PUBLIC RECORD OFFICE
Reference :-
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30
of the drug watched. The period spent in hospital would not be a lengthy one, depending on the stage in which the case was admitted, as a long-continued affection would require a longer period of treatment, as after the expulsion of the parasites the after treatment can be carried out at their own homes.
Treatment in Hospital-Thymol is the drug that I employ in the treatment of ankylostomiasis, and it has yielded the best results. The patient is carefully prepared three or four days prior to the administration of the thymol; the bowels are kept active by saline aperients administered every morning, the diet being light and easily digested, viz., milk, arrowroot, &c., and beef tea; the chief object in the preparation of the patient being to get rid of the large quantity of mucus formed in On the morning of the the intestines, and in which the parasites lie buried. administration of the thymol no food, except a pint of milk, is allowed the patient, and two hours afterwards the first dose of thymol is given; it is given in the form of cachets, each containing 40 grains of thymol, and one is swallowed every hour until 120 grains have been taken: during this period no food, except water, is allowed the patient. Four hours after the administration of the last dose of thymol a saline aperient is given, and the patient allowed his diet. The stools are carefully washed and examined, and invariably show a large quantity of worms, although occasionally the first stool may only contain a few. The above treatment is carried out on three alternate days, and four days after the last administration of thymol the fæces are carefully examined microscopically for ova, and are invariably found to be quite free of them.
The after treatment of the case now begins, and consists in the administration of tonics, chiefly iron and arsenic, the diet is increased, but is still one which is easily digested, and in from ten days to a fortnight the patient is discharged cured, to continue his tonics for a still further period at his own home. I usually admin- ister the iron and arsenic in the following form, and find it answer admirably :-
Colony Hospital,
Grenada.
22 January, 1905.
Rx.
Tinct. Ferri Perchlor. :
Liq. Arsenii Hydrochlor. :
Mag. Sulph.:
Syrup Aurantii
Aqua ad
M. Sg. 3 ss. t.d.s. p.c.
T. M. RUSSELL LEONARD,
House Surgeon.
A FURTHER REPORT ON WORK DONE, IN CONNECTION WITH ANKYLOSTtomiasis, at THE COLONY HOSPITAL, ST. GEORGE'S, GRENADA.
In a report which I submitted to the Government on December 1st, 1911, I ventured to draw attention to the extreme prevalence of ankylostomiasis which obtained in the Colony: and suggested that, from an economic standpoint, it was advisable to put into force measures which would stamp out the disease: First, in order to improve the present public health of the Colony; and secondly, and chiefly, for the purpose of guarding against the effects which its continued presence, especially amongst the poorer class, must have upon the labour market of the future.
Since submitting that report both the results I had obtained and the measures I advocated have been criticised-not always unkindly--and I consider that, now, as the result of a further seven months' work on the subject, and the consistency of the results obtained in a further series of over a thousand examinations, am compelled to again bring the subject to your notice and again urge the necessity for a vigorous campaign against the parasite which is the motive force in this frightful and insidious scourge.
I must, however, make my position quite clear with regard to my advocacy for these measures by stating at once that malaria and tuberculosis, which one is too well aware of the frequency of, can be fought along the same lines and con- temporaneously with the hookworm-which is only more terrible because of the larger death-rate which results from its ravages in this Colony.
31
The parasites which were found, in the last series examined, numbered fourteen : and were as follows:-
Nematodes: 1. Ankylostoma duodenale.
Cestodes:
Protozoa:
Insecta:
2. Ascaris lumbricoides.
3. Oxyurius vermicularis.
4. Trichocephalus trichiurus.
5. Strongyloides stercoralis.
6. Taenia solium.
7. Taenia? confusa.
8. Amoeba dysenteriae.
9. Balantidium coli.
10. Balantidium minutum.
11. Cercomomas intestinalis.
12. Paramoecium coli.
13. Trichomonas intestinalis.
14. The larval forms of Chrysomyia macellaria and another
Muscid, not yet identified."
The percentage infection of the more common of these parasites, together with those obtained from the results given in my former report, for comparison, is given below :-
1,000 cases examined.
400 cases examined.
642 cases- -64 2 per cent. and 237 cases-59 25 per cent.
A: duodenale A. lumbricoides
705
31
T. trichiurus
738
-70-5 -73.8
21
281 345
#
"
O. vermicularis
95
9:5
31
11
17
S. stercoralis
121
-12.1
54 75
-70.25 -86.25 11 -13.50 -19:50
??
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11
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It will be noticed, from the above lists, that, apart from Ascaris lumbricoides, which remains a constant, the percentages shown in the longer series are less than those previously given-with the exception of that of Ankylostoma, which is actually 5 per cent. larger.
The examinations have been consecutive, and so include many cases which displayed no apparent symptom of ankylostomiasis.
As I pointed out in my previous report a definite connection exists between this disease and those of the heart and kidney which are so frequently met with in medical work in this Colony; and a consecutive series of 172 cases suffering from cardiac and renal disease either separately or together yields striking testimony to the closeness of the connection which actually does exist.
Renal Disease-associated with ankylostomiasis Cardiac
"
"
Both organs affected-associated with ankylostomiasis Renal Disease-not associated with ankylostomiasis Cardiac
"
52
70
37
9
2 2
Both organs affected-not associated with ankylostomiasis Showing that, whereas in 159 cases these diseases occurred in conjunction with ankylostomiasis, they only occurred in 13 cases of the series in which this parasite was not present.
In other words, the association was one of 925 per cent.-a percentage out of all proportion to the degree of infection which we know obtains amongst the sick population generally.
The type of heart disease which is found in these cases is generally that of dilatation, secondary to degenerative changes in the heart muscle and consequent upon the action of the toxins absorbed from these parasites.
It is, I believe, stated that the hilly nature of this island is responsible for the great number of patients suffering from heart disease which one finds here. Apart from the fact that I know of no mountainous country which is remarkable for cardiac disease of a primary nature, I think that the above figures will enable us to fix the blame, not on the hills, but upon the infected soil which covers them; the hills themselves only acting as an aggravating cause upon an already diseased organ.
With regard to the treatment of ankylostomiasis, it may be of interest to note that during the past six months three separate methods of treatment have been
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