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5. With regard to a Medical Officer to take charge of the work, I recommend Dr. W. B. Grannum, Visiting Physician to the General Hospital. Dr. Grannum would either devote his whole time to the work, or, as the scope of the work is morc or less limited in Barbados, he would undertake it as a part time appointment. In the former case I recommend that the salary given be £500 per annum, with £50 as travelling allowance, and in the latter case £300 per annum with £50 travelling allowance.
6. I understand that the International Health Commission stipulate always that the Medical Officer in charge should devote his whole time to the work, and this is recommended. In this case Dr. W. B. Grannum might be seconded for duty with the ankylostomiasis campaign, if arrangements could be made ad hoc with the Directors of the General Hospital.
4th March, 1915.
Enclosure 3 in No. 92.
JOHN HUTSON,
EXTRACT FROM Annual REPORT OF PUBLIC HEALTH Inspector for 1913.
Ankylostomiasis.
183. This disease prevails in Barbados, especially in the parish of St. Andrew and in certain parts of St. Joseph and St. John. Dr. Johnson, the Pathol ogist, has reported on the first 446 persons examined for ankylostomiasis-31 non- selected cases from the General Hospital and 82 from the Parochial Almshouses, some of the latter being suspected cases. The first 200 were reported on in October, 1913, and the last 246 in March, 1914 (a few days ago).
184. Of 446 persons examined 53, or 117 per cent., were found to be infected. the infection being greatest in the districts already mentioned.
GENERAL PREVALENCE OF ANKYLOSTOMIASIS.
Parish.
St. Michael
Christ Church
St. Philip
St. George
St. John
St. Joseph
St. Thomas
St. James
St. Peter
St. Lucy
St. Andrew
Total
Cases examined.
Cases infected.
120
*6
48
1
36
6
48
1
25
6
25
6
28
2
32
4
22
0
24
38
18
446
53
It will be noted that the parish of St. Michael is being infected from the endemic districts.
185. The following report on the first 200 cases was sent to the Governor by the Public Health Inspector in November, 1913:-
"Dr. Johnson's report confirms what we have known for many years that the anæmia of the 'Scotland district' of the island is largely due to ankylostomiasis. The figures are too small for definite conclusions to be drawn for other parts of the island. As the investigation proceeds and the numbers of observations increase the exact prevalence of the disease can be ascertained in every district.
"Meanwhile, we should take stock of the situation in relation to the recent visit of Mr. W. Rose, Director of the International Health Commission of the United States. This Commission has been formed to administer large sums of money, amounting to many millions of dollars, which Mr. Rockefeller proposes to devote to improving the health conditions of the world.
Having carried out a successful campaign against ankylostomiasis in the Southern States, working through the local authorities in each district, the Inter- national Health Commission have obtained the approval of the Secretary of State for the Colonies and the Secretary of State for India for Mr. Rose to visit the
* Four of those had recently come from St. Andrew, St. Joseph, and St. John.
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British West Indies and the East Indian possessions and dependencies of the Crown, to take stock of the situation in reference to ankylostomiasis in these places, and, as I was informed by Mr. Rose, to assist in controlling the disease where the con- ditions are favourable and where assistance from outside is desired. Mr. Rose was very insistent that the Commission worked only in connexion with local agencios and where its help was desired.
I took him in two districts where ankylostomiasis is prevalent, and in the Turner's Hall district of St. Andrew he was much impressed with the necessity for a regular campaign against the disease, judging from the naked eye appearance of the people. I gathered from frequent conversations with him that, if asked for, assistance would be given by the International Health Commission even to the extent of sending one or two special workers to assist in dealing with the disease. Mean- while, we have to obtain sufficient information to show a case for assistance. If 200 cases of ankylostomiasis can be diagnosed by microscope in the parishes of St. Andrew, St. Joseph, and St. John (below the cliff), where it is most prevalent, there is no doubt that application to the International Health Commission for help to deal with the disease will be favourably received and efficient help given. We should not be too proud to get assistance in such a matter from such an organiza- tion, which is ready to assist the British Colonies and the whole world in grappling with serious health problems.
