18210
93
No. 49.
TRINIDAD.
THE GOVERNOR to THE SECRETARY OF STATE. (Received 10 p.m., 18th May, 1914.)
TELEGRAM.
[Answered by No. 60.]
YOUR despatch of 24th March, Miscellaneous.*
•
Legislative Council has
approved vote. Arrangements can be made to commence 1st July.--LE HUNTE.
18165
No. 50.
SIR,
(No. 319.)
GOLD COAST.
THE GOVERNOR to THE SECRETARY OF STATE. (Received 18th May, 1914.)
Government House, Accra, 28th April, 1914.
WITH reference to the 2nd paragraph of Major Bryan's despatch No. 71 of the 30th January last, I have the honour to transmit, herewith, a copy of a letter from the Acting Principal Medical Officer, dated the 1st April, covering a report on the prevalence of ankylostomiasis in the cocoa districts of Akwapim in the Eastern Province, which has been prepared by Dr. G. E. H. Le Fanu.
I have, &c.,
HUGH CLIFFORD,
Governor.
PUBLIC RECORD OFFICE
Reference :-
C.O. 885
SIR,
Enclosure in No. 50.
Medical Department, Victoriaborg, Accra, 1st April, 1914.
I HAVE the honour to forward a report from Dr. George Le Fanu on the pre- valence of ankylostomiasis in the cocoa districts of Akwapim.
2. Although the time at Dr. Le Fanu's disposal was limited, I certainly think
he has gathered enough evidence to confirm Dr. Muller's verbal statement to me that
a large percentage of the people in the cocoa districts were infected, especially
those working on the farms.
3. It is interesting to note the negative results in four cases carefully examined
at Adawso. These four persons were exposed to infection, but, owing to the fact
that they constantly wore boots, were saved from acquiring the disease.
4.
I am in agreement with Dr. Le Fanu that the treatment by drugs of this disease is unsatisfactory, as reinfection is so easy unless strict personal cleanliness
is observed.
5. In conclusion, I would suggest that all Europeans (officials) travelling in these districts be instructed to advise the chiefs and people as to the importance of having latrines built and the danger of allowing the people to ease themselves in the bush and farms, &c.
The Honourable
The Colonial Secretary,
Victoriaborg, Accra.
I have, &c.,
E. H. TWEEDY,
Acting Principal Medical Officer.
* No. 89.
| 5814: not printed.
23 PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE COPYRIGHT PHOTOGRAPH—NOT TO BE REPRODUCED PHOTOGRAPHIC-
||Page 511
PUBLIC RECORD OFFICE
Reference :-
TTCO 885
23 PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE COPYRIGHT PHOTOGRAPH-NOT TO BE REPRODUCED PHOTOGRAPHIC-
94
REPORT ON The Prevalence of AnkyLOSTOMIASIS IN THE COCOA Districts OF AKWAPIM.
THE disease known as ankylostomiasis (in America as uncinariasis) is due to and other an infection with small nematodes inhabiting the intestine of man animals, and which, by causing local injuries and by the secretion of a poisonous substance in their glands, give rise to certain clinical symptoms varying much in their nature and severity.
Two worms are concerned in this disease: Ankylostoma duodenale, first described in 1842, and Necator americanus (synonymous Uncinaria americana), first described in 1902 by Stiles. The Necator is the worm indigenous to Africa, whence it was exported to America when slavery was a growing industry, and with this worm the present inquiry is concerned.
Dr. Müller, of Aburi, kindly placed at my disposal a number of worms accidentally found in a patient's stool which was being searched for the head of a tape worm. Of these, three males and two females have been examined and were The eggs found in the samples found to correspond with Necator americanus,
examined during this inquiry were also found to belong to this species, so that no mention need be made of the ankylostome proper.
The chief differences between the two worms are found in the buccal armature, and in the caudal copulatory bursa of the other, which in the Necator shows certain marked differences, particularly with regard to the posterior rays or ribs, which are bifid and are widely separated from each other.
The eggs of the two species resemble each other closely, but the egg of Necator is appreciably longer than that of the ankylostome, a difference in size which becomes very obvious when comparison is made with the eggs of Ascaris lumbricoides and Trichocephalus frequently found in human fæces.
Result of the Inquiry.
Aburi, Adawso, and Komfrodua were visited, and in each place a number of stools were examined for the eggs of the three worms commonly infesting the gut: Necator americanus, Ascaris lumbricoides and Trichocephalus. The results of the examinations are clearly shown in attached table.
