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PUBLIC RECORD OFFICE

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19 PUBLIC RECORD OFFICE, LONDON

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5. I would suggest that interesting information on the subject might be obtained from Dr. C. W. Branch, at present on leave in England, who has made a special study of this disease, and whose crusade against it I refer to in my Blue Book report for the year 1902-3.*

I have, &c.,

EDWARD J. CAMERON,

His Excellency

Administrator.

Sir Ralph C. Williams, K.C.M.G.,

Governor of the Windward Islands,

&c., &c., &c., Grenada.

Colonial Hospital, 18th January, 1908. The prevalence of ankylostomiasis (uncinaria) in St. Vincent has been pointed out by Dr. C. W. Branch, and the figures given in this report are taken from a paper on the subject, by him, and published in the "Journal of Tropical Medicine," September 1st, 1905.

"116 hospital and dispensary patients of the labouring class, taken at random, were examined in order to determine the percentage of uncinarial infection.

In 116 cases uncinaria (anchylostoma) were present in 77, equal to 66 per cent. Two-thirds of the labouring class of the island are, therefore, infected, more or less, with the parasite."

There are no data available of there being any marked increase in the severity of the disease during the rainy season, though, possibly, the wet season favours the occurrence of ankylostoma dermatitis, and increases the incidence of the disease.

(a) There are no sanitary measures in force in the Colony for dealing with the disease.

(b) Latrine accommodation is not provided on estates, and such as exists in centres of population, e.g., in small towns, consisting of wooden buildings erected on piles in the sea, do not meet the requirements of the bulk of the population.

(c) The method of treatment employed at the Colony Hospital, where all cases are treated, is to give 2.0 grammes (sic) at 4, 6, 8 and 10 a.m. on an empty stomach; breakfast of milk or pap at 12, and a dose of mag. sulph. earlier or later in the after- The noon, according to the state of the patient, and the action of the bowels. patient is usually sent home next day unless he be dropsical, or very anæmic and feeble, and given an iron mixture for a week; when he returns for re-examination and repetition of his thymol, if eggs are still found in his fæces.

(1st) For the treatment of ankylostomiasis in plantations is recommended the establishment of convenient centres, or hospitals, under the management of the district medical officer, assisted by a competent nurse the only one at present available being the Colony Hospital.

(2nd) The treatment en masse would be mainly "preventive," and would be brought about by the education of the people; by the teaching of the hygiene of the disease in the elementary schools, and especially as the disease affects each particu- lar village.

(3rd) The institution of general sanitary measures for the guidance of the labouring population, with special reference to cleanliness, and eating of meals with cleanly washed hands; and special sanitary measures, by the establishment of properly controlled latrines, under efficient supervision, with compulsory instruc- tions for their use.

CYRIL H. Durrant,

Acting Medical Officer of the Kingstown District.

EXTRACTS from Report of Dr. Pike, Medical Officer, No. 4 District, 10th February,

1908.

*

*

ศ

'Prophylactic Measures.

"After considering all these facts, one can only come to the opinion that the disease can be prevented by careful attention to personal health. The systematic

• Colonial Report [Annual], No. 403.

117

In the

employment of latrines and the boiling of all water used for drinking purposes The principal personal rules are are the most important prophylactic measures. careful washing of the hands and nails before eating whenever mud has been handled. For the sake of the community care should be taken that indiscriminate defecation over the country should not Le allowed, and also I would suggest a pro- mulgation of simple sanitary rules within the understanding of the natives. West Indies the practice of walking and working on soil, dry or damp, with bare feet undoubtedly is a big factor in the prevalence of this discase. In other words, shoe the people, try to stop them eating earth, and try to make them wash their hands before they eat food, and you will have no anchylostomiasis in the Island of St. Vincent."

"Treatment.

"There is only one specific for this disease, and that is thymol. It should be given in large doses, that is, 30 grains at 8 a.m., 30 again at 12 mid-day, and a big dose of castor oil at 4 p.m. in the afternoon. Thymol should never be given unless the doctor is within easy call, as if his instructions are disobeyed death may result. The only other treatment that is of the slightest good is magnesium sulphate in one drachm doses three times a day. But this treatment, though efficacious at times, cannot compare with the thymol treatment introduced by Bozzolo. Personally speaking I believe that no other treatment has the slightest effect upon this disease except those that I have already mentioned. The diet should be milk and soup, while the patient is under treatment, all solid food being avoided.

Remarks.

"In my practice here I find that anchylostomiasis is most prevalent amongst the Portuguese, and I am strongly of opinion that this disease is largely due to the fact that the average West Indian labourer works without shoes or socks always. He thus gets his feet covered with earth which is most probably impregnated with the larvæ of Uncinaria duodenale. The black and coloured races are by no means immune from this disease, but the Portuguese show as a rule the most severe types. In St. Vincent nearly all cases of anchylostomiasis have to be treated in hospital, as no dependence can be placed upon most of the relatives of the sufferer. The disease is very much less common in what is known as "The Carib country" than in that portion of the district which extends from the Mount Bentinck River to the Biabou River. The most infected village in my district is Madeira Valley. In conclusion I would draw special attention to my remarks under the heading of Pro- phylactic Measures.'

CYPRIAN R. PIKE, M.R.C.S. (Eng.), L.R.C.P. (London), &c.,

Medical Officer, 4th District.

February 10th, 1908.

8581

SIR,

No. 66.

WINDWARD ISLANDS (ST. VINCENT).

COLONIAL OFFICE to DR. C. W. BRANCH.

[Answered by No. 67.]

Downing Street, 18 March, 1908.

I AM directed by the Earl of Elgin to transmit to you the enclosed despatch* from the Governor of the Windward Islands forwarding one from the Administrator

of St. Vincent on the subject of ankylostomiasis in that Colony.

2. Lord Elgin would be obliged if you would be so good as to favour him with your observations on the report in Mr. Cameron's despatch.

3. I am to request you to return the despatch with your reply.

• No. C5.

I am, &c.,

H. BERTRAM COX.