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C.O. 885
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC-- COPYRIGHT PHOTOGRAPH-NOT TO
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THE SENIOR Sanitary OFFICER, NORTHERN PROVINCES, NIGERIA, to THE PRINCIPAL MEDICAL Officer, ZungeRU.
Zungeru, 28th December, 1914.
Entozoal Infection.
IN conformity with your memorandum of the 26th instant, I have gone carefully through the returns rendered to you, up to date, by those Medical Officers who have carried out investigations, during the current year, into the incidence of the infections quoted above.
2. The results, so far as they go, justify the opinion at which you arrived well nigh two years ago, when you concluded that ankylostomiasis was much more widely distributed over the Northern Provinces than had been formerly supposed.
3. Touching entozoa other than ankylostomata, we are pretty much where we were; for we always knew that they were so common that the average native probably considered himself abnormal if he did not harbour them.
4. The figures for combined malarial infection and ankylostomiasis do not appear to me to be sufficiently broadly based to prove anything. Of course, we have always known what a pernicious combination the mixed infection constitutes. 5. I am cordially at one with Dr. Pirie in his plea for the education of the native it is the kernel of the whole question. My colleague Dr. Foy and myself, in our tours through the country, are doing what we can in the direction of giving the same teaching generally as are Dr. Pirie and other keen Medical Officers in their own districts.
But sanitary mission work is a slow process and, speaking generally, must be effected on the principle: "gutta cavat lapidem, non vi, sed sæpe cadendo." It is otherwise, however, at recognized stations to which Medical Officers are permanently posted; and, with the cessation of the present disastrous war, I fancy you will be anticipating a substantial move forward in such favoured
localities.
6. One of the most practical and practicable--moves forward is to make the wells of all salga towns extra-mural. His Excellency has already signified his approval of this procedure in connexion with the lay-out of all new towns in which the salga system may be adopted. Much can be done to improve matters in the Mohammedan towns, whether or not Medical Officers be resident near them; but I fear that, with some few exceptions, the pagan towns will be susceptible of but little appreciable improvement for years to come.
It is needless to tell you that, for political reasons, this must be so.
7. Dr. Foy and myself shall have the subject constantly alive, while schooling the two mallamai apprentice inspectors sanctioned in the 1915 Estimates.
8. I find the attached report* by Dr. Ferguson, of British Guiana, as inspir- ing as it is interesting and instructive. May I suggest that you have it printed for circulation among your Medical Officers, as the Surgeon General of British Guiana has already done in the case of his Medical Officers? Fortunately, very few of your Medical Officers can be accused of being lethargic; but Dr. Ferguson's report is so stimulating that, in my opinion, its quickening influence ought to be applied to every station in the Northern Provinces.
9. What time post-bellum prosperity shall have been attained it may be well to contemplate large free issues of thymol and quinine at the discretion of the various Medical Officers.
10. The time when the universal inspection of cattle and carcasses and improved methods of cookery shall have appreciably lessened the incidence of entozoa, other than ankylostomata, is still far distant.
M. CAMERON BLAIR,
Senior Sanitary Officer,
Northern Provinces.
EXTRACTS FROM REPORTS ON ENTOZOAL INFECTION.
1. As the Medical Officer is unable to leave the station, practically all the cases examined were resident at Baro, and so mostly employed by the railway and performing regular work. This made universal examination and treatment a
British Guiana, Combined Court, No. 771.
79
difficult matter, and consequently quite the majority of cases were those that came up to the hospital from one cause or another. Of these by far the greater number cannot be regarded as diseased, as they came under notice for some temporary condition, such as traumatism, which could not be associated in any way with ankylostomiasis.
The rule was to give each case selected for examination a dose of salts, and to make two preparations from the resulting motion. In this way probably only a small percentage was overlooked.
2. The total percentage of cases infected with ankylostomiasis was 35.8 per cent.
3. Relation of Ankylostomum duodenale to Necator americanus.-I found no case of an unmixed infection of Necator americanus. Of the forty-eight cases infected with Ankylostomum duodenals, eleven double infections were noted, and in these Ankylostomum duodenale were always more numerous, usually very much so.
cases the average
4. Number of Ankylostomes expelled.-In the infected number of worms expelled was slightly below twenty. The greatest number was one hundred and fifty, and the smallest nil.
5. Europeans. I examined seven cases where symptoms suggested a possi- bility of infection. I found none infected.
6. Symptoms. These were mostly conspicuous by their absence, and in many. often cases from which the largest number of worms were obtained, absolute good health seemned to prevail. In the following list I am tabulating the symptoms which appeared not to be due to other ailments. Many were only slight;—
(a) Pain in epigastrium: five.
Anemia: six; only profound in one case.
Edema : nil.
Lassitude: probably in a fair number.
Fever: thirteen; in five of these malaria was present.
I might here state that in my series I could detect no definite relationship between the two diseases.
(Swelling of joints: I found seven cases of marked swelling of the knee joint, which disappeared rapidly after treatment with thymol, and for which I could find no other cause, having eliminated all other likely conditions.
(g) Rheumatic pains: eleven; it seems possible that many cases that are returned as myalgia or myositis may be primarily ones of ankylos- tomiasis.
7. Racial. The only evidence of any significance is that not one of the seventeen Coast natives examined had, ankylostomiasis, although some had other infections. This is probably due to the fact that they very nearly always wear
boots.
8. Occupational.-The only suggestion under this head is that Europeans' boys are more liable to infection. If this is so it is probably due to the fact that they eat mixed and unsuitable food.
9. Treatment. In all cases except a few the treatment was by three twenty. grain doses of thymol, preceded and followed by a purge. The patient was not allowed to take food for about twenty hours before the administration of the thymol.
The
The symptoms disappeared after this treatment in nearly every case. 10. Fatal Case. One case, a youth of about 16-18, describing himself as a Beriberi, and who appeared to be semi-European in descent, proved fatal. patient was very weak, anæmic, and debilitated, and died even before a modified treatment could be adopted. As far as could be ascertained from examination before death, no other important lesion except ankylostomiasis existed.
Unfortunately a post-mortem examination was not made.
11. Eosinophilia.-This varied from 7 to 18 per cent., and was present in every case examined, except the fatal one, in which the eosinophil cells were only 1.5 per cent.
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