PUBLIC RECORD OFFICE
Reference :-
C.O.885
PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO
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(b.) Wire Gauze is undoubtedly far superior to any less resistant a protection, as the constant repairs to muslin or mosquito-net, due to their destruction by other insects or from exposure, render them costly and expensive in time and labour in many cases. A saving may, with judgment, be effected in expense by a judicious use of varnished cotton-net in some cases.
The framework for doorways and doors is, with a supply of wire gauze and net, highly desirable for at least two rooms, suitable for the reception of European patients at this house, as a means of checking the infection from malarial patients to their neighbours.
(c.) Free ventilation with open doors, when a strong draught is available, is undoubtedly a quick, ready method of freeing any room from mosquitoes for a time. Personally, my small experiments have only led me to the conclusion that a hand- net is to be otherwise preferred, and that fumigation by "Izal," or fine threads covered with bird-lime running across the room at a high level, &c., are practically inadvisable from their need of constant attention.
(d.) Except to those who suffer severely from heat, I strongly advise the fine close-meshed best quality of muslin for mosquito protection at night, in preference to the ordinary mosquito netting, which, if but very slightly flawed, is readily permeable to insects. They are, too, in my finding, slightly stronger than the latter. (e.) I have personally seen to the distribution of copies of Dr. Manson's "Malaria: Its Causes and Prevention," in slip form being exhibited as advised.
(f.) Having had the advantage of instruction at the School of Tropical Medicine, London, as a pupil of Dr. Manson's, my services are willingly placed at the disposal of the Government Medical Officer in charge of this Protectorate.
(g.) I have the honour to hope that, suitable appurtenances in gauze, and money. being granted, to be able to convince the other Europeans and higher-class natives in the vicinity of the advantages to be secured by adoption of the above measures, at present the tendency being to disregard such old-established evils of tropical residence.
ALFRED J. M. PAGET. Lamu, August 30, 1901.
SIR,
Dr. PAGET to Dr. MACDONALD.
Lamu, August 15, 1901.
I HAVE the honour to report, in reply to your letter of the 20th July, forward- ing brochures by the Royal Society Committee, now investigating malaria, that the local conditions at Lamu which have a bearing upon this disease, and which to some extent may be considered as modifying the general statements contained in the above reports, are as follows:-
I would first beg to bring to your notice the Report on malarial and black-water fevers of Central Africa in the pamphlet for the years 1899-1900, p. 19, in order to show some yery marked differences between the statements of the mixed observations taken in Central Africa, and some observations made locally here.
In malarial fevers, as such, I find that the generally accepted belief in typical temperature charts from observations to be almost useless, for the types of malarial fever are almost, if not entirely, under a classification of race as apart from periodicity of attack.
With only one exception-that of a Hindu-the black or native population, when attacked by fever, are found with high temperature, and extreme prostration within, at most, only six hours from the first premonitory symptoms.
One is thus very seldom able to obtain any record of the rapidity marking the rise in temperature to, say, 104° Fahrenheit to 105° Fahrenheit or more, which one frequently observes; and the fall of temperature, either in the treated or untreated cases, is just as valueless; for with this one rise and fall all temperature significance in regard to the case seems to end completely. The native patients, with the one ex- ception I mention, do not show, nor have I observed, any temperature variations which would have been expected with quartan, tertian, or other periodicity. This one attack, lasting usually twenty-four hours, leaving no visible trace beyond the sequelæ of anæmia, enlarged spleen, dyspepsia, and such physical signs.
In the case of Europeans resident here, or temporarily staying either in Lamu or in the neighbourhood, what I have written above so far applies that in the character
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of the temperature curve we have only the record of a short but severe remittent fever, which more and more, in the case of those long (over five years) resident, in or near here, tends to become shortened in length, but increased in severity, and approximating to a hyperpyrexial or foudroyant type in its thermal character while it lasts; but once having dropped, all character seems to leave the temperature -observations.
Thus I should ascribe to the temperature curve a remarkable, but complete, lack of significance, except in its direct guidance, for the treatment of hyperpyrexial cases, and the commencement of its fall as an indication for the general exhibition of quinine, methyl blue, or other destructive agent for the parasite.
So much stress has been laid on the significance of the temperature chart that I feel it need be added, without undue length, that quinine, when withheld, did not seem to affect any certain return of the attack where natives were concerned.
I have no desire to weary your attention unduly by any lengthy physiological observations either on the plasmodium, its changes, or on the pathological observations made on the blood of those affected here, for I feel that the interest occasioned by such observations must, under present circumstances, be notably wanting both in control observations, and open to grave fallacies at first from inaccuracy of observa- tion and other accidents. would rather beg your consideration of the subject of the administration of quinine, and to compare it with the statement made on p. 23 of the article under consideration.
May I venture to point out that neither in the case of typhoid fever nor in the case of malaria is the examination of the peripheral blood circulation of any certain and conclusive diagnostic significance.
It has been repeatedly shown by Koch, Kitasato, and Kunig, as well as Wood- head and other English observers (Cobbett and Kanthack), that such blood as is to be used for certain diagnosis either for the Widal reaction or for plasmodia should be withdrawn from the body by splenic puncture, which is diagnostic, irrespective of quinine administration or of antityphoid serum, as long as the pathological condition is still existent apart from any sequelae of a depressed physical condition.
Quinine in large doses of 10 to 20 grains given on a falling temperature and exhibited in rare cases to 40 to 50 grains a-day has been found by local experience to give the best results obtainable with this drug.
Black-water Fever. Of this discase I have only had the experience of one case. The treatment adopted in this case was the result of the acceptance that the condition of the kidneys was one of passive filtration. All symptoms ceased completely after the administration of three small doses of cantharides, though the malarial symptoms and sequelæ persisted. I may mention that this case occurred previous to the article on this subject by Dr. Moffat, which appeared (March 1901, "Journal Tropical Medi- cine"). Locally, the administration by the mouth of quinine may be given notice under its controlling power, as affecting the tendency of malarial subjects to the severe ulcers and sloughing sores to which these people prove very liable, who are wholly drawn from the untreated native patients whose residence at a distance, or other cause, renders them unable to obtain medicine during their short severe illness, and who lack the enterprise to obtain medicine till compelled by their condition to do so.
With regard to the printed slip Miscellaneous, No. 132, on the measures for the prevention of malaria; under Prevention, I have to inform you that the present resi- dence of myself and wife has been fitted with copper wire gauze, of 1 millim. diameter across the mesh. This has proved effective for all mosquitoes where fitted; but, under the salt-laden condition of the air, shows a rapid loss of clearness and some deteriora- tion; it is, moreover, very costly. Its chief merit lies in its strength, where such pro- tection has to be also open to exposure to strong winds. Varnished coarse mosquito curtaining would answer equally well in protected situations.
Mosquitoes here, as elsewhere in British East Africa, I believe, are very nearly indifferent to the light or dark, as regards the time of their feeding, but show a marked inability to repeat an attack where the wind is stronger than the lightest breeze.
A partial clearance of vegetation near the house has proved to greatly diminish the number of all insects generally which made their way in, but large numbers of mosquitoes take refuge in the native huts which adjoin this residence.
The large number of infected malarial wells throughout the town can only be
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