Miscellaneous. 404 [June 1907. 



eases can be separated I am equally convinced. Amongst others, the following 

 diseases are, I consider, largely responsible for "debility": I. Anchylostomiasis ; 

 2. Dum-Dum fever (which undoubtedly exists amongst Indian coolies in this 

 country) ; 3. Worms ; 4. Starvation (due to improperly cooked food which cannot 

 be digested) : 5. Sprute ; 6. Malaria in a vicarious form. 



Such cases cannot be separated without careful examination and scientific 

 investigation, and the hospital is their proper place. The number of coolies who die 

 annually of " debility" is at present much too nigh in estate hospitals, and to my 

 mind reflects upon the class of dressers employed usually in estate hospitals, and 

 also reflects detrimentally upon the planter, and upon the revenue of the country. 



Ulcers.— That these cases which cause such an enormous number of hospital 

 birds, and " slackers" amongst labour forces here, can be dealt with by similar 

 methods to those quoted by me above for Anchylostomiasis, I have no doubt. The 

 cause lies beyond question hidden in a word, wounds ; whether caused by biting flies, 

 the Anchylostoma, sugar-cane leaves, stoney ground, or what not, the original cause 

 of ulcer amongst coolies is, I believe, a woun d, and the method of their prevention 

 is quite obvious. 



The admissions for this disease in Krian district during 1905 amounted to 

 5,322 in a total labour force of approximately 7,200, and if the average number of 

 days for which each case was in hospital be put at say 10, the total monetary loss 

 to the estates must have been about 14,000. During 1906, 3,617 cases were returned on 

 a labour force of 7,135. 



Dum-Dum Fever.— This disease undoubtedly does occur in imported Indians, 

 but that it can arise or ever has arisen de novo in this country, is not certain. As I 

 have already stated it may be confused with Anchylostomiasis, and some other 

 debilitating diseases ; the diagnosis c an only be made microscopically, and con- 

 siderable skill is necessary in the prepara tion of the specimen. 



There is as yet no known cure for the disease. The disease has also been 

 called Kala-Azar. The principal symptoms will be anaemia, swelling, weakness, 

 enlargement of the spleen and liver, and great general debility. The cases must, of 

 course, be sent to hospital, if only to have the diagnosis made. 



Bilharzia Disease —Endemic in Africa, this disease has happly not invaded 

 this country to any extent. The symptoms affect either the bladder or the rectum, 

 causing in either position a discharge of blood and mucus. It may be confounded 

 with dysentry when affecting the latter. The accurate diagnosis can only be made 

 microscopically and no first aid treatment is likely to be necessary. In the event of 

 severe bladder pain occurring, the general treatment of inflamation of that organ 

 (irrespective of the cause), namely a hot hip bath, and barley water to drink, 

 should be kept in mind. The disease is caused through bad drinking water. 



Worms.— Many natives harbour intestinal parasites, the commonest being the 

 round worm. 



Tape worms occur but rarely in my experience, but of whipworms the same 

 cannot be said. Intestinal worms cause a marked amount of debility and frequently 

 anaemia also. The treatment of the tape worm is frequently a protracted pro- 

 cedure, as the head of the worm is not easy of expulsion, the treatment is ext. of 

 male fern, or thymol, both of which drugs require careful handling. The round 

 worm is expelled by santonin, which drug— although it may cause yellow vision- 

 should occupy in this country a position more akin to that occupied by quinine than 

 it at present holds. 



Despite the arbitrariness of the statement, I am of opinion that every coolie 

 arriving in poor condition should have an ounce of castor oil on the day of his 

 ar*l i and 6 grains of santonin next morning. The question of the psychological 



