BAHAMAS.
i
MEDICAL AND SANITARY REPORT
For the Year Ending 31st December, 1934.
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K ft NASSAU, NEW PROVIDENCE: H Ji' PRINTED BY THE NASSAU GUARDIAN, LTD.
I; 1935.
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ANNUAL MEDICAL AND SANITARY REPORT FOR THE YEAR ENDING 31st DECEMBER, 1934.
CONTENTS.
I. ADMINISTRATION.
(a) Staff. (b) Financial.
II. PUBLIC HEALTH.
(a) Ordinances (b) General Remarks: Pre-natal Clinics. Infant Welfare. (e) Diseases. (d) Vital Statistics.
III. HYGIENE.
SaNITATTON. 1. Public Water Supply. 2. City Sewerage System. 3. Sanitary Inspections.
IV. PUBLIC HEALTH MEASURES, V. BUILDINGS. VI. PORT HEALTH. VII. HOSPITAL. VIII. RESEARCH. IX. INFANT WELFARE STATISTICS. X. BARRACKS AND PRISON. XL BACTERIOLOGICAL AND VENEREAL DEPARTMENTS. XII. METEOROLOGY. 2
L ADMINISTRATION,
(a) Staff*
Staff of the Medical and Sanitary Departments.
Chief Aledieal Officer and Resident Surgeon J. M. Cruiksbank, Government Bacteriologist and Medical Officer George Kinneard. Assistant Medical Officer IB A, Quackenbush, District Medical Officers: Harbour Island A. T, IX W hitfield, Cat Island R, Cumberbateh. Andros W. A. Foulkes. Eleuthera D. A. Fields, Inagua L. C. Huggins Abaco A. -J. Eyres. Superintendent of Hospital H. L. Sumner. Chief Sanitary Inspector IT. F. Knowles (Acting), Assistant Sanitary Inspectors: Harry Pyfrom. G. W. Harrison, S. O’Day. C. T. Elden. Quarantine Officer M. H. Hall. Matron Miss A. Baines, Nursing Sisters: Miss L. Sutton. Miss S. G. Raine. Miss M. E. Shaw. Dispenser G. B. Strachan. Relieving Officer S. A. Wallace. Chaplain Rev. A. Douglas. Supervisor of Nassau Market L. B. Albury. Clerk to the C. M. O. and Health Board Miss Kathleen E. Albury.
Native Nursing Staff is made up as follows: 2 Staff Nurses on general duty. 1 Staff Nurse on permanent duty, Infirmary. 1 Staff Nurse—Nurses’ Supervisor. 3 Assistant Nurses. 18 Probationer Nurses in training. 3
Dr. J. M. Cruikshank, Chief Medical Officer, made a medical and sanitary inspection tour of certain Out Islands of the Bahamas during the year.
Dr. H. A. Quackenbush was on leave from the 8th June, 1934, to 22nd October, 1934, during which time several of the Out Island Medical Officers attended the Bahamas General Hospital in order that they might become acquainted with the technique of recent advances in medical and surgical treatment.
Drs. A. J. Eyres and R. Cumberbatch were on leave from the 17th October, 1934, to 16th January, 1935, and from 10th October, 1934, to 15th January, 1935, respectively.
Dr. A. T. D. Whitfield was transferred to British Guiana.
Mr. H. L. Sumner, Superintendent of the Hospital, was on leave from the 11th June, 1934, to 26th November, 1934, during which time his duties were performed departmentally. Miss A. Baines, Alatron of the Hospital, was on leave from the 9th July, 1934, to 9th November, 1934, and Miss L. Sutton, senior Nursing Sister, acted as matron.
Mr. L. B. Albury, Supervisor of the Market, was on leave from 1st August, 1934, to 24th October, 1934, and Mr. G. B. Strachan, Dispenser, from 36th July, 1934, to 17th December, 1934, their respective duties being performed departmentally.
(b) Financial.
Revenue of the Colony, 1934. £ 298707 3 6 Actual Expenditure Aiedical and Sanitary Department 1934.£ 24408 8 10
The average cost to the Government per resident patient per day has been reduced from 4s. 6d. to 4s. This figure in¬ cludes all overhead charges such as salaries of staff, medicines and dressings, food, clothing, electric light, water and sewer¬ age rates, etc, 4
II. PUBLIC HEALTH,
(a) Ordinances.
There were no ordinances affecting the public health dur¬ ing the year.
(b) General Remarks.
The Pre-natal Clinic is doing a much needed work. It is operated by the Roman Catholic Sisters, and attended by a private practitioner. Attendance during the year, 891.
The Infant Welfare Association is continuing its excellent services. One Nurse is employed. Three (3) Clinics, at¬ tended by a private practitioner, are held each week. Ap¬ pended are statistics of the Infant Welfare Association.
(c) Diseases.
There have been no epidemics during the year.
Typhoid. 32 cases of typhoid were reported this year as against 10 for the previous year. The increase this year is attributable to the increased rainfall. Previous to 1931 typhoid cases averaged from 60 to over 80. The marked decrease is attributable to the greater accessibility of the Chlorinated City Water Supply through standpipes instead of wells in certain sections, and on account of those still using well water, boiling it before it is used. Also wholesale inoculations have been carried out among patients attending the Out Patients’ Department, 4710 inoculations having been given.
Diarrhoea. The number of cases of diarrhoea under ob¬ servation at the hospital in patients over two (2) years of age has decreased, whereas in children under two (2) years has increased. This increase in cases under two (2) years of age is believed to be due to the increased rainfall and thus more unsanitary sources of water became accessible to children.
