out by comparing two places whence nearly the same number of specimens have been sent, and the number positive is about the same; for instance, Montego Bay and Port Maria. In com- paring the figures for these two places, ankylostome alone was found in 58 of the former, but in 138 of the latter, while ascaris was only found once as the sole infection in Port Maria, and in union with others only 15 times, as compared with 76 at Montego Bay.
I am unable to put forward any suggestion to explain this peculiarity of distribution.
4. Examinations of specimens of pus, urines, and sputa do not call for any comment, as they come under the ordinary laboratory routine.
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5. Examinations of rats.—One thousand four hundred and fifty-six of these One have been examined, but in no instance has Bacillus pestis been isolated. matter in this connexion i8 worthy of note, namely, the frequency with
the livers which
of these rodents contain encysted cestodes. There may be only one, but in some livers I have seen as many as seven- teen, so that the organ appeared to consist almost entirely of coiled-up tapeworms enclosed each in a separate membrane. I have no literature here refer to regarding the animal parasites of rats, and cannot identify these worms; therefore, possibly they are Tania crassicollis. A brief description will not be out of place. The head shows four suckers, inarmate; a roetellum with two rows of hooklets, usually sixteen in each row, but I have counted as many as eighteen in a row-thirty-two to thirty-six hooklets in all. The length of the worm has varied from 3 cms. up to as much as 20 cms., terminating in each case in a swollen, pear-shaped segment, and the number of segments varies from 40 to 320 or a little more, which is the longest I have come across. In no instance have I found any indications of differentiated sexual organs. Occasionally, but very rarely, I have found a cysticercus form with invaginated head showing the four suckers and thirty-two booklets.
8. Bacterial examination of water supplies.—In addition to the regular monthly examinations of the Kingston water supplies, some samples of mineral waters made and sold in the town have been submitted to analysis at the request of the Acting Medical Officer of Health. In all, sixty-nine analyses have been carried out during the six months under review.
7. Autopsies of special cases.—One hundred and twenty-nine of these have been performed; and of the number the following are worthy of detailed mention:-
(1) J.R., male, 35 years. Admitted 24th September, 1914, complaining of pain in the abdomen and back; stated that he had been ill for two months. No history of any injury. Temperature 990 Fahr. Constipation trouble- some, no vomiting; tenderness in epigastrium, no distension of abdomen. Thoracic organs apparently normal; no albuminuria. During the succeed- ing fortnight there was no improvement, in fact, the abdominal pain and tenderness increased. A month later there is a note to the effect that the patient was jaundiced and was growing weaker, and that there were distinct nodules to be felt in the liver. The weakness increased, and the patient died about six weeks after.
At the autopsy the liver was found to be crowded with secondary nodules of a growth the primary seat of which was the pancreas. The head of this organ was altered into one large mass, which projected against and pressed upon the common bile duct. The stomach was free of growth, and there were no markedly enlarged glands in the portal fissure. Šection of a portion of the growth proved it to be carcinoma.
(2) L.M., female, 4 years old, black. Was suddenly seized with vomiting and convulsions at noon on 17th December, 1914, and died in three hours. At the autopsy the thymus was found to be large, measuring 13 cms. x 8 cms. × 2 cms., and extending fully two-thirds over the front of