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used upon separate series of cases at the Colony Hospital, St. George's. The drugs employed being a. thymol, b. eucalyptus oil, castor oil, and chloroform, and c. beta- naphthol. The conclusions arrived at, as the result of these various forms of treatment, are as follows:-
a. Thymol. If this drug be given in full doses it is dangerous, if in smaller doses it is not effective. Consequently, when administered to a fully developed adult, in twenty grain doses, it occasionally took as long as a month to free the patient of the parasites--the dose being repeated once on the day of administration and administered on alternate days until the parasites ceased to appear in the motions. It not infrequently happened that, even when the parasites ceased to appear, the ova of the worm were discovered on microscopical examination, and further treatment with beta-naphthol was necessary to complete the expulsion of the parasite.
Besides being dangerous in full doses and ineffective in smaller ones, the drug is an expensive one (58. per lb.). This, coupled with the prolonged stay in hospital, makes thymol a most unsatisfactory mode of treatment, for general use, from an administrative standpoint.
b. Eucalyptus oil, Castor oil, and Chloroform. This mode of treatment proved, if possible, both more dangerous and less effective than thymol, and, in my opinion, its use is unjustifiable. Certainly, in any form of heart affection its use is absoluely contra-indicated, and this renders its administration in this disease inadmissible. I cannot conceive of any condition when its use would be preferable to either thymol or beta-naphthol.
c. Beta-naphthol. The results obtained with this drug have been most satis- factory, and, in consequence, no other mode of treatment is now used at the Colony Hospital. The method of administration in use is as follows:-On the night previous to administration a saline purge (mist. alba, two ounces) is given. The following morning thirty grains of beta-naphthol, suspended in mucilage, is given At midday another saline purge at 6 a.m. This is repeated at 8 a.m. and 10 a.m.
is given. The patient is kept in bed and dieted with milk on the day of adminis- tration. This treatment is repeated on alternate days until the parasite disappears from the stools. It is uncommon for treatment to need repetition on more than three occasions, and it is not unusual to rid the patient of the parasites by one day's treatment.
The only complication which I have met with in the treatment of ankylostomiasis with beta-naphthol is that of haemoglobinuria. This complication has occurred on On each occasion the five occasions--three times in males and twice in females.
drug has been stopped at once: and the liquid extract of ergot, in half-drachm doses, substituted. In four of the cases the haemoglobinuria stopped in twenty-four hours, and in the fifth within two days: and treatment with beta-naphthol was resumed, after a few days' rest, without any recurrence of the renal symptoms.
The points in favour of beta-naphthol are its effectiveness as a vermifuge, its rapid and complete expulsion of the parasites, its cheapness (28. per lb.), and the absence of danger which attends its administration.
It may be of interest to note here that two cases of chronic cystitis cleared up completely whilst under treatment for ankylostomiasis. I do not consider this to have been a coincidence, as another case which had resisted other forms of treatment yielded to treatment by this drug.
I think now that in beta-naphthol we have a remedy which is safe and effective, and one which might be used for out-patient work in the districts. This would be especially useful in those places which are practically riddled with the disease, e.g., the Mt. Moritz district, the estates around Gouyave, and the estates in some parts of the St. David's district.
up in pill form-five For this kind of work the beta-naphthol could be made grains to each pill-and given in five, ten or fifteen grain doses (according to the age and condition of the patient) on alternate days for ten days or a fortnight.
This course was, I believe, adopted by the Porto Rico Commissioners with regard to thymol, and with good results: and I consider could be undertaken with beta- naphthol with far less risk.
Proper latrine accommodation is also a necessity and should be made com- pulsory on each estate and house-holder.
With regard to latrine accommodation on the estates in Grenada I know little from my own personal observation; but of one district which I have visited I can
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speak with knowledge. Here the population of considerably over a hundred work some on the estates near by, others on their own gardens and plots of land; and yet there is not a single latrine in the place with the exception of that which is provided for the overseer of the estate. The people generally are infected with hookworms and many of the worst cases of the disease which come up to the hospital for treatment are drawn from this area.
Personal hygiene, proper latrine accommodation, and good drainage are the keynotes to the extermination of this disease; and I am confident that all money spent on measures dealing with these objects will be saved many times over in the recurrent waste expenditure which is needed annually for the treatment of the disease and its sequelae.
R. P. COCKIN.
7th July, 1912.
REPORT ON THE EXAMINATION OF 400 SPECIMENS OF HUMAN EXCREMENTA AT THE COLONY HOSPITAL.
During the past few months a consecutive series of examinations of human excrementa have been made by me at the Colony Hospital; and as the results obtained from these examinations appear to me to be of considerable consequence to the Government, and are indicative of a most serious position with regard to the public health of the Colony, I beg to submit the following figures and comments for perusal.
The number of cases examined was 400, and these included patients from all classes of society, of all ages, and suffering from the most diverse ailments.
The parasites found (which exclude bacterial parasites) number ten: and were as follows:-
Nematodes: 1. Ankylostoma duodenale.
Cestodes:
Protozoa:
Insecta:
2. Ascaris lumbricoides.
3. Tricocephalus trichiurus.
4. Oxyuris vermicularis.
5. Strongyloides stercoralis.
6. Taenia solium.
7. Amoeba dysenteriae.
8. Cercomomas intestinalis.
9. Balantidium coli.
10. The larval form of Chrysomyia macellaria (the screw
worm).
Of the 400 examinations only nine were found negative, whilst many specimens contained as many as four, five, and, in one case, six, parasites. The usual result was to find A. duodenale, A. lumbricoides, and T. trichiurus in company.
Only one case of tapeworm infection was discovered, and that was found as
sole occupant of the intestine in which it occurred.
The percentage of infections was as follows ·
A. duodenale A. lumbricoides
T. trichiurus
O. vermicularis
S. stercoralis
A. dysenteric
237 cases
59.25 per cent.
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Cercomomas intestinalis and the larvae of the Muscid, Chrysomyia macellaria, were each found in two cases: and Taenia solium and Balantidium coli each in one case only.
From these figures it will be seen that ankylostomiasis is prevalent to the extent of 60 per cent. of the sick population of the island. By this I do not mean that these cases are sent up as such, or give histories which would lead one to suspect that ankylostomiasis was in question at all, but who, upon examination, are found to harbour the parasite.
Many of these cases present no symptoms of the disease, excepting eosinophilia, and excepting a systematic examination of the stools were made would be passed by to swell the already enormous crowd of infecting agents. In certain ailments
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