Tuberculosis. There is a moderate decrease in the number of admissions during the past year. Pellagra. There have been 23 admissions to hospital this year as compared to 47 last year. This disease continues to decrease during years in which the islands are not devast¬ ated by hurricanes, in other wrords, citrus fruits are more avail¬ able for the poor people. There were no hurricanes during this year, whereas there were two in 1933 in the Out Islands.
Malaria.. Is not common. Practically all cases are im¬ ported from other countries or brought from some of the southern islands of the Bahamas.
Dengue Dever.. Ten (10) cases of Dengue Fever were reported, the first since 1922.
Small Pox- No cases since epidemic of 1926,
Venereal Diseases: Fewer cases of primary syphilis are admitted to hospital because these cases are now seeking early treatment at the venereal clinics. Under tertiary syph¬ ilis is included all tertiary manifestations, including syphi¬ litic heart condition, cerebral haemorrhage due to syphilis and the several sequelae of syphilis. Hence the figures pertaining to tertiary syphilis are liable to considerable fluctuation. From the types of syphilis seen at the venereal clinics and the decrease in the number of primary infections, one is confident that the incidence of syphilis is not on the increase.
Helminthic Diseases. Worms are very prevalent. The most prevalent types found are ascaris lumbricoides, oxyuris vermicularis, and trichuris trichiura.
Leprosy„ Both the Nodular and Anaesthetic types are found. The Nodular predominates. Alepol is giving better results than did the Chaulmoogra Oil previously used. This disease is not on the increase. During the year all known patients residing in the Out Islands suffering from Leprosy were removed to the central Lazaretto. This accomplish¬ ment should in time show a considerable fall in the incidence of leprosy in the islands.
Diphtheria„ No cases of diphtheria were reported during the year. (d) Vital Statistics.
Estimated Population 1933 62679)
Births 19341 Male 1085 Female 921 2006 Deaths 1934:: Male 540 Female 488 1028:
Immigration 1934:: Male 4156 Female 3528 7684
Emigration 1934: Male 4046 F emaie 3514 7578 •
Estimated Population 1934 63763)
Increase 1084
III. HYGIENE.
Vitamine Deficiency.
The Board of Agriculture is continuing its effort to stim¬ ulate farming and in the absence of hurricanes, vitamine deficiency diseases can be practically eradicated. It ‘will be only a matter of time until the inhabitants can be taught to eat the fruit and vegetables which grow naturally in these Islands.
Citrus fruits, spinach, other green vegetables and tomatoes are available.
Tuberculosis. The climate is most conducive to good health. The prevalence of this disease is entirely due to bad housing and ventilation. This condition can be overcome by substituting a knowledge of hygiene for existing super¬ stitions believed in by the uneducated poorer classes
The Board of Education and Medical Departments are co-operating in an effort to educate the public school teachers and school children with regard to Hygiene and Sanitation. The sections of the City in which the Nassau Improvement Association have been working are showing a marked im¬ provement in the sanitary condition of the Public Grounds and private yards, and more people are growing vegetables and fruit on small plots of land in their yards for private consump¬ tion.
Sanitation.
1. The number of houses supplied from Chlorinated City Water supply is 1020, an increase of 56 over last year. Instead of Public Wells there are 50 standpipes supplying city water, an increase of 10 over last year,
2. There are 255 buildings Connected to the Sewerage System (an increase of 30 over last year). Although the sewers are not available in certain inhabited parts of the island, nevertheless with the improved water supply and sewerage system where available, the anticipated decrease in the number of cases of Typhoid and Enteritis is being realized.
Now that the City Sewers are in operation, bath water, kitchen water, etc., which previously had emptied into the streets and back yards are gradually becoming a thing of the past, and finally obnoxious nuisances and breeding places for mosquitoes heretofore found in the public streets will be great¬ ly reduced.
Dairies, Bakeries, Restaurants, Butcher Shops^ Food Shops, Barber Shops and Bottling Factories must have a certificate of sanitation before being allowed to operate.
The cleaning of the streets is under the administration of the Health Board, Due to financial stringency, namely, a 20% reduction in the money allocated for public health and sanitation, it was found necessary to reduce the staff of sanitary inspectors and street sweepers. However, in spite of this handicap, a good standard of hygiene and sanitation has been maintained.
The City Public Market and Slaughterhouse, which are controlled by the Health Board, have been improved strum turally and are now more sanitary. 8
All Butchers are examined medically and pronounced fit before being allowed to follow their trade.
It is hoped the new rules made under The Health Act will soon be in force, which among other improvements will neces- sitate all food-handlers being certified free of infectious or contagious diseases.
The City Water and Ice are analyzed monthly. To date both the water and ice are of a high standard bactei iologiealiy,.
Dairy Milk is also examined periodically.
Periodic sanitary and medical inspection of the Industrial School is carried out by the Assistant Medical Officer- Re¬ port appended.
The Barracks and Prison are inspected quarterly with regard to Sanitation by the Assistant IViedieal Officer. Re¬ ports appended.
Below are Tables showing the sanitary inspections carried out during the year..
Table L
House to house inspections by Sanitary Inspectors during 1934, 32,134, a decrease of 2,203 over last year.
Table II.
