PUBLIC RECORD OFFICE
Reference :-
C.O. 885
23 PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC- COPYRIGHT PHOTOGRAPH-NOT TO
108
Prevalence of the Disease.
In Pahang ankylostomiasis was responsible for 228 cases, or 3 per cent, of the total cases treated in all hospitals during 1913, against 286 or 5 per cent. in 1912, with a death-rate of 8-77 in 1913, against 11-53 in 1912.
In Negri Sembilan ankylostomiasis was responsible for 340 cases, or nearly 2 per cent. of the total cases treated in all hospitals during 1913, against 319 or nearly 2 per cent. in 1912, with a death-rate of 197 in 1913, and 15-98 in 1912.
In Selangor ankylostomiasis accounted for 1,218 cases, or 5-49 per cent. of all cases treated in 1913, as compared with 910 cases or 2.82 per cent. in 1912, with a death-rate of 14-03 in 1913, and 15-93 in 1912.
Incidence as to Nationality.
The Indian appears to be more affected than any other nationality. Out of 1.186 cases treated in 14 hospitals in Selangor, Negri Sembilan, and Pahang during 1913, 727 were Indians, 409 Chinese, and 50 Malays and Javanese.
The percentage is as follows:-
Indians, 61. Chinese, 34.
Malays, 4.
Incidence as to Districts.
Taking the figures of the same 14 hospitals for 1913, the districts which have a large Tamil agricultural labour force show the largest number of cases, e.g. :-
Klang Hospital, 215 cases, or 18 per cent.
Raub Hospital, 160 cases, or 13 per cent.
Kajang Hospital, 125 cases, or 10 per cent.
District Hospital, Kuala Lumpur, 326 cases, or 27 per cent. Seremban Hospital, 80 cases, or 6 per cent.
Incidence as to Age.
Children of tender years, 2 and 3 years of age, contract the disease, and people
60 years of age are not free from it.
of over
Taking the figures for the 14 hospitals for 1913 we find :-
46 cases from 1 to 15 years of age.
711
429
"
11
16 to 30
"
>>
over 30
11
11
Seven cases occurred in children from 2 to 5 years of age, viz. :—
2 years of 1.
age
3
3.
31
"
4
37
5
2.
1.
"}
of
and over. Incidence as to Sex.
There were 12 patients 60 years age
Out of the 1,186 patients, 93 only were females, one female to nearly thirteen males, and out of the 93 females 81 were Tamils. This is to be expected from the large male population, and shows no special proclivity to the disease on the part of the male sex.
+4
The relative distribution of the two species of Ankylostomes. Dr. Stanton, in his report on ankylostomiasis in 1909 states:—
"The so-called "New World" hook-worm (Necator americanus) formed Old World" form (Ankylos- about 80 per cent. of the total number. The toma duodenale), though relatively infrequent in Tamils, is the more common form found in Chinese. Occasionally the two forms are found in the same subject."
Treatment.
I. Curative. Thymol and beta-naphthol are chiefly used in the hospitals here and appear to be equally efficient. In 1909 Dr. Gerrard made some observations with regard to the treatment of ankylostomiasis with these two drugs, and produced the undermentioned figures, which show that the combination of thymol and beta- naphthol gave the best results:—
Percentage
Cases.
Deaths.
of deaths.
Stay in hospital.
Thymol only
51
6
193
28.48 days
Beta-naphthol only
47
7
14.8
38-89 days
Mixed (gr. v. of each)
110
4
5.6
23.07 days
100
Dr. Glenny reports that in Sumatra he saw marvellous results from the use of Ol. Chenapodii, which is almost exclusively used there now.
II. Prophylactic.-Latrine accommodation, adequate and properly protected water supplies, the absolute prohibition of the use of human excrement in vegetable gardens, carefully washing the hands after working in the fields, are the chief preventive measures indicated, not only on estates, but in mines, all Sanitary Board areas, and all areas outside Sanitary Board control.
In addition the inspection of all newly-arrived coolies and the prompt treat- ment of all cases that may be detected may be urged, also the systematic periodical medical inspection of all labourers employed upon estates, mines, etc.
These measures are to a certain extent carried out on the estates and Sanitary Board areas, but not in other areas.
SIR,
In hospitals all stools are disinfected.
A. J. MCCLOSKY, Acting Senior Medical Officer, Selangor, Negri Sembilan, and Pahang.
28th March, 1914.
In reply to your letter No. 2 in 233/1914, of 12th February, I have the honour to put up herewith copies of reports or returns from the Health Officers, giving information as to the prevalence and distribution of ankylostomiasis in the Federated Malay States, and of the measures taken to cope with it.
2.
At estate hospitals in the Kuala Lumpur district 386 cases were treated, with 37 deaths, during the year 1913.
At estate hospitals in Pahang 47 cases and 2 deaths were reported during the same period.
3. The parasite Ankylostoma duodenale is widespread in the peninsula; many years ago I examined 400 consecutive admissions to the district hospital, Kuala Lumpur, and found that over 90 per cent. harboured hook-worm.
4. Its occurrence in Europeans appears to be rare; in nineteen years only one
case, in the Colony of Penang, has come under my observation.
5. In the absence of intercurrent complaints, such as malaria and dysentery, it
is unusual for this nematode to produce symptoms necessitating hospital treatment.
6. In areas of intense malarial infection it not infrequently plays a prominent part and brings about a fatal issue in cases of pernicious malaria. serious and fatal complication of chronic malaria.
It is the most
7. Too much prominence should not be given to the reported deaths from this disease upon estates. Cases with general edema and anæmia are admitted to hospital, and should they upon admission have no marked rise of temperature or parasites in the peripheral blood, but, on the other hand, be found to harbour hook- worm, they are diagnosed as ankylostomiasis and reported dead of that disease when a fatal issue follows.
8. It is a custom on some estates to examine new labourers for this parasite, and those found to harbour the worm are labelled as suffering from ankylostomiasis, and treated for this complaint. The practice is undoubtedly a good one, but con- clusions drawn from the figures of such estates and estate hospitals are apt to be misleading, because few cases seek hospital treatment on account of symptoms produced by ankylostome infection, but are sent to hospital for the sole reason that they have hook-worms or ova in their gut.
9. The most important measure of prevention has been the insistence upon some form of pit or trench latrines on estates; it cannot be said that the use of latrines by the labourers is universal, but objections are becoming less frequent and planters are begining to recognize both the possibility of making their coolies use them and their value as a preventive sanitary measure. The protection of water supplies upon estates may in a minor way assist in preventing infection, though to what if any extent the disease is water-borne in this country has not been determined.
10. The local literature on this subject is not extensive; in the studies from the Institute for Medical Research, 1908, Daniels reports the occurrence of ova in 13 out of 21 Malay prisoners, and he also states that "Clinically cases of profound anæmia due to anchylostoma are uncommon in Malay, but do occur." He further "Out of 328 post-mortem examinations on Chinese, the deaths due solely to says,
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