June 1907. J 



403 



Miscellaneous. 



recently I met a coolie homeward bound with a species of ray which was quite bad, 

 and I have no doubt his intention Avas to share it with his family ; I confiscated the 

 fish and got a conviction against the vendor.) 



As ptomaine poisoning diarrhoea is difficult of diagnosis, and the protraction 

 of the illness very variable, and as it may be confused with other diseases (which I 

 shall deal with below) I think that these cases ought to be segregated, many of 

 them might be tubercular or typhoidal in nature. The necessity of regular inspect- 

 ions of the food in the estate shop is a fairly obvious duty, and will help to prevent 

 the ptomaine cases if all questionable articles are confiscated and destroyed. 



Anchylostomiasis. — This disease, of which little is as yet known amongst 

 laymen, has been of late years so threshed out pathologically, that it is now, to the 

 tropical physician, an open book, writ large, and easy of diagnosis microscopically. 

 This scourge of the West Indian planter at one time, will be one of the most serious 

 diseases to be dealt with in this country, unless prompt precautions are taken with 

 regard to its prevention and cure in such places as it now occurs. 



The disease in its fully developed stage exhibits the following symptoms : 

 anaemia, swelling, diarrhoea, abdominal pains, muscular pains or pains in the joints, 

 and a lassitude, which may be remarked frequently as the first symtom. The disease 

 untreated invariably terminates fatally, but if the treatment be applied in time it 

 is not very difficult to deal with, and the patient usually recovers. It is due to the 

 action of a minute worm which lives in the upper part of the small intestine and 

 sucks blood from the patient, eventually causing a deep anaemia or wateriness of 

 the blood, which is followed by the symptoms enumerated above. The gravity of 

 the disease is proportional to the number of worms present in the intestine. 



The parasite can enter the system either by the mouth in drinking water, or 

 by the skin, and it works havoc amongst coolies in infected areas. The worm can 

 live in moist earth for a considerable time, and many authorities believe that it can 

 multiply outside the body. The ova of the worm are voided in large numbers by 

 sufferers from the disease and then undergo development into worms capable of 

 infecting persons throuerh the skin. When the almost total absence of latrine 

 accomodation for coolies is considered, together with the habits of the Tamil, and 

 the fact that they work barefooted, the chance of a worm gaining admission into a 

 human being must be regarded as " rosy." The treatment, consisting as it does in 

 the administration of a somewhat dangerous drug — namely, thymol— I do not intend 

 to deal with herein, but it may be useful to hospital dressers to remember that the 

 drug is soluble in the following : chloroform, oils, turpentine, alcohol, glycerine 

 and ether (a useful pneumonic for these drugs is cotage), if they be administered to 

 patients when thymol has been exhibited poisoning follows. The prophylaxis of 

 the disease is simple, but extremely difficult— if I may be permitted the bull— simple 

 because it consists in either compelling coolies to wear shoes and gaiters or putties 

 when at work, or in smearing their legs with some stickly substance, before they go 

 to work— in the West Indies the planters, driven to extreme straits, eventually 

 stamped out the disease by insisting upon the coolies stepping into green Stockholm 

 tar before going to work. I believe any oily thick substance will serve the purpose ; 

 the prophylaxis is difficult, because it is obviously a tedious process to prove to the 

 native mind that such simple measures are necessary and effective for the preserva- 

 tion of their health. Latrines and a lines watchman are absolutely necessary to 

 see that sanitary instructions are followed. 



Debility. — One of the principal headings of disease under which a multitude 

 of diseases are in reality included, it is a serious cause of invaliding and stoppage of 

 work. That there exist cases which are not easily relegated to their proper 

 heading I am, alas, only to ready to grant, but that in the majority of instances these 



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