PUBLIC RECORD OFFICE
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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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I admit at once that the numbers dealt with are not sufficient to give reliable results, though I think they are suggestive.
Curve A shows the percentage of ankylostome infected individuals divided into their age groups, but it is to be carefully noted that these results are obtained from a single simple examination of the feces of each patient.
Curve B shows a similar curve, but the figures are only obtained as a result of carefully washing and centrifuging the fæces, and therefore probably represents the actual percentage of individuals infected in each age group.
The figures for the early and late years of life are so few that it has not been considered justifiable to make up the curve for those years.
Curve A shows a gently graded curve up to the most active and prime years of a native's life and then an equally graded fall, and represents the period of life at which the infections with ankylostome are sufficiently heavy as to be detectable on a single simple examination of the fæces. In other words, curve A represents a curve of "grossness" of infection, and shows that the most gross infections occur between the ages of 15 and 30.
Comparing curve A with curve B it appears that, though 75 per cent. of indi- viduals between the ages of 10 and 15 are actually harbouring ankylostome worms, only 40 per cent. are at all heavily infected, while later on, e.g., between 20 and 30
of years
60 age,
cent. of natives are infected, all but 10 per cent. being heavily per infected. The term "heavily infected" used here means that a single simple examination will readily reveal the fact that the individual is infected.
The form of curve B suggests that the majority of individuals become infected during the earlier years of life, but that the infection slowly dies out, possibly as a result of cleanlier habits or the wearing of boots, or both these conditions.
I have not been able to make out similar curves to the above for each native tribe, owing to the small numbers to be dealt with, but a curve B made up from the exami- nation of creole patients alone shows an almost exact reproduction of the form shown in curve B above.
3. Racial Incidence.-The racial incidence is given below for a few of the tribes met with at the hospital and jail. The number examined in some cases is too small to admit even a probable percentage.
Nationality.
93-3
Total cases.
Positive in-
Percentage.
Creole
241
79
32.7 per cent.
Timnee
106
61
57.5
"
31
Mendi
60
38
J
Sherbro
27
13
48
19
13
Kroo
24
3
12.5
11
»
Susu
20
10
50
11
Limbah
17
10
58.8
33
Mandingo
12
7
58
Galliness
14
6
60
17
}}
Possibly an interesting point is shown in the case of the Kroos, where the low per- centage of infected individuals may be accounted for by the fact that the majority of the patients were seamen and probably therefore less exposed to infection.
4. Hæmoglobin Estimations.-One hundred and sixteen prisoners were This was done with Tallqvist's examined as regards their hæmoglobin index. hæmoglobinometer scale, as it, at first, was the only one available, but later à few controls were made to compare its working with Oliver's hæmoglobinometer: very little difference was noted, and though the method is admittedly open to objection it has obvious great advantages, and I think the results are comparable.
Seventy-three prisoners showing the presence of ankylostome ova had a hæmo- globin percentage varying between 60 per cent. and 80 per cent., but the majority had 70 per cent. hæmoglobin or lower.
Forty-three prisoners who did not show the presence of ankylostome ova had a hæmoglobin count varying between 30 per cent. and 80 per cent., but the majority, or 68 per cent., had a hæmoglobin value of 75 per cent. or over.
There are obviously no marke.l examples of anæmia amongst these cases, though the ankylostome carriers usually had a count of 70 per cent. or lower, while the non- carriers usually had a count of 75 per cent. or higher.
5. Colour Index.-Among 67 cases showing ankylostome infection 47, or 70 per cent., had a colour index of 7 or lower, while among 42 prisoners in whom 110
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ankylostomes were found 22 only (which represents 52 per cent.) had a colour index of 7 or lower and in six of these cases there were illnesses that might in themselves have caused a low index, namely, subtertian malaria in five and chronic dysentery in one.
The average colour index for the positive cases works out at 68, while it works out at 72 amongst the negative cases.
6. Blood Counts. Red cell counts have been performed on 110 prisoners, amongst whom 67 showed the presence of ankylostomes.
The counts on the 67 positive cases varied between just over seven million and just under three-and-a-half million, the average count working out at 5,356,700, while the average count for the 43 negative cases was 5,023,200.
If the anæmia caused by the ankylostome worm is of the chlorotic type one would expect to get the type of count shown above but in rather a more marked form. The results obtained suggest an anæmia of a very mild chlorotic type.
Total leucocyte counts have been done on 110 prisoners, of whom 67 showed the presence of ankylostome worms. The average leucocyte count in the 67 posi- tive cases works out at 7,492, while the 43 negative cases give an average of 6,610. There is nothing of note to be derived from these counts, and it is extremely doubt- ful whether leucocyte counts in any form are of any value whatever in the native, who usually has some skin condition or minor septic lesions which might interfere. At present I have only been able to complete the differential leucocyte count in 60 cases: the eosinophil count amongst 33 prisoners showing the presence of anky- lostomes worked out with an average of 147 per cent., while among 27 prisoners who did not harbour the ankylostome the average eosinophil count worked out at 9.1 per cent.
7. Extent of Infection.-These remarks are entirely based on results obtained at the prison. Fifty-nine prisoners were treated with thymol in order to evacuate the worms, all stools passed after the treatment being carefully washed and sieved and the worms removed: it is probable that a large number were overlooked.
All of these 59 prisoners showed the ova in the fæces except four, in whom the thymol treatment was given in order to see to what extent failure to find ova in the stools was evidence of absence of infection.
Of the 55 prisoners showing ankylostome infection 40 had a single treatment with 40 grs. thymol, 2,718 worms recovered; 13 had a single treatment with 60 grs. thymol, 2,087 worms recovered; one had a double treatment with 60 grs. thymol. 434 worms recovered; one had a double treatment with 40 grs. thymol, one worm recovered.
Of the four cases showing no evidence of ankylostome infection two had a single treatment with 40 grs. thymol, 30 worms recovered; one had a single treat- ment with 40 grs. thymol, no worms recovered; one had a single treatment with 60 grs. thymol, no worms recovered.
Thus in 57 prisoners 5,270 ankylostome worms were recovered, giving an aver age
infection of about 92 per man, though the worms recovered varied between a I think that this must be considered minimum of 1 and a maximum of 588.
to be a high figure in view of the fact that in only two instances was more than a single treatment given.
Both Ankylostoma duodenale and Necator americana were recognized, but the former formed the majority. No specimen of oesophagostomum was seen.
Owing to an unfortunate accident the whole collection of worms got thrown away before I had the opportunity of working out the actual percentage of each variety of worm.
8. Treatment. Complete starvation for twenty-four hours was an essential part of the treatment, only water being allowed during this time.
The last meal taken was at 5 a.m.; at 4 p.m. an aperient was given, either two ounces of mistura alba or three to four drachms of sulphate of soda: at 6 a.ın. the next day 20 or 30 grains of powdered thymol were given in a draught of water, and this was repeated at 7 a.m. The aperient was again repeated at 9 a.m. and A considerable all the subsequent stools examined and passed through a sieve. amount of mucus was frequently passed, which made the washing of the stools a tedious process. I have not had the opportunity of re-examining the patients to estimate the efficiency of the treatment.
G. G. BUTLER.
L