Health Board orders issued during 1934,, 79- Prosecutions Nik Convictions Nil- Dismissed Nik
IV. PUBLIC HEALTH MEASURES.
During the past year many of the valuable recommend¬ ations made by Sir Wilfred Beveridge during his official visit to the Bahamas in 1927 have been attempted and although financial stringency has prevented their being carried out in toto, still, considerable improvement in Public Health has been accomplished, which should bear fruit in the near future. 9
1. Last year the Pond District, which is a low-lying and thickly populated section of the City of Nassau, was greatly improved with regard to its sanitation.
The surface level of this District was raised from 6 inches to 18 inches in various sections by using as “fill” the sand which has been dredged from the harbour.
As a result of this the number of cases of Enteritis reported from this area has greatly fallen off and no cases of typhoid occurred.
2. 10 additional stand-pipes have been installed through¬ out the island so that at present there are 50 such sources of chlorinated city water available to the poor people.
3. Free Typhoid inoculations have been performed by the Medical Staff for the Public Health Department.
4710 inoculations have been given at the Hospital Out- Patients’ Department as against 2311 last year.
4. Free Toxoid inoculations also have been performed.
The Hospital and Health Rules have been revised and brought up to date, paying particular attention to the control of Dairies, Restaurants, Barber Shops, Aerated Water Fac¬ tories, Slaughterers, Food Handlers, Aiosquito Control, Drain¬ age and Refuse, etc.
These Revised Rules made under The Health Act are now awaiting approval by the Government.
V. BUILDINGS.
1. Private Patients. A bungalow containing an operating theatre and 6 rooms, each with private bath. 2. Infirmary. A two-storied building for aged and decrepit. Accommodation for 30 females and 30 males. 3. Pauper Hospital. A two-storied building, containing 2 Operating Theatres, X-Ray Department, and public and semi-private wards. Accommodation for 40 females and 40 males. 10
4. Isolation Building. A bungalow capable of accommodating 12 patients. 5. Male Mental Hospitals: (a) A two-storied building—-25 separate rooms for pauper patients. (b) Bungalow-—containing four rooms for accommodation of private patients. 6. Female Aiental Hospitals: (a) A one-storied building having separate rooms ac¬ commodating 16 pauper patients. (b) A single-storied building composed of a ward and accommodation for 10 pauper patients. (c) A bungalow containing 4 rooms for private patients. 7. Other Buildings are: (a) Out-Patients’ Department and Dispensary. (b) Laboratory. (c) Central Kitchen. (d) Central Laundry. (e) Mortuary and Post-Mortem Building. (f) Administration Building, containing Public Health and Hospital Offices. (g) Separate residences for each of the three Medical Officers, the Superintendent, European Staff and Native Staff. (h) Garages for 2 Ambulances, 6 Garbage Trucks and personal cars.
VI. PORT HEALTH.
The Port Officer examines the Bills of Health and in the event that there is any doubt as to the Ship's Bill of Health, a Medical Officer is summoned by the Officer of the Port to inspect the ship before it is granted pratique. There have been no diseases of a quarantinable nature -discovered this year.
A total of 198 aeroplanes and 572 vessels were granted pratique during the year.
During an outbreak of Dengue Fever in Florida all planes and vessels from that state arriving in Nassau were visited upon arrival by a medical officer.
Through the co-operation of the Airways Co. and steamship agencies all planes were flitted before arrival at Nassau 11 and when possible similar precautions were taken with regard to ships in an effort to prevent infected mosquitoes from being introduced into the Colony.
In this connection it may be stated that only 10 cases of Dengue were reported in Nassau.
VII. HOSPITAL.
The distribution of the patients to the various Depart¬ ments and results of treatment are shown in the appended table. The majority of “relieved” cases are either venereal or wrere transferred to the Out-Patients’ Department, where they were eventually discharged as cured.
Table I.
Remain¬ Admitted Died Remain¬ Distribution Sex. ing 1934. 1934. ing 31-12-33. 31-12-34.
Alexandra Hospital F 34 893 104 26 F 62 1340 136 40 Victoria Jubilee M 39 82 20 34 Infirmary F 34 53 16 34 Lazaretto M 8 5 1 10 F 7 4 1 10 Mental Hospital M 30 31 1 27 F 30 25 3 35 Private Patients’ M 0 33 3 0 Building F 2 38 0 0
246 2504 285 216
The following table shows comparative figures of the w ork performed in the Hospital during the last seven years.
Admissions. 1928 1929 1930 1931 1932 1933 1934
Alexandra Hospital 1545 1832 1580 1643 2052 2260 2147 X-Ray Examinations 127 149 85 80 98 80 116 Deep X-Ray Therapy Treat- ments 15 25 15 15 25 Operations 204 248 255 247 300 311 415 Maternity Cases 83 131 137 186 205 272 258 Prescriptions Dispensed 27023 24440 20878 22399 27608 34402 31372
The next table shows the prevalence of the more important diseases for the same period. 12
1928 1929 1930 1931 1932 1933 1934
Pellagra 79 81 61 35 27 47 23 Pulm. Tuberculosis 130 122 43 60 44 83 60 Enteric Fever 75 65 79 31 29 10 32 Gonorrhoea 178 166 150 163 102 144 105 Syphilis 85 131 95 143 115 159 121
X-Ray Department.
Many cases of Fibroid Uteri and skin conditions are being treated. Private Cases X-Rayed 67 Pauper Cases X-Rayed 42 Treatments given 25 Fluoroscopic Examinations 7
In the Out-Patients’ Department 23,718 medical and sur¬ gical cases were seen, also 499 accident and Police cases treated. 954 attended the dental clinics; 5,306 surgical dressings were applied.
Nurses’ Routine.
