PUBLIC RECORD
OFFICE
Reference :-
C.O. 885
24 PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC-
COPYRIGHT PHOTOGRAPH—NOT TO
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Hæmoglobin. The percentage of hæmoglobin in the fellah who is not infected with ankylostomiasis varies from 40 to 80 per cent.; 60 to 70 per cent. is the usual amount among those who have not got bilharziosis; those who are so affected have 10 per cent. less hæmoglobin.
The average rise of hæmoglobin under treatment was 19 per cent. at Qaliub (from 34 to 52) and 9 per cent. at Qalama (from 63-2 to 72-5).
Out of 1,291 patients in whom an estimation of the percentage of hæmoglobiu was made, it was found that 65 had a hæmoglobin percentage of 10 or less than 10. The extremely good results obtained by Dr. Ferguson in British Guiana by means of small repeated doses of ten grains of thymol on six days of the week, until about 100 doses have been given, has not yet been tried in Egypt. It appears to be highly suitable for the eradication of the disease from prisons, schools, and labour gangs, but unsuitable for the treatment of a free and untrammelled adult popula tion. It will be put into operation experimentally on a large scale on my retura to Egypt.
naphthol, Other Anthelmintics.-The other anthelmintics used were sodium and oleum chenopodii. The action of sodium s naphthol was similar to that of thymol, but less efficacious. Oleum chenopodii given in a dose of 45 minims ou sugar and followed by castor oil and chloroform was inefficient (as shown in table V.*).
β
General. All the patients have been treated as in-patients for the reason that the fellah are unable to carry out home treatment. It has been found necessary for the doctor to be present during the administration of thymol, in order to insure that moistened and placed it is carried out properly. The cachet or wafer of thymol
in the mouth of each patient by the male nurse, and the patient swallows it after taking a draught of water. Other methods of administration have been found to be unsatisfactory.
It is the rule for the patients to lie down until the aperient is given, three hours after thymol administration. As the thymol is given on three successive days. during which the patients remain in hospital, and as the bringing of suitable food by the patients themselves, or by their friends for them, has been found to be imprac ticable, it is necessary to provide a mid-day meal for the patients on these days. The patients are, therefore, taken in for at least three days, on each of which one meal is given; they are then discharged and they come as out-patients for further examination and for the administration of hæmatinics.
At one travelling hospital, and at the private permanent hospital, patients are being taken into the hospital for a week as previously described. Detailed observa- tion is only possible by having at any rate one hospital where in-patients remain during the whole of a period of treatment and examination. This is looked upon as an experimental and teaching centre, and has proved very valuable for the purpose.
The cost of food per head is 28 mills. on full diet and 18 mills. on thymol diet (not including coal or cooking butter).t
Incidence of Ankylostomiasis.-No estimate of the amount of the disease in Egypt has yet been arrived at. A careful survey of the province of Sharqia will be made shortly. An examination of the fæces of the pupils in a number of schools, of the inmates of prisons, and of village watchmen, will be made in order to arrive at a satisfactory estimate of the incidence of the disease.
Scientific Investigations. In addition, scientific investigation is about to be made in the villages to find out if there are any main centres of infection, and whether infection is more usually oral or dermal. It is a significant fact that no As soon as a sufficient cases of ground itch have been seen up to the present. number of worms are collected a research will be made as to the toxin reputed to exist in them.
A careful investigation of the cases that have been discharged from the hospital as cured will be carried out, in order to find how many persons become reinfected.
Sanitation. In most of the villages and towns of Egypt there are practically no latrines, those existent in private houses and in the mosques being totally insufficient for the needs of the population. This, no doubt, has a great influence on the spread of the disease owing to the soiling of waste land in and around the villages by the excreta of infected people. The question of the possibility of the adoption of some conservancy system has been considered, but up to the present * Not printed. ! English money: full diet 7d., thymol diet 44d. American money: full diet 14 cents, thymol diet 114 cents.
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no method has appeared to be of practical value, owing to the habits of the fellah, the density of the population, and the low level of the flat delta country.
Education in Sanitation.-Leaflets as to how to avoid infection and how to get cured when infected are being distributed in the country districts. Every day a short lecture on the same subject is read out to the patients in the hospitals. Arrangements have been made for the native "First Aid Assistants" of the Public Health Department to undergo a period of instruction at the ankylostomiasis hos- pitals, from which it is expected that they will carry back useful information to their villages.
Later on instruction will be given in the schools.
Bilharziosis. Like ankylostomiasis and ophthalmia, bilharziosis has been en- demic in Egypt for untold ages, the eggs of the parasite having been demonstrated in mummies of the Twentieth Dynasty. Unlike the other two diseases, no curative drug or treatment has as yet been discovered, nor is the complete life history of the parasite known,
The percentage of patients seeking treatment for ankylostomiasis who are affected by bilharziosis amounts to 44 per cent. (see table IX.*). This was proved in all cases by finding bilharzia ova in the urine.
Pellagra. Pellagra is frequent in some parts of Egypt; the extent to which it causes economic loss to the country is as yet uncertain, although probably con siderable. While the cause of the disease is unknown it is impossible to initiate any measures for its prevention.
Clinical and scientific investigations were commenced some time ago by Dr White, one of the Government bacteriologists in the province of Sharqia, where he Also Dr. had for a time under his observation 200 cases of pellagra in boys." Chalmers, the present Director of the Wellcome Research Laboratories at Khartoum, visited Egypt for the purpose of studying one of the aspects of the disease.
Careful notes of all cases of pellagra seen at the ankylostomiasis hospitals are made and should prove of value in the future.
The percentage of patients definitely affected with pellagra varied very much in different localities. At Qaliub Hospital, where patients severely affected by ankylostomiasis come from long distances, the incidence was 395 per cent., while at Qalama Hospital, which is reserved for the inhabitants of Qalama village, the incidence is only 10-25 per cent.
Conclusion. The difficulty of organizing a campaign against ankylostomiasis is probably greater in Egypt than in other countries, since the details of all arrange. ments for work in the country districts must be so carefully studied, and since constant inspection must be made to see that orders given are carried out.
This preliminary note will, at any rate, show that every endeavour is being made by the Department of Public Health, headed by the Director-General, Lieutenant-Colonel Sir David Semple, to make the campaign a successful one. The great interest which Lord Kitchener feels in public health was apparent in his report on Egypt for 1913, and it is due to him that a beginning has been made in the organization of such measures of treatment and of elementary sanitation as will, in the course of time, lead to an enormous improvement in the present con- ditions, if not entirely free Egypt from ankylostomiasis.
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No. 15.
COLONIAL OFFICE to THE INTERNATIONAL HEALTH COMMISSION. Downing Street, 1st August, 1914.
SIR,
I AM directed by Mr. Secretary Harcourt to express to you his thanks for your letter of the 13th of July,† on the question of the prospects of permanency which can be held out to candidates for employment in appointments for which provision may be made by the International Health Commission.
2. The substance of this letter will be communicated to intending candidates.
I am, &c.,
HENRY LAMBERT.
·
Not printed.
+ No. 12.
26675
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