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C.O.885

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Sousino, too, lays much stress on this, when he says that the anæmia so frequently ascribed to ankylostoma only is, in reality, often complex, and the ankylostoma only one of the elements in its production: and in its (ie., anæmia) etiology we find playing in different degrees low diet, excessive and enforced labour, want of sufficient clothing, exposure to damp and great heat, depressing and moral influences, all acting independently of, or together with, the presence of ankylostoma."

4. In India Dobson found ankylostomes present in over 75 per cent. of a very large number of coolies recruited from the same class as the coolies sent to British Guiana. Rogers, who has worked specially at this subject, both in Assam and Calcutta, found in a large number of cases examined that these worms were present in about the same proportion as noted by Dobson; ankylostomes are, therefore, present in the great majority of coolies sent to British Guiana, no matter what their apparent health be.

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5. The treatment for the expulsion of these worms is far from exhilarating or pleasant. It is as follows:-Liquid diet for two days, followed by a purgation, then a series of large doses of thymol, followed about twelve hours later by another purge the stools are then examined microscopically four or five days later, and if no ova are found it is so far satisfactory, but if some ova are still being passed (not a very infrequent occurrence), then the treatment has to be repeated all over again. The exhibition of thymol in large doses frequently gives rise to unpleasant, though not dangerous, symptoms; and occasionally to distinctly dangerous symptoms, and even to death. It must be admitted that this depleting treatment would hardly be a good preparation for a voyage through the Bay of Bengal in the monsoon. Your extensive experience as an Emigration Agent in India will enable you to realise whether my fear that under this treatment an appreciable number of coolies would stampede is groundless or otherwise. Moreover, the treatment could not be applied in the case of those coolies who are not in the Depôt for more than six days prior to embarkation. It is obvious, also, that the treatment and systematic examination of the stools of all the emigrants (which alone would redeem the process from the reproach of being a farce) would involve the employment of an additional native doctor, as the ordinary native doctor could only conduct this examination and treat- ment by neglecting some of his ordinary and most important work, which, as you know, is very heavy during the last ten days prior to embarkation.

6. The examination, preparation, thymolising, and subsequent examination of a case would take about nine days, and even at the end of that time absence of eggs in stools would be no proof that the parasite had been finally extirpated, for quite frequently a certain proportion of the male, and all the immature female, ankylostomes survive the thymol treatment, and continue their parasitic life, passing eggs later on in large numbers. From all these facts and considerations I arrive at the following conclusions :----

(a) It would be unscientific and useless to restrict examination and treatment to those suffering from anæmia; and, moreover, we do not pass coolies suffering from anæmia, except slight degrees of it only appreciable by a microscopic blood count.

(b) The examination and treatment of all cases in depôt is based on sound principles, but is, I am afraid, attended with serious difficulties and drawbacks, as detailed in paragraphs 5 and 6, and could, moreover, be never applied to all the coolies.

If, however, you decide on carrying out this treatment, on securing the services of an additional native doctor, and also of another method, I shall be happy to instruct him in the examinations of motions for the ova of ankylostomes, &c., and to show him plates and specimens under the microscope.

I have had a fair experience of ankylostomiasis, as is inevitable in the work of an Indian surgeon, but as both Drs. Dobson and Rogers, who have worked specially at ankylostomiasis, are in Calcutta, I took an opportunity of consulting them on this subject, and the method suggested of dealing with it, and I may say that they entirely concur with the conclusions summarised above.

In conclusion, I would point out that unless ankylostomiasis (I do not mean the mere presence of ankylostomes, but their effects) is extensively prevalent amongst coolies of under two years' service in Demerara, the disease is probably more often due to frequent re-infection in British Guiana; and this leads me, as a matter of interest, to inquire of you, who know Demerara so well, what are the latrine arrange- ments in vogue on the estates where coolies are quartered? As the Acting Surgeon- General, in his circular to Medical Officers, Managers, and Attorneys, intended to

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grapple and stamp out the disease, makes no reference to this subject, I presume, therefore, that latrine arrangements on estates are satisfactory; by this I mean that coolies on estates are not allowed to pass their dejecta here, there, and everywhere, as in rural areas of this country, but are sufficiently under discipline so that arrange- ments obtain under which their dejecta are received either in latrines or in deep trenches carefully supervised; unless some such system exists, of course, all other measures would be futile.

(No. 285.)

I have, &c.,

H. W. PILGRIM.

M.B. (Lond.), F.R.C.$. (Eng.),

25th March, 1903.

SIR,

IN continuation of my No. 95, of 22nd July, 1902, on the subject of the treat- ment in depôt of intending emigrants suspected of suffering from the ankylostoma parasite, I have the honour to submit, for His Excellency's consideration, a report from Major Pilgrim, F.R.C.S., (L), to whom I communicated the instructions conveyed under your No. 4063, of 13th June, 1902, from which it would appear that anæmia is by no means symptomatic of the presence of this parasite in the human species, but that the worm affects the majority of healthy Indian peasants.

2. Apart from Major Pilgrim's professional standing, which is among the front rank of Calcutta medical men, he has quoted the experience of two of the fore- most specialists, Colonel Dobson and Major Rogers, who have devoted much time to the study of ankylostomiasis.

The weight of medical experience and knowledge would seem, therefore, to

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be against Dr. Godfrey's theories.

4.

To carry out the instructions from the Colony for the treatment of intending emigrants whom this parasite inhabits, on the requisite scale, would be quite impossible.

5. It would be futile to insist on healthy emigrants submitting to a most dis- agreeable treatment, even were it possible to deal with such large numbers as eight hundred or a thousand at one time. The result would be a stampede of the whole depôt population.

6. Under these circumstances I shall defer the attempt to give effect to

Dr. Godfrey's suggestions until I hear further from the Colony.

7. At sea would appear to be the proper place for treatment of ankylostomiasis,

as would appear to be the opinion of at least one of the surgeons, who proposed that microscopes should be supplied to them for the purpose.

I have, &c.,

ROBERT W. S. MITCHELL, C.M.G.,

Government Emigration Agent

for British Guiana.

The Honourable A. M. Ashmore, C.M.G., Government Secretary,

British Guiana.

SIR,

Government Secretary's Office,

REFERRING to your letter, No. 285, of the 25th March last, I have the honour,

Georgetown, Demerara, 10th June, 1908. by direction of the Governor, to inform you that the Surgeon-General, to whom Major Pilgrim's report on the subject of ankylostomiasis was referred (together with Dr. Manson's remarks on the general correspondence), states that he is of opinion that the treatment of grave cases of the infection should be carried out during the voyage to the Colony,

I have, &c.,

The Emigration Agent

for British Guiana,

Calcutta.

33391

N. DARNELL DAVIS.

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