CO885-(23-24) — Page 347

། :། ་། །

PUBLIC RECORD OFFICE

Reference:-

CO. 885

23 PUBLIC RECORD OFFICE, LONDON

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

100

3. All openings to tanks, etc., are also gauze capped, and orders are issued as to precautions against water being allowed to stand in old-tins, pools, etc., when avoidable.

4. The only mosquito-borne diseases existing in the Protectorate are malarial fever and horse-sickness; and our precautions, as herein referred to, together with more systematic use of prophylactios (combining quinine with arsenic, iron, etc.), have led to a very large reduction in the number of cases of fever, while the virulence of the disease has greatly decreased.

5. With regard to horse-sickness we are also doing everything possible, and our losses have been very greatly reduced, comparing the percentage now with that of twenty years ago.

6. I am afraid that, beyond the foregoing, I can offer no report which would be of the least value; but if, in future, more organized measures should become possible, they will be carried out and reported.

His Excellency

The High Commissioner,

Cape Town.

19228

No. 109.

LEEWARD ISLANDS.

I have, &c.,

F. W. PANZERA, Resident Commissioner.

THE GOVERNOR to THE SECRETARY OF STATE.

(Received 26th April, 1915.) [Answered by No. 115,]

Government House, 25th March, 1915.

(No. 107.) SIR,

I HAVE the honour to transmit a copy of a report by Dr. W. McDonald, the Medical Superintendent of the Charitable Institutions in Antigua, showing the progress that has recently been made in the treatment of yaws in that island.

2. Dr. McDonald and some of the other Medical Officers on the staff have shown considerable zeal in carrying out the plan of action which I laid down in 1913, and we seem to be within measurable distance of the time when "yaws" will be prac- tically eradicated from these islands. Salvarsan" has proved a priceless boon.

3. I am not aware that there is anything new in the method of treatment fol- lowed by Dr. McDonald, but it is interesting to note that, in his opinion, it is not necessary that cases should be kept in a hospital for any length of time. The cost of treatment thus appears to be greatly reduced, while the results are said to be equally satisfactory. In dealing with the question of expense, Dr. McDonald in his menio- randum has made no reference to the cost of "salvarsan." The drug is still an expensive one, and the outlay under that head has been considerable. It goes with- out saying, however, that the cost of freeing the people from a disease which, up to recent years, was a veritable plague is a negligible factor when compared with the measure of relief effected.

I have, &c.,

Enclosure in No. 109.

H. HESKETH BELL,

Governor:

TREATMENT OF YAWS BY INTRAMUSCular InjectIONS OF SALVARSAN.

To the end of December, 1914, there were 286 cases of yaws treated at the Holberton Hospital by intramuscular injections of salvarsan.

Yaws became a notifiable disease in October, 1913; up to that date very little attention was paid to the disease in Antigua, and it was the general opinion, even of the medical men, that yaws was not prevalent and of very little importance. Nothing was done for these cases: there was no special hospital for yaws, as is the case in Dominica, Montserrat and St. Kitts. They suffered for years, unheeded, shunned. and hidden away in remote villages.

.8

101

Method of Treatment. In all cases over fourteen years of age the full dose, grms. of salvaraan, was used; between the years of four and fourteen years the medium dose of grms. was generally used, and below four years the smallest dose of 2 grms. was used.

The salvarsan was received from the broken ampule into a dry sterilized glass mortar, and then nine drops of a 15 per cent. solution of caustic soda was added and the mixture was thoroughly ground up and mixed by a sterile glass pestle. Then 4 c.o. of distilled water was added and mixed and then the 15 per cent. solution of caustic soda was added drop by drop till the solution became quite clear. This clear solution of salvarsan was received into a recently sterilized glass “record” syringe. Preparation of Patient. The only preparation that is necessary is to paint the site for the injection with pure carbolic acid. I at first used to paint the spot with tincture of iodine, but for some time I have used pure carbolic acid instead, as the carbolic acid renders the injection almost painless and is a much stronger antiseptic

than tincture of iodine.

Sise of Injection. The point chosen for the injection was at the junction of the middle and upper thirds of a line drawn from the tuber ischii to the anterior superior iliac spine, the solution of salvarsan being injected deep into the gluteal muscles. Painting the spot with pure carbolic acid has made the introduction of the needle quite painless, but the actual injection of the solution is still very painful. The needle is boiled separately for each individual case. After the injection, the needle puncture is immediately sealed with collodion and gauze.

After Treatment.—Fhe patient is immediately put to bed for two days and the temperature taken every four hours.

After Effects.--Nearly always there is a slight rise of temperature: in some cases as high as 102°: the site of injection becomes hard and painful, but rest in bed and formentations soon relieve this, and in nearly all cases by the third day the patient is all right and is sent home to complete the cure. In all the cases by the third day the yaws tubercles begin to dry up and the ulcers show signs of healing. In two cases necrosis of the tissues resulted at the site of injection, necessitat- ing the removal of the necrosed tisse under chloroform. But in the majority of the canoe the results were most: brilliant without any evil result whatever, the yaws tubercles drying up and melting away in a most marvellous manner.

Other good effects were that in all cases that complained of pains in the joints and feet, the effects were magical, the pains rapidly ceasing, and patients that had been crippled for months were able to walk about without pain, in a few days.

Recurrence. At the time of writing, out of the 286 cases that have been re- examined only one case has recurred; this case is now cured by a second dose, show- ing that the first dose was not quite large enough.

Advantages. From the administrative point of view the advantages of the treatment of yaws by salvarsan are obvious. The former method of treatment of yaws in the old Yawa Hospital was most unsatisfactory; in fact it was a dead failure in most cases, and was most costly without any hope of eradicating the disease in any community, the average stay of cases in the old Yaws Hospital being about four months: some cases staying as long as eighteen months.

In Grenada, St. Lucia, Montserrat, and St. Kitts and other places where there are special yaws hospitals, under the new treatment by salvarsan the cases are kept in only twenty-one days on an average. The saving on dietary alone by this treat ment is enormous. Here in Antigua there is no provision for a special hospital for these cases: there is no special vote and the vote for the general hospital is not increased by one penny, and yet we are able to treat and cure more cases of yaws in a year than any of these other islands who have a special vote and a special yaws hospital.

The treatment of yaws by the intramuscular injection of salvarsan is not in an experimental stage; the rapid curative results are well known; with practically no evil results. Then what is the reason for keeping these patients in hospital för

three or four weeks until the last sign of yaws has disappeared?

It is quite right to keep them in hospital for three days, to make quite sure that

no evil realta are going to happen; then, if everything is all right, send them home to complete the cure, which will go on at horne just as well as in the hospital.

I very soon adopted this method of keeping these patients only three days in

hospital (it is not done anywhere else for three reasons:-

(a) If I kept the cases in hospital for three or four weeks I could only treat a very limited number in a month, as I have no separate beds for yaws.