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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Health, the estate conditions did not come under his notice, but one path through a plantation along which the writer went to the hospital was loathsome from the deposits of fæces. In Kuantan in 1911 the writer acted as Health Officer in addition to other duties. Javanese and Chinese coolies were chiefly employed on the estates and ankylostomiasis was rare. These races use latrines.
an
8. In all places a high percentage of Chinese employed on vegetable gardens develop the disease, and every effort should be made to prevent the use of night soil as manure. When Health Officer the writer prosecuted many persons for act likely to spread disease," Section 268 and 269 Criminal Penal Code and Section 278 of the Code, and got convictions for spreading night soil on vegetables.
9. In one case a European lady was infected with typhoid fever through the Over seven agency of flies from a garden where night soil was being used. hundred flies were caught in the house in one day.
I am not aware that the use of night soil is actually illegal, but Sanitary Boards own the night soil, and in some cases it was possible to prosecute success- fully for theft.
10. The late Resident of Perak, Sir E. W. Birch, told the writer that he had in vain tried to have the use of night soil made a crime, carrying punishment with it. There is great need to have Inspectors visiting all vegetable gardens, and none should be allowed within one and a half to two miles of any Sanitary Board limits. 11. Prevalence.--During 1913 in Batu Gajah Hospital only 34 persons were directly admitted for ankylostomiasis, but many others were infected where it was an intercurrent disease. Kinta is a mining district and the incidence of disease on the various races works out at :-Indians 38-23 per cent., Chinese 5294 per cent.. and Javanese 1764 per cent. Many infected Chinese were vagrants, although they Chinese on mines are not badly infected gave their occupation as "mining coolie."
as a rule. They use latrines consisting of planks placed over a stream or mining hole, and do not bathe in the same place as many Tamils do.
12. Again, the Chinese spend more on their food and generally are better fed and of better physique than the average Tamil, and, as remarked above, the dry sand of a mine is not a favourable ground for the growth of larvæ. Mines usually do not show as high an incidence of malarial fever and other diseases, and all round the conditions of health are better than on many estates.
13. Javanese and Malays are Mohammedans and have not the same prejudice against latrines that is seen amongst the Tamil coolies. Their habits also are far more cleanly.
14. Tamils. Here one is at once faced by the ignorance and conservation of the Tamil coolies. their dirty habits and the trammels of the caste system. Excellent latrines may be built, but no "caste" man will use them if they have been Again, the systematic use of the microscope in pariah." contaminated by a suspected cases is, I fancy, "honoured more in the breach than in the observance by most estate doctors.
15. I have known of cases in the Batu Gajah Court where managers said that the Medical Officer of the estate nerer mustered the coolies for inspection and only Some doctors' visits last only saw those who voluntarily presented themselves.
minutes, not hours. The tendency, not unnaturally, is for a private practitioner to Without inspection, and frequent undertake more work than he can really do. inspection, how can early cases be detected?
16. One estate doctor told me that drugs were useless, and that he had proved microscopically that cases were never cured. I can only question his treatment and knowledge of the disease.
17. Estate Conditions.-On some estates hundreds of coolies are employed, and in the case of Tamils the most liberal provision of latrines must be made to avoid the caste prejudices. Coolies generally have two feeds of curry and rice a day at eleven o'clock, often in the field, and again on their return to the lines. Their food itself tends to produce catarrhal conditions of the intestine and aggravates acquired or existing ankylostomiasis.
18. The eleven o'clock meal often consists of cold rice cooked the evening before, and consequently "sour" when eaten. So far as I am aware it is the excep- tion, not the rule, to supply temporary latrines for weeders and infection may occur in the field.
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19. Latrines made of attaps, easily moved from place to place as weeding advances, are simple to make, cheap in cost, and under the attap shelter a simple trench and a few foot boards complete the necessary accommodation. Coolies are very afraid at night, and in addition to any trench system near the coolie lines I would advocate the supply of a few latrines close to the lines and furnished with buckets for use at night. The path to the latrine and the place itself should be freely lighted.
20. The opening of extra latrines in Batu Gajah Hospital in 1912 has reduced illness. Coolies are seldom ill now, and this has stopped the use of the land Remembering that every female below the lines as a depositing place for fæces. worm "produces prodigious and everlasting streams of eggs," and that on estates these eggs fall on good ground for the feeding and growth of the larvæ, it is easy
infect
many. to see that a few infected persons may
33 66
ground itch," local names for the "bunches of Cornish mines, are well known on estates, but how often is their importance recognized? Whatever opinion may be held as to the gravity of ankylostomiasis by itself, every one will admit the importance of the condition when other diseases Small numbers of the worm may not be of importance to the infected person, but large numbers unquestionably are.
21.
"Coolie itch,"
""sore feet,'
are common.
22. The action of the worn is threefold:—
+
(a) The constant injection of the poisonous secretion of the buccal glands into the host's blood,
(b) The destruction of the intestinal mucous membrane of the host. (c) The constant loss of blood even if it be small.
More remote are the
digestive troubles and epigastric pains, and consequent tendency to dysenteries,
etc.
In children it tends to delay development and stunt the growth. 23. Prophylaxis.—Early diagnosis of the cases.
**
This can only be attained by mustering the coolies on estates and elsewhere sore feet" and when the doctor visits. Removal of all cases of "ground itch," anæmia. Carefully made and repeated examinations of the fæces for eggs, repeated every ten days for at least thirty days and isolation in hospital of the infected.
So.
24. The proper use of drugs.-Too many medical men believe that the use of one of the common vermifuges casually given will prove effective. This is not The patient requires to be prepared beforehand for at least twenty-four hours. The mucus in the intestine should be got rid of by light dieting and suitable aperients, and lastly, the vermifuges should be administered. In one case which the writer treated for Tania saginta, another medical man had been given the patient, a European, a dose of male fern every month from January to June. Forty- eight hours in hospital, suitable dieting, and one dose of male fern brought the head
The same applies to ankylostomiasis.
away.
25. The after treatment of the anamia often consists of the exhibition of tincture ferri. perchlor. in large doses and this is quite unsuitable. The most easily digested preparations of iron should be given. In examining for eggs one of the well known methods of finding eggs in fæces should be adopted, the casual examina- tion of a cover glass of fresh fæces is not sufficient.
26. Drugs.-The following list shows the effect of the various drugs, and was The drugs were given in five taken from a recent Indian Medical Gazette. successive doses:
Drug.
Doel.
First Done.
Second Dose.
Third Dose.
Fourth Dose.
Fifth Doso.
Per cent.
Per cent.
Per cent.
Per cent.
Per cent.
Thymol Eucalyptus
90 gra.
97.87
2.18
0.0
2.5 grs.
74.2
7.2
17.0
1.18
0.87
Izal
4 drachme
90.0
10.0
0.0
Beta-naphthol
GO gra.
86:0
14.0
0-0
Beta-naphthol
90 grs.
97.88
1-58
0-89
Pelletierine tannate; 12 gre.
0.0
0.0
Thymol and beta-naphthol show practically equal results; but the paper went on to say that the constitutional disturbance after thymol treatment was often great, while with beta-naphthol it was far less and the drug is cheaper.