PUBLIC RECORD OFFICE
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Reference :-
885
22 PUBLIC RECORD OFFICE, LONDON
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18. The other adult was a female, 21 years old, who had an abundant eruption of characteristic yaws granulomata on her face, neck, and chest. She also was treated at her home, which was at a considerable distance from mine. The Salvar- san was used in an aqueous solution (9 grains in 120 minims of sterile water), and 60 minims of this solution were injected intramuscularly into each buttock. During and immediately after the injection she felt pain, which lasted about two days, but which was not severe enough to prevent her from sleeping. She had fever, which The drug was began about six hours after the injections and lasted two days. administered at 12 noon, on a Wednesday, and when I saw the patient on the following Saturday at 9 a.m., I found a change in the yaws growths, which had shrunk and subsided considerably, and which, the patient said, no longer itched. She was then entirely free from pain and fever. Two weeks after the injection the growths had entirely subsided, leaving the crusts slightly adherent to the skin. At the end of the third week they had completely disappeared, leaving dark, smooth spots to show their former sites. The patient said she felt quite well again, and was only a little weak.
19. The results of the foregoing experiments prove that Salvarsan can be safely and effectively used in the treatment of out-patients at public dispensaries.
20. For adults nine grains in 120 minims of water is a sufficient dose. 21. For children I would recommend a dose of two grains for a child of four years of age-an additional quarter grain for every year of life above the fourth year. This would require three grains for a child of eight years, and four grains for one of twelve years.
22. The age limits for the children should be four to twelve. I would not advise the use of the drug in children younger than four as out-patients at a public dispensary.
23. A cart will be required to convey to their homes any of the patients who may feel too much pain after the injections to walk there.
24. Children residing in the same district must be ordered to attend at the same dispensary on the same day so that one cart may be sufficient for all who need such a conveyance.
25. As the age limits recommended are the same as those fixed for compulsory school attendance, the school registers would serve as guides to the homes of the children.
28. The Health Officers could be employed to inspect the schools to ascertain which, if any, of the children in attendance are suffering from yaws, and to visit the homes of the absentees for a similar purpose.
27. The Health Officers would then report to the Medical Officers monthly the names and residences of the children suffering from the disease, and the latter would order the attendance of such children at the dispensaries at certain hours on specified days.
28. The Health Officers would be required to keep a Yaws Register in which they would enter the names of all children reported by them to the Medical Officers as suffering from yaws, and all the necessary particulars regarding age, residence, attendance at the dispensaries, as well as the decisions of the Medical Officers as to whether the children are really suffering from yaws or not, and the result of the treatment as certified by the Medical Officers.
29. Legislation in this matter should follow as much as possible the lines of the Vaccination Ordinance.
30. The difficulty experienced by me in obtaining a sufficient number of suitable cases for the experiments reported above shows the need of making attendance at the proposed yaws dispensaries compulsory. It is, of course, not only necessary to legislate in this respect, but to enforce as rigidly as may be practicable all the provisions of such legislation. The recent inclusion of yaws among the notifiable, diseases has produced no results, because no means have been provided for tracing and punishing defaulters. It is essential that a public official shall be specially appointed, as I have advised above, to search for cases of yaws, and not only to report them to the Medical Officers, but also to prosecute those who have failed to comply with the law in this respect. Fortunately, yaws is a disease which, when presenting characteristic appearances, can readily be recognised by those among whose children it prevails. The Health Officers would have an equal experience in this matter; and any affection which can reasonably be considered by them to be yaws should be dealt with as yaws by such officers. The parents and guardians of
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the children would have an opportunity of appealing in disputed cases to the Medical Officers, whose decisions would be final, and would guide the Health Officers with regard to prosecution.
His Honour
The Administrator,
St. Kitts-Nevis.
Case.
Age.
I.
7
II.
9
I have, &c.,
J. NUMA RAT,
Medical Officer, District 6.
CASES OF YAWs treated with Salvarsan, October and November, 1911. Condition on admission to the Yaws Ward.
Cutaneous Symptoms.
Encrusted granulomaia and squamous patches over various parts of the trunk
and limbs.
Large cicatrices resulting from serpiginous ulceration over various parts of the body and chiefly over the buttocks; edges of cicatrices studded with small ulcers.
(Yaws from early childhood) similar condition to that of No. II; scars most
numerous on the limbs.
Sqnamo-papular rash all over the trunk and limbs.
Doubtful case-only a framboesial ulcer near the ankle.
Papular rash chiefly on elbows and knees. Condyloma-like granulomata
between, or rather in the cleft of, the buttocks.
Large encrusted granulomata on trunk and limbs and condyloma-like granu-
lomata în cleft of buttocks.
Granulomata on forearms and legs.
Granulomata on neck, trunk, and limbs: numerous squamous patches over
body and limbs.
Granulomata on face and prepuce.
Granulomata on toe and back.
III.
15
IV.
8
V.
7
VI.
9
VII.
8
VII.
IX.
X.
XI.
3
*
CASES TREATED WITH SALVARSAN, OCTOBER AND NOVEMBER, 1911. Summary of Temperature Charts.
Previous to injection with the drug.-The temperature in the first four cases treated was taken during a few days previous to the administration of the drug for purposes of comparison. It was found to vary as follows when above normal;
Case 1-99 for 5 days; on 6th day 100° a.m. and p.m.
Case 11-98-99° for 5 days; on 6th day 100° a.m., and 99o p.m.
Case 111-99° for 4 days.
Case IV.-99-100° for 2 days.
After first injection with the drug-The following variations above 100° were observed after the first injection with the drug, 24 grains having been used in each
of the first four cases and three grains in the last six :-
Case 1-101° on 3rd day.
Case II-101° on 2nd day; 100-101° on 4th day.
Case III-101° on 1st day (p.m.); 101° on 3rd and 4th days.
Case IV-102° on 2nd day (p.m.); 101° on 3rd day.
Case V-In this case only the injection of 1', grain used for the second injec-
tion in the first four cases was administered.
Case V'I-102 on 3rd day (p.m.); 101° on 4th day.
Case VII-101° on 1st day (p.m.); 101° on 3rd, 4th, 7th, and 8th days (p.m.).
Case VIII-101° on 2nd day (p.m.); 101° on 3rd, 4th, and 8th days (p.m.).
Case IX.-In this case the temperature never rose above 100°.
Case X-101° on 2nd and 5th days.
Case XI-In this case the temperature never rose above 100°.
After the above periods the temperature varied between 98° and 100°, until it
finally sank at the end of November in some cases to normal, while in others it kept
at 99° while the patients remained in hospital.
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