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

Date:
1900
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Licence: Public Domain Mark

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

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    6fFT. I, I Mjidical Jou&nax J J7 .►'/*)clinically by the fact that cramps are seldom present in | diarrhoea, or if present, rarely severe, the collapse is not so f «omplete as in cholera, the voice is never so low and weak as £ ia cholera, the pulse though weak and small is never so low Pm in cholera, the stools are never the pure “ rice water” of ' the graver malady, but always somewhat stained with faecal iinatter. The reaction stage is less marked than in cholera ?cases, and some irritant cause is also usually to be found. I 'am strongly inclined to believe that in this form of “hot weather diarrhoea ” the clue will be found to many of those ' mysterious cases of isolated sporadic attacks of “cholera.” Jlf “summer diarrhoea” can occasionally kill adults in Europe, I am certain that “hot weather diarrhoea” in India can da so. Colonel Kenneth MacLeod said: This paper on hot weather diarrhoea raised two important questions; first as regards the distinction between cholera nostras and cholera Asiatics, and secondly, assuming that these are essentially different, or at any rate differently caused diseases, what the organism or toxin is which gives rise to the former. In the abseneeof bacteriological investigation thequestion of diagnosis is often very doubtful in India; but experience confirms the view taken by Major Buchanan in this paper, that these cases which are very common both in Europeans and natives, adults and infants, in the hot weather are not cases of cholera Asiatica. We are ignorant of what the precise causation is, and it is best that we should acknowledge this, and content our¬ selves to await further research, which is urgently desirable. THE DISEASES OF GOORKHAS. By Andrew Duncan, M.D., M.R.C.P., F.R.C.S., Physician to the Seamen’s Hospital, Royal Albert Docks, London. During the last year of my service in India. I had the good fortune to be associated with many Goorkha regiments, and as the result of this experience I found certain facts in their medical history to exist which I had not previously noticed in connection with the men of other native regiments. These facts I propose to briefly put before you. Malarial levers.—Shortly after taking over medical charge of the 2nd (P.W.O.) Goorkha Rifles I was struck with the intractable character of the malarial fever in many cases amongst the men. The fever proved to be peculiarly resistant to the usual anti-malarial remedies, so much so that in no other race in India have I experienced such difficulty in com¬ batting the disease. A number of drugs were tried, and I came to the conclusion that two methods of treatment only were of avail in these cases. First, the treatment by the rectal injection of 15 to 20 grs. of quinine. Should this not avail, then the only measure left was sick-leave to another district. Cases in which for three or four weeks 30 grs. of quinine had been taken by the mouth without avail would often yield at once to 20 grs. by the rectum. Next to quinine, treat gave the best success in thpse severe casts. Phthisis.—The manner in which phthisis occurs and its course, is also somewhat peculiar. Cases of an irregular fever used to come into hospital. Repeated examination of the lungs, which I was taught by experience never to omit, for many weeks would show no physical sign. Suddenly, one morning I would find sub-crepitant rales commencing at the apex. The early symptoms then almost invariably advanced with great rapidity. In fact, I have never seen such rapid cases of tuberculous disease of the lung as I have seen in Goorkhas. And in reference to this I may perhaps mention an extraordinary case I once had under my care. A Goorkha had been for three or four weeks in hospital when the signs of rapid disintegration of the lung appeared. Subcrepitant rales were succeeded by humid crackling rales, and a large mass of tubercu¬ lous glands appeared above the clavicle. So ill was he that for two or three days I went to the hospital fully expecting he had died in the night. But one morning, to my astonishment, he appeared much better, and, to cut a long story short, the signs abated, the gland enlargement disappeared, and eventually the man went out perfectly well. The treatment was by in¬ halation of creosote. I do not think there could be any doubt «s to the accuracy of the diagnosis. Mumps.—Goorkhas are very prone to mumpj in their native country. Nearly always in the few weeks immediately subse¬ quent to the joining of the new recruits, mumps would occur in the regiment. And the same remark must be made with regard to measles. Ophthalmia.—Shortly after joining my regiment I was struck with the comparatively large number of cases of ophthalmia met with. I was at first inclined to suppose that the Goorkhas were in some peculiar way predisposed to this disease. How¬ ever, I was called in one day to attend the wife of a Goorkha Rifle officer for phthisis, and was at once struck with the bad ventilation of her hut. Examination of the huts of the mar¬ ried and bachelor lines now showed the following important differences : Bachelor huts had no doors, had large airy win¬ dows opposite one another, fully 2 feet square and kept open ; the food was cooked in separate buildings. The married huts were irregular in shape, windows smaller and not opposite one another, and generally closed with articles of dress, and the food was cooked in the huts. The inner room was dark and the atmosphere not fresh. Next the incidence of ophthalmia was as follows : 1895 Married, 30 ... SiDgle, 11 cases. 1896 ,f 68 ... tf 7 tt 1897 up to Aug. 28th. „ 50 ... ,, 12 ,, On August 28th the regiment went on service and ophthalmia at once disappeared. I inquired of the medical officers of the other Goorkha regiments and found no such incidence of ophthalmia, with the exception of the 3rd Goorkha Rifles. Here the lines consisted of four airy double-storeyed barracks for a certain number of bachelors ; the remainder of the latter and all the married men living in a series of tents closely ag¬ gregated under the brow of a hill. Twenty-one cases of ophthalmia occurred in 1896, of these 20 came from the latter barracks. Enteric.—It has been often stated that the Goorkha soldier is prone to enteric. This has not been my experience. I have only seen one case of enteric (and this was judged to be enteric from the typical Dature of the temperature chart chiefly) during my service in India amongst native troops. The case was however in a Goorkha. Surgeon-Major Armstrong, the Residency Surgeon in Nepaul, informed me that in his ex¬ perience the Goorkha race is by no means prone to the disease. He has never had a case in hospital, civil or mili¬ tary in Nepaul, and has only seen 2 cases in females. A DISCUSSION ON ANKYLOSTOMIASIS I.—Major G. M. Giles, M.B., F.R.C.S., I.M.S., Sanitary Commissioner N.W. Provinces and Oudh, India. The phenomenon of parasitism is so widely diffused through¬ out the animal kingdom that it is more than probable that the evolution of the parasite has commonly coincided with that of the host, so that it is by no means surprising to find Dr. Sandwith, of Cairo, quoting a translation of a Hieratic papyrus 3.450 years old, which shows that even then anky¬ lostomiasis was known as the AAA disease, though the writers assumed that the wTorms were the effect instead of the cause of the disease. Quoting still from Dr. Sandwith’s paper (written for the eleventh International Medical Congress held at Rome in 1894) we find that the earliest mention of this special ansemia in modern times was from Brazil in 1648, and in Guiana in the beginning of the eighteenth century, but it was not till 1843 that Dubini, of Milan, first discovered the parasitic cause of the disease. After this Pruner (1847), Grasinger (1851), and Bilharz found it to be very common in Egypt, but these discoveries attracted no particular attention until the memorable outbreak of this disease amoDgst the workmen engaged on the construction of the St. Gothard tunnel brought its importance prominently to the notice of the medical world. , x . .. A few years later Leichtenstern and Lutz demonstrated the existence of a free stage, but owing possibly to climatic diffi¬ culties did not succeed in rearing the so called rhabdites to sexual maturity; Lutz describing the still immature worms as becoming “encapsuled” and subsequently calcified. I believe myeelf that this is really a death and not a life history, and that the appearances described relate merely to the slow destruction of the embryos placed under conditions unsuitable to their well being. Since the St. Gothard outbreak the disease has been recog-