Lectures in Anatomy, Physiology, Medicine, Psychiatry, Dietetics, Obstetrics, Surgery and Practical Nursing are given to the undergraduate nurses by the Resident Staff.
During the past year all remaining unqualified attendants in the mental hospitals have been replaced by student nurses and a graduate nurse is now in charge of these departments. Pyschiatry is now part of the curriculum of the student nurses and each nurse spends six months of her general training in one of the mental hospitals.
Also each nurse is required to spend three months in the Bacteriological Laboratory as part of his or her training.
Steps have been taken to provide certain parts of the Out Islands (where district medical officers only occasionally visit) with first aid “dressers.” Suitable candidates are given a course of six months at the Bahamas General Hospital in general training, special attention being directed towards recognizing the common native ailments and their appro¬ priate treatment as well as first aid treatment of accidents, etc. During the past year three ministers of religion completed this course and are now practising as unqualified practitioners in the Out Islands. At present there are three candidates taking this course. In this way it is expected that a great deal of suffering will be abated and ridiculous Out Island prac¬ tises will be overcome.
The standard of entrance for candidates in general nursing has been raised, viz., only applicants who have a high school leaving certificate, Junior Cambridge Certificate or equivalent, are accepted.
The one exception to this rule is in regard to candidates for ■course in Midwifery. However, applicants for training in midwifery who cannot fulfill this rule are only granted a licence (after six months training) to practice in the Out Islands.
Revenue.
Revenue from all sources amounted to £1370 19s. 10d.s a decrease of £370 10s. 5d. The New Ward remained empty for long periods and showed a decrease on the previous year of £448 4s. Od.
Comparative Statement of Revenue.
1934. 1933. New Ward £ 375 6 0 £ 823 10 '9 Hospital and Asylums 693 6 6 691 0 0 Out Patient Department 25 17 9 15 15 6 Ambulance Fees 24 10 .2 33 o 6 X-Ray Fees 145 15 8 79 15 0 Bacteriological Department 106 •3 9 79 6 9 Miscellaneous 18 18 3
: 1370 19 10 £ 1741 10 3
Expenditure.
'Total expenditure from open votes amounted to £12,877 14s. od., but expenditure on the Hospital from annually re¬ current and special provisions amounted to £12,120 Is. Id., a -reduction on the previous year of £3,512 8s, 7d. Included in 14 this amount is a sum of £1.389 14s. 3d., paid to other Gov¬ ernment Departments, viz., the Electrical and the Water and Sewerage Departments..
Salaries of officials under “ Personal Emoluments” account for a further expenditure of £3,430, making a total expenditure on the Hospital of £15,550 Is. Id.
On this basis the daily running cost of the institution was £42 12s. 10d., and the average cost per resident patient per day was 4s..
The fact that these figures apply not to the fiscal year but to the calendar year detracts somewhat from their value for purposes of comparison..
The cost of outside activities—Relief, Pauper Passages, Out Island Medical Service and Funeral Expenses—-are ex¬ cluded, but all overhead charges affecting the Hospital are included.
Relief and Miscellaneous Returns.
Out Island pauper relief was discontinued but for purposes* of these returns, the number of Out Island paupers may be taken as... 450 No. in receipt of free rations in Nassau at the end of the year.. 117
567
The following miscellaneous returns are of interest.
Amount of foodstuff issued for Relief (Grits and Sugar) 14665 lbs Pauper passages paid 207 No. of ambulance calls 1726 No. of treatments at Out Patients’ Dept. 23718 No. of Prescriptions made up at Dispensary 31372 Average No. of patients and inmates per day 216 No. of admissions to Plospital 2803 Deaths 286 No. treated at dental clinics 954 No. of typhoid injections given in O. P. Dept. 4710 VIII. RESEARCH WORK.
Filarias. Approximately 2% of the population are infested with til aria ozzardi. Recent research in other islands of the West Indies suggests Culicoides Stephensi to be the vector. Culicoides is very prevalent throughout the various islands of the Bahamas and it is hoped that time will be available to make a study of the local Culicoides as a vector of this disease.
Dysenteries and Fnteritis. Amoebic Dysentery is fairly prevalent in the Colony but is a mild type. Only occasional cases of Amoebic Hepatitis are encountered and seldom a case of Liver Abscess.
% What organisms are involved in dysenteries of the bacillary type is a problem yet to be investigated. A great many of the cases appear to be nutritional, i.e., pellagra. At all ages diarrhoea is a common symptom in cases admitted to hospital while in the absence of the characteristic dermatitis a diagnosis of pellagra may be difficult. Somewhat empirically orange juice given intra-venously has been prepared in the laboratory for these cases.
The orange juice is secured aseptically, filtered and ad¬ justed to a R Id. of about 7.4, This is then administered intravenously in doses of 10 c.c. and given daily or every other day. Beyond demonstrating that it is a harmless pro¬ cedure it is too early to speak of results. It offers some prom¬ ise, especially in checking diarrhoea.
Climatic Bubo is very prevalent. Freds antigen was pre¬ pared in the laboratory fortesting the intro-euti reaction’rof patients referred to the Venereal Clinic. The antigen, pre¬ pared according to Frei’s technique, was tried out on a series of controls to eliminate false positives and seems entirely satisfactory and has repeatedly agreed with clinical diagnoses. The use of this antigen has enabled us to diagnose a number of cases of esthiomene that previously had been regarded as syphilis. V
16
INFANT WELFARE STATISTICS.
