CO885-(18-19) — Page 627

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PUBLIC RECORD OFFICE

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19 PUBLIC RECORD OFFICE, LONDON

ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO

SIR.

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Endon, St, George's, January 23rd, 1908. REFERRING to the Secretary of State's despatch relating to Ankylostomiasis which was forwarded in the Colonial Secretary's circular minute of the 7th instant, I have the honour to forward the following information, as regards this district, as requested.

The disease undoubtedly exists to a considerable extent among the poorer classes, but it is only in a small majority of the cases that it incapacitates them as regards their work. The greatest number of cases come from the Mount Moritz District amongst the poor white Barbadians. A large number of the huts in which these people live have no floors and thus the risk of infection and re-infection by contact with the contaminated soil on the earth floors is greatly increased. A few cases also come from Boca and Annandale. Thorough treatment in hospital is undoubtedly very successful in the more serious cases, but unfortunately re-infce- tion very commonly occurs on the return home of the patient. The avoidance of this would seem to be practically an impossibility here, where the labouring popu- lation chiefly live in isolated houses and not in barracks, as I understand is the case in British Guiana. The establishment of public latrines would, in my opinion, be useless for the places where the disease chiefly exists unless the use of them were made compulsory for any case found to be infected and a complete examina- tion of the stools of the inhabitants of the infected districts were made from time to time. Otherwise I feel sure that the poorer classes would never be induced to use them, and, the houses being so scattered, an efficient supervision would be almost an impossibility.

I cannot say that I have noticed any increase in the severity of the disease during the rainy season, nor in the number of patients applying for treatment.

The only efficient means of eradicating the disease by sanitary measures is undoubtedly by the establishment of public latrines, the disease being one which is spread almost entirely by contamination of the soil by faecal matter, but how this could be carried out in a scattered population such as exists in this district I am at a loss to know.

I have, &c.,

Honourable Acting Colonial Secretary.

T. C. ORFORD,

Medical Officer, No. 3 District.

Reply to Circular 2352/1907, 7th January, 1908. "Ankylostomiasis "As to prevalence of in the Colony and measures for suppressing it.

I have treated ankylostomiasis for 12 years and find few cases in Grenada Dr. Boyd in his report on the Colony severe enough to deserve hospital treatment. and Yaws Hospitals, 1897, referring to 1896, says: "Fewer cases of ankylostomiasis have been admitted during the year, no doubt owing to the disease being more generally treated outside, &c." This mountainous island, abounding in the purest water, cannot be compared with British Guiana. Most of the labouring popula- tion live in isolated huts and “are not gathered together "as in sugar-cane countries; barracks are exceptional and small.

Treatment of Ankylostomiasis.

II. The British Medical Journal, 25th November, 1905, has a practical article on the prophylaxis of ankylostomiasis. My experience verifies the statements made. Salt is an efficient remedy. The negroes of Grenada will hardly eat anything but salted food and in spite of unwashed hands are as a body immune.

The Barbadian whites at Mount Moritz, St. George's, and the East Indians and infants who cannot conform with this dietary suffer. It is remarkable how often a puny child gathers strength once it takes its parents' food. Latrines might be applied to barracks, but there are very few and would not be used in private lots and are impracticable in long stretches of cocoa fields.

Gastro-enteritis in infants frequently means ankylostomiasis, as they eat their ad off their hut floors. The rainy season seems to affect the children, not the adults, from this cause.

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III. Town lots should be kept clean. Two latrines are supposed to serve Grenville with a population of about 1,500. Vegetation is a convenient receptacle for household slops and this has been pointed out for years by different medical officers, but asking for powers to judge when vegetation in proximity to tropical houses is excessive and detrimental is going beyond the routine of cleaning drains and so is not approved of.

In page 592 of the American Modical Association Journal Dr. Leonard sug- gests the pigmented areas on the tongues of many negroes are points of entrance of the ankylostoma, whereas this is only a hereditary peculiarity found in the healthiest children and mothers.

27th January, 1908.

THE HONOURABLE COLONIAL SECRETARY,

N. S. DURRANT,

Medical Officer, No. 7 district.

In reply to circular letter, 2352/1907, of 7th instant, I beg to state that ankylostomiasis is met with occasionally in this district (No. 9). It is by no means a common affection here but it certainly does exist in sporadic form in some of the villages. Advice has been given from time to time to those suffering from it that all fecal matter should be deposited in one place (viz., a hole dug out of the earth for the purpose) and the mess thickly covered with a layer of white lime at least once a fortnight, but how far this advice has been acted upon by those chiefly affected, viz., the poorer classes is, I fear, quite another matter. Personally, 1 think unless compulsory measures be enforced by the Legislature in the case of those affected by the disease, I see no hope of permanently eradicating ankylostomiasis from the district, for as long as fæcal deposits are disseminated with no regard to sanitary precautions and the ova of the worm are allowed to get back to the human host, the cycle will go on repeating itself endlessly.

In severe cases the treatment usually followed is the administration of thymol in 20 or 30 grains dose, the patient having been previously prepared by a brisk purgative. Another dose of purgative is administered two hours after the thymol is given. On the following day a tonic of perchloride of iron combined with arsenic and a bitter tonic is administered. I have found this treatment fairly successful in general practice. Of course in a general hospital the treatment is incomplete until all signs of ova in the fæces have disappeared and to obtain this it will be found necessary to repeat the administration of the thymol.

St. David's,

27th January, 1908.

G. N. ALEXIS.

Colony Hospital, Grenada, February 17th, 1908. Report on Ankylostomiasis.

1. The post of House

in a position to answer-5.

Surgeon having no district attached to it; I am only Statistics, and

5c. Treatment of severe cases.

2. Statistics.-

Colony Hospital for years 1904-1907.

1904.

1905.

1096.

1907.

150

214

Number of cases treated Percentage of cases of Ankylostomiasis to 20 per cent. 34 per cent.

number of admissions.

157

51

17 per cent. 6 per cent.

A large number of these cases were admitted suffering from other diseases. Thus in 1904 out of the 150 cases recorded, 70 were for ankylostomiasis alone, while the worms occurred as a complication to other diseases in the remaining 80.

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