CO885-(23-24) — Page 616

PUBLIC RECORD OFFICE

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Reference :-

C.O.885

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

24 PUBLIC RECORD OFFICE, LONDON

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iv. General conclusions:-Out of the 118 cases examined, seventy-four, or 62-7%, are positive. But it must be stated that this is the result of only a single examination of the fæces of cases. I was not as adept as I became after some practice, and my opinion is that the percentage here represented is a good deal lower than it really is even for a single examination of fæces. Of the positive cases rather more than 52% give 70% of hæmoglobin, or less, but only five cases give less than 70%. Of the negative cases only 32% give 70% of hæmoglobin, or below- that is, 68% of the cases show a higher percentage of hæmoglobin than 70%, the majority registering 80% hæmoglobin. Most of the cases examined were persons who did not complain of any illness: no particular form of illness is therefore ascribable to these cases showing ankylostomiasis and ankylostoma ova in their fæces."

9. The Medical Officers at Cline Town, Moyamba, Northern Sherbro (Pujehun), and Bo have sent in “nil” returns for ankylostomiasis for the first half of the year. It is to be hoped that their efforts at investigation will be more successful during the latter half of the present year. It should be mentioned in this connexion that the Medical Officer at Bo remarks that he had been prevented through eye trouble from undertaking the necessary microscopic examination; but he states that his condition has now so much improved that he hoped to make a systematic investiga- tion of all cases during the latter half of this year.

10. I have now, myself, to report briefly the case of Father Alachniervicz, of the Roman Catholic community in Freetown.

The Father, a Pole by nationality, has been resident in this town for the last six years, and, he informs me, has enjoyed average good health all the while until about the middle of the year 1913. He then noticed that he suffered from a certain He had been degree of malaise and a general indisposition to exert himself. engaged since January of that year with building operations in connexion with an extension of the Convent premises. where the work necessitated the digging up of the soil in a "lot" previously occupied by natives. The work was very arduous and entailed a considerable amount of actual contact with the soil while laying the foundation of the new buildings.

Father Alachniervicz is a strong, thickly set, dark man of medium height, and does not usually take much notice of passing indispositions, which he knows are a matter of occasional experience for everyone in this climate; but the loss of energy and the weakness persisted so long and asserted themselves so much that he was obliged at last to seek medical advice. He was seen in June, 1913, by a doctor, who, suspecting the presence of the parasite, treated him accordingly.

The building operations were still continued, and the Father was compelled daily to handle soil. Not a great deal of improvement appeared to follow the course of treatment, so that in November of the same year, his ill-health becoming 80 pro- nounced, and anæmia, dyspepsia, heart weakness and loss of body strength super- vening, the Father thought it advisable to consult someone again, and saw me.

The patient looked" white," but there was no degree of anæmia: the com- plexion had never been ruddy. Heart action was rapid, the pulse somewhat "small,” and the tongue was furred. The lungs, liver, spleen, and kidneys were normal. The temperature, it was stated, had shown irregular rises for some time previously, Dyspeptic troubles were complained but was normal at the time of consultation.

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of, and there was a tendency to diarrhoea: there was no blood in the evacuations. A microscopic examination of the blood showed moderate eosinophilia, but there An examination of the was no other marked pathological condition noticeable. hands (the only possible channel of infection) discovered no eruptions or skin disease at the time; but Father Alachniervicz stated that he had noticed that for some time on the hands and at the base of the before he had suffered from a little "itch

A curious sensation that fingers-little pimples containing some watery matter. struck the Father much at the time was that on various occasions he felt á piercing sharp pain under the skin of the hands and wrists, as if "a needle was trying to come through.” The intensity of the sensation varied the Father never saw anything exude; and the pain, after lasting for some time-usually five or minutes, but on one occasion for a whole day-gradually passed away.

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An examination of the fæces twice confirmed, both times. a diagnosis of anky. lostomiasis. The usual treatment with thymol, followed up with tonics, was satis- factory; and a good recovery was made.

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The building operations, however, had to be continued, the Father promising to take the greatest care of his hands by washing them frequently during the time; but, in spite of all precautions, some symptoms of a fresh infection showed them- The diagnosis was selves some five months later in April of the present year. confirmed in the usual manner and further treatment by thymol undergone.

The Father is now still in the Colony and apparently free of the disease, as argued from a microscopic examination of the fæces; he appears to be in good health.

11. It is perhaps premature, at the present time, and with the material in hand, to dogmatize as to the distribution of ankylostomiasis, and the extent of its When further reports and a injurious effects on the people, in Sierra Leone.

great many more detailed facts are forthcoming it will be time enough to make But one point that statements that will possess the rare merit of accuracy. impresses even the casual reader of these reports is the comparative valuelessness of returns rendered under varying conditions of investigation and opportunity. This variability is a more or less constant feature of some, at least, of the research work that has been so largely undertaken during recent years on the West Coast of Africa. It must be admitted, however, that the difficulties involved in a question of this nature are very great. But, as matters are at present, Colonies where a disease is for one reason or another specially taken up and studied, and where cases are correctly and conscientiously returned, appear to be the worst sufferers, while if no special attention is paid to these particular diseases, that locality enjoys a reputation for healthiness that is incorrect and misleading.

12. It is evident from even the returns here available that the prevalence of ankylostomiasis in Sierra Leone is considerable, and that the disease is distributed more or less generally throughout the country. The native, for obvious reasons, is mostly infected; although the occurrence of infection in the case of the single Euro- pean reported shows that they also are exposed to this danger. A more thorough investigation amongst the Europeans in the Colony and Protectorate may possibly result in the discovery that infection, in some degree, is not as rare as it is thought at present.

13. As far as the reports at hand tend to prove, it would appear that the do not suffer from ill-health and majority of persons harbouring the "hook worm disability which may reasonably be attributed to the presence of the parasite. But the statement that the presence of ankylostomes in their human host does not generally produce characteristic or severe or even profound perversion of body- health should be made and accepted very cautiously; the data at present are insuffi- cient. The case reported from Bonthe of a woman suspected of suffering from 'beri-beri," but who, it was found, died most probably of a heavy infection of anky- lostomes, is interesting and instructive. It must also be stated that in the case of the European Father the symptoms of the disease were well marked with only a moderate infection of the parasite.

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14. Sufficient has not yet been accomplished to justify any pronouncement on the relative responsibility of the parasites of malaria and ankylostomiasis in deter- mining the anemia and other symptoms ascribable to both these diseases.

15. The organization of a campaign in this Colony against this disease at any future time will need careful and efficient manipulation. Opportunities, not only for the adoption of measures for the prevention of the spread of the disease, but also for its proper and uniform investigation, can only be offered to Medical Officers when arrangements for the necessary equipment and the expenditure required for are forthcoming. the work involved have been thought out beforehand and Measures against malaria, in the distribution of quinine to the children of some of the schools in Freetown, have been provided for during the coming year in Estimates.. But the free distribution of quinine for the prophylaxis of malaria has been the vogue on the West Coast for some considerable time; and the benefit to themselves Treatment for ankylos- is now appreciated, in a general way, by most natives. tomiasis, however, will be altogether a new lesson to be taught to the masses of the people. But similar methods to those for the campaign against malaria may be adopted; and the work may be carried out on the same lines as the fight against ankylostomiasis at present in progress in Egypt, namely :-

annexes in connexion with the several out- patients' departments and dispensaries for the investigation and treat- ment of this disease.

(a) The institution of