Table giving Births and Deaths of Infants in 1934:
Number of living births registered 579- Number of still-births 22 Total number of deaths under one year 60 Total number of deaths over one year 30
Proportion per 1,000 Deaths under One Year of Age oc¬ curring at each period:.
Age at Deaths No of Proportion Children. per 1000. Under 1 day 15 350.0 1 day and under 1 week 10 166.0 1 week quid under 2 w eeks 3 50.0 2 weeks and under 3 weeks; 4 66.6 3 weeks and under 4 weeks 3 50.0 1 month and under 2 months 3 50.0 2 months and under 3 months 3 50.0 3 months and under 4 months 1 16.6 4 months and under 5 months 6 100.0 5 months a>nd under 6 months 1 16.6 6 months and under 7 months 1 16.6 7 months and under 8 months 4 66.6 8 months and under 9 months 1 16.6 9 months and under 10 months 4 66.6 11 months and under 12 months 1 16 6
A death rate of 103.4 per thousand living births eomnared with 119.5 in 1933, 127.5 in 1932 and 131.9 in 1931.
Table of Deaths of Clinic Children during years 1929r 1930, 1931, 1932, 1933 and 1934 •
Year. No* on Under Over Register. 1 Year. 1 Year* 1929 1135 15 22 1930 2149 18 33 1931 2475 20 10 1932 2347 20 18 1933 2580 29 14 1934 2607 23 22 17
Home Visits.
Number on Active File Area Families. Chidren. Eastern 626 982 Central 935 1151 W estern 544 736 Fox Hill 136 171
2241 3040
Table showing number of visits to children needing special care, and number of routine home to home visits:
Under Over One Year. One Year. Special visits 419 451 Routine visits 798 3395 Initial visits 582
1799 3846
Total visits paid by one Nurse, 5645.
Infant Welfare Clinics.
Clinics. Total No. Held Attendances. New Cases. Victoria 49 4045 196 Central 50 4734 311 W estern 45 2594 183 Fox Hill 12 543 28
156 11916 718 ' •
Number of attendances at Dispensary referred by Welfare, 2123.
Referred to Out Patients’ Department: Children 67, Adults 2.
Admissions to Bahamas General Hospital of Welfare Children, 55. Adults advised and helped, 51.
Laboratory tests: Children, 9, Adults, 20,
Mothers referred to Ante-natal Clinic, 6,
Immunisation for Diptheria, 9.
Lent to the mothers for home treatments, apparatus, 80.
Special examinations by Dr, Stein for the Infant Welfare Association:
Vision and Other Eye Conditions.
Adults, Children, No, of eases seen 15 22 Operations performed 6 7 Treatments given 7 No. of eyes refracted 1 1 Referred for observation 8 7
Ear, Nose and Throat Conditions,
AdultsChildren, Total No- of cases seen 6 63 Tonsillectomies done by courtesy the Bahamas Hospital) 38 Other operations 1 Referred for observation 22 Treatments 2 4
Total number of attendances of children at Dr. Stein’s Office, 121,
Amount of Free Nourishment Distributed at the Clinics.
Bought by the Association.: Protein 8 tins, Dextri-Maltose 5 tins. Gifts to the Association: Condensed Milk 204 tins, Dextri-Maltrose 2 lbs. Dry Milk 112 lbs. 19
From the Bahamas General Hospital: Cod Liver Oil 66 gals. Vegex 11 lbs., 12 ounces
X. BARRACKS AND PRISON.
The reports of the Medical Officer who has charge of these Departments are appended.
XI. BACTERIOLOGICAL AND VENEREAL DEPARTMENTS.
Out Patients’ Department.
The reports are appended.
XII. METEOROLOGY.
The Meteorological returns are appended.
J. M. CRUIKSHANK, Chief Medical Officer. £0
X. ANNUAL MEDICAL REPORT ON POLICE FORCE,
Nassau, Bahamas, January 10th, 1935.
Dear Siri
I have the honour to submit the following report on the Medical Service supplied to The Bahamas Police Force.
The1 entire force was inoculated against Typhoid Fever during the year 1934.
Ninety men of the force of orie hundred and fifteen men reported sick during the twelve months.
The details were as follows:
Number of sick men during year 520 Admitted to Barracks hospital 60 Admitted to Bahamas General Hospital 15 Number of Venereal Disease cases 10 Deaths —'
( have the honour to bey Sir, Your obedient servant,
EL A. QUACKENBUSH, Assistant Medical Officer,• ifhe Chief Medical Officer, Bahamas General Hospital, Nassau, Bahamas. X. ANNUAL MEDICAL REPORT ON PRISON,
■Nassau, Bahamas, January 10th, 1935,
I have the honour to submit the following report in con¬ nection with the Medical Service supplied to the Nassau Prison.
No changes in routine were made from previous years.
One thousand, nine hundred and twenty-five prisoners were seen at sick parade, including four hundred and ninety- •six admissions, and five hundred and twenty-seven discharges.
Three prisoners only were transferred to the Bahamas General Hospital for treatment.
There were no deaths, natural or judicial.
The usual run of diseases were encountered with a slight -decrease in Venereal Disease cases.
No epidemic occurred, and there was little evidence Food' Deficiency diseases.
I have the honour to be. Sir, Your obedient servant,
H. A, QUACKEMBLSH, Assistant Medical Officer.
The Chief Medical Officer, Nassau, Bahamas. XI. ANNUAL REPORT ON GOVERNMENT BACTERIOLOGICAL LABORATORY, 1934.
