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PUBLIC RECORD OFFICE

Reference :-

mmimmimC.O. 885

23 PUBLIC RECORD OFFICE, LONDON

ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- | COPYRIGHT PHOTOGRAPH-NOT TO

SIR,

(Circular 64: No. 2191.)

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20.

Island Medical Office, Kingston, June 10th, 1913. I HAVE to request that you will send up weekly to Dr. Scott, Government Bacteriologist, for examination for hookworm, three specimens of fæces from the creole inmates of your hospital.

(Circular 79: No. 2940.)

SIR,

21.

I have, &c.,

J. E. KER,

Superintending Medical Officer.

Island Medical Office, Kingston, 11th August, 1913.

Ankylostomiasis

I HAVE the honour to request that, whenever a creole patient suffering from hookworm disease or infection is seen by you, you would be so good as to give him a copy of the placard issued by the Central Board of Health re on 12th February, 1913, some of which were sent to you. Copies can be obtained in this office if needed.

SIR,

(Circular 90: No. 3226.)

22.

J. E. KER,

I have, &c., Superintending Medical Officer.

Island Medical Office, Kingston, 3rd September, 1913.

I FORWARD herewith a supply of leaflets "How to take medicine for anæmia arising from hookworm infection," and have to request that you will hand one to each patient treated by you as an out-patient and one to each pauper treated. Capsules for out-patient treatment can be supplied on requisition.

(Circular 82: No. 2992.)

SIR,

23.

I have, &c.,

J. E. KER, Superintending Medical Officer.

Island Medical Office, Kingston, August 12th, 1913. I FORWARD, for your information, some interesting observations by Dr. E. J. Wyler, M.D., London, on the treatment of ankylostoma by thymol.

I have, &c.,

J. E. KER, Superintending Medical Officer.

EXTRACT FROM report of Dr. E. J. WYLER (M.D., London).

Treatment.

There appears to be no doubt that thymol is the most efficient anthelmintic for this disease. I have found it perfectly safe; and from perusal of some of the litera- ture on the subject one feels bound to conclude that many of the evil effects of the drug are really due to improper administration. Some writers advocate à light or fluid diet on the day preceding treatment. But it seems to me of the greatest importance that no food whatever should be given on the day preceding the adminis tration of the drug, or on the day itself until at least six hours after the last dose of thymol, and I think it very probable that neglect of this precaution has some- times enabled sufficient fat or oil to gain admission to the intestinal tract to cause a toxic dose to be dissolved and absorbed. (I have made it an invariable rule to exclude meat-on account of the accompanying fat-and also, of course, palm oil

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from the first meal after treatment.) Though the number of cases treated by me by the 90 gr. method (see below) is too small to enable absolute conclusions to be drawn, the fact that no toxic symptoms of any kind were displayed in any of my cases suggests that with proper precautions the drug may be administered in this dose with safety.

It was given in the following way when the 90-gr. dose was employed:-

(1) On the previous day no food of any kind, and at 4 p.m. 6 drachms of

sulphate of magnesium. (2) On the following morning:

at 6 a.m., 30 gr. of thymol;

at 7 a.m., 30 gr. of thymol;

at 8 a.m., 30 gr. of thymol;

at 4 p.m., 6 dr. of mag. sulp.

(3) From 6 a.m. until noon the patients were kept recumbent.

When the 60 and the 40-gr. dose was employed it was given in two equal doses, one at 6 a.m. and the other at 7 a.m., with the precautions above described

The thymol was always given in a finely triturated state and washed down with a little water. The two smaller doses were tried in order to ascertain whether an efficient anthelmintic action could be obtained with them, but they were soon abandoned in favour of the 90-gr. dose. The dejecta, not specially treated for the separation of ova, were examined one week after thymol administration, with the following result :-

Of seventeen prisoners who received the 40-gr. treatment ova were found m

eight (47 per cent.).

Of forty-seven prisoners who received the 60-gr. treatment ova were found

in fourteen (= 297 per cent.).

Of fifty-seven prisoners who received the 90-gr. treatment ova were found

in six (= 105 per cent.).

The examination of the dejecta as I have carried it out is only, of course, a very rough test of the relative efficiency of the 90-gr. treatment, but I give the figures for what they are worth.

It would seem desirable in a routine practice to give, at any rate, two 90-gr. treatments, since only a certain proportion of the worms (about 90 per cent.) are expelled at the first onslaught.

NOTE.

Taking the world as a whole, with the possible exception of the malarial organisms, ankylostoma is, I suppose, responsible for more unhappiness and inefficiency than any other parasite, and, for the most part indirectly, for no incon- siderable number of deaths. Practically all tropical countries are permeated with the worm, and in places where the conditions for its propagation are not unfavour- able it may reduce four-fifths of the population to a continual state of chronic ill- health, which is only terminated by their premature decease, commonly from some secondary infection.

The great prevalence of the infection, with all its attendant disabilities, is of massive importance, not only from the standpoint of the medical officer or of the student of eugenics, but also from its influence, probably profound, on commercial prosperity.

42122

(No. 240.)

SIR,

No. 10.

BRITISH HONDURAS.

THE GOVERNOR to THE SECRETARY OF STATE. (Received 6 December, 1913.)

Government House, Belize, 20 November, 1913. I HAVE the honour to acknowledge the receipt of your Miscellaneous despatch

of the 26th August,* on the subject of the Rockefeller Sanitary Commission and the eradication of ankylostomiasis.

• No. 3.