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PUBLIC RECORD OFFICE

Reference :-

C.O.885

19 PUBLIC RECORD OFFICE, LONDON

ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC-

COPYRIGHT PHOTOGRAPH-NOT TO

10422

SIR,

118

No. 67.

WEST INDIES.

DR. C. W. BRANCH to COLONIAL OFFICE.

(Received 24 March, 1908.)

[Answered 6 April, 1908 (10422).]

16, Bedford Place, Russell Square, W.C., March 22, 1908.

I HAVE the honour to submit, for the information of the Secretary of State for the Colonies, the enclosed remarks and suggestions on hook-worm-disease in the West Indies.

If you consider it advisable to have the MS. type-written, I shall be happy to correct the copy before it is submitted for consideration.

I have, &c.,

C. W. BRANCH,

Medical Officer, Kingstown District, St. Vincent.

Enclosure in No. 67.

During the last fourteen years or so attention has been several times drawn to the prevalence of hook-worm disease in several of the West Indian Colonies, both in official reports and in medical publications. Daniels and Conyers, in British Guiana; Galgey, in St. Lucia; McDonald, in Antigua; myself, in St. Vincent; and Leonard, in Grenada have all reported in the same strain.

I had found the hook-worm in St. Kitts in 1895. It has for some years been recognized in Barbados. In my first hospital report-for 1902-after my appoint- ment to St. Vincent I emphasized the importance of the effects of hook-worms on the population. I later estimated that two-thirds of the labouring class are infected. I have elsewhere pointed out that this disease was prevalent among negro slaves in the earlier colonial days in the West Indies, and was recognized as an entity, though of course the parasite was unknown.

The hook-worms had for some time been regarded as belonging to a single species under the name Anchylostomum duodenale. Stiles, however, found that the prevalent hook-worm in Porto Rico was a second species, and named this Necator Americanus, under the impression that it belonged to the western world. But Leiper has since shown that it is common in Africa, and Looss found it in pygmies from the Great Forest. It has lately also be found in China.

It seems more likely, therefore, that the Necator americanus was brought to the American continent by the negro slaves. Both species now exist intermixed in the West Indies, as shown by Leonard for Grenada and myself for St. Vincent and Trinidad. The Anchylostomum duodenale may have been introduced later by Indian coolies though, on the other hand, it is by no means certain it was not rather carried to the old world after the Discovery. It is not. as far as I am aware, determined which species occurs among the Amerindians, in the heart of Brazil for example, where they have not come into contact with the negroes; so that we are not in a position to accuse the Indian labourers of introducing the disease into the West Indies.

At any rate it is certain that hook-worm disease has long existed, and is now firmly established, in the West Indies and South America; and it is idle to regard the importation of worms in the coolies as a serious addition to the prevalence of the disease.

Treatment.

Native

The diagnosis and treatment of hook-worm are fortunately easy. dispensers can be readily taught to recognize the eggs of the worm under the micro- scope, as I have myself proved. A simple microscope with a low power, such as may be got for £3, suffices.

119

The treatment by thymol is rapid and efficient, but owing to its danger, if alcohol is taken, should not be attempted on peasants except in hospital. In a report for 1902 I mentioned cowitch as a possible substitute, and I have obtained some success with it. But I confess that the efficiency of thymol has deterred me from pursuing the experiments with cowitch and other native-growing plants.

Since the report of the use of eucalyptol at the Kasr el Ainy Hospital in C'airo, I have employed this drug with satisfaction, but as the dose is rather more expensive, I reserve it for old and feeble persons, in whom only I have found thymol dangerous, even without the addition of alcohol. If, however, a more general and systematic treatment of the population were undertaken, then the eucalyptol should be preferred. It is safe and efficient, and as in most cases it will not be necessary to admit the patients to hospital, the treatment will be cheaper. Only the grave cases will require indoor treatment. It is one of the features of hook-worm anæmia that even a great diminution of red corpuscles and hæmoglobin index does not produce as helpless a state as a less degree of anemia from some other causes. The patient can, therefore, walk about and do some work, and can

be treated at home.

For the after treatment a course of iron will be required, and owing to the depreciation of the digestive functions, I strongly urge that ferric salts should not `-- be given. The citrate of iron and ammonia is by far the mildest and Lest tolerated of the inorganic preparations. The organic forms of iron are too expensive for this It is not necessary to give larger doses than 0'15 gramme three times a day, and even this is not assimilated.

use.

Prophylaxis.

It must be borne in mind that there are two modes of infection by hook-worms, by the mouth and through the skin.

The egg hatches quickly-in two days. The larvæ leave the fæces and migrate into damp soil or water. In a few days they are no longer to be found in the fæces, but are all in the water in the culture dish. They are soon developed to the stage ready for transmission to the human Lody. I have successfully infected with larvæ twelve days old. They live in water a long time. I have kept them 48 days, and Braun states they may live 60 days.

The larvæ do not seem able to penetrate the skin when dry, nor do they do so It is true that Looss infected himself, at first accidentally very quickly when wet. and after by design, with drops of larva-laden water. But in ignorance of these details of Louss's experiments I could not see the larvæ effect an entry in my own skin nor in that of a black, even in half an hour. I got no itching red spot from a drop of infective water as did Looss. To obtain a successful skin inoculation I had to cover the water with gutta-percha tissue bandaged over for an hour or so.

I am, therefore, of opinion that infection can only occur by prolonged exposure to infected mud. In wet weather, or if a person had to work in mud, the infective material could remain wet long enough for the larvæ to gain an entrance into the skin.

The validity of the ground-itch as an Anchulostoma dermatitis is doubtful. I obtained only a very slight skin eruption, which disappeared in two or three days. Looss and Sandwith in Cairo failed to see any eruption in cases that were after- wards proved to be successfully infected. The American observers have described an eruption produced experimentally, but this may be accounted for by the concen- tration of the larvæ they employed, and the septicity of the material with bacteria.

"Ground-itch," like "coolie-itch" in some British West Indies and

craw-

craw" in West Africa (teste Prout), no doubt includes various skin eruptions, of which scabies crustosa is in the West Indies the commonest.

The adult worms do not appear in the intestine until three months after the infection. No doubt a sudden large infection may occur, followed by a rapid acute illness, as described by some observers. But usually the process of natural infection is the slow accumulation of worms.

I have observed cases which indicate that a period of about two years is required to produce distinct illness.

In field labourers in St. Vincent I believe that the mode of infection is commonly if not mainly by drinking water of pools and shallow springs in the neighbourhood of inhabited and cultivated ground. I know of some such water holes, which are regularly used, and hope some day to make an opportunity of collecting and examin-