82
in this district 31 per cent, show no departure from health due to harbouring anky- lostomes, and 27 per cent. only a mild degree of anemia, which may or may not be due to ankylostome infection. That is to say, nearly 60 per cent. can fairly be classed as 'carriers.' Another 27 per cent, have only mild symptoms, and though it is probable that they have been harbouring ankylostomes for years, are not suffer- Severe cases are extremely rare, for ing any serious inconvenience on that account. if existing in any number they must certainly have been unearthed in examining such a large number of people."
Dr. Eldred suggests that a racial tolerance has been acquired, and he does not regard the disease as one of any serious importance, as affecting the welfare or efficiency of the native of the North Nyasa District.
3. With regard to double infection with malaria and ankylostomiasis, Dr. Eldred has examined 275 children, both for enlarged spleen and for the presence of ankylostome ova in the stools, regarding splenic enlargement as a criterion of infection by malaria. He found that anæmia was present in 58 per cent. of children infected with ankylostomes, and in 62 per cent. of those who were uninfected.
Of those infected with ankylostomes :-
38 per cent. had both enlarged spleen and anæmia.
21 per cent. had enlarged spleen and no anæmia.
20 per cent. had no enlarged spleen and anæmia.
21 per cent. had neither enlarged spleen nor anæmia.
Dr. Eldred goes on to say, "The deduction is that 59 per cent. of children with and 20 per cent. from a certain ankylostomes are also infected with malaria. degree of anæmia, probably not due to malaria, and possibly due to ankylostome infection; the remaining 21 per cent. being free from malaria, the ankylostome infection not causing any anæmia.”
With regard to other symptoms produced by ankylostomes, Dr. Eldred gives the following table:-
General Development.
Percentage of Children showing one or more of the symptoms detailed below.
Good.
Fair.
Bad.
Circulatory.
Anemia, with or Gastro-intestinal. without Enlarge. ment of Spleen.
83
African has acquired, is a matter for conjecture; tolerance being here used in the sense that a person infected with ankylostomes may exhibit no symptoms of anky- lostomiasis.
As regards prophylaxis, the whole problem of prevention may be summed up by saying that what is essential is the construction of deep trench latrines. Medicinal treatment, though a useful adjunct, must be regarded as a subsidiary measure; for if the soil continues to be polluted re-infection will necessarily follow.
As a preliminary to the construction of latrines, the amalgamation of scattered This concentration of the communities into villages of some size is necessary. population is already taking place in some districts, as the result of the operation of the District Administration (Native Villages) Ordinance; and the measure should be extended so as to apply to all districts.
It will readily occur to those members of the Advisory Committee who have experience of Africa or the East that at most partial success is all that is antici- pated. Reference has incidentally been made to the United States and to British Guiana, wherein remarkable results have been achieved. It needs to be borne in mind, however, that in the States we are dealing with a European population, accustomed to the use of latrines, and where infection is largely attributable to their faulty construction. In British Guiana eradication of the disease has been possible on plantations where the workers are limited as to numbers, compactly housed, provided with suitable latrines, and where at all times they are accessible for examination and treatment.
None of these conditions obtain in a country such as this; but with a population amenable to control and not altogether wanting in intelligence, it is hoped that some measure of success will ultimately be attained. The construction of latrines, and insistence on the people to use them, after the underlying objects have been fully and repeatedly explained, is in itself a sanitary reform of much value, which needs to be persevered with; for, apart from ankylostomiasis, such a measure will also operate in the direction of minimizing the danger of fly-borne and water-borne diseases as well.
I have, &c.,
The Honourable the Acting Government Secretary.
H. HEARSEY,
Principal Medical Officer.
PUBLIC RECORD OFFICE
Reference :-
गय
C.O. 885
23 PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO
Infected Non-infected
Per cent.
Per cent.
Per cent.
64 66
32 82
4 2
Per cent.
8
Per cent. 28
· 12
Per cent. 58
14510
62
4. Dr. Eldred states that of 129 children infected with ankylostomes not a As close a watch as possible has single case of arrested development was seen. been kept on these cases, and up to the 31st December only one child is reported to have died. As will be seen on reference to the preceding table the infection has very little influence on physique. The symptoms most commonly met with in children were gastro-intestinal, and in 16 per cent. these symptoms were probably directly attributable to ankylostome infection.
5. An area in the neighbourhood of Karonga, in the North Nyasa district, has been selected and kept under observation for the past six months. Prophylactic measures in operation therein include the systematic treatment of all cases of infec tion, the erection of suitable latrines, and attention to the general sanitation of the villages. I am of opinion that it is advisable to await the results of these measures before embarking on any other line of action.
From what has been said by Dr. Eldred, the Medical Officer specially deputed for duty in connexion with ankylostomiasis, it will be seen that as regards the North Nyasa district, in which the question has been studied with some degree of closeness and continuity, no very appreciable difference as to unfitness for work, or poorness of physique, is noticeable among the infected as compared with the uninfected; and that as regards children the harbouring of ankylostomes can hardly be said to cause arrested development, or to influence the death-rate in infants.
These findings are, however, not in accord with the observations which have been made in the United States on the one hand, and in British Guiana on the other. Whether or no there is in respect of this infection a racial tolerance, which the
No. 40.
THE INTERNATIONAL HEALTH COMMISSION, WASHINGTON, to
14794
SIR,
COLONIAL OFFICE.
(Received 10.20 p.m., 13th April, 1914.)
TELEGRAM.
[Answered by No. 42.]
FOUR West Indian budgets adopted.-INTERNATIONAL HEALTH COMMISSION.
No. 41.
INTERNATIONAL HEALTH COMMISSION to COLONIAL OFFICE. (Received 22nd April, 1914.) [Answered by No. 42.]
725, Southern Building, Washington, D.C., 13th April, 1914. THE budgets submitted by the British West Indian Colonies and approved at London by the Ankylostomiasis Committee and the Secretary of State for the Colonies have been adopted by the International Health Commission for sums not to exceed the following amounts respectively:
Trinidad Grenada
St. Lucia
St. Vincent Antigua
£2,421
1,856
1,262
1,148
775
F 2