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PUBLIC RECORD OFFICE

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21 PUBLIC RECORD OFFICE, LONDON

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re-examined on the 28th October for ova; and even then in some batches one or more would have been found to have survived the third treatment and require a fourth treatment. It will thus be seen that a batch of 80 coolies arriving on the 1st October will be required to be examined and treated for at least the whole of that month, and in some cases longer, before they could be considered to be free from these worms. If only one "treatment was given, it would mean that nearly half the coolies so treated would go to the Colonies containing ankylostomes. The latest authoritative pronouncement on ankylostomiasis and its treatment is con- tained in a report by Ashford, King, and Gutierrez, who examined and treated a large number of cases in one of the West Indian Islands called Porto Rico. Of 4.630 Porto Rican patients treated with thymol, the worms were entirely expelled in 3,630 cases; 1 treatment was required in 1,518 cases; 2 treatments in 1,166 cases; 3 treatments in 518 cases: 4 treatments in 247 cases; 5 treatments in 104 cases; 6 in 47 cases; 7 in 19 cases; 8 in 6 cases; 9 in 3 cases; 10 in 1 case; and 11 treatments in one case.

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With the exposition of what the examination and treatment really means, it remains for the authorities to decide-

(a) whether a thorough system of examination and treatment should be adopted which would involve a stay in the depôts for a long period and be very costly;

(b) whether a merely make-believe system of one treatment should be adopted, which would be of but little gain to the Colonies, as explained, and at the same time tend to make emigration unpopular and increase the difficulties of the management in depôt;

(c) whether the Colony should not itself undertake the examination and treatment of coolies immediately on arrival, and afterwards enforce on the estates a rigid system for supervising the proper disposal of excreta: since the faces of ankylostome-infected patients represent the potential infection in concentrated form, it is clear that a proper disposal of the discharges is the great factor in preventing ankylosto- miasis. Build proper privies and insist upon their being used. This one line of prevention, if carried out, is sufficient to blot ankylosto- miasis out of existence."

21. As the Colonial Office in their letter of 8th March, 1911, addressed to the India Office, merely asked for suggestions, I beg that rules for the systematic treatment of coolies in the Calcutta Emigration depots may not be introduced until the Colonial Office have had an opportunity of learning from its agents in India what the probable effect of such rules would be. The colonies of Trinidad, Jamaica, and Fiji have not asked for measures for the eradication of ankylostomiasis to be taken, nor has the Colonial Office asked on their behalf, and I request, therefore, that measures not be introduced for them until an opportunity has been afforded

may them for expressing their wishes.

22. In British Guiana and all the West Indies, I am informed, ankylosto- miasis is endemic. To what purpose, then, would any measures taken in Calcutta be if the coolie becomes reinfected on arrival?

23. In conclusion, I submit that a coolie is a free agent and cannot be forced to undergo medical treatment against his will. Whatever rules may be introduced, they cannot be made operative until the coolie has expressed his willingness to submit, and, if he believes himself to be in good health, he will not submit to so drastic a treatment as that which the eradication of ankylostomiasis necessitates.

A. MARSDEN,

Calcutta, September 12th, 1911.

Government Emigration Agent for Trinidad, &c., and Officiating Government Emigration Agent for British Guiana.

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Major H. W. PILGRIM, I.M.S., M.B. (Lond.), F.R.C.S. (Eng.), Senior Surgeon to the General Hospital, Calcutta, Depôt Surgeon to the Emigration Agency for British Guiana, to ROBERT W. S. MITCHELL, Esquire, C.M.G., Govern- ment Emigration Agent for British Guiana.

Calcutta, 25th March, 1903.

SIR,

I HAVE the honour to acknowledge your memorandum, No. 1298, dated 14th February, 1903, enclosing various letters on the subject of the prevalence of ankylo- stomiasis amongst coolie immigrants to British Guiana, and asking my opinion on the measures suggested for dealing with it.

In the first place, I note that the letter written to you direct by His Excellency the Governor suggests the microscopic examination of the stools, and the treatment (where necessary) of all the emigrants whose stay in the Depôt gives the necessary opportunity. This is consistent, and were not the process handicapped by serious disadvantages, it would be well worth trying. On the other hand, the letter sent by the Governor, at the instance of the Acting Surgeon-General, to the Colonial Office through the Crown Agent restricts the examination and treatment to every case of anæmia detected on the voyage. This second method would not, in my opinion, lead to valuable results, for an examination restricted to the anæmic would ignore a very large number of emigrants infected with the parasite but not anæmic, and who would on landing be able to disseminate the disease, and possibly to become the subjects of ankylostomiasis themselves. Inspector's Report, after commenting on the remarks of a Surgeon Superintendent In the extracts from the Medical he says, "In this connection, I may mention that a large percentage of the cases of this season's coolies sent by me to the Public Hospital, Georgetown, for examination, were found to have the ankylostomum duodenale." This remark is only interesting in so far as it is in harmony with the well-known work of Indian experts in this field, such as Giles, Dobson, and Rogers, whose results are tabulated in the literature of most languages, setting forth that the ankylostomum duodenale is to be found in the motions of the great majority of coolies in India. The discovery in Georgetown Hospital of the presence of ankylostoma in a large percentage of coolies should hardly, therefore, have evoked surprise or comment.

It would be useless to attempt to cope with the matter in the Calcutta depôt, except each batch of coolies was thymolised wholesale; and apart from the question of available time, there are many other difficulties that would have to be faced.

I propose formulating a few facts and experts' opinions about this worm and its prevalence amongst Indian coolies which will put you, and any other interested in the subject, in a fair position to estimate how far the method suggested of dealing with this parasite in the Calcutta depôt is likely to lead to desirable results.

1. Man is infected by contact with earth, mud, or water contaminated with the excreta of people harbouring ankylostomes. The worms within the intestines are constantly passing a stream of eggs, but these eggs undergo no further develop- ment in the intestine; the number of worms in any given case do not, therefore, increase, except a fresh infection occurs, and after a time (some say a few months, some a few years) these worms die. It is certainly the case that infection is effected

in ordinary cases by the ingestion of a small number of larvæ at a time, and if exposure to infection continues, or is renewed, frequent subsequent infections occur, adding to the number of worms in the case so exposed. As this parasite is common in the West Indies, it is, therefore, quite possible that ankylostomiasis makes itself felt amongst coolies in British Guiana, either as a result of fresh infection there. leading to so large an invasion that the powers of the host become eventually sapped; or this latter effect may result if the lot of the patient should happen to be cast in hard lines, and the general health suffers.

2. The exact conditions under which ankylostomes injure the health are not quite understood; for instance, it is a fact that the symptoms of pronounced ankylo- stomiasis may occur in patients harbouring only a few ankylostomes. On the other hand, it is equally true that these worms may be present in vast numbers in people apparently in the best of health. Individual idiosyncrasy and environment, there- fore, play an important part in the production of symptoms.

3. The presence of anemia and ill-health should not be ascribed to ankylo: stomes until all other possible causes, such as malaria, organic disease, climatic effects, are carefully excluded, for undoubtedly excellent health is maintained in a large number of cases in India in spite of the presence within of ankylostomes.

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