"I recommend :-
(1) That a special effort be made to ascertain definitely the prevalence of the disease in the districts mentioned, and
"(2) That when a case for assistance is made out, as it certainly can be, an application be made to the International Health Commission for assistance, with the approval of the Secretary of State for the Colonies. 'Meanwhile the necessary information can be obtained by the Pathologist, and, as I have already offered, I am willing to assist Dr. Johnson in this investigation, which may involve visits to the infected districts for collection of material, etc Mr. Rose has promised to send us samples of the boxes used in the United States for collecting specimens of fæces, but meanwhile it is possible to use bottles, ointment boxes, or empty tins for collecting material. These should be distributed with the help of the Commissioners of Health, clergymen, school teachers and Inspectors of Health, who can explain to the people what is required, and who will, I am sure, readily give their assistance.
A short leaflet should be printed for circulation with the boxes, briefly explain- ing the objects in view, and what should be done by persons wishing to be examined for the disease. The printing of 500 will cost next to nothing, and the results will be worth a hundred times more than the cost of the leaflet.'
To whom it may concern,
ANKYLOSTOMIAsis Leaflet..
Much of the weakness, bad health, and poverty of blood in some districts are caused by certain worms in the intestines. These worms lay eggs, which are passed in the operations or excrement of persons who have these worms.
These egge can only be seen with a microscope, and when they are found in the excrement it is certain that the worms are in the intestines from which the excre- ment comes.
The ordinary worm medicines have no effect on these worms. They require a special remedy.
If you are pale and bloodless, or have shortness of breath and beating of the heart on walking upstairs or up a hill, you are probably suffering from these worms. If wish to find this out, put into a box, which will be given you, a small
you piece of your excrement, write your name and address on the box, and return it to the person from whom you get the box.
If the eggs of these worms are found, your name will be noted; and it is hoped that before long free treatment for the complaint will be offered you. This will cost you nothing.
186. Although no special investigation has taken place in the most infected districts, the above figures clearly show that a case has been made out for un organized effort to combat the disease, and the Government will now doubtless apply to the International Health Commission for assistance in treating the disease systematically.
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(No. 158.) SIR,
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No. 93.
SIERRA LEONE.
THE GOVERNOR to THE SECRETARY OF STATE,
(Received 26th April, 1915.)
Government House, Sierra Leone, 8th April, 1915. WITH reference to my despatch No. 540, of the 29th September last,* I have the honour to transmit herewith a report by the Principal Medical Officer on the incidence of ankylostomiasis in the Colony and Protectorate for the half-year ended the 31st December, 1914.
I have, &c.,
E. M. MEREWETHER,
Governor.
Enclosure in No. 98.
A REPORT ON THE INCIDENCE OF ANKYLOSTOMIASIS IN THE Colony and PROTECTORATE OF SIERRA LEOne, founded on Statistics FURNISHED FOR THE PERIOD 1ST JULY TO 318T DECember, 1914.
On the 30th of December, 1913, Departmental Circular No. 37/1913 (of which a copy is attached), together with a copy of the Secretary of State's despatch No. 515 of 1913, was sent to each Medical Officer.
2. In September, 1914, a report was submitted by the Acting Principal Medical Officer, Dr. Collett, covering the period 1st January to 30th June, 1914.
3. The following observations are extracted from the reports sent in by Medical Officers :-
Bo. Dr. McConaghy.
I have the honour to inform you that, during the half-year ending 31st December, 1914, I examined the stools of 80 boys at the Bo School.
In only one case did I find the ova of Ankylostomum duodenale. This was a boy called Fodi, who suffered from anæmia and debility. The Principal of the Bo School informed me that he was listless in class, although he apparently tried his best to fix his attention on what was going on.
I treated him with eucalyptol in the beginning of November, and, although I have examined his fæces twice since, I have not found any ova. The boy is greatly improved, both physically and mentally. He is about 15 years old. Kaballa. Dr. J. Y. Wood.
