CO885-(18-19) — Page 94

PUBLIC RECORD OFFICE

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Reference :-

C.O.885

18 PUBLIC RECORD OFFICE, LONDON

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

174

DESCRIPTION OF ENCLOSURE.

Name and Date.

Subject.

Mr. Bryce, Washington, December 4

Eraulication of Ankylostomiasie.

Enclosure in No. 131.

(No. 175. Commercial.)

SIR,

British Embassy, Washington, December 4, 1907. On the receipt of your despatch, No. 95, in this series, of the 18th ultimo, I requested the Bureau of Insular Affairs of the War Department to furnish me with the information desired by the Colonial Office respecting the eradication of ankylostomiasis in Puerto Rico.

I was informed that they possessed only one copy of the primary report on the subject, and none of the secondary report on the results of the measures taken to stamp out the disease. They stated that they would immediately request the autho- rities at Puerto Rico to furnish further copies.

I have the honour to transmit one copy of the primary report* and hope to be able to forward the secondary report in about three weeks.

The Right Honourable

45440

Sir Edward Grey, Bart.,

&c., &c.,

&c.

No. 132.

I have, &c.,

JAMES BRYCE.

SPECIAL REPORT ON THE TREATMENT OF ANKYLOSTOMIASIS BY RICHARD FONCECA, SURGEON-SUPERINTENDENT OF THE SHIP "MERSEY."

(Received December 25, 1907.)

On the 15th October, 1906, after my voyage in the ship " Forth," I wrote a report suggesting certain proposals as to the treatment of ankylostomiasis during the voyage on coolie ships. In that report I stated that 75 per cent. of the coolics were infected with this parasite, and that there were no apparent symptoms to indicate this infection, owing to the favourable conditions under which the coolie was placed during the voyage. I suggested that if coolies were to be landed free, or compara- tively free, from this infection, all the adults should be treated twice during the passage.

I was directed by the Crown Agents for the Colonies to carry out this suggestion

in the ship "Mersey," with this reservation, that no emigrants were to be subjected to treatment should they object to it.

I now submit this special report of the result of the experiment, as to the treat- ment of all adult emigrants on this passage in the ship" Mersey."

First, as to the matter of emigrants objecting to the treatment, I did not find a single objector in all the number. It all depends on how the case is stated to the coolie. If he is told that he has within him certain worms that will in time under- mine his health and incapacitate him from work and prosperity, and that the treat- ment will clear him of these worms, and in support of this, if a few of the worms collected from one of the coolies treated be shown to some of the emigrants, I do not think many objectors will be found.

I began the treatment a month after embarkation from Calcutta, the weather being exceptionally bad previous to this in the Bay of Bengal. Before beginning this treatment I think it best to wait until the emigrants have recovered from sea- sickness, and have become accustomed to their surroundings.

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A portion of the between deck fore and aft for men and women was set apart for the cases under treatment; these places were occupied each day by the lots under treatment. Special cases were treated in the hospitals and the stools examined microscopically. I selected 25 men and 10 women in the order of their names on the muster roll. To each of these I gave a dose of half an ounce of sulphate of magnesia overnight, and at 6, 8, and 10 next morning a 10-grain dose of beta- At 12 another half ounce dose of naphthol. No breakfast meal was allowed. sulphate of magnesia was given, but if the previous dose had acted too freely, the second dose should be made smaller. The deck latrines were used by these patients. At 3 p.m. the ordinary dinner meal was given, after which these emigrants were In all 602 adults were sent away, and a fresh lot took their places for treatment. treated in 18 days, and this treatment was again repeated between St. Helena and Demerara. The only adults not treated were the women advanced in pregnancy and those recently confined. I thought it prudent to exclude these women. With the exception of these, every adult in the ship has been twice treated during the voyage as described above. It will not be possible in a steamer, where the passage is very much shorter, and the number of emigrants larger, to treat all the adults twice over.

I consider beta-naphthol an absolutely safe drug in the doses given. I did not With ordinary care, and exclud- find any injurious effects from it in a single case. ing any emigrants suffering from acute disease or extreme debility (whenever the purgative action of the magnesia may do harm), I see no danger in administering this drug.

Even after this treatment, in the 45 selected cases treated and examined in the hospitals I was able to detect in five of them ova of the ankylostome, but to a much less extent than previous to treatment, proving how difficult it is to dislodge them entirely. In the general treatment it did not take more than half an hour in all to serve out the drugs to 35 adults a day.

Before leaving home I had made for me 6,000 5-grain tabloids of beta-naphthol at a cost of 30 shillings, and the sulphate of magnesia cost in Calcutta 10 shillings. This works out at less than a penny for each case treated. I paid this amount-£2 -out of the £5 allowance for extra drugs. Should the treatment for ankylostomiasis be adopted in all coolie ships it would be a great hardship to expect surgeons to defray these expenses from the £5 allowance. As the amount is so small I suggest that a grant of £2 extra be provided if the continuance of this treatment be decided on.

With regard to the immediate Lenefit to the coolie during the voyage after the I have had coolies just as healthy and treatment, I can frankly say I saw none. landed them in as good condition on previous voyages when the presence of this infection was not even thought of and no treatment administered. But one would not expect to find any very material immediate advantage. The idea of the treatment is to protect the coolie from the injurious effects of this parasite when he becomes debilitated from other causes, for it is chiefly under these conditions that this infec- tion becomes an important factor, and turns the balance against the individual, either destroying his life from extreme anæmia or prolonging his recovery from what- ever other disease he may be suffering from, and also produces a low form of health that incapacitates him from hard manual labour.

I am aware of the fact that, even supposing that a coolie is cured during the voyage of ankylostomiasis, he will be re-infected after he has worked for some time on the plantations of Demerara. The authorities there are fully alive to this, and every precaution is taken to minimise infection, and prompt early treatment is universal in the Colony. I therefore think that it is a great advantage to the coolie to be landed free or comparatively free from this infection before he begins life in the Colony, and on these grounds I advocate this treatment. It is simple, it is safe, it is inexpensive, and the small amount of time needed to carry it out efficiently is well spent.

I was pleased to see while I was in Calcutta that Mr. Bolton, who was acting as Agent for British Guiana, after reading my report on the subject, had instituted a course of treatment to the coolies while in dépôt before embarkation, and had already done so with coolies going to Mauritius. He informed me that his native depôt doctors were now fully convinced as to reality of this infection, and that he intended continuing the treatment and apprehended no difficulty in doing so.