77
Para. 42
The special officer should be allowed to move Ms own subordinates accord-
ing to Ms discretion. His time should on no account be taken up by the
compilation of returns. He should be encouraged to make all suggestions
which he thinks fit to offer. He should understand that his duties extend to
the care of patients and the prevention of the disease where practicable; and
not to scientific research, except in the second place. He should know how to
use the microscope for the treatment of malaria and ankylostomiasis. He and
his subordinates would probably require tent equipage.
A call for volunteers for the duty would probably permit of a good selection
being made.
I do not know whether this scheme will be considered feasible. I fear,
however, that I can suggest no other which is at all likely to have any
influence in checking the present epidemic of kala-azar.
But as I have frequently pointed out, the questions with which we are
concerned in kala-azar apply also to malarial fever in general; and as my
present duty extends to a consideration of this, I think I should take the present
opportunity to draw attention officially to a very important matter—referred to
in the preceding paragraph—the proper scientific method of diagnosis in
malarial fever and ankylostomiasis.
In the use of the microscope science has given us a means of diagnosis in
these diseases which generally far exceeds in accuracy the old symptomatological
methods, and which is frequently essential to the correct treatment of patients.
In the opinion of every authority on these diseases these means should be
often employed; that is, I think, as a routine as regards ankylostomiasis, and,
when necessary, as regards malarial fever.
The intestinal worm called ankylostomum duodenale, which lives by
suction of the blood, is known to be widely prevalent in India, and causes,
directly or indirectly, a mortality the extent of which will only be gauged when
the microscope is generally used for its detection; while malarial fever is well
known to be the most important of tropical diseases.
Many medical men now employ the microscope in the diagnosis and treat-
ment of these diseases; and the time appears to be ripe for urging its general use
by the profession. I beg, therefore, to recommend that the medical services in
this country be encouraged gradually to introduce the method referred to into
ordinary practice.
For this, the following measures may be suggested :—
(1) All medical officers may be urged to make themselves gradually
familiar with the necessary technique — a matter of no great
difficulty, since a large number are already acquainted with it.
(2) Thorough practical instruction in this matter should be given in the
medical schools in this country. Medical subordinates already in
the employment of Government should be instructed as opportu-
nity offers by the medical officers under whem they are serving.
(3) In localities where ankylostomes are prevalent, small, strongly-made
microscopes of weak powers, suitable for the detection of the eggs
of these and other intestinal worms, should be issued to all dispen-
saries. Such microscopes may, I think, be manufactured in
Europe for the purpose, at the cost of about ten to twenty
shillings each—possibly at a lower cost if ordered in large numbers.
(4) More powerful microscopes, provided with lenses suitable for the
examination of blood, should be possessed either by all com-
missioned medical officers or by all hospitals, Civil and Military,
where such medical officers are employed.
With reference to (2), I think it advisable to mention that during the
course of my present studies I have come cross two medical subordinates in
charge of dispensaries who, though many of their patients were then suffering
from the worst degree of ankylostomiasis, informed me that they had never
even heard of the disease. They certainly know nothing about it; were not
acquainted with the microscopical method of detecting the worms; had no
microscopes to use for the purpose; and were, in fact, treating these severe
cases of the disease with tonics for "malarial cachexia." Similarly, I have
generally found medical subordinates in this country to be quite insufficiently
instructed in regard to tropical parasitology — that is, in regard to what are