During the six months July to December, six cases of ankylostomiasis were seen at the dispensary, diagnosis being confirmed in each case by the microscope. The symptoms were generally irregular fever, colicky pains in the abdomen, alternating attacks of diarrhoea and constipation, with weak- ness and irregular heart beat. Dropsy was observed in one case only. One case was that of a boy of 14, who was admitted to hospital and kept under observation for ten days. He complained of headache, weakness, fever (101°), diarrhoea, with severe pains, accompanied by great tenderness over the region of the appendix, while axillary, inguinal, and posterior cervical glands were enlarged. The blood showed anæmia, but no trace of malaria. He was treated with bismuth and pulv. ipecac. co. and improved, only to relapse in a few days. On searching the blood again no trypanosomes or malarial para- sites were found, but eosinophilia was marked. The fæces were examined and large numbers of ankylostome and ascaris eggs were found, with oxyuris. He was then treated with eucalyptus mixture and improved so rapidly that he was discharged cured in a few days. His friends afterwards stated he had been in the habit of eating earth. Before his discharge I prepared to make a film of cervical gland juice, but, to my astonishment, I found prac tically all the glands had disappeared with the exception of a few in the inguinal region.
* No. 29.
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The
Three cases came from the prison, so a systematic examination of the fæces of all prisoners was carried out, as well as of each fresh admission to
Altogether thirty were examined. the jail during the six months. results were as follows:-ankylostomes and ascaris were found in nine; anky- lostomes, ascaris, and amoeba coli in one; ankylostomes, ascaris, and strongy- loides, one; ankylostomes, ascaris, trichocephalus and tænia, one; ankylos- tomes and amoeba coli, one; ankylostomes alone in five; ascaris alone, six; tænia, two; amoebe, two; while only two were entirely free. In most cases only a single film was examined, while many had an aperient administered before- hand.
Out of the whole number twenty were found to harbour ankylostomes, giving 66 per cent. Of these twenty, half had a few only, four had a fair number, six had large numbers present.
With the exception of the three cases of actual ankylostomiasis already mentioned none complained of illness, but on making a thorough physical examination I found most showed signs of more or less anæmia, usually slight, four had murmurs in the mitral region of the heart (one having an aortic murmur also), while five stated they had suffered previously from colic. One from 20 to 60, of all was a woman, the rest were men of all ages classes, and drawn from all parts of the district. From the physical exami nation I am inclined to think many were not suffering from ankylostomiasis It is probable even a larger as a disease, although infected with the worms. number were infected, although no eggs appeared in the single film examined. Ankylostomiasis has been suspected in a number of cases where digestive ailments or weakness were complained of, but the diagnosis could not be established, as the people have the most marked reluctance to have their fæces examined, usually never returning on being asked for a specimen. practically impossible to carry out any investigation except in the case of prisoners in the jail. Although the number of these was rather small I think it may be taken ankylostome infection is widespread in this district. Batkanu. Dr. P. A. Clearkin.
It is
During the past six months, 90 persons have been examined for ankylos- tomiasis. Of these, 22 were children.
Adults. The greater number of these were prisoners in the district jail. The results of the examination were as follows:-
Total examined.
68
Nil. 22
Ankylostomum.
32
Ascaris. Oxyuris.
9 19
Trichocephalus.
3
This gives the percentage of those infected with ankylostomiasis as 46-6. The method of examination was rather crude. It consisted of giving the person a purge and searching the fæces under a microscope for ova. have no doubt that the number of infected persons would be found much higher if a more efficient method were adopted.
Anæmia. Of these 32 persons found infected the blood was examined in 20. For the blood count a Thoma-Zeiss hæmocytometer was used, and for the hæmoglobin a Tallquist hæmoglobin scale. The average anæmia was 3,932,000, and the average hæmoglobin was 61.8 per cent.
There was only one case in which the anemia and debility appeared serious. This was Chief Court Messenger Soriebah Sese from Port Lokkoh, who was sent by the Acting District Commissioner to Batkanu for examina- tion by the Medical Officer, as he was continually on the sick list. Ova were found in his fæces, the red cell count was 2,900,000, and hæmoglobin 60 per cent.
None of the other cases showed any symptoms. Children. Out of the 22 children examined there were only 4 in which ankylostome ova were found. This is equal to 18.1 per cent.
The following are the details of the examination :-
Nil. Ankylostomum.
12
Total examined.
22
4
Ascaris.
5
Oxyuris. 5
Trichocephalus.
nil. Anæmia. The percentage of hæmoglobin was taken in these four cases, but a blood count was not taken. The average percentage of hæmoglobin was 65 per cent.
Treatment. It was unfortunately impossible to watch the cases care- fully and observe the effects of treatment-
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