The obtainment of samples of fæces for examination was a matter of some delicacy, and any success obtained was largely due to the tact and intelligent co-operation of Mr. Thompson, Sanitary Inspector in Mangoase, etc. Seventy-seven specimens were examined and in these Necator eggs were found to be present, either alone or associated, in 28, or 376 per cent. The 25 specimens examined at Komfrodua showed, however, a much higher percentage, amounting to a little over 60 per cent.
The simple method of suspending a very minute quantity of fæcal material in water was resorted to in order to deal with the amount of material in hand, as there was not time to employ the more reliable, but more elaborate, laboratory methods.
When it is borne in mind that in this way only an infinitesimal quantity was examined in each case (with an exception to be referred to presently), it becomes obvious that the results of examination must not be accepted as definite, but as afford- ing an indication of the extent to which the infection may exist.
The exception referred to was in the case of four educated natives in good positions, whose fæces were examined very thoroughly on 16th February at Adawso, with absolutely negative results. This is too small a number on which to base an argument, but the result again indicates that the wearing of shoe gear and the use of private latrines safeguards the owners from infection.
The question of the clinical symptoms to which the infection gives rise could not be considered in the conditions in which the inquiry was instituted and one is met with considerable difficulties. It can be settled only by patient inquiry into the systems of patients found to be infected with Necator, and the elimination of phenomena attributable to other diseases. Even pronounced ankylostomiasis may be mistaken for some other disease if the stools are not systematically examined. while at the same time Necator carriers may fail to show any disturbance in health. When this question is determined, it will also be possible to arrive at an estimate of the economic importance of the disease in the Gold Coast Colony.
The cause of the widespread infections is to be sought partly in the climate, which gives the conditions of warmth and moisture favourable to the development of the worm, and in the insanitary habits of the natives. Fæces containing eggs in
95
large numbers are deposited at random, the larvæ escape and gain access to the same host or a fresh one by puncturing the skin, or by contaminating hands and clothing, whence they are easily transferred to the mouth,
Whatever the economic importance of these worm infections may be to the Colony, there can exist no doubt as to the desirability of doing away with them. The prevention of ankylostomiasis has received an enormous amount of attention since the epidemic of the St. Gothard Tunnel in 1890, and consists in the cure of the infection. The latter is secured by personal cleanliness and the proper disposal of fæces.
Medical treatment should be carried out only in hospital, or at all events under strict medical supervision, as the administration of vermifuges such as thymol and eucalyptus is associated with great danger, which absolutely prohibits the distribu- tion of these drugs on a large scale. Unfortunately there is no Government hospital in the district concerned.
Further, the administration of suitable drugs can produce no lasting benefit as long as the present facilities for reinfection continue to exist.
The real remedy is in sanitary improvements, especially with regard to sewage disposal. The deep pits in use in the cocoa districts are eminently suitable for this purpose.
Scrapings taken from the damp timber covering these latrines were examined for larvæ with a negative result. But a long time will elapse before ignorant natives will abandon the ancestral habit of easing themselves when and where the need arises.
Progress in this respect is bound to be gradual, but its onset can be checked only by reliable statistics, given from an adequate number of examinations per year, of the percentages of infections.
In conclusion, I am of opinion that these infections are by no means confined to the cocoa districts, but that they exist whenever the same insanitary conditions exist and where a careful search is made for them.
G. E. H. LE FANU,
Medical Officer.
Attached:
Table showing results of examination of fæces. Two drawings* of the caudal bursa of Necator americanus (male) from specimens supplied by Dr. Müller of Aburi.
Place.
Date.
G. E. H. L.
Table of RESULTS OF EXAMINATION OF STOOLS, FEBRUARY, 1914.
Specimens Necator. Ascaris. Examined.
Tricho cephalus. Ascaris.Trichoc.
Necator Necator and and
Necator, Ascaris and
Ascaris and Trichoc.
Negative.
Trichoc
1
Aburi
5 February, 1914
1
9
8 February, 1914
8
1
7 February, 1914
2
9
20
20 17
14 February, 1914
8
16 February, 1914
4
17 February, 1914
2
Totals...
9 days
77
18
18
B
5
1
Adawso
Komfrodua
Adawao
10 February, 1914 11 February, 1914 18 February, 1914
111
| |--~** | -
1 1 1 1 | T
11
1
1
6636
1
92
Totals of specimens examined Necator americanus in Ascaris lumbricoides in Trichocephalus trichiurus in
77
28 or 37-6 per cent.
23 or 31-0 per cent.
9 or 11-6 per cent.
G. E. II. LE FANU,
Medical Officer.
Accra,
21st February, 1914.
* Not reproduced.
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