433
PUBLIC RECORD OFFICE
गय
Reference :-
C.O.885/25
PUBLIC RECORD OFFICE, LONDON
ALLY WITHOUT PERMISSION OF THE BE REPRODUCED PHOTOGRAPHIC-
COPYRIGHT PHOTOGRAPH-NOT TO
18
(4) Two hours after the first dose of thymol, say, at 8.0 o'clock, the nurse gives the patient the second half of the dose of thymol.
(5) Two hours later, say, at 10.0 o'clock, the nurse gives the patient another dose of salts. This dose of salts is very important, as its object is to clear the bowel of the hookworms that have been forced to loosen their hold on the intestinal wall by the action of the thymol, and to get rid of the excess of thymol before it has had time to produce any harmful effects on the patient. Nothing should be eaten on the day the capsules are taken until the final dose of salts has acted thoroughly. If the patient feels weak or dizzy from the salts, a cup of black coffee, without milk or cream, should alone be allowed.
The reason for the exclusion of alcohol and oils from the diet during the treatment is that these substances dissolve thymol, making it actively poisonous and dangerous to the patient. Gravy, butter, milk, creams, and all other fatty or oily foods, as well as alcoholic substances, as liquors and patent medicines, should be forbidden on the evening before and the day of the treatment.
Nurses are instructed not to treat people who have developed the following conditions
(1) Persons with diarrhoea.
(2) People with swelling of the feet and ankles, or puffy eyelids, as these are evidences of heart or kidney disease.
(3) People suffering with fever or acute diseases, such as typhoid fever, malaria, dysentery, etc.
(4) Pregnant women.
(5) Very old emaciated people, who are made weak by the treatment.
The above persons are seen again by the Medical Officer and the treatment modified as he sees fit.
Usually it requires from two to six treatments to produce a cure. Occasionally à case requires more treatment, sometimes as many as twelve to
fourteen.
About one-half the cases are cured after two treatments.
Nurses are required to make daily written reports of the treatment they have given that day and the specimens they have collected for re-examination. This report gives the individual number of patients to whom treatment has been given, the dose of thymol administered, and the number of the treatment, whether first, second, third, etc. Each nurse is furnished with a special daily report book for this purpose.
The pages of these books are printed forms which facilitate the making of the reports.
VIII. Re-examination,
No re-examination is made until at least six days have elapsed since the last treatment. The reason for this is that the toxication of the thymol causes the female ankylostomes that are not eliminated by the treatment to stop laying eggs for a few days.
Thus if the patient were examined too soon after treatment he might be erroneously pronounced cured, when in reality he is still infected.
Before re-examination each patient is given his first treatment, and a week later his second treatment. Six days after his second treatment he is examined. If he is still positive, he is given his third and fourth treatments separated by an interval of a week, and then, six days after the fourth treatment, he is again examined. If he is still infected after his second re-examination he is re-examined after each treatment thereafter.
Re-examinations are conducted by the same microscopical technique as that The results of re-examinations are recorded in the case heretofore described. record hooks and in the nurse's treatment book.
IX.-Issuing of Health Certificates.
No...
M..
19
ANTIGUA ANKYLOSTOMIAsis CommisSION.
Health Certificate.
of
.191
has been examined by the Antigua Ankylostomiasis Commission and is certified to have been found FREE FROM HOOKWORMS.
X-Difficulties of Treatment.
Hookworm eradication, like any undertaking which must reach and be responded to by the whole of a given population, is beset with difficulties. Amongst these are:-
(1) The inaccessibility of part of the population.
(2) Indifference on the part of some of the patients.
(3) The fact that the great majority of treatments must be given on Sunday. (4) In a thickly populated district with a high percentage of infection, such
as is met with in other West Indian islands, a nurse may give from sixty to one hundred and twenty-five treatments a week; whereas, in Antigua, with its some- what scattered population and comparatively light (though none the less dangerous) infection, a nurse is able to give only from thirty to forty treatments a week.
Some people are difficult to treat on account of their work; for instance, milk carriers, who are never at home except at night.
XI-Sanitary Condition in the District.
In this area the water supply is from open roadside ponds which are not covered in any way and are exposed to all sorts of surface drainage. In a few instances the water for drinking purposes is rain-water collected in cisterns. In view of these circumstances it is believed that the pit latrine, while not ideal from the sanitary point of view, is the best solution of the problem of the disposal of human excreta in the rural district of Antigua. The erection of a pit latrine is a simple and inexpensive matter, and it requires practically no attention to keep it in proper order.
An expensive latrine could not be made universal, on account of the poverty amongst the lower classes; an inexpensive latrine requiring frequent attention, such as the bucket latrine, would be neglected and become almost as bad, as a menace to health, as no latrine at all. Therefore the Government of Antigua has decided to require the installation of pit latrines.
In the York Valley District there are four hundred and thirteen inhabited houses, of which number only ten are equipped with satisfactory latrines.
The Government of Antigua has appointed sanitary inspectors, who will enforce the proper installation and use of latrines.
Postscript.
During December, 1915, Dr. Covington was unfortunately obliged to leave Antigua on account of his health. He was temporarily relieved by Dr. H. L. Kearney, who completed the York Valley campaign.
Preliminary Table of Results for the York Valley District. Period 15th September, 1915, to 31st December, 1915. Census
Refused to be examined Examined
Number of people infected
1,956
35
1,921
524
Removed before being treated
15
Died before being treated Not treated for medical reasons
2
25
A form of
Number of people to be treated
481
Infected, but not yet treated
49
When a person is found on microscopic examination to be free from ankylos- tome infection, i.e., either cured or not infected from the beginning, he is given a certificate to that effect. These certificates are given to stimulate interest in the work and to promote co-operation on the part of the infected. this certificate is appended :-
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