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24760

4

No. 2.

MEMORANDUM ON THE PREVALENCE OF ANKYLOSTOMIASIS IN THE BRITISH EMPIRE.

It is difficult from the papers available to form an exact estimate of the prevalence of the disease in the British Empire, but from the references below it will be seen that this is considerable.

West Indies:—~

Jamaica, 75-79 per cent. [Cd. 6669, page 136.] St. Lucia, 100 per cent. [Cd. 6024, page 198.] Barbados, nil. (So reported.)

Bahamas, nil. (So reported.)

British Guiana, 24.5 per cent.

Three observations on

58-2 per cent. 57-2 per cent.

the percentage of immigrant tion.

infec-

[Cd. 3992, page 69.]

Dr. Law.

457 per cent. of all post-mortem examinations

reveal the parasite.

St. Vincent, 66 per cent. Trinidad, prevalent.

West Africa:-

Southern Nigeria, 100 per cent. in the Udi District. (Journal of Tropical

Medicine, July 1st, 1913, page 193.)

Northern Nigeria.-There was no return of the disease in the Annual Medical

and Sanitary Report for 1911.

In 1912 there was one case in a European and seven native cases with one death.

In 1913 Dr. Johnson found a 42 per cent. infection of the prisoners

in the gaol at Zungeru.

Gold Coast. In 1911 three cases with one death were returned.

Of five native cases supposed to be suffering from yellow fever, three were found to be infected in 1913.

Gambia, nil.-The disease has not yet been reported from the Gambia. Sierra Leone. In 1911 five cases occurred, of which three at least were in

Freetown.

Egypt, 100 per cent.-Manson's Tropical Diseases.

East Africa:-

20-30 per cent.-Albutt and Rolleston's Tropical Diseases.

Uganda, 1911.-Eight cases were returned.

East Africa Protectorate.-There were four admissions (with one death) for this disease into the Mombasa Jail Hospital in 1911. In the other hospital returns this, disease is perhaps grouped under "Parasites." Nyasaland. In the north Nyasa District it is estimated that near the lake 60 per cent. are infected; in the hilly country 33 per cent. are infected. The infection is by Necator Americainus only. Journal of Tropical Medicine, July 1st, 1913, page 195.

Dr. Stannus, from observations at Zomba, estimates the prevalence at 42 per cent. in the Zomba District.

South Africa, Natal.-The disease has been introduced into Natal, and occurs as about a 60 per cent. infection of Indian coolies. (Journal of Tropical Medicine, January, 1911, page 25.)

India, 75 per cent.-Manson.

Ceylon, 100 per cent, infection of coolies. [Cd. 5514, page 83.]

The disease is responsible for 90 per cent. of the total deaths.

per cent.

Malay, 25

56 cent.

per 54 per cent.

31 per cent.

These are the results of observations in various places. Eighty per cent. of these are cases of infection by the Necator Americainus. The Ankylostoma duodenale is more common among the Chinese. [Cd. 4999, page 127.] These figures all point to the fact that the disease is more prevalent than records show. In many places, where the disease has been looked for, it has been found, though its presence has not been suspected for years.

32

per

cent.

5

MEASURES TAKEN Against the Disease.

It is difficult to estimate the extent of the measures taken to combat the disease,

for some Colonies prefer to act rather than to report, while others content themselves with a pious text-book expression as to what ought to be done.

The measures that have been taken seem to depend on two factors :-

(1) The economic value of the locality in which the disease has been found,

8.g.-

British Guiana, Ceylon, Natal; and

(2) The individual keenness of the Medical and Sanitary Officers. There has been no general attempt to grapple with the problem in the Empire as a whole, and only to a limited extent in the individual Colonies affected.

The various methods that have been adopted may be classified as follows:- 1. The examining for ova by the microscope.--The Rockefeller Sanitary Com- mission has found the routine examination of school children to give a good estimate of the degree of infection of the population. (3rd Report, p. 14.)

In most British Colonies the first step is the examination of prisoners. This has been the case in East Africa and in Southern and Northern Nigeria.

In British Guiana, and perhaps Ceylon, the examination of immigrant coolies and of coolie labourers has been found possible.

In the Bahamas, and perhaps Bermuda, it is doubtful that the disease has been systematically looked for by this means.

2.

The routine treatment of cases so discovered.-Ferguson, of British Guiana, treated his cases with small doses of thymol (grs. X) every night. He found the ova gradually disappeared from the fæces. This method took four months to establish a cure, with but little inconvenience to the patient.

Wyler, in Southern Nigeria, finds Nicols's method, namely, by two 90 grain doses of thymol, given with an interval of a week between them, effects a cure, but the patients must be under medical supervision in hospital. ("Journal of Tropical Medicine," July 1st, 1913, p. 193.)

Johnson, in Northern Nigeria, finds the eucalyptus treatment inefficient. He advocates two doses of 60 grains of thymol with an interval of four days between them. If, after a week, ova are still present, a third dose of 60 grains effects the

cure.

The Committee of 1908 recommended the distribution and sale at Post Offices of beta-naphthol, but the Committee of 1913 negatived this as too dangerous.

In this connection Nicols's paper on treatment is of interest. (Journal of Tropical Medicine," January 1st, 1912, pages 1-5.)

3. The mapping of these observations Survey work. There is no definite record of this anywhere. No doubt the distribution of the disease in British Guiana, Egypt, and parts of India and Ceylon is fairly accurately known by the Medical and Sanitary Departments concerned.

4.

The prevention of soil pollution by the provision of adequate and suitable latrine accommodation.-The arguments often used against such provision are:-

(1) The initial expense.

(2) The statement that the latrines will not be used.

Both these arguments have been found false where the experiment has been

definitely tried.

5. Disposal of sewage :-

(a) By burial.

(b) Pipe-borne sewage.

(c) Incineration. (This method is largely employed in Ceylon.)

(The introduction of these methods depends entirely on :-(1) The value of the place in which it is established. (2) Local conditions.) Educational methods. The system of dispensary exhibits practised by the Rockefeller Commission has not been tried in British Colonies.

8.

The subject of ankylostomiasis is dealt with in the Primer of Tropical Hygiene in use in the schools of St. Vincent.

Educational methods were advocated, in their recommendation No. 5, by the Committee of 1908.

7. The abandoning of fouled ground or the treatment of it by ploughing or with lime has apparently not been tried, at any rate, on any great scale.