CO885-(23-24) — Page 500

།།༄། །

PUBLIC RECORD OFFICE

Reference :-

C.O. 885

23 PUBLIC RECORD OFFICE, LONDON

ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC-

COPYRIGHT PHOTOGRAPH-NOT TO

Antiquity of disease.

10340

SIR,

72

No. 33.

TRINIDAD.

THE SECRETARY OF STATE to THE GOVERNOR.

(Miscellaneous.)

[Answered by No. 49.]

Downing Street, 24th March, 1914. WITH reference to your despatch No. 52 of the 2nd February,* I have the honour to inform you that opportunity was taken of Mr. Wickliffe Rose's visit to London to discuss with him the arrangements for the proposed campaign against ankylostomiasis in Trinidad.

Mr. Rose informed me that the International Health Commission had approved of an expenditure not exceeding £2,665 during the first year on this service, and had authorized him to settle the details of the budget.

I now enclose for your information and guidance a copy of the budgett as finally accepted by Mr. Rose. This budget provides for a Medical Officer in charge and two Assistant Medical Officers; and it has not been thought necessary to include the house allowances originally suggested, an inclusive salary being provided. other respects the budget follows the proposals made in your despatch under reference, which appear to have been drawn up with care and consideration.

In

I request that you will take an opportunity of inviting the Legislature to vote the whole cost of the proposed work, the amount to be recovered from the Commission being shown as a special item of revenue.

You will observe that it is intended that the cost of drugs, accounting, and audit should be met by the Colonial Government.

I propose to invite applications without delay for the three medical appoint- ments. Such preliminary steps as are possible should be taken in the Colony in anticipation of the arrival of the Medical Officers, and in particular progress might be made with the selection and training of microscopists. Every effort should be made to provide, without cost to the Commission, suitable accommodation for office purposes, and, if practicable, for quarters for the Medical Officers. I shall be glad to learn by telegraph the earliest date on which the Medical Officers should arrive in Trinidad.

I understand that the Commission desire to be furnished with quarterly reports of the work done, and that suitable model forms will be supplied from Washington. Duplicates of all reports should be forwarded to me.

You will recognize that the value of the work which the Commission propose to undertake will be materially impaired unless adequate, continuous, and energetic measures for the improvement of sanitation and the enforcement of sanitary regula- tions are also adopted. I have no doubt that the campaign of the Commission will have a valuable effect in educating the people in the necessity of simple sanitary precautions; and this should make it easy for the Government, at a comparatively small cost, to reduce to a minimum the risk of re-infection of the population. The Commission may reasonably expect that the generous provision which they are making should be met by the hearty co-operation of the Trinidad Government. shall be glad if you will keep this aspect of the question constantly before you, and will draw particular attention in your periodical reports to the progress made in the improvement of sanitary conditions.

No. 34.

I have, &c..

L. HARCOURT.

NOTE ON ANKYLOSTOMIASIS IN EGYPT, by SIR DAVID SEMPLE. (Received from Dr. A. E. Shipley, 25th March, 1914.)

It is supposed that ankylostomiasis has been existent in Egypt for more than three thousand years. During recent times it has received attention both from biologists and physicians. Dr. Looss, Professor of Biology and Parasitology at the Cairo Medical School, has made an exhaustive study of the disease, and is perhaps

*No. 15.

Enclosure 1 in No. 87.

73

Clinical Previous work

in Egypt.

trentment in Egypt.

the most generally recognized authority on the life history of the worm. researches and reports on the treatment of the disease have been published by Drs. Sandwith, Phillips, and Day, of the Government Hospital, Cairo, and by others.

Up to a few months ago a certain number of cases of ankylostomiasis were being Previous treated in Egypt at the 22 Government General Hospitals every year, and also at the In addition, the Church Missionary Society Church Missionary Hospital in Cairo. has established a centre for treatment in the Delta.

Recently a campaign has been undertaken by the Government to provide special Present experimental treatment for the disease by means of a travelling hospital on the lines campaign. of the travelling ophthalmic hospitals which have already proved so successful in spitals.

The Egypt, and it has been placed under the same direction. H.H. the Khedive inaugu- rated this hospital on 1st December last in the presence of Lord Kitchener. hospital contains accommodation for 100 in-patients. Also a wealthy notable is providing and will maintain a small hospital with accommodation for 30 in-patients. At both these hospitals the treatment will be entirely gratuitous.

Travelling

Ankylostomiasis is complicated in Egypt almost invariably with bilharziasis and Clinical. frequently with pellagra. Investigation of all these diseases is proceeding at the ankylostomiasis hospital.

The degree of impoverishment of the blood is such that the percentage of hæmo- globin is reduced from the normal (100) to 10, or even lower.

The work carried on at the ankylostomiasis camp is, however, not confined to the Treatment. routine treatment of the disease by means of thymol. Experimentation with other anthelmintics and with various hæmatinics to combat the anæmia, which is the chief symptom of the disease, is being carried out.

The successful treatment of ankylostomiasis caused by the Ankylostoma duodenale is by no means such a simple business as one has been led to believe from a perusal of the reports of ankylostomiasis campaigns in other countries. In some cases nine or ten doses of the anthelmintic are required before the adult worms present in the intestines are got rid of as shown by the persistent absence of ova from the fæces. A re-development of the disease after apparent cure may occur. caused by the migration of larvæ to the intestine which have previously been wan- dering about under the skin, and re-infections, though to what extent is not yet known, are almost certainly frequent.

It must be remembered that it is the symptoms of anæmia which the patient comes to the hospital to be cured of, since the worm does not occur in the fæces of those affected by it except after the administration of an anthelmintic, nor does the fellah usually believe the doctor who tells him that his complaint is caused by worms in his inside. So that unless the anæmia can be cured the patient will not come to be treated. And the administration of an anthelmintic to the highly-anæmic and very poorly-fed fellah without giving him good hospital food as well as a hæmatinic This enormously increases the expense of any is not always of much value. generalized campaign.

In addition, scientific investigation is about to be made in the villages to find scientific out if there are any main centres of infection, and whether infection is more usually investigations. oral or dermal. As soon as a sufficient number of worms are collected a research will be carried out by Dr. Charles Todd, Assistant Director of the Hygienic Institute, Cairo, into the toxin reputed to exist in them, with the assistance of an Egyptian doctor specially appointed for the purpose.

In most of the towns and villages of Egypt there are practically no latrines, Sanitation. those existent in private houses and in the mosques being totally insufficient for the needs of the population. This, no doubt, has a great influence on the spread of the disease, owing to the soiling of waste land in and round the villages by the excreta of infected people. The question of the possibility of the adoption of some conservancy system is being considered.

The sum of £E5,546 has been recently granted by the Egyptian Government to Financial study the best means of checking the disease. Mr. R. S. Kennedy, M.B., Cambridge, provision. has been appointed to carry on the investigations and to supervise the clinical work

of the Egyptian doctors in charge of the two hospitals.

The lines along which the campaign is being carried out are as follows:—

Future

1. The increase of ankylostomiasis hospitals and ankylostoma dispensaries development,

for treatment.

2. The collection of information as to the incidence and distribution of

the disease throughout the country.

3. The determination of which of the two methods of infection, viz., oral or

dermal, is the more common in Egypt.