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PUBLIC RECORD OFFICE

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Reference :-

C.O. 885

ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC:

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22 PUBLIC RECORD OFFICE, LONDON

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One

SIR,

(9) Nose and palate lesions and periosteal nodes improved rapidly.

patient presenting a suppurating lesion in the right nostril, which was completely obstructed, began to improve the next day after injec- tion. In one case an old man, who had been given the small dose of 0.25 grammes when presenting an extensive framboesiform eruption, returned five months later with a recrudescence of painful foot yaws.

4. In conclusion, the results show that Salvarsan is an effective cure for parangi in every stage of the disease, with the possible exception of cases in which destruction of bone occurs. Cases treated with one injection seven months ago have shown no tendency, up to the present, to relapse. A more extensive period of obser- vation will determine whether treatment has completely eradicated the disease, and more persistent treatment in cases where bone necrosis has occurred will determine the efficiency or the reverse of the drug in such cases. Further experiments are also indicated in connection with the dosage of the drug.

The Honourable

The Colonial Secretary,

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am, &c.,

A. PERRY,

Colombo.

Principal Civil Medical Officer and

Inspector, Government Hospitals.

No. 38.

WINDWARD ISLANDS (ST. LUCIA).

THE ACTING GOVERNOR to THE SECRETARY OF STATE.

(No. 122.) SIR,

(Received 1 October, 1912.)

[Answered by 35811 : not printed.]

Governor's Office, St. Lucia, 11th September, 1912. REFERRING to the concluding paragraph of your despatch, No. 44, of the 18th June last, I have the honour to forward, for your information, a report by Dr. Hughes, Medical Officer of the Soufriere District, and in charge of the Poor Asylum and Yaws Hospital, in which he details the effect and connected results of a steady application of the Salvarsan treatment in the last-mentioned institution during the last six months.

2. This report goes to show that the public has not been slow to recognise the benefits to be derived by them from the new treatment, and reluctance to enter the Yaws Hospital appears to be no longer a difficulty to be overcome, eagerness for the treatment having apparently taken its place. The improved conditions of appear- ance, attendance, and comfort at the Asylum, my efforts towards which have been actively seconded by Dr. Hughes, and also by the local Visiting Committee, whose interest I have been able to revive, may have contributed to some extent to the over- coming of this reluctance.

3. The report also indicates that the Asylum accommodation has so far been equal to the increased call upon it.

4. In view of the success with which the treatment has been attended, and on the strong recommendations of both Drs. Nicholls and Hughes, with whom I have been in correspondence on the matter, it has been arranged to obtain further supplies of the Salvarsan remedy, and to actively continue the treatment, though this will mean some excess of the provision for medicines on the Estimates, and a supple- mentary vote will be taken and submitted for your approval in due course.

I have, &c..

• No. 22.

EDWARD J. CAMERON,

Acting Governor.

san

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Enclosure in No. 38.

Soufriere, 5th September, 1912. I HAVE the honour to submit the following special report on the use of "Salvar- at the Yaws Hospital.

1. From the appended return it will be seen that 112 cases were treated from 12th March to 29th August, with a break of three months from 9th April to 16th July, owing to supply of Salvarsan having run out. Of these 83 have been discharged cured. The average stay after treatment is about 27 days, whereas under the old method it is well over three months. Taking it as three months, there is a saving to the Government of 23s. 7d. on each patient, less 5s. 6d., cost of a full dose of Salvarsan. This is for dietary only, and is exclusive of cost of administration, wear, and tear of clothing and bedding, and other expenses incidental to the upkeep of an institution. This average of 27 days is somewhat misleading, as children usually remain in hospital for a few days after they are fit for discharge, till their parents can be communicated with; and further, those patients treated in March and April who, for one reason or another, had to be reinjected, could not be done till July, as the stock of Salvarsan was exhausted. In patients injected after 5th August a sufficient time has not elapsed for a cure to be effected.

2. Quantity and methods.—I am inclined to the opinion that larger doses of this drug can be used with comparative safety. I now in all cases above 14 years of age administer the full dose of 6 gr., and I feel sure that 8 gr. in healthy adults will be more effective and rapidly beneficial. The quantity in children under 12 years of age is regulated by the age, weight, and general condition of the patient.

As to method, I, in the first instance, adopted the subcutaneous method, selecting between the shoulder blades as the seat of puncture. In several instances necrosis resulted, and this I attribute to the lack of tissue in this neighbourhood in the ordinary ill-fed and ill-nourished type of patient one meets at the Yaws Hospital. I now make use solely of the intramuscular method, and so far I have not had a single case of necrosis or other untoward effect, and the results are more uniformily successful. I do not possess the apparatus for, and have never made use of, the intravenous method.

3. After-treatment.-Patients are made to lie up for forty-eight hours, after which they are compelled to bathe regularly in the sea. This, I find, assists markedly in the clearing-up process. Meanwhile, mercury in comparatively large doses is being administered. I use the ordinary liq. hyd. perch. of the pharmacopoeia, as this, I find, is the preparation of mercury least apt to produce salivation, &c., as it must be borne in mind that the coloured race is very susceptible to the effects of mercury.

4. Effects. In an ordinary case, after forty-eight hours the crusts begin to show signs of drying up, and the process of clearing up is after this fairly rapid. From observation yaws clear up much quicker on the body than on the face. Moist surfaces, such as the interior of the nose and the vicinity of the anus and vulva, do not clear up rapidly. In some cases the result is little short of marvellous, and in a week or so the patients are fit for discharge. In a few instances, however, very little, effect is noticed, and the treatment had to be carried out sometimes two and any. even three times before a cure was effected. This, however, only occurred in cases treated by the subcutaneous method, and may have been due to an insufficient dose or to idiosyncrasy.

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As I mentioned under the head of Method, I experienced some cases of necrosis under the subcutaneous but none in the intramuscular method.

Some pain is complained of, but by no means in the majority of cases. I have not come across any cases of real intense pain, and so far as this symptom is con- cerned. I think it can be regarded as a negligible quantity when one considers the excellent general results.

There is also the question of the effect on the mind. The patients are ever so much more cheerful and happy, and nearly all experience a feeling of well being. This mental influence is experienced even in cases of leprosy, where the drug has no appreciable effect on the progress of the disease.

5. Recurrence. Under this head I fear I cannot yet express any definite opinion, as sufficient time has not yet elapsed. Suffice it to say, however, that so far I have not met with, neither have I been notified of, any recurrence in cases treated by me. Patients treated with Salvarsan on being discharged are warned and impressed with the fact that they must regularly report to the Medical Officer of their respective districts, who is notified that the patient has been under treatment

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