CO885-(23-24) — Page 156

PUBLIC RECORD OFFICE

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ILT CO. 885

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23 PUBLIC RECORD OFFICE, LONDON

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by obvious difficulties. The usual procedure carried out in Porto Rico and the Southern States is to call attention to the probable frequency of the disease among the people, to invite the attendance of people suffering from anemia and ill health at certain stations on given days, bringing with them a small sample of their faeces." A microscopic examination of the samples, which is not elaborate and requires no staining of specimens, &c., is at once made, and the patient, if found infected, is given directions for treatment. Failing this general crusade, it would not be too difficult to discover the percentage distribution of the disease in our institution population, or, at any rate, among the new admissions during a special period.

4. Until some information of the prevalence of the disease is available, nothing definite can be said in reply to the last paragraph of the Secretary of State's letter, except that the disease exists in Barbados, that its prevalence and distribution are not known, and that no special measures have been taken to cope with it.

11th September, 1913.

Enclosure 2 in No. 11.

HONOURABLE COLONIAL SECRETARY.

JOHN HUTSON.

The

WITH the material supplied to me I have examined the "fæces” of 200 patients, viz., 118 from the hospital and 82 from the various almshouses. hospital cases were not selected, but from some of the almshouses the specimens were taken from suspected cases :-

From St. Michael, 51 cases examined, 3 were found to be infected. From St. Peter, 11 cases examined, none were found to be infected. From St. Philip, 17 cases examined, 3 were found to be infected. From St. Andrew, 17 cases examined, 9 were found to be infected. From St. Lucy, 11 cases examined, 1 was found to be infected. From St. George, 19 cases examined, none were found to be infected. From St. James, 16 cases examined, 2 were found to be infected. From St. Thomas, 13 cases examined, 1 was found to be infected. From St. Joseph, 12 cases examined, 3 were found to be infected. From St. John, 12 cases examined, 3 were found to be infected. From Ch. Ch., 21 cases examined, none were found to be infected. These figures show that out of 200 cases examined 25 were found to harbour the This report, owing to the small number of cases examined, does ankylostoma ova. not give an idea of the extent of the disease in the Island, but it shows, at least, the districts most infected. I am continuing my investigations, and the parochial medical men are now assisting me by sending specimens frequently. Dr. Bancroft, the Senior Resident Surgeon at the Hospital, is sending me the "fæces" of every patient on admission into the hospital. I have asked that particulars as to locality, age, colour, sex, &c., be sent with each specimen; after the examination of some thousands of cases in this manner a definite idea as to the extent of the disease can be arrived at. I intend also to visit the various districts in which the disease is most prevalent, in order to study the conditions on the spot. Mr. Rose, Dr. J. Hutson, In Turner's Hall District, and myself paid a very interesting visit to St. Andrews.

Dr. M. Skeete showed us many families of poor whites, and in every family there were some of the members infected, and in some of the families all the members were infected. With reference to St. Michael's parish I found only three infected out of 51 examined; in one of these cases the patient told me that he had lived all his life in St. Andrew, and had only quite recently settled in Bridgetown. In the second case the patient gave the same statement, only that in his case he had resided in St. Joseph's parish. In the third case the patient had recently returned from Panama. So that, properly speaking, no cases were found in the parish of St. Michael. With reference to the parish of St. Andrew, over 30 per cent. of the cases examined were found to be infected; most of the cases came from Turner's Hall and Chalky Mount Districts. In St. James both of the infected cases came from Hole- town, and in St. John's two out of three infected cases came from Martin's Bay.

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I have found that among the blacks, ankylostomiasis in a good many cases does not produce any severe symptoms. I constantly come across the ova in the " fæces of hospital patients who are apparently quite well, and who have been admitted for some other condition, often for a surgical operation. I am convinced, not only from

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the result of this report (which I have before said is too small), but from investiga- tions previously made, that the disease is not a very serious one in Barbados. I may state that in several pellagrin I found the ova of ankylostoma. Ankylostomiasis, possibly, to a certain extent is a contributory disease to pellagra, as on account of the lowering effect on the vitality of the patient it renders him more likely to become infected.

The ascaris, or round worm, is very common here. I found the ova of this worm in 60 per cent. of the cases examined.

The Tricocephalus dispar, or whip worm, is also very common. I found the ova

in 85 per cent. of the cases. Fortunately, this parasite is not known to do any harm, and produces no symptoms.

The Strongyloides stercoralis I found in two cases.

With reference to race, the majority of the patients were black or coloured, with the exception of St. Andrew, 4 out of 17 were white.

The Necator americanus is the worm found here. It is possible that the anky- lastoma duodenale is here, and it may be found later on.

18th October, 1913.

Enclosure 3 in No. 11.

HONOURABLE Colonial SecRETARY,

R. M. JOHNSON.

1. DR. JOHNSON's report confirms what we have known for many years-that the anæmia of the "Scotland District" of the Island is largely due to ankylostomi- asis. The figures are too small for definite conclusions to be drawn for other parts of the Island. As the investigation proceeds, and the number of observations increase, the exact prevalence of the disease can be ascertained in every district.

2. Meanwhile we should take stock of the situation in relation to the recent visit of Mr. W. Rose, Director of the International Health Commission of the United States. This Commission has been formed to administer large sums of money, amounting to many millions of dollars, which Mr. Rockefeller proposes to devote to improving the health conditions of the world.

3. Having carried out a successful campaign against ankylostomiasis in the Southern States, working through the local authorities in each district, the Inter- national Health Commission have obtained the approval of the Secretary of State for the Colonies and the Secretary of State for India for Mr. Rose to visit the British West Indies and the East Indian possessions and dependencies of the Crown, to take stock of the situation in reference to ankylostomiasis in these places, and, as I was informed by Mr. Rose, to assist in controlling the disease where the conditions are favourable, and where assistance from outside is desired. Mr. Rose was very insistent that the Commission only worked in connection with local agencies, and where its help was desired.

4. I took him to two districts where ankylostomiasis is prevalent, and in the Turner's Hall District of St. Andrew's he was much impressed with the necessity for a regular campaign against the disease, judging from the naked-eye appearance of the people. I gathered from frequent conversations with him that, if asked for, assistance would be given by the International Health Commission, even to the extent of sending out one or two special workers to assist in dealing with the disease.

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7. Meanwhile, the necessary information can be obtained by the pathologist, and, as I have already offered, I am willing to assist Dr. Johnson in his investigation, which may involve visits to the infected districts for collection of material, &c. Mr. Rose has promised to send us samples of the boxes used in the United States for collecting specimens of" fæces," but meanwhile it is possible to use bottles, ointment boxes, or empty tins for collecting material. These should be distributed with the help of the Commissioners of Health, clergymen, school teachers, and inspectors of health, who can explain to the people what is required, and who will, I am sure, readily give their assistance.

8. A short leaflet should be printed for circulation with the boxes, briefly explaining the objects in view, and what should be done by persons wishing to be examined for the disease. A suggested leaflet is attached.

JOHN HUTSON.

11th November, 1913.

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