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PUBLIC RECORD OFFICE

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IC.O. 885

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were examined shortly after arrival at Port Swettenham, nine of these, or 6-25 per cent., bad ankylostome ova in the fæces without showing any symptoms of ankylostomiasis; I do not diagnose ankylostomiasis merely by the microscope, and my chief difficulty is in diagnosing it from malarial fever. I believe my figures of 1.89 per cent. of the admissions to Klang Hospital in 1910 and 1911 being cases of ankylostomiasis, can be taken as a fair indication of the amount of ankylos- tomiasis in this district, and, if there is an error, that the truth lies higher, say, 2.5 or 3 per cent., because certain cases showing profound anæmia and oedema had fever and malarial parasites in their blood and were diagnosed as malaria, even though they had ankylostome ova in the fæces, and it is possible ankylostomiasis was present as well. The Government hospitals are far superior to estate hospitals, and microscopical examinations and post-mortems are systematically made, but I place very little reliance on the number of admissions to estate hospitals which are said to be due to ankylostomiasis. A list* of hospitals in this district is appended showing the total admissions and the admissions from ankylostomiasis last year. The measures taken to prevent ankylostomiasis in this district are the erection of latrines, and when these are made more use of I think there will be less ankylos- tomiasis. Ankylostomiasis in this district is not so serious as malarial fever, but mixed infections of malaria and ankylostomiasis add to the gravity of the prognosis.

I have, &c.,

A. S. MILLARD, Health Officer, Coast.

The Senior Health Officer,

Federated Malay States, Kuala Lumpur.

SIR,

Office of the Senior Medical Officer,

Taiping, 4th March, 1914.

In reply to your letter No. 233/14, of the 12th ultimo, I have the honour to enclose the particulars regarding ankylostomiasis therein desired.

2. These, save with the exception of an able report from the Medical Officer, Batu Gajah, are not so full as I should have desired, but as you express urgency in your letter I have not returned them for further amplification, but can do so if you so desire. I notice the Commissioner left England on the 24th January,

1914.

3. As regards the occurrence and distribution of ankylostomiasis other than those cases seen in hospitals, the only remedial measures are those taken by the few estates which have Medical Officers attached, and by no means a large proportion of these.

A large number of estates on the score of expense prefer to employ a Medical Officer who visits rarely, or who from the multiplicity of estates he is required to visit is quite unable to devote any time or attention to the vast majority of the coolies, a fact reported by myself when recently acting as Health Officer, vide your 347/13 and others.

A very large number of estates in Perak have no Medical Officer at all, others employ a Medical Officer whose infrequent visits render them practically useless.

Regarding race, when coolies of the class colloquially known as "Kling," viz., Tamil, Telugu, Malayalam, etc., are employed ankylostomiasis almost invariably exists; other races of Indian coolies, together with Chinese, are far more cleanly in their habits and suffer much less than the above-mentioned..

5. On some few estates all new coolies are admitted to hospital and the fæces examined for ova; I regret to say that I am only aware of but four estates in Perak on which this praiseworthy habit is practised; could it be made a routine practice the incidence of ankylostomiasis would be much diminished.

6. A further factor conducive to the spread of this disease is the aversion of As managers to regard trench latrines as other than semi-permanent fixtures. Health Officer I was continually urging managers to occasionally shift their trench any latrine latrines to other spots with but indifferent success; the continual use of leads to the ground in its immediate vicinity being extensively defiled by fæces, defilement which is rendered much worse by wet weather.

7. I have frequently advocated the placing of buckets near the lines for night

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use; any ordinary coolie will defecate just outside the lines at night or in the drains surrounding them rather than walk a few yards to a latrine; this placing of buckets for night use should, I consider, be rendered compulsory on all estates.

8. On estates water-logged in wet weather and those in which the subsoil water is but a few inches below the surface, e.g., certain coast districts, Matang, Kurau River, etc., some sort of pail or bucket collecting system is needed, trench latrines being impracticable. I do not think, however, that ankylostomiasis exists to the same extent in coast lands, the brackish and salt subsoil water probably having a detrimental effect on its growth.

9. Most managers are now beginning to realize the importance of seeing that their coolies are well fed, but numerous estates still pay no attention to this impor- tant factor. Some ten years ago, on a large sugar estate in Province Wellesley, I recommended hot conjee being served free at 5.30 a.m. to all working coolies before muster, ere leaving for the field to work in the sugar plantations; this was adopted by the Company, with the result that the hospital admission rate was more than halved in the ensuing months.

Where great anæmia exists on any estate, from whatever cause, I think some hot meal to coolies ere proceeding to work should be compulsory.

10. In conclusion, I am of opinion that it is only by the employment of com- petent estate Medical Officers, with a training in tropical medicine, and who have sufficient time to adequately perform their duties, that this disease can be stamped out.

The soil of nearly all estates is rapidly becoming a breeding ground for this parasite, with disastrous results to the physical well-being of the labourers and considerable financial loss to the rubber industry.

I have, &c.,

S. C. G. Fox,

To the Principal Medical Officer, Federated Malay States, Kuala Lumpur

Senior Medical Officer, Perak,

Tanjong Malim Hospital, 23rd February, 1914.

Ankylostomiasis.

Distribution and Prevalence.-Cases are met with mostly among Tamils from estates. A few stray cases can be seen among Chinese, but the symptoms are not, at least during admission, so marked as in the case of Tamils. Generally speak- ing, cases of ankylostomiasis are diagnosed as such during the routine examination of stools of every patient, and in the absence of any other more marked signs or symptoms. The classical description of the disease, excepting for the anæmia and anasarca, is rather an exception than rule with Tamil patients.

Gastric disturbances or the extreme grade of anæmia interfering with circu- latory system is only occasionally found, so that some of the cases with the diagnosis marked as ankylostomiasis are, strictly named, cases of ankylostomiasis infection, and bear an analogous relation to the patient's system as ascares infection does, though no doubt in a more serious degree by virtue of the peculiar habits of the

worms.

Occasionally Tamil patients seek admission for either a tired sensation and great weakness of the "jone" feeling in the extremities, or a vaguely defined burn- ing and irritating sensation along the soles of feet. In such cases stools are often negative, but with a course of beta-naphthol treatment the symptoms quickly disappear. The cases met with in Tanjong Malim Hospital are mostly from estates.

The following figures show prevalence and distribution :

Year,

Total Treated.

Cases of Ankylostomiasis,

Deaths. Par cent.

1918

1,841

1912

1,261

88

40

96

2.98

4

7.61

10

STREIN

Per cent. of Mortality in Ankylostomiasis,

10.00 10-41