I have the honour to submit the following'report regarding the Government Bacteriological Laboratory.
The usual clinical and public health laboratory work has been done during the year but its volume has increased and its nature has been more varied.
The laboratory offers the following types of service:
(a) Clinical. All the usual laboratory proceedings of a diagnostic character are carried out for the private prac¬ titioners and the Bahamas General Hospital.
The Kahn precipitation reaction is done but not the Was- sermann.
The services of the laboratory are also available for the District Medical Officers who care to send in material for examination.
(b) Several substances are prepared for use in the hospital, such as solutions of morphia, glucose, saline, antimony, etc. Typhoid Vaccine is made for use at the Out-Patients’ Depart¬ ment.
(c) Bacteriological control of food—largely restricted to milk and water.
Regular examination of City Water is carried out. Samples are collected at different points over the distributional system. Control of hardness, salinity, etc., is carried out by the Staff of the City Waterworks Department.
A few samples of water from other sources wTere examined during the year.
Bacteriological examination of certain other food-stuffs such as cray-fish, canned food, etc., was made. fd) Investigations of a medico-legal character were done n't the request of the police.
During the year cultures from the throats of a random ■sample of school children were collected.
Observations were made on some 400 patients.
Information was sought as to:
(a) Prevalence of Coryne bacterium diphtheria (b) R-Hsemolytie streptococci.
Although there was at the time no reported diphtheria it was possible to isolate the causative organism in two cases* suggesting that the disease exists as a subclinical entity in the Colony, and explaining the high degree of immunity to diphtheria which one observes.
Seme 5% of the cases examined show ed the presence of haemolytic streptococci. Information was sought on this point in view ef the fact that in this area such serious conditions as scarlet fever, erysipelas, acute rheumatic fever and strepto¬ coccic septicaemia are rarely diagnosed.
The Schick Test to show" susceptibility to diphtheria was carried out at the same time as throat cultures were secured. In coloured children despite a somewhat liberal interpretation of the test over 90% proved negative. A smaller group of white children showed only some 60% nega¬ tive.
During the year also, a report was submitted from this laboratory in regard to utilising the salt and lime found in the Colony, far commercial purposes.
The Venereal Clinic, This clinic continues as in previous years. I think it may be said that syphilitic patients are nowr securing longer periods of treatment and that the number under treatment continues to grow.
Return relating to all persons who were treated at the Venereal Clinic for Syphilis dining the year ended December 31st, 1934: 24
Table I.
Treatment of Syphilis.
Males.. Female®.. Primary 14 4 Secondary 22 16 Tertiary 70 82 Congenital. 2 2 Unclassified 19 10
Total 127 114
Table II.
Males completing at least one course of arsenic 64 Males who ceased to attend before completing one course 63
Total Males 127
Females completing at least one course of arsenic 36 Females who ceased to attend before completing one course 78
Total Females. 114
Total persons who received arsenic 241 Total number of arsenic injections 1303
Subsequent to the completion of an arsenic course 20 in¬ jections of bismuth were offered and approximately 211 per¬ sons began such a course. Of these only some 33 actually completed the full course—many nearly completed it., 1647 injections of bismuth were given.
Patients under treatment withN.A.B. December 31st 28 Patients under treatment with bismuth December 31st 50
Return relating to patients who attended at the Venereal Disease Clinic for irrigation, local dressings, treatment:
Total attendances of males (aggregate) 2724 Average monthly attendance 227 Average daily attendance 9 25
The Kahn Test was carried out on 998 patients.
Return relating to patients who were referred to the Venereal Disease Clinic for tartar emetic injections:
Total number of persons referred 264 Number showing Positive Frei-intra-cuta test 97 Average under treatment at any one time 10 Total number of injections of tartar emetic 1460
The Venereal Disease Clinic is open every day except Sun¬ days and holidays. The number treated and the amount of treatments given have shown steady increase over previous years. Various factors have contributed to a lack of precise records and a follow-up system but possibly some of these can be eliminated in the coming year.
I have the honour to be, Sir, Your obedient servant,
GEORGE KINNEARD, Bacteriologist.
The Chief Medical Officer, Nassau, Bahamas. 26
REPORT ON OUT-PATIENTS’ DEPARTMENT.
Nassau, Bahamas, 10th January, 1935-
The Chief Medical Officer, Nassau, Bahamas.
Dear Sir,
I have the honour to submit the following report on the Out-Patients’ Department of the Bahamas General Hospital for the year 1934.
Total number seen and treated 23718,
This number is practically the same as for the previous twelve months*
Dental consultations with Dr. Wright 954*
Routine Anti-Typhoid Inoculations are still being carried oht* During 1934 4,710 new patients were inoculated*
The Out-Patients’ Drugs and general routine in this De¬ partment has been unchanged from previous years*
The number of accident cases treated, including Police cases, totalled 499.
I have the honour to be, Sir, Your obedient servant,
H. A. QUACKENBUSH, Assistant Medical Officer* 27
ANNUAL MEDICAL REPORT ON INDUSTRIAL SCHOOL.
Nassau, Bahamas, January 10th, 1935.
Sir,
I have the honour to report that inspections are made quarterly at the Industrial School for Boys, including in¬ dividual physical examinations of the boys, and sanitary sur¬ veys of the quarters and grounds.
During the year the inadequate sanitary arrangements have been attended to.
All cases of dental caries are sent to the Dental Clinic at the Bahamas General Hospital. Also all surgical requirements and minor operations are taken care of at the Hospital.
