CO885-(23-24) — Page 622

PUBLIC RECORD OFFICE

Reference :-

││ | ། །། ། mmmmmimC.O. 885

24 PUBLIC RECORD OFFICE, LONDON

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

use

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The method adopted in British Guiana of cleaning the microscope slides after Immediately after use they were was simple, time-saving, and effective.

At the dropped into a bowl containing a strong solution of Jeyes' fluid or lysol. close of the day's work they were stirred about in this bowl until all particles of fæecal matter were detached; then they were removed, thoroughly rinsed through several waters, and wiped dry. The tin containers and toothpicks were, of course, discarded after use.

In British Guiana, in a district of 14,000 inhabitants, three young East Indians were found sufficient to do the microscopical work. Previous experience with the microscope was not found to be essential. After several weeks of training these men were examining from 100 to 125 specimens daily, and this number should be materially increased with further experience.

5. Treatment.

The purpose of the campaign in British Guiana was primarily, of course, to eradicate ankylostomiasis, but in doing this we were to test two methods of administering the thymol

1. The "daily" method, which had been successfully used by Dr. J. E. A. sugar Ferguson in treating the indentured East Indian labourers on the estates of Peter's Hall District;

and,

2. The "intensive" method, which had been used almost exclusively in the United States in the extensive campaign waged against hookworm disease in the Southern States.

The "daily" method of treatment, as it was employed in British Guiana, required that the adult patient be given 10 grains of thymol each day, except Sunday, for four months, or approximately 100 doses. No purgative was necessary and no modification of diet or habits was required, except abstention from alcoholics for a few hours after the thymol was taken.

As rapidly as the villages in area B--five in number could be examined microscopically, those found infected were placed on the "daily" treatment. This area had a population of 3,563, of whom 3,207 were examined, showing 1,918 to be infected with ankylostomiasis.

The thymol-distributors were accompanied by the Supervising Medical Officer on their first visit to each patient, and, later, certain days were appointed for each village when he visited all malcontents and could be consulted by the patients. This practice established a bond of sympathy and understanding between the Medical Officer and the people which insured more perfect co-operation throughout the campaign.

It was not found difficult to induce most of those infected to begin treatment. Many of them were eagerly responsive to the idea of "getting something for "Certificates of Health," nothing," and all seemed to covet the little cards, or which were issued to those not infected with ankylostomiasis, and promised to those who would persist in the treatment until cured.

Of the several elements of population dealt with the East Indians, who com- pose approximately half of the population, were the most docile and easily managed.

The fact that this method of treatment did not require the patient to make any sacrifice in diet, or habits, was a persuasive talking-point in inducing the infected to begin treatment, but this advantage was more than lost when it was learned that a dose of thymol was to be given them daily for the long period of four months. It was from the prolongation of treatment that most of our difficulties with this method arose. A considerable number became tired of the daily dose, and were inclined to abandon treatment, the improvement in physical condition being so slow that it was often not recognized sufficiently to encourage them to continue. During the period of four months there were often interruptions in the course of treatment by unavoidable circumstances-absence from home, intercurrent illness, etc.. and, since its efficacy seems to depend largely upon its regularity, this added to the difficulties.

The rather elaborate force required for the distribution of the daily doses of thymol one distributor to each 200 patients-made it necessary to recruit this force from a low-salaried source-$8.00 to $10.00 per month-and it was very difficult to secure trustworthy people at this price.

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The constant demand made upon the time of the Supervising Medical Officer to see the dissatisfied and persuade them to continue the treatment was so heavy that it would materially limit the area or population which could be handled by one such officer.

After the treatment was well under way in area B, the village of Meadow Bank was selected and placed under treatment by the "intensive" method.

This village, with a population of 520, had an infection of 52 per cent, or 275. The "intensive" method of treatment, as employed here, provides that the adult be given 40 to 60 grains of powdered thymol on one day in each week until cured. This dose of thymol is preceded and followed by an active saline purga- tive, and the patient is required to abstain from food for at least eighteen hours during the treatment. It has been found that better results are obtained if the thymol is finely powdered and triturated with from half to an equal quantity of sugar of milk, and given in a cachet or gelatine capsule. It may be of interest to give in detail the method used in administering the thymol by the "intensive

method.

Directions.

""

1. On the day preceding the treatment give a large dose of sulphate of magnesia at 5 p.m. No supper should be eaten. The saline should thoroughly cmpty the alimentary canal.

2.

Remain in bed the following morning without food.

3. At 6 a.m. take one-half of the thymol; at 8 a.m. take the remainder. 4. Take a large dose of sulphate of magnesia at 11 a.m. This should be repeated if a thorough movement of the bowels is not secured within two hours.

5. No food should be taken until after the bowels have moved thoroughly, and then no greasy foods, milk, alcoholics or malt drinks should be indulged in.

6. The usual diet and habits may be resumed on the day following treatment.

7. If the patient feels weak or dizzy during the treatment give one-half cup

of strong coffee without sugar or milk.

8. Careful examination of the dejecta from the second dose of sulphate of magnesia should show the dead worms expelled.

9. Several of these courses of thymol given at weekly intervals are usually necessary for cure. (See form of printed directions in Appendix.)

There is a scientific reason behind each step of the treatment as detailed by these directions, which must be evident to the mind of the medical man who 18 familiar with the disease. Since ankylostomiasis is a disease which will not yield to haphazard medication, many cases proving obstinate under any methods of treatment, and since thymol is a drug which must be given under certain restric- tions in order to be safe and efficient, it is well to have definite directions to follow in its administration.

More than fifty per cent. of our cases were cured in British Guiana with two treatments, or in eight days after the first examination. A very small percentage required more than three treatments. Almost any person who is convinced that the ankylostome is present in his or her body will readily consent to give one day out of each week for two or three weeks to be cured of this malady. Thousands of working-people, miners, carpenters, farmers, and clerks, have been treated on Sundays, thus losing no time from their labours.

It has been repeatedly stated that the above-mentioned dose of thymol is "dangerous." In reply to this, I will point to the fact that more than a million maximum doses of thymol have been administered in the United States to persons of every age, colour, race, and physical condition, and that most of these treat- ments were taken by the patients in their own homes without supervision from nurse or physician, and yet without a fatality, or serious physical disturbance, except in a very limited number of cases, where the patients indulged in alcoholic drinks with the thymol still in the intestinal canal.

Further, it is evident that in a large number of cases the thymol was incor- rectly taken, for many of these people were illiterate and densely ignorant. I fancy there are but few drugs in the pharmacopoeia which could stand so severe a test and still be considered comparatively safe.

At the end of this chapter is given a complete report of the campaign in Meadow Bank, with the "intensive" method, and a partial report from Agricola village, where the campaign with the "daily" treatment is drawing to a close.

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