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.

    13/16 page 547
    I would take this opportunity of pointing out that I believe ie spread of many other entozoa is effected in precisely the une manner, that is through the medium of food and not of ,ater. In the town of Moulmein, which in regard to sanita- ion is probably the most neglected town in the whole of Jarmah, infection with ascarides is almost universal. About «*very third person applying for treatment in the outdoor department of the Civil Hospital is an applicant for. worm 'medicine. The water supply is mainly derived from uncovered shallow wells, of which many are without parapets, and in' seasons of drought often run dry. I have taken water from one of the dirtiest of these wells when nearly dry, have filtered it and subjected the residue to microscopical exami¬ nation without finding therein a single ovum or embryo of jmyentozoon. ! i k it would seem, therefore, from a consideration of these data, that no marked diminution in the prevalence of and mor¬ tality from ankylostomiasis in Burmah can be looked for until some system of sanitation has been generally adopted which will obviate the broadcast distribution of infective night soil. And to this question of night soil conservancy the attention of the authorities concerned should, I think, be given. I V.—Patrick Manson, C.M.G., F.R.S., LL.D., M.D., Physician to the Seamen’s Hospital Society, Greenwich. Dr. Patrick Manson said: It is somewhat singular that rhabdomena intestinale was so seldom found by Giles in Assam, considering that it is so frequently associated elsfewhere with the ankylostoma, and that the climate >Bnd othel: physical conditions closely resemble thoie of Cochin China, where the parasite is extremely common, and where, indeed, it was first discovered by Normand. I have frequently met with it in the stools of Indians. I have twice encountered the ankylo- Btoma in dangerous profusion in Englishmen from abroad. One case came from the West Indies. He had been in hospital for many months, and had been discharged as hopelessly all with pernicious aneemia. Fortunately after his discharge as an incurable he consulted a practitioner in the country, Uho found ova recognised to be those of the ankylostoma. sender treatment with thymol the patient got quite well. A dicond case came from Singapore. Ankylostomiasis had been diagnosed, but specific treatment was postponed until it could be undertaken under more favourable climatic conditions. When I saw the patient he was profoundly anaemic, as in ad¬ vanced Bright’s disease, with vertigo,tinnitus,palpitation, and all the symptoms of advanced anaemia. Every slide of his faeces 8howed numerous ankylostoma ova. Under thymol he rapidly recovered, and left for the East again quite well. I am aston¬ ished at Dr. Fearnside’s statements as to the therapentic im¬ potence of thymol. In my experience it rarely fails, provided it be given in adequate and rapidly repeated aoses, say 30 grs. every hour, for four times. The diagnosis of malaria from ankylostomiasis by hsemocytometric methods, though in- seresting and valuable from a pathological point of view, is impracticable under ordinary circumstances. Dr. Rogers’s statements as to the presence of a leucocytosis during the. acute stage of malarial infection are not in accordance with recent observation. Perhaps I misunderstood his meaning ; but the presence of a leucocytosis is generally held nowadays to exclude a diagnosis of malaria. I am disappointed that none of the papers have alluded to Powell’s interesting obser¬ vation that betel nut chewing is possibly a protective habit in the natives of Assam, Burmah, and the Eastern Peninsula, acquired instinctively in consequence of its prophylactic virtues against the ankylostoma. I agree with Colonel Baker’s rematk that the parasite is generally acquired in food and dirt rather than in water, and that improved methods of night soil conservancy are much to be desired on this account in the East. I believe the Chinese method of dealing with night soil to be a good one on sanitary grounds. The soil is stored in cemented tanks, where it rots and ferments for months before it is used as a fertiliser. During this period of storage it is probable that the ova and embryos of the in¬ testinal entozoa it may contain are killed. VI.—Major Ronald Ross, I.M.S.(Ret.). Liverpool School of Tropical Medicine. Major Ronald Ross remarked regarding the life-hittory of the parasite, that he had carefully studied Major Giles’s ex¬ periments on a rhabditiform stage, had partly followed them and considered that they were sound. He thought that Son- sino’s criticism of these experiments was unsound. Sonsino said that Giles had mistaken rhabdomena for ankylostoma ; Major Ross supported Giles in Etating that the former were un¬ common in Assam—at least in Nowgong, and thought that such a mistake was too obvious a one to be easily made by a competent observer. He held that the well-known fact of the disease being so commonly an earthworker’s disease supported Giles’s discovery. He had long maintained the opinion le- .garding its mode of infection just given by Colonel Baker, and thought that there was little to be said in favour of infection by the route of drinking water. Regarding the clinical effects of the parasite, he scouted the idea that it was always harmless. It was impossible to fix the exact number of parasites required to produce pathological reaction. Rogers’s estimate of 500 was probably much above the mark in many cases. Obviously, numbers required to produce reaction must vary inversely as the strength of the host. Fifty ankylostoma might destroy a patient already debilitated by other disease or starvation. The speaker considered that the parasites might also produce a toxic effect, and referred to Daniel’s discovery of yellow pig¬ ment in the organs of cases of ankylostomiasis—examples of which he had seen. He concurred with the observers in thinking that the worms might leave the patient in the last 6tages of the disease. He entered a plea for the much more general use of the microscope for the detection of the ova in the localities where the worms were prevalent, and cited the in¬ stance of a hospital assistant in charge of a dispensary full of cases of ankylostomiasis who had not even heard of the disease, and who was treating the cases for malarial cachexia. VII.—James Cantlie, M.B., F.R.C.S., Surgeon, Seamen's Hospital, Royal Albert Docks, London. Mr. James Cantlie stated that, stimulated by the researches of Dr. Walker in Borneo in connection with the presence of the ankylostoma in beri-beri, he had carried out a careful investigation on the subject in Hong Kong in 1S93, but failed? to find either the ova or the fully-grown parasite amongst Chinese coolies suffering from beri-beri. TROPICAL LIVER ABSCESS. THE MANAGEMENT OF LUNG LESIONS CONSEQUENT ON LIVER AliSCESS. , By Colonel Kenneth Macleod, L.L.D., M.D., Professor of Clinlcsd and Military Medicine, Army Medical School, Netley. Of all the routes by which spontaneous evacuation of abscesses of the liver takes place the pulmonary route is the most common. Randus’s statistics show that among 159 cases in which liver abscesses discharged spontaneously, 59, or 10 5. per cent., opened into and through the right luDg, and 31, or 5.5 per cent, into the right pleural cavity; or, taken together, in 16 per cent, of these cases the pointing of the abscess took place upwards, through the diaphragm and into- the thoracic cavity. The selection of this route in prefeience to others depends mainly upon the situation of the abscess, the principle of progress in the direction of least resistance coming into play. Whether the abscess bursts into the pleural cavity or irrupts into or erodes the lung, so as to esta¬ blish a secondary abscess in that organ, must depend upon The extent and strength of protective pleuritis to which the progress of the pointing has given rise. . .. When the discharge into the pleural cavity is primary, the event is indicated by characteristic physical signs, and can be very readily and safely certified by exploration. In such cases there is but one indication and rule of treatment, which is to make a free opening into the pleural cavity, removing, if necessary, a bit of rib, and to establish efficient drainage. The opening must be made and the drainage conducted under strict antiseptic precautions. It happens occasionally that the discharge of a hepatic abscess into the right pleural cavity is a secondary event caused by the bursting into it of a lung abscess of hepatic origin, or by a wound of the pleural fold in exploring or cutting into a liver abscess. In these eases the cavity and its contained material are apt to be septic. The
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