A discussion on ankylostomiasis / G.M. Giles [and others].

Date:
1900
Catalogue details

Licence: Public Domain Mark

Credit: A discussion on ankylostomiasis / G.M. Giles [and others]. Source: Wellcome Collection.

    12/16 (page 546)
    cisely the opposite holds, for there is no argent necessity to pour iron into the stomach, very little of which will be ab¬ sorbed (Burge), when there is already a large stock- in an organic combination ready to hand in the liver and Bpleen, while on the other hand arsenic and bone-marrow tabloids (the latter of which more especially I have found to be of extreme value in malarial cachexia) are strongly indicated in order to increase tha output of the red corpuscles which are being or have been destroyed by the fever. These indi¬ cations I have followed with great success in many cases, and although they are often carried out as a result of em¬ pirical knowledge, a rational basis is afforded them by the research which I have described. References. 1 First Indian Medical Congress Report. 2 The Epidemic Malarial Fever of Assam or Kala-azar, a reply to criticisms, Rogers. 3 Report on Kala- azar, Rogers. 4 Reporton Kala-azar, by Ross. 5 Snort Notes on Ankylo¬ stomiasis, by Otho Galgey, of St. Lucien. 6 The Distribution and Harmful¬ ness of tbe Ankylostoma, Rogers. Journal of Tropical Medicine, October, 1898 7 Report on Beri-beri or Amemia of Assam, by Major G. M. Giles. Indian Medical Gazette, January, 1898. 2 Indian Medical Gazette, 1899, p. 91. 10 On the Epidemic Malarial Fever of Assam or Kala-azar, Med.-(?hir. irons., vol. lxxxi, 11. 1 Ibid., vol. lxxxii. 12 British Medical Journal, September 24th, >898. 13 Jour, of Path, and Bad., December, 1898. 14 Indian Medical Gazette, 18S3. 15 Translation of Lutz's paper on Ankylostomiasis in Kynsey's Beri beri of Ceylon. IV.—Oswald Baker, M.D., Surgeon-Lieutenant-Colonel I.M.S. (Ret.). Physician to Out-patients, Seamen’s Hospital, Royal Albert Docks, London. The contribution to the discussion of this subject which I wish to make relates entirely to a consideration of the preva¬ lence of ankylontomiasis in Burmah. My attention was first drawn to this question by the perusal of Dr., now Sir William, Kynsey’s report on an:emia in Ceylon, issued by the Ceylon Government in 18S7, of which I was fortunate enough to obtain a copy shortly after its publication. It appeared to me on reading this report that the anmmia so common in Burmah might also, as in Ceylon, be the result of ankylostomiasis.' Although the ankylostoma duodenale was not at that time known to exist in Burmah, it seemed highly probable that on investigation this parasite would be found to be very preva¬ lent throughout the province, for both the habits of the people and the climatic features of the country were in the highest degree favourable to its existence and dissemination. In returning to Burmah, therefore, I lost no time in making an inquiry into the matter ; nor had I long to wait, for within a few days of resuming charge of my duties a Hindu lad was admitted into the civil hospital suffering from amemia in a profound degree, for the production of which there was no obvious explanation. The condition of this patient was prac¬ tically identical with that of a person who had bled to the verge of death, and the symptoms he presented were precisely those and those only which result from great loss of blood from whatever cause arising. Ankylostoma ova in abundance were at once found in his stools, and on the day following this discovery two of the worms, both dead, were seen in his eva¬ cuations. While the existence of the ankylostoma in Burmah was thus proved, the fact that this blood - sucking parasite was extremely prevalent throughout the pro¬ vinces was soon afterwards established beyond doubt. In the Moulmein Gaol, of which I held medical charge, so prevalent was the ankylostoma among the prisoners that I seldom failed to detect its ova in cases not only of simple anaemia, but also of anaemia associated with specific diseases. As. however, an investigation limited to convicts already in¬ habiting the gaol, was open to the objection that the prisoners in question might have acquired the pai’asite subsequent to their admission, it was resolved to examine the stools of a large number of prisoners at the time of admission. Now, the gaol at Moulmein is what is known as a central gaol, and as such receives within its walls, criminals sent not only from the town but also many who are brought in from different parts of the province. Obviously, if large numbers of newly ad¬ mitted prisoners were found infected with ankylostomata, my belief that the parasite was extensively