Besides this regular tour of inspection the hospital supplies an ambulance service for any ill inmates, whom the Super¬ visor sends to the Out-Patients' Department from time to time as required.
The School is also supplied with a few necessary drugs and medicines upon my signature, and also any special prescrip¬ tions that I may issue for individual cases.
I have the honour to be, Sir, Your obedient servant,
H. A. QUACKENBUSH, Assistant Medical Officer.
The Chief Medical Officer, Nassau, Bahamas. TABLE IV. ij Eh w a o Ph o o O o Ph H W H £ Ph P$ tC W O W P2
RETURN OF DISEASES AND DEATHS (IN-PATIENTS) FOR THE YEAR 1934.
Remain¬ Yearly Total. Remain¬ ing in Total ing in Diseases. Hospital Cases Hospital at end of Treated. at end of 1933. Adm issions Deaths. 1934.
Epidemic, Endemic and / Infectious Diseases. Enteric Group: Typhoid Fever... 32 6 32 2 Malaria, Tertian. 1 1 Whooping Cough. 2 2 Diptheria. 3 3 6 Influenza. 8 8 Dysentery: Amoebic. 8 1 8 Bacillary.. 3 3 Leprosy. 2 2 Epidemic Cerebro-spinal Fever.. 1 1 1 Tetanus.. 3 2 3 Mycosis. 1 1 ! Tuberculosis, Pulmonary and Laryngeal. 10 70 46 80 10 Tuberculosis of the Intestines or Peritoneum.. . . 7 3 7 Tuberculosis of Bones and Joints 2 3 5 1 Tuberculosis of other organs: Bones. 3 3 ^Other organs.... 1 1 1 Tuberculosis, disseminated: Acute. 1 1 1 Chronic. 5 4 5 Syphilis: Primary... 4 4 Secondary. 22 2 22 Tertiary. 2 80 14 82 Hereditary. 1 15 16 'Soft Chancre. 7 2 7 Gonorrhoea and its complications 1 94 1 95 Gonorrhoeal Opthalmia. 1 6 7 2 Gonorrhoeal Arthritis. 1 4 5 Granuloma Venereum. 1 1 1 1 1 II.—General Diseases not men- tioned above. Cancer or other malignant Tu- mours of the Buccal Cavity.... 1 1 Cancer or other malignant Tu- mours of the Peritoneum, In- testines, Rectum. 2 2 Cancer or other malignant Tu- mours of the Female Genital Organs. 11 4 11 Cancer or other malignant Tu- mours of the Breast. 1 4 2 5 Cancer or other malignant Tu- mours of the Skin. 1 3 4 Cancer or other malignant Tu- mours of Organs not specified.. . 2 2 2 Tumours, non-Malignant. 7 1 7 RETURN OF DISEASES AND DEATHS (IN-PATIENTS) FOR THE YEAR 1934’,
Remain¬ Yearly Total. Remain¬ ing in Total ing in Diseased Hospital Cases Hospital at end of Treated. at end of 1933. Admissions- Deaths. 1934.
i Chronic Rheumatism.. 3 I 3 Pellagra.. 6 29 10 35 2 Diabetes (not including Isspidug) 1 1 1 Anaemia: Pernicious. 1 3 4 Other Anaemias and Chlorosis,.. . 1 2 1 3 1 Diseases of the Thyroid Gland: Myxoedema .. 2 j 2 Diseases of the Para-Thyroid Glands. v 2 2 2 Alcholism... 12 3 12 Auto-Intoxication.... 1 1 III.—Affections of the Nervous System and Organs of the Senses. Locomotor Ataxia.. 11 11 1 Other affections of the Spinal Cord.... 1 1 Apoplexy: Haemorrhage... 13 5 13 Thrombosis.. 3 1 3 Paralysis: Hemiplegia. 5 5 Other Paralyses. 2 2 Other forms of Mental Alienation 16 16 1 Epilepsy. 8 8 Eclampsia, Convulsions (non-pur- peral) 5 years or over. 1 1 Infantile Convulsions...... 5 5 Hysteria... 6 6 Neuritis .... 2 2 Affections of the Organs of Vision: Diseases of the Eye.. . 7 7 Conjunctivitis.... 2 2 Tumours of the Eye.. 1 1 Other affections of the Eye.... 16 16 I Affections of the Ear or Mastoid Sinus... 2 7 9 IV.—Affections of the Circulatory System. Diseases of the Heart: Mitral . - .. 4 4 Aortic. 1 1 2 Myocarditis.. 2 12 8 14 Diseases of the Arteries: Aneurism. 1 4 5 Arterio-Sclerosis. 1 1 Diseases of the Lymphatic Sys- tern: • Lymphangitis. 2 2 Lymphadenitis, Bubo (non-' specific). 41 41 Haemorrhage of undetermined cause. 1 1 1 mrom OP DISEASES AND DEATHS (IN-PATIENTS) FOR THE YEAR 1934.
Remain¬ Yearly Total. Remain¬ ing in Total ing in Diseases, Hospital Cases Hospital at end of Treated, at end of 1933, Admissions Deaths. 1934.
