104
(c.) Rubber Estate in Selangor No. 2.
This place was formerly considered to be a very "unhealthy" one, chiefly on account of the prevalence of malaria. The amount of illness. from this disease is now stated to be much less.
Examination of 67 coolies, who on the day of examination were at work, gave
the following results :-
Ova of ankylostomes alone
Ova of ankylostomes and round worms
Ova of ankylostomes and whip worms
Ova of round worms alone
Ova of round worms and whip worms No ova found
9
24
3
18
2
11
67
105
number of coolies in each place was examined for the presence of malaria parasites. The results were as follows:-
(a.) Estate Hospital in Negri Sembilan. (Number of specimens examined 133.)
No parasites found
Parasites of benign tertian malaria alone Parasites of sub-tertian (malignant) malaria alone Parasites of benign tertian and sub-tertian malaria Parasites of quartan malaria
15
16
2
10
90
133
Percentage of patients harbouring malaria parasites, 32.
(b.) Rubber Estate in Selangor No. 1.
(Number of specimens examined 160.)
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Reference :-
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11
22
2
Ova of round worms alone
Percentage of coolies harbouring ankylostomes, 54.
(d.) Rubber Estate in Selangor No. 3.
This is an estate recently opened up, and is near No. 2. Owing to quinine prophylaxis, the sickness rate has not been a high one.
Examination of 114 coolies, who on the day of examination were at work, gave
the following results :-
Ova of ankylostomes alone
...
Ova of ankylostomes and round worms
Ova of ankylostomes, round worms, and whip worms
Parasites of benign tertian malaria
No parasites found
2
158
160
Percentage of coolies at work harbouring malaria parasites, 1.
(c.) Rubber Estate in Selangor No. 2.
(Number of specimens examined 55.)
l'arasites of benign tertian malaria alone...
3
23
Ova of whip worms alone
Parasites of sub-tertian malaria alone Parasites of benign tertian and sub-tertian malaria Parasites of quartan malaria...
14
1
1
No parasites found
Ova of round worms and whip worms
36
5
Ova of round worms, whip worms, and thread worms No ova found
1
55
31
Percentage of coolies at work harbouring malaria parasites, 35.
114
(d.) Rubber Estate in Selangor No. 3.
(Number of specimens examined 160.)
Parasites of benign tertian malaria alone
9
Parasites of sub-tertian malaria alone
19
Parasites of benign tertian and sub-tertian malaria
Parasites of quartan malaria...
2
1
No parasites found
129
160
Percentage of coolies harbouring ankylostomes, 31.
In this series of examinations, therefore, there is found sufficient evidence of the widespread nature of the infection, varying from 25 per cent. in the case of coolies on a "healthy" estate to 56 per cent. in the case of patients admitted to an estate hospital.
It will be noted that, except in the case of the estate hospital patients, few of these coolies can properly be said to be suffering from ankylostomiasis. In each infected individual, however, all the potentialities are present for the development of that disease and for the conveyance of the infection to his fellows.
2. The relative distribution of the two species of ankylostomes was determined from the examination of a large number of worms recovered from estate coolies after the administration of anthelmintic drugs and in the course of post-mortem examina- tions. About two thousand worms were examined.
The so-called "New World" hook-worm (Necator americanus) formed about 80 per cent. of the total number. The "Old World" form (Ankylostoma duodenale), though relatively infrequent in the Tamils, is the more common form found in Chinese. Occasionally the two forms are found in the same subject.
3 and 4. The determination of the proportion of Tamil labourers suffering from the effects of ankylostomes, and of the relative importance of ankylostomiasis as the cause of death, presents considerable difficulty. Owing to the frequent existence in this country of other infections, notably malaria and dysentery, in indi- viduals harbouring ankylostomes, the part played by these latter parasites inducing disease or a fatal result is not easy to estimate. It may perhaps be safely inferred from the experiences of workers in countries where malaria and dysentery are practically non-existent that this part is an important one.
With a view to throwing light on this aspect of the question, the blood of a
Percentage of coolies at work harbouring malaria parasites, 19.
In view of the fact that the coolies on these latter estates (Selangor Nos. 2 and 3) are regularly being given quinine as a prophylactic, it is unexpected to find such & large number in whose peripheral blood malaria parasites are to be found. Taken in conjunction with the comparatively high ankylostoma incidence, these observa- tions appear to re-affirm a conclusion reached by an investigator in the Southern United States that "the existence of uncinariasis (ankylostomiasis) in an individual who is also the host of malarial parasites apparently has some real influence in causing the malaria to be more persistent than usual, in spite of ordinary or earnest anti-malarial medication." It has been found that in certain patients suffering from malaria thorough quinine treatment has proved ineffective. examination the presence of a co-existent ankylostoma infection has been deter
On further mined, and, after treatment with anthelmintics, the malaria has yielded readily to ordinary dosage of quinine.
Two hundred and fifty coolies at work on a Negri Sembilan estate where auky- lostomiasis was prevalent were examined for evidences of anæmia; about 30 per cent. were found to be suffering from a moderate grade and about 7 per cent. from
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