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6. That patients should be kept in bed after an injection as long as reaction fever lasta.
7. That the dose for age adopted by me in these cases has worked satis- factorily and may be laid down as a safe method
A full dose for an adult.
A third of dose for a child of twelve.
Half a dose for a person of sixteen.
↑
A full dose for a fairly strong patient of eighteen or nineteen years. 8. The patients undergoing treatment must be kept under observation for the purpose of watching reaction fever and signs of arsenic poisoning.
9. That the success of this treatment has been proved by the results and by the fact that inmates frequently volunteer for it, and have to be refused as not being suitable cases.
Remarks.
Having had thirty years' experience of yaws, and having completely wiped out that disease from the Island of Nevis when I was stationed there, I feel that I may, perhaps, be allowed to express my opinions on the method of dealing with the native population in stamping it out. I think the first rule to be observed is that coercion must not be employed. It is much better to let the working population see for themselves that it is to their own advantage to undergo the salvarsan treat- ment; when they are assured of this there will be no difficulty. They will come in large numbers and ask for it. But the moment the treatment is forced on them a spirit of antagonism and opposition is stimulated, and then the difficulties of dealing with the disease in a country like Jamaica will become very great. Now happily, the method of treatment seems to have reached perfection, when carried out with skill and care. I think it will be quite possible to eradicate it.
There is another consideration in the matter which is a most important one. I have noticed in these cases reported above and elsewhere that frequently syphilis and yaws co-exist, and it has now been demonstrated by bacteriologists that yaws and syphilis belong to the same family, the germs of both being very closely allied; it therefore seems to me that any attempt to stamp out yaws should be coupled with similar attempts to stamp out syphilis, or, at any rate, to treat it in a similar way and by the same means as those used for yaws. To make my meaning clear, I say with conviction that if we have hospitals for the treatment of yaws we must use those hospitals for the treatment of syphilis. That yaws can be eradicated by the use of hospitals I myself have proved beyond doubt, having got rid of it from the island Nevis, where I was stationed twenty-two years ago. I then had a small hospital of forty beds, and, in the course of six years, there was after the end of that time not a single case left in the island, where previously the death rate from yaws had been very considerable.
Dr. Nicholls, of Dominica, inspected that hospital and can confirm these facts. Since then the hospital has been closed and I have not heard of any serious outbreak of the disease since.
On my arrival here, and on being ordered to take charge of St. David's District, I recommended that yaws hospitals should be opened on the coast, but this was not favourably considered, on account of the expense it would have entailed, which I regret, as the expense since then and now will be many times greater than the original cost.
Neuritis in its relation to pauperism.
Remarks:-Whilst reporting on cases in the Almshouse, it is necessary that I should refer to chronic peripheral neuritis, which has its home in Jamaica, and from the large percentage of cases in the Almshouse-about 20 per cent.-would appear to be the chief cause of pauperism, and is therefore of the first economical importance.
To find out the exact causes, means of inception, and history of this disease has been a subject of constant thought with me for over twenty years, and now that the bacteriologists have come to our aid it seems not unlikely that in the near future we may be able to speak with more certainty about it than we have in the past.
I have been fortunate in enlisting the interest of Dr. Scott, the Government Bacteriologist, and Major Harrison, Royal Army Medical Corps, of Up Park Camp, and I propose to supply them with specimens, life histories, and any other
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information required, and I believe that these methods of inquiry, if continuously carried out, will eventually settle points of doubt and place us in the right direc- tion of dealing with an evil which is sapping the strength of the population.
The knowledge at present possessed about peripheral neuritis is very little. It amounts to this:
It has been stated erroneously, as I think-that it is identical with beri beri. That the two diseases have many points of resemblance there can be no doubt, but neuritis, as seen here, lacks many of the essential features of beri beri.
From experiments carried out by me on a small scale at the Almshouse it has been found it is capable of improvement in young people and in the middle-aged by regular and wholesome diet, quite as well as by medicinal treatment:—
Firstly, with quinine.
Secondly, with iodide of potash, and
Thirdly, with all three drugs.
From this it would appear to be a food disease like beri beri, but we do not notice the dyspnoea and the great and rapid mortality observed in beri beri. It may be found to have some connexion with the other diseases so common here, viz., syphilis and yaws, or in some unknown cause, or it may be found that these diseases pave
the way for neuritis in the same way that it is said to be in the case of tubercle.
C. R. EDWARDS, District Medical Officer.
Cases 2 and 11 seem to call for some explanation. Case 2 was the worst case of syphilis I have ever seen. His condition was deplorable, and beggars all description. He apparently only had a few days to live. His improvement after the first injection was so remarkable that I was induced to give another injection in about three weeks' time. I believe that caused his death, although he showed no signs of arsenic poisoning, but he developed fever, which may have been reactionary, and, in his weak condition, was sufficient to cause death.
Case 11 can be explained by his having had a cerebral tumour of syphilitic origin, which I regret I had not an opportunity of verifying by post-mortem examination.
C. R. EDWARDS.
No.
Name.
Agc.
Discaac.
No. of Injec- tions.
Result and Remarks.
1
Much
Subse.
Died.
improved.
quently developed phthisis and died.
Much improved after first dose. A second injection
given three weeks after.
Reactionary fever.
Rapid and complete cure.
I,
now earning her living as
Complete recovery.
Complete clieck to the disease.
1
Daniel Ennis
Years. 20
Syphilis.
2
Emmanuel Mathias
40
Very extensive development
of syphilis.
2
y...
Ellen Anderson
17
Deep ulcer on leg extending
1
to the bone. Of seven
years' duration.
a servant.
4 ...
George Freckleton...
20
Deep chronic ulcer and scars
1
of ulcers. Of seven years'
duration.
5 ...
Bichard Wright
27
Advanced syphilis with deep
1
uloars and loss of hard
palate.
6
Nathan Smali
82
Advanced syphilis, scaly
2
Complete recovery
Interval
suption on akin, and
of three months between
marks of deep ulseration.
first and second injections.
7 ...
Arthur Masou
22
Of seven years' duration. Chronio aleers, breaking
1
Complete recovery.
8
Jane Pinto...
85
down to deep ulceration. of four years' duration. Uleers on legs, arms, fore- arms, and hard palate. Chronic laryngitis. Has stains on skin of yaws.
1
Complete recovery.
98
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