PUBLIC RECORD OFFICE
Reference :-
C.O. 885
23 PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH—NOT TO
Bigbest
21 lbs.
Group 1.
88
Of the 29 boys who attended three times, 16 were technically cured, that is to say, not only did they cease to exhibit any signs of the disease, but they ceased to expel any worms. Of the remaining 13, 12 were practically cured, i.e., they have ceased to exhibit any sign of the disease, and they have improved in physical con- dition and have gained in weight, but they continue, however, to expel a few worms. Such cases are classified by Ashford and King, in the Records of the Puerto Rico Investigation as "practically cured."
Only one boy failed to respond to treatment. His weight remained stationary and his physical condition much the same.
The average gain in weight for these 29 boys is 4lbs. each, for a period of three and a half months, and five boys showed the high individual gains of 14 lbs., Of these five cases, two were mild, one 11 lbs., 10 lbs., 10 lbs. and 10 lbs.
moderate and two marked.
It is a very significant fact that these boys, who averaged a gain of 43 lbs. each on the third attendance, had averaged a gain of only 14 lbs. on their second attend- ance, showing the beneficial effect of the second course of treatment.
These boys have lost all their anæmia and show marked physical improvement. Group II.
These 16 boys were unable to return for a third course of.treatment in March, as they had been either discharged from the school or sent out to work as appren- tices. The results in this group are recorded only six weeks after treatment, and are the effects of only one course of treatment. This is deeply to be regretted, for the rate of improvement is seen in Groups I. and III. to have been very much greater during the six weeks succeeding the second course of treatment than during the six weeks succeeding the first course of treatment. The recorded results in this Group therefore do not by any means adequately represent the benefits which these boys have actually received through treatment. Thus these records, taken in Jan- uary, show an average increase of weight of only 14 lbs., which, however, is slightly greater than the average increase in Group I. at the same period. The January record of this shows, moreover, that three of these boys had lost weight and one had gained nothing and showed a practically unchanged physical condition.
So convinced was I, however, that these boys would ultimately improve sub- stantially as a result of the second course of treatment, that I made a special effort to hunt them up and succeeded in getting five boys up for a clinical examination on 12th April, the result of which is highly satisfactory and is classified under the heading of Group III.
Of these five boys in Group III. there were two who, having showed a loss of weight of 14 lbs. and 14 lbs. in January, now showed a gain of 4 lbs. and 7 lbs. respectively. The third boy (Case No. 36), whose weight in January was unchanged, has now gained 4 lbs.: the fourth case (Case 14), having shown a gain of 10 lbs. to The fifth boy subsequent second treatment, now showed a further gain of 4 lbs.
(Case No. 35) shows the most astonishing results in the whole series. This boy, suf- fering from a moderate infection, gained 1 lb. only in six weeks after the first treatment, but in twelve weeks after the second treatment he has actually gained individual 201 lbs., showing a total gain of 214 lbs. This is all the more remarkable in view of the fact that he was of good average development when he came under treatment, and illustrates in a remarkable manner the good effects to be obtained by treating the cases of moderate infection; and this is the type of the disease the importance of which is denied and the presence of which is most commonly overlooked, or wil- fully ignored, by medical as well as by lay authorities.
These five boys showed also on clinical examination, in addition to increase of weight, marked improvement in their general physical condition and complete absence of anæmia, although they had all been suffering from anæmia before
treatment.
In summarizing these results we find that the boys in Group I. show an average gain of 44 lbs.
The boys in Group II. show an average gain of 11 lbs.
The boys in Group III. show an average gain of 10 lbs.
21 boys have been technically cured.
21 boys have been practically cured.
1 boy is improved, but not cured.
2 boys failed to respond to treatment.
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The failure of these two to react to treatment may be due to a natural immunity, cases of which have been recorded by Stiles, especially among negroes.
A noticeable feature of the record is the proportionately increased improve- ment in weight and physical condition which is observed in the period subsequent to the second course of treatment, showing in a marked manner the beneficial effects I would like to draw particular attention to of the second course of treatment. the marked response to treatment of cases of the moderate type; thus, of the six highest individual gains of 211 lbs., 14 lbs., 14 lbs., 111 lbs., 10 lbs., and 10 lbs., four of these are of the moderate type. These results particularly emphasize the gain to the community in economic efficiency which would be obtained by an organized attempt in investigating, treating and preventing this disease.
I attach a table setting forth the improvement in weight and physical con- dition in Groups I., II., and III. respectively.
I deeply regret there was no hemoglobinometer available for the examination
of these boys, as regards their percentage of hæmoglobin, before and after treat- ment. A hæmoglobinometer has now been obtained for future work.
In regard to preventive measures, I have drawn up for use in the Industrial In framing these rules I have School a few simple notes and sanitary rules. endeavoured to suit them to local conditions and to make them as simple and prac- tical as possible. These notes and sanitary rules are attached.
20th April, 1914.
ANCHYLOSTOMIASIS,
W. M. McDONALD,
Medical Superintendent.
Anchylostomiasis is a disease caused by a minute worm which lives in the intestines of man and gives rise to poverty of blood.
Symptoms.-Pallor skin, lips and tongue. Breathlessness on slight exertion. Beating of the heart. Pain in the pit of the stomach and giddiness.
Anchylostomiasis may be acquired in two ways.
(1) The embryos may be swallowed in water or food, and so enter the intes
tines of man.
(2) The embryos may penetrate the skin and so enter the circulation and find In most cases there is, at the point of their way into the intestines.
entry, a skin disease known as ground itch.
Sanitary Rules for the Prevention of Anchylostomiasis. Ground itch :--Is the most common origin of all cases of anchylostomiasis. All The boys' feet should be boys to report at once cases of ground itch or toe itch. frequently inspected for ground or toe itch.
Prevention:-The depositing of excreta on the ground should on no account
be allowed.
The boys should use latrines on all occasions when possible.
When working in the fields without latrine accommodation, the boys must be made to pass their excreta into holes dug for the purpose, and the excreta must then be covered up carefully with earth.
On returning from working in the fields all the boys must bathe their hands and feet with soap and water.
Their hands must always be washed with soap and water before eating anything.
The boys should avoid soiling the mouth with muddy hands, eating with muddy hands, eating muddy vegetables or fruit, drinking muddy water, and acci- dentally drinking water while bathing.
The boys should not bathe in common water bath: shower bath should be used.
W. M. McDONALD.
20th April, 1914.