A denoids,. 3 3 V.-—Affections of the Respiratory System. Diseases of the Nasal Passages: Polypus.., .... 4 4 Coryza.... 3 3 Bronchitis: Acute... 32 1 32 Broncho-Pneumonia...... 2 8 3 10 Pneumonia: ] Lobar... 10 7 10 Unclassified ...... 4 4 4 Pleurisy, Empyema... 3 1 3 Asthma. 10 10 VI.—Diseases of the Digestive System. Diseases of Teeth or Gums: Caries, Pyorrhoea, etc...... 6 6 i! Other affections of the mouth: Stomatitis. 7 7 Affections of the Pharynx or Ton- sils: Tonsilitis... 100 100 Pharyngitis,.. 3 3 Ulcer of the Duodenum . 1 ' 1 1 Other affections of the Stomach: Gastritis. 3 3 Diarrhoea and Enteritis: Under two years.. 2 29 11 31 Diarrhoea and Enteritis: Two years and over.. 3 51 7 54 Colitis. 1 1 Diseases due to Intestinal Para- sites: Ascaris.. . 1 17 2 18 Oxyuris ...... 1 1 Appendicitis.. 1 14 1 15 Hernia.. 22 22 Affections of the Anus, Fistula, etc..... 16 16 Other affections of the Intestines: Enteropotosis. . U.. 1 1 Constipation. 2 228 2 230 Cirrhosis of the Liver: Alcoholic... 7 3 7 ! Other affections of the Liver: Abscess.. . 1 i : 1 Hepatitis.. 3 3 ; Cholecystitis... 2 2 Jaundice. . .. 2 Peritonitis (of unknown cause) 4 2 4 Other affections of the Digestive System. 5 i 5 VII.—Diseases of the Geniio uri- nary System (non-Venereal). i Acute Nephritis. 4 2 4 P2
RETURN OF DISEASES AND DEATHS (IN-PATIENTS) FOR THE YEAR 1934,
] Remain¬ Yearly Total. Remain¬ ing in Total ing in Diseases'. Hospital Cases Hospital at end of # Treated. at end of 1933. Ad r issions Deaths. 1934. O Chronic... La 11 2 13 Other affections of the Kidneys: Pyelitis, etc.. . 6 6 TTrinarv Calculus- . 3 3
Diseases of the Bladder: Cystitis.. 1 8 9 Diseases of the Urethra: Stricture...... 6 6 1 Other than stricture...... 30 30 1 Diseases of the Prostate: Hypertrophy... 1 2 3 Prostatitis.. 2 2 Diseases (non-Venereal) of the Genital Organs of Man: Epididymitis.. 6 6 Ulcer of Penis. 20 20 Cysts or other non-malignant Tu- mours of the Ovaries: 2 2 Salpingitis. .. • • 5 5 Abscess of the Pelvis.. 3 1 3 Uterine Tumours (non-maiignant) 17 1 17 Uterine Hemorrhage (non- puerperal).. 2 2 Metritis.. • • • 28 28 Other affections of the female Genital Organs: Displacements of Uterus...... 1 1 1
Amenorrhoea.. 2 3
Dysmenorrhoea... 24 24
Leucorrhoea.• • 11 11 Diseases of the Breast (non- puerperal: Abscess of Breast...... 5 5
VIII.—Puerperal State.
Normal Labour.. 10 258 268 9 Accidents of Pregnancy: 1 . 35 Abortion. 37 Ectopic Gestation.. 2 2 Other accidents of Parturition- 1 2 3 Puerperal Septica emia. 1 1 1 Puerperal Eclampsia.. . . 3 3 3
IX.—Affections of the Skin and
Cellular Tissues. 8 5 8 Gangrene.-. 4 46 4 b Abscess. .. 53 3 54 2 Cellulitis. 1 1 La Tinea... 1 4 4 Scabies.. Other Diseases of the Skin: 1 2 14 14 Eczema.-. 1 2 Psoriasis. 2 1 Elephantiasis. 1 33
RETURN OF DISEASES AND DEATHS (IN-PATIENTS) FOR THE YEAR 1934.
Remain¬ Yearly Total. Remain¬ ing in Total ing in Diseases. Hospital Cases Hospital at end of Treated. at end of 1933. Admissions Deaths. 1934.
X.—Diseases of Bones and Or- gans of Locomotion (other than Tuberculosis). Diseases of Bones: Osteitis. 2 4 6 Diseases of Joints: Arthritis. 1 35 26 Synovitis. 1 1 Other Diseases of Bones or Or- gans of Locomotion. 5 5 XI.—Malformations. Malformations: Hydrocephalus. 1 1 1 XII.—Diseases of Infancy. Congenital Debility. 5 4 5 Premature Birth. 3 3 3 Other affections of Infancy. 5 1 5 Infant neglect (infants of three months or over). 5 5 1 2 XIII.—A [lections of Old Age. Senility. 13 2 Senile Dementia. 3 5 2 21 2 XIV.—A sections produced by Ex- ternal causes. Food Poisoning: Botulism. 3 3 Attacks of poisonous animals: Insect Bite. 2 2 Other accidental Poisonings. . . 6 6 Burns (by Fire). 2 17 2 19 4 Burns (other than by Fire). 2 2 Drowning (accidental). 1 1 Wounds (by cutting or stabbing instruments).. . 25 25 Wounds (by Fall). 7 7 Wounds (crushing, e.g., railway accidents, etc.) 1 1 Dislocation. 1 1 Sprain. 5 5 Fracture. 2 29 2 31 2 Other external injuries. 3 75 75 3 Deaths by violence of unknown cause. 1 1 1 XV.—Ill-Defined Diseases. Sudden Death (cause unknown). . 1 1 1 Diseases not already specified or ill-defined: 96 1 96 5 Asthenia. 1 15 3 16 Hyperpyrexia. 1 1 Malingering. 3 3
Total. 86 2233 217 2319 66
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