disseminated would receive substantial confirmation. I determined, therefore, with the aid of a trained assistant, to examine micro¬ scopically the stools of 100 prisoners admitted consecutively into the g-aol, as-soon as possible after their reception. Before the observations were fully completed, however, I was transferred from Moulmein to an appointment elsewhere, but the transfer did not take effect until 89 of the proposed ex¬ aminations had been made. The results obtainea may I think be accepted as representing the degree of prevalence of hel¬ minthiasis among the lower classes of the adult population of British Burmah. Of the 89 prisoners, 17 were natives of India, and 3 were Chinamen. Taking the natives of Burmah ah ne, of whom there were 69, it was found that no fewer than 38, or 55 per cent., were infected with ankylostomata ; that 33, or 49 per cent., had whip worms; and 30, or 43 per cent , had round worms; while the stools of 2 contained the ova of the tape¬ worm. Only ro out of the 69 were without some species of entozoon. 80 that whilst 55 per cent, harboured ankylostomata, as many as 86 per cent, were the subjects of helminthiasis of some form or another. It may, I think, therefore, from theee observations be safely concluded that the ankylostoma duo¬ denale is present in the intestines of at least half of the poorer classes of the inhabitants of Burmah. That a high prevalence of ankylostomiasis is both directly and indirectly responsible for much mortality there can be no question, but the extent of this mortality unfortunately cannot be ascertained. Numerous deaths take place annually, especially among the. lower orders, from “ unknown causes ;,r and in hospitals and gaols the mortality from anaemia and) general debility of uncertain origin is often high. Much of this loss of life, set down to unknown causes, to amemia and to general debility, is, I think, unquestionably due to anky¬ lostomiasis. I drew attention to this mortality in a short paper on Ankylostomiasis in Burmah, which was published in the Indian Medical Gazette some twelve years ago. I further pointed out that an infection with ankylostomata, unless ade¬ quate to the production of pronounced an?emia, would probably altogether escape recognition. I also explained that the reason ankylostomata were not always found post mortem in fatal cases of ankylostomiasis was due to the circumstance that these nematodes, subsisting on human blood, often abandoned tiieir impoverished and amemic victims before death, owing to want of sufficient or suitable nourishment. Subsequent observers, amongst whom I would mention Giles, have expressed very similar views. That ankylostomiasis should obtain so high a degree of pre¬ valence in Burmah can,, when the habits and customs of its- population are considered, hardly cause surprise. There is practically no night soil sanitation in the out-lyiug villages of Burmah, and most of the inhabitants defsecate on to the ground through holes in the floors of their dwellings. Left on the surface of the soil, exposed to wind and rain, a portion of this excrement becomes spread broadcast over the land,whilst some of it, in the form of mud, is carried into the houses of the people, and is deposited on their floors. Now the majority of the Burmese do not use chairs and tables at their meals, but squat on the- floors and eat their food with their fingers out of plates and bowls set down on the floor in front of them. When travelling they often dispense altogether with feeding utensils, and sometimes substitute the leaves of certain trees. Under such circumstances, the general prevalence of intes¬ tinal entozoa is, I would affirm, inevitable. Kynsey has maintained that water is undoubtedly the chief source of infection in ankylostomiasis, and has stated that the prevention of this disease consists essentially in the use of pure water. I do not think that such is the case. On the contrary, I believe the infection is conveyed through the medium of contaminated food, and that water has but little to- do with the matter. In support of this opinion I would point out that among the 89 prisoners already referred to there were, as stated, 17 natives of India and 3 Chinese. Now these men. both Indians and Chinese, are far cleaner feeders than the Burmese, although the source of their water supply is the same. Of these 20 aliens only two were found infected with anky¬ lostomata being 10 per cent., as against 55 per cent, of the Burmese. Moreover, Giles has shown that watpr retards and finally arrest3 the development of anky'ostou a embryos. There is, Giles states, “no condition more ho3’ile to them, than when immersed in water.”