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severe anchylostomiasis, and his stools were loaded with ova of the parasite. He was cured and sent home, when his younger brother and their father came in suffering also severely from anchylostomiasis. They were cured in their turn, and [? I] found out that their house had no privy, and that the night soil was thrown away on to the land in the neighbourhood. I took particular care to explain to these people the nature of the disease from which they suffered, and what arrangements were necessary to be made to prevent re- infection. They listened carefully to me, and thanked me profusely for my advice, which they said they would not only follow themselves, but would try to get followed by all their neighbours."

13. The people referred to belonged to the upper class of peasant proprietors; and, as they followed my advice, no person from their particular district has come to me to seek my help in trouble due to the effects of the parasite of the hook worm.

14. It appears to me, therefore, that this intelligent class of people may be reached by distributing amongst them a leaflet describing-the disease, its danger, its cause, and the precautions necessary to be taken to prevent its spread. Such a leaflet might be circulated also amongst the ministers of religion, the district magistrates, the justices of the peace, and those public officers who go about amongst the people, with a request from the Government that they will do all they can to spread the information in the leaflet amongst the people.

15. Should the Government approve of the plan contained in the preceding paragraph, I shall be pleased to write such a leaflet in simple language that will be understood by the people most concerned.

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that it is the habit of the labourers to go to the ponds and wash their hands, and feet, after their daily work.

I might also state that they prefer the same water for drinking purposes. The disease does certainly appear to be more common among men than women, though the men and women follow similar field occupation, and apparently it is a discase of young and middle aged.

Later on I would like to forward a further report on this subject, but the matter requires much time.

As I have stated before, few of the cases are sent to the public institutions as suffering from ankylostomiasis, but under a more or less vague diagnosis, and many of the cases although thoroughly infected show no symptoms.

So far I have not been able to differentiate the Ankylostomum duodenale from the Uncinaria Americana, but I have little doubt that the results are practically the same.

Honourable the Acting Colonial Secretary,

&c.,

30081

&c.,

&c.

No. 78.

I have, &c.,

FREDK. L. NORRIS.

PUBLIC RECORD OFFICE

Reference :-

PELE C.O.885

19 PUBLIC RECORD OFFICE, LONDON

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

His Honour

SIR,

the Administrator of Dominica,

I have, &c.,

H. A. ALFORD NICHOLLS,

Senior Medical Officer.

Enclosure 5 in No. 77.

Holberton Hospital, 22 July, 1908.

I HAVE the honour to report, for His Excellency's information, that I have examined 114 persons, taken haphazard, for ankylostomiasis.

These were admissions to either the prison, poor house, or hospital.

Of the 114 persons, 17 were found to be infected with the Ankylostomum duodenale, or Uncinaria Americana.

This amounts to nearly 15 per cent. of cases examined.

The cases were sent in for various disease of low heath-such as ulcer, diarrhoea, dyspepsia, &c., and destitution.

Only a small number of the cases in which the ova of the ankylostomum were found in the fæces suffer from actual ankylostomiasis; by this I mean advanced anæmia due to the presence of helminths; but that the Ankylostomum duodenale, or the Uncinaria Americana, has a very prejudicial effect on the labouring classes here I have little doubt.

Many of the cases where the ova were found in the stools presented no marked symptoms of anæmia, but others showed symptoms of an advanced type.

The treatment that has been followed here has been to administer 15 grains of thymol twice a week, followed by a saline purge. Practical experience has shown that it is highly undesirable to use any oily purgatives, and for this reason I prefer not to have the patients on a milk diet, or to administer stimulants.

The thymol treatment is usually kept up for three or four weeks, and at the end of that time they are treated with iron and arsenic for three months; they are then generally found to be improved in health and are then discharged as relieved, but it has been my experience that these same people return in a year or so, as bad

as ever.

Although I have looked carefully for any cutaneous lesions of the legs, hands, or forearms, I must confess that I have never observed them, nor have I ever been able to obtain any history of any skin disease from the patients.

In Antigua the labouring classes on the estates have no latrine accommodation as a rule, but use the open cane fields for that purpose; but I have noticed, however,

EAST AFRICA PROTECTORATE.

PRINCIPAL MEDICAL OFFICER'S REPORT FOR 1907. (Received in Colonial Office August 17, 1908.)

(Extract.)

Supplementary Report by Dr. A. Robertson on Ankylostomiasis and Bilharzia at Kilindini during 1907.

Of the 129 cases recorded under the heading of Animal Parasites more than 70 per cent. have been caused by the Ankylostomum duodenale. The chief symptoms of this disease are due to the very intense anæmia which causes the patient to come first for treatment. It is a very common disease among the Swahilis, and, strange to say, comparatively rare among the Indians. This is usually attributed to the more cleanly habits of the latter compared to the former, but I do not think that the Indian coolie is any whit cleaner in his habits than the average Swahili, and yet he escapes; perhaps this may be due, as in many other diseases, to a natural immunity. I always make it a routine to have the motions of all patients affected examined on admission, and once a week till discharge.

I adopt a similar procedure as regards the blood, and in several of the worst cases I have found the percentage of hæmoglobin to be as low as 15. The blood microscopically presents all the characters of advanced anæmia.

It has been the custom to treat the disease with large doses of thymol from the commencement. I adopted the same procedure, but found in two cases which died, on post mortem, great congestion of the kidneys, which I thought might be due to thymol poisoning.

cures sooner established.

I now make it my practice to commence the treatment of each case with 1 grain of thymol three times a day, increasing the dose per day up to 20 grains. In con- junction with this I also give large doses of ferri et ammon. cit. or tinct. ferri perchlor., and since using this treatment I have not only had no deaths from this disease, but improvement in the condition of the patient has been more rapid and

Bilharzia. I have accidentally discovered this disease in one or two cases which have been admitted into hospital suffering from some other affection. The patients complained of nothing that would point to this disease, and it was only in the routine examination of the urine that I came to learn they were suffering from it. I experi- mented with several drugs, but found the best results from the use of urotropine in 74 grains three times a day.

With urotropine, however, the urine still contained varying quantities of blood, and I added to the treatment benzoic acid in 15 grain doses, also three times a day. This has proved most satisfactory.

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