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PUBLIC RECORD OFFICE

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Reference :-

mimC.O. 885

23 PUBLIC RECORD OFFICE, LONDON

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are treated they are liable to keep the disease going. When I visited Moore Town several such cases were brought to me, but it was impossible to inject them as they had to walk back several miles over very rough country.

Except the Government erects a temporary shelter or provides conveyance (e.g., a mule), to take these cases back home, they are bound to remain a menace and must nullify the idea of finally stamping out the disease.

On account of the distances to be travelled the latter suggestion is scarcely practicable.

From my experience I would suggest that a certain centre be taken (e.g.,. Moore Town). From this centre one could visit the neighbourhood and inject as many as possible in their own homes; at the same time, à tent or temporary building should be erected at the centre, where those whom it is impossible to visit could be brought. These could be dosed and kept for a few days; if they are unable then to provide conveyance on account of poverty, a small sum, probably never more than a shilling, would serve to hire the necessary conveyance to take them home. By this method there would only be a small extra cost per head and the time taken to dose a whole district would be little, if at all, lengthened. No untoward consequences followed the injections. One case had a small patch of necrosis at the seat of injection, and one was slightly jaundical a few days after the injection. jaundice has now cleared up, however, and had probably nothing to do with the injection.

J. G. MOSELEY, Assistant District Medical Officer.

14th April, 1914.

The

REPORT ON THIRTY CASES OF YAWS TREATED BY SALVARSAN IN THE DUNCANS DISTRICT OF TRELAWNY DURING THE MONTHS OF FEBRUARY AND MARCH, 1914.

THESE cases were selected from cases seen in the villages of Stewart Town, Jackson Town, Clark's Town, Kinloss, and Duan Vale, and were the most serious cases seen nearly all were children as stated in my return. Some of these cases were of a very severe type. One child had large ulcers between the buttocks exud- ing a most offensive discharge-six days after injection these ulcers had healed and the yaws on the other parts of the body were drying up.

The results in all cases were excellent, and the opinions of the mothers and fathers concerning the use of the drug soon changed from one of aversion to complete belief in its usefulness.

Only in one case was there much constitutional disturbance-i.e., fever sweats, but these symptoms soon passed off.

The people as a whole are very pleased with these results, and I do not anticipate any trouble about using the drug. Cases should, however, be selected there are many children who appear to be hovering between life and death, but with no definite disease—these are the most dangerous cases to treat. F. A. G. PURCHAS,

17th April, 1914.

Enclosure 4 in No. 46.

District Medical Officer.

DR. E. SMITH, ULSTER SPRING, to THE SUPERINTENDING MEDICAL OFFICER. SIR,

Ulster Spring, 30th March, 1914.

WITH reference to your letter 49/89, dated 12th January, 1914, I have the honour to attach form No. 4566, with the results in thirty cases of yaws treated with salvarsan.

The treatment was undertaken without hospital facilities in all cases and was uniformly successful.

All injections were intragluteal.

A slightly alkaline solution was always used, being the one which, in my opinion, is followed by the least pain.

In four instances it was found necessary to repeat the injection after about three weeks, as the disease was not quite cured by the first; in each case the repeated dose was promptly followed by relief.

There were no deaths, nor was there any cases in which the severity of the ymptoms after the injections justified fear of it.

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High temperature and rigors were noted in a case in which the eruption was extensive and 'recent.

Twenty of the cases were treated at their homes and ten at my dispensary, the latter returned home after several hours rest. Some walked, others rode, the greatest distance being eight miles. No special inconvenience was noted after The journey.

In order to widen the scope of the experiment as much as possible some old cases were taken, the oldest being one in which the infection was of four years' After fifteen standing, the man was unable to walk and had been made a pauper.

days he appeared quite cured and has since been taken off the pauper roll.

The treatment necessitates much travelling in order to reassure the patients, for on or about the third day there is pain and swelling at the site of the injection associated, in most cases, with a slight rise of temperature. relatives, although I took care to warn them in each case.

The youngest patient treated was two years old.

This alarms the

Hospital accommodation may be necessary for the very weak in order to facilitate supervision.

I experienced no difficulty in getting people to submit to the treatment. Several persons offered themselves after my list was closed.

If the injections are to be continued it would be best to get tubes containing half or quarter the amount in the present supply, as a large proportion of the cases are in children..

From the above I conclude that the treatment of yaws by salvarsan would be very much more certain of good results than the old treatment. Not only is this the case with respect to the patient himself, but it saves his neighbours.

It is noticed that an imported case in a certain section of the district is often followed by a crop of other cases. If the first few cases were quickly cured the risk of infection to the healthy would be appreciably decreased.

I have. &c.,

EYRE SMITH,

SIR,

Enclosure 5 in No. 46.

District Medical Officer.

DR. C. R. EDWARDS, DISTRICT MEDICAL OFFICER, HALF-WAY-TREE, to THE SUPERINTENDING MEDICAL Officer.

Half-Way-Tree, 13th April, 1914.

I HAVE the honour to forward a special report on the use of salvarsan in the Union Poor House, with some remarks on chronic neuritis, for the informa- tion of His Excellency the Governor. I shall be glad if you will forward this report at your earliest convenience.

Superintending Medical Officer,

Kingston.

I have, &c.,

C. R. EDWARDS, District Medical Officer.

REPORT OF CASES TREATED BY SALVARSAN IN THE UNION POOR HOUSE.

THE Conclusions which may reasonably be drawn from a study of these forty cases appear to me to be these:-

1. That there is considerable risk in the intravenous method of injection.

That the results obtained by the intramuscular method are perfectly satis- factory and free from risk if not repeated.

2.

3. That there is risk from second and subsequent injections if sufficient time is not allowed to intervene.

4.

That the time cannot be definitely stated in any given case at present, but, judging from the limited number of cases treated by me, I should say that three months ought to elapse between a first and second injection, and that only when the patient's condition is undergoing marked improvement.

That the effect of a single injection is greatly enhanced by following it with a course of iodide of potash and arsenic in the usual doses.

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