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C.O.885

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accommodate himself to the new conditions in which he is and he begins to look forward to arriving in the Colony and to earning money there. Marked improvement is seldom seen till the third week and often not till the fourth or even later-that is, not till the ship has passed the Cape.

Once improvement sets in it is usually continuous, so that the coolie on arrival is on the up grade. The excitement of arriving, the joy at being on shore where he can move about, and the feeling that in a few days he will at last be drawing pay, all this stimulates him mind and body, and the improvement not only continues but does so at an increased rate during his early days in the Colony.

14. We do not mean at all to decry the value, under suitable conditions, of thymol in clearing out ankylostomes; we merely mean to say that large numbers of coolies to whom no thymol has been given have been landed in the Colonies in excellent physical condition and that they had arrived at that condition on board from a previous state of some anæmia and listlessness, while Dr. Neish's reports would show that the thymol treatment had not removed these conditions on board ship.

15. How fallacious may be one's estimate of successful results will be under- stood by referring to the case of Dr. Fonceca. In his report ex "Mersey," 5th December, 1907, he gives five failures in 45 cases treated and examined in hospital- that is, 11 per cent. of positive failures; yet the percentage found infected on their arrival in British Guiana of the coolies ea" Ems," 1908, was 55, and that after he had himself put them through the full double course.

16. Now a series of examinations extending with intervals over a considerable period of time may justify one in regarding the patient as free from the worms, but one or two negative results does not prove him to be so. infected (ie., of failures) was probably much higher than 55. Compare this with Thus the percentage of Dr. Fonceca's own estimate of 11 per cent. of failures.

17. In regard to Sir. P. Manson having recommended the adoption of the Fonceca procedure we quote from the memorandum which we submitted to you through our then Honorary Secretary (Surgeon Kenny) on 22nd April 1908 :-

With regard to Sir Patrick Manson's letter in which he approves of Dr. Fonceca's proposal, we assume that Sir Patrick Manson has, when ordering medical treatment, been accustomed to do so, whether in hospital or elsewhere, under conditions in which he could ascertain (1) that the person was in a condition fit for treatment and (2) that he (the patient) would be under proper care during the treatment. Sir P. Manson would, therefore, naturally conclude that a course such as that now under consideration would have been recommended only under conditions similar to those to which he himself had been accustomed. no one of Sir Patrick Manson's experience and eminence would, if he were We feel sure that fully acquainted with the conditions on emigrant ships, endorse a suggestion that drugs should be there given to a lot of healthy people in a wholesale routine fashion.

No one accustomed to work in a well organised shore hospital, with its trained staff, can know the difficulties which confront a Surgeon on an Indian emigrant ship, even in his purely medical work. But in addition to that

work he is responsible for the discipline, sanitation, diet, amusements &c. Out of a crowd of ignorant coolies he has to organise nurses, policemen, cooks, cleaners &c. and to constantly supervise them. His only assistance is from two-sometimes three-more or less helpful native compounders, who, in their turn, need direction and supervision. In addition to this he has to contend with unfavourable weather and has medical charge of a crew numbering nearly 100 people."

18. The following is taken from Sir P. Manson's "Tropical diseases" Revised Edition.

"Certain precautions have to be observed in employing this drug (thymol). At times it gives rise to a very unpleasant form of intoxication, vertigo, excitement, &c. It is advisable, therefore, for the patient to keep his bed and to lie down for several hours after the last dose. Thymol is very insoluble in water, and is, therefore, in ordinary circumstances, not readily absorbed in poisonous quantities. Should, however, the patient, while thymol is present in the stomach, partake of any alcoholic drink, there is considerable risk of poisoning ensuing. Alcohol, ether, glycerine, turpentine, chloroform,

and oils are all solvents of thymol and must therefore be avoided while thrs drug is being exhibited.

"Thornhill related an instance in which a fatal result was brought about apparently by the neglect of the obvious precautions suggested by these facts. A man had received 30 grains of thymol in water at 7 a.m. no special symptoms after it, and at 9 a.m. the nurse gave him a second dose He experienced of 30 grains. This man was supplied with arrack (native spirit) as an extra, and as in such cases a portion of the arrack was usually given at 9 a.m. the nurse gave it to him just after administering the second dose of thymol. The result was that intense collapse set in almost at once, and, in spite of all efforts, the man died within twenty-four hours, the collapse manifestly being due to the arrack dissolving the thymol, which was thus absorbed. Thornhill mentions two additional cases of thymol poisoning occurring in his own experi- ence; other writers have recorded similar fatalities."

Sir Patrick Manson does not refer to beta-naphthol, but Castellani and Chalmers state that it should be given "with the same precautions as with thymol." 19. If accidents such as those referred to above can happen in a shore hospital with trained nurses and where there are none but sick people to be looked after, would they not be much more likely to occur amongst some hundreds of people crowded together on a coolie ship?

20. If the proposed procedure were as safe, efficient and easy of application as it is said to be, why should we object to adopt it? It would not much trouble a surgeon to walk along a line of coolies and see his compounder give each one a dose of medicine. If the matter began and ended there it might present little difficulty, but it is to be remembered that fatal results may ensue either from such a cause as that reported by Sir P. Manson (see above, paragraph 18) or from a coolie eating prohibited articles of food, such as ghi, oil &c. It is evident that such accidents are much more liable to occur on a crowded coolie ship than in a hospital on shore, sup- plied with a well trained staff of attendants and where the isolation and control of a patient are much easier.

21.

In reference to paragraph 2 of the despatch from the Governor of British Guiana (B. Guiana 69, 25.3.13) we wish to respectfully express our regret that His Excellency should consider that length of service, combined with experience of the conditions under which the people who are intrusted to their care have to live. should incapacitate us for our duties unless we have had a course at a School of Tropical Medicine.

22. We have not, as a body, taken such a course, not because we would not take the necessary trouble, but because we did not think that we should get much aid therefrom in our special work.

23. Such a course is useful to one practising on shore in the tropics in a mixed community of sick and healthy, where many of the diseases are practically con- fined to the tropics and so cannot be studied in a general hospital, and where a knowledge of the bearing on health and sickness of climate, soil, water supply, animal and vegetable life, &c., are of great importance.

24.

In contrast to this, a Surgeon-Superintendent has charge of a body of people who are supposed to be, on embarkation, in sound health, and, excepting the children, in the prime of life.These people are on board ship for a comparatively short period, during which questions of soil, water supply, &c., do not exist, and even climate is not usually important in the sense in which it is so in tropical medicine ashore.

25. The course, too, is highly scientific, involving use of microscope, chemical analysis and such. On board of a coolie ship conditions are unfavourable, we might say, antagonistic, to accurate scientific work. Now, in medicine, inaccurate scientific observations act as do false premises in logic, that is, they mislead. Some idea of the difficulty of pursuing scientific works on these ships may be gained from the fact that, owing to noise, vibration, &c., it is frequently almost impossible to hear accurately the heart or lung sounds, even in bronchitis and pneumonia. A surgeon has often to almost entirely rely on his experience of similar cases in his diagnosis and treatment.

26. The diseases from which coolies mostly suffer during the voyage are diarrhoea, dysentery, fever, bronchitis, pneumonia, measles, conjunctivitis and such. All these can be readily studied in a general hospital and their treatment, in so far as this is applicable on coolie ships, had been settled long before the Schools of

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