437
16
(5) To treat until cured all infected persons (except those refused treatment for medical reasons) in his district.
(6) To collect at the proper time specimens of fæces for re-examination of those persons under treatment.
(7) To supply each person cured with a certificate of health from the Director. The duties of the supernumerary nurses are in general the same as those of the
The supernumerary nurses work under the direction of the nurses. The duties of the caretaker are the care of the office and the washing of the glassware used in the microscopical work.
nurses.
V.-Census-taking and the Sanitary Survey.
After the preliminary educational campaign the next work to be done is the taking of a census of the district and a sanitary survey. For this work the area is divided into districts, one district for each nurse.
The nurse goes to each house in his district, numbers the house with chalk, records the name, age, and sex of each person, notes the class of latrine used, and leaves containers for specimens of fæces from each member of the family. Instruc- tions are left for these specimens to be prepared for the following morning, when the nurse returns for them and takes them to the laboratory for examination. In this manner the nurse covers his entire district, numbering each house, whether occupied or not, recording the name of each person residing in the district, noting the character of the latrine used by each household, and collecting specimens of bowel motions from every individual.
The data collected during the census and sanitary survey is recorded by the nurse in a book for that purpose, called the census book, the form of which is shown below:-
Census Book.
Latrine.
Remarks.
Casc Number
Name
Age.
8.x.
Race.
D.
E
F.
17
Rules for Centrifuging.—When a microscopist has accumulated twenty negative specimens he then prepares them for the centrifuge as follows:-
(1) The containers are placed on the diagrammatic chart on the numbers 1-20, and are then taken up one by one, beginning at 1. The numbers 1-20 are also marked after the corresponding names on the microscopical report sheet.
(2) Into a small glass jar, which had previously been filled three-fourths full of water, a sufficient portion of the specimen is placed, and an emulsion is made by stirring with a toothpick.
(3) This emulsion is then poured through a funnel into a centrifuge tube, one end of which has been previously corked.
(4) A cork is placed in the other end of the tube, and the tube is then placed in the centrifuge at the number corresponding to the number on the chart from which the specimen was taken.
(5) After the twenty specimens have been prepared as above and centrifuged, smears are made from the outward end of each tube and examined as before. Three smears must be examined before the specimen is pronounced negative.
After the specimens are examined the results are recorded in the case record book in a column for that purpose opposite each patient's name.
VII-Treatments.
When all the specimens from a district have been examined and the results entered in the case record book, a treatment book, containing only the names of the infected persons, is made out. This book the nurse carries with him to record the treatments as he gives them. It gives him a list of all the infected persons in his district, together with each individual's age, race, sex, number, and the number of the house in which he lives.
Before any treatments are given the Director accompanies the nurse on a visit to all the infected persons and determines what dose shall be given each person and what persons are not to be treated. In this manner the danger of administering thymol to a person in whom it is contraindicated is obviated.
In Antigua it has been found that, in order not to inconvenience the patients, the great majority of treatments must be given on Sunday. This means that the nurses have little to do during the week, so in order to reduce idleness amongst the nurses to a minimum, supernumerary nurses who work only on Sundays are employed. These nurses assist the regular nurses and work under their direction. In this campaign the drug used is finely powdered thymol mixed with equal parts of powdered milk sugar, and given in capsules. In the accessory purgative part of the treatment magnesium sulphate in solution is given. This solution is prepared by dissolving fifteen pounds of the salts in three gallons of boiling water, which is then approximately a 2-1 solution. The dose of the solution is twice that of the crystals.
Dosage Table.
Thymol.
5 grains
Age. 1-5
5-10
10
10-15
20
11
15-20
30
Adults
Above 50
40 30
33
Salta.
2 drams
4
23
PUBLIC RECORD OFFICE
Reference :-
885/25
PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC-
COPYRIGHT PHOTOGRAPH-NOT TO
<<
case record
After the census and survey work is completed the name, age, race, and sex book, which of each person in the district is recorded in a large serves as a permanent record.
VI.-Examination of the People.
After taking the census the nurse collects the specimens of fæces and brings them to the laboratory for microscopical examination. The microscopical examina- tion is conducted under the supervision of the Director by trained microscopists. The microscopists are thoroughly schooled in their duties, and are able to recog- nize the eggs of all the common intestinal parasites. The technique used in this laboratory for the microscopic examination of fæces is as follows:-
Microscopical Technique.-Two large smears are to be made from each specimen and examined in the ordinary way. If the specimen is found to be negative on being examined in this way it is to be put aside and centrifuged.
Smears are to be made with wooden toothpicks, a different toothpick being used for each specimen and for each slide
6
JJ
1 ounce
11⁄2 ounce 11
Nurses are thoroughly instructed in their duties by the Director before they are allowed to give treatment.
The following instructions for administering treatment are given to the nurses: (1) Treatments are not to be repeated until one week has elapsed since the last treatment.
(2) On the night before the thymol is to be given the patient is advised to eat a light supper without food containing grease or oil or alcoholic liquors. At bed-time a dose of salts is given to clear the bowel of substances in which thymol is soluble, such as oils and alcohols, which may remain in the bowel from previous meals; also to purge clear the bowel of mucus and give the thymol opportunity to act more directly on the ankylostomes.
(3) The next morning, say, at 6.0 o'clock, the nurse gives the patient half the dose of thymol.
B 2
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