58 
AnJcylostomiasis in Grenada 
the disease ought not to be forgotten when making examinations, yet 
its presence need not be invariably assumed until the contrary had 
been proved with the aid of the microscope. 
One fact, however, which caused me much perplexity when taking 
over the cases in the Hospitals was the unusually large number of 
patients who were suffering from some degree of dilatation of the heart. 
This, I was informed, was extremely common in the island and was ex¬ 
plained by the heavy work which the labourers employed on the large 
estates in the interior of the island (which is very rugged and moun¬ 
tainous) were called upon to do. This explanation did not seem to me 
to be satisfactory, since when in charge of mountainous districts in both 
Cyprus and Southern Nigeria I had not noticed a similar state of things 
to exist; also I found that the disease was not absolutely restricted to 
estate workers in Grenada. This condition of the heart and the fact 
that there were in the Hospitals several patients suffering from an in¬ 
termittent fever, which did not respond to quinine and in the hlood of 
which I was unable to find either malarial parasites or filaria, led me to 
make investigations with regard to the cause of both these maladies. 
From the examinations of the blood which I had already done, I 
was aware that a considerable degree of anaemia was usually present, 
and that eosinophilia was marked. I consequently commenced to 
examine films from the stools of these patients and found that the ova 
of Ankylostoma duodenale were constantly present. This led me to 
examine the stools of all the patients in the Hospitals, and I was 
amazed to find that over 80 “/o of them had the ova of this 
parasite present in their excreta. A systematic examination of the 
dejecta of all those subsequently admitted to the Hospitals was in¬ 
stituted, and the results obtained showed the widespread extent of the 
disease amongst all those connected with estate work and its especial 
prevalence amongst the labouring class. There was, however, a certain 
proportion of these cases which had never worked either on the estates 
or in the gardens usually connected with them ; and several of the cases 
were of young children of three years of age and upwards. The number 
of cases examined in this series was fourteen hundred, and included re¬ 
presentatives from every grade of society in the Colony, from every part 
of the island, and of every age—from young children of three years to 
old men of eighty-five. 
In this series it was uncommon to find the Ankylostoma ova alone, 
the usual combination of parasites in a specimen being: Ankylostoma 
duodenale, Ascai'is lumhricoides, and Trichocepi talus trichiurus. In one 
