PUBLIC
RECORD
OFFICE
ول
Reference:-
!། ཟ། །「:「 ཱ། mmmm miC.O. 885
24 PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO
10
2. I have received from Sir J. Hayes Sadler a favourable report in regard to Dr. Morrison, and I, therefore, approve of the appointment of that officer on the terms provided in the Estimates for the Assistant Medical Officer, for a term of one year in the first instance.
3. I shall be glad to receive for record formal particulars of Dr. Morrison's qualifications and experience.
27874
DEAR SIR,
No. 14.
I have, &c.,
L. HARCOURT.
DR. A. F. MACCALLAN to COLONIAL OFFICE. (Received 30th July, 1914.)
New University Club, S.W., July 29th, 1914. I ENCLOSE a copy of my report on ankylostomiasis in Egypt. The Rockefeller Commission has already received a copy, which Mr. Rose is manifolding and distributing.
Enclosure in No. 14.
Yours very truly,
A. F. MACCALLAN.
PRELIMINARY NOTE ON THE ANKYLOSTOMIASIS CAMPAIGN IN EGYPT, 1914, BY A. F. MacCallan, M.D. CAMBRIDGE, F.R.C.S. England, Director of OphthaLMIC HOSPITALS, OF EPIDEMICS, AND OF THE ANKYLOSTOMIASIS CAMPAIGN. PUBLIC HEALTH Department, EgypT.
Read at the Annual Meeting of the British Medical Association, Aberdeen, 1914. Origin of Campaign.-Up to a few months ago no serious effort to check the ravages of ankylostomiasis had been undertaken in Egypt, although a certain num- ber of cases were being treated in the wards of the Government General Hospitals and at the Church Missionary Hospitals.
In September of last year arrangements were made by the Department of Public Health, on the initiative of Lord Kitchener, to investigate the disease at a temporary annexe to one of the General Hospitals.
Committee.—Valuable advice as to treatment and arrangements was obtained from a consultative committee consisting of Dr. Loos, Professor of Zoology, Dr. Ferguson, Professor of Pathology, and Dr. Day, all of the Government Medical School, Dr. Todd, of the Government Bacteriological Laboratory, and Dr. Hastings, of the Department of Public Health. The scheme was quite successful and a large number of patients presented themselves for treatment.
Travelling Hospitals.-The direction of the ankylostomiasis annexe devolved upon me about six weeks after clinical work had commenced. The annexe was converted into a travelling hospital in tents with beds for 100 patients; the organi- zation being carried out on lines similar to those of the travelling ophthalmie hospitals. The treatment now carried on is entirely free and voluntary, people who can afford treatment in their own houses not being admitted.
A smal The staff consists of a doctor, a clerk, and the requisite attendants. enclosure or harem is reserved for women patients, of whom great numbers apply for treatment.
The laboratory for microscopical examination of fæces, urine, and blood forms an important feature of the camp.
This hospital was inaugurated by H.H. the Khedive in the presence of Lord Kitchener on 1st December, 1913, at Qaliub, a town of 16,000 inhabitants, situated about ten miles from Cairo.
A small branch hospital in tents has also been organized for work in a village named Qalama, about five miles from Qaliub.
Permanent Hospital. A permanent hospital for the treatment of his tenants has been started by a large landowner at his country seat in the Province of Qaliubia. There is accommodation for 30 in-patients. The doctor is provided by the Govern- ment, but all other expenses are paid by the Pasha after being sanctioned by me. The hospital was inaugurated by Lord Kitchener on 22nd May, 1914.
11
International Health Commission.-The International Health Commission was founded by Mr. Rockefeller some years ago and endowed with seven million pounds sterling The Commission arranges for the eradication of ankylostomiasis in all parts of the world.
The Director-General of the Commission, Mr. Wickliffe Rose, visited Egypt in February and made a careful study of our experimental arrangements for treating ankylostomiasis. As a result of his recommendation the Commission has granted a sum of $30,000, or £6,000, on condition that the Egyptian Government gave a similar sum. £12,000 is therefore at our disposal for the expenses of the current
year.
Territorial Unit Scheme.-It has been decided to expend the money in the initiation of a scheme of treatment for Sharqia, one of the fourteen provinces of Egypt, containing 879,000 inhabitants. The scheme will include one large travel- ling hospital, four small travelling hospitals in the various country districts, each capable of dealing with a hundred patients, and in the capital town of the province several houses will be hired and converted into hospitals, each capable of accommo dating 30 patients.
The Treatment. The number of ankylostomiasis cases treated up to 30th April has been 1,011; of these 628 have been cured and 383 have been relieved. definition of cure adopted has been the absence of worms from the fæces and the absence of eggs on microscopical examination of the faces on the second day after "Relieved" means that a number of worms have been the last dose of thymol. expelled as the result of one or more doses of thymol.
Further experience will teach us whether or not the above definition of cure is a correct one. There are, of course, various fallacies in this definition, as no notice is taken of cases in which the worm may be encysted in the intestinal mucosa, or in which larvæ may be present in the lymphatics or subcutaneous tissue, not having yet reached the intestine. We have been greatly hampered by the absence of a skilled staff, and the definition above given is tentative only. However, the Rockefeller grant will now enable us to employ two British doctors who are acquainted with tropical diseases, and who will pursue investigation into all aspects of the disease.
·
The first day is the day of admission The course of treatment lasts a week. after the eggs of the ankylostoma worm have been found in the excreta. No food is allowed after the mid-day meal. In the evening one ounce or 30 grammes of sodium sulphate is given, which acts on the fellah as a gentle aperient and empties the intestine. On the second day 60 grains or 4 grammes of thymol, finely powdered and mixed with milk sugar, is given in cachets. During thymolization the patient is invariably kept in a recumbent posture. Three hours after the thymol an ounce or 30 grammes of sodium sulphate is given, which expels the dead worms and the thymol which killed them. The only food the patient has on thymol days is a good nid-day meal. On the same evening an ounce or 30 grammes of sodium sulphate. is given. No oil or alcohol, which are solvents of thymol, is allowed; the thymol therefore traverses the intestine with very little absorption and does not produce collapse.
Similar treatment is pursued on the third and fourth days.
The fifth and sixth days are days of rest, during which the patient has three meals a day, the stools being examined for the ova of the worm on the morning of the sixth day. If the ova are absent the patient is discharged as cured on the seventh day. If ova are present the thymol course is recommenced on the ninth day. The dose is reduced for children, but boys of 11 or 12 years of age bear three grammes of thymol quite well.
Results of Treatment.-By these three days of treatment 70 per cent. of the cases may be cured by one course of thymolization in lightly infected places; in heavily infected places where there are severe cases the results are not so good by 20 or 30 per cent. (see Tables I., II., III.).*
The treatment adopted at first was thymolization once a week, the average number of doses for patients cured varying from 3-2 to 4-12. Such a method of the treatment is unsuited to the needs of Egypt, since it was very expensive and because the fellah cannot spare the time to remain so long absent from his home. The three days' treatment was, therefore, devised, which includes three consecutive days of thymolization.
* Not printed.