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12 Other Infections.-Many cases of ankylostomiasis were combined with other infections. The following were discovered in the following numbers:—
Tania saginata, 8.
Trickuris trickinia, 16.
Ascaris lumbricoidis, 15.
Strongyloides intestinalis, 6.
No case of bilharziasis was noted.
These seemed to occasion no obvious symptoms except that possibly, in the case of Ascaris lumbricoidis, there were some vague abdominal pains.
Baro,
16th September, 1914.
W. G. COBB,
Medical Officer.
EXTRACTS FROM REPORTS ON ENTOZOAL INFECTION.
THE method of treatment was as follows:-
First day, admitted to hospital and given one ounce mag. sulph., and no food during the day.
Second day, at 5 a.m., twenty grains thymol, repeated at 6 a.m.
At about 8 a.m., one ounce of mag. sulph. was given, and all stools examined. During the last three months three twenty-grain powders of thymol have been given, at 5, 6, and 7 a.m.
The previous examination of the stools for ova was given up, as it was found that quite a number of patients whose stools failed to show ova were infected with ankylostomes, and was shown after thymol treatment.
Of the 400, 107 (27 per cent.) were infected with cestodes, 171 (43 per cent.) were infected with ankylostomes, and 267 (67 per cent.) with entozoa of one species or another.
Cestoda.-27 per cent. were found infected. In practically every case the tapeworm was Taenia saginata.
Table of Tribal Distribution of Cestode Infections.
Hauss.
Fulani. Nupe. 35 per cent. 41 per cent 10 per cent.
Yoruba. 20 per cent. 30 per cent.
Beriberi,
Pagan. 19 per cent.
Down
River. Coast.
Nil. 5 per cent.
They represent
The Fulani, Hausa, and Beriberi are the most highly infected. tribes from parts of the Northern Provinces more or less free from teetse-fly disease, and so large herds of cattle are kept.
Meat may thus enter more largely into their dietary. Eating meat that has only been partially cooked on spits is a common custom among the Hausas.
The coast and down river peoples are very free from cestode infection, owing to Natives infected with cestodes do not their more thorough methods of cooking. seem to suffer in health to any great extent. They come up for treatment usually because they have seen the segments in their fæces, and as a rule have no other symptoms.
Ankylostome Infections.-171 (43 per cent.) of those examined were infected. Of these 10 (6 per cent.) were duodenale, and the remainder Necator americanus. Table of Tribal Distribution of Ankylostome Infections.
Hausa.
Fulani. Nupe.
Yoruba.
Beriberi. Pagan.
Down
River. Coast
45 per cent. 38 per cent. 53 per cent. 56 per cent. 80 per cent. 47 per cent. 25 per cent. 24 per cent.
The highest percentage is seen to be in Yoruba, Nupe, Pagan, and Hausa. The main factors that determine the incidence of ankylostome infections are:-
1. Sanitation (customs and habits).
2. Climate (humidity).
It is more or less the custom of all tribes when left to themselves to deposit the faces in the bush immediately surrounding their huts, or villages, or to use primitive cesspits made inside their compounds, and often near their wells, so that as regards sanitation the various tribes are at about the same level. Any variation in the tribal distribution of ankylostomiasis is more likely to be due to variations in the humidity, and the relative lengths of the rainy and dry seasons.
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The table above indicates that the Beriberi, Fulani, Hausa, who live in the drier and less humid parts of the Northern Provinces, have the lower percentage of infections, and their residence for a longer or shorter time in Lokoja would tend to give a higher percentage than if they had been living in their own districts. The low percentage in down-river and Coast natives is mainly due to improved sanitary customs and cleanliness. They are chiefly clerke and educated natives. If the natives could be educated to live under better sanitary conditions, and to exercise greater cleanliness in the preparation of their food, considerable reduction in the number of ankylostome and other entozoal infections could be got.
Associated Conditions.-Mild anæmias, enteritis, colitis, nephritis. In 195 The hæmoglobin natives the hæmoglobin was estimated by Tallquist's method. ranged from 65 to 95 per cent. Of the 195 examined, 148 (76 per cent.) showed a percentage of 75 or over, while 47 (24 per cent.) were under 75 per cent. Of the former, 52 (35 per cent.) were infected with ankylostomes; while of the latter 31 (66 per cent.) were infected. The ankylostome infections were more often associated with the lower percentages of hæmoglobin. No marked eosinophilia was In this case there was noted except in one case, where it reached 23 per cent.
the
more
no ankylostome infection, only Oxyuris vermicularis and a blood micro-filaria.
Among prisoners, enteritis and colitis were frequently associated with ankylos- tome infections. The main cause of these diseases was probably imperfect husk- ing and grinding of the guinea corn and gero food. Outside the prison, though the ankylostome infections were as common, these diseases were much less frequent. Nephritis. Six or seven cases were described in last year's report showing oedema. Two more cases have been seen. The symptoms are slight oedema in mild incipient cases, and general edema and anasarca in advanced cases. The pulse rate was slow or normal in bed, and became accelerated on exertion. The respiration in cases without hydrothorax or ascites was normal. No cardiac murmurs were noted. Tenderness on pressure on the calf muscles was present, and epigastric tenderness; the knee jerks diminished or absent. There were no paretic symptoms. Urine was pale, low specific gravity, alkaline, or faintly acid, no albumen, and only mucous deposit. In the blood the hæmo- The hæmoglobin cytes in marked cases were reduced to about 4,000,000 per e.m. was diminished, but not to the same extent as the hæmocytes, and the hæmoglobin There was considerable leucocytosis. The tempera- index was usually over 1. ture sometimes showed a slight evening rise. The cases were mostly pagans, and all had a history of beer drinking. Treatment for ankylostomes was negative in Treatment for the cedema three cases, and in the others only a few were found. gave only temporary relief. Post mortems have been held on three of these cases. The liver and kidneys In two a few ankylostomes were found, in the third, none. were small and under weight. Parts of the internal organs were sent to the In two of the Director, Yaba Research Institute, for microscopic examination. cases, adults, about 50 years of age, patchy interlobular cirrhosis and cloudy swelling was found in the liver, and well marked cirrhosis of the kidneys.
In the third case, adult about 30 years old, the liver was congested and showed hæmorrhages, and cloudy swelling. These, then, are evidently cases of nephritis, the younger man showing a more acute, and the older man had developed a more chronic and cirrhotic, type.
These cases are interesting, as they may account for cases of beri beri reported from time to time, or might be taken as cases of ankylostome anæmia.
Malaria. Only cases where the malarial parasite has been found have been taken. The common mosquito in Lokoja is Pyretophorus costalis, a malarial carrier. It breeds in all the streams and springs during the rains, and natives resident in Lokoja soon develop a certain resistance to malarial infection, and it is seldom that parasites can be found in adults. During the rains a company of soldiers came into Lokoja after being about three years in Maidugari. Quite a number of these developed malaria shortly after their arrival, and parasites were easily found. Only five were found in whom malarial and entozoal infections were combined. One was combined with ankylostome infection alone, one with Anemia in these cases tapeworm, and three with ankylostome and tapeworm.
was not marked. There has been little opportunity of examining children. The two examined were about 12 years of age, one had ankylostomes and the other tapeworm. It has been found difficult to get